Is it possible to specialize in Ortho hip surgery

[RJGOP]

I have quite a while before I even have to decide which type type of physician I wish to become, let alone choosing which sub specialty I wish to pursue, but I was wondering if an orthopedic surgeon could exclusively specialize in hip surgeries, or would that specialization additionally entail joint replacements and surgeries of the entire body? Thanks in advance.

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[deleted407021]

There seem to be a few fellowships for hip and lower extremity reconstruction.
http://orthopaedics.iu.edu/adult-reconstruction-fellowship/
https://meded.beaumont.edu/adult-reconstruction-surgery-fellowship-hip-knee
There's several more on the first page of google results.

Edit: thanks doc.

 

[phunky]

You would do a fellowship in joint replacement surgery. What joint you focus on in your practice would be up to you. I know orthopaedic surgeons who pretty much only do knee replacements. I haven't met any that only do hips though. I don't think it pays as well for the time spent in the OR. There are also a lot more knee replacement patients than hip replacement patients (more than double) out there. Hip replacements are also a more tiring procedure.

 

[Mad Jack]

Most of your hip repairs are going to be on Medicare patients, which do not pay well at all. Worse still, complication rates for hip surgery are much higher than many higher paying and less time intensive ortho procedures. So yeah, you could specialize in hips, but it would be a dumb move financially.

 

[BeastQuake]

[QUOTE
Nothing's stopping an orthopedic surgeon from working just on hips if they want. They don't necessarily need fellowship training.[/QUOTE]

Not true. Being a general orthopaedist will not allow one in this day and age to operate on only one area of the body. One of the up and coming areas of specialization in orthopaedics is hip preservation. Those trained in this area of work primarily with hips, although depending on your practice, working ONLY on hips is probably not realistic. For example, if you're working in an academic setting that takes trauma call, no matter your area of specialty, you will still need to perform trauma cases if necessary. The only surgeons capable of operating on only one part of the body are primarily those who have been the foremost leaders in their fields and have pioneered new techniques in a certain area of practice. Although there are certainly exception, almost all specialty trained physicians feel comfortable and are capable of operating outside their area of specialization.

 

[Cyberdyne 101]

Dr. Bryan Kelly is an example of a hip specialist that focuses his practice on non-arthritic hip disorders.
http://www.hss.edu/physicians_kelly-bryan.asp#.U6cP0Im9LCQ
I don't think there are many like him though. He's one of those uber-specialists. Currently, more sports med ortho surgeons are adding hip arthroscopy to their armamentarium.
Some pediatric ortho surgeons focus on correcting hip deformities such as developmental hip dysplasia in addition to other stuff.
It seems that a lot of hip surgeons that specialize in replacements also work on arthritic conditions of the knee.

Edit: this site has information on ortho fellowships and subspecialties.
http://www.hss.edu/fellowships.asp#.U6cSwIm9LCQ

 

[Law2Doc]

Most of your hip repairs are going to be on Medicare patients, which do not pay well at all. Worse still, complication rates for hip surgery are much higher than many higher paying and less time intensive ortho procedures. So yeah, you could specialize in hips, but it would be a dumb move financially.

Actually no it's not a dumb move financially. I know people in private hospitals in nice neighborhoods where most of their clients actually have good insurance, and they bang out a couple dozen hip replacements a week operating two to three days a week. And virtually all of their patients represent repeat business because anyone with one bad hip has another brewing. In fact in terms of time intensive procedures hips aren't worse than knees and nothing as time consuming as hands, spines etc. So no, this is a LOT of people's golden tickets and I don't know where you are getting your information from.

 

[RJGOP]

There seem to be a few fellowships for hip and lower extremity reconstruction.
http://orthopaedics.iu.edu/adult-reconstruction-fellowship/
https://meded.beaumont.edu/adult-reconstruction-surgery-fellowship-hip-knee
There's several more on the first page of google results.

Edit: thanks doc.

Thank you for the help.

 

[prettyNURSEtoMD]

I work at a surgery hospital as well and there is a physician who only does hips and I've seen his billing and these are not just Medicare patients. He is racking up! He is known for doing hips in DFW.

 

[RJGOP]

Most of your hip repairs are going to be on Medicare patients, which do not pay well at all. Worse still, complication rates for hip surgery are much higher than many higher paying and less time intensive ortho procedures. So yeah, you could specialize in hips, but it would be a dumb move financially.

That is what I was worried about, hurting myself financially by only doing hip surgeries. Like you said, candidates for hip replacements and surgeries are typically Medicare patients, sometimes even Medicade I might add, and they are less frequent. Thanks for the information.

 

[Cyberdyne 101]

Actually no it's not a dumb move financially. I know people in private hospitals in nice neighborhoods where most of their clients actually have good insurance, and they bang out a couple dozen hip replacements a week operating two to three days a week. And virtually all of their patients represent repeat business because anyone with one bad hip has another brewing. In fact in terms of time intensive procedures hips aren't worse than knees and nothing as time consuming as hands, spines etc. So no, this is a LOT of people's golden tickets and I don't know where you are getting your information from.

The hip and knee arthoplasty docs in my area also seem to do very well.

 

[RJGOP]

Perhaps you are correct, invalidating, partially, one of my replies to Mad Jack. It probably just depends were you work. If I were to practice in a wealthy retirement area, then yes, I could potentially have a strong income.

Actually no it's not a dumb move financially. I know people in private hospitals in nice neighborhoods where most of their clients actually have good insurance, and they bang out a couple dozen hip replacements a week operating two to three days a week. And virtually all of their patients represent repeat business because anyone with one bad hip has another brewing. In fact in terms of time intensive procedures hips aren't worse than knees and nothing as time consuming as hands, spines etc. So no, this is a LOT of people's golden tickets and I don't know where you are getting your information from.[/QUOTE

 

[RJGOP]

Dr. Bryan Kelly is an example of a hip specialist that focuses his practice on non-arthritic hip disorders.
http://www.hss.edu/physicians_kelly-bryan.asp#.U6cP0Im9LCQ
I don't think there are many like him though. He's one of those uber-specialists. Currently, more sports med ortho surgeons are adding hip arthroscopy to their armamentarium.
Some pediatric ortho surgeons focus on correcting hip deformities such as developmental hip dysplasia in addition to other stuff.
It seems that a lot of hip surgeons that specialize in replacements also work on arthritic conditions of the knee.

Edit: this site has information on ortho fellowships and subspecialties.
http://www.hss.edu/fellowships.asp#.U6cSwIm9LCQ

Thanks again. You always provide great information.

 

[Mad Jack]

Actually no it's not a dumb move financially. I know people in private hospitals in nice neighborhoods where most of their clients actually have good insurance, and they bang out a couple dozen hip replacements a week operating two to three days a week. And virtually all of their patients represent repeat business because anyone with one bad hip has another brewing. In fact in terms of time intensive procedures hips aren't worse than knees and nothing as time consuming as hands, spines etc. So no, this is a LOT of people's golden tickets and I don't know where you are getting your information from.

I got my info from an ortho surgeon that I've known for like, six years. I specifically asked her about reimbursement for hips vs knees vs hands, and she lamented that hips were pretty much the worst due to how much medicare had cut the payments on them.

 

[RJGOP]

You would do a fellowship in joint replacement surgery. What joint you focus on in your practice would be up to you. I know orthopaedic surgeons who pretty much only do knee replacements. I haven't met any that only do hips though. I don't think it pays as well for the time spent in the OR. There are also a lot more knee replacement patients than hip replacement patients (more than double) out there. Hip replacements are also a more tiring procedure.

Thanks for the insight. Perhaps it would be more financially advantageous to specialize in all areas of joint replacement ie. shoulder, hip, knee... As apposed to only hip.

 

[RJGOP]

I work at a surgery hospital as well and there is a physician who only does hips and I've seen his billing and these are not just Medicare patients. He is racking up! He is known for doing hips in DFW.

Yeah, I guess it depends where you practice. Exclusively doing hip operations could potentially be a lucrative endeavor, given the right environment.

 

[Cyberdyne 101]

Perhaps you are correct, invalidating, partially, one of my replies to Mad Jack. It probably just depends were you work. If I were to practice in a wealthy retirement area, then yes, I could potentially have a strong income.

In Manhattan (NYC), you'll see that quite a few ortho surgeons do arthoplasty (hip, knee, and/or shoulder) in addition to sports medicine procedures. It seems that the patient population in this area permits this broader scope of practice. If you look at the HSS sports medicine fellowship info, you'll see that it also trains surgeons in shoulder and knee replacements (although probably not in the more complex revision cases).
So yeah, it appears that location plays a role in how specialists tailor their practice.

 

[Cyberdyne 101]

Thanks for the insight. Perhaps it would be more financially advantageous to specialize in all areas of joint replacement ie. shoulder, hip, knee... As apposed to only hip.

It's also more fun IMO to switch things up a bit. Although some seem to thrive on the "1 joint practice." A surgical oncologist once told me that a few of his colleagues focus on one organ-lol. I guess you do what makes you happy.

 

[circulus vitios]

Not true. Being a general orthopaedist will not allow one in this day and age to operate on only one area of the body. One of the up and coming areas of specialization in orthopaedics is hip preservation. Those trained in this area of work primarily with hips, although depending on your practice, working ONLY on hips is probably not realistic. For example, if you're working in an academic setting that takes trauma call, no matter your area of specialty, you will still need to perform trauma cases if necessary. The only surgeons capable of operating on only one part of the body are primarily those who have been the foremost leaders in their fields and have pioneered new techniques in a certain area of practice. Although there are certainly exception, almost all specialty trained physicians feel comfortable and are capable of operating outside their area of specialization.

What about the orthopods who work in rural areas or otherwise non-academic places of employment?

 

[RJGOP]

It's also more fun IMO to switch things up a bit. Although some seem to thrive on the "1 joint practice." A surgical oncologist once told me that a few of his colleagues focus on one organ-lol. I guess you do what makes you happy.

That is an excellent point. I would have to seriously take that into consideration. I also think it would be more financially advantageous to do more procedures than just hip arthroplasty. The variation would probably keep me sane as well.

 

[Law2Doc]

... I also think it would be more financially advantageous to do more procedures than just hip arthroplasty. The variation would probably keep me sane as well.

Actually if you do just one procedure you potentially can make more money. You don't have to stock hardware that might sit, you and your staff get very fast, have fewer intraoperative complications because practice makes perfect, can manage patients based on a fixed algorithm (healing times are similar so you wean pain meds at hour X and start PT on day Y, etc) and you ideally ultimately get known as the local expert. The trick is getting in the business, but I'm not sure it's much harder to keep your schedule full with just hips vs hips and knees -- it's an aging arthritic population out there and there are already a lot more knee guys.

But the big thing is the speed. If you are doing cases exactly the same way every time it's much more of an assembly line. There's a reason Henry ford used to say people could have a car in whatever color they wanted as long as that color was black -- if it's all the same there are huge benefits in streamlining. If you have to change gears, as you would switching from knee to hip to shoulder to ankle, you will do fewer cases a day, both because you have to stop and think more, and because you will constantly be screaming for equipment that somehow wasn't prepared for the procedure or in the room.

 

[BeastQuake]

What about the orthopods who work in rural areas or otherwise non-academic places of employment?

Usually those in rural areas are one of the few orthopaedist around, although this might not always be the case. As a result, they will work on anything and everything that comes through the door, save for the complex spine/hand/oncology/fracture-revision cases that require transport for treatment at a large hospital facility with the resources to tend to such complex cases. Other non-academic places really depends as well. Some private practices specialize in primarily one area/joint, although like was said above, we are trained to operate comfortably and competently in all aspects on orthopaedic care.

 

[phunky]

Thanks for the insight. Perhaps it would be more financially advantageous to specialize in all areas of joint replacement ie. shoulder, hip, knee... As apposed to only hip.

Most joint replacement surgeons I know (I know a lot) either focus on lower or upper body. I've never met one that does both.

 

[katiemaude]

I have quite a while before I even have to decide which type type of physician I wish to become, let alone choosing which sub specialty I wish to pursue, but I was wondering if an orthopedic surgeon could exclusively specialize in hip surgeries, or would that specialization additionally entail joint replacements and surgeries of the entire body? Thanks in advance.

Just going by what I've seen at the hospitals in my region, there are orthopedic surgeons who do almost 100% TKRs and hips and those that do a variety (shoulder/knee scopes and repairs and some total shoulders and the occasional uni knee or total knee with the odd hip fracture here and there). Then there are the hand specialists, and orthopedic surgeons who concentrate solely on the spine. I think they all get involved in traumas and there are some guys who specialize in traumas.

I would venture to say that there are specialists for every body part in major metro areas but, for regional hospitals, you are more likely to see the hodgepodge.

 

[RJGOP]

Most joint replacement surgeons I know (I know a lot) either focus on lower or upper body. I've never met one that does both.

That is interesting. Actually, many orthopedic surgeons that I've met have done either knee and clavicle, or knee and shoulder- something along those lines. Anyway thanks for the comment.

 

[RJGOP]

Just going by what I've seen at the hospitals in my region, there are orthopedic surgeons who do almost 100% TKRs and hips and those that do a variety (shoulder/knee scopes and repairs and some total shoulders and the occasional uni knee or total knee with the odd hip fracture here and there). Then there are the hand specialists, and orthopedic surgeons who concentrate solely on the spine. I think they all get involved in traumas and there are some guys who specialize in traumas.

I would venture to say that there are specialists for every body part in major metro areas but, for regional hospitals, you are more likely to see the hodgepodge.

Thanks for the insight and personally, if I had to choose now, I would likely choose to become a joint replacement orthopedic surgeon focusing primarily on shoulder an hip. I suppose I could have a major change of heart in the next four years though. Thanks again.

 

[RJGOP]

I would venture to say that there are specialists for every body part in major metro areas but, for regional hospitals, you are more likely to see the hodgepodge.[/QUOTE]

That is probably true, unless of course, there is another orthopedic surgeon who can do the same cases as you. Thanks for the insight.

 

[RJGOP]

Actually if you do just one procedure you potentially can make more money. You don't have to stock hardware that might sit, you and your staff get very fast, have fewer intraoperative complications because practice makes perfect, can manage patients based on a fixed algorithm (healing times are similar so you wean pain meds at hour X and start PT on day Y, etc) and you ideally ultimately get known as the local expert. The trick is getting in the business, but I'm not sure it's much harder to keep your schedule full with just hips vs hips and knees -- it's an aging arthritic population out there and there are already a lot more knee guys.

But the big thing is the speed. If you are doing cases exactly the same way every time it's much more of an assembly line. There's a reason Henry ford used to say people could have a car in whatever color they wanted as long as that color was black -- if it's all the same there are huge benefits in streamlining. If you have to change gears, as you would switching from knee to hip to shoulder to ankle, you will do fewer cases a day, both because you have to stop and think more, and because you will constantly be screaming for equipment that somehow wasn't prepared for the procedure or in the room.

While the point you made about the speed of procedures is true, it is possible, given the right environment, it would be advantageous to vary the procedures you do. If you start to do those procedures enough, just like the hip procedures, you can become very quick and very apt with them as well. However, you made some very good points and I appreciate your insight.

 

[Law2Doc]

While the point you made about the speed of procedures is true, it is possible, given the right environment, it would be advantageous to vary the procedures you do. If you start to do those procedures enough, just like the hip procedures, you can become very quick and very apt with them as well. However, you made some very good points and I appreciate your insight.

It's not only just how quick you personally can do each kind of procedure but how quick your team can set up the room, have all the tools you like ready to go, etc. If it's a dozen of the exact same procedures each day done exactly the same way it's quick, and nobody is stopping to ask questions, find equipment, etc. If you are trying to do a hip then a knee then a shoulder, the set up time is going to kill your productivity. You really need the assembly line mentality to make big money. Thinking "I do enough knees and hips that I'm going to eventually be fast enough" is never going to compete with the guy who does one procedure over and over again every day. He's doing a finite number of movements, by heart. You are just kidding yourself if you think that if you do a bigger variety you can ever get that machine-like.

 

[Cyberdyne 101]

It's not only just how quick you personally can do each kind of procedure but how quick your team can set up the room, have all the tools you like ready to go, etc. If it's a dozen of the exact same procedures each day done exactly the same way it's quick, and nobody is stopping to ask questions, find equipment, etc. If you are trying to do a hip then a knee then a shoulder, the set up time is going to kill your productivity. You really need the assembly line
mentality to make big money. Thinking "I do enough knees and hips that I'm going to eventually be fast enough" is never going to compete with the guy who does one procedure over and over again every day. He's doing a finite number of movements, by heart. You are just kidding yourself if you think that if you do a bigger variety you can ever get that machine-like.

Maybe this is an exception, but quite a few ortho surgeons around here do 3 joints and combine arthroscopy with arthroplasty in their practice. Maybe it's different because it's NYC and HSS, but they do pull that off here. And it does run like a well-oiled machine. For example, you can possibly schedule your knee stuff for one day and the shoulder/elbow stuff for another day. At least that's what I've witnessed.

 

[RJGOP]

Maybe this is an exception, but quite a few ortho surgeons around here do 3 joints and combine arthroscopy with arthroplasty in their practice. Maybe it's different because it's NYC and HSS, but they do pull that off here. And it does run like a well-oiled machine. For example, you can possibly schedule your knee stuff for one day and the shoulder/elbow stuff for another day. At least that's what I've witnessed.

Yes, that is a good point. You could just schedule certain procedures on certain days to mitigate the difficulty of preparing, which in turn would expedite the process. Then you could still maintain the "assembly line" mentality. You could earn a lot of money that way too.

 

[Cyberdyne 101]

Yes, that is a good point. You could just schedule certain procedures on certain days to mitigate the difficulty of preparing, which in turn would expedite the process. Then you could still maintain the "assembly line" mentality. You could earn a lot of money that way too.

Just for informational purposes, you can look up ortho departments, clinics, practices etc in specific regions and get an idea of how some ortho docs divide
their practice (in terms of areas of specialization). The following are combinations that I've seen online and in person.

-Knee, shoulder, and elbow (ankle as well for some) "sports medicine"
-Foot and ankle (some dance ortho surgeons add the knee to this combination)
-the addition of hip arthroscopy to a knee and shoulder practice
- a sole focus on shoulder and elbow
- hand and elbow (sometimes shoulder is added to this)
-Hip and knee reconstruction (arthroplasty and osteotomies) some also include hip arthroscopy while others also do ACL reconstructions in addition to the joint replacements
-spine
-trauma
-tumor
-peds (deformities, scoliosis, sports medicine) peds is pretty broad

And as I mentioned before, some sports med docs find ways to mix in arthroplasty of the knee, shoulder, and/or hip, although this may not be common.

 

[katiemaude]

Again, I am only going by my limited knowledge of what I see at my hospital. I work with two large orthopedic groups. They tend to divide into the categories I mentioned. The surgeons who do the majority of knee and hip arthroplasty cases do ... only knee and hip arthroplasty. They can fill their block with it all month. They refer the other cases to their colleagues who do the total shoulders and scopes; vice versa, those guys will send them most of their total hips and usually their total knees. I don't know if it works this way everywhere.