Best USA Cities to Start an Orthopedic Practice

Starting an orthopedic practice in the United States is both a lucrative and strategic business move. With the aging population, increasing sports injuries, and rising demand for specialized musculoskeletal care, orthopedic practices have tremendous potential for growth. However, location plays a critical role in determining the success of a medical practice. From patient demographics and insurance coverage to competition levels and reimbursement rates, choosing the right city can shape the future of your orthopedic career.

In this comprehensive guide, we’ll explore the best USA cities to start an orthopedic practice focusing on market opportunities, healthcare infrastructure, patient demand, and business environment.

Why Location Matters for Orthopedic Practices

Before diving into the list of cities, it’s important to understand why location strategy is so crucial for orthopedic surgeons and healthcare entrepreneurs:

• Patient Access & Demographics: Areas with aging populations, active communities, or higher rates of joint-related conditions offer better patient volume.
• Reimbursement & Payer Mix: Reimbursement rates, insurance coverage, and Medicare patient percentages affect revenue streams.
• Competition Landscape: A city with fewer orthopedic specialists per capita can offer a competitive advantage.
• Healthcare Ecosystem: Availability of hospitals, rehab centers, ambulatory surgery centers, and imaging facilities supports practice growth.
• Regulatory & Business Environment: States with physician-friendly regulations and efficient licensing processes allow smoother operations.

When these factors align, orthopedic practices can achieve higher profitability, operational efficiency, and patient satisfaction.

1. Dallas Fort Worth, Texas

A thriving healthcare hub with strong patient demand

The Dallas–Fort Worth (DFW) metroplex is one of the top choices for orthopedic practice startups. With a rapidly growing population and a high proportion of aging baby boomers, the demand for orthopedic and musculoskeletal services is consistently strong.

Why DFW stands out:

• Population Growth: One of the fastest-growing metros in the U.S., adding hundreds of new residents daily.
• Aging Demographics: Increased prevalence of joint replacements, arthritis, and degenerative conditions.
• Business-Friendly Regulations: Texas has no state income tax and offers a relatively physician-friendly legal environment.
• Robust Healthcare Network: Home to Baylor Scott & White Health, UT Southwestern, and numerous private hospitals.

2. Nashville, Tennessee

The “Healthcare Capital of the U.S.” with lower competition

Nashville isn’t just famous for music, it’s a major healthcare industry hub, housing more than 500 healthcare companies. For orthopedic practices, Nashville offers a unique blend of low competition and a booming healthcare ecosystem.

Key advantages:

• Lower Orthopedic Specialist Density: compared to larger metros like New York or LA.
• Strong Hospital Presence: Vanderbilt University Medical Center, HCA Healthcare headquarters, and numerous surgical centers.
• Rapid Population Growth: Young families and retirees create a diverse orthopedic case mix from sports injuries to joint replacements.
• Cost Efficiency: Tennessee has lower practice operating costs and favorable malpractice insurance rates.

3. Phoenix–Scottsdale, Arizona

Year-round active lifestyle fuels orthopedic demand

With warm weather, outdoor culture, and a large retiree population, Phoenix–Scottsdale has become a magnet for orthopedic services. The demand for joint replacements, sports medicine, and spine care is high year-round.

Why it’s ideal:

• Large Retiree Base: Arizona is a top destination for retirees, who are primary consumers of orthopedic services.
• Sports-Oriented Population: High participation in golf, hiking, and recreational sports increases injury volumes.
• Favorable Reimbursement: Arizona has a good payer mix and Medicare coverage landscape.
• Growing Healthcare Infrastructure: Mayo Clinic, Banner Health, and several specialty hospitals operate in the region.

4. Raleigh–Durham, North Carolina

A blend of innovation, growth, and aging population

The Raleigh–Durham (Research Triangle) region is known for its innovation and rapidly growing population. For orthopedic surgeons looking to establish a new practice, this region offers balanced patient demand and manageable competition.

Key Highlights:

• Aging & Active Population: A mix of retirees and younger professionals with sports injuries.
• Academic & Medical Ecosystem: Duke Health and UNC Health provide excellent referral networks and collaboration opportunities.
• Quality of Life: Ranked among the best places to live in the U.S., which helps with staff recruitment and retention.
• Stable Reimbursement Environment: Consistent insurance coverage and low uninsured rates.

5. Denver, Colorado

High demand for sports medicine and joint care

Denver’s active, outdoorsy population means orthopedic injuries and sports-related conditions are common, creating steady demand for orthopedic specialists.

Why Denver works well:

• Active Lifestyle: Skiing, hiking, and cycling contribute to high injury volumes.
• High-Income Population: Strong private insurance coverage improves payer mix.
• Expanding Hospital Networks: UCHealth, Centura Health, and private surgical centers support orthopedic growth.
• Growing Tech & Health Workforce: Ideal for attracting skilled staff and referrals.

6. Tampa–St. Petersburg, Florida

Ideal for joint replacement and geriatric orthopedic services

Florida consistently ranks among the top states for orthopedic demand due to its large elderly population, particularly in Tampa St. Petersburg. Orthopedic surgeons focusing on joint replacement, rehabilitation, and spine care find a strong market here.

Advantages:

• High Medicare Patient Base: One of the highest per-capita elderly populations in the U.S.
• Seasonal Surge: “Snowbirds” from northern states increase demand in winter months.
• Established Healthcare System: AdventHealth, BayCare Health, and HCA Florida networks.
• Favorable Tax Environment: No state income tax supports higher take-home earnings.

7. Minneapolis St. Paul, Minnesota

Top-tier healthcare system and stable patient volume

The Twin Cities are home to some of the nation’s best healthcare systems, including Mayo Clinic (nearby in Rochester) and Allina Health. While winters are harsh, the healthcare infrastructure and payer stability make it an excellent city for starting an orthopedic practice.

Key Strengths:

• Integrated Health Systems: Strong referral networks and collaborative care models.
• Excellent Reimbursement Rates: Minnesota ranks high for physician payments.
• Stable Patient Volume: Mix of aging residents and active younger populations.
• Innovation Environment: Close proximity to medical device companies and research institutions.

Factors to Consider Before Choosing a City

Even in top-performing cities, success depends on aligning your practice strategy with the local market. Here are essential factors to evaluate before making a final decision:

1. Competition Analysis

• How many orthopedic surgeons per capita?
• What subspecialties are oversaturated (e.g., sports medicine vs. joint replacement)?

2. Payer Mix & Reimbursement

• What percentage of patients have private insurance, Medicare, or Medicaid?
• Are there favorable orthopedic reimbursement rates in your target city?

3. Referral Networks

• Availability of primary care physicians, physical therapists, and imaging centers that can support referrals.

4. Cost of Operation

• Rent, staffing, malpractice insurance, and equipment costs vary greatly by region.

5. Regulatory Environment

• Some states have certificate of need (CON) laws that may impact opening surgical centers.

6. Quality of Life

• Consider factors like schools, housing costs, commute, and cultural amenities for both you and your staff.

How A2Z Billings Supports New Orthopedic Practices

Starting a new orthopedic practice goes beyond location; it involves efficient revenue cycle management, credentialing, payer enrollment, and compliance. That’s where A2Z Billings comes in.

Our team provides:

• End-to-End Revenue Cycle Management: ensuring faster reimbursements and minimized denials.
• Credentialing & Enrollment Services: so you can join insurance networks quickly.
• Accurate Medical Billing & Coding: essential for orthopedic specialties with complex procedural codes.
• HIPAA-Compliant Processes: to protect patient data and your practice reputation.
• Real-Time Claim Tracking & Analytics: helping you monitor cash flow and growth.

With A2Z Billings as your billing partner, you can focus on patient care while we handle the financial backbone of your practice.

Final Thoughts

The best USA cities to start an orthopedic practice offer a mix of strong patient demand, favorable business environments, efficient reimbursement structures, and robust healthcare networks. Whether you prefer the bustling energy of Dallas, the healthcare capital of Nashville, or the scenic outdoors of Denver, the key is aligning your practice model with local demographics and payer dynamics.

FAQs

1. What factors should I consider before choosing a city to start an orthopedic practice?
   When selecting a location, consider patient demographics, local competition, payer mix and reimbursement rates, referral networks, operational costs, and state regulations. These factors influence both the clinical and financial success of your practice.
2. Which U.S. city offers the best reimbursement rates for orthopedic services?
   Cities in Minnesota (e.g., Minneapolis–St. Paul) and Texas (e.g., Dallas–Fort Worth) generally offer strong reimbursement environments due to favorable payer mixes, high insurance coverage rates, and efficient claims processing.
3. Is it better to open an orthopedic practice in a large metropolitan area or a mid-sized city?
   Both have benefits. Large metro areas offer high patient volume but may have more competition, while mid-sized cities often have fewer orthopedic specialists, lower operational costs, and strong community referral networks—making them excellent for growth-oriented practices.
4. How can orthopedic practices ensure strong revenue from the start?
   Successful practices focus on accurate coding, efficient billing, payer credentialing, and clear referral strategies. Partnering with a professional medical billing company like A2Z Billings ensures faster reimbursements and fewer claim denials.
5. Do state regulations affect opening an orthopedic practice?
   Yes. Some states have Certificate of Need (CON) laws that regulate opening new surgical centers or expanding facilities. Licensing timelines, telehealth regulations, and malpractice laws also vary, so researching state-specific rules is essential before choosing your city.