Top 5 Spine Fellowships

Thought this thread could use an updated perspective. Everyone's top five is going to be different, but here are my thoughts having recently gone through the process looking at the academic programs. These are the "top" places in my mind, in alphabetical order. Hopefully others will contribute their perspective.

Emory - Probably the best overall fellowship out there at the moment. Excellent cervical, degen, and deformity experience. Enough trauma, but not a ton. Big names include Heller, Rhee, Yoon and Boden. Fellows were without a doubt the most enthusiastic about their experience of any program in terms of operative autonomy and experience. Unmatched cervical experience with Heller and Rhee. Fellows also have a great lifestyle and good pay with supplemental Grady orthopaedic trauma call. Case load is enormous due to the efficient orthopaedic and spine hospital. Basic science and clinical research opportunities are there, particularly with Boden's lab if interested. Interview was a lot of fun, and you can definitely tell they are very proud of their tradition. Would have loved to have matched here.

Jefferson - Best trauma and degen experience out there. Came to this interview thinking it would be really high, but I felt it took a big hit with Todd Albert leaving for HSS (which was announced the day of our interview...). Fellows still seemed happy and had crazy autonomy. Jeff will remain a great fellowship as long as Vacarro is around, but losing Albert hurt them in my mind. Research opportunities were excellent.

Pitt - Another program that seemed to be near the top of everyone's list. Kang and Donaldson are excellent teachers and mentors. The operative autonomy afforded to the fellows was outstanding, but the faculty were still around to teach. Fellows were very happy and enthusiastic about their experience. Research factor was ok, not the best, but made up by the camaraderie between staff and fellows and operative experience. Great exposure to bread and butter degen spine, peds deformity, trauma. Not much in the way of adult deformity, which could be a good thing depending on your perspective (for me a positive). Pittsburgh was affordable, but boring if you are single. Really liked this program.

Rush - Rush has been and continues to be among the top programs in the country, it has just changed its flavor in recent years. The unique thing about the Rush fellowship is the minimally invasive experience. Frank Phillips seems to be the emerging big name here and between him and Kern Singh, the minimally invasive experience is unparalleled by the other top programs. Howard An seems to be slowing down. This and living in Chicago for a year were very appealing to me. Fellows seemed genuinely happy with the experience. Zero trauma exposure.

Wash U - Didn't interview here (conflicted with Pitt), but from all accounts this remains the place for adult deformity. They put out a ton of research and the cases are very complex. People I talked to on the trail were somewhat turned off by the effect of the "super fellow" and the high floor work load.

Honorable mention :

Leatherman - Very surprised by this interview. Great operative experience and autonomy. Big cases, including lots of deformity. Downside was possibly limited cervical experience (learn from neurosurgeons for the most part), fair amount of service-work (PGY-6 feel), and primary level-1 thoracolumbar trauma call Q4-5 (i.e. the ER has your pager # and all cervical trauma goes to neurosurgery), and no MIS. Research opportunities were much better than I had thought.

Stanford - Didn't interview here, but people I knew that did loved it.

NYU - Excellent deformity exposure, reasonable MIS, great research machine, wasn't sure about the fellow autonomy factor. No trauma exposure.

OrthoCarolina - Had to cancel this interview due to inclement weather, but heard a lot of people really liked it here. Great clinical experience with good lifestyle and pay (supplemented call). Limited trauma and deformity. Not a research powerhouse. Darden is a stand-up guy by all accounts.

Utah - Great all around exposure, good autonomy. Excellent degen, deformity, and trauma. No real MIS experience. Brodke is the man and would be a great mentor down the road.

I think as orthopaedic surgeons we relate very easily to the college sports rankings that pervade half the channels on my Direct TV, ESPN news, and just about everywhere else on my news feed. We are also, as a discipline, perhaps more competitive than others in medicine and have this pressing desire to define who is number one and top 5 and top 10 for this or that subspecialty. As you can see (even for college sports rankings) everyone's opinion is different and even more so on these forums as much of what is put out there is very subjective. There is no Street and Smith's or Sporting News for Residencies and Fellowships and a lot of what people pass on as dogma is mostly just word of mouth. I can't know how all fellowships compare against eachother, I only have my own experiences to draw on. Obviously, there are those more well-regarded then others and, in many respects, these reputations serve the trainee better in the academic setting than in private practice. I am not faculty at a fellowship program currently, so I am not trying to sell any of you on one program or another. This is just what I feel is a more objective way to approach this and present something that may be based on a balanced view of the fellowship field and not just repeated word of mouth or my own subjective opinion.
The Top 5 or what have you changes invariably based on the trainees goals, particularly since the fellowships have moved into a Match in recent years. If you plan on a career in private practice then the most important features are likely
1. Operative experience
2. Non-operative management of patients
3. Experiences related to operating in a private practice environment and nuances of running a practice.
If you are dedicated to an academic practice:
1. Operative experience
2. Non-operative management of patients
3. Research experience
4. Mentoring and career development opportunities

In terms of the operative experience, it is ideal to have a balance with exposure to a broad scope of clinical cases and surgical approaches balanced against the autonomy necessary to allow a fellow to develop into a practicing spine surgeon who is able to operate independently. If you plan to go into academic medicine, you will have to develop some skills in the research arena as your advancement will depend on academic as well as clinical productivity. Having valuable mentors who can create opportunities for you, even after you leave the fellowship program, are also a vital necessity - -particularly in the academic field. All fellowships are not the same in terms of these criteria and there is wide variation due to differences in accreditation vis what you see in residency. Also, as fellowships are largely proprietary (they depend more on the personalities in the program than the program themselves) fluctations can occur when an eminent personality departs and meaningful differences may develop in terms of the quality of the program over just a short period of time. When looking at programs taking into account what faculty is there now, who graduated from there and where have recent trainees landed, and what are the programs prospects in the next 2-3 years. For academic programs - look at the literature over the last few years and see who is publishing the high quality literature, look at faculty who are represented in the societies, presidential lines, etc. This, along with your impressions at the interview and ancillary considerations such as location, etc, clearly will play into how you rank the programs.

In terms of overall balance - covering most of the features I have postulated above - in the academic area I think it goes without saying that you have to include Jefferson, Rush and Wash U on the list, as well as Pitt, HSS and Harvard Combined (MGH/BWH).

For programs that are not necessarily affiliated with a medical school (and might be considered community programs by some) - I think Texas Back has to be near the top of the list for certain, and perhaps also Cedars Sinai and the Akbarnia fellowship in San Diego.

Interesting perspective, I interviewed at and didn't rank the MGH program, don't know anyone who considered it a top 5 program... Likewise, HSS is known for being largely an observational fellowship, although the recent addition of Todd Albert may change things if he isn't tied up with adminstrative duties as Chairman. Also, TBI is known for having aggressive indications for multilevel arthroplasty (that NASS has recently set guidelines against). Akbarnia has retired, but agree that 5-10 years ago that was a good spot.

Thanks much for the information. I'm applying to Spine next year and was wondering if anyone else would be willing to crack and provide some reviews on the West coast fellowships. We hear a whole slew of different things (much of which is outdated) and any additional reviews would be much appreciated! Thanks and best of luck to everyone this year.

Anyone from NYC has input on the autonomy of HSS vs NYU spine fellowship? what about adult deformity exposure at each institution?

mesocool wrote: Anyone from NYC has input on the autonomy of HSS vs NYU spine fellowship? what about adult deformity exposure at each institution?

anyone have any updates on more current information? what some of the current top 5 are?