August 07, 2025
4 min read
The U.S. health care landscape has had a major shift characterized by a sharp increase in costs since the passage of the Affordable Care Act in 2010.
According to the American Medical Association, the national health expenditures in 2023 increased 7.5% to $4.9 trillion. This was higher than the 4.6% increase seen in 2022. In addition, per capita health care spending in 2023 was $14,570. In 2023, hospital expenditures increased 10.4% to $1.5 trillion, which was more than the 3.2% increase seen in 2022.
While the number of physicians has increased modestly, administrators and their role in health care has dramatically expanded, which has diverted resources from direct patient care and has increased overhead costs. Beyond the financial aspect, this exponential growth of administrators over physicians has fundamentally changed the power dynamics in medicine.
Role of AI
AI has emerged as a pivotal force in the changing landscape of health care. Physicians, including orthopedic surgeons, are leveraging the benefits of AI platforms to improve clinical efficiency, streamline workflows, reduce bureaucratic tasks, identify best practices and enhance physician-patient relationships.
Administrators are prioritizing AI to optimize revenue cycle management for the health care system, standardize protocols and diminish the autonomy, independence and leadership of physicians. Their aim may be to suggest that the health care system, rather than uniquely talented physicians, is responsible for the highest level of patient care.
Now, a “hidden race” is underway. If physicians do not engage and embrace the role of AI in medicine at all levels of care, then we will lose the race and jeopardize any opportunity to preserve patient-centered care.
The time physicians spend on documentation and administrative tasks erodes the amount of time they have for direct patient care in the office, consultations, surgeries and innovation. AI platforms can automate documentation, improve predictive models for expected outcomes, provide patient education programs, create care plans and customize rehabilitation. AI programs will soon handle the coding and billing based on the documentation gathered through ambient scribe monitoring of patient visits, insurance approvals, prior authorizations, patient records, rehabilitation protocols and operative notes with direct transmission to the revenue cycle process.
Administrators are racing ahead with AI to bolster control of all aspects of the health care system, especially advanced revenue cycle management. AI-powered analytics can forecast revenues, automate claims processing, reduce denials, improve and accelerate reimbursement, assess physician productivity and tighten control over providers.
Hospitals and health care systems have prioritized employing physicians, including orthopedic surgeons, to maximize control over physician services and the ancillary services necessary for patient care. The employment of orthopedic surgeons and ownership of their ancillary services most commonly results in a decreased attribution of these services as integral to their practice, followed by subsequent reduction in the recognition of income directly related to the physician’s work. Even with more productivity in terms of evaluation patients, the result will be negative for most physicians. Factors can contribute to physician burnout due to higher workload, increased administrative burden, loss of autonomy, reduced income and decreased job control.
Potential of AI
The race to harness AI’s potential to enhance the non-physician component of health care is already evident in some medical specialties. In radiology, studies have shown that AI models are associated with improved documentation efficiency. In primary care, AI may empower less expensive advanced practice providers to manage evaluations, non-surgical treatments and use of ancillary resources. This may lead to more complex cases bypassing the primary care physician for direct referral to specialists, potentially reducing or eliminating the role of primary care physicians.
Orthopedic surgery is undergoing a rapid and dynamic transformation. Many external influences are shaping the future of our profession. AI-based advances are changing the development of devices, surgical planning, use of robots and tools to predict risks and optimize implants. Technology has advanced quickly, especially in procedures related to joint replacement, spine and fractures. Innovations are now tackling the challenges of soft tissue imaging and modeling through 3D MRI segmentation, AI-driven preoperative planning and the integration of AI tools into the OR.
If orthopedic surgeons desire to be independent, autonomous and innovative in their practices, then they must take the lead in guiding AI outside the OR and focus on improving patient-physician care. If AI initiatives are left to administrators, the priorities will shift toward maximizing patient access, managed care models, more surgeons at lower compensation levels, and metrics to enforce protocol compliance and efficiency at the expense of empathy.
Hidden race
The race is only hidden if we ignore the obvious signs and fail to recognize AI’s powerful influence. Sitting on the sidelines means we allow administrators to decide our future through their focus on revenue, efficiency, volume and control.
Orthopedic surgeons must lead in developing AI in the office and in the OR. We must advocate for and create tools to automate administrative tasks and enhance our clinical and surgical skills. The power of AI enables us to compete and succeed by leveraging our education, experience and intuition to develop the tools despite the resources and capital of health care administrators.
We all need to participate if we want to win this hidden race. We will win the race if we remain focused on the physician-patient relationship. When we pursue AI with a patient-first mindset, we can reduce administrative interference, focus on surgical skills, techniques and outcomes that promote healing. The patient-physician bond is built on trust and direct interaction. AI supports hands-on assessment, direct patient interaction and postoperative care of orthopedics. With AI, we can secure patients’ trust and advocacy to ensure orthopedics thrives in the future.
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Anthony A. Romeo, MD, is the Chief Medical Editor of Healio | Orthopedics Today. He can be reached at Healio, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
Sources/Disclosures
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Expert Submission
Disclosures:
Romeo reports receiving royalties from, being on the speakers bureau and a consultant for, and doing contracted research for Arthrex.
