ORTHOPAEDIC SPECIALIST REGISTRAR TRAINING AND ATTITUDES TO SPINAL SURGERY: REASONS FOR POOR RECRUITMENT AND SUGGESTIONS FOR IMPROVEMENT

Abstract

To quantify the expected shortage of Orthopaedic Specialist Registrars (SpRs) planning careers in Spinal Surgery with one third of Specialist Spinal Surgeons due to retire in the next 3 years and to provide the needed expansion of 25% in the existing number of 175 surgeons.

A postal survey of the 528 SpRs was performed with a response rate of 71%. The critical question was the post accreditation intention as either a Specialist Spinal Surgeon (greater than 70% of elective work), as a Surgeon with an Interest in Spinal Surgery (more than 30% of elective work), a surgeon doing occasional Spinal Surgery (less than 30% of elective work) or one who avoids all Spinal Surgery. This attitude could then be taken into account when analysing the training provided and the perceptions of Spinal Surgery to identify factors which could be discouraging an interest in Spinal Surgery.

Sixty nine percent indicated that they intended to avoid all Spinal Surgery. Thirty five (9%) intended becoming either Specialist Spinal Surgeons or Surgeons with a Spinal Interest but only 9 (2%) are in their final two years of training. The declared intention to avoid Spinal Surgery increases from 54% in the first 2 years of training, to 70% in the middle 2 years, and to 75% in the final 2 years and post CCST fellowships. Based on a projection of the 4. 3% response intending to become Specialist Spinal Surgeons there will be a shortfall of 34 Specialist Spinal Surgeons by 2005.

The features of Spinal Surgery which appear to have a negative affect and overwhelm the potentially attractive features are badly organised clinics; the perceived psychological complications of spinal patients; and a perceived inadequate exposure to spinal surgery during SpR training.

The modification of training programmes so that all SpRs are exposed to Spinal Surgery in the formative first three years; properly structured spinal clinics; and a need for Spinal Surgeons to be encouraging and enthusiastic about this field of surgery are essential.