Are general orthopedic surgeons limited in scope?

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lazylama

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Hello everyone, I am currently on my ortho rotation and asked one of the orthos why every ortho in our hospital is so limited in scope (we have hand, foot, spine guys...etc each only practicing within their fellowship scope) and that i would like to be a general ortho and do everything because the idea of doing surgery all over the body is what really draws me to ortho.

He said that general orthos in the true sense no longer exist because of the growing body of knowledge and procedures needed to master, he also added that even general orthos nowadays don't do everything and they just do the same 20-30 procedures and refer everything else to subspecialists

Are general orthos really just doing about 30 procedures? Do they HAVE to from a medico-legal and competence standpoint?
Is there anywhere I can find the list of said procedures?

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Hello everyone, I am currently on my ortho rotation and asked one of the orthos why every ortho in our hospital is so limited in scope (we have hand, foot, spine guys...etc each only practicing within their fellowship scope) and that i would like to be a general ortho and do everything because the idea of doing surgery all over the body is what really draws me to ortho.

He said that general orthos in the true sense no longer exist because of the growing body of knowledge and procedures needed to master, he also added that even general orthos nowadays don't do everything and they just do the same 20-30 procedures and refer everything else to subspecialists

Are general orthos really just doing about 30 procedures? Do they HAVE to from a medico-legal and competence standpoint?
Is there anywhere I can find the list of said procedures?

You can do general orthopedics in small towns without fellowship. Most hospitals will not credential you to do spine without spine fellowship, similarly no replants or big tumor cases. Every thing else is fair game.

Common things are common. Bulk of your general practice will probably be 20-30 procedures, so your attending is not wrong. But if you want to fix scapulas or do lapidus, or fix SCFEs, or pollicization, no one will stop you, as long as you do them competently. Whether you can do them competently is a whole different topic.
 
Is fellowship pretty much mandatory in Orthopedics these days? I mean if your ambition in to practice at a suburban hospital the rest of your life.
 
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Is fellowship pretty much mandatory in Orthopedics these days? I mean if your ambition in to practice at a suburban hospital the rest of your life.
N=1 literally every ortho i have seen in all hospitals is fellowship trained
 
You can do general orthopedics in small towns without fellowship. Most hospitals will not credential you to do spine without spine fellowship, similarly no replants or big tumor cases. Every thing else is fair game.

Common things are common. Bulk of your general practice will probably be 20-30 procedures, so your attending is not wrong. But if you want to fix scapulas or do lapidus, or fix SCFEs, or pollicization, no one will stop you, as long as you do them competently. Whether you can do them competently is a whole different topic.
What cases can a general orthopedic surgeon be expected to do competently out of residency?

And assuming he does an advanced case like pollicization will the general ortho be protected from a medico-legal standpoint if something goes wrong?

Thank you for the help!
 
What cases can a general orthopedic surgeon be expected to do competently out of residency?

And assuming he does an advanced case like pollicization will the general ortho be protected from a medico-legal standpoint if something goes wrong?

Thank you for the help!

Arthroplasty:

Total Hip Arthroplasty (Chapter 4)
Total Knee Arthroplasty (Chapter 5)
Hip Hemiarthroplasty (e.g., femoral stem prosthesis, bipolar arthroplasty) (Chapter 40)
Unicondylar knee arthroplasty / Unicompartmental knee arthroplasty (Arthroplasty, knee, condyle and plateau; medial or lateral compartment)


Shoulder and Elbow:
Total Shoulder Arthroplasty (Chapter 37)


Hand and wrist:

Carpal Tunnel Release (Chapter 9)
Surgical Treatment Of Cubital Tunnel Syndrome
Trigger Finger Release


Sports:
Diagnostic Knee Arthroscopy: Surgical Technique (Chapter 1)
Diagnostic Shoulder Arthroscopy: Surgical Technique (Chapter 2)
Hip Arthroscopy: Labral Repair and Femoroacetabular Impingement (Chapter 31)
Elbow Arthroscopy (Chapter 32)
Arthroscopic Rotator Cuff Repair (Chapter 30)
Anterior Cruciate Ligament Reconstruction With Patellar Tendon (Chapter 3)
Anterior Shoulder Stabilization: Surgical Technique (Chapter 29)
Acromioclavicular Joint Reconstruction (Chapter 39)
Arthroscopic meniscal repair of the knee for traumatic meniscal tears
Arthroscopic partial meniscectomy of the knee for degenerative meniscal tears
Arthroscopic decompression of subacromial space +/- partial acromioplasty +/- coracoacromial ligament release


Trauma and casting:
Femur:

Femoral Shaft Fractures: Intramedullary Nailing (Chapter 16)
Femoral Neck Fractures: Open Reduction and Internal Fixation (Chapter 6)
Femoral Neck Fractures: Prosthetic replacement
Femoral Neck Fractures: Percutaneous skeletal fixation
Intertrochanteric Femur Fractures: Intramedullary Hip Screw (Chapter 7)
Intertrochanteric Femur Fractures: Sliding HIP Screw (Chapter 8)
Intertrochanteric, Peri-trochanteric or Subtrochanteric Femoral Fracture: Intramedullary implant
Intertrochanteric, Peri-trochanteric or Subtrochanteric Femoral Fracture: ORIF

Tibia:
Tibial Shaft Fractures: ORIF
Tibial Shaft Fractures: Intramedullary Nailing (Chapter 17)
Tibial Plateau Fractures: ORIF (Chapter 28)

Humerus:
Proximal Humerus Fracture Fixation: ORIF and Closed Reduction Percutaneous Pinning (Chapter 34)
Pathologic Humeral Shaft Fracture: ORIF (Chapter 23)
Adult Distal Humerus Fractures: ORIF (Chapter 15)

Ankle:
Bimalleolar Ankle Fracture: ORIF (Chapter 11)
Distal Fibular Fracture: ORIF (lateral malleolus)

Hand:
Metacarpal Fractures: Closed Reduction and Percutaneous Pinning (Chapter 35)
Distal Radius Fractures: ORIF (Chapter 36)
Closed Reduction Forearm and Wrist (Adult) (Chapter 14)

Clavicle:
Midshaft Clavicle Fracture: ORIF (Chapter 38)


Pediatrics:
Pediatric Techniques: Supracondylar Humerus Fracture Percutaneous Fixation (Chapter 18)
Pediatric Techniques: Clubfoot Casting and Clubfoot Surgical Correction (Chapter 19)
Pediatric Techniques: Percutaneous Pinning for Slipped Capital Femoral Epiphysis (Chapter 20)
Epiphysiodesis for Limb Length Discrepancy and Angular Deformity (Chapter 21)


Foot and ankle
Ankle Arthrodesis (Chapter 12)
Hindfoot and Midfoot Fusion (Chapter 13)
Compartment Syndrome: Four Compartment Leg Release Technique (Chapter 27)
Bunionectomy (hallux valgus)


I used the content outline of the book "Case Competencies in orthopedic surgery" (this book is based on the ACGME case minimums)
and I integrated the most common orthopedic surgery procedures based on these 2 studies into the content outline:
Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery (nih.gov)
Randomised Trial Support for Orthopaedic Surgical Procedures
and grouped everything by subspecialty

It comes out to about 50 procedures rather than just 20/30 however i am just a med student interested in the specialty, you need an orthopedic surgeon (like @OrthoTraumaMD and @DarkHorizon) to decide whether this list is representative of the procedures a general orthopedic surgeon does or if it is missing/excessive
 
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Is fellowship pretty much mandatory in Orthopedics these days? I mean if your ambition in to practice at a suburban hospital the rest of your life.
90% of residents do fellowship. However, this still means 1 out of every 10 is going out into general practice. My program has a reputation of getting good experience in residency so that over the past ~15 years, about 25% of our residents have gone straight into practice. So it's definitely doable.
 
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Total Hip Arthroplasty
Total Knee Arthroplasty
Hip Hemiarthroplasty
Carpal Tunnel Release
Surgical Treatment Of Cubital Tunnel Syndrome
Trigger Finger Release
Diagnostic Knee Arthroscopy
Diagnostic Shoulder Arthroscopy
Arthroscopic Rotator Cuff Repair
Anterior Cruciate Ligament Reconstruction With Patellar Tendon
Anterior Shoulder Stabilization: Surgical Technique
Arthroscopic meniscal repair of the knee for traumatic meniscal tears
Arthroscopic partial meniscectomy of the knee for degenerative meniscal tears
Arthroscopic decompression of subacromial space +/- partial acromioplasty +/- coracoacromial ligament release
Femoral Shaft Fractures: Intramedullary Nailing
Femoral Neck Fractures: Percutaneous skeletal fixation
Intertrochanteric Femur Fractures: Intramedullary Hip Screw
Tibial Shaft Fractures: Intramedullary Nailing
Tibial Plateau Fractures: ORIF
Bimalleolar Ankle Fracture: ORIF
Distal Fibular Fracture: ORIF
Metacarpal Fractures: Closed Reduction and Percutaneous Pinning
Distal Radius Fractures: ORIF
Closed Reduction Forearm and Wrist (Adult)
Midshaft Clavicle Fracture: ORIF
Pediatric Techniques: Supracondylar Humerus Fracture Percutaneous Fixation
Ankle Arthrodesis
Hindfoot and Midfoot Fusion
Compartment Syndrome: Four Compartment Leg Release

It comes out to about 50 procedures rather than just 20/30 however i am just a med student interested in the specialty, you need an orthopedic surgeon (like @OrthoTraumaMD and @DarkHorizon) to decide whether this list is representative of the procedures a general orthopedic surgeon does or if it is missing/excessive
I removed the duplicates and left all the ones I could reasonably expect a general orthopedist to be doing. There are of course some other types of cases that would fit but aren't included.
 
I removed the duplicates and left all the ones I could reasonably expect a general orthopedist to be doing. There are of course some other types of cases that would fit but aren't included.
Thanks for the review man!
Could you add the cases you thought are missing? i would like to refer to your list when I start ortho residency
 
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Thanks for the review man!
Could you add the cases you thought are missing i would like to refer to your list when I start ortho residency
That is actually a pretty good idea it would provide a clear foundational skillset to aim towards mastering during residency, I would be interested as well!
 
That is actually a pretty good idea it would provide a clear foundational skillset to aim towards mastering during residency, I would be interested as well!
Exactly! other than that it would provide med students a clear idea of the specialties bread and butter, i wish we had something similar for every specialty
 
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