title: How much tumor surgery do early-career orthopaedic oncologists perform?
abstract: BACKGROUND
  There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions.
  
  
  OBJECTIVE
  The aim of the study was to use the objective case log volumes of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations for individual participants, (3) individual practice characteristics that were associated with the number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's career and surgical practice.
  
  
  METHODS
  Fifteen fellowship-trained orthopaedic oncologists out of a potential pool of 33 (45%) in their first 4 years of practice responded to a survey by submitting complete operative case lists for a 2-year period. We recorded the type of procedure and determined associations between the annual number of tumor operations and total operative caseload, years in practice, and some details of individual practice patterns. Each participant completed a survey regarding practice-related sources of stress and satisfaction. A total of 5611 surgical cases were available for review. For the entire cohort, there were 3303 (59%) tumor procedures, 973 (17%) trauma, 890 (16%) adult reconstruction, and 445 (8%) other.
  
  
  RESULTS
  The median annual number of total operations was 214 (range, 63-356) and median annual number of tumor operations was 135 (range, 47-216). The median proportion of tumor operations in an individual practice was 56% (range, 43%-94%). The annual number of tumor operations correlated with the total annual number of operations (r = 0.73, p < 0.001). Sources of stress and satisfaction were similar to the general membership of the Musculoskeletal Tumor Society (MSTS), apart from more early-career surgeons regarding case volume as important (29 of 104 [28%] of MSTS versus 11 of 15 [73%] of early-career, p < 0.001).
  
  
  CONCLUSIONS
  The typical early-career orthopaedic tumor surgeon had fewer than 60% of his or her operative procedures directly related to the subject of his or her fellowship training in orthopaedic oncology. Overall, the challenges and rewards of clinical practice are similar to oncologic surgeons later in their career. This study is a first step in assessing early practice characteristics and may be of value to the prospective orthopaedic oncologist, fellowship educators, and the society in workforce discussions. Early-career practice patterns have not been previously presented, to our knowledge, for any subspecialty of orthopaedic surgery, and we hope that this study will stimulate similar efforts throughout the field.
  
  
  METHODS
  Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA, 52242, USA, benjamin-j-miller@uiowa.edu.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Miller
authors.forename: Rajiv
authors.initials: R
authors.lastname: Rajani
authors.forename: Lee
authors.initials: L
authors.lastname: Leddy
authors.forename: Emily E
authors.initials: EE
authors.lastname: Carmody Soni
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: White
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D002983:Clinical Competence; D006801:Humans; D007588:Job Satisfaction; D009985:Orthopedics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*