Why Do a Surgical Fellowship? Why Do Two?

November 3, 2015

After medical school graduation, every surgeon in every specialty – orthopedics, bariatrics, gynecology, urology, ophthalmology – undergoes rigorous training. The period of training is called a surgical residency.

More and more surgeons are now also pursuing additional specialized training during what is called a surgical fellowship. So while the residency exposes surgical trainees to a broad range of diseases and procedures, the fellowship narrows the focus considerably. For example, an orthopedic surgery residency would expose the trainee to hand, spine, foot, and joint surgery. It would include experience with both adult and pediatric surgery. By contrast, an orthopedic surgery fellowship would narrow the experience to such surgical areas as sports injuries, which are treated with arthroscopy, or arthritis, which is treated with joint replacement

So what does a fellowship mean for patients? Does it signify a more qualified surgeon? In this video interview, we put these questions to Amir Jamali, an orthopedic surgeon who specializes in knee and hip surgery. Dr. Jamali leads a hip arthroscopy surgery package for Surgeo and he chose to do two fellowships. We wanted to know why and what he thought it meant for patients looking for surgical quality.

Click the video to hear the conversation. A transcript follows.


Surgeo: We’re back with Amir Jamali, hip surgeon, asking a simple question. Amir, every surgeon trains, every surgeon does what’s called a residency after graduating from medical school. Some surgeons go beyond the residency into what’s called a fellowship. You didn’t do a fellowship: you did two fellowships. So, the question is: what’s the point of a fellowship and why would you want two of them?
Jamali: In my case, I trained in San Diego where there was a tremendous interest in preservation of joints.  I also had a wonderful professor who got me interested in joint replacement. So, I did want to understand how joint replacements could be done in a very excellent way and also needed to do a revision – a redo of a joint replacement and feel very comfortable doing those.  After I had done my fellowship, I worked for a year but I still had a hunger to learn more about preserving joints and that led me to do a second fellowship which was in Switzerland which was specifically on hip preservation. Essentially how can we get joints, hips specifically, to be remodeled, how can we re-sculpt the joint to get it to last longer so it doesn’t require a replacement down the road.  That’s what led me to the second fellowship.  In general terms, the question of why two fellowships, I think people are really expecting a certain level of expertise these days and many generalists are no longer even able to find positions in bigger cities or more competitive markets. Many people now, over 70-80% of graduates are now doing fellowships if not higher. 
Surgeo: So, you’re making an argument that fellowships are important form a surgeon’s perspective. What I’m trying to get at is the difference that it makes to patients.  I’ll give you a couple of related questions: One is, you’re doing a procedure now, arthroscopy, that you didn’t learn in your fellowship or in your residency.  And, so does the fellowship really matter?  I mean, here you are doing this new thing just because you’re interested and innovative and you’re, I guess, a life-long learner.

And here’s a more patient-centric question.  Look, one of the surgeons we have for joint replacement is not fellowship trained. He’s actually a family physician who decides to become an orthopedic surgeon. Unusual.  But he did an orthopedic residency. The recommendations that we have on this are phenomenal, stellar.  The OR nurses, anesthesiologist, his peers, the administrators – they all send their family, friends to him.  The question is which are the variables that help a patient understand if a surgeon is good, if a surgeon is good enough to operate on them?  It would appear that the fellowship is certainly not the “be all, end all” answer to that. 
Jamali:  Right, I think the fellowship is a very quick and efficient way to gain a large amount of experience in a short amount of time. So the surgeon you’re referring to, for example, may have been doing a number of joint replacements over years at a moderate or high volume. If that person is interested enough to go and do courses and spend time at meetings and also have a high volume, I think they can clearly obtain the same level of expertise as someone who has done a fellowship. The fellowship in some ways is a checkbox that indicates you have worked as an apprentice under someone who is an expert in the field and in a relatively short period of time, usually a year, gained a fair amount of experience.  But still, if you’re out in the real world doing those cases at a higher volume and are also up to date on the literature you can achieve very similar if not better results on your own.  As far as hip arthroscopy, when I started doing that surgery, there really were no fellowships that were providing a high volume of the techniques that were evolving in real time.  Now I envy the people that are training because all that has been developed and it’s basically given to them in a very quick way, rather than in the old days when we had to apply techniques from open surgery to arthroscopy and it was much more challenging.  But, in some ways, it was more exciting to be on the cutting edge. So, fellowships are now being done in hip arthroscopy, but they weren’t even available in the current form 8 or 9 years ago. 
Surgeo: I guess what we’re coming to is fellowships are a really great way to hone your skills after your basic training, but medical technology evolves and if you want to stay with it, you gotta keep learning with or without the fellowship.  With that I will say thank you and we will talk again soon.
Jamali:  My pleasure.


About the Author: