Practice habits in board-eligible shoulder and elbow orthopedic surgeons

There is little data regarding newly practicing orthopedic surgeons and their surgical preferences during the 6-month case collection for the American Board of Orthopaedic Surgery Part-II. The purpose of this study was to conduct a comprehensive survey analysis regarding the practice habits of board-eligible orthopedic surgeons specializing in shoulder and elbow surgery. We hypothesize that surgeons would opt out of most complex surgical cases and controversial treatment options during the time of boards case collection.

An anonymous 27-question survey was created through Microsoft Forms and distributed through the American Shoulder and Elbow Surgeons. The survey was sent to all surgeons who graduated from an American Shoulder and Elbow Surgeons accredited shoulder/elbow fellowship from 2017 to 2021 in order to capture surgeons who recently applied for American Board of Orthopaedic Surgery Part-II. Respondents were able to choose from the following answer choices for each procedure question: "No indication for this procedure in my practice," "I would not do this during boards collection but otherwise would do it," or "I would do this during boards collection."

A total of 54 board eligible orthopedic surgeons completed the survey. A majority of respondents stated they were in private practice (44.4%). Over half of respondents (63%) were more aggressive with non-operative management during their board collections period. Furthermore, over half of respondents (53.7%) had cases meeting their surgical indications that they did not do during the 6-month board collections period that they otherwise would have performed. Regarding specific survey questions and procedures, there was a majority of surgeons stating they would do the indicated procedure during boards collection for universally adapted procedures such as anatomic total shoulder arthroplasty with stemless humeral head for primary osteoarthritis (98.1%), patient-specific instrumentation for anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty (rTSA; 92.3%), rTSA for primary osteoarthritis (90.7%), rTSA with augmented baseplate (96.3%), and rTSA for massive irreparable rotator cuff tear (98.1%). For more controversial treatment questions, particularly regarding biologics, more surgeons tended to state no indication for the procedure in their practice or that they would not perform the procedure during boards collection (79.6% and 87%, respectively).

Our study shows that indications for surgery are adjusted during the monitored board collection period, perhaps indicating a need for further adjustments to the process in the future to reflect an individual's practice pattern more accurately. However, these findings must be cautiously interpreted in the setting of a small sample size and lack of statistical analyses.