Top 20 Orthopedic Programs

After talking to attendings and friendly PD's at my home institution and on my aways during my 4th yr, i think these are the consensus top tier programs:

HSS, UCLA, Mayo, Iowa, UCSF, Harvard, Case Western

I agree with the previous post that most of us agree on about 75% of the programs, and those are probably the true top tier. In talking to attendings though, they seemed biased towards programs where they knew the faculty on a personal basis...interestingly, I didn't find much of a bias regarding where they trained.

I would agree with this. We have an attending at my program who is good at his particular specialty, but only b/c he did a fellowship and got great training that year. He admits he did his fellowship b/c he felt unprepared surgically and wanted get good at one small area so that he could focus on that and not do stuff he is not comfortable with. Dont get me wrong, he is very good in his little niche, but not so good with everything else.

I got to disagree with the last poster. One of my attendings told me about a former fellow at our program. He came from a different program which is known for a lack of operating experience for the residents and hardly any trauma. This fellow consistantly had to call in other people to help on Trauma call because he didn't know how to handle the cases that came in.

While I understand the points being made here, I doubt you would get a poor training anywhere you go in orthopaedics. I asked the same question at every interview with a chief resident-would you feel comfortable going out into the real world and dealing with any general orthopaedic (including non-pelvis trauma) problem that came into your office or ED-and they all surprisingly said yes. Therefore I came to the conclusion that there is little chance a program will be accredited if you do not get an overall good, broad training, and if this is the case why not go somewhere that has some big names in the area you are interested in.

I agree with bonedoc. I've wanted to do sports medicine since college, and that had absolutely no bearing on the program that I picked for residency. And any one who knows CWRU's program knows that sports is in no way, shape, or form our strong suit. I picked CWRU because, of the 12 places that I interviewed, it was in my eyes the best "total package." And for me that meant getting a broad exposure to EVERY single aspect of Orthopaedics and being comfortable handling most general Orthopaedic issues. I also wanted to go to a place where the residents got the crap kicked out of them on trauma call. Why? Because just about all Orthopods need to do trauma, and I wanted a "mini-fellowship" during residency so that I will be able to handle most general trauma things that will come across my door step or at the very least do the appropriate damage control and not screw the traumatologist that I'm gonna send it out to. So that's my take on it. Pick a place that's gonna train you to be a good Orthopaedic Surgeon. Not just a good trauma, spine, sports, upper extremity, joints, peds, hand, tumor or foot/ankle guy. Sorry about the shameless plug for CWRU
Rendering Error in layout BBCode/Image: Layout 'BBCode/Image:default' Not Found. Please enable debug mode for more information.


Bone_Jock

It is interesting to hear people talk about choosing residencies based on what they think they want to do (sports, spine, etc) Every resident in my program that is doing a fellowship in something came in thinking they wanted to do something else. I came in thinking I would do spine (cant remember why i thought that now). That lasted until about halfway through my second year. I discovered I really liked trauma and now am going to a great trauma fellowship in 2007.
My point is that choosing a residency based on the fact that they may have a strength in the area you THINK you want to go into could be considered short sighted. I think you would be better off to find a place that gives a good broad exposure. You might be surprised at what you end up doing. Also, dont underestimate the effect of the faculty you work with in a certain area turning you on/off to it. You may think you wanna do hand but if all the hand attendings at your residency are jerks you probably will have a bad taste in your mouth about the field. A lot of people ask me how I can do trauma b/c, I will admit it, there are plenty of traumatologists around with "personality issues". However all the ones I have personally worked with have been super cool, down to earth people, including my fellowship directors so that was never an issue with me

Bottom line is to keep your options open so early in your career

After interviewing or speaking with people who interviewed at these places, the top I saw/heard about were:

Very Top Tier
HSS, WashU, Rush, Duke, UCLA, Mayo, Iowa

Top Tier
Pitt, Harvard, Campbell Clinic, Cleveland Clinic, Case Western, UCSF

Other Top Places
U Washington, Michigan, Hopkins, Vandy, UC-Davis, Loyola, Northwestern, UT-SW, Florida

Hope this helps. Each program has its strengths and if you really want to be sure you are going to the best place for you (and be a good applicant) do some research. If you know you don't want to do trauma, and are trying to decide between sports, joints, or spine somewhere like Rush or HSS would be your top choice. If you like Peds, pick somewhere with its own Peds hospital and a large peds department to get a broad spectrum of approaches and multiple perspectives on indications and treatments. If you know you want to do research go somewhere that offers a 6th year (Case, Cleveland Clinic) and has big researchers. If you don't know what you like you can narrow it down by city, area of the country, research, time with community docs, etc.

I'm currently an intern at U of M. I ranked this program in my top 3 and am very excited that I matched here. I don't think I could be happier at another program. I also don't think there is anything "keeping it from glory." If anyone has any specific questions or concerns, please feel free to email me (Apurva Shah - [url=mailto][email protected][/url]).

damn, dude, you make me proud to be a texan.

cheers.
firegirl

the SEC is king (followed now by the ACC). Texas had their year, but if a team can go undefeated throughout the regular season and the SEC championship game, they shouldn't even have to play for the national championship - just give it to them, because their conference schedule is the most punishing by far. Look at USC, Texas etc. - 2 MAYBE 3 tough teams all year, blow out the cream puffs and walk in healthy to the bowl games.

You are probably right about brachial plexus surgeries at community programs, there are probably only a handful a year here. However, unless you are going into hand, in which case, you will be doing a hand fellowship, it isn't really necessary to see many, or any for that matter.

Once again, I would stress that top 20 is dependent on what you want in a career. If you want to go into academics, you will most likely want to go to a big time research place with the names and contacts to get yoru career started off. If you know you interested in being a sub-specialist, you may want to go to a place with some big names in that particular specialty. If you want to do a fellowship, but still practice a fair ammount of general orthopaedics, or be a generalist, you will likely want to go somewhere that will get you the best operative experience possible. For me, it was a no-brainer. I knew I wanted to be a generalist and I am happy to be training at a place that has allowed me to be primary surgeon, or first assist on almost 100 TKAs at the midway point of my PGY3 year.

I agree that it's impossible to make a top 20 list for everyone, but I wanted to give a shout out to NYU-HJD....definitely top 20 if you want either academics or private practice. I think it sometimes gets overlooked because it's in the same city as HSS, but this place is an extremely strong program and was the most balanced place that I interviewed at. It's very pro-resident, they have a great chairman(Zuckerman), great didactics, operative experience is awesome, tons of research opportunities if you want them, outstanding group of guys that are probably closer than most small programs, and of course you're in a sweet neighborhood in NYC.

re previous post.

while there many people have listed the same programs. clearly others have suggested some about which there is no consensus. it is misleading to suggest any program can be top 20.

I agree you want to come out of residency well trained technically. That said, I dont think you need to do 100 DHS cases during a 5 year period to become skilled. The advantage of the big name programs is the wide variety of cases one encounters. I'm no expert, but I doubt many community programs see a ton of brachial plexus operations etc, etc.

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
Rendering Error in layout BBCode/Image: Layout 'BBCode/Image:default' Not Found. Please enable debug mode for more information.
. 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.

Amen ortho2003. Great post.

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.

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.

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.

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.