TO THE EDITOR:
I commend Dr. Sarmiento for "Commentary. Responding to Change" (80-A: 601-603, April 1998). He expressed, rather eloquently, thoughts that I am certain many of us have had over the last few years. Any orthopaedic surgeon who has been practicing for any length of time is aware that Dr. Sarmiento is well known in the Academy. Therefore, he is in a position to speak his opinion and, hopefully, to have others listen. Those of us out in the trenches do not have the stature needed for our opinions to carry any weight even though they may mirror those of Dr. Sarmiento. Having finished my residency in 1967, I was trained in both the operative and the nonoperative treatment of fractures and other musculoskeletal problems. I agree with Dr. Sarmiento that there are many in our specialty who believe that they are trained only as surgeons and not as complete orthopaedists.
I think that Dr. Sarmiento was right when he criticized the emphasis on fellowship training that is prevalent today. Much of what many fellowship-trained orthopaedists are doing used to be considered part of what any well trained orthopaedist should be able to do, and do well. The fact that many orthopaedists today restrict their practices to, for example, the knee, the upper extremity, fractures, or joint replacements is, in my opinion, carrying specialization to the extreme.
I thank Dr. Sarmiento for a very thoughtful, incisive, and much needed article. I hope that the thoughts that he expressed will be considered carefully by all who are in a position to make the changes that he suggested. The many vested interests opposed to his opinions, I am sure, will say that these ideas are antiquated and are not to be heeded.
John W. Thompson, M.D.: 9155 South West Barnes Road, Suite 65, Portland, Oregon 97225