He and other speakers did not propose a policy of raising educational standards specifically to decrease enrollments. Indeed, Mark C. Gebhardt, MD, a member of the Residency Review Committee in Orthopaedic Surgery and director of the American Board of Orthopaedic Surgery, started and ended his presentation by saying neither organization is involved in determining or controlling the number of practicing orthopaedic surgeons in the United States. However, it's an idea that surfaces when orthopaedists consider the few options they have to affect the future of the profession. From the audience, James Hamilton, MD, a program chairman for 17 years, said he once held that view, but not anymore. Dr. Luck asserted that reductions will come only through voluntary actions by individual programs or federal mandates.
Voluntary reductions are already underway.
The 157 accredited orthopaedic surgery residencies in the United States, graduate 617 residents a year, said Dr. Simon. In the last three years, the Residency Review Committee has approved the requests of nine orthopaedic surgery programs to have permanent reductions, resulting in a decrease of 12 graduating residents in five years. The reductions were made at the request of the sponsoring institution because of individual economic and political issues at the sites. In the floor discussion, Robert Karpman, MD, observed that high tech companies, which he compared to orthopaedics, have trouble predicting three to six months into the future. Orthopaedists remember that in the 1960s the federal government actions stimulated training of physicians because of a perceived shortage of doctors.