Tuesday, January 20, 2015

The Fellowship Matches in Orthopedic Surgery

The Journal of Bone and Joint surgery has a new article on the experience of the fellowship matches in orthopedic surgery, many of which started after a study of the (then unraveled) match process in the 2008 article,
Harner, Christopher D., Anil S. Ranawat, Muriel Niederle, Alvin E. Roth, Peter J. Stern, Shepard R. Hurwitz, William Levine, G. Paul DeRosa, Serena S. Hu, "Current State of Fellowship Hiring: Is a universal match necessary? Is it possible?," Journal of Bone and Joint Surgery, 90, 2008,1375-1384.

The new report, by Lisa K. Cannada, MD, Scott J. Luhmann, MD, Serena S. Hu, MD, and Robert H. Quinn, MD is
The Fellowship Match Process: The History and a Report of the Current Experience, 2015-01-01Z, Volume 97, Issue 1, Pages e3(1)-e3(7), The Journal of Bone and Joint Surgery.

It's gated, so here are some relevant paragraphs:

"Beginning in 2007, there was substantial movement from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Association (AOA) to promote a coordinated match process for orthopaedic fellowships. It is estimated that at least 90% of all orthopaedic surgery residents participate in a year of fellowship training 1 . The results of a survey at the 2007 AOA Symposium on Fellowships found that 79% of attendees believed that the current process was unacceptable and 87% believed that the process was unfair to residents 2 . The situation of those disciplines that were not in an organized match process was compared with problems often seen in a decentralized labor market 2 . A survey of residents indicated that 80% of residents were in favor of an organized match for fellowship and wanted a later date in their fourth postgraduate year for the decisions 2 .
"There have been previous attempts at a formalized match process for fellowship positions. However, the process for most subspecialties unraveled over time. The failure of the match process in the past was due to a variety of reasons: fewer applicants than positions, interviews in the third postgraduate year, early offering of positions, and the lack of a regulated process with a central agency for applications with deadlines 

The Orthopaedic Hand Surgery Fellowship Match is administered by the National Resident Matching Program (NRMP) and has been so since 1990.
The American Shoulder and Elbow Surgeons (ASES) made arrangements to administer their own match, which they have done since 2005.
The Sports Match was run through the NRMP until 2005. Sports rejoined the formal match process in 2008, using the San Francisco Match (SF Match).
The Adult Reconstruction Match joined SF Match in 2009, and the match is now run with the same applications and timeline as the Tumor Match. There has been no formal match in place for tumor fellowships in the past.
The Pediatric Orthopaedic Society of North America (POSNA) had a previous match that had failed, in part, because of noncompliance by the fellowship programs and directors. POSNA ran another match from 2008 to 2009 and joined SF Match in 2010.
The Spine Match involves cooperation among multiple societies: the North American Spine Society, the Cervical Spine Research Society, and the Scoliosis Research Society. They joined SF Match in 2009.
The American Orthopaedic Foot & Ankle Society was the pioneer in the new match process, initially beginning in 2006 through the NRMP. Subsequently, the American Orthopaedic Foot & Ankle Society joined SF Match in 2007.
The Orthopaedic Trauma Association (OTA) had a match program in the 1990s that dissolved. The OTA reinstated the match in 2007, which was initially administered through the OTA. In 2008, the OTA formalized the match process through SF Match."

Another important aspect is the time away from work and the financial burden of interviewing. As mentioned, residents have an average of ten interviews. This number seems to be consistent between the subspecialties and to be representative of the number of interviews for the fellowship match process. The subspecialty societies have different approaches to the process. The OTA previously offered interviewing at its annual meeting in the fall. However, many programs still require on-site interviews. Currently, the OTA annual meetings offer information sessions from the programs. In this way, the applicants can meet and can interact with faculty and can decide if the program would be suitable for them. The meeting affords the applicants the ability to talk to the fellowship program faculty and current and past fellows before spending several hundred dollars on an interview. Sports fellowships attempt to offer regional interviews so that the applicant can attend several interviews in a short time period, saving time and the added expense of additional flights.POSNA permits interviews at the International Pediatric Orthopaedic Symposium. The society encourages applicants to attend formal interviews at the fellowship location, but it is not a requirement.The Board of Specialty Societies Match Committee has offered interview space to each subspecialty society during the AAOS Annual Meeting. One perceived limitation of regional or national meeting interviews is the inability of the applicant to see the program site firsthand.The cost of the interviewing process associated with the match process has been raised as a concern by applicants from almost every subspecialty society. The costs cited by applicants in the post-match survey response from the applicants ranged from $600 for the interview process to more than $5000.".."A previous reason cited for the failure of the previous matches was the lack of process regulation. To ensure the integrity of a match process, guidelines need to exist. The biggest concerns lie in the area of communication between applicants and programs after the interview. The precedent for the current strict rules could possibly be traced back to the failure of the previous matches in the 1990s and early 2000s. There was no universal match process at that time. The ASES rules state: “No communication between the applicant and program director/staff after the interview.” Likewise, the spine and sports subspecialties have similar strict rules of no communication. The sanctions that each society has in place are available on their web sites. The subspecialty society for the respective match imposes any sanction necessary. Most sanctions to the program involve restriction from participation in the match for a specific time period to fellowship faculty not being allowed to serve on subspecialty boards of directors and/or committees or to the program being banned from making podium presentations or receiving research grants. There have been no major sanctions reported by any subspecialty society.In conclusion, with the advent of a fellowship match and the increased number of applicants, the fellowship application process is not so different from the residency application process. 

1 comment:

Unknown said...

It is really interesting how more and more people are entering an orthopedic program each year. The way that they set up the interviews so the applicants can attend several in a short period of time is really smart. I think this will really advance the field of orthopedic surgery. http://si-pt.com