The competitive landscape for orthopedic and spine practices is changing rapidly. As value-based care expands, AI advances and more procedures move to the outpatient setting, leaders say success will depend on far more than surgical expertise alone.

Editor’s note: Responses have been lightly edited for clarity and length.

Question: What do you believe will be the single biggest competitive advantage for orthopedic and spine practices over the next five years, and why?

Bryce Basques, MD. Spine Surgeon and Director, Minimally Invasive and Endoscopic Spine Surgery, Brown University (Providence, R.I.): The single biggest competitive advantage will be ownership and equity investment in ASCs because of the ongoing migration of high-value orthopedic and spine cases to the outpatient setting. Practices that own their ASCs have a durable revenue stream that insulates them from declining physician reimbursement and diminishing margins on other ancillary revenue such as therapy and imaging. Ownership lets surgeons control scheduling, case selection, implant costs and the patient experience, which drives both efficiency and the kind of outcomes and satisfaction that increasingly determine referral patterns and value-based contracts. Orthopedic and spine practices that own the setting where surgery is performed will be the ones that stay independent, profitable and in control of their future.

Tan Chen, MD. Orthopaedic Spine Surgeon at Inova Orthopaedics & Sports Medicine (Fairfax, Va.): Over the next five years, the biggest competitive advantage for orthopedic and spine practices will be delivering an exceptional patient experience. While technology such as minimally invasive surgery, AI and robotics will continue to advance, what truly sets a practice apart is making patients feel heard, informed and supported throughout their entire journey. Patients want to be treated with respect and decency, to feel listened to and to know they are being cared for as a person, not just a diagnosis or an MRI. The practices that combine outstanding clinical outcomes with compassionate care, easy access and clear communication will earn the greatest trust and become the first choice for patients seeking spine care.

Quentin Durward, MD. Neurosurgeon at CNOS (Dakota Dunes, S.D.): The single best competitive advantage for spine practices, whether in neurosurgery or orthopedics, will be experience. Surgeons with long-established practices have climbed the learning curve, managed most spinal conditions many times over, learned to handle complications and unexpected surgical findings, and become more efficient and cost-effective. Many newly trained surgeons, especially those without mentorship, will likely struggle for a while. Their results will be scrutinized by referring physicians, patients, colleagues, hospital quality committees, insurers and government payers.

I believe the most successful practices will support new surgeons through case discussions, involvement in surgical planning, experienced partners’ attendance at complex cases, help during unexpected intraoperative events and diligent postoperative care.

Those foundational principles will always outweigh trying to be first with a new technology or relying on gimmicks. Old dogs can learn new tricks, and if a technology offers significant benefit, everyone will adopt it soon enough.

Andrew Fanous, MD. Chair of Surgery at Inova Mount Vernon Hospital and Medical Director of the Inova Eastern Region Spine Program (Alexandria, Va.): I believe the single biggest competitive advantage for orthopedic and spine practices over the next five years will be delivering a seamless, data-driven, patient-centered continuum of care, not simply providing excellent surgery. The landscape is shifting from volume-based care to value-based care, with patients prioritizing convenience, transparency, access, communication and long-term outcomes. At the same time, payers and employers increasingly reward providers that demonstrate high-quality outcomes while controlling costs. Practices that integrate advanced analytics, AI, digital patient engagement, remote monitoring and standardized clinical pathways will be best positioned to differentiate themselves. These tools enable earlier intervention, more personalized treatment, better patient adherence, fewer complications and stronger outcomes reporting.

Equally important is coordinating care across the entire patient journey, from referral and diagnosis through surgery, rehabilitation and long-term follow-up. Practices that reduce friction, shorten wait times and communicate proactively will build stronger patient loyalty and referral relationships. Ultimately, the practices that succeed will become trusted, high-value care organizations that consistently deliver measurable outcomes, exceptional patient experiences and operational efficiency. That combination will provide a lasting competitive advantage.