Please let me complete the picture here. In the US, most Ortho residents match into Ortho out of medical school, into a 5-year, ACGME accredited, "categorical" program. The first year of training (internship) is usually 1/2 general surgery, 1/4 ortho, and 1/4 rotations in ER, Rheumatology, Radiology, Anesthesia, Medicine, and/or other relevant specialties. The subsequent four years are devoted to orthopedics. Progression is assumed unless the resident fails to meet basic criteria.
Applicants who do not match in Ortho often accept "preliminary" general surgery positions (as opposed to 5-year categorical general surgery spots). These one-year internships are ACGME accredited. Interns in "preliminary" spots can then apply to start as 2nd year residents in Ortho, or any other surgical specialty of their choosing (including general). Sometimes, they are accepted into first-year positions which require that they repeat intern year. Sometimes they apply in Ortho, but do not match.
Applicants who fail to match in Ortho after completing a general surgery internship (whether "preliminary" or "categorical"), have a very tough choice. They can give up the Ortho dream and pursue an alternative career, they can accept a research position in the hope of improving their application, or they can look for non-categorical orthopedic training positions.
I know of 2 types of non-categorical clinical orthopedic positions:
(1) At Lenox Hill, we offer a "house officer" position. House officers at Lenox Hill are treated as PGY-2 residents. They are given all the responsibilities and all the opportunities that the PGY-2 position entails. Their experience is identical to that of categorical PGY-2 residents. At the end of the year, they are able to accept categorical PGY-3 positions (meaning that the duration of their training may be no longer than that of applicants who matched in Ortho earlier in their careers). Most house officers apply for PGY-1, PGY-2, and PGY-3 ortho spots in order to maximize their chances of matching. Lenox Hill house officers usually accept PGY-2 or PGY-3 spots.
(2) As there are more clinical/research fellowships in the Orthopedic specialties than there are qualified graduates of domestic residency programs, some fellowship programs will accept applicants who have not completed (or even started) a residency. This does not count towards the 5-year training requirement, but it does allow the prospective Ortho resident the opportunity to learn Ortho and impress a respected Ortho attending enough to hopefully secure a spot the next time around. I do not know which fellowships do this, but a discussion with your local program director (or a post on the board) may help you learn about this type of opportunity.
I hope this information is useful.
To those applicants interested in the house officer position at Lenox Hill, please be advised that the position has been filled for the 2007-2008 academic year. The position has occasonally become vacant mid-year in the past. This can occur if the house officer is accepted into a categorical position that becomes open mid-year. For this reason, qualified applicants should periodically contact Pat Kennemur in the Department of Orthopaedics (212) 434-2710 to express continued interest.
