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The Spine Blog

Friday, May 8, 2020

Who becomes a spine fellowship director?

Spine fellowship directors have a major role in the professional development of the surgeons they train. As a result, they have a significant influence on the overall field as they mold the next generation of spine surgeons. In order to understand the field of spine surgery, one must study the process through which spine surgeons are educated, as this process passes along the knowledge, technical skills, and culture that define the subspecialty. Dr. Donnally and colleagues from Thomas Jefferson University and the University of Miami sought to determine the educational and professional characteristics of spine fellowship directors. They used the NASS Fellowship Directory to identify 103 fellowship leaders and then contacted them in order to obtain their CVs. When this was unsuccessful, they used on-line resources to obtain data. They found that 96% of fellowship leaders were male, with an average age of 53. The mean duration of time in the position was about 10 years, indicating that fellowship leaders were promoted to the position at an average age of 43. Interestingly, about 25% of fellowship leaders completed fellowships at one of three institutions:  Case Western Reserve (10), Washington University (9), and Thomas Jefferson University (7). The mean Scopus H index was 23.8, substantially higher than the mean reported for spine surgery fellowship faculty overall (13.6) by a prior study.1 About 20% of fellowship directors had been on the Board of Directors of either NASS, CSRS, or SRS.

This is a novel study looking at the relatively unstudied topic of leadership in spine surgery education. While scholarly interest in orthopedic residency education has increased over the past decade, very little has been written about subspecialty fellowship education. Spine fellowship training lasts only one year, however, this year likely has a disproportionately large influence on the development and practice patterns of spine surgeons. This paper was a simple cross sectional survey of fellowship leaders, and it had some methodological limitations. The authors did not report how many fellowship leaders actually supplied them with their CVs, so we do not get a sense of how much missing data were present. In some ways, the paper just scratches the surface of the issue and does not address the deeper questions such as what personal and leadership qualities do fellowship directors possess. The results do highlight the homogeneity and lack of diversity in the field. Very few fields remain over 95% male, though this will likely change slowly over time as more female spine surgeons are trained. The authors did not ask the fellowship directors to report their race, though there is likely a lack of racial diversity in this cohort as well. Just as important, and possibly more striking, is the lack of educational diversity among the fellowship leaders. The outsize influence of a few institutions in training future fellowship directors may limit the diversity of thought in the field. There is a large body of spine surgery dogma passed along from one generation to the next, oftentimes with very little evidence supporting it. This study offers some interesting insights about the characteristics of spine fellowship directors. To truly understand who these people are and how they got there would require a deep sociological dive.

Please read Dr. Donnally's article in the May 15 issue. Does this change how you view the role of spine fellowship directors?

Adam Pearson, MD, MS

Associate Web Editor


1.            Schoenfeld AJ, Bhalla A, George J, Harris MB, Bono CM. Academic productivity and contributions to the literature among spine surgery fellowship faculty. Spine J 2015;15:2126-31.