Will there be an Orthopaedic Fellowship Match Program?

Few doubt the benefits of a coordinated matching program for orthopaedic fellowship hiring. But “the devil is in the details.” Getting buy-in and agreement from the various orthopaedic specialties involved with the match, as well as from the fellowship programs, is a necessary albeit time-consuming step.

The possibility of an orthopaedic fellowship match program came one step closer to reality at the recent Unity Summit held in Dallas. Representatives from the various organizations belonging to the Board of Orthopaedic Specialty Societies (BOS) gathered to discuss the issue at a meeting coordinated by Christopher Harner, MD, and AAOS First Vice President Joseph D. Zuckerman, MD. Dr. Zuckerman expressed the hope that “we can all be in the same chapter, if not on the same page.”

Why bother?
Approximately 90 percent of all graduating orthopaedic residents plan to enter a postgraduate fellowship program. But the current decentralized system extends the process and puts pressure on residents to choose a program quickly. Some interviews are scheduled even before residents begin their 4th postgraduate year, and more than half of prospective fellows accept their first offer. (See “Reinstituting a universal fellowship match: A resident’s perspective”)

Efforts to reestablish a universal orthopaedic fellowship match were triggered in 2007, when the American Orthopaedic Association presented a symposium on the “Current State of Fellowship Hiring,” which focused on the complicated state of fellowship employment and hiring as well as the potential effects of reinstituting a match. Of the 213 members in attendance, 79 percent thought that the current fellowship process was unacceptable, and 87 percent agreed that it was unfair to residents.

Subsequent meetings and a symposium at the 2008 AAOS Annual Meeting led to the creation of a workgroup—the Orthopaedic Fellowship Match Program Initiative (OFMPI)—during the 2008 National Orthopaedic Leadership Conference (NOLC). This meeting focused efforts on standardizing various aspects of the match process so that a “federation” of specialty fellowship matches could be developed.

Specialties a step ahead
Since then, three specialties (spine, sports, and trauma) have developed match programs for 2010, using the services of the San Francisco Matching Program (SFMP), which also administers the fellowship match for the American Orthopaedic Foot and Ankle Society (AOFAS). Three other specialties (adult reconstruction, oncology and pediatrics) are working to establish a match for 2011. The National Resident Matching Program runs the hand fellowship match, and the American Shoulder and Elbow Society runs its own match.

Although these steps are encouraging, they do not solve the problem from the resident’s perspective. The differences in application dates, the timing of interviews, and the lack of a common match date would continue to present problems for residents (Table 1).

The OFMPI hopes to achieve a degree of universality by establishing a common application and standardizing “list due” and “match” dates for all residents who will begin fellowships in 2011. The issues of sanctions for those programs that do not adhere to the rules is left to the specialty society(ies) who are managing their specialty match. Eventually, the OFMPI might work toward using a single matching entity.

But will it work?
According to Dennis Thomatos, manager of the SFMP, an orthopaedic match program could benefit from the experiences of the ophthalmology fellowship match, a successful program for nearly 20 years. He encouraged early communication, a review and comment period for participants, and an understanding of how participating groups can use and benefit from the match.

Leveraging technology to ensure ongoing communication is essential, said Mr. Thomatos, who encouraged participants to clarify expectations and parameters of participation early on and to establish processes for dealing with issues as they arise.

“Implementing a match changes the way programs used to do things,” said Mr. Thomatos, “so getting programs to fully understand what is expected and keeping them informed is key.”

Specialty societies that have a match program seem satisfied with the results. According to the AOFAS, during the 2008 match, 60 percent of participating programs filled all their slots; the previous year, just over half (51 percent) of participating programs filled all their slots. In the hand matching program, 87 percent of programs filled all slots.

According to F. Todd Wetzel, MD, who chairs the Resident and Fellowship Education Committee of the North American Spine Society (NASS), “The spine match is promising, with 70 programs (130 slots) and 113 applications.” With three participating societies (NASS, Cervical Spine Research Society, and Scoliosis Research Society), the spine match uses a standard application and has encountered “no major issues.”

The Orthopaedic Trauma Association (OTA) found that “this formalized process was actually increasing our applicant pool,” reported OTA President J. Tracy Watson, MD. Interview times and match dates for the OTA are tied to the organization’s annual meeting and resident fracture course, which provides opportunities for residents to interview with several programs.

What’s next?
Discussions are continuing to ensure that a 2011 implementation date for an orthopaedic fellowship match is possible. At the 2009 AAOS Annual Meeting, specialty societies will be invited to identify a key contact person as a liaison to the OFPMI and will focus on setting dates for lists and match announcements for the 2011 match cycle. In addition, the role of the BOS will be further defined, and work on a standardized application form will be reviewed. A subsequent meeting at the 2009 NOLC would finalize the program specifics.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org