title: Graduates of Orthopaedic Residency Training Are Increasingly Subspecialized: A Review of the American Board of Orthopaedic Surgery Part II Database.
abstract: BACKGROUND
  Orthopaedic fellowships first gained popularity in the U.S. in the 1970s, and since that time, the percentage of orthopaedic residency graduates pursuing subspecialty fellowship training has increased. Prior reports have shown an increase in subspecialization from 1988 through 2002; however, the current number and proportion of graduates pursuing fellowship training since 2002 are unknown. The purpose of this study was to determine the percentage of recent graduates who pursue fellowship training and the proportion of procedures that these graduates perform within their area of fellowship training.
  
  
  METHODS
  Data from the American Board of Orthopaedic Surgery Part II examination for board certification were used to determine the number and percentage of fellowship-trained and non-fellowship-trained applicants from 2003 to 2013. The percentage of cases performed by fellowship-trained applicants within their area of fellowship training was calculated and was analyzed as a function of time and a function of fellowship training category. Linear regression was used to determine trend as a function of time.
  
  
  RESULTS
  The percentage of fellowship-trained applicants increased from 76% in 2003 to 90% in 2013. Of the 1,257,161 procedures performed by fellowship-trained applicants, 981,077 (78%) were performed within the surgeon's area of fellowship training. Spine and hand-trained applicants performed more than 85% of their procedures within their area of fellowship training.
  
  
  CONCLUSIONS
  From 2003 to 2013, the percentage of fellowship-trained applicants taking the American Board of Orthopaedic Surgery Part II examination gradually increased to 90%. In the same time period, fellowship-trained surgeons performed an increasing proportion of procedures within their area of subspecialty training. Orthopaedic graduates have become increasingly subspecialized over the past decade.
authors.affiliation: Department of Orthopaedic Surgery, University of California at San Francisco, Box 0728, MU-320 (P.K.H., K.C., and N.B.) and MU-3326W (T.P.V.), 500 Parnassus Avenue, San Francisco, CA 94143.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Horst
authors.affiliation: Department of Orthopaedic Surgery, University of California at San Francisco, Box 0728, MU-320 (P.K.H., K.C., and N.B.) and MU-3326W (T.P.V.), 500 Parnassus Avenue, San Francisco, CA 94143.
authors.forename: Kevin
authors.initials: K
authors.lastname: Choo
authors.affiliation: Department of Orthopaedic Surgery, University of California at San Francisco, Box 0728, MU-320 (P.K.H., K.C., and N.B.) and MU-3326W (T.P.V.), 500 Parnassus Avenue, San Francisco, CA 94143.
authors.forename: Neil
authors.initials: N
authors.lastname: Bharucha
authors.affiliation: Department of Orthopaedic Surgery, University of California at San Francisco, Box 0728, MU-320 (P.K.H., K.C., and N.B.) and MU-3326W (T.P.V.), 500 Parnassus Avenue, San Francisco, CA 94143.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Vail
mesh_terms: D004503:Education, Medical, Graduate / Q000706:statistics & numerical data / Q000639:trends*; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007396:Internship and Residency; D009985:Orthopedics / Q000193:education* / Q000706:statistics & numerical data; D013038:Specialization / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States