It is true that the three shoulder/elbow surgeons left Penn for Jefferson. I'm a Penn resident and it really has left our program much weaker. Dr. Williams is really the most well known name in shoulder surgery, with multiple textbooks, and a great teacher and it is really a loss to the program.

In my opinion the top academic programs are:

HSS, Mayo, Rush, Jefferson, and Iowa.

I dont think Harvard really fits this list anymore. HSS and Mayo are obviously undoubtedly on the list. I'm going into Spine and Jefferson really is the spine leader in the country. With Alex Vaccaro, the new chairman Todd Albert, Hilibrand, and Anderson it is the busiest spine center in the country. They get all the spine trauma being the regional spinal cord injury center and they have the most sought after spine fellowship in the country. I have a buddy across the water at Jeff and he says the program has changed considerably since Albert became chairman - with the junior residents being pulled off the scut services (joints/spine) to have a more operative experience early. My buddy is a pgy-2 and he actually even said that the chairman (albert), met with our chairman (lackman) and there may be a chance that lackman leaves us to go to jeff. This is really upsetting because it would further weaken our program. Its apparently all financial - penn is not interested in putting up for the great surgeons that we have/had.

Iowa is still debatable, it may be close with Cleveland Clinic and Pitt.

http://www.residentphysician.com/Orthop ... nkings.htm

This link has the amounts of NIH funding for 2005.

The top five NIH funded programs are:
University of Rochester, Jefferson, Yale, Iowa, and Wash U.
Rochester has the most funding at 4.0 million (9 awards), while Jefferson is second with 3.1 million, but 11 awards.

This of course just gives us an idea of which program have significant amounts of research going on. There are clearly sources of funding other than NIH, but NIH is the largest scientific funding organization in the world and for orthopaedics as well.

I'm a fourth year interested in research and looking at programs and this is definitely helpful. I actually rotated at Yale and Jefferson and am astonished at how much basic science and clinical research both places have. I didn't get the impression that Yale was clinically as strong, but they definitely have quite a bit of research in process. They also have a research block for the residents. Jefferson recently added a two month research block in the PGY-3 year, and apparently may be adding another block of research/elective for the PGY-4 or PGY-5 year.

I hear that rochester is even MORE amazing for research. Any one have any experience there?

I've always felt that Jefferson is one of the best ortho programs in the country. The only comment above I question is Jefferson being the busiest spine center in the country. I don't think this is true. They may be the busiest for spine TRAUMA (Seattle may give them a run) but not for elective spine. There are a lot of spine centers with way more than 4 surgeons that have higher volume of cases.

Also don't forget about the Jefferson Hand Center, one of the better hand fellowships in the country. I believe a weakness in the program is ortho trauma, at least it was a few years ago. There are way too many level 1 trauma centers in Philly and the love is spread rather thin, at least compared to some really busy trauma centers.

There is no way to rank the consensus top 5, 10, or 20 programs, but everyone seems to think it is necessary.

How are you going to rank it? IS NIH funding the be-all and end-all? If so, then IU, Michigan,and San Diego must be in the top 10.

Is it big names? That seems to be all Harvardorthorez is concerned with in his/her post. If so, then I think you guys are once again showing your East coast arrogance. Seattle has the names equal to your programs...speaking of Seattle, there is a shoulder guy there, who obviously couldn't hold a candle to the Jefferson guys, but some of you may have heard of him...Fred Matsen.

Should we base it publications? If so, then all we need to do is look at the last 5 years of JBJS and the major subspecialty juournals and we can easily come up with our top programs.

Maybe we should consider operative volume. I've done 2500+ operative cases single scrubbing. How many cases do the residents at harvard get without fellow or other resident in the room competing with them? Whether you like to admit it or not, operative experience does play a role in academic orthopaedics too. It doesn't matter who your staff is if you can't see them behind to two fellows and the chief.

Bottom line is we have no idea what the top program, academic or not is. You can't base it on names and NIH funding and unless you have spent a few years there, which no one on this forum can say for any program other than their home program, you have no idea what the program is like. If you are gogn to try to do it based on names, NIH funding, publications, and heresay o this forum, then all you are doing is participating in mental masturbation and ego stroking.

For those of you that need a little less ego stroking, but really want an academic program with opportunities for an academic career, any of harvardorthorez's top 5, along with penn, rochester, cleveland, case, hjd, pitt, rush, hopkins, Michigan seattle, UCSF, Virginia, UTSW, and many others are elite "academic" programs that are very difficult to place in a rank order(unless you are form the East Coast, then we know that Iowa and Mayo ar the only programs that can be mentioned outside Boston, NY, and Phili).

I will quit

im an east coaster at one of the aforementioned 'big' programs, but who cares i sure as hell dont all i know is that im damn happy just to be doing what i want

holla back if you hear me

What a bunch of crap...how much ego stroking do you East coast guys need? There is no way to rank the consensus top 5, 10, or 20 programs, but everyone seems to think it is necessary.

ditto.
People seem to like compartmentalizing everything in a nice neat little box.
It usually turns in to a big round of dick waving b/c someone has an insecurity and needs to feel "special"

Wash U, can be compared, can't be beat.

Yes...Wash U has to be the top academic program right now.

ortho2003: don't be so defensive. It's just a discussion.

Academics is a competitive game, programs are constantly trying to recruit the best and brightest, biggest names to boost their research program/prestige. While clearly not important to you, it is REAL; not a figment of our imagination.

I think the definitive question should be "who would you let operate on your wife/husband"? Some guy who's in the OR doing the operation day in, day out .... or some snotty bow tie wearing prick who wrote a great book but who only cuts a few time a week??

Say no more. Train me by the clinician any day.

Ortho 2003:

What is the point of going to great lengths to match at an "elite top 5 academic program" if you cannot brag about being at an "elite top 5 academice program" once you get there? Although amusing to sit back and watch the East Coast arrogant academic elite sit around and rank themselves (and a bit annoying at times), you can take comfort in the fact that while they are busy looking up NIH funding data, you are off learning to operate to become a damn fine orthopod. I went to a community program to, and while all the ego stroking by some of those in academic orthopedics can get old, it is only expected when you look at some of the personalities that are drawn to those types of programs. All programs train their share of eggheads, but eggheads are MORE LIKELY to pursue elite academic programs because of their very nature. I just feel sorry for the majority of normal guys that have to go through five years of training at some of those top programs who land some of those people every year. Simply take comfort in the fact that based on your case volume, you will be more prepared to take on your first year in practice than 90% of those coming out and let the eggheads sit back and rank each other.

Before I set off 20 more responses below, let me clarify: I certainly didn't mean to imply that academic programs (even "top" ones) are full of eggheads. I'm quite confident that the majority of residents at academic institutions are intelligent as well as competent in the OR and graduate to become very competent surgeons. Those guys (and gals), however, are probably not the ones spending time on message boards arguing about the meaningless rank order of programs. It only takes one or two eggheads to create a perception.

back to the point of this thread...
now that all the people NOT in the academic programs are done bi**ching (hopefully). I'm a fourth year at Columbia (kind of a fifth year - i took a year off to do research), and I rotated at HJD, Jefferson and Rush. Ive talked to a bunch of ortho residents/attendings over the last 6 months and it seems like the general consensus is that the strongest academic programs (also very strong clinically, but have an EXTREMELY strong academic reputation and generally match VERY WELL FOR FELLOWSHIPS) are:

HSS, Mayo, Jefferson, and Wash U.

I also just wanted to make one point. Based on my experience i think one thing is obvious. Being academic does not make you a "bookworm. and not know stuff clinically." EVERY SINGLE REALLY ACADEMIC ATTENDING I WORKED WITH had a huge patient base operated like crazy because they had such a good reputation. Most of them were phenomenal surgeons, but i cant deny that some were average. But one thing is clear to me. The more academic places tend to have a large volume. For example, I rotated at jefferson and spent two weeks on the spine service. Alex Vaccaro often times was operating in 4 different ORs on any given day (being the primary surgeon in two of them) and doing up to 8-10 BIG CASES. AND THATS ONE SPINE SURGEON. I mean, this guy is out of control. This flows onto the residents too -- i mean the residents in his two primary rooms did the whole exposure whether it be cervical/lumbar and even started the decompression. The residents did the pedicle screws on their side, while the Attending did the pedicle screws on their side. It was fu**ing awesome.

SO AGAIN, VOLUME/ACADEMICS ARE BOTH THINGS THAT I THINK ARE EXTREMELY IMPORTANT WHEN SELECTING A STRONG PROGRAM.

The big academic places, being tertiary referral centers, attract complex cases. I don't know how many times I've heard someone say that a big name doesn't equate with good surgeon. while this may be true in certain cases, by and large, surgeons who work at these centers do harder cases. Experience with complex cases makes you a better surgeon. These are cases that the average orthopod in the community doesn't want to touch.

ahhh always with the familiar pissing contest.

i'm just happy to be training in a specialty i love.

Here is my take: I only interviewed at academic residency programs, so I'm not familiar w/ the strength of community programs, sorry.

UCSF, Harvard Wash U, U of Wash, UPitt,

UCSF: probably one of the strongest academic operative program, my guess is that it's on par w/ most community program in terms of surgical experience. I would have love it here if matched.
Harvard: I would say Harvard is a blend of UCSF and HSS in terms of operative experience. I really liked this program and residents were really cool. Most attendings were really receptive to residents.
UPitt: both research and operative powerhouse. location is questionable, but awesome training overall and produces a lot of leaders.
Both "Wash" programs: similar to Pitt. No real drawback. Well-balanced program w/ aggressive program directors intent on making their program the best in the nation.

Comment on HSS (since people will question why I didn't put HSS on top 5): probably the best hospital, but definitely not the best residency program. It's largely an observational residency (maybe except for the joint service) despite high volume.
Antsy attendings + VIP pts = sleeping residents holding the retractor.
While lower in volume, you probably get better operative experience at Columbia or NYU-HJD.

Im at temple and one of our newest attendings did the hand center fellowship at Jeff...per her its one of the strongest hand programs in the country. She said the residents and the fellows get to work with Lee Osterman, Randall Culp, Taras, Zelouf, and some other big names in hand who operate quite a bit.

Here is a vote for Wash U. Top notch attendings. The key, however, is to find a program that matches your learning style. Goal of residency is to develop a strong foundation so you can continue to learn once you finish. As a resident you do not realize how much you will learn during your first year or two out of training.

any updates on this? lets not have this become an argument again...but any major changes in programs across the country? Major attending losses?

I have been curious about NIH trends for a while, so I finally compiled this list. Sorry, lots of data, and I cannot figure out how to show it in a better format here. If interested, it might be better to cut and paste into excel. But anyways, here are the past 5 years of NIH awards to 'medical schools' in the dept of ortho. The format is:

.................2007.....2006....2005.....2004.....2003.....TOTALS
SCHOOL....#...$.....#...$.....#...$.....#...$.....#...$.......#.....$


UNIVERSITY OF ROCHESTER 14 $5,143,403 12 $4,509,553 9 $3,957,638 10 $3,466,178 5 $2,101,967 50 $19,178,739
YALE UNIVERSITY 8 $2,709,885 9 $2,741,810 8 $2,935,804 10 $3,746,988 9 $3,324,152 44 $15,458,639
UNIVERSITY OF IOWA 9 $4,309,025 8 $3,885,245 5 $2,276,188 4 $2,163,389 6 $2,553,363 32 $15,187,210
CASE WESTERN RESERVE UNIVERSITY 14 $3,656,959 6 $1,633,221 6 $1,790,362 8 $2,439,547 16 $4,372,979 50 $13,893,068
WASHINGTON UNIVERSITY 13 $3,228,234 10 $2,880,845 8 $2,212,061 12 $2,733,378 11 $2,260,676 54 $13,315,194
THOMAS JEFFERSON UNIVERSITY 8 $2,564,611 10 $3,011,313 11 $3,074,121 6 $1,366,936 9 $1,889,548 44 $11,906,529
UNIVERSITY OF PENNSYLVANIA 10 $2,944,612 10 $2,852,720 7 $1,950,762 6 $1,776,032 5 $904,728 38 $10,428,854
UNIVERSITY OF MICHIGAN AT ANN ARBOR 7 $1,446,507 7 $1,450,871 8 $2,087,969 8 $1,811,310 4 $1,062,912 34 $7,859,569
UNIVERSITY OF CALIFORNIA SAN FRANCISCO 7 $1,720,695 9 $1,638,764 5 $1,008,683 6 $1,430,868 6 $818,107 33 $6,617,117
UNIVERSITY OF WASHINGTON 5 $1,183,805 6 $1,371,827 6 $1,195,934 6 $1,502,730 6 $1,308,755 29 $6,563,051
UNIVERSITY OF CALIFORNIA LOS ANGELES 5 $1,138,937 5 $1,276,727 5 $1,270,723 4 $1,208,754 4 $1,237,527 23 $6,132,668
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE 5 $1,330,632 5 $1,496,861 4 $1,117,970 4 $1,029,418 5 $1,070,900 23 $6,045,781
UNIVERSITY OF PITTSBURGH AT PITTSBURGH 5 $1,332,515 2 $651,818 3 $777,731 5 $1,584,971 5 $1,636,348 20 $5,983,383
UNIVERSITY OF MINNESOTA TWIN CITIES 1 $187,760 5 $1,039,852 5 $1,273,185 8 $2,041,023 5 $1,379,716 24 $5,921,536
UNIVERSITY OF CALIFORNIA SAN DIEGO 5 $1,325,917 6 $1,440,911 6 $1,546,755 3 $516,893 4 $732,376 24 $5,562,852
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS 4 $1,081,208 2 $728,515 4 $1,358,348 3 $744,857 6 $1,477,974 19 $5,390,902
UPSTATE MEDICAL UNIVERSITY 2 $587,910 3 $693,155 4 $658,382 6 $1,415,848 6 $1,583,579 21 $4,938,874
UNIVERSITY OF VIRGINIA CHARLOTTESVILLE 7 $1,248,651 8 $1,154,445 5 $880,188 2 $775,174 2 $829,224 24 $4,887,682
MOUNT SINAI SCHOOL OF MEDICINE OF NYU 3 $927,762 4 $1,325,815 3 $1,059,438 3 $880,241 2 $457,458 15 $4,650,714
DARTMOUTH COLLEGE 3 $2,503,708 0 $0 0 $0 0 $0 1 $1,350,000 4 $3,853,708
PENNSYLVANIA STATE UNIV HERSHEY MED CTR 1 $291,616 3 $489,592 4 $749,917 4 $776,216 5 $955,639 17 $3,262,980
JOHNS HOPKINS UNIVERSITY 1 $331,372 2 $725,690 3 $818,885 3 $859,873 2 $514,403 11 $3,250,223
UNIVERSITY OF FLORIDA 4 $550,039 5 $944,686 3 $815,192 2 $623,434 1 $240,231 15 $3,173,582
UNIVERSITY OF MISSOURI KANSAS CITY 3 $1,900,753 2 $794,341 1 $372,965 0 $0 0 $0 6 $3,068,059
UNIVERSITY OF CALIFORNIA DAVIS 3 $636,733 2 $424,156 3 $733,237 3 $696,176 2 $462,578 13 $2,952,880
UNIVERSITY OF MARYLAND BALTIMORE 3 $745,191 3 $767,446 2 $540,540 1 $279,180 1 $279,180 10 $2,611,537
UNIVERSITY OF SOUTHERN CALIFORNIA 4 $906,011 5 $1,086,822 1 $243,750 0 $0 2 $357,094 12 $2,593,677
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE 1 $294,483 2 $536,283 2 $549,188 3 $755,415 1 $306,134 9 $2,441,503
UNIVERSITY OF CALIFORNIA IRVINE 2 $416,410 3 $450,810 1 $306,564 3 $744,558 3 $432,512 12 $2,350,854
UNIVERSITY OF TENNESSEE HEALTH SCI CTR 1 $271,797 1 $279,914 1 $286,650 1 $274,820 1 $437,800 5 $1,550,981
UNIVERSITY OF TEXAS MEDICAL BR GALVESTON 2 $348,664 2 $355,249 2 $360,714 0 $0 0 $0 6 $1,064,627
UNIVERSITY OF NORTH CAROLINA SCH OF MED 0 $0 0 $0 2 $144,558 4 $388,510 4 $395,778 10 $928,846
HENRY FORD HEALTH SYSTEM 1 $300,350 2 $555,128 0 $0 0 $0 0 $0 3 $855,478
UNIVERSITY OF ARIZONA COL OF MEDICINE 0 $0 0 $0 1 $228,172 1 $294,812 1 $331,711 3 $854,695
STATE UNIVERSITY NEW YORK STONY BROOK 1 $166,826 1 $205,706 0 $0 1 $75,250 3 $225,750 6 $673,532
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT 1 $312,236 1 $349,000 0 $0 0 $0 0 $0 2 $661,236
NEW YORK UNIVERSITY SCHOOL OF MEDICINE 3 $377,347 1 $223,080 0 $0 0 $0 0 $0 4 $600,427
VANDERBILT UNIVERSITY 0 $0 2 $535,533 0 $0 0 $0 0 $0 2 $535,533
LOYOLA UNIV CHICAGO STRITCH SCH OF MED 0 $0 0 $0 0 $0 1 $259,000 1 $259,000 2 $518,000
EMORY UNIVERSITY 1 $248,205 1 $255,618 0 $0 0 $0 0 $0 2 $503,823
OREGON HEALTH & SCIENCE UNIVERSITY 1 $198,660 0 $0 1 $295,288 0 $0 0 $0 2 $493,948
UNIV OF MASSACHUSETTS MED SCH WORCESTER 1 $488,364 0 $0 0 $0 0 $0 0 $0 1 $488,364
UNIVERSITY OF SOUTHERN MAINE 1 $142,037 1 $251,669 0 $0 0 $0 0 $0 2 $393,706
UNIVERSITY OF NEW MEXICO ALBUQUERQUE 1 $162,211 1 $164,932 0 $0 0 $0 0 $0 2 $327,143
UNIVERSITY OF TOLEDO HEALTH SCI CAMPUS 1 $302,072 0 $0 0 $0 0 $0 0 $0 1 $302,072
COLUMBIA UNIVERSITY HEALTH SCIENCES 1 $289,800 0 $0 0 $0 0 $0 0 $0 1 $289,800
UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL 1 $287,993 0 $0 0 $0 0 $0 0 $0 1 $287,993
BOSTON UNIVERSITY SCHOOL OF MEDICINE 0 $0 0 $0 0 $0 1 $80,750 1 $80,750 2 $161,500
UNIVERSITY OF COLORADO DENVER/HSC AURORA 0 $0 1 $75,191 1 $77,000 0 $0 0 $0 2 $152,191
MEDICAL COLLEGE OF WISCONSIN 1 $68,540 0 $0 0 $0 0 $0 1 $75,000 2 $143,540
WAYNE STATE UNIVERSITY 1 $75,250 0 $0 0 $0 0 $0 0 $0 1 $75,250
UNIVERSITY OF LOUISVILLE SCH OF MEDICINE 0 $0 0 $0 0 $0 0 $0 1 $73,084 1 $73,084
HARVARD MEDICAL SCHOOL 0 $0 0 $0 0 $0 0 $0 1 $70,450 1 $70,450


I had to do the last couple of years by hand (NIH won't rank medical schools anymore, for whatever reason), so there might be some errors, but hopefully not too many

Again, this list is just for the total NIH awards for medical school ortho depts. HSS, for example, got something like 10 mil just last year, but these institutes are not on the list.

Anyways, I hope that this might be interesting to some of us interested in research and/or academic ortho.