One large session at AAOS this year engaged an audience of orthopedic surgeons around the questions of hospital-based employment, which for 43 percent of the audience (as counted by session attendee touch-screen voting) was something they already had or were considering doing.  While the panel of discussants had both employed and non-employed physicians, as well as a hospital CEO and an academic that had studied physician alignment issues, all were in agreement around why today employment was a major question for physicians.  The rising costs and growing administrative burden of running a private practice, coupled with threatened reductions in reimbursement and increased regulations, has elevated the question of employment for most orthopedic surgeons. Most agreed on the hospital perspective as well--having employed physicians can help the hospital gain market share, stabilize their staff, control costs, all while engaging physicians on improving and demonstrating quality outcomes.