25-Year Analysis of Orthopaedic Surgeons Opting out of Medicare Relative to Physicians From Other Specialties

BACKGROUND: Increasing administrative burdens and decreasing reimbursements associated with Medicare have prompted many physicians to opt out of Medicare. This study assessed the prevalence and characteristics of orthopaedic surgeons who opted out of Medicare relative to physicians from other specialties. METHODS: This was a cross-sectional study of orthopaedic surgeons using data from the Centers for Medicare and Medicaid Services (CMS). The CMS provided the names of orthopaedic surgeons who opted out of Medicare and their practice locations from 2000 to 2024. CMS data were used to calculate the prevalence of physicians opting out of Medicare in the 25 largest specialties by number of physicians. Additional physician characteristics were collected from publicly available resources. RESULTS: From 2000 to 2024, there were 330 orthopaedic surgeons who opted out of Medicare, which increased by an average of 11% per year (R2 = 0.472, P < 0.001) from 0% to 1.9%. The top orthopaedic subspecialties represented in the Medicare opt-out group were spine surgery (30.9%), general orthopaedic surgery (25.2%), and orthopaedic sports medicine (20.9%). Most orthopaedic surgeons opted out of Medicare at later career stages, including between 25 to 29 years (19.7%) and ≥30 years (44.5%) after medical school graduation. The Northeast (3.4%) and Midwest (0.9%) had the highest and lowest Medicare opt-out rates, respectively (P < 0.001). The states with the highest Medicare opt-out rates were New York (7.2%), New Jersey (5.3%), and Arizona (3.7%). Relative to the 25 largest specialties by number of physicians, orthopaedic surgery ranked tenth by Medicare opt-out rate (1.9%). Psychiatry (21.1%) and infectious disease (0.1%) ranked first and last, respectively. CONCLUSION: The rate of Medicare nonparticipation in the orthopaedic surgery workforce is currently small but increasing. Several characteristics were associated with Medicare nonparticipation in orthopaedic surgery, including spine surgery and geographies in the Northeast. Future investigation is needed to understand underlying motivations behind physicians opting out of Medicare.