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How Much Tumor Surgery Do Early-career Orthopaedic Oncologists Perform?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 25 October 2014

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.

Questions/purposes

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.

Level of Evidence

Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA, 52242, USA

    Benjamin J. Miller MD, MS

  2. Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA

    Rajiv Rajani MD

  3. Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA

    Lee Leddy MD

  4. Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA

    Emily E. Carmody Soni MD

  5. Department of Orthopaedics and Rehabilitation, University of Oklahoma, Oklahoma City, OK, USA

    Jeremy R. White MD

Authors
  1. Benjamin J. Miller MD, MS
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  2. Rajiv Rajani MD
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  3. Lee Leddy MD
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  4. Emily E. Carmody Soni MD
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  5. Jeremy R. White MD
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Consortia

The Musculoskeletal Oncology Research Initiative

Corresponding author

Correspondence to Benjamin J. Miller MD, MS.

Additional information

The Musculoskeletal Oncology Research Initiative included: Benjamin J. Miller MD, MS, University of Iowa, Iowa City, IA, USA; Rajiv Rajani MD, University of Texas Health Science Center, San Antonio, TX, USA; Lee Leddy MD, Medical University of South Carolina, Charleston, SC, USA; Emily E. Carmody Soni MD, University of Rochester, Rochester, NY, USA; Jeremy R. White MD, University of Oklahoma, Oklahoma City, OK, USA; Aditya V. Maheshwari MD, SUNY Downstate Medical Center, Brooklyn, NY, USA; Cynthia L. Emory MD, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; David D. Greenberg, MD, St Louis University, St Louis, MO, USA; Kevin M. MacDonald MD, Virginia Mason Medical Center, Seattle, WA, USA; Raffi Avedian MD, Stanford University, Redwood City, CA, USA; Tessa Balach MD, University of Connecticut, Farmington, CT, USA; Kurt R. Weiss MD, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Yee-Cheen Doung MD, Oregon Health and Science University, Portland, OR, USA; Judd E. Cummings MD, University of Arizona, Scottsdale, AZ, USA; and Jonathan A. Forsberg MD, Walter Reed National Military Medical Center, Bethesda, MD, USA.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Iowa, Iowa City, IA, USA.

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Miller, B.J., Rajani, R., Leddy, L. et al. How Much Tumor Surgery Do Early-career Orthopaedic Oncologists Perform?. Clin Orthop Relat Res 473, 695–702 (2015). https://doi.org/10.1007/s11999-014-3934-x

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  • DOI: https://doi.org/10.1007/s11999-014-3934-x

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