Interested in ortho but hesitant due to the NEED of fellowship

[Doc mu]

I wanted to ask how the ortho job landscape is nowadays where almost everyone is fellowship trained:

1- Is it harder to get jobs as a fellowship trained ortho since you are now practicing in a niche with far less volume (naturally) than the general orthopod that used to see everything bone related?

2- Do you still get to do some of the very common ortho procedures you are comfortable with regardless of your fellowship? i.e. ortho spine doing primary TKA and THA
and if so how many procedures are they approx?

3- Is it true all orthopods should be well-versed in trauma regardless of specialty due to having to share call?

4- I heard fellowship training delegated most orthos to doing the same procedures over and over again, is variety really dead in your practice?

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[DarkHorizon]

Difficult to answer your question, I will just say that if you want to practice anywhere desirable, you’ll have to do a fellowship. But that doesn’t mean you only have to limit your practice to the scope of your fellowship. You can do anything you want, except spine. For spine, most hospitals require you’re spine trained.

However, in a competitive market, you’ll have difficulty in establishing yourself if you want to do cases beyond your fellowship scope, such as doing cuff repairs as a trauma guy. It would take time to establish, and you’ll have many other fellowship trained surgeons to compete with, including your own partners.

But, if you want to go to a rural underserved practice, you don’t need a fellowship. You can do full breadth of general Ortho, other than spine. You’ll hit the ground running from day 1.

 

[Doc mu]

Difficult to answer your question, I will just say that if you want to practice anywhere desirable, you’ll have to do a fellowship. But that doesn’t mean you only have to limit your practice to the scope of your fellowship. You can do anything you want, except spine. For spine, most hospitals require you’re spine trained.

However, in a competitive market, you’ll have difficulty in establishing yourself if you want to do cases beyond your fellowship scope, such as doing cuff repairs as a trauma guy. It would take time to establish, and you’ll have many other fellowship trained surgeons to compete with, including your own partners.

But, if you want to go to a rural underserved practice, you don’t need a fellowship. You can do full breadth of general Ortho, other than spine. You’ll hit the ground running from day 1.

Oh wow okay makes sense, does that also mean you take no trauma call in an urban center and the trauma guys exclusively deal with trauma?

 

[DarkHorizon]

Oh wow okay makes sense, does that also mean you take no trauma call in an urban center and the trauma guys exclusively deal with trauma?

There are places like that where only trauma guys take trauma call but they are in a minority. Most places, everyone takes trauma call but most of the trauma goes to the trauma guys, you just tee it up for them the next day. Non trauma guys can do more trauma on their call days and will do hip fractures and nail some femurs and Tibias. Anything complex usually goes to trauma guys.

 

[OrthoTraumaMD]

I wanted to ask how the ortho job landscape is nowadays where almost everyone is fellowship trained:

1- Is it harder to get jobs as a fellowship trained ortho since you are now practicing in a niche with far less volume (naturally) than the general orthopod that used to see everything bone related?

2- Do you still get to do some of the very common ortho procedures you are comfortable with regardless of your fellowship? i.e. ortho spine doing primary TKA and THA
and if so how many procedures are they approx?

3- Is it true all orthopods should be well-versed in trauma regardless of specialty due to having to share call?

4- I heard fellowship training delegated most orthos to doing the same procedures over and over again, is variety really dead in your practice?

1. No. Most people want someone who is fellowship trained nowadays.
2. You can, but a) that will likely be the purview of your partners and b) you won’t want to as ideally you will be busy enough with whatever your subspecialty is. I know some sports guys that also dabble in joints and do some trauma when on call so it is possible.
3. Not well versed, but enough to get you through the night when you’re on call, which almost anyone should be able to do after residency. If your practice has a trauma person they will take over in the am (which is what I think should happen everywhere as trauma isn’t an afterthought like some people treat it as)… and if not then you take whatever “simple” trauma came in when you’re on call. (Some people are more comfortable with that than others.)
4. Some ortho subspecialties have more variety than others yes. That’s why I picked trauma because it has more. But there is something to be said for familiarity and not having to wonder what you will get when you walk in the door.
(Just FYI, in the real world when you’re applying, do not call ortho surgeons “orthopods” or “orthos” to their face unless you’re already one of them.)

 

[Doc mu]

1. No. Most people want someone who is fellowship trained nowadays.
2. You can, but a) that will likely be the purview of your partners and b) you won’t want to as ideally you will be busy enough with whatever your subspecialty is. I know some sports guys that also dabble in joints and do some trauma when on call so it is possible.
3. Not well versed, but enough to get you through the night when you’re on call, which almost anyone should be able to do after residency. If your practice has a trauma person they will take over in the am (which is what I think should happen everywhere as trauma isn’t an afterthought like some people treat it as)… and if not then you take whatever “simple” trauma came in when you’re on call. (Some people are more comfortable with that than others.)
4. Some ortho subspecialties have more variety than others yes. That’s why I picked trauma because it has more. But there is something to be said for familiarity and not having to wonder what you will get when you walk in the door.
(Just FYI, in the real world when you’re applying, do not call ortho surgeons “orthopods” or “orthos” to their face unless you’re already one of them.)

Thank you for the reply, legendary AMA orthopedic surgeon*

Why do you think orthopedic surgeons* are the only surgeon subspecialists that persistently (90%+) do fellowships nowadays whereas urologists (50%), ENT (dk the number just know it is way less than ortho tbh) and ophtho (65%) do not do so nearly as frequently, do you think everyone will eventually follow the ortho model of becoming a sub-subspecialist?

BTW where i am from you decide on a fellowship 2nd/3rd year of your ortho residency and you start doing extra cases in your decided fellowship since then so the trend is getting pretty out of hand

 

[OrthoTraumaMD]

Thank you for the reply, legendary AMA orthopedic surgeon*

Why do you think orthopedic surgeons* are the only surgeon subspecialists that persistently (90%+) do fellowships nowadays whereas urologists (50%), ENT (dk the number just know it is way less than ortho tbh) and ophtho (65%) do not do so nearly as frequently, do you think everyone will eventually follow the ortho model of becoming a sub-subspecialist?

BTW where i am from you decide on a fellowship 2nd/3rd year of your ortho residency and you start doing extra cases in your decided fellowship since then so the trend is getting pretty out of hand

I don’t know about other surgical fields. My guess is that there is enough variety and detail within a particular ortho subspecialty to stay busy even if you do only hand or only spine etc etc. Ortho is so vast and enormous that being a generalist is not possible if you truly want to do something well. Trauma alone (forget about the 7 other subspecialties) has 8 major journals every month; you can’t possibly keep up to date with everything to the degree you may need if you want to do right by patients.

 

[Doc mu]

I don’t know about other surgical fields. My guess is that there is enough variety and detail within a particular ortho subspecialty to stay busy even if you do only hand or only spine etc etc. Ortho is so vast and enormous that being a generalist is not possible if you truly want to do something well. Trauma alone (forget about the 7 other subspecialties) has 8 major journals every month; you can’t possibly keep up to date with everything to the degree you may need if you want to do right by patients.

I was actually thinking about trauma the other day and wanted to ask you if you see ortho trauma ever going minimally invasive like everything else someday or even somehow

 

[OrthoTraumaMD]

I was actually thinking about trauma the other day and wanted to ask you if you see ortho trauma ever going minimally invasive like everything else someday or even somehow

There are some procedures where we are already “minimally invasive” but the nature of fractures is such that it will never be 100%.

 

[DarkHorizon]

I was actually thinking about trauma the other day and wanted to ask you if you see ortho trauma ever going minimally invasive like everything else someday or even somehow

Maximally invasive, as my mentor said, some times you have to look at the fracture to actually fix it. I mean it in jest but “minimally invasive” stuff is mostly marketing gimmick.

 

[Doc mu]

Maximally invasive, as my mentor said, some times you have to look at the fracture to actually fix it. I mean it in jest but “minimally invasive” stuff is mostly marketing gimmick.

It may be a marketing gimmik now but MI procedures are increasing by the day, i wouldn't be surprised if a few years from now the entirety of ortho (barring total joints maybe) becomes minimally invasive especially since patients are now increasingly demanding minimally invasive procedures