Are Recently Trained Tumor Fellows Performing Less Tumor Surgery? An Analysis of 10 Years of the ABOS Part II Database

Kyle R. Duchman, Benjamin J. Miller

The majority of orthopaedic trainees pursue additional subspecialty training at the conclusion of residency. Although national trends indicate that fellowship-trained surgeons are more frequently performing cases in their defined subspecialties, this may not be the case for recently trained tumor fellows. Prior work has established that low tumor case volume is a significant stressor for recently trained tumor fellows. Given the relative rarity of musculoskeletal tumors, it is important for prospective trainees to have clear expectations for the proportion of specialty-specific procedures early during their careers. In addition, knowledge of anticipated specialty case volume is important to optimize fellowship training and to provide guidance for meeting the public health requirements for orthopaedic oncology. We wished to determine (1) the number of examinees who self-reported tumor fellowship training during the last decade; (2) how many tumor fellowship-educated surgeons did an additional fellowship(s) in other subspecialties; (3) the number and proportion of tumor, trauma, adult reconstruction, and other procedures performed by tumor-trained fellows; and (4) changes in the proportion of procedures performed by tumor-trained fellows during the 10-year period of the study. The American Board of Orthopaedic Surgery Part II database was used to identify examinees who reported tumor fellowship training between 2004 and 2013. All submitted procedures were broadly categorized as "tumor," "trauma," "adult reconstruction," or "other." Annual procedure volumes were calculated and univariate analysis allowed comparison of categorized procedures during the duration of the study. The median annual number of candidates reporting tumor fellowship training was 12.5 (range, 7-16). There were 28 of 118 (24%) candidates who reported additional fellowship training. A total of 14,718 procedures were performed by all candidates with tumor fellowship training during the 10-year period of the study, 42% of which were categorized as tumor procedures. Overall, only 36% of candidates reported tumor procedures making up greater than 50% of their case volume. Between 2004 to 2005 and 2012 to 2013, the proportion of tumor procedures decreased (45% versus 36%; p < 0.001), whereas the number of adult reconstruction procedures increased (9% versus 19%; p < 0.001). Between 2004 and 2013, only one-third of recently trained tumor fellows had practices with tumor procedures accounting for greater than 50% of their total case volume. Furthermore, the proportion of tumor cases performed by recently trained tumor fellows decreased during the same time. The proportion of specialty-specific procedures is lower in orthopaedic oncology than other orthopaedic subspecialties, which is important information for current trainees interested in orthopaedic oncology fellowship training and for orthopaedic oncology educators. The findings in this study should serve as an initial platform for further discussion regarding the optimal number of fellowship-trained orthopaedic oncologists required to meet regional and national needs for an accessible and proficient work force.