Why see a shoulder specialist?
By Scott Humphrey, MD
We live in a world of increasing specialization. As more and more new information is discovered in any particular field it becomes harder and harder to maintain a level of expertise without specializing.
The field of orthopaedic surgery is no exception. Though orthopaedic surgery is itself a specialty field, many orthopaedists choose to complete additional training to subspecialize after their general training. Orthopaedic subspecialty fields include musculoskeletal trauma, sports medicine, hand, spine, foot and ankle, and shoulder and elbow. Each of these subspecialty groups produces its own expanding body of knowledge, making it difficult if not impossible for an orthopaedist to stay current in multiple fields.
In addition, specialization has been shown to be beneficial because there is value in repetition for surgeons who perform a particular procedure. Practice is the repetition of an action to improve its quality. The value of practice is recognized in sports, music, and surgery.
According to researchers at the University of Washington , 75% of shoulder replacement surgeries are performed by a surgeon who does only one or two of these procedures per year. They conclude that patients may be better served by a surgeon who sees a large volume of shoulder surgery cases, because the number of times a surgical procedure is performed may have a bearing on how well it is done.
Their findings are supported by researchers for other orthopaedic subspecialties. In an article titled “Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population,” Katz et al  provides data supporting the concept that specialists have better outcomes. Specifically, they found that surgeons who performed over 50 hip replacements per year had half the complication rate of those who performed 10 or fewer of these procedures. It is likely that a similar effect may relate to shoulder surgery.
What Makes Someone a Shoulder Specialist?
Once a person is trained as an orthopaedic surgeon, there are three ways by which he or she may become a shoulder specialist:
Many orthopaedic surgeons who specialize in shoulder and elbow surgery are fellowship trained, meaning that they have completed an additional year of training to focus on surgery of the shoulder and elbow. There are a limited number of shoulder and elbow fellowship positions that are recognized by the American Shoulder and Elbow Surgeons organization. These programs tend to place an emphasis on both arthroscopic surgery as well as joint replacement and reconstructive surgery.
Sports medicine fellowships provide another avenue by which orthopaedic surgeons may receive additional shouder training. The American Orthopaedic Society for Sports Medicine recognizes a limited number of sports medicine fellowships. These fellowship programs often place an emphasis on arthroscopic surgery, with less emphasis on total joint replacement.
It is also possible to become a shoulder specialist without completing a fellowship. A typical example is the orthopaedic surgeon who develops an interest in shoulder surgery independently while being in general practice for several years. This surgeon may receive many patient referrals from his or her orthopaedic colleagues, who recognize that the doctor has become highly skilled at shoulder surgery.
Making the Most of Your Appointment with a Specialist
When seeing a shoulder specialist for the first time, there are several things you can bring that will maximize the effectiveness of your office visit:
Your primary doctor may offer to send these to the shoulder specialist's office for you. Keep in mind, though, that clinics and hospitals are often bureaucracies, and your items may be lost in the shuffle. It is always safer to hand carry your medical records and films to your appointment.
1. Hasan SS, Leith JM, Smith KL, and Matsen FA, 3rd. The distribution of shoulder replacement among surgeons and hospitals is significantly different than that of hip or knee replacement. J Shoulder Elbow Surg 12: 164-169, 2003.
2. Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, and Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 83-A: 1622-1629, 2001.