Most orthopaedic trainees undertake fellowships to land a consultant post

Nearly all orthopaedic trainees have undertaken at least one fellowship to help them compete for the limited number of consultant posts, a survey of 176 senior members of the British Orthopaedic Trainees Association has found.1

The survey found that 42% of respondents had completed one fellowship, 41% had completed two, and 11% had completed three or more. Only 6% had not undertaken any fellowships.

When applying for consultant posts, applicants ranked their fellowship experience as the most important aspect of their CV, over operative experience, research, and subspecialty qualifications. A third of respondents saw their fellowship as an important stepping stone to becoming a consultant.

Orthopaedic and trauma surgery is one of the most competitive specialties. The total number of consultant positions advertised in 2012 is expected to be 160. The British Orthopaedic Trainees Association’s survey found that 84 (58%) of the 145 respondents who were able to respond to the question about appointment to a consultant post had not yet been appointed despite most having done at least one fellowship. However, 25% of respondents had been appointed within six months, 10% between six and 12 months, and 6.5% between one and three years.

Tim Briggs, vice president elect of the British Orthopaedic Association, expects that doing a fellowship will become more and more important. “The best of the best will gain these transitional fellowships which will help them in getting the consultant job that they want,” he said. “Fellowships will enhance surgical skills and develop the managerial side of what you need in consultant practice.”

The association is lobbying to boost the number of orthopaedic surgeons in the NHS from a current ratio of one consultant for every 27 700 of the population to one consultant per 15 000 of the population over the next 10 years.

The authors of the survey claim that their results “highlight issues with workforce planning and a lack of insight into the demands of an ageing population. It seems unlikely that this situation will change, and it may even be exacerbated over the coming years.”

Briggs said, “By 2031 15.3 million of the population will be over 65, patients are living longer, and we are seeing an increase in musculoskeletal disease. There is going to be an avalanche of it over the next 10-15 years, and we’ve got to be ready for it.

“The BOA [British Orthopaedic Association] has been very focused on this and is ahead of the game compared with many other specialties in creating these accredited fellowships to try and enhance training,” he added.

The British Orthopaedic Trainees Association’s survey also found that the majority of respondents (75%) had begun their first fellowship before obtaining their certificate of completion of training (CCT) and that 37% had begun a second fellowship before reaching CCT status. However, the authors say that the “jury is still out” on whether all fellowships should be completed after the CCT is achieved.

Briggs added: “I have 60 trainees, and I will not allow my trainees to go on fellowships before they’ve got their CCT, but I believe they need to go on fellowships to consolidate the training they’ve had before applying for a consultant post.”

Two thirds (68%) of fellowships held by members of the British Orthopaedic Trainees Association were located in the UK or the Republic of Ireland, with 16% in Australia and 8% in Canada. The most popular focus for subspecialty fellowships was arthroplasty (20%), followed by shoulder and elbow (18%), knee (16%), and foot and ankle (14%).