Residents want AAOS, AOA to reform and centralize fellowship match process

A recent survey of orthopedic residents revealed that the postgraduate orthopedic fellowship hiring process is not working well and is in need of reform.

"The process this year, as in recent years, was complete chaos," Anil S. Ranawat, MD, said at the American Academy of Orthopaedic Surgeons (AAOS) 75th Annual Meeting.

He recommended that the present "decentralized system" be organized in specialty-specific matches, or better yet a centralized universal match system.

During an AAOS symposium co-sponsored by the American Orthopaedic Association (AOA), he presented results of the online survey sent to 112 residents - approximately one resident per program. The AOA, Harvard University and Stanford University business schools helped with the 27-question survey; 65 residents responded.

The goal was to gather data to perhaps support some common assumptions about the negative impact of a decentralized, nonmatched process on residents, he said.

Ultimately, respondents stressed that "it is the role of the AOA and the AAOS to help solve this problem," Ranawat added.

Among responders, 90% were entering a fellowship and 70% participated in a decentralized matching system.

Ranawat said when the survey results were first reviewed at the AOA Resident Leadership Forum in 2007, more than 90% of the residents reported that they disliked the current system and favored reform to a more centralized match-based system.

After completing applications and interviewing begins, 76% of all residents and 90% of sports medicine applicants felt they had insufficient time to make an informed decision. Some felt they had inadequate surgical training or exposure to subspecialties to make an informed decision.

"The entire process has unraveled," Ranawat said. "Applications are due earlier and earlier. Residents now have to decide on which subspecialty as early as postgraduate year 3 (PGY-3), and some even in their PGY-2 year."

The interview process is also too long and can extend well into April.

"This is all consistent with a decentralized process," he said. "Some people even argue we should do this in the PGY-5 year to give residents that much exposure to various fields.

"This is clearly an unraveled process, based on our data," Ranawat said.

For more information:
Anil S. Ranawat, MD, can be reached at Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021; 646-797-8700; e-mail: ranawatanil@hss.edu. He has no direct financial interest in any product or company mentioned in this article.

Reference:
Ranawat A. The resident perspective. Symposium F: Current state of the fellowship hiring process: Is a universal match necessary? Is it possible? Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.