This episode explores the ongoing challenges and potential solutions surrounding Medicare physician payment reform and the sustainability of orthopedic practices. Dr. Robert Orfaly, editor in chief of AAOS Now, is joined by Dr. Adam Bruggeman, Chair of the AAOS Advocacy Council, to discuss the history of payment models from the sustainable growth rate (SGR) to MACRA, the impact of budget neutrality, and the consequences of stagnant reimbursement rates. Dr. Bruggeman shares insights into how these financial pressures are threatening the viability of independent and group practices, driving consolidation, and affecting patient access to care. The conversation highlights current advocacy efforts to secure inflationary updates for physician payments and emphasizes the importance of physician engagement and storytelling in influencing health policy. Host: Robert Orfaly, MD, Editor in Chief, AAOS NowGuest: Adam Bruggeman, MD, Chair, AAOS Advocacy Council