Session 19

Today, I'm going to do a deep dive into some match data for Orthopedic Surgery, which is one of the more competitive specialties out there. Let's look at the data to see if this holds true and find out who you can set yourself up for success early on if this is something you’re interested in.

In general, Orthopedic Surgery is a surgical specialty. It's a five-year residency with a lot of subspecialties after that. I had Dr. Muppavurapu to talk about being a hand surgeon back in Episode 05 and he talked about the many other things you can do like joints, spine, hand, and so much more. Today we're going to talk generically about ortho residency matching as a medical student.

[02:55] Number of Programs, Spots, U.S. Seniors

NRMP is the MD application. (If you're reading this way in the future, words like ACGME and AOA won't really mean much because the MD and DO residency programs will have merged assuming all goes well as planned out for 2020.)

Looking at Table 1 for the NRMP Results and Data 2016 Main Residency Match, there are 163 programs in the country for orthopedic surgery. Just to give you an idea of the number of programs for other specialties, Anesthesiology had 119 PGY-1 spots and 77 PGY-2 spots, a total of 196 compared to 163 for Orthopedic Surgery. Neurosurgery had 105 programs, Emergency Medicine had 174 programs. This somehow gives you an idea of how many programs are out there for Orthopedic Surgery.

Another important number to look at here is the number of spots available. Orthopedic Surgery had 163 programs with 717 different spots available so that's average of 4.398 spot per program. Comparing to other programs, Emergency Medicine had only 11 more programs but more than double the number of spots offered.

Out of the 63 programs for Orthopedic Surgery, none of the programs went unfilled. Many residency programs here had 100% fill rate so it's not unusual but again, an important thing to keep in mind.

As you think about your specialty, how competitive is it for you to match into? How spots are going to be available? If you don't match for some reason, can you do the Supplemental Offer and Acceptance Program (SOAP)? Can you find an open program? For something competitive like Orthopedics, you probably won't be able to find one and it's going to be much, much harder for programs that typically go completely filled.

There were 717 available spots while there were 1,058 total applicants. 874 of those were U.S. Seniors. Note that the number of U.S. Seniors applying are even more than the spots offered. Out of the number of students that matched, 650 were U.S. Seniors. That means U.S. Seniors make up 90.6% of students that matched into orthopedic residency. U.S. Seniors here are allopathic U.S. Seniors (students at MD Programs).

Ortho do not have any programs that match directly into PGY-2 positions. They are all categorical spots where you apply for ortho, you do your internship right there in that one program for five years.

[07:25] Allopathic and Osteopathic Students

There is always this DO versus MD "competitiveness" going on in the premed world. Here is where there is some bias among residencies. Orthopedic Surgery has been known historically as one of the biggest residency programs out there that has some negative bias towards DOs.

NRMP Match Data Table 2 shows matches by specialty in applicant type and looking at Orthopedic Surgery with 717 positions, 717 filled, 650 were U.S. Allopathic Seniors, 49 were U.S. Grads (this refers to those who either took some time off and didn't apply during the normal time you're supposed to apply to residencies or maybe didn't match the first time, went and got some research opportunities and ended up matching after graduating), and only 4 of the 717 were osteopathic students. That is just about half of 1%.

Compared to other specialties, Anesthesiology seemed very favorable to DO's with osteopathic students comprising 14.4% of all that matched. While in Emergency Medicine, 11.8% of those that matched in the filled spots were osteopathic students. Apparently, Orthopedic Surgery stuck with the the tried and true position of not being very "DO friendly."

Remember that osteopathic schools and students can apply to osteopathic residencies and you can also apply to the MD residencies which accounts for the number of osteopathic numbers on the NRMP (allopathic) data. But in the osteopathic world, there are orthopedic surgery residencies. Therefore, don't think that just because you only got into an osteopathic school that your chances of getting into an orthopedic surgery residency are going to be slim to none.

Based on the AOA Match Data for 2016, there are 40 Orthopedic Surgery programs in the osteopathic world, with 121 positions, 118 were filled, 3 went unfilled. In the MD world, it's highly unusual to have unfilled orthopedic spots.

[11:06] Growth, Positions Filled, U.S. Seniors and All Applicants

NRMP Match Data Table 3 shows the growth of each of the specialties over the period of five years (2012-2016). Orthopedic Surgery is among those growing at a good pace around 2.5% each year. With 682 spots in 2012, it has grown to 717 in 2016 which suggests a pretty steady growth. This is good for you especially if you're thinking about Orthopedics since it means there are more and more spots offered.

The data in Table 7 confirms how Orthopedic Surgery is usually a specialty that doesn't go unfilled. There were no available spots in 2016, 2015 and 2012, only 2 spots in 2014, only 1 spot in 2013.

Looking at Table 8, it shows the Positions Offered and Percent Filled by U.S. Seniors and All Applicants (again, U.S. Seniors being MD Seniors that have graduated from an MD school).

In 2012, 94% of those offered a position consist of U.S. Seniors. This percentage dipped to 91.9% in 2013 and went back up to 93.4% in 2014, and 94.3% in 2015, and then dropped down further to 90.7% in 2016. This tells us that there are a lot of students who are non-U.S. Seniors filling these spots. They could be international medical graduates or U.S. grads that were not Seniors who are people that have taken some time off.

[14:15] PGY-1 for All Applicants and Osteopathic Students and Unmatched Students

Table 9 shows the percentage of applicants that have matched to a PGY-1 spot in each specialty compared to the whole. Anesthesiology is at 4%, Emergency Medicine with 7.1%, Family Medicine 11.5%. Orthopedics is 2.7% which is pretty small compared to some of the bigger ones like Family Medicine, Internal Medicine, and Pediatrics. Even Psychiatry is pretty big at 5.1%.

For the Osteopathic students looking at the NRMP Match Data Table 11 shows the percentage of students that are osteopathic graduates that matched into Orthopedics with only 0.2% of all osteopathics students that matched did match into Ortho that means only 0.05% osteopaths matched into a spot. And comparing this to the bigger programs, Anesthesiology at 6.4%, Emergency Medicine at 9.3%, and Family Medicine at 15.9%. Again, it is very hard for an osteopathic student into a MD orthopedic surgery residency.

NRMP Match Data Figure 6 shows the percentages of unmatched U.S. Seniors and independent applicants who ranked Ortho and other specialties. 25.1% of all those that applied to Orthopedic Surgery went unmatched, 20.8% were U.S. Seniors, 56.6% were unmatched independent applicants (the DOs and international medical grads). As a non-US allopathic medical school grad, it's very hard to match into an allopathic orthopedic surgery residency.

[17:05] Charting the Outcomes for U.S. Allopathic Seniors

Looking at the data found in NRMP Charting the Outcomes 2016, Table 1 breaks down the number of applicants per position for Orthopedic Surgery. With 717 positions offered and 1,034 applicants, there were 1.4 applicants per position. Outside of four other specialties, Orthopedic Surgery is the most competitive. Dermatology is last at 1.4, General Surgery at 1.49, Psychiatry at 1.54, and Vascular Surgery at 1.91. This goes to show how Orthopedic Surgery is a highly competitive residency.

Chart 4 shows the Median Number of Contiguous Ranks of U.S. Allopathic Seniors. This is the ranking of how many programs they've ranked, they've matched and didn't match. And this is always one of the biggest question marks if you don't match into a residency, which is: Did you apply to enough spots? The answer is usually no. This is very similar to medical school application where if you didn't get it, you'd have to ask yourself if you applied to enough schools to increase your odds.

For Orthopedic Surgery, the median number of contiguous ranks was 12. Those that did not match was only 6. So if you only ranked half of those that matched, then you'd have a much better shot at not getting in.

[19:15] USMLE Step 1 Scores, Research Experiences, and AOA

If you're a medical student getting ready to study for the Boards or if you're in your first year and just preparing, we are launching a Step 1 Level 1 Board Review Podcast called Board Rounds in the next couple of weeks so stay tuned for that! Subscribe to it now.

Charting the Outcomes 2016 also shows the USMLE Step 1 scores for U.S. Allopathic Seniors. For Orthopedic Surgery, it's at the top spot with some of the other more competitive specialties with those that matched averaging at 248-250 and those that did not match were right there on 240. Therefore, you need to do well on Step 1 to match into Ortho.

One of the misconceptions about Orthopods is them being dumb jocks but that's not true of course. You need to get really great board scores to get into Ortho and research experience doesn't lack either. Based on Chart 8, the mean number of research experiences is 4 for those that matched and 8 for those that did not match. So if you're interested in Orthopedics, do some research as it seems important based on this data.

Chart 12 shows the percentage of U.S. Allopathic Seniors who are part of AOA (Alpha Omega Alpha), the honor medical society that highlights the students who do well the first couple years of medical school. For Orthopedic Surgery, 34% of those that matched are AOA students while 12% for those that did not match. The takeaway here is to start off medical school doing really very well so you can try to get AOA.

[21:47] Medscape Lifestyle Report 2017

The Medscape Lifestyle Report 2017 presents data on burnout, bias, race, etc. Orthopedic Surgery is in the bottom half of the burnout chart at 49%. Yes, this is still a lot but this is the bottom half of the chart. The biggest takeaway is that a lot of physicians are burned out and Orthopedics is one of the least, which is good.

How severe is the burnout? Orthopedic Surgery is in the lower half of the chart.

Which physicians are the happiest? Orthopods make up the top half with 37% saying they're happy at work and 71% saying they're happy outside of work. This is another pretty good data compared to the rest.

[23:00] Medscape Physician Compensation Report 2017

Looking at the recently updated Medscape Physician Compensation Report 2017, Orthopedics is at the top of the list for most compensated physicians with an average annual compensation of $489,000. If you're interested in Orthopedics then you will probably make a very good income which is well-deserved. And this is up 10% from last year.

Only 48% of Orthopods feel fairly compensated and this is strange considering they're the highest paid of all the specialties. 79% of Orthopods say they'd choose Medicine again, and unsurprisingly, 95% of Orthopods say that they'd choose Orthopedics again. In general, Orthopods are pretty happy with their career choice.

[24:29] My Final Thoughts

I hope this helped you get some clarity with Orthopedics Surgery if this is something you're interested in. I hope you're also pretty early on in your journey because as I've mentioned, research is necessary and you need to do well on Step 1 as well as try to get AOA. Therefore, you need to start setting yourself up for success as soon as you can.

Links:

NRMP Results and Data 2016 - Main Residency Match

AOA Match Data for 2016

NRMP Charting the Outcomes 2016

Medscape Lifestyle Report 2017

Medscape Physician Compensation Report 2017

Board Rounds Podcast

SS 05: What Does the Life of an Orthopedic Hand Surgeon Look Like?

NRMP

ACGME

AOA

Supplemental Offer and Acceptance Program (SOAP)

AOA (Alpha Omega Alpha)