Top 20 Orthopedic Programs

"top 20"--depends on the eye of the beholder, in other words my top 20 is different from another applicant's

although a lot of people would rank HSS No. 1 if given an interview and the "good letter"-- if you are interested in being a community orthopod, dont like big cities, and really want warm weather, HSS would not be in your top 20

if you dont like my answer and really want an official top 20, i suppose you could see what US News and World Report defines as their top 20 hospitals for orthopaedics--

one could try to make a list of the "top 20" most competitive ortho programs, defined by the program that gets the most applications per residency spot-- i would imagine places like HSS, Harvard, UCSF might be on this list-- when people use the term "top 20"--this may actually be what they mean.

Ultimately 90-95% of programs out there are going to train you well to be an orthopaedic surgeon--every program has strenghts and weaknesses, you should be looking at the specific characteristics of a program (big vs. small, community vs. academic, location, research focus, do you fit in with the residents, family considerations, etc.)--to decide what your "top 20" is.

Hope that helps.

I agree....thats like saying who are the 20 hottest women in the world?
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You'll find that when you phrase the question "Top 20", people are hesitant to answer. When you rephrase it "what are some of the top programs in most people's sense from an academic standpoint?" people will be more forthcoming.

Here is my opinion of some of the top academic programs that I think few would argue with:

HSS, Harvard, Penn, Pitt, Duke, Emory, Rush, WashU, Vandy, Iowa, Mayo, U of Washington.

In my opinion, these are the ones that stand out from the pack academically. I'm sure I missed a few. Then, there are numerous others that provide excellent training, where everyone passes the boards, become great surgeons, and get excellent fellowships. Only a very, very small pack of deficient programs.

You'll find that very few of these programs are well-rounded and balanced. Most have strengths in particular areas (HSS-sports, joints; UW-trauma; Emory-trauma).

From what I hear, the ones that seem to be both superb academically and well-rounded are: Harvard, Pitt, WashU, Iowa. Surely there are many others.

Hope that helps. Good luck.

The rankings in US News and World Report have everything to do with the hospital and nothing to do with residency. If you carefully review the sub-categories used to determine the rankings you will see that these include number of nurses to patient, number of ancillary staff, percentage of deaths and average length of stay. Collegial reputation plays a heavily weighted role in the process, something US News has been criticized for in the past. Residents, number of attending staff and other program considerations (with the exception of research dollars) never make the list for US News. This is a publication for patients, extremely arbitrary, and I don't think it should ever be used to determine the best places to train in the US. Number of nurses on the floor does not equal better training.
Unfortunately or not, there is no Street and Smith's publication that annually ranks the top 20 teams in the ortho game. Everything depends on who you ask and what you're into.
If you have your eyes on the prize of being a future chairman at Duke, your top 20 will be vastly different from someone who wants to be proficient at general orthopaedics and practice right out of the gate without doing a fellowship. I would posit that some on the rank lists above supplied by individuals are composed based solely on the rep of the "brand" or program name-which does not equivicate to good, or even the best training.
That being said, in my opinion th best in the nation from my perspective only(IN no particular order):
Cleveland Clinic, Mayo, Johns Hopkins, University of Virginia, Harvard, University of Washington (one of the most balanced and well-rounded), NYU-HJD, Thomas Jefferson, Univ Pennyslvania, Akron General/Northeastern Ohio Univ Coll of Med, Campbell Clinic, UNC, Cincinatti, SUMMA/Northeastern Ohio Univs Coll of Med.

But this just my opinion, all anyone can ultimately give.

with all do respect, i must disagree with ajcrown, if 90-95% of ortho programs out there train you well and 90-95% of ortho people are cool--
# of nurses/patient should be the number one factor to consider--especially if the nurses are hot!

wow im glad i realized this today, before it was too late--im going to go revise my rank list right now.
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I think we all have this same question when we sit down and apply to programs. This thread pops up every year. I pretty much agree with what has been said. It depends on what you're looking for.

1. This forum tends to be heavily weighted towards midwest/east coast programs. So no one ever seems to mention programs west of the mississippi or in the deep south. I'm sure there are some phenomenal programs in those regions, just not many "posters" from that part of the country. I'm a midwesterner, I couldn't tell you any thing of value about programs in those regions.
2. I asked the residents at programs where I rotated what their top places were. The same 10 or 15 programs always came up. I think this is a good place to start.
3. Disregard the US news and world reports. There are some great Orthopaedic Departments on the list, but this doesn't correlate with quality of residency training. There is a difference.

Ultimately, decide what you're looking for and ask people who are in the field. They can usually steer you in the right direction.

Bone_Jock,
So what were the 10-15 top places that the residents mentioned to you? Also, do the residents from different programs mind when you ask them what the best programs are? It seems like when this question is asked even on this anonymous forum, people immediately get on the defensive. Does this occur with the residents? Thanks.

Every time this question is asked on this forum you always get a bunch of blah blah blah dissecting your question. It appears that you're asking for opinions on what most people agree the top 20 programs are which to me would mean most widely respected. Obviously there is no reliable ranking system (agreed that US News is ranking hospitals NOT residency training) but here is what I've heard from numerous sources about what programs would be considered top (in no particular order):

HSS, Harvard, Mayo, Iowa, U of Washington (perhaps the most well rounded in addition to the exceptional trauma experience), WashU, UCSF, Pittsburgh, Duke, Emory, Miami, Campbell clinic, Brown, Utah, UT Southwestern, Penn, Rush, NYU-HJD, Columbia, Hopkins.

Obviously these are all academic programs but these are the places where pioneers in the field are and those that make the policy do the research and generally drive the field forward.

some places go keep an eye out for in a few years would be Utah (great new chairman with phenomenal facilities), Stanford (was in disarray but now has great new chairman), UNC (good core group of young faculty), Maryland, Wisconsin.

My 2 cents.

I am suprised that Michigan doesn't come up in the discussion of top 20. I'll give you that they might not be top 10 but should be in top 20.

Is there something about the program keeping it from glory so to speak.

I will be starting med school in the fall and wanted to know if there was any type of correlation between ranking of programs and subsequent earning potential/yearly salary of non-academic medicine? Simply put, will you make more money if you do your residency at Harvard versus a "County Hospital"?

If any correlation exists between your residency "status"
and your future income, which it probably doesn't, it might be an inverse one. Although few orthopedists in general are in academics, those that train at the "top", more academically oriented, residencies tend slightly more towards academics. And academic physicians have a noticeably lower average salary than community physicians. If your main goal is to be a community physician and make a good living then the determining factor will be your own work ethic and business sense, and your residency will be a minor factor.

No resident should take issue with that question, as most of us were there a short time ago. As for your question, when I asked residents who the top 10 were I got names like (in no particular order) Harvard, Rush, Iowa, Mayo, Thomas-Jefferson, CaseWestern, HSS, Wash U, Pittsburgh, Emory, Duke, Cleveland Clinic, Mich, Hopkins, Northwestern, Rochester, Darthmouth, Miami, Yale. . . . .it's been a while, so I'm sure I'm leaving some out. But those were some of the names that continuously popped up over and over again. But as mentioned before, I'm a midwesterner and many of the residents I polled were from the MW/East coast, so the list is heavily weighted towards those regions.

I've been wanting to stay neutral, but I think most of us know what is meant by top 20 ortho programs. It's like asking what the best teams in college football are. You won't get a consensus. i.e. I love the Big 10 and I think it's the best football around, but someone in other parts of the country might argue that The Big 12, PAC 10, or SEC is king. That's a REASONABLE argument. But when you chyme in and say that Kent State and the MAC conference could play with anyone in the country people are going to look at you like your crazy. . . . .See AJCrown's post above. No disrespect, but when you mention 4 Ohio Ortho programs in your top 20 and fail to even put CWRU amongst the top programs in Ohio, that discredits your argument right away. The Akron programs are good community programs, but to put them in the same boat as Harvard, Jeff, and UPenn is not right. . . .no matter what you base your ranking on (location, operative experience, research, name recognition, etc). When I think of top 20, I think of the total package.

When you pick up JBJS, Spine, JPO, JOT or look at the speakers at various national meetings, the authors or the people on the podium will generally be from the big name programs. Much of the research that drives much of what we do in Ortho comes out of the so-called "top programs." Feel free to disagree, that's the purpose of a forum. I'm sure I'm gonna get blasted for this post
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Top Ten Dream Residency Programs:

HSS
Mayo
Pitt
Wash U
Iowa
Harvard
Brown
Campbell Clinic
Rush
Cleveland Clinic

My opinion in no particular order...
HSS, Harvard, Iowa, Duke, Mayo, Rush, Joint Diseases, UCSF, Brown, Wash U, Pittsburgh, Campbell Clinic, Yale, UCLA, Cleveland Clinic, UW, Johns Hopkins, Columbia, Miami, U Penn

Since no one can seem to agree on which programs are "top 20" and even what criteria one would use to make that distinction, what is it then that going to one of these so-called top places makes a person so much better off? I have met my share of wacko's from ivory tower places and also from other programs. I have done rotations at some places on peoples list in this thread (as a resident, not a student) and I can tell you that I went in expecting to be bowled over by the difference from my "humble community based program". I was not. I had as good or better knowledge and surgical skills as a pgy4 than most of the chiefs I met.
My point is that other than the previously mentioned reasons (prestige/personal ego, wanting to stay in academics, love of research) training at a top 20 program alone will not automatically make you a better surgeon. You still have to be dedicated to continual learning and bettering yourself. You still have to be ethical. You still have to have a good work ethic and be courteous and professional to your peers and the support staff. I would hate for medical students reading this forum to think that they have to go into a "top 20" program or else they will come out somehow inferior.
I am not to saying that "top 20" programs are bad, that would be retarded. I am just saying that their are lots of other factors that go into how "good" of a surgeon you become other than the fact that you have a diploma from HSS, harvard, WashU, etc, etc.

this post is getting pretty funny with all the debate about the idea of "top programs." seems like lots of people are getting defensive about their program.

anyways, here is my list from the interviews i did last year.

HSS, Columbia, University of Washington, Harvard, U Penn, Wash U, Rush, Pitt, UCLA, CWRU, Michigan


other programs that i didn't interview at but would put among the top from discussions with other residents and reputation:

Iowa, Duke, Mayo, UCSF, Campbell Clinic, Cleveland Clinic

i think it is interesting that many say no one can agree on what the top 20 are, but it seems from the few of us who have actually answered the original posted question, we seem to agree on >75%, which to me is fairly good agreement.

I went to the AO course early in my PGY2. I was partnered with a PGY2 from the almighty HSS for the labs. We were working on a basic intertroch fracture using a sliding hip screw. I started putting together the instruments to get started and the conversation went something like this.

HSS guy: Have you seen any of these before?

Me: Yeah, I have probably done 8 or 10.

HSS: You've done them?

Me: Yeah, I actually did one skin-to-skin when I was a rotating student at my program.

HSS; Wow, that's awesome.

Me: You guys must just do a lot of ER call as a PGY2.

HSS: No, we mostly do floor call. There PGY3's do ER call.

Me. Floor call, what is that?

HSS: We change dressings, make sure people have there discharge stuff together, transport to x-ray, stuff like that.

Me; Wow, when do you get in the OR.

HSS: A little bit during our PGY2 and PGY3 year, but during our PGY4 and PGY5 we spend a lot of time in the OR with teh fellows.

Me: So you are still double scrubbing as a PGY4 and PGY5.

HSS: On a lot of the services we have fellows doing most of the cases, but some of them the PGY4s and PGY5's single scrub.

Me: Wow, we never double scrub other than occasionally as an intern.

This little interaction solidified that I was right when I never considerred applying to a lot of these so-called "top 20" programs. I knew I wanted to be a community surgeon, not an academic, and I wanted to be able to do genreal if I didn't have a fellowship that I was interested in doing. I find it very hard to believe that a person could come out of a program like this and be a competent general orthopod.

If you are interested in academics, which statistics show only 5-10% of all orthopods will be in an academic practice, going to a high powered research place should be high on your list and places named by bone jock and many of the others in this forum are probably the elite places. You will have more publications and have more contacts than you will have going to the smaller blue collar places. However, if you want to be a gerneralist or fellowship-trained community guy, then your top 20 may be very different. Many of our recently graduating chiefs have had similar experiencees to bonedoc when they did their fellowships. They ran into guys that came from these "top programs" that were now during their fellowships and had surgical skills or the PGY3 and PGY4s at our program.

I asked this same question while I was going through the interviewing/match process and what I ultimately realized was that the real question should be which are the top 20 ortho programs to train at as a resident. I interviewed at many of the programs that have been listed above and despite the "reputations" that are propagated on this board, I ultimately decided where to rank first based on the following criteria:
1. Reputation- somewhere that people in ortho know of which will help land you in a good fellowship or get a job anywhere. In other words, selecting a program which will not narrow your options in the future.
2. Operative experience- This is not just based on absolute number of cases, but how many cases and what breadth of cases will you be the primary surgeon actually performing the operation. Many of the programs listed above are filled with fellows who do the cases and heavy-handed attendings who are publishing their results and don't want them potentially marred by a relatively inexperienced junior resident. You may also see multiple residents scrubbed into the same case because the volume is limited. The research and faculty may be great, but you have to consider how much will this really impact the quality of surgeon you will become. For the MS4's: consider what it might be to stand in line and watch other people do cases for the next several years.
3. Research opportunities: If you want to do research, get published , and present nationally do the opportunities exist?
4. Personalities: Are these the kind of people you would like to spend the next five years with?
5. City/environment: Would you like to live there? What will your quality of life be like outside of residency?

When considering these criteria, it becomes apparent that the "top 20" will vary based on personal tastes and aspirations.

I do think that if you are certain you would like to go into academics then the reputation and research opportunities should weigh most heavily in deciding your "top 20".

There are some outstanding programs in the country which have not been mentioned on this particular thread. The best way to really learn about programs is to rotate or interview there or to speak with someone who has.

Good Luck.

Amen ortho2003. Great post.

I agree 100% with the above two posts. I did my 3 months of Orthopedics during the Intern year and did ~8 DHS and Pinning (6 of them was skin to skin), 4 Gamma Nails (both antegrade and retrograde approaches-80% of the case), several Fracture plating where I did 80 % of the case, did the Fem. component of a few total knees and also made cuts on the tibia/fem, reduced ~ 10 distal rad. fx in the ED, multiple hardware removals, did ~7 ACL recon where I drilled the Tib/Fem tunnel and also prepared the graft, also was walked through several knee scopes, couple of distal fem plates (did 70% of the cases), etc. In our program, as an intern, you take call at one of our hospitals with the PGY 2 and 3s, where you are the only Ortho person inhouse and talk with the attendings directly. (you also have a PGY 4 that backs you up during the night if needed) When you are on call, you scrub one on one with the attending on all add on cases for the day, so the experience is excellent. I also think a lot of the community/non "top 20" ortho programs have some of the best operative experience.

When I was a 4th yr med student, I rotated with a couple of the programs that are considered top 20 by some, and the experience was very different. Seeing a PGY-4 holding hooks/retractors in the OR on total joint cases is almost painful. I have seen chief residents watch attendings scope on simple cases.... and having fellows is overall bad for the resident's experience, since fellows will be scrubing with the PGY-4 or 5 and the PGY 1 or 2, then sometimes the med student....

Reputations aside, ultimately, you want to come out a program as a "competent" orthopod. Some places will make you more skilled vs other places..... but you also have to ask your self, are you willing to compromise reputation and research experience for operative experience. Some of the top 20 programs mentioned above will also give you excellent opertive training along with the rep and research, but you just have to figure out which one and is often hard to do. Also when you do find the perfect program for you, then your next biggest challenge is getting a spot in that particular program
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. The Match is unpredictable and given the ultra competitiveness of Ortho, anything can happen. Most of the time, people are just happy to get a spot. Also alot of residency is what you make of it, you can learn as much as you want or just enough to get by.

The bottom line is that you need to find a balance and also know what you are looking for in a program (also what you can get out of the program in 5 yrs). I have personally worked with an attending who was trained at a "top 5" Ortho residency, who told me that after 5 yrs at this place, he "had" to do a fellowship because he was not competant enough to go out into practice and operate by himself. He also told me that if he had the choice over again, he would have gone to another place to train where the residents was able to operate more and as the primary surgeon on the cases.