Current State of Fellowship Hiring: Is a Universal Match Necessary? Is It Possible?

Currently, approximately ninety percent of the six hundred twenty graduating orthopaedic residents are planning on entering a post-graduate fellowship. Since January of 2005, two of the largest fellowship match programs, Sports Medicine and Spine Surgery, were dissolved by the NRMP due to the gradual decline in participation, leaving approximately seventy percent of applicants in a non-match, decentralized system. This leaves Hand Surgery, Shoulder and Elbow, and Foot and Ankle as the only three orthopaedic subspecialties still in some match program. This has created an extremely complicated hiring environment for all residents. This paper focuses on the current state of fellowship employment and hiring in orthopaedic surgery, on the likely effects of reinstituting a match, and on how this might be accomplished. For this purpose, we present the results of surveys we conducted of fellowship directors and residents, discuss how the present market for orthopaedic surgery fellows resembles the market for medical residents prior to the introduction of the NRMP, and discuss how another fellowship market has successfully reinstituted a match after experiencing a comparable failure.