Blue Collar vs. White Collar Programs
These are the two main distinctions within Orthopaedic Surgery residency programs. Like everything in life, there are always shades of grey. But for the most part, Ortho programs can be lumped into one or the other.
Blue Collar – as the name implies, you’re going to work your butt off. These are traditionally very high volume, high trauma programs. Lots of cases, a plethora of consults during night call, and a more chaotic environment. Usually associated with large Level 1 Trauma Centers (mostly county hospitals). These programs place less emphasis on didactic teaching, favoring the “learning by doing” model. There’s also a lot of senior resident to junior resident teaching. Residents begin operating much earlier in their training. Research is not a huge focus, and robust support infrastructure for research may be limited. Ultimately, Blue Collar programs pump out extremely competent Orthopaedic Surgeons, albeit without a CV showcasing many publications in reputable journals. If you go to a program like this, you’ve seen (and more importantly – done) such a breadth of cases that you’re essentially ready to start practicing in the community.
- Pros – excellent surgical volume and operative experience
- Cons – less formal teaching, less impressive research resume, longer hours
White Collar – unlike the above, White Collar programs have less volume and weaker operative training. More emphasis is placed on formal didactic teaching, theory, and research. Residents traditionally publish an impressive number of manuscripts and have a strong support structure (aka...funding and dedicated time) to engage in research. Residents operate later relative to Blue Collar programs. There are often a lot of Fellows at White Collar programs, because of these programs’ name recognition due to research. More Fellows means residents will not get the same case volume, because Fellows will take the more challenging cases. Ultimately, these programs look more impressive on paper and will pad the research resume at the expense of truly robust operative training.
- Pros – excellent resume with strong research potential, less strenuous hours
- Cons – weaker operative experience, less ready to go out and enter practice
Before we delve in further, keep in mind that these are generalities of the two broad categories. There are many crossovers within individual programs. But overall, programs will fall mostly within one category or the other.
You need to decide which type of program is better for you (and the best way to do that is via away rotations). If you have academic aspirations and hope to become a Department Chairman/Chairwoman one day, White Collar programs may be more suitable. On the other hand, if you see yourself living and practicing in the suburbs of a large city without much emphasis on research activity, then Blue Collar may be the better choice. But really, the only way to know is to experience it. And that’s where away rotations come in.