The Role of AI in the Orthopedic Surgery Practice

Podcast: The AOFAS Orthopod-Cast
Date: February 25, 2026
Episode Theme:
Exploring the practical integration, opportunities, and ethical challenges of artificial intelligence (AI) in modern orthopedic surgery practices, especially in foot and ankle care. The episode brings together several leading surgeons at the AOFAS summer meeting to discuss AI’s impact on clinical efficiency, documentation, patient communication, medical-legal considerations, training, and the future of the profession.

Main Discussion Points

1. How AI is Currently Used in Orthopedic Practices

• Clinical Documentation and Note Generation:
  • Many surgeons are using AI, often paired with a scribe, to produce clinic notes.
  • AI-generated notes are reviewed for accuracy before signing; this minimizes clerical burden.
  • Some systems automatically transcribe and structure physical exam findings based on spoken dialogue.
• Letters of Recommendation & Administrative Tasks:
  • AI is widely used to draft letters for residency, fellowship recommendations, and promotion.
  • Dr. Joe emphasized the importance of reviewing and personalizing AI-generated letters:
    "I think it's fine for AI to generate the letter, but you've got to review and agree with all the content." (01:32)
• Patient Education:
  • AI-generated patient-facing materials are being explored, though integration remains tentative.
• Surgical Documentation & Coding:
  • AI helps optimize operation notes to ensure comprehensive and accurate coding for billing.
  • Dr. Anish Kadakia described dictating generalized op notes into his phone and using AI (e.g., ChatGPT) to structure them for maximal code clarity and efficiency (13:09).

2. Medical-Legal, Consent, and Privacy Considerations

• Transparency and Oversight:
  • Disclosure to patients about AI-generated notes and recordings is increasingly common.
  • Concerns about oversight: Will transcripts be routinely retained? How long should these records be stored?
• State Laws & Written Consent:
  • In some states (e.g., Illinois), dual-party consent is legally required to record conversations.
    "Our system basically said you have to have a written consent. So legally you need to have a written consent of the patient in Illinois." – Dr. Anish Kadakia (05:22)
• Medical-Legal Documentation:
  • More comprehensive dialogue transcripts may help defend care quality in legal cases.

3. Patient Reactions and Cultural Shifts

• Mixed Patient Acceptance:
  • Some patients are uncomfortable with full-transcript documentation or being recorded.
  • There are generational and privacy issues: not all patients are willing to have AI or audio involved.
  • Dr. Nick Strasser noted:
    "Some patients don't like it. Now we've been doing it long enough where I've had a couple patients say, I would prefer not to, you know, have the AI note. And... it captures everything." (04:46)
• Recording by Patients:
  • Surgeons report increasing incidents of patients recording (audio/video) without disclosure.
  • Surgeons generally support transparency but are wary of malice-driven recordings.

4. Efficiency and Workflow Improvements

• Coding and Billing Optimization:
  • AI aids in separating operative note components, maximizing code capture, and aiding template reuse.
    "It makes sure that you separate deep incision, separate paragraphs so it's easier for your coders." – Dr. Anish Kadakia (14:33)
• Pre-Authorizations and Work Comp:
  • AI produces insurance-specific templates for pre-authorization and can generate work comp impairment ratings using standardized references.
• Patient Inquiries and Portal Messages:
  • AI provides more thorough, empathetic responses to patient portal messages than many physicians, which can enhance patient satisfaction (32:01).

5. Training, Skills, and Generational Concerns

• Losing Documentation Skills & Critical Thought:
  • Worry over future trainees relying solely on AI without learning to synthesize clinical information, write notes, or craft letters.
  • Dr. Ben:
    "If you don't get the training, like writing a good letter, knowing good grammar and syntax, if you don't have that... that check, I'm not sure [future generations are] going to get that training." (22:14)
• Changes in Education:
  • Analogous to the shift from handwriting and manual typing to digital tools.
  • Incumbent on educators to ensure critical thinking and clinical synthesis skills are preserved.

6. AI, Patient Empowerment, and Professional Identity

• Patients as Informed Consumers:
  • Tools like Grok and ChatGPT are used by patients to interpret MRIs, recommend surgeons, and suggest treatments.
  • Surgeons shared anecdotes about patients trusting AI over expert opinion, sometimes leading to contentious interactions.
  • Dr. Anish Kadakia:
    "That is the next level... Grok is interpreting their MRI, telling them what their diagnosis is… what the appropriate procedure is, and then telling them who the expert… is." (17:20)
• Erosion of Physician Authority:
  • Some panelists foresee a diminishment in the physician’s role as trusted information gatekeeper as AI becomes more competent and accessible.
  • Concerns about eventual reductions in compensation for consultative and diagnostic services as AI takes over non-procedural knowledge work (33:01).

7. AI in Surgery and the Future of Practice

• Surgical Video and Data Collection:
  • Surgeons are beginning to record all surgeries for data analysis and AI learning/training purposes.
  • AI has already demonstrated proficiency in technical procedures (34:40).
• Potential for Robotic Surgical Automation:
  • Surgeons discuss the prospect of fully automated procedures and the impact on job security and training.
  • The near future likely brings further job stratification; technical procedural skills may remain the final domain exclusive to surgeons, but even these may eventually be challenged.

8. Ethical and Societal Questions

• Loss of Human Touch:
  • Concerns about the loss of personal connection in patient care and professional camaraderie, driven by technology’s prevalence in daily life, especially for younger generations.
  • Discussion about the fading art of the personal letter, gratitude, and nuanced communication.
  • Dr. Ben:
    "If you get to the point where... everybody's using ChatGPT to write out your little rec, then you shouldn't have a letter of rec as part of what you need. Get rid of that." (24:30)
• Professional Adaptation:
  • The panel agrees adaptation is inevitable; AI will radically change the profession, but those who learn to use it to their advantage will thrive in the near term.

Notable Quotes & Memorable Moments

• Dr. Anish Kadakia:

  "AI is like the computer, it's over. It's 100% going to impregnate every aspect of our life." (05:17)

• Dr. Nick Strasser:

  "What I like so much is it assigns… what is changing so much is billing and coding and using the correct language. And so that's what I've really liked it for..." (16:00)

• Dr. Joe:

  "I think the biggest thing that's been more accurate for me is my documentation about risk and benefits... I'd say one liner instead of, like, when you're having some major surgery… So I agree... the more I document that, the better it is." (09:24)

• Dr. Ben:

  "I'm afraid that the younger generation, if you don't get the training... if you just go automatically to this, that filter... I'm not sure they're going to get that training." (22:14)

• Dr. Eric Silverman:

  "They prefer the AI response because we answer quickly... Right. But instead it says all that. Well, thank you so much for reaching out. I appreciate your concern..." (32:01)

• Dr. Anish Kadakia:

  "Our value as physicians is going to diminish over the next 10 years. I hope you got jobs, but I, I, that's my real fear." (34:01)

Key Timestamps

• [00:49] — Introduction to AI in orthopedic practice
• [01:11] — Practical AI uses: note generation, letters, patient education
• [02:33] — Medical-legal challenges and need for guardrails
• [03:53] — Transparency, dialogue transcription, and patient consent
• [05:17] — State laws about recording; consent requirements
• [12:48] — AI in surgical coding and operation notes
• [17:20] — Patients using AI (Grok) for medical interpretation
• [19:23] — AI’s role in work comp and impairment ratings
• [22:14] — Concerns over loss of critical documentation skills
• [24:30] — Ethical implications of AI-written letters/communications
• [32:01] — AI vs. human responses to patient inquiries
• [33:01] — Erosion of physician’s role as information gatekeeper
• [34:08] — Future of surgery and surgical data for AI learning

Takeaways for Practice

• Adopt AI Early and Wisely: Using AI for documentation and coding leads to immediate workflow improvements but must be paired with critical review.
• Stay Vigilant about Privacy and Consent: Always adhere to legal requirements and maintain patient trust through transparency.
• Teach and Preserve Critical Skills: Ensure new trainees learn basic synthesis and communication, not just how to edit AI drafts.
• Prepare for Shifting Patient Expectations: Be ready for highly informed patients and more scrutiny regarding decision-making.
• Recognize the Direction of Change: The future will see more automation, with non-procedural roles shrinking and even procedural roles potentially threatened.
• Advocate for Appropriate Use: Look for opportunities to shape AI policy in healthcare to preserve quality and professional integrity.

Final Thought

"Right now, it's definitely to our advantage. And there are real concerns in the next 10, 20 years that we are going to either be paid a lot less or we may be supplanted by some sort of machinery. But that's a worldwide concern." – Dr. Anish Kadakia (35:23)

The panel wraps up with a consensus that AI will transform orthopedic practice, and the profession must adapt urgently—using AI as a tool, not a replacement, while safeguarding the art, ethics, and value of surgical care.