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MEETING DEMAND
North Carolina healthcare providers are investing in orthopedic care to keep up with a growing population and improve outcomes.
Dr. Kurt Wohlrab can’t wait until Southern Pines Orthopedic Surgery Center opens. “It’s still under construction, and we’re expecting to get the keys in April,” says the Pinehurst Surgical Clinic orthopedic surgeon. Constructed in partnership with FirstHealth of the Carolinas, the 24,000-square-foot orthopedic outpatient clinic will have two operating rooms, four procedure rooms and on-site physical therapy. It’s expected to employ 30 people, and he anticipates moving as many as 3,000 surgeries a year from Pinehurst Surgical Clinic and adding more from there.
All types of orthopedic procedures will be performed at Southern Pines Orthopedic Surgery Center. That capacity is expected to create efficiencies for providers. It’ll help patients, too.
“Focusing solely on orthopedic procedures will save patients time and money,” Wohlrab says. Dubbing it an “orthopedic center of excellence,” he says its ability to provide same-day procedures, for example, eliminates the overhead costs associated with overnight hospital stays. “Outpatient surgery centers also free up hospital operating rooms for more serious procedures,” he says.
Demand for orthopedic care is growing across North Carolina. Meeting that need has become a priority for healthcare providers. They’re adding capacity in small towns and big cities alike. They’re applying unique strategies to ensure needs are met and outcomes improve for patients of all ages.
GROWING NEED
North Carolina’s population is one of the country’s fastest-growing. The N.C. Office of State Budget and Management projects it’ll reach 11.7 million people in 2030, making it the seventh most populous state, up from ninth now. Nearly a quarter of its counties, from Onslow in the east to Buncombe in the west, had populations greater than 125,000 people in 2020.
Demand for orthopedic surgery and services is growing in step with North Carolina’s population, says Dr. Joshua Patt, vice chair of education for Atrium Health, who specializes in musculoskeletal oncology and spine surgery and serves as director for the orthopedic surgery residency program. Atrium Health’s parent company is Advocate Health, headquartered in Charlotte and one of the largest healthcare systems in the United States.
“There’s a higher burden of need as we age, and the baby-boom generation is creating a huge amount of need for total joint arthroplasty,” he says. “Our workforce has not kept up, and we are forecasted to see a significant deficit of orthopedic surgeons over the next 20 years.”
The National Library of Medicine reported there will be 2% fewer orthopedic surgeons and 3% more demand for their services by 2036. And projection models used in a study presented at the 2023 annual Meeting of the American Academy of Orthopaedic Surgeons show that orthopedic surgeons will have to double their total joint arthroplasty caseload or increase their numbers by 10% every five years to meet demand by 2050.
Traditionally, orthopedic practices have treated older adults suffering from arthritis, broken bones from falls or worn out joints. Today, more adults are active well into their senior years, and older athletes are showing up with sports injuries. In Pinehurst, where golf, horseback riding, tennis and other activities are age defiant, Wohlrab says the local community of retirees strives to stay in the game. Pickleball and CrossFit top the list of causes for sports injuries among baby boomers, he says. “I have a 74-year-old lady who is in the CrossFit games every year and a couple of 60-plus men who compete in CrossFit nationally,” he says. “Our active seniors realize they only have one body in this life, and they want to use it.”
Helping patients return to an active lifestyle is what Wohlrab and his fellow orthopedic surgeons love most about their profession. “They tell us we gave them their lives back, and they appreciate it,” he says. “That’s what makes our job great.”
ADDING CAPACITY
North Carolina’s certificate of need law was written with good intentions. As a means of cost control and placing healthcare services where they’re needed, state Department of Health and Human Services permission is required before healthcare providers procured certain equipment, built buildings, offered services or added beds. But to help meet growing demand, legislation began relaxing those requirements in November, when ambulatory surgical centers no longer needed a certificate of need to expand in counties with populations greater than 125,000 people as of 2020. The acquisition of MRI machines won’t need a certificate of need in those counties starting in November. This opens the door for further expansion of services in urban areas for other surgical centers and for moving more surgical cases from inpatient hospitals to ambulatory surgical centers.
A certificate of need to relocate two operating rooms to Pinehurst Surgical Clinic was given in 2023. And while the recent changes won’t impact Moore County, whose population is about 100,000 people, other practices are poised to take advantage of the opportunities created.
EmergeOrtho is the largest physician owned orthopedic practice in North Carolina and was ranked as the country’s sixth-largest orthopedic practice in 2023. It was formed in 2016, when four North Carolina-based orthopedic groups merged, and it now has more than 65 locations across the state. In October, it merged with three physician-owned orthopedic practices in Greensboro, collectively known as Southeastern Orthopaedic Specialists.
EmergeOrtho CEO Allison Farmer says the practice logs more than a million office visits, more than 600,000 therapy visits and more than 50,000 surgeries annually. Its expanding medical team currently counts about 370 orthopedic specialists and physicians. “We’re finding that with advances in technology and certificate of need relief on being able to expand the operating rooms in ambulatory surgery centers that is going to get people back home and back to work faster and at a lower cost,” she says. “Adding the certificate of need relief on MRI machines means that EmergeOrtho can take advantage of both opportunities to bring greater care at a higher value to North Carolina.”
Loosening Medicare requirements are facilitating growth, too. At one time, they dictated that joint replacement surgeries must be done as inpatient procedures, but data found that ambulatory surgical centers were just as safe as hospitals and better for patients in most cases. “When I started training, patients receiving a knee replacement were in the hospital for three to five days after surgery,” Atrium’s Patt says. “Now their average hospital stay is zero days.”
EXPANDING FOOTPRINTS
Many places in rural America suffer from a healthcare deficiency, according to the National Library of Medicine. That includes orthopedic care. These healthcare deserts are created by many factors, including fewer healthcare workers, fewer medical students with rural backgrounds and the lack of notable exposure to rural practices during residencies. Limited local community and healthcare system opportunities and financial barriers add to these concerns. Solutions include building a pipeline of rural orthopedic talent with support from industry, healthcare systems, professional organizations, government and academic institutions.
When large healthcare systems expand into rural communities, patients have the best of both worlds. They can receive treatment close to home while having a large fully equipped urban hospital nearby. CarolinaEast Health System serves the residents of its hometown, New Bern, whose population was 31,291 in 2020, according to the U.S. Census Bureau. But it also serves those living in surrounding rural counties.
Pinehurst-based FirstHealth has nine locations in surrounding rural counties and attracts patients from a 15-county radius. Some insurance carriers list FirstHealth as a preferred provider, and Wohlrab often sees patients from even farther away.
Cone Health OrthoCare has six locations, starting in Greensboro. There is an OrthoCare Alamance office in Burlington and one in Eden, which is open two days a week with full X-ray capabilities. Dr. Mark Cairns is an orthopedic surgeon and one of two specialists at OrthoCare Reidsville. He and Dr. Stanley Harrison split the surgical duties. “We’re mostly a general practice, although my fellow physician and I have training in sports medicine,” Cairns says. “He does total knee replacements, while I do total shoulder replacements and some hip replacements. So, we run almost the full gamut and see a little bit of everything.”
At EmergeOrtho, which serves rural communities by providing comprehensive orthopedic services through a network of 60 outpatient offices from the mountains to the coast, patients can make appointments or urgent care visits for same-day needs without a referral. Access to urgent care clinics makes a difference in rural regions. “People who have an orthopedic injury look for access and answers immediately,” Farmer says. “At our orthopedic urgent cares, we have the imaging equipment and casting supplies and providers that know how to diagnose fractures and the need for possible surgeries.”
APPLYING TECHNOLOGY
Dr. Jessica Woodcock is a general orthopedic surgeon at CarolinaEast, and her patients range from toddlers to senior citizens. “I see patients ranging from kids with fractures to high schoolers with sports injuries, and as they age, I see them for joint replacements,” she says. “The beauty of my practice is being able to take care of a patient over the years. I did many knee replacements for patients when I was pregnant nine years ago, and they still remember that and keep track of my family.”
Woodcock’s patients, regardless of their age, benefit from technology. It makes surgeons more efficient, which directly improves patient outcomes. Robotics, for example, is taking a bigger role in surgery and image guidance and increasingly personalizing the implants used in joint replacements. “Technology and orthopedics go hand in hand,” she says. “When I came out of training over 10 years ago, robotic surgery was starting to phase in, and over the past two or three years, many joint surgeons have started using some sort of navigation robotics.”
Artificial intelligence is starting to play a role in how physicians document their patients’ progress and update their records. Woodcock believes that AI will someday predict genetic factors that create a need for orthopedic surgeries. “I think we’ve gotten pretty good at repairing tendons, ligaments and bones, but there is a big future for AI at the molecular level, how we help people heal and how we can prevent diseases,” she says. “It’s being studied in the labs at big institutions and may lead someday to preventing conditions like osteoporosis and osteoarthritis.” ■
— Teri Saylor is a freelance writer in Raleigh.
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