The Current Practice of Orthopaedic Oncology in North America

Abstract

This information can assist the fellowship directors and related professional societies in tailoring their educational programs and the interested orthopaedic resident to make a more informed career choice.

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

“…In our experience, much of the emphasis in the orthopaedic oncology workforce and educational issues is focused on sarcoma treatment [1,15]. The results of this study emphasize that there is a significant need for the skills of an orthopaedic oncologist outside of sarcoma treatment and this must factor into these discussions.…”

“…For example, many limb salvage procedures are lengthier than arthroscopies or even most arthroplastys, which may skew the numbers. However, a direct comparison to established orthopaedic oncologists showed that early-career surgeons performed a median of 23 annual procedure on sarcomas, which is less than half of the 58 average annual sarcomas reported by the MSTS membership [15]. There are a number of possible explanations for the relatively low productivity in the group we surveyed.…”

“…An additional explanation may be that patients with sarcoma are preferentially choosing more seasoned practitioners and the number of patients with sarcoma who were treated will increase as a surgeon ages. The previous MSTS survey [15] was based on surgeon recall and not derived from actual case logs, so it is also plausible that there were overestimations regarding the number of sarcomas treated, and in reality, the gap is not so wide. Finally, it is possible that many of the current employment opportunities are in orthopaedic groups or geographic areas where there is an established oncology service, and the total number of sarcomas any one surgeon may treat is diminishing, which is potentially concerning because high volume has been linked to improved outcomes in some orthopaedic procedures [4,13].…”

“…A previously published survey of the general membership of the MSTS [15] was completed by the 15 study participants who submitted cases. The survey has not been formally validated but was designed by several orthopaedic oncologists to include questions most relevant to the clinical practice of orthopaedic oncology.…”

“…In a survey of the Musculoskeletal Tumor Society (MSTS) membership, White et al [15] reported that established orthopaedic oncologists spent an average of 71% of their clinical time practicing within the specialty, treating an average of 58 total bone and soft tissue sarcomas annually. Although this assessment can help define what an average tumor practice may look like, the survey reflected primarily established surgeons several years or decades into their career and it was based on surgeons' recall estimations of cases they performed, not actual case logs.…”