Return on Investment (ROI) of Orthopedic Fellowships

In this video, Dr. Webb talks about the ROI of doing a orthopedic fellowship!

The return on investment of a orthopedic fellowship in this video i’m going to talk about that today what’s up everyone this is dr webb here thank you guys for watching this video make sure you subscribe new videos coming every week you don’t want to miss them so there’s a article that just came out the return on investment of an orthopedic fellowship training

This is a 10-year update that i thought was really interesting and i’m going to talk about that in this video today so for those who don’t know the way it works you do four years of medical school five years of general orthopedic surgery residency and then you do an optional one year fellowship there are some fellowship programs out there that are two years

And there are some people that do two fellowships well ninety percent of people in orthopedics do a fellowship this is mainly due to uh making yourself more marketable after you complete all of your training or if you want to better your skill sets say for instance you went to a residency program that didn’t do a lot of trauma surgery and you want to become a

Orthopedic trauma surgeon well most people would do a trauma fellowship to increase their skill set or to get more cases or to get more experience well what a lot of people don’t talk about during this path and along our training is the financial impact that doing a fellowship has we’re just under the impression that uh you know we’re going to do a fellowship

And it’s common that a lot of people do a fellowship so i’m going to do a fellowship and i kind of felt that way just because everyone else was doing a fellowship i didn’t want to be the only person not doing the fellowship but a year before me the residents who graduated there was one person who did not do a fellowship and worked as a general orthopedic surgeon

Went straight into practice the year before that there was another individual who went straight into practice without doing a fellowship so it’s about 90 percent of people that do a fellowship this is only for orthopedics i can’t speak about other specialties out there but we’re going to jump into this article so a couple terms that you should be aware about that

They talk about in this article number one is npv this is the uh summation of all future cash flows of an investment mino minus the initial cost the initial cost is the initial loss of income during the period uh fellowship training and this is the income that would have been otherwise made by graduating residents minus the salary from the fellowship they also

Talk about the break-even point and for each specialty and orthopedics this was calculated and defined as a point in time in which your initial investment costs equals the net return that’s the break even points there’s a lot of different fellowships out there that you can do after your general orthopedic surgery residency you can do foot and ankle surgery you

Can specialize in hand surgery spine surgery trauma surgery oncology sports medicine joint replacement shoulder and elbow so lots of different options that you can do well which of these you know gives you the best return on your investments because i have other videos talking about how much a fellow makes and for most people depending on what part of the country

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That you’re in most people anywhere between 55 thousand to sixty thousand to seventy thousand seventy five thousand but if you graduate from residency and go straight to work well you know you can make up to six hundred thousand seven hundred thousand dollars right off the bat so you have to calculate you know that missed income during that year and for a lot

Of people this could be six hundred thousand dollars so and what is the roi or return on investment on doing this fellowship year this article talked about from 1984 to 2014 the number of advertised kind of general orthopedic surgery jobs decreased from 95 percent to 32 percent whereas job openings requiring fellowship training increased from five percent to 68

So a lot of jobs that are out there when you finish your training uh the job openings they’re looking for people that are fellowship trained and that’s a marketing you know strategy that that you can use you can say i’m fellowship trained in hand surgery i’m fellowship trained in orthopedic trauma surgery you know that just makes you more marketable so there are

A lot less jobs out there for people that are graduating and going straight into the workforce you also have to consider the medical school debt uh over the last few years this is actually cr increasing the average medical student will come out of medical school with about two hundred thousand dollars in debt and during this training you know a lot of people

Don’t pay back any of their student loans and that they defer all of their payments well you know this can have a you know significant financial impact as well just because that additional year of not making any payments to your student loan this could mean that you’re paying an additional 25 000 or additional 10 000 15 000 to your overall loan balance just by

Not making any payments uh during your fellowship year but that’s to that’s only if you don’t make any payments uh during your fellowship year so they gathered this information uh from a database that you know gives us the average salaries for orthopedic surgeons and they pull all of these orthopedic surgeons and they ask them hey what is your salary in this

Particular aspect of the uh part of the u.s they were not able to collect data for shoulder and elbow surgeons as well as they excluded the data from orthopedic oncologists but just because the people that responded to the survey there were only 12 surgeons so not a lot to draw from that the american association of medical colleges and the amga which reports kind

Of the median or the average salaries for orthopedic surgeons and it’s something that we use in the negotiation process when talking to different hospitals and different and with different contracts they reported that the main pgy6 fellow salary was around 68 000 and the general orthopedic surgeon compensation if you go straight into practice it was around 633

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000 so the investment cost was around 565 000 that’s what you lose that’s essentially what i’m losing this year from doing this fellowship so you have to take that into consideration when talking about the break even point and we we said that the break even point is the time where you your investment cost equals the net return so the break-even points for each

Specialty we consider here that the break-even points for spine surgery had the shortest one being at five years that mean it takes about five years after you’re done with all your training to even break even and even start making money so but some specialties like sports medicine uh trauma surgery you know they said sports medicine they don’t break even until 26

Years have been in practice which is uh pretty uh crazy so in financial terms an investment can be considered advantageous if the npv is greater than zero and in some specialties uh this can be considered a disadvantage so fellowship training and hand surgery or pediatrics or foot and ankle meet those uh that criteria which means they have a negative uh return

On investment or it takes a number of years to even break even so this figure here shows the net present value of the different specialties and you can see that spine has a positive npv the other subspecialties like pediatrics foot and ankle hand surgery has a a negative one you can see foot and angle definitely has a higher npv than uh the other specialties out

There and i i think this is more due to the reimbursement rates for foot and ankle surgeries the surgeries in spine surgery the they’re compensated at a higher rate say for instance you do one surgery and spine surgery which you know you may get reimbursed three thousand dollars one surgery and foot and ankle surgery one thousand dollars eight hundred dollars

So um you know the the reimbursement rates are a lot different which can affect this uh npv uh value so i thought this was a pretty interesting article that talked about the return on investment of doing a fellowship you know throughout my whole training you know it’s been pounded in my head that you know most people do a fellowship you know you have to think

About what fellowship that you’re going to do so i felt a little bit of pressure to do a fellowship which i’m glad i did one because it makes me more marketable but this article really didn’t take into consideration the loan interest that students have that builds up over time if you go right into practice and you start making money well you can start paying

Back your student loans a lot sooner it also didn’t talk about the different practice models academic versus private practice versus being an employee this will affect how much you get paid as a position and the uh the quote that they gave about six hundred thousand dollars in terms of the compensation for a general orthopedic surgeon well this differs in terms

Of your specialty spine surgery usually makes more than the hand surgeons or the foot ankle or the pediatric orthopedic surgeons so i don’t think this article really took that into consideration but it does um you know brings to light that you have to think about you know that additional year it’s a lot of money that you’re losing out on well if you want to go


Into foot and ankle surgery or hand surgery pediatrics your return on investment is not going to be as robust as if you went into spine surgery so you have to take that into consideration you don’t have to do a fellowship it’s not required but you know hospitals are asking for different employees different contracts they’re they’re asking you know did you um

You know receive fellowship training so 90 of people do a fellowship and um i imagine when this article came out a lot of other people are going to question whether they are going to do a fellowship versus going straight into practice it’ll be interesting to see how people respond to this survey another thing this article didn’t talk about is the other forms of

Income when you are out in practice there are different ways that you can make money from consulting to teaching ancillary income which is money from like different investments that you have in your surgery center or different equipment that you own well this can be a you know substantial amount of money for a lot of people this can be a hundred thousand dollars

A year or two hundred thousand dollars per year in addition to what you’re making as a surgeon um in clinic and surgery so this article really didn’t talk about that some people make more money on their ancillary income than they do as a just a surgeon so they may make let’s say 400 000 as a surgeon but they bring home five hundred thousand dollars in ancillary

Income um which this article didn’t talk about also moonlighting and fellowship some people work extra hours moonlighting is you know taking a position or job in addition to your normal kind of fellowship or if you’re out in practice and you work at one hospital well you can moonlight which means you work at additional hospital to make extra money this article

Really didn’t talk about that there are a lot of fellows out there that moon lights and take extra you know jobs for money uh you know you have to take those numbers into consideration also so you know i think this article you know just brings to light that you really have to take into consideration what you’re losing out on when you do additional year of

Training for some specialties this can be a lot of money and for some specialties the return on investment it can take anywhere between 10 to 15 to 20 years just to break even just because you did a fellowship year what are your thoughts put it in the comments below i would love to hear from you this is dr webb thank you guys for watching this video make sure

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Transcribed from video
Return on Investment (ROI) of Orthopedic Fellowships By Antonio J. Webb M.D.