Hand versus Shoulder & Elbow

[shandy]

How do you advise residents who want to focus on the upper extremity, but are struggling with the decision on fellowship applications of hand versus shoulder & elbow? There seem to be fewer and fewer "upper extremity" fellowships.

I've heard some say it boils down to whether you like microscopy or arthroscopy, but is that really true? Is it unreasonable in this day and age to expect to find a practice in a moderate-large sized city and truly practice from the plexus to the fingers?

Finally, I've heard through the grapevine that shoulder and elbow jobs are few and far between at this point. Anybody willing to share their first hand experience out there?

Thank you in advance.

[jyc3274]

If you are interested in plexus to the finger tips, my advice is to do two fellowships; one in shoulder surgery, then in hand and microvascular. I think the extra year will be worth it to you, especially if you want to be in the city. Usually pretty competitive markets. I don't think that you can get adequate training in hand or shoulder with a hybrid one year fellowship. For me, did a ASES fellowship. The job market was/is actually very good for shoulder surgeons. Every group wants one because of the stuff that others can't do.

[pantel]

Can anyone make comment to the programs for ASES match. I have not seen a post regarding ASES fellowships and just wanted to get some folks opinions

Thanks

[pantel]

Bump

[wnlevine]

What information would be helpful?

thx

wnl

[pantel]

Just wanting to see the opinions of folks that went through the interview process. Which programs stood out to them during the interviews. Also, roughly how many residents apply for ASES fellowships each year and how many go unmatched. Do you have an opinion on the new universal application to be used this fall for the ASES match?

Thank you again for your input into this forum, it has been very beneficial over the years.

[wnlevine]

For the ASES 2011-2012 Match (some of this data was obtained via post-match survey monkey sent to all applicants:

1. 22 programs with 36 fellowship positions

2. 51 applicants

3. All 36 fellowship positions filled through the match (i.e. no "scramble")

4. 15 unmatched applicants

5. 22/36 (61%) matched at their 1st or 2nd choice

6. Of those residents who matched - the mean # of programs that they interviewed was 8

7. Of those residents who did not match - the mean # of programs that they interviewed was 7

8. Mean # of programs applied to by the applicants
0-5 13%
5-10 40%
>10 47%

9. # of residents also considering the AOSSM match
Yes 17%
No 83%

The Universal application was introduced this year in direct response to feedback from the resident applicants over the last several years. It should simplify the process of course.

I hope this provides useful information --

good luck

wnl

[shulder]

15 unmatched applicants is surprising

Dr Levine

Would you have any break up of above stats if they were all US graduates or few were IMG's as well

appreciate your response

Thanks

[wnlevine]

I am sorry but I do not have the breakdown of the 15 who did not match.

wnl

[gms]

anyone w/ any experience going through the match, or even prior to match process being started, in shoulder and elbow? looks somewhat competitive and i'm a yr away from having to make a decision on fellowships. not much info out there on these fellowships and what they might be looking for in an applicant.

thanks

[8049ers]

I was interesting seeing the stats that were posted above. Particularly #9:

9. # of residents also considering the AOSSM match
Yes 17%
No 83%

A couple questions:

Do fellowship programs know that applicants are applying to both ASES programs and Sports programs at the time of offering interviews or ranking applicants?

If so, are those individuals who are considering both ASES and Sports fellowships considered differently than those who are only applying to ASES programs (i.e. considered as being "not committed" to becoming a shoulder and elbow surgeons)?

Thanks in advance for you input and advice!

[wnlevine]

The ASES match is completed well before the AOSSM match has actually even begun. The ASES match list is due December 10th and the results will be distributed the following week. The AOSSM match is completed in April/May.

There are usually very few people who apply in both matches. Over the last 5 years, the only applicants who apply in both apply only to the Columbia fellowship since it is ACGME-accredited in Sports but is part of the ASES match. From our perspective it has never hurt an applicant's chances and they are considered on the usual merits not by which match they are applying to.

Hope that answers your question --

wnl

[orthoguy123]

For folks planning to do two fellowships - one in hand and one in shoulder/elbow - which fellowship area are you doing first?

[orthoguy123]

Anyone got any insight? Do you start proximal and work distal? Or is it just the opposite - distal to proximal?

[BonesAndGroans]

After going through hand interviews, I get the impression more programs are trying to be "total upper extremity". If you were unsure about doing two fellowships, I would do hand first and see how comfortable you are with your shoulder/elbow experience. I've also heard that job wise, hand trained guys are finding it easier simply because a pure shoulder/elbow practice is harder to fall into straight out of fellowship. Don't know how much truth there is to this. There aren't a bunch of spots anyway for the shoulder/elbow route and my guess is these guys aren't having much trouble finding work.