Factors Influencing the Decision to Pursue Multiple Fellowships Following Graduation from Orthopaedic Surgery Residency

Abstract

Among practicing orthopaedic surgeons, the population that self-identify as generalists has been declining for the past three decades, while sub-specialization has become more prevalent. As more residents are pursuing fellowship training, some elect to complete multiple fellowships, but due to a lack of research, there is a lack of insight into the reasons behind these decisions. The purpose of this study was to determine factors influencing the decision of orthopaedic surgery residents to pursue more than one fellowship following graduation from residency. An anonymous survey was distributed via email to all PGY-4 and PGY-5 orthopaedic surgery residents who had matched into one or more fellowships in the spring of 2021 and 2022. Responses were analyzed to determine the prevalence of different specialties, reasons for pursuing fellowship, and among those pursuing more than one fellowship, the reasons they chose to do so. 259 responses were collected from residents entering a fellowship, with 74 (28.6%) entering fellowships in the Midwest, 54 (20.8%) in the Southwest, 51 (19.7%) in the Northeast, 42 (16.2%) in the Southwest, and 32 (12.4%) in the West. 19 (7.3%) respondents reported matching into two or more fellowships. Among the fellowships pursued, sports medicine was most popular with 10 (52.6%) respondents; followed by shoulder/elbow (5; 26.3%). Out of all 259 respondents, 252 (97.3%) indicated their fellowship choices were based on interest, and 192 (74.1%) were also affected by marketability. Mentorship played a role for 173 (66.8%) and training in an area of deficiency was important for 149 (57.5%). Among those pursuing multiple fellowships, many combinations seem to have been made to decrease the time to breaking even on the financial investment involved in pursuing fellowships after residency. Most orthopaedic surgery residents elect to pursue fellowship training due to personal interest in the field, as well as to increase their marketability, and shorten the time to breaking even in comparison to the loss of compensation required for pursuing fellowship. Our results indicate that residents pursuing multiple fellowships are those interested in less marketable specialties, who then pursue a second fellowship with higher returns on investment, such as completing fellowships in pediatrics and sports medicine.