Can Primary Care Providers Prevent Unnecessary Musculoskeletal Surgeries?

Most non-surgical orthopedic problems should be managed in the primary care setting. Instead, unnecessary tests, procedures, and surgeries contribute to $1 trillion in medical waste each year and leave patients feeling even worse. Here are three buffers for Primary Care Providers to ensure patients are receiving the right care.

A staggering number of Americans – 126.6 million, or one in two adults- suffer from a musculoskeletal condition. Most common non-surgical orthopedic problems should be managed in the primary care setting. Instead, an astounding amount of unnecessary testing, procedures, and even surgeries have left patients feeling worse instead of better. Plus, they are riddled with debt, contributing to the astronomical amount of medical waste in the U.S. healthcare system. 

Tailoring the treatment to the diagnosis is critical. Inundated schedules and growing burnout often cause Primary Care Providers (PCP) to jump to a treatment prematurely because they don’t have the time or energy to adequately assess the patient and draw out the details that will help them dial in on a diagnosis. 

Most doctors went to medical school because they wanted a fulfilling career that makes a difference in people’s lives and positively impacts their communities. Why are so many musculoskeletal patients being put under the knife too soon, or worse, when they shouldn’t be at all?

One Problem: Surgeries are Lucrative

Dr. Brian Gordon, ChenMed’s National Director of Orthopedic Surgery, says, “Spine surgery can be very lucrative.”

“You start to live large, and it can become a monster that needs to be fed,” alluding to the current fee-for-service model – that rewards procedures over preventative care and fosters patient relationships – as a secondary driver for this mindset. “I’m certainly not condemning all of my colleagues with a broad brushstroke,” he shares. “But I think we can deceive ourselves into doing something for the wrong reason and not realize it.”

So how can unnecessary surgeries be prevented? Here are three safeguards that can ensure patients receive the right care, by the right specialist, at the right time.

3 Safeguards to Prevent Unnecessary Surgeries

The Hippocratic Oath starts with, “First, do no harm.” But despite patient safety initiatives, surgical safety checklists, and more, there is still a considerable margin for error when it comes to patients ending up in surgery erroneously. Here are three buffers every PCP can provide to present an unnecessary procedure for their patients. 

1. Primary Care Providers (PCP) are the prime gatekeepers. Almost always, the initial treatment for a musculoskeletal patient could and should be done by a PCP. Consider this: only 20% of doctors in America are PCPs, and the fee-for-service model forces the hand of physicians to maintain a packed schedule with an outrageous number of patients each day. The time available to connect with and thoroughly diagnose a patient – much less build a lasting, trust-based relationship – is waning.
   
   By adding just 2-5 more minutes per visit, you can dive deeper into your patients’ pain and uncover the details integral to an accurate diagnosis and viable treatment plan. Consider asking, “What have I not asked?” or “What have I not yet considered?” There are never enough hours in a day – but you can add immense value and be part of the growing movement to rebuild primary care by adding mere minutes with your patients.

2. Timely consults between PCPs and key specialists. Key-person dependency – or when an organization relies too heavily on one person – often falls on doctors. A team-based approach can integrate care in a way that improves patient outcomes as well as reduces medical waste, and take the edge off of overarching burnout plaguing doctors everywhere after the pandemic.
   
   One of the biggest roadblocks to more streamlined, integrated care is communication breakdown (or none) between PCPs and specialists. There is untapped potential in returning to the residency model where learning doctors lean on the knowledge and experience of more seasoned experts. 
   
   Working collaboratively on the best treatment plan can prevent unnecessary hospitalizations and surgeries, beginning with PCPs and specialists putting their heads together before deciding on a hardline treatment plan. Speaking to – in the case of a musculoskeletal issue, an orthopedic surgeon – can ensure the PCP has asked all the right questions and performed a thorough exam. The patient will feel more confident in the treatment plan given their PCP consulted with an orthopedic surgeon on their unique issue, saving them time and money. 

3. Stop treating a problem you have not yet diagnosed. Is an X-ray a suitable treatment for a patient with persistent pain? Sure. But to send them running to get an MRI? Unnecessary scans or exams are not always the best approach. It’s instrumental for quality patient care and favorable outcomes to decide on a diagnosis before ordering tests and prescribing treatment. Given that the fee-for-service model curtails a PCP’s ability to spend quality time with their patients, this is a challenge that must be overcome to avoid more medical waste, misdiagnosis, or worse, mistreatment.

“You can’t do a job, especially where people’s lives depend on it, if you aren’t enjoying it,” Dr. Gordon urges. And while complex and often impossible challenges persist in the healthcare space, as providers, there is a unique opportunity to make a difference during every visit – but like any seed you sow, the harvest doesn’t come overnight.

To learn more about the role of Orthopedics in Primary Care, listen to the full episode of Faisel & Friends with Dr. Brian Gordon. Faisel and Friends is a primary care podcast that discusses the state of healthcare in America. Subscribe now to receive the latest episodes.