July 1, 2022 – As they get started in their careers, orthopaedic surgeons with subspecialty training in sports medicine spend much of their time performing other types of orthopaedic procedures, reports a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.
“Early-career sports medicine candidates are likely to perform >40% of cases outside of the specialty of sports medicine,” according to the analysis by Robert H. Brophy, MD, of Washington University in St. Louis and colleagues. The authors discuss the implications for the types of experiences trainees should gain as they prepare for their first years of sports medicine practice.
Young sports medicine specialists can expect to start out as ‘generalists’
Dr. Brophy and colleagues analyzed the numbers and types of surgical cases submitted by nearly 3,330 surgeons who completed a post-residency fellowship training program between 2003 and 2020. Case lists are a key step for surgeons seeking to earn certification by the American Board of Orthopaedic Surgery (ABOS).
Twenty-six percent of surgeons applying for ABOS certification had completed fellowships in sports medicine, the largest subspecialty in orthopaedics. During the 6-month case-collection period, the candidates submitted an average of about 100 cases each.
Of the submitted cases, 58.5% were categorized as sports medicine or arthroscopy procedures – in other words, over 40% of early experiences were non-sports medicine procedures. General orthopaedic or trauma surgery procedures accounted for about 29% of cases, adult reconstructive surgery for 4.5%, and “other” procedures for about 8%. The researchers write, “Less than 25% of sports medicine-trained candidates had at least 75% of their surgical volume in sports medicine/arthroscopy.”
Although the overall number of sports medicine/arthroscopy procedures decreased during the study period, the proportion of such cases remained about the same. From the early 2000s to 2020, the candidates performed fewer shoulder and knee arthroscopy cases and more hip and shoulder arthroplasty cases – reflecting trends in the management of common bone and joint problems during that period.
About 10% of sports medicine-trained surgeons also completed fellowship training in at least one other subspecialty. The number of dual-trained candidates pursuing additional training in pediatrics and adult reconstructive surgery increased during the study period, whereas the number seeking trauma surgery training decreased.
The study is the first to analyze surgical case mix and specialization patterns of early-career sports medicine surgeons, providing important information for trainees, training programs, and practicing surgeons. Based on their findings, Dr. Brophy and colleagues conclude, “[T]he average young surgeon’s practice is, realistically, that of a generalist surgeon with an emphasis on sports medicine.” The researchers suggest that sports medicine trainees should be sure to gain experience in performing different kinds of procedures – including general orthopaedic surgery, trauma surgery, and adult reconstructive surgery – in order to prepare themselves for their first few years in practice.
DOI: 10.2106/JBJS.21.01129