Professionalism and the Economics of Orthopaedic Trauma Care

Introduction

The practice of medicine is fundamentally and historically based in service; whether service to patients, service to communities, service to society, or service to one's partners and colleagues, the professional lives of physicians are linked to service. The professional lives of those doing orthopaedic fracture care are even more closely aligned to service, as the individuals treated have sustained painful injuries that cannot be scheduled or predicted. As such, the services of the orthopaedic fracture specialist also cannot always be scheduled or predicted, inculcating these individuals with an even higher service expectation than in many of their colleagues.

Whether written or unwritten, professional service is governed and shaped by contractual relationships. This chapter provides information on and explores three such relationships: that between an orthopaedic surgeon and his or her hospital and community related to providing orthopaedic care in the hospital emergency department; that between the medical profession and the federal government regarding obligations for the emergency medical treatment of patients; and that between an orthopaedic fracture surgeon and his or her group or hospital regarding the economic value of orthopaedic fracture care. While these three topics may seem unrelated, they are actually highly related, as all are matters of great importance to those in the practice of orthopaedic fracture care, all require knowledge that goes beyond the medical training received in residency and fellowship, and all involve relationships with colleagues, hospitals, and insurers. Understanding the issues, facts, perspectives, and considerations—from the perspectives of all involved in these matters—will better prepare orthopaedic fracture surgeons for a successful career and healthier relationships with their colleagues, hospitals, communities, and payers.