Orthopedic practices across the country are entering 2026 with a reality no one is excited about — but everyone is living with:
More work. Fewer people. Higher expectations. Shrinking margins.
The orthopedics boom isn’t slowing down. Case volumes continue rising. Imaging demand is up. Surgical schedules are packed. Payer requirements are tighter than ever. And administrative workloads have become heavier, more complex, and more error-prone.
Yet hiring has never been harder.
Turnover is high. Competition for experienced billers, coders, and auth specialists is intense. Salaries are rising faster than reimbursement. And even when practices do hire great people, they struggle to keep them long enough to stabilize operations.
Orthopedic CEOs, CFOs, COOs, and practice administrators all describe some version of the same problem:
“We’re doing 20–40% more work than we were before the pandemic… with 20–30% fewer staff.”
This is the ortho staffing squeeze — and it’s not going away.
But the practices that are navigating it successfully aren’t relying on luck. They’re making deliberate changes in how work gets done, who does it, and where automation fits in.
This deep dive breaks down why the staffing squeeze is happening, the hidden costs leaders often miss, and what high-performing orthopedic groups are doing to operate efficiently with smaller teams.
Why Orthopedic Practices Are Struggling to Staff Administrative Roles
Orthopedic operations have always been labor-intensive, but several forces converging at once have made staffing dramatically harder.
1. Prior Auth, Coding, and Denials Have Become More Complex
Administrative work has grown in both volume and complexity:
More prior auth requirements
More multi-step clinical criteria
More complicated CPT bundles
More clinical documentation required
More portal submissions
More denials and appeals
More payer rule changes
The result is simple:
Even highly skilled staff need more time to complete the same workload.
For practices with smaller teams, this creates immediate bottlenecks.
This is exactly why more orthopedic groups are using Magical’s agentic AI employees to take over the repetitive, rules-based parts of prior auth, eligibility, and denials—letting staff focus on higher-skill tasks.
2. Orthopedic Administrators Are Burning Out
Orthopedic RCM is fast-paced, high-pressure, and incredibly detail-oriented. Staff handle:
High-dollar surgeries
Complex imaging workflows
Continual status checks
Multi-payer requirements
Long documentation packets
Surgeon expectations
Patient expectations
Endless rework
Burnout drives turnover. Turnover increases workload. Increased workload drives more burnout. It’s a vicious cycle.
And it’s hitting orthopedics harder than most specialties because MSK volumes are so high.
3. Competition for Experienced Staff Has Exploded
Orthopedic practices are not competing only with each other.
They’re losing candidates to:
Hospitals
Health systems
Telehealth companies
National MSK startups
Virtual back-office service companies
Remote RCM firms in other states
The staff who remain in the industry can be choosier — and they often choose roles with:
Remote options
Better pay
Lower complexity
More predictable workloads
Orthopedic groups can’t always match those dynamics, especially on complexity.
4. Remote Work Shifted the Labor Market Permanently
Administrative healthcare workers discovered the benefits of remote work during the pandemic — and many won’t go back.
Orthopedic practices that require full on-site work have a much smaller candidate pool.
Even partially remote RCM roles are harder to fill because:
Not all tasks can be done remotely
Surgeons expect quick office coordination
Patient-facing tasks require in-person staff
Documentation is scattered across physical and digital systems
This keeps staffing pools shallow — and turnover costly.
5. Training and Onboarding Take Longer Than Ever
New staff need to learn:
EHR systems
PM systems
Imaging workflows
Conservative therapy rules
Surgical scheduling workflows
Payer portals
Clinical documentation patterns
Surgeons’ preferences
Billing and coding protocols
It can take 6–12 months for a new hire to become fully productive.
That slows down operations and increases reliance on a few “experts,” which increases operational fragility.
The Hidden Costs of Running Ortho Operations With Smaller Teams
Most practices know they are understaffed. Fewer realize the multi-layered financial impact.
1. Slower Prior Auth = Delayed Surgeries = Delayed Cash
Even small delays can ripple into:
postponed surgeries
less predictable OR utilization
frustrated patients
surgeons with gaps in schedules
cash flow dips
Smaller teams simply can't keep up with the follow-up volume required.
2. More Denials — and More Denials That Never Get Worked
Denials increase when:
criteria aren’t checked
documentation is missing
CPTs mismatch
approvals aren’t caught
statuses are missed
auths don’t cover every code
But the bigger problem is this:
Denials pile up. And smaller teams can’t work them fast enough.
By the time the practice gets to them, many are already unrecoverable.
3. More Tasks Slip Through the Cracks
Understaffed teams experience:
missed PA submissions
missed eligibility checks
missed plan changes
missed approvals
missed denials
missed filing deadlines
missed secondary claims
This isn’t laziness — it’s math.
When humans have too many high-volume, repetitive tasks, things get forgotten.
This is one of the first workflows many practices shift to Magical—letting AI employees handle the high-volume micro-tasks that humans struggle to keep up with.
4. Staff Spend Too Much Time on Low-Value Work
Highly skilled staff spend hours every day:
hunting for documentation
scanning PDFs
logging into portals
copying/pasting between systems
downloading imaging
checking statuses
filling out forms
reworking denied claims
collecting PT notes
This is not revenue-driving work. It’s just… work.
And it drags down productivity across the entire practice.
5. Recruiting Costs Spike
Fewer candidates mean:
more job ads
more recruiter spend
more agency fees
more interview time
more vacancies while searching
All while tasks continue piling up.
How High-Performing Orthopedic Practices Are Surviving (and Thriving) With Smaller Teams
The practices that are navigating the staffing squeeze successfully aren’t just “working harder.” They’re reengineering how work gets done.
Here are the strategies that are rising to the top.
1. Prioritizing “Highest-Impact” Work First
High-performing teams triage work based on:
revenue impact
clinical urgency
payer complexity
surgeon schedules
downstream dependencies
Not all tasks are equal.
These practices ruthlessly focus human attention on:
surgical cases
complex denials
escalated PAs
high-dollar claims
payer disputes
exceptions and edge cases
Everything else gets streamlined, automated, or reassigned.
2. Eliminating Manual, Repetitive Tasks Through Automation
The most productive ortho groups in 2026 aren’t trying to replace their teams — they’re augmenting them.
They use automation to take over:
eligibility checks
authorization submissions
portal monitoring
documentation collection
status checks
payment posting prep
denial routing
claim validation
secondary billing triggers
This allows the humans to work at the top of their license.
Magical’s AI employees now automate many of these workflows end-to-end—without integrations—giving orthopedic teams hours back every single day.
3. Standardizing and Centralizing Workflows
Smaller teams can’t rely on tribal knowledge.
High-performing practices:
use structured checklists
document CPT rules
create standardized templates
use central queues
reduce workflow variation across staff
eliminate “everyone does it differently” patterns
Standardization reduces errors and makes coverage easier when staff are out.
4. Cross-Training Staff Across Multiple Roles
Cross-training is becoming essential.
Practices are training staff to handle:
basic auth tasks
eligibility and benefits
simple coding checks
payment posting basics
claim follow-up
portal navigation
This creates flexibility — and reduces dependence on any single team member.
5. Rebuilding Workflows Around True Capacity
Rather than asking staff to do 40% more work in the same hours, leading teams:
simplify documentation requirements internally
extend lead time on PAs
automate follow-ups
batch repetitive tasks
remove bottlenecks
rethink surgeon scheduling rules
redesign handoffs between departments
They don’t wait until someone is overwhelmed. They design capacity intentionally.
6. Outsourcing Targeted, High-Burden Tasks
Selective outsourcing is becoming more common, especially for:
complex coding
high-volume data entry
large denials backlogs
benefits verification
one-time cleanup projects
This creates breathing room while permanent solutions are built.
7. Leveraging Agentic AI Employees as “Force Multipliers”
This is the biggest shift happening in 2026.
Orthopedic practices are discovering that many tasks don’t require human judgment — just consistency, accuracy, and speed.
AI employees handle:
repetitive portal workflows
structured data collection
multi-step payer sequences
status monitoring
form completion
documentation prep
queue routing
error checking
They don’t replace staff — they multiply their capacity.
This is why more orthopedic practices are using Magical to give their teams extra bandwidth without hiring—especially in prior auth, eligibility, denials, and posting.
The Future: Ortho Practices That Redesign Work Will Outperform Those That Try to Out-Hire the Problem
Hiring your way out of the staffing squeeze is no longer realistic.
The practices thriving today are the ones who:
eliminate low-value work
automate the work humans shouldn’t be doing
focus staff on high-impact tasks
build fail-proof workflows
stabilize operations with reliable automation
prevent burnout by reducing workload
reduce operational risk through standardization
The staffing squeeze is real. But so is the opportunity it creates.
Orthopedic practices that adapt will emerge stronger, more efficient, and far more resilient than those still relying on the old model of “just hire more people.”
Want to see how much more your team could get done with the staff you already have?
Magical can walk you through a quick workflow assessment to show where agentic AI employees can reclaim time, reduce burnout, and improve revenue flow — without adding headcount or requiring any IT lift.