{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/orthopedic-surgeons-except-pediatric/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Orthopedic Surgeons, Except Pediatric", "soc_code": "29-1242", "category": "Healthcare", "us_employment": 14100, "median_annual_wage": 358550 }, "verdict": "SAFE", "risk_resistance": 93, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 17, "embodiment": 20, "liability_shield": 19, "trust_premium": 17, "judgment_accountability": 20 }, "reasoning": { "task_resistance": "Cementing a revision hip through scarred tissue, judging fracture reduction by feel under fluoro, and salvaging a case when the femoral canal fractures on broaching are tasks no software performs; the 3-point deduction reflects that dictation, ICD-10/CPT coding, pre-op CT templating, and initial radiograph reads are already being handed off to algorithms.", "embodiment": "You are scrubbed, gowned, standing over a bleeding surgical field for two to four hours, using a mallet, saw, and reamer on live bone while lead-aproned under a C-arm — this is the ceiling case for physical work in an environment whose variability (osteoporotic bone, aberrant vessels, unexpected nonunion) is discovered by hand mid-procedure.", "liability_shield": "State medical licensure, ABOS board certification, hospital credentialing and privileging by specific procedure, plus a malpractice premium among the highest of any specialty mean the operative note carries your name and your name alone; the single point off is because informed consent, device-manufacturer liability for implant failure, and hospital enterprise coverage absorb a sliver of exposure that would otherwise be entirely yours.", "trust_premium": "Patients get referred, then interview two or three surgeons before deciding who opens their knee, and volume follows reputation among primary care physicians, PTs, and prior patients; it lands at 17 rather than 20 because a meaningful share of your caseload is trauma call, where the patient arrives unconscious with a hip fracture and never chose you.", "judgment_accountability": "Operate now or brace for six weeks, hemi versus total, when to abandon a limb salvage for amputation, whether an infected arthroplasty gets a washout or a two-stage revision — these are irreversible, contested calls made with incomplete information and no protocol that resolves them, and you defend them at M&M and in deposition." }, "rationale": "The core of this job is manual: reducing fractures, placing hardware, performing arthroplasties and arthroscopies in a sterile OR with soft-tissue variability no current robot handles autonomously — surgical robots like Mako are surgeon-guided tools, not replacements. AI is already competitive at reading radiographs and MRIs and will absorb documentation, coding, and pre-op templating, but the operative decision (operate vs. conservative management, which implant, what to do when anatomy differs from the plan) sits with a licensed, personally liable surgeon. Patients choose the individual who will cut them, and malpractice law makes that choice legally load-bearing.", "outlook": "Through 2035 AI takes over imaging pre-reads, planning, and paperwork, letting orthopedic surgeons operate more and chart less; the number of surgeons is constrained by residency slots and an aging population, not by software.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "Embodiment and accountability are already at ceiling; liability could reach 20 if state medical boards or CMS formalize that autonomous or semi-autonomous robotic surgical steps require a credentialed surgeon of record physically scrubbed and signing an intraoperative attestation — analogous to the ACGME/CMS teaching-physician 'key portion presence' rule already applied to resident-performed cases, extended by rule to robotic autonomy. Watch FDA's device labeling for surgeon-supervision conditions on any autonomous orthopedic cutting system.", "plausibility": "plausible", "would_add": 1 }, { "dimension": "trust_premium", "change": "Rises if hospital-published surgeon-specific outcome scorecards (already live in the UK's National Joint Registry consultant-level reporting and CMS's move toward provider-level THA/TKA complication rates) become standard in US, since named-surgeon volume/revision data pushes patients to select individuals rather than institutions or 'the robot'. Also raised by continued growth of direct-pay orthopedic centers (e.g., Surgery Center of Oklahoma model) where the buyer explicitly purchases a named operator.", "plausibility": "already happening", "would_add": 2 }, { "dimension": "task_resistance", "change": "Rises modestly as AI absorbs the readable tier — radiograph/MRI interpretation, pre-op templating, dictation, coding, prior-auth letters — leaving a day composed disproportionately of operative work and ambiguous operate-vs-conservative conversations. This is a genuine two-tier job and the shift is underway with FDA-cleared fracture-detection tools.", "plausibility": "already happening", "would_add": 2 } ], "ceiling_note": "Embodiment (20) and judgment_accountability (20) are already maxed; total headroom is ~5 points at most. At 93/100 the score is bounded by measurement, not by exposure — any further movement is cosmetic." }, "adjudication": null, "employment_history": { "points": [ { "y": 2021, "emp": 16260, "wage": 239200 }, { "y": 2022, "emp": 19060, "wage": 239200 }, { "y": 2023, "emp": 14820, "wage": 239200 }, { "y": 2024, "emp": 14160, "wage": 239200 }, { "y": 2025, "emp": 14100, "wage": 358550 } ], "from": 2021, "to": 2025, "change_pct": -13.3, "comparable_from": 2021, "spans_soc_revision": false }, "pivots": [], "license": "https://cookedindex.com/terms" }