Ortopedics

Specialists in orthopedics and trauma surgery deal with the human musculoskeletal and support system, consisting of bones, tendons and muscles. Your range of treatments ranges from conservative orthopedics to endoprosthetics, from fracture treatment to multiple traumas.

Unlike general practitioners or radiologists, orthopedic surgeons must be competent in emergency matters. This means that the condition of a seriously injured person must be assessed quickly so that other specialists can be involved and necessary interventions can be carried out. Orthopedic and trauma surgery is a manual subject; it depends less on gross strength and more on skills such as rapid comprehension, stress resistance and dexterity.

In Germany, there are 14,711 specialists in orthopedics and trauma surgery. Of these, 13,736 are employed. 4,603 work as outpatients, 8,633 as inpatients in a clinic, 112 in authorities, companies and similar institutions.

Some doctors decide to specialize after completing their specialist training. This is quite possible in this field,

but you must first clarify whether it is possible to start a new practice in your preferred region. The general rule is: if the coverage level in an area is less than 110%, then there is an approval from the health insurance and you can open a new practice. If the coverage level is more than 110%, only the takeover of an existing practice is possible.

At the beginning you start with a "Common Trunk" - that is, a structured 2-year basic training: 6 months are spent in the emergency room, 6 months in intensive care medicine in surgery, a further 12 months of training can take place in another area. You then spend another four years learning exclusively in orthopedics and trauma surgery, where you perform the relevant examinations, operations and procedures. The total training period in orthopedics and traumatology is 72 months, during which the relevant specialist skills are acquired.

Joint replacement plays an increasingly important role as we age. And endoprostheses are constantly being optimized. In the last 10 years alone, digitalization - such as the virtual representation of joints, especially those of the knee and hip - has gained a lot, if not even started a small revolution..The nature of digital and artificial intelligence – in the field of endoprosthetics – undoubtedly enriches the surgeon’s know-how after adequate training and experience. Certain physical areas that are difficult to reach with the surgical instrument can be reached precisely through virtual analysis and subsequent implementation by the robotic arm or navigation system. This is at least currently possible in abdominal surgery and urology (e.g. the Da Vinci surgical system).Robot-assisted navigation in endoprosthetics or spinal surgery shows us a new possibility that will point the way to future work in the operating room. It is to be expected that the corresponding systems of an industrial robot will be optimized to such an extent that orthopedic surgeons will see their complex work simplified, at least in the coming years with regard to the first implant. However, complex surgical treatments, such as replacement prostheses after failure or loosening of the implant, remain entirely in the experienced and competent hands of the surgeon. The disadvantage could be that artificial intelligence (AI) in the operating room increasingly overshadows the expertise of the surgeon. The individual surgeon and the patient do not choose the doctor they trust, but rather the “machine”. Special clinics such as the ATOS clinical group, which stands out because it brings together outstanding experts under one roof, will no longer exist. The only strength may therefore no longer be its surgical expertise, but rather the personality that accompanies the patient on the path to recovery. The robot takes care of the manual part. In the design and material of the future, the previous CT examination will be evaluated with software so that mainly custom-made knee prostheses can be implanted that come directly from 3D printers. At the moment we are still working with robust metal implants that do not correspond in any way to the elastic modulus of the bone. It can be assumed that completely new materials with bone-like elasticity and therefore physical properties of bones will come onto the market and be implanted.

As a specialist in orthopedics and trauma surgery, you can specialize in, for example, spine surgery, hand surgery or emergency surgery. It may make sense to complete additional training in the relevant area. According to the model of further training regulations, there are various additional training courses, for example for hand surgery, orthopedic rheumatology or sports medicine.In principle, orthopedists cover the entire spectrum of musculoskeletal surgery, but those who specialize in older patient groups will have a particularly intensive schedule in the future. The greatest challenge in the field of orthopedics and trauma surgery is the aging population. We are seeing more and more osteoporotic fractures. Older patients usually have significant underlying diseases that must be taken into account when providing care.

Salaries in hospitals Salaries of hospital doctors are influenced by several factors and are regulated by collective agreements. There are different rates for different groups and types of employers, but the remuneration usually does not differ significantly (e.g. for municipal and religious employers, university hospitals or private clinic companies). The current collective agreement between municipal employer associations provides for increases in the basic salary in two stages:

From 1 April 2024 to 30 June 2024: Assistant doctors in the 1st year: €5,288.32 Specialists from the 3rd year: €8,078.81 Senior doctors from the 3rd year: €9,991.49 Senior doctors from the 2nd year: €11,019.20 In addition to the basic salary, additional payments may be provided for on-call service, permanence services and participation in the pool, which may amount to 20-40% of the basic salary.

Income is not the same as net profit! The net income per orthopedic practice in 2021 was approximately 362,000 euros, which is approximately 8% higher than the average for all outpatient practices (= 336,000 euros). The average turnover in 2021 was 805,000 euros. Net profit cannot be equated with net profit, as essential cost items such as depreciation from the purchase of the practice and all preventive expenses are not included. Furthermore, net profit refers to a practice and not to the owner of a practice. In a group practice, for example, the net income must be distributed among the number of practice owners.

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