Intellectual interest propels career path for orthopedic residents

Issue: April 2011

Conventional wisdom favors lifestyle and economic considerations when an orthopedic resident in the United States maps out a career. Yet an online survey found that economics was dead last among fellowship priorities, whereas intellectual interest in the field trumped.

The results of the survey, which was completed by 498 residents (86% male, 13% female, 1% no sex designated), appeared in the American edition of The Journal of Bone and Joint Surgery. Overall, 91% of the respondents planned to enroll in a fellowship.

The subspecialty of choice (with some residents indicating more than one field) was sports (28%), followed by arthroplasty (21%), hand surgery (14%), trauma (12%); pediatrics (8%), shoulder and elbow surgery (8%), spine surgery (8%), foot and ankle surgery (6%) and oncology (2%).

However, 40% of respondents listed intellectual interest as their top career priority, followed by educational (36%), lifestyle (21%) and economic (4%).

“There have been quite a few studies recently about a projected workforce shortage of orthopedic surgeons, plus a lot of anecdotal discussion, in particular shortages in certain fields such as joint replacement, arthroplasty and pediatrics,” said principal author Sanaz Hariri, MD, an orthopedic surgeon in private practice in Los Gatos, Calif.

Hariri, who served as a health policy fellow at the American Association of Hip and Knee Surgeons (AAHKS), noted that the organization pondered as to why orthopedic residents were not entering arthroplasty nearly as frequently as before. “In fact, there are a lot of arthroplasty fellowships that are going unfilled, which end up being filled by foreign medical graduates or simply not filled at all,” she said.

While at AAHKS, Hariri heard from senior orthopedists who “were absolutely 100% convinced that people are not going into hip and knee replacement because of lifestyle and economics,” Hariri told Orthopedics Today. “They thought people don’t want to spend their in-patient rounds tending to sick, older patients. The reimbursement for hip and knee replacements has also decreased over time.”

In contrast, sports medicine does not involve rounds. Cases are also relatively well reimbursed and you can do more of them,” Hariri said.

Discovering that intellectual interest in a field was the driving force for residents came as a huge surprise to the study authors. “Do they think the cases are interesting and that the field is exciting?” she asked. “Do they have a role model in that field that inspired them or that they want to emulate?” Hariri said. Conversely, “residents seem to have no idea how much surgery is reimbursed.”

Hariri concedes, though, that sports may have been chosen as the top subspecialty because “the attending in sports are charismatic and are excited about what they are doing. Patients are also dynamic and interesting.” On the other hand, residents are not entering arthroplasty as often because “they do not think it is interesting.”

The survey also found that significantly more women than men planned on a pediatric fellowship (24% vs. 6%), but significantly fewer women were interested in a sports fellowship (11% vs. 31%).

Women were also more likely than men to reduce their workload to part time at some point during their career (65% versus 47%). “Still, we were surprised by the number of men who were planning on going part time,” Hariri said. “I think this will surprise a lot of practicing orthopedists. I don’t believe they think about taking time off to raise children, eldercare or pursue other interests. This is definitely a generational difference.”

But the two generations align for projected retirement age: about 64 years for both groups.

To shore up projected shortages of orthopedic surgeons, “we need to identify which fields are most at risk, then develop very systematic programs to excite residents about those fields – intellectually, as well as role models and mentors,” Hariri said. “The emphasis cannot be on selling a field based on economics and lifestyle.”

Hariri believes arthroplasty will encounter the most severe workforce shortage. However, the uncomplicated primary procedures will not attract interest; rather, the challenging revisions and infections, she said. “These revisions are a puzzle,” she said. “No revision is the same. You really need to be creative and think outside the box.”

Arthroplasty leaders becoming active mentors and role models to residents can also be an effective strategy for increasing the number of practicing hip and knee surgeons, she noted. – by Bob Kronemeyer

Reference:

Hariri S, York SC, O’Connor MI, et al. Career plans of current orthopaedic residents with a focus on sex-based and generational differences. J Bone Joint Surg (Am). 2011;93:e16.

Sanaz Hariri, MD, can be reached at 555 Knowles Dr., Suite 200, Los Gatos, CA 95032; 408-871-1800; e-mail: sanaz@post.harvard.edu.