As an Orthopedic Sports Surgeon at Midwest Orthopaedics at RUSH, I’ve benefited tremendously from the camaraderie and mentorship provided by Charles A. Bush-Joseph MD. On Friday, March 14th, our friend Chuck, shared his medical business acumen and leadership experience with all who attended the Kennedy Lectureship on Specialty Day, “The Sports Medicine Practice and Its Evolution in Today's Consolidating Environment,” at the 2025 AAOS Annual meeting in San Diego. The award is recognized in honor of past president, John C. Kennedy, MD, FRCS(C), and is supported by the Kennedy Family Endowment and the American Journal of Sports Medicine. Chuck was selected by Chris Kaeding MD, the current president of the American Orthopedic Society for Sports Medicine. Our colleagues from the American Orthopedic Foot and Ankle Society partnered with us for this combined meeting.
Chuck’s talk was both insightful and timely, especially as we navigate a rapidly changing healthcare environment shaped by consolidation, financial pressures, and emerging technologies. The field has evolved significantly from its early days, and understanding this progression is key to positioning ourselves for success in the future. With Dr. Bush-Joseph’s permission, allow me to provide a summary of his lecture:
The origins of sports medicine are often overlooked, but they provide valuable context for our current practice. From Herodicus in the 5th century BC, who first recognized the link between exercise and health, to early 20th-century team physicians working alongside athletic trainers, sports medicine has always been driven by the need to optimize performance and recovery. Dr. Bush-Joseph highlighted the contributions of Dr. Robert Leach, a surgeon who fought for sports medicine’s legitimacy when it was still considered secondary to trauma or general orthopedics. His belief that sports medicine should serve all athletes, not just the elite, remains foundational to our specialty. Whether treating professional athletes or weekend warriors, our goal as surgeons is to help patients return to their best functional state while minimizing long-term risks.
One of the most relevant issues discussed in the lecture was the changing nature of orthopedic practice, particularly the dramatic shift from private practice to hospital- and corporate-employed models. The numbers highlight changes with time, with 70% of physicians now being employed by hospitals, private equity firms, or corporate entities. Only 44% of physicians own independent practices, down from 76% in 1980. The number of hospitals has also declined significantly due to mergers and acquisitions. This trend toward consolidation has major implications for sports medicine practice. On one hand, large health systems and physician “supergroups” offer financial stability, administrative support, and access to advanced resources. On the other hand, they come with significant downsides, including loss of autonomy, complex referral networks, and the risk of physician disengagement.
The traditional physician-owned sports medicine practice is being replaced by multi-specialty musculoskeletal groups that integrate orthopedics, rehab, imaging, and ambulatory surgery centers under one umbrella. While this model increases efficiency and negotiating power with payers, it also raises concerns about physician independence and the corporatization of patient care. Many physicians enter this field for direct patient interaction, hands-on care, and the ability to make clinical decisions based on expertise rather than administrative directives. As consolidation continues, it is important to remain actively involved in shaping the professional landscape to ensure that the core values of sports medicine are preserved.
Another key takeaway from the lecture was the financial reality of practicing sports medicine today. While Orthopedic surgeons continue to have strong median compensation, the payment process has changed dramatically. Employed surgeons rely on salary, RVUs, and net patient collections, while private practice surgeons must navigate upfront costs, equity buy-ins, and revenue-sharing models. Private equity firms have also entered the orthopedic space, offering cash infusions to practices but often at the expense of long-term physician control. The 2023 Kaufman Hall Report highlighted that orthopedic surgeons increasingly underwrite lower-revenue service lines while hospitals and insurers exert downward pressure on reimbursement. Medicare physician payments, when adjusted for inflation, have declined 33% since 2001, yet hospital revenue continues to climb. These financial pressures push physicians to think strategically about how we position ourselves within the system, whether through better contract negotiations, restructuring compensation models, or advocating for fair reimbursement policies.
One aspect of the lecture was the role of artificial intelligence (AI) and digital health in sports medicine. AI is becoming increasingly integrated into diagnostic imaging, surgical planning, and predictive analytics for patient outcomes. However, this rapid technological advancement raises important questions: who controls the data, will AI enhance decision-making or replace physician judgment, and how do we balance technological progress with patient-centered care? The rise of digital musculoskeletal care platforms further complicates this landscape. Telemedicine, remote rehabilitation, and employer-based care models are shifting patient access away from traditional physician offices. While these platforms improve efficiency and expand access to care, they also fragment patient management and reduce direct physician involvement. Orthopedic surgeons should be proactive in adapting to these changes while ensuring that patient care remains our top priority.
The 2025 Kennedy Lecture was not just a reflection on sports medicine’s past; it was a call to action for our future. The field is changing rapidly, and Orthopedic surgeons take an active role in shaping its direction. We need to advocate for sports medicine as an essential specialty, not just a subspecialty of orthopedics. We must find ways to thrive in a consolidated healthcare environment without losing autonomy. We must embrace innovation while ensuring that technology serves, rather than replaces, physician expertise.
Image by Denis Novikov / Getty
Dr. Forsythe has no conflicts of interest to report.
