I am a medical student and considering ortho as a possible specialty. I am a bit confused about how fellowships work within ortho. As a resident, do you learn how to work on every part of the body? Then for fellowship you specialize. If you were a sports orthopedic surgeon, would you work on a patients hand if they injured it while playing sports? Knee? Elbow? Hip? Spine? etc
Can someone explain to me which fellowships allow you to do which surgeries and what the bread and butter surgeries are for each fellowship?
I am curious because I think I would be happiest working on the greatest variety of anatomy. Which type of orthopedic surgeon has the most breadth of procedures?
I am a medical student and considering ortho as a possible specialty. I am a bit confused about how fellowships work within ortho. As a resident, do you learn how to work on every part of the body? Then for fellowship you specialize. If you were a sports orthopedic surgeon, would you work on a patients hand if they injured it while playing sports? Knee? Elbow? Hip? Spine? etc
Can someone explain to me which fellowships allow you to do which surgeries and what the bread and butter surgeries are for each fellowship?
I am curious because I think I would be happiest working on the greatest variety of anatomy. Which type of orthopedic surgeon has the most breadth of procedures?
Thanks in advance for any help!
I am not an attending, but...
Ideally during residency you would get good general training with rotations through all subspecialties (this may not always be the case). People do fellowships for several reasons. Some do it because their residency didn't cover a certain area well enough so they need to do specialty training in that area to feel comfortable with taking care of orthopaedic problems associated with it. Some do fellowships for marketing reasons - regardless of your ability/experience in a certain area it looks better to customers/patients and potential employers if you are "fellowship trained in X." Some do it because there are just some parts of orthopaedics that are very specialized (beyond what you may see during residency) and you want an in-depth training in that aspect of ortho. Many orthopaedic surgeons still have some sort of general component to their practice even if they subspecialized (a trauma surgeon may also fill some of their operative days by doing a couple joints, etc). So regardless of your subspecialty you can still have variety.
I'm also not an attending, but as a resident I can tell you the exposure you will (only can speak for my own residency) get as a resident will teach you all areas of ortho in moderate depth. If you want to be "the guy" for any certain area you need a fellowship. As a general rule most ortho guys/gals don't do a lot (or any) spine without a fellowship, and they tend not to do a lot of hand either. Having said that, the practice of ortho is growing as far as the types and complexities of surgeries to the extent that most fellowships will train you to do things you just didn't have time to get into depth in residency.
I've worked with an orthopod in residency who does it all from spine fusion with instrumentation to trigger finger releases and carpal tunnels to total hips/knees to scopes and all the trauma he gets on call. He's not the norm, however. In most metropolitan areas you'll find moderately large ortho groups where you have a fellowship trained person to take on any complex problem in any specific area. In more rural practices general orthopods seem to do a lot of most basic things and send pts to the larger centers for the more complex problems in any given area. This is both better for the patient and smarter for the orthopod medical legally speaking. For example, you can do joints as a general guy, but it's been shown that most of the complications come from orthopods who do less than one joint per month. We all have to feel out what we are comfortable with and what we are not (even after fellowship) for the patients' sakes.
I think once you get into residency and find more out about the breadth of ortho out there, you might realize that even within a certain fellowship there is a large variety of pathology and anatomy. We all take general call anyway, so you get so see just about everything on call. You decided what you're comfortable with and what you send to the fellowship trained orthopod in that area.
One passing thought is you might want to focus on residency first. There is plenty of time once you're in residency to ponder fellowships or general ortho. Good luck.
