Ummmm, I'm gonna have to go ahead and disagree there. The sports fellowship trained guy who only does "basic knee and shoulder scopes" and then refers a tendon transfer probably is not realistic. If you are sports trained, then you are trained to deal with *complex* sports related issues. Any general orthopod can perform "basic scopes." In fact, most general guys are not going to refer an ACL or rotator cuff out to the sports guy. Why should they? That's straight cash, homey. Just like it doesn't take a fellowship trained adult recon guy to do a primary knee or hip. A general guy usually would not refer that out either.
I think it's a bit misguided to thing community = simple and wide variety and academic = complex and narrow scope. I think that's a gross generalization. I think your type of practice basically depends on what you want to do and what you are comfortable with. It also depends on your location as well.
If you live in a rural area, well, then you will have to be prepared to do a wide variety of things. From fracture work to scopes, basic hand, peds, whatever. You would probably send super smashed articular stuff or pelvises or complex total joint revisions, but your patients will get bitter if you send them to the city for anything "not within your subspecialty".
Likewise, if you live in a big city and you're hoping to have a sports only or joints only practice that might not be feasible unless you are in an academic setting or in a multispecialty group and you're set up as "the joints guru" or "the spine guy" then great. Otherwise, you may have to do cases outside of your fellowship to keep the lights on.
Once again, it depends what kind of practice you want and the market forces where you are. Ideally, residency prepares you to do everything. Now, that may not be reality and some guys may only want to do cases for which they are fellowship trained. It usually accurate to say academic guys do whatever they are specialized in. Private guys may do a wider variety of cases, but some private guys are in a large multi-specialty group setting and they can have a specialized practice.
I can't see rural guys with a narrow scope, as this won't allow them to make money. I say that, however I know a former sports fellowship program director who moved out to rural Colorado and only does sports. There are exceptions to every gross generalization.
