Advocacy 101 for the Early-Career Arthroplasty Surgeon: Payment, Policy, and Professional Sustainability.

Modern hip and knee arthroplasty surgeons graduate prepared to manage complex deformity, revision surgery, complications, and high-volume clinical practice but often receive little formal preparation for the payment and policy systems that determine whether that care remains accessible and sustainable. For early-career surgeons, this gap between clinical work and reimbursement reality can feel confusing, frustrating, and outside their control. Yet, payment policy directly shapes patient access, practice viability, workforce morale, and professional autonomy. This primer provides an "Advocacy 101" primer for arthroplasty surgeons in their first five years of practice, focusing on the core mechanics of physician payment: relative value units, the Medicare conversion factor, budget neutrality, 90-day global periods, and the distinction between physician professional fees and facility payments. It helps with understanding how declining inflation-adjusted reimbursement, increasing postoperative workload, outpatient migration, consolidation, and alternative payment models are reshaping the arthroplasty practice environment. We also discuss opportunities within bundled payment models, Transforming Episode Accountability Model, and gainsharing, emphasizing that surgeons who understand implant costs, postacute pathways, and episode spending are better positioned to lead value-based care. Advocacy should not be framed as politics, but as professional stewardship, a patient-centered responsibility to preserve access to high-quality joint replacement before policy decisions become constraints that surgeons simply inherit.