Working in a safety-net academic center, I’ve witnessed firsthand the challenges faced by underserved populations, particularly in places like Appalachia where specialized care is scarce. Here, the dire consequences of orthopedic complications, such as periprosthetic joint infections (PJI), are magnified. PJI treatment is intricate and costly, necessitating specialized centers akin to cancer centers, with dedicated collaborative teams that are continually immersed in the newest literature and perioperative protocols.
PJI is associated with extended hospitalizations, high disability rates, decreased quality of life, and a significant mortality rate that is comparable to metastatic colon cancer. Poor physical function, an inability to live independently, and fear of disease progression or death cause significant psychosocial distress, depression, and anxiety. Addressing such infections demands a multidisciplinary approach, one that involves a complex, orchestrated effort from various healthcare professionals.
The treatment process begins with the removal of the infected hardware, followed by the insertion of a temporary antibiotic spacer. Patients then undergo a six-week regimen of IV antibiotics, which ultimately culminates in another surgery to implant the final hardware. Infectious disease specialists, hospitalists, and pharmacists collaborate to optimize antibiotic treatment. Patients, often malnourished and with poor wound healing, require the expertise of a dietician to help restore their nutritional status. The prolonged course of IV antibiotics necessitates consistent blood level monitoring, which is meticulously managed with the aid of pharmacists. Additionally, extensive physical therapy and rehabilitation are integral to help patients regain function and mobility. In this intricate and multifaceted process, the orthopedic surgeon serves as the quarterback for these patients. They are tasked with coordinating the care between the aforementioned specialists, and ensuring that each aspect of care is integrated to optimize patient outcomes.
A fellowship-trained surgeon specializing in periprosthetic joint infection is required to navigate these complex problems effectively. Without this level of leadership and coordination, these patients are at risk of receiving suboptimal care. The challenges are even more pronounced in rural and underserved areas. Many rural healthcare setups lack the necessary resources and expertise to holistically address these challenges. This disparity underscores the urgent need for physician-lead specialized medical interventions, ensuring that every patient has access to the comprehensive care they deserve.
One patient’s story particularly stands out. He traveled over three hours from western Kentucky, driven by his wife. A retired mechanic, he had managed with a hip replacement for over a decade. However, recent complications had rendered him dependent, a stark contrast to his previously self-reliant nature. He recounted, “It was that shower faucet trim plate. It just kept leaking. I could’ve changed it myself… But I had to ask my wife. I can’t bend down anymore. Your spouse becomes your care-taker.” His words poignantly capture the emotional weight of feeling like a burden.
While he minimized his physical discomfort, the psychological toll was evident. Such experiences highlight the deep emotional and personal impact of orthopedic complications on an individual’s self-worth and dignity. Confronted with feelings of helplessness, frustration, and despair, their sense of independence and quality of life is compromised. Fortunately, after a successful 2-stage revision, he was on the path to reclaiming his independence.
In today’s evolving healthcare landscape, the role of mid-level providers, such as nurse practitioners and physician assistants, is undeniably invaluable. They often serve as the first point of contact for patients, providing essential, compassionate, and competent care. However, managing highly complex and nuanced medical issues, such as PJI, requires the depth and breadth of a physician’s training.
Physicians, through years of rigorous medical education and specialized training, develop a deep well of knowledge and clinical acumen essential for leading healthcare teams, especially in complex cases. They bear the responsibility of staying abreast of the newest diagnostic and treatment modalities, as it is ultimately the surgeon that takes on full ownership of the patient’s care. This is not to diminish the role of other team members, but rather to highlight the distinct and complementary roles within a healthcare team.
As leaders, physicians are trained to consider the entire clinical picture, including immediate issues, underlying comorbidities, psychosocial factors, and long-term treatment implications. In this context, physician-led teams are uniquely positioned to oversee all aspects of a patient’s care, ensuring that treatment plans are tailored to individual needs and circumstances.
As I continue my training, I remain steadfast in my commitment to addressing disparities in access to specialized care. I am dedicated to ensuring that patients, regardless of their background, receive treatment they deserve. In a physician-led model, the expertise of the entire team is harnessed and directed synergistically, with the physician serving as the guiding force, ensuring that patient care is safe, effective, and of the highest quality.