The Characteristics of Surgeons Performing Total Shoulder Arthroplasty: Volume Consistency, Training, and Specialization

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  • Between 2012 and 2014, 1,374 surgeons performed >10 total shoulder arthroplasties (TSA) in Medicare patients in at least one year.
  • From 2012 to 2014, the number of surgeons performing at least 10 TSA in Medicare patients increased from 834 to 1,078, while the number of TSA increased from 21,137 (25.3 per surgeon) to 26,765 (24.9 per surgeon).
  • Many of these surgeons had a diverse surgical practice, with nearly one-half performing total knee arthroplasty, one-third performing non-arthroplasty knee surgeries, and >80% performing non-arthroplasty shoulder procedures.
  • Only one-third of these surgeons had formal fellowship training specific to shoulder and elbow.
  • In order for the current supply of shoulder and elbow fellowship-trained surgeons to meet the Medicare TSA demand, each currently practicing fellowship graduate would have to perform 140.6 TSA in Medicare patients annually.




Total shoulder arthroplasty (TSA) has proved a cost-effective, reproducible procedure for multiple shoulder pathologies. As utilization of TSA continues to grow, it is important to investigate procedure diversity, training, and other characteristics of surgeons performing TSA. To identify surgeons performing TSA in the Medicare population, the Medicare Provider Utilization and Payment Databases from 2012 through 2014 were used. This dataset includes any provider who bills Medicare >10 times with a single billing code. A web-based search was performed for each physician performing >10 TSA in all years of the study to identify their surgical training characteristics. Between 2012 and 2014, 1374 surgeons (39 females [2.8%]) performed >10 TSA in Medicare patients in at least 1 year (71,973 TSA). Only 44.3% (609/1374) of surgeons met this threshold for all 3 years (55,538 TSA). Of these 609 surgeons, 191 (31.3%) were shoulder and elbow fellowship trained (21,444 TSA). Shoulder and elbow fellowship-trained surgeons were at earlier points in their careers and practiced in large referral-based centers with other surgeons performing TSA. In addition to TSA, surgeons performed other non-arthroplasty shoulder procedures (80.2% of surgeons), total knee arthroplasty (46.3%), repairs of traumatic injuries (29.8%), total hip arthroplasty (27.8%), non-arthroplasty knee surgeries (27.2%), elbow procedures (19.6%), and hand surgery (15.4%) during the study period. With less than one-third of TSA performed by shoulder and elbow fellowship-trained surgeons with consistent moderate-volume practices, the impact of consistent high-volume practices and targeted fellowship training on quality must be determined.

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