We run a fellowship program here in Colorado. In just a few weeks, our two fellows from 2017–2018 will graduate and three new fellows will come into the practice. Because of this, I often get asked by resident physicians about what they should do to have the best career possible. This is my top 5 pieces of advice list.
Beginning in the late 1980s, interventional cardiology changed cardiac care forever. It made it less invasive and reduced open-heart surgery rates by more than half. Well, it’s the ’80s again, but this time it’s interventional orthopedics. What I mean by that statement is we are in the adoption and innovation years of the biggest paradigm shift in musculoskeletal care in your lifetime. I’m sure that there are cardiologists now that lament the bad decisions they made in the ’80s and ’90s when they couldn’t see the interventional cardiology train coming while some of their colleagues did.
Interventional orthopedics is a medical specialty where physicians train to precisely place substances that can facilitate healing (orthobiologics) in specific areas of the musculoskeletal system. This is quite different from surgical orthopedics, and, in fact, the goal is to help patients avoid more invasive surgical procedures. To learn more, please see my video below:
After a doctor completes medical school and residency training in a specific field, he or she can go for additional and more specialized training called a fellowship. For information on our program, see below:
I should note that due to the extensive time it takes to learn all of the procedures needed to practice interventional orthopedics at a high level, we only offer the three-month mini-fellowship on a case-by-case basis. For example, in our experience, only a handful of physicians around the country could walk into our program advanced enough to qualify for a mini-fellowship.
Regrettably, for resident physicians today looking for a fellowship, we are in the early stages of the broad adoption of both interventional orthopedics and orthobiologics (things like stem cells, PRP, and other things that help tissue heal). This means that corticosteroid injections, radiofrequency lesioning, implanted stimulators, pain pumps, and many orthopedic surgeries are on the verge of being phased out. Why? Regenerative medicine is simply a much better mousetrap.
Hence, if you’re a young physician, you want to make sure you get trained in what’s next and not what’s yesterday’s news. However, most universities that offer fellowships in interventional pain, sports, or orthopedics offer none or very little regenerative medicine education. Hence, carefully choosing what you do now will either make you a leader in the field in your early career or put you behind the curve without knowing what you don’t know like everyone else.
To expound, this means that pretty much everywhere you train is locked into the 1980s and 1990s methods of using high-dose steroids that harm tissue, zapping nerves dead, implanting pain stimulators or pumps, or cutting out damaged areas. This is often the direct opposite of learning how best to heal damaged tissue, and many of these procedures are contraindicated in that effort. Hence, signing on to an interventional pain, sports med, or orthopedic fellowship will have you learning all sorts of techniques that rapidly become obsolete early in your early career.
The upshot? You are exiting residency in the middle of a tectonic shift in orthopedic care that will move us from managing symptoms to healing tissue. However, because the latter is in its early stages of adoption, decisions you make now will either make you a leader and superstar in the evolving world of interventional orthopedics and orthobiologics or way behind the curve struggling to catch up. Hence, follow my 5 pieces of advice to become the former rather than the latter.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…