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A Critical Appraisal of the First-year Experience of 5 Pediatric Orthopaedic Surgeons

Fletcher, Nicholas D. MD*; Larson, Annalise N. MD; Glotzbecker, Michael P. MD; Shore, Benjamin J. MD, MPH, FRCSC; Hydorn, Christopher R. MD§

Journal of Pediatric Orthopaedics: September 2014 - Volume 34 - Issue 6 - p 655–659
doi: 10.1097/BPO.0000000000000158
Special Topics

Background: The transition into practice following a fellowship in pediatric orthopaedics is challenging. This study seeks to describe the first-year experiences of 5 pediatric orthopaedists.

Methods: An Institutional Review Board-approved retrospective review was conducted of 5 pediatric orthopaedic surgeons’ first year in practice. All were fellowship trained and practiced at private or academic subspecialty groups. Clinical volume, payor mix, surgical cases, as well as complications were evaluated.

Results: A total of 1172 surgical procedures were available for review. Surgeons performed an average of 234 cases with a mean case load of 19.5 procedures per month. Fracture care and surgical management of infection represented the largest number of procedures. 42.3% of patients were covered by government insurance or were uninsured. Surgeons saw an average of 30.5 new patients per week in clinic. Of these, 10.7% of patients were scheduled for an elective surgical case. A sample of clinical practice revealed that 41.3% of patients were covered by government or no insurance. 17.8% of surgical patients sustained a complication with the majority being minor or expected. 18.8% of complications were major and required repeat operation. Complications peaked in the fourth month of practice.

Conclusions: Although clinical and surgical volumes can vary during the first year of practice, fracture care and surgical management of infection represent the majority of operative cases. A large portion of surgical volume results from emergent care, whereas elective cases are more elusive with only 1 in 10 elective patients resulting in surgical treatment. Despite a significant number of untoward events related to surgery, major surgical complications are uncommon in the first year of practice.

Clinical Relevance: The majority of surgical cases in the first year of practice are due to trauma and infection. A high volume of patients must be seen to establish a practice, particularly given the high rate of Medicaid patients. These figures provide benchmarks to guide training programs and to establish realistic expectations for new pediatric orthopaedic surgeons and their partners.

*Department of Orthopaedics, Division of Pediatric Orthopaedics, Emory University, Atlanta, GA

Department of Orthopaedics, The Mayo Clinic, Rochester, MN

Division of Pediatric Orthopadics, Children’s Hospital of Boston, Boston, MA

§The Moore Clinic, Columbia, SC

The authors declare no conflicts of interest.

Reprints: Nicholas D. Fletcher, MD, Department of Orthopaedics, Division of Pediatric Orthopaedics, Emory University, 59 Executive Park South NE, Atlanta, GA 30329. E-mail:

© 2014 by Lippincott Williams & Wilkins