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Orthopaedic Care for Children

Who Provides It? How Has It Changed Over the Past Decade? Analysis of the Database of the American Board of Orthopaedic Surgery

Hosseinzadeh, Pooya, MD*; Obey, Mitchel R., MD*; Nielsen, Ena, BA; Andras, Lindsay, MD; Kiebzak, Gary M., PhD§; Mignemi, Megan, MD; Sawyer, Jeffrey R., MD; Albanese, Stephen, MD#; Flynn, John M., MD**

Journal of Pediatric Orthopaedics: March 2019 - Volume 39 - Issue 3 - p e227–e231
doi: 10.1097/BPO.0000000000001277
Selected Topics

Background: The field of orthopaedic surgery has subspecialized over the past decade with an increasing number of graduates of orthopaedic residency programs entering fellowship training. The number of graduates from pediatric orthopaedic fellowships has also increased over the past decade. We hypothesize as the number of pediatric orthopaedic fellowship graduates has increased, the proportion of orthopaedic cases completed by pediatric surgeons in comparison with adult surgeons has also increased. We have used the database of the American Board of Orthopaedic Surgery (ABOS) to analyze the trends in who is providing the orthopaedic care for children.

Methods: Procedure logs of applicants for ABOS part II certification from 2004 to 2014 were collected and pediatric cases were used for this study. Applicants were divided into pediatric orthopaedic surgeons and adult orthopaedic surgeons based on the self-declared subspecialty for part II examination. CPT codes were used to place the cases into different categories. Descriptive and statistical analysis were performed to evaluate the change in the practice of pediatric orthopaedics over the past decade.

Results: ABOS part II applicants performed 102,424 pediatric cases during this period. In total, 66,745 (65%) cases were performed by nonpediatric surgeons and 35,679 cases (35%) by pediatric surgeons. In total, 82% of the pediatric cases were done by adult surgeons in 2004 which decreased to 69% in 2009 and to 53% in 2014 (r=0.8232, P=0.0019). In pediatric sports medicine, pediatric orthopaedic surgeons performed 7% of the cases in 2004 which increased to 14% in 2009 and to 28% in 2014 (300% increase from 2004). Pediatric surgeons also increased their share of pediatric trauma cases. In total, 12% of lower extremity trauma cases were attended by pediatric surgeons in 2004 compared with 47% in 2014 (235% increase from 2004). In upper extremity trauma, pediatric surgeons increased their share of the cases from 12% in 2004 to 43% in 2014 (175% increase from 2004).

Conclusions: Over the past decade, pediatric orthopaedic specialists are caring for an increasing share of pediatric cases. Pediatric trauma, pediatric spine, and pediatric sports medicine have seen the greatest increase in the percentage of cases performed by pediatric orthopaedic surgeons.

Level of Evidence: Level III.

*Washington University School of Medicine, St. Louis, MO

University of Souther California

Children’s Hospital of Los Angeles, Los Angeles, CA

§Nemours Children’s Hospital, Orlando, FL

Vanderbilt University Orthopedics, Nashville

Campbell Clinic, Memphis, TN

#Upstate Orthopedics, Syracuse, NY

**Children’s Hospital of Philadelphia, Philadelphia, PA

No funding was received by authors and their institutions for this work.

The authors declare no conflicts of interest.

Reprints: Pooya Hosseinzadeh, MD, Washington University School of Medicine, Pediatric and Adolescent Orthopaedic Surgery, Washington University Orthopaedics, One Children’s Place, Suite 4S60, St. Louis, MO 63110. E-mail:

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