When Charlottesville, Va.-based UVA Health opened its comprehensive orthopedic center, A. Bobby Chhabra, MD, chair of orthopedic surgery at UVA, had already spent nearly a decade helping bring the project to life.
The building gave the department room to grow. It brought clinics, outpatient operating rooms, imaging, rehabilitation, research and education into one place. Surgeons who once worked in separate buildings could suddenly walk next door to discuss a difficult case.
Four years later, Dr. Chhabra does not consider the building the department’s greatest achievement.
“Legacy is not a building,” he told Becker’s. “Legacy is the culture, and it’s the people that you train.”
That distinction is central to how Dr. Chhabra thinks about the department as it marks its 100th anniversary.
Over the past decade, UVA Orthopaedics has expanded its faculty, built a comprehensive orthopedic center and increased its clinical reach. But much of that growth, Dr. Chhabra said, was designed around a less visible objective: bringing people who had been working in parallel into the same system.
The strategy reflects a broader challenge in orthopedic care. Specialists have become increasingly subspecialized. Care has become more technologically sophisticated. Yet patients can still move between surgeons, imaging centers, rehabilitation providers and other services that operate largely independently.
Dr. Chhabra believes better orthopedic care requires the opposite.
“You can’t provide the best patient care unless you have people who are collaborative, and you work in a culture and an environment that supports you,” he said.
The building helped create that environment. The harder work was creating the culture inside it.
From fragmented care to one front door
Before UVA’s orthopedic center opened, the department’s services were spread across multiple locations. Patients might see a surgeon in one building, travel elsewhere for imaging and go somewhere else for physical therapy, braces or orthotics.
Physicians experienced a similar separation. Dr. Chhabra, a hand and upper-extremity surgeon, described patients who arrived with numbness, weakness or tingling that appeared to be a hand problem but was actually coming from the cervical spine.
Previously, the spine surgeon he needed might have been working in another building on a different schedule.
“I would not see my partners for weeks on end,” he said. Today, that specialist may be in the clinic next door. The difference can sound mundane: proximity. But Dr. Chhabra believes it changes the way care is delivered.
A surgeon can walk over and ask a colleague to look at a difficult case. Residents and fellows encounter more specialists throughout the day. Clinical research teams are embedded near physicians and patients. Imaging, therapy and other services can be coordinated without sending patients across a health system.
“It took us from a fragmented approach,” Dr. Chhabra said.
The center was also built around the continued movement of orthopedic procedures into the outpatient setting. Cases that once required hospitalization, including many joint replacements, increasingly needed outpatient operating capacity that the department previously lacked.
The result is less a collection of orthopedic services than an attempt to create a single operating system for musculoskeletal care. Patients can see a specialist, undergo imaging, receive a brace and meet with a therapist in the same location.
The model also extends to unscheduled care. UVA opened an after-hours orthopedic clinic for acute injuries that can be treated outside the emergency department, such as an ankle injury that needs evaluation and an X-ray but not necessarily hours in an emergency room.
For Dr. Chhabra, that is another version of the same objective: remove unnecessary friction between the patient and the appropriate level of care.
The building was designed for the workforce, too
Healthcare facilities are frequently described as patient-centered. Dr. Chhabra wanted UVA’s orthopedic center to be team-centered as well. The two ideas, he believes, are inseparable.
“You want to take the best care of patients, obviously,” he said. “But I also built a team-centric building.” That means giving physicians, nurses, therapists, residents, fellows, researchers and other staff the resources and proximity needed to work together.
It also means treating culture as infrastructure. A sophisticated operating room can expand what a surgeon is technically capable of doing. But if physicians rarely speak with colleagues outside their subspecialty, or staff lack the support to remain in their roles, the technology alone cannot create coordinated care.
The same is true in education. Dr. Chhabra has spent his medical career at UVA, first as a medical student and resident and then for 25 years on the faculty. He entered his 14th year as department chair in 2026.
The lesson he most wants residents to carry with them is not a particular technique. It is to resist complacency.
“Never be complacent in what you do,” he said. “Always respect the field of medicine and respect every patient you care for.”
Repeated procedures can create confidence. They can also make clinicians comfortable enough to stop preparing with the same intensity. That is when problems begin, he said.
Complications will happen even to experienced surgeons. The responsibility is to continue learning, prepare for them and remain willing to seek help when a case does not go as planned.
The next challenge is economic
UVA Orthopaedics enters its second century with a problem that cannot be solved by putting everyone in the same building. The economics of providing care are getting harder.
Dr. Chhabra wants the department to continue growing to meet patient demand, expand access, adopt new treatments and support research.
Each of those priorities costs more money. At the same time, he sees reimbursement declining while labor, technology and implant costs rise.
“How do you make this work?” he said. That question now sits behind many of the ambitions health systems have for orthopedic care.
Hospitals want to invest in new technologies. Surgeons want access to better implants and tools. Academic departments want to fund clinical trials and research that may produce the next generation of treatments. Employees expect competitive compensation, and experienced clinicians are difficult to replace when they leave.
The financial room to support all of it is narrowing.
“What you don’t want, and what I won’t accept, is us providing subpar care because we financially can’t do it,” Dr. Chhabra said.
He does not believe health systems can solve that pressure alone. Maintaining innovative care, he said, will require conversations among government, health system leaders, physicians and industry, including more realistic discussions about the costs of implants and technology.
Academic centers face another layer of pressure because research also requires sustained investment.
“You want to keep advancing the field,” he said. “You don’t want to go backwards.”
For a department celebrating 100 years, that may be the more important question than what it has already built. UVA spent years bringing orthopedic surgeons, trainees, researchers and services closer together. The result was not simply a new building. It was an attempt to make collaboration routine rather than exceptional.
Now the institution has to preserve that model in an environment where almost everything required to sustain it is becoming more expensive.
Buildings get old, as Dr. Chhabra likes to say. Culture can endure. The challenge is making sure the economics of healthcare allow it to.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
