Is general ortho still an option?

[chilo_SDdml]

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Hey everyone,

I am an MS1 currently under a certain loan forgiveness program that takes care of tuition as long as I commit to service in a rural area after training. It is not limited to primary care, so ortho is an option, however fellowship training is not in the contract.

Where Im from there are a few general ortho docs still practicing, but I wanted to get some opinions from some attendings that may be practicing in community settings to see if general orthopedics is even possible 10 years from now.

Thanks everyone.

 

[OrthoTraumaMD]

This has been asked before — search the forums.
General Ortho is dying out as groups and hospitals increasingly want fellowship trained people. 95% of graduating residents do a fellowship. You’d have to really practice in the middle of nowhere if you want to be a generalist.

 

[smr]

This has been asked before — search the forums.
General Ortho is dying out as groups and hospitals increasingly want fellowship trained people. 95% of graduating residents do a fellowship. You’d have to really practice in the middle of nowhere if you want to be a generalist.

Where is the actual data for this? I know most residents do fellowships but that doesn't mean there are no positions for generalists. On every job site I have viewed there has been what looks like no shortage of positions for general ortho docs and their median salary isn't significantly different from any other fellowship trained docs (excluding spine) looking over the last past years of MGMA data. I realize if a person wanted to work in a major medical center/academic location they would likely need to be fellowship trained, but otherwise I do not really understand the incredible emphasis being placed on sub specialty training within ortho?

 

[NMDO]

An Analysis of Orthopaedic Job Trends in the United States Over the Past 30 years

Here is some data showing increasing number of advertised jobs requiring fellowship training. Ortho is becoming very subspecialized, especially in larger cities. That said, there are still general orthopedic jobs out there, even some in decent sized cities. Unlikely to find a general ortho job with a large group or academic center, although I do know of a few people from my program who recently joined large private groups doing general ortho.

 

[OrthoTraumaMD]

Where is the actual data for this? I know most residents do fellowships but that doesn't mean there are no positions for generalists. On every job site I have viewed there has been what looks like no shortage of positions for general ortho docs and their median salary isn't significantly different from any other fellowship trained docs (excluding spine) looking over the last past years of MGMA data. I realize if a person wanted to work in a major medical center/academic location they would likely need to be fellowship trained, but otherwise I do not really understand the incredible emphasis being placed on sub specialty training within ortho?

Horst PK, Choo K, Bharucha N, Vail TP: Graduates of orthopaedic residency training are increasingly subspecialized: A review of the American Board of Orthopaedic Surgery Part II Database. J Bone Joint Surg Am 2015;97:869-875

In 2015, 90% of residents were doing a fellowship. It’s higher now.
As I said, if you want to be somewhere rural, you can do general. But hospitals and practices want specialists because patients are becoming increasingly savvy and want people with increased training. Also, fellowship trained physicians can perform more complex procedures (that pay better) in a shorter amount of time. Additionally, some hospitals require fellowship training to be granted privileges to do certain procedures (spine is a big one).

 

[Hygienist38]

Sorry to thread jack, but similar question: If I do, for example, a sports or a joints, and look for a job in a major city like Boston or LA, would I, in most cases, be stuck doing only operations within my fellowship? Or is it common/relatively easy that I can join as a Joints guy in a major city, and do like, say, 50% joints and 50% general? (just using joints as an example, if there's another fellowship that's more conducive to such an arrangement then let's go with that as long as it's not impossible to find a job w/ that fellowship)

 

[NMDO]

Sorry to thread jack, but similar question: If I do, for example, a sports or a joints, and look for a job in a major city like Boston or LA, would I, in most cases, be stuck doing only operations within my fellowship? Or is it common/relatively easy that I can join as a Joints guy in a major city, and do like, say, 50% joints and 50% general? (just using joints as an example, if there's another fellowship that's more conducive to such an arrangement then let's go with that as long as it's not impossible to find a job w/ that fellowship)

Possibly if you are hospital employed...If you join a private group, I don't think the fellowship trained sports surgeon would be thrilled about his adult recon trained partner doing ACLs and RCRs.

 

[DarkHorizon]

Sorry to thread jack, but similar question: If I do, for example, a sports or a joints, and look for a job in a major city like Boston or LA, would I, in most cases, be stuck doing only operations within my fellowship? Or is it common/relatively easy that I can join as a Joints guy in a major city, and do like, say, 50% joints and 50% general? (just using joints as an example, if there's another fellowship that's more conducive to such an arrangement then let's go with that as long as it's not impossible to find a job w/ that fellowship)

Just went through the job search and this is very common. There are a decent amount of general jobs in big cities, but they all want fellowship trained guys, even if th job requires decent amount of general orthopedics.

IMO, sports is the new general, especially in a big city. There is a saturation of sports guys in big cities, and you more or less become a general guy with sports focus. You can do some general doing joints too, but there are lots of joints floating around, especially complex and revisions, so usually, once you get busy, most joints guys do not do much general.

 

[smr]

Just went through the job search and this is very common. There are a decent amount of general jobs in big cities, but they all want fellowship trained guys, even if th job requires decent amount of general orthopedics.

IMO, sports is the new general, especially in a big city. There is a saturation of sports guys in big cities, and you more or less become a general guy with sports focus. You can do some general doing joints too, but there are lots of joints floating around, especially complex and revisions, so usually, once you get busy, most joints guys do not do much general.

This is why it is hard to understand the situation that seems to be happening in ortho. There doesn't seem to be a true need for so many sub specialists. Instead of having multiple fellowship trained docs doing half general, why not let one general ortho person do all of that work? What does "outside of a major city" mean? Is it like 30 mins away from the major hospitals/med center or in some small town in the middle of no where?

 

[DarkHorizon]

This is why it is hard to understand the situation that seems to be happening in ortho. There doesn't seem to be a true need for so many sub specialists. Instead of having multiple fellowship trained docs doing half general, why not let one general ortho person do all of that work? What does "outside of a major city" mean? Is it like 30 mins away from the major hospitals/med center or in some small town in the middle of no where?

Depends what city, NYC, Chicago, LA? Probably at least 2 hours or so.

Cleveland, Pittsburgh, Orlando? Not so much, probably 30-40 mins.

 

[Innocent2]

This is why it is hard to understand the situation that seems to be happening in ortho. There doesn't seem to be a true need for so many sub specialists. Instead of having multiple fellowship trained docs doing half general, why not let one general ortho person do all of that work? What does "outside of a major city" mean? Is it like 30 mins away from the major hospitals/med center or in some small town in the middle of no where?

Because even a specialist will take call on a regular basis. That is the general portion. To do a joint replacement or the more complex, you need training AND that pays more.
One generalist can’t cover 24/7.

How far away? Until you no longer see the clinics and outpatient surgery centers of the hospital systems and drive another hour more. That virtually eliminates the east and west coast and the greater metropolitan area of any city. You would need to think of a “town” not city.