Orthopedic "Scope of Practice"

[RocketSurgeon41]

Over the past few months I have started to develop an interest in Orthopedic Surgery, specifically joint replacement and general fracture repair (ORIFs, etc). After shadowing extensively, my interest has only grown. I'm a bit murky on the scope of practice regarding specific specialists in ortho surgery.

It is my understanding that a physician who has completed an Ortho residency may be considered a "General" ortho surgeon who reduces fractures (open/closed), splints, repairs damaged ligaments, etc. I have also seen many times the lists of orthopedic surgical fellowship-designated specialties that have included Foot/Ankle, Hand/UE, Pediatric, Trauma, Sports, Joint Replacement, spine, and perhaps a few others.

My question is, are hand/UE or joint replacement procedures for example, reserved for those who have completed fellowships in those areas? Or can a "General" ortho surgeon perform a hip replacement? And the reverse of that, are hip/knee specialists restricted to only performing replacement procedures? Or do they also tend to general fractures, trauma, etc on days where no replacement procedures are scheduled.

If I sound totally ignorant, It's because I am, and I apologize. Only seeking to learn! Thanks for the time and help!

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[OrthoTraumaMD]

An orthopedic surgeon (barring spine, which not all hospitals grant in terms of privileges unless you have experience doing it) is allowed to perform any procedure he or she wishes. Whether they should is another story. Most hospitals will look askance at a joints guy doing complex hand stuff. But no, nothing would stop them from that from a legal standpoint.

 

[RocketSurgeon41]

An orthopedic surgeon (barring spine, which not all hospitals grant in terms of privileges unless you have experience doing it) is allowed to perform any procedure he or she wishes. Whether they should is another story. Most hospitals will look askance at a joints guy doing complex hand stuff. But no, nothing would stop them from that from a legal standpoint.

Thanks so much for your explanation, makes it a bit more clear!

 

[spartywrx]

A generalist will commonly do most all orthopedic procedures. The more rural you get the more likely it is they do everything. Most generalists do not do spine anymore, that ended in the 1990s or early 2000s and if you want to do spine you would do a fellowship to get credentialed at your hospital.

A generalist's weekly schedule of cases would likely be THA, TKA, rotator cuff, ACL, carpal tunnel, and some hip fractures or ankle fracture ORIFs.

 

[RocketSurgeon41]

A generalist's weekly schedule of cases would likely be THA, TKA, rotator cuff, ACL, carpal tunnel, and some hip fractures or ankle fracture ORIFs.

Oh, I wasn't aware of that. Is that likely to be the case in a rural setting only? Or do urban generalists have similar variety? I was under the impression that THA and TKA procedures were reserved specifically for joint specialists, and generalists ha doled non-specialty procedures only. But from what you're saying I assume that it's more favorable to go to a specialist for a joint replacement, but they don't have a monopoly on those procedures. From what you're describing, if I was to be fortunate enough to match into ortho, I'd love be to be a generalist. The variety in cases seems very appealing.

 

[OrthoTraumaMD]

Urban generalists have similar variety. Joints is something every general person does. It's the most common procedure actually--- the bad revisions then get sent to the specialty joints guys. But the term "urban generalist" is an oxymoron-- if you're practicing in a large city, chances are you have to specialize.

 

[VincentAdultman]

Yeah the general Ortho guys are usually in rural areas (I am one). In the city/suburbs multispecialty groups consisting of fellowship trained surgeons dominate.

 

[bat28]

There is a difference in what you are proficient in performing and what you are "able" to perform. Legally, you can perform any surgery. From a malpractice insurance and hospital privileging standpoint- for a non-fellowship trained orthopod, you can typically do anything except spine. Now, every place is different-- they can credential you for specific subspecialties if they choose. (There is a surgery center outside phili that will only give hand surgery privileges to plastics/gen surgeons who have done a hand fellowship, but all orthopods).

The other issue is geographic-- if you practice in an area with a lot of options (many surgeons), it can be more difficult to find a job or build a practice without fellowship training. That is very market dependent though. There are general ortho guys that have successful practices in cities (Philadelphia), but it is less common.

Essentially, you should finish residency being proficient in most total joint procedures, trauma, basic hand procedures, sports (knee/shoulder arthroscopy) etc. Fellowship allows you to improve in one area, but lack of fellowship does not typically limit which of those services you choose to offer. You can be an outstanding surgeon in any subspecialty, fellowship or not.

 

[bruins08]

there is no such thing as a generalist in an urban center

 

[OrthoTraumaMD]

there is no such thing as a generalist in an urban center

That's not actually true. I work with several of them. It's just rarer than the "specialty" orthopod.