April marked the inaugural single orthopaedic fellowship match. In previous years, sports medicine, shoulder and elbow, adult reconstruction, tumor, spine, foot and ankle, pediatrics, trauma, and hand surgery were separate matches, most of which occurred on different dates throughout the year. Each specialty match was a separate application process, so applicants had little opportunity to apply, interview with, or rank fellowships in different specialties.

More than 90 percent of graduating orthopaedic residents in the United States choose to pursue fellowship training. Although not common, some applicants for fellowship are interested in more than one specialty. There are also yearly scenarios where applicants would like to do a fellowship but are trying to train in a specific city or region of the country for family or personal reasons.

Over the past decade, there has been fluctuating interest in different specialties; subsequently, some specialties are more “competitive” in terms of number of positions available relative to number of applicants. For example, the match in adult reconstruction has been very competitive in the past few years, with significantly more applicants than positions available. In contrast, some specialties have significantly more positions available than applicants.

A combined match offers an opportunity for applicants to apply to both more competitive and less competitive specialties, perhaps as a safeguard against not matching at all. For fellowship programs, a single match offers a potentially larger applicant pool. It is the hope that a single match system may also lessen the likelihood of applicants going unmatched, fellowship spots going unfilled, and fewer programs and applicants “scrambling” to fill open positions.

All orthopaedic fellowship matches use SF Match for their fellowship match processes, except for hand surgery. Transitioning to a single match was facilitated by all specialties already using the same match vendor individually. Hand surgery has more complexity compared to other specialties, as there are applicants and training programs in orthopaedic surgery, as well as plastic and general surgery. Hand surgery uses the National Resident Matching Program (NRMP) for the fellowship match and is not included in the new single fellowship match process.

The development of combining the orthopaedic fellowship matches, except for hand, began two years ago with the AAOS Fellowship Committee. This year, the orthopaedic fellowship match was combined for foot and ankle, sports medicine, spine, shoulder and elbow, trauma, adult reconstruction, and tumor. In order for the process to work, the Fellowship Committee needed to condense and unify the documents and materials requested of applicants. Different specialties had unique requirements and distinct application forms in the historical separate match system.

The AAOS Fellowship Committee includes members elected or assigned from each specialty. The committee developed a common application form (CAS), as well as an agreed-upon set of documents for those applying to the single fellowship match, which includes:

• CAS
• curriculum vitae
• U.S. Medical Licensing Examination Step 1/COMLEX 1 or equivalent
• letter of good standing from program director
• three letters of reference

All fellowship programs and directors are encouraged to adhere to the list of requested documents and not ask applicants for other materials.

In the new single match, applicants can apply to, interview with, and rank programs across all specialties except for hand surgery. The process then matches each applicant with the best fellowship according to a standard algorithm. Specialty is not considered in the match algorithm, as all fellowship programs are considered part of the single match. This year, there were 891 registered applicants for the single fellowship match and 787 submitted rank lists (Table 1). On average, applicants applied to 31 fellowship programs. Fifty-seven applicants went unmatched this year, and 730 applicants matched. Forty-four percent of applicants matched with their first choice for fellowship, and 74 percent matched with one of their top three choices. The new single match system does not appear to have adversely affected any of the specialties.

Over the past few years, as well as this year, adult reconstruction and hand surgery (NRMP match) were the most competitive in terms of number of applicants relative to number of positions available among specialty programs in the match (Table 2). The percentage of spots filled in different specialties ranged from 71 percent to 99 percent. Overall, 92 percent of fellowship positions were filled between the combined match and hand match. Sports medicine continues to have the most applicants and positions available. In the new single match, it was interesting to see how many applicants applied to fellowship programs in different specialties. Ultimately, 92 percent of applicants applied to fellowship programs in only one specialty, with 8 percent applying to two or more specialties (Table 3).

This year’s orthopaedic fellowship match was deemed a success. The AAOS Fellowship Committee will continue to monitor and adjust the fellowship match process in the near future to facilitate the best possible process for both applicants and programs.

Brian R. Wolf, MD, MS, FAAOS, is professor and vice chairman of finance and academic affairs in the Department of Orthopedics and Rehabilitation at the University of Iowa Hospitals and Clinics, as well as the head team physician for University of Iowa Athletics.

Scott Steinmann, MD, FAAOS, is chair and professor in the Department of Orthopaedic Surgery at the University of Tennessee. He also has a shoulder and elbow practice at the Erlanger Orthopaedic Institute.

Erin Volland, MPA, CAE, is the senior manager of member engagement at AAOS. She can be reached at volland@aaos.org.