Justin Taylor Smith, MD

Orthopaedic Surgery Sports Medicine Fellow at Steadman Hawkins Clinic of the Carolinas

[Justin Taylor Smith, MD @JustinTSmith53]

Burnout isn't about losing heart. It's about losing control.

We built TurnKey AI Practice to give it back to physicians. Over $1M raised, all from doctors.

Our founder story on KevinMD: https://t.co/YT8hkLQvc0

[Justin Taylor Smith, MD @JustinTSmith53]

Honored to be on the cover of Surgery Business Magazine — April 2026.

Cover headline: The Billion-Dollar Specialty — Orthopedic Surgery Reigns Supreme in ASCs.

Three of my articles inside this issue:

→ The Surgeon-CEO Mindset (p. 18) — Less than 25% of physicians remain independent. Not because independence is impossible, but because we've been conditioned to believe it is. Don't hate the player. Hate the game, which is the corporatization of medicine.

→ Cash is King (p. 76) — Direct-pay specialty care is not boutique. It is the rational response to what patients are already telling us — rising deductibles, surprise bills, and weeks lost to referral delays. "Cash-pay is only for the rich" is one of the most expensive myths in modern medicine.

The throughline across all these: stop asking permission. You trained for over a decade. You make life-altering decisions with a blade in your hand.
You are not too fragile to read a P&L statement.
Build anyway!!

Read the issue: https://t.co/iHkB4xVvew

Justin T. Smith, MD, FAAOS, FAANA, ABOSD
Founder & CEO, Journey Orthopaedic Institute & TurnKey AI Practice Inc.
https://t.co/7ULLj8n2dp | https://t.co/ZzOcaBr1d5

#SurgeryBusinessMagazine #OrthopedicSurgery #PhysicianEntrepreneur #IndependentMedicine #DirectSpecialtyCare #AIinHealthcare #SurgeonCEO

[Justin Taylor Smith, MD @JustinTSmith53]

Most pain is manageable

Some pain needs answers

Know the difference

[Justin Taylor Smith, MD @JustinTSmith53]

Day 5. Admin day.

Yes — I’m building an AI-native orthopaedic practice…
and I still carry a paper to-do list in my pocket.

AI workflows.
Automations.
Integrations.

But nothing replaces clarity of thought. And sometimes that starts with pen and paper.

Today was about discipline:

• Finalizing HIPAA audit files for submission
• Cleaning up documentation from recent patients
• Preparing articles for Business of Surgery Magazine (April feature 👀)
• Breaking down the myths around independent practice

Here’s the reality:

Less than 25% of physicians today are independent.
Not because they don’t want to be — but because reimbursement drops, overhead rises, and the system pushes consolidation.

And when that happens, decision-making shifts.

Less physician-directed care.
More insurer and administrator influence.

In my opinion, that erosion has weakened the physician-patient relationship.

That’s why I’m building Journey Orthopaedic Institute.
That’s why I’m building TurnKey AI Practice.

To put the ball back in the physician’s court.
To prove independence is still possible.
To show that with smarter systems and better infrastructure, you can practice medicine for the right reasons again.

Sometimes progress requires thinking outside the box.

[Justin Taylor Smith, MD @JustinTSmith53]

Day 4.

Healthcare reform starts at home.

Signed JOI up for a health sharing-style plan through Health Access Solutions — a more cost-effective alternative to traditional insurance. Lower premiums. More predictable costs. Built around price transparency and direct pay.

As an orthopaedic surgeon who understands how distorted pricing has become, I refuse to overpay into a system that lacks clarity. If we’re building a transparent, cash-based model at JOI, our internal coverage should align with that philosophy.

After locking that in, I was back in the MMU.

Onsite diagnostics.
First round of StemWave shockwave therapy.
Immediate relief for patients who’ve lived with years of chronic orthopaedic pain.

Less invasive.
Evidence-based.
Right intervention at the right time.

Then shifted into founder mode — meeting with the TurnKey dev team to review executive board feedback and architect Version 2 of our AI-orchestrated intake system.

At the same time, pushing through HIPAA and SOC 2 compliance — policies, security controls, governance structure. The least glamorous, most critical part of building an AI healthcare company.

We’re not just building a clinic.
We’re building infrastructure.

Clinical delivery.
AI systems.
Compliance discipline.

[Justin Taylor Smith, MD @JustinTSmith53]

PAIN RELIEF ISN'T THE FINISH LINE

Confidence and capacity are. 

SAVE this post and follow along for tips to staying healthy!

[Justin Taylor Smith, MD @JustinTSmith53]

Pain is an alarm

Not always a diagnosis

Treat the system -- not just the signal

SAVE this to remind yourself for next time

[Justin Taylor Smith, MD @JustinTSmith53]

Day 3.

Work hard. Play hard.

No UI builds.
No SOP revisions.
No property negotiations.

Just 20 miles at the Ride & Seek mountain bike race at the U.S. National Whitewater Center.

12 checkpoints.
3 mystery spots.
Most checkpoints wins.

It rained the two days before — which meant mud, slick climbs, blown-out corners, and zero room for hesitation.

We came in 2nd place!!

Close enough to feel the edge.
Hungry enough to come back stronger.

Business and racing aren’t that different:

• Manage energy
• Choose your lines
• Adapt to changing conditions
• Keep moving when traction isn’t ideal

Building JOI.
Building TurnKey AI.
Building endurance.

Day 3 was recovery for the mind — and stress testing for the legs. Cheers!

[Justin Taylor Smith, MD @JustinTSmith53]

Flare-Up ❌ Failure

Pain Fluctuates

Contact matters more than fear. 

Comment "Flare-up" and what you think you need to change to manage the system.

[Justin Taylor Smith, MD @JustinTSmith53]

Pain relief is step one. 

Function is the goal. 

Rehab must prepare you for life, not just the clinic

TAG YOUR Physical Therapist if you agree!

[Justin Taylor Smith, MD @JustinTSmith53]

Day 2.

This is where most people quit.

Still in the MMU this morning — real patients, real problems, real outcomes. The clinical standard doesn’t drop just because you’re building something bigger.

Between cases: refining SOPs.
Every workflow documented.
Every friction point identified.
If it’s not systemized, it doesn’t scale.

TurnKey AI Practice build continued — tightening UI logic, refining intake flows, stress-testing edge cases inside Claude + Antigravity. AI is powerful. But only if the architecture is disciplined.

Late afternoon: calls about the JOI flagship property.
Square footage.
Build-out costs.
TI allowances.
Risk tolerance.

This is the part nobody sees:

• Legal structure
• Compliance planning
• Capital allocation
• Infrastructure before aesthetics

We’re not just launching a clinic.
We’re engineering a model.

Day 2.

[Justin Taylor Smith, MD @JustinTSmith53]

Morning: inside the MMU seeing patients — proof that you don’t need a huge campus to deliver high-level orthopaedic care.

Midday: writing SOPs.
Because vision without systems is just noise.

Afternoon: building the TurnKey AI Practice UI with Antigravity, running on Claude Opus 4.6 — designing workflows that actually reduce cognitive load instead of adding to it.

Evening: negotiating property to secure the flagship location for Journey Orthopaedic Institute.

Mobile clinic.
AI infrastructure.
Brick-and-mortar flagship.

This is what building an AI-native, independent surgical practice actually looks like.

Not glamorous.
Highly intentional.
System by system.

If you’re a physician, founder, or operator who wants to see how this gets built from zero — follow along.

Day 1.

[Justin Taylor Smith, MD @JustinTSmith53]

We’re building this in public.

Two companies.
One mission.

Journey Orthopaedic Institute — a direct-care, athlete-first orthopaedic practice built for autonomy, access, and outcomes.

TurnKey AI Practice — the AI infrastructure powering the next generation of independent medical practices.

For years, I operated inside a system that wasn’t designed for speed, ownership, or innovation.

So I decided to build one that is.

This series will document:

• The wins and the setbacks
• The real estate negotiations
• The tech stack and AI workflows
• The clinical model
• The financial risk
• The lessons I’m learning in real time

No fluff. No “overnight success.”
Just the unfiltered process of building an AI-native, independent surgical practice from the ground up.

If you’re a physician, operator, founder — or someone who believes healthcare can be done better — follow along.

Episode 1 starts now.

[Justin Taylor Smith, MD @JustinTSmith53]

The goal isn’t more surgery.
The goal is better outcomes.

For athletes.
For active adults.
For longevity.

Follow along for the Journey

[Justin Taylor Smith, MD @JustinTSmith53]

Words matter.

“Degenerative” often describes age-related change, not failure.

Symptoms are sometimes more important than images. Clinical correlation is crucial.

Save this!

[Justin Taylor Smith, MD @JustinTSmith53]

Simple is better than fancy.

These three movements cover:
• strength
• control
• resilience

Do them consistently.

Save this

#strengthtraining #injuryprevention #sportsmedicine #orthopedics #athletetraining #fitnessover40

[Justin Taylor Smith, MD @JustinTSmith53]

Most knee pain isn’t a “broken part.”
It’s a mismatch between load and capacity.

Fix the system before cutting the joint.

Follow for more real-world sports cases

[Justin Taylor Smith, MD @JustinTSmith53]

Injections are not magic.
They’re a tool.

Best used to:
• calm inflammation
• restore motion
• allow proper rehab

Used alone, results fade.

Follow for evidence-based sports care

#sportsmedicine #orthopedics #cortisone #injuryrehab #athletelife #painmanagement

[Justin Taylor Smith, MD @JustinTSmith53]

The shoulder doesn’t work in isolation.
If the scapula is unstable, the cuff pays the price.

Fix mechanics before chasing injections or surgery.

Save this and follow for more.

#shoulderpain #rotatorcuff #sportsdoc #orthopedics #shoulderrehab #injuryprevention

[Justin Taylor Smith, MD @JustinTSmith53]

MRIs don’t treat people.
Clinicians do.

Imaging must match:
• symptoms
• physical exam
• functional limitations

Otherwise, it’s just information.

Comment “MRI”

#sportsmedicine #orthopedics #mriresults #injurymyths #kneepain #shoulderpain #backpain #athletecare