ortho attending AMA

[OrthoTraumaMD]

Hi SDNers,

I have some free time and so am happy to answer any questions you may have about the myths and realities of orthopaedics, resident life, and general questions. Just avoid the "what are my chances with score X" questions-- so many better posts and options on this site for that. Orthogate is also a good site for their "ask the attending" section.

A bit about me: orthopaedic trauma attending, practicing in an academic setting in the US. My practice includes admin/research/education/mentorship responsibilities as well.

Ask away.

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[cbrons]

Ur a female in ortho?

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[FindMeOnTheLinks]

Thanks for doing this, it is always helpful for med students. I'm an M2 not really interested in surgery at this point, but curious what made you choose orthopedics over other surgical fields? And why surgery vs non-surgery? Thanks.


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[Brorthopedic]

What are the hours like as a trauma orthopod?

 

[OrthoTraumaMD]

What are the hours like as a trauma orthopod?

I still work 80 hours/week but much of it consists of admin/research/educational efforts. Clinically it's anywhere from 40-50 depending on how much trauma comes in. Trauma is seasonal so summer is worse for the polytraumas, winter worse for fragility fx (wrists, ankles, hips). Changes from week to week. Some days I have lots of free time, other days I work all day. Not predictable, unlike the rest of ortho.

 

[doggydog]

How much do you bench?

 

[SunsFun]

How's the ortho job market in costal cities like NYC, LA, SF? Are there any openings at all and what kind of a pay-cut are we looking at?


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[OrthoTraumaMD]

How much do you bench?

No idea. Never tried.
On a serious note, if any women (or smaller men) are reading this, sedation and technique (and in some cases, good assistants in the ER) trump brute force every time. I'm a slightly built woman, weigh 120 lbs, and there has never been a hip i wasn't able to reduce, even in patients three times my size. the bro stereotype doesn't apply to all of us.

 

[tymont12]

I've recently heard a number of orthopods saying the work can be more rote than people think: two hips before noon, two hips after. Rinse, wash, repeat. What are your thoughts on the variety of ortho?

 

[OrthoTraumaMD]

How's the ortho job market in costal cities like NYC, LA, SF? Are there any openings at all and what kind of a pay-cut are we looking at?


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Depends on your subspecialty and whether you want to do private practice or academics. Without a more specific set of criteria, I can tell you the fastest growing markets are in the midwest and central US. On the coast, expect lots of competition, especially in academics, and as much as 100-200K less pay than if you go somewhere less "desirable." The major cities are saturated and if you practice something very specific (such as myself), those job openings may not be available. However, if you absolutely must live in a major city, be prepared to give up some of your wish list items -- I rejected a job offer that was in a major city but would not offer me opportunity for research, which was important to me.

 

[SunsFun]

Depends on your subspecialty and whether you want to do private practice or academics. Without a more specific set of criteria, I can tell you the fastest growing markets are in the midwest and central US. On the coast, expect lots of competition, especially in academics, and as much as 100-200K less pay than if you go somewhere less "desirable." The major cities are saturated and if you practice something very specific (such as myself), those job openings may not be available. However, if you absolutely must live in a major city, be prepared to give up some of your wish list items -- I rejected a job offer that was in a major city but would not offer me opportunity for research, which was important to me.

Thanks for your reply!

Yeah I've lived in a smaller town for undergrad and Med school (1 mil) and I am tired of endless driving and suburban nightmare along with patients asking me at least monthly whether I am planning on "going back" to where I came from after training. I don't expect all of this to go away but idea of living in a city appeals to me more and more. I know it's gonna be tough regardless of specialty and I will be making some big sacrifices.


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[OrthoTraumaMD]

I've recently heard a number of orthopods saying the work can be more rote than people think: two hips before noon, two hips after. Rinse, wash, repeat. What are your thoughts on the variety of ortho?

The joint replacement subspecialty is much more "rote" than the other seven ortho subspecialties (some would argue there are more, but the basic ones are: joints, spine, sports, trauma, hand, tumor, peds, and foot+ankle). total hips and knees are, for the most part, indistinguishable. But the variety within your daily life in other subspecialties knows no bounds. You can make your job whatever you want--- if you are bored of joints, take trauma call. You will wish for the "boring" life really fast after that. But some of the issue is that most patients and hospitals want "fellowship-trained" surgeons, so we are pigeon-holed into doing certain things (hence the joke about being a surgeon for "just the left hand"), and it's harder to have variety in your work that way. (>95% of ortho residents go on to subspecialize, some doing more than one fellowship.) That lack of versatility is part of why I went into trauma -- fracture care is not as restricted to body part or procedure, and there are dozens of ways to fix even a simple ankle fracture. I'd kill myself if I had to do only total joints every day-- although I'd probably be home for dinner every night! So everything has its pluses and minuses. I hope that answers your qn adequately.

 

[HybridEarth]

Thank you for doing this! I am very interested in innovation/research and coupling it with patient care, and I'd like to become a leader in the field. As such, I would like to know what you think are some brand new or up-and-coming areas in ortho (stem cell therapy, cartilage restoration, etc.) that have relatively unexplored waters that will have plenty of opportunity for people such as myself. Thanks again!

 

[OrthoTraumaMD]

First of all, thank you so much for doing this!

It’s my understanding that the gender disparity in orthopaedic surgery is largely due to self-selection. However, considering that it is such a male-dominated field, do you feel that you have encountered barriers throughout your journey to becoming an orthopaedic surgeon that your male counterparts did not face?

Yes, self-selection is correct. Despite a push from programs to recruit more women, the number of ortho residents who are female has plateau'd somewhat at around 10%. (Currently number of ortho female attendings is 3-7% depending on what you read.) And that's how it should be. Only those willing to do the work and sacrifice what needs to be sacrificed should get in. Gender should not matter, only work ethic should (hence, neither being male nor female should be an advantage when applying, although the reality is that as a woman applicant, you are much more likely to stand out and more likely to be recruited if a program has a goal to diversify--- which in my mind is ridiculous-- the best applicants should be selected regardless of gender). But I digress... About your question on barriers, the answer is no. Ortho is very accepting as long as you pull your own weight, work hard, and don't mind d**k jokes, endless sports discussions (you don't need to participate, though), or being chest-bumped if a case goes well (that did happen to me once as an intern, LOL). If I can define any barriers, they mostly came not from orthopods themselves but from either people around me (family members questioning if it was a fitting job) or my own fears ("am i OK with having kids later in life?"). I also encountered some unsavory characters when I was a medical student (two attendings who hit on me aggressively), but they were older and not orthopods. Thankfully, regressive attitudes are dying out--- my own father said upon hearing my stories, "Don't worry, all those geezers are gonna retire and die soon, and their attitudes will die with them."

 

[CornFed]

Everyone is always worried about hrs/wk, yet rarely mention overall lifestyle. Do you feel 80+ hrs/wk still allows you family time, time for hobbies, life outside of medicine, etc? Or is most of your time outside of the hospital still consumed by reading up on cases/preparing for the next day?

Also, going into ortho, was lifestyle an important factor for you?

Thank you very much for taking the time to do this!

 

[mvenus929]

Ur a female in ortho?

The only all female OR I have been in was when I was on ortho as a med student. Two of my classmates are females who went into Ortho. It's not as weird as you make it sound.

 

[OrthoTraumaMD]

Thank you for doing this! I am very interested in innovation/research and coupling it with patient care, and I'd like to become a leader in the field. As such, I would like to know what you think are some brand new or up-and-coming areas in ortho (stem cell therapy, cartilage restoration, etc.) that have relatively unexplored waters that will have plenty of opportunity for people such as myself. Thanks again!

Look up OREF (the Orthopaedic Research and Education Foundation), they have some opportunities for residents, and under "research profiles," you can see what kind of work people are doing that the foundation felt deserved grant money. There is great interest in basic science these days: orthobiologics, etc. Within trauma, it's mostly new techniques and implants that make cases easier, as well as fracture healing adjuncts (grafts, BMP), and the research that deals with prevention and treatment of osteoporotic and geriatric fractures.

 

[username456789]

The only all female OR I have been in was when I was on ortho as a med student. Two of my classmates are females who went into Ortho. It's not as weird as you make it sound.

Well it's not "weird", but only about 1/10 orthopods are women, possibly fewer in academics. So I can understand the surprise.

 

[OrthoTraumaMD]

Everyone is always worried about hrs/wk, yet rarely mention overall lifestyle. Do you feel 80+ hrs/wk still allows you family time, time for hobbies, life outside of medicine, etc? Or is most of your time outside of the hospital still consumed by reading up on cases/preparing for the next day?

Also, going into ortho, was lifestyle an important factor for you?

Thank you very much for taking the time to do this!

I am extremely type A, and work is very fun for me, so my perspective on it is a little different. I enjoy reading ortho journals even in my free time, and our field is growing so fast that as a researcher and educator I won't be able to keep up if I don't. Also, patients need me to know the latest clinical data so I can give them actual percentages etc when discussing different surgical options (you have a X% chance of failure with this procedure, etc). I would say that outside of work, about half my time is ortho-related and half is devoted to "life" - sleep, hobbies, family etc. I will say that you can't have TONS of hobbies as a surgeon, so you have to choose those you care about the most: gym, art, whatever. I write fiction, it gives me pleasure and although i don't have hours and hours every day for it anymore like i did in college, I still devote some time each weekend to write. The key to living life successfully as a surgeon AND not being overwhelmed by work is planning. I plan everything: grocery shopping, date nights. It can feel a bit ridiculous, and the downside is that few things in my life are spontaneous-- but at least I feel like I have time for a little bit of everything, because otherwise work grows like a weed and consumes everything else. It happened to me as a resident, and I make an effort on a daily basis to ensure that I remain "human."
As for whether lifestyle was an important factor--- no. If it were, I wouldn't have chosen a surgical field and would have done pretend surgery (also known as derm).

 

[SunsFun]

I am extremely type A, and work is very fun for me, so my perspective on it is a little different. I enjoy reading ortho journals even in my free time, and our field is growing so fast that as a researcher and educator I won't be able to keep up if I don't. Also, patients need me to know the latest clinical data so I can give them actual percentages etc when discussing different surgical options (you have a X% chance of failure with this procedure, etc). I would say that outside of work, about half my time is ortho-related and half is devoted to "life" - sleep, hobbies, family etc. I will say that you can't have TONS of hobbies as a surgeon, so you have to choose those you care about the most: gym, art, whatever. I write fiction, it gives me pleasure and although i don't have hours and hours every day for it anymore like i did in college, I still devote some time each weekend to write. The key to living life successfully as a surgeon AND not being overwhelmed by work is planning. I plan everything: grocery shopping, date nights. It can feel a bit ridiculous, and the downside is that few things in my life are spontaneous-- but at least I feel like I have time for a little bit of everything, because otherwise work grows like a weed and consumes everything else. It happened to me as a resident, and I make an effort on a daily basis to ensure that I remain "human."
As for whether lifestyle was an important factor--- no. If it were, I wouldn't have chosen a surgical field and would have done pretend surgery (also known as derm).

What's with the tongue-in-cheek derm hate? I noticed several surgeons on SDN have a propensity to "sarcastically" look down on dermatology, especially Mohs surgery.

I can't quite put a finger on it, but it seems all too often that when someone asks "can I have a good lifestyle?" question, there is often some vague reply along the lines of "since you asked, I assume you may not be that committed (aka hard-working) and maybe should explore fields like derm". I am not saying that what you said here, but my impression of this post + other similar replies leads me to feel like there is some degree of snobbism that comes across quite often from docs in surgical specialties. Am I completely off base here and ortho culture is nothing like that?

 

[OrthoTraumaMD]

What's with the tongue-in-cheek derm hate? I noticed several surgeons on SDN have a propensity to "sarcastically" look down on dermatology, especially Mohs surgery.

I can't quite put a finger on it, but it seems all too often that when someone asks "can I have a good lifestyle?" question, there is often some vague reply along the lines of "since you asked, I assume you may not be that committed (aka hard-working) and maybe should explore fields like derm". I am not saying that what you said here, but my impression of this post + other similar replies leads me to feel like there is some degree of snobbism that comes across quite often from docs in surgical specialties. Am I completely off base here and ortho culture is nothing like that?

Nah, I think there is a bit of projection here. I make no assumptions about how hardworking someone is. I've been in this field long enough to know that no surgical specialty is truly a "lifestyle" specialty-- particularly during residency. When someone asks about lifestyle, I imagine someone who wants to work 9-5. Not that there is anything wrong with that, but I don't know any surgeon who does. Maybe some exist out there. So maybe I (and other surgeons) need a better explanation of what someone means when they ask about lifestyle.

As for why the derm sarcasm, I have a problem with dermatologists calling themselves "surgeons." Being a surgeon carries the implication that you underwent the grueling hours of a surgical residency. Sorry, but if you're barely going beyond dermis, it isn't surgery. But who knows, maybe I have my own biases. When I was a resident, starving and sleep-deprived after 30 hours of call, too dizzy from sleep deprivation to drive home safely, and trying instead to catch a few quiet minutes in the resident library, I was awoken by two giggling, dressed-to-the-nines derm residents, with fully done hair and makeup, loudly complaining about how 730am was too early to come in to work. (I had to be in by 430am, by comparison, and left at 9pm when they left at 3). So seeing these people call themselves "surgeons" when they weren't in the trenches pisses me off.

 

[Prilozack]

Do you find any difference between MD and DO orthopedic surgeons? And also chances of program matching between the two?

 

[CornFed]

Nah, I think there is a bit of projection here. I make no assumptions about how hardworking someone is. I've been in this field long enough to know that no surgical specialty is truly a "lifestyle" specialty-- particularly during residency. When someone asks about lifestyle, I imagine someone who wants to work 9-5. Not that there is anything wrong with that, but I don't know any surgeon who does. Maybe some exist out there. So maybe I (and other surgeons) need a better explanation of what someone means when they ask about lifestyle.

As for why the derm sarcasm, I have a problem with dermatologists calling themselves "surgeons." Being a surgeon carries the implication that you underwent the grueling hours of a surgical residency. Sorry, but if you're barely going beyond dermis, it isn't surgery. But who knows, maybe I have my own biases. When I was a resident, starving and sleep-deprived after 30 hours of call, too dizzy from sleep deprivation to drive home safely, and trying instead to catch a few quiet minutes in the resident library, I was awoken by two giggling, dressed-to-the-nines derm residents, with fully done hair and makeup, loudly complaining about how 730am was too early to come in to work. (I had to be in by 430am, by comparison, and left at 9pm when they left at 3). So seeing these people call themselves "surgeons" when they weren't in the trenches pisses me off.

I suppose I should've clarified further when I asked. I meant more along the lines of "will I be able to have a solid relationship with my family if I chose to pursue ortho?" I am not looking for a 9-5 career by any means, but am looking to have solid relationships with my future children and wife as well as some other interest outside of medicine.

 

[Prilozack]

I suppose I should've clarified further when I asked. I meant more along the lines of "will I be able to have a solid relationship with my family if I chose to pursue ortho?" I am not looking for a 9-5 career by any means, but am looking to have solid relationships with my future children and wife as well as some other interest outside of medicine.

I know quite a few ortho surgeons personally who have great lifestyles. I would assume it depends on the practice and also the person individually.

 

[OrthoTraumaMD]

Do you find any difference between MD and DO orthopedic surgeons? And also chances of program matching between the two?

I have only met a few DO surgeons in my life, so I can't speak to their quality. Unfortunately I can't answer the second question either, as I have zero experience with DO programs. The only thing I can say is than ortho in an MD program is one of the top 5 toughest specialties to match into.

 

[SunsFun]

Nah, I think there is a bit of projection here. I make no assumptions about how hardworking someone is. I've been in this field long enough to know that no surgical specialty is truly a "lifestyle" specialty-- particularly during residency. When someone asks about lifestyle, I imagine someone who wants to work 9-5. Not that there is anything wrong with that, but I don't know any surgeon who does. Maybe some exist out there. So maybe I (and other surgeons) need a better explanation of what someone means when they ask about lifestyle.

As for why the derm sarcasm, I have a problem with dermatologists calling themselves "surgeons." Being a surgeon carries the implication that you underwent the grueling hours of a surgical residency. Sorry, but if you're barely going beyond dermis, it isn't surgery. But who knows, maybe I have my own biases. When I was a resident, starving and sleep-deprived after 30 hours of call, too dizzy from sleep deprivation to drive home safely, and trying instead to catch a few quiet minutes in the resident library, I was awoken by two giggling, dressed-to-the-nines derm residents, with fully done hair and makeup, loudly complaining about how 730am was too early to come in to work. (I had to be in by 430am, by comparison, and left at 9pm when they left at 3). So seeing these people call themselves "surgeons" when they weren't in the trenches pisses me off.

Very interesting. Thanks for the insight. With regard to lifestyle, that's kind of what I was getting at. There seem to be some sort of "don't ask don't tell" type of thing going on with surgeons. Like as if you're not supposed to be thinking about that and asking questions. When you do ask, you get some variation of "chose something else (derm)" reply from many surgeons. Maybe that's what I meant by my perception of ortho culture...not sure.

Your sentiment regarding dermatological surgery reminds me of similar arguments made in multiple MD vs NP/PA threads in here with one important difference. You do reflect on the question of whether it's your own biases or if those "in the trenches" do indeed "deserve" the title over others.

 

[OrthoTraumaMD]

I suppose I should've clarified further when I asked. I meant more along the lines of "will I be able to have a solid relationship with my family if I chose to pursue ortho?" I am not looking for a 9-5 career by any means, but am looking to have solid relationships with my future children and wife as well as some other interest outside of medicine.

Then my answer is yes. If you want to have that relationship with your family, as well as hobbies, then you will. Ortho will not stop you. The one caveat is that you may have to have a few hobbies as opposed to many, and could only go to, let's say, a few of your kids' games instead of all of them. If you choose to spend more time with your family, something will have to be given up at work (say, not publishing as much). Most of us don't notice what we give up, because being an orthopod compensates for it. It is just that good.

 

[OrthoTraumaMD]

Very interesting. Thanks for the insight. With regard to lifestyle, that's kind of what I was getting at. There seem to be some sort of "don't ask don't tell" type of thing going on with surgeons. Like as if you're not supposed to be thinking about that and asking questions.

Let me put it this way. When someone gets close enough to ask me that question, they're usually a med student doing the ortho rotation. And on an ortho rotation, you should be thinking about ortho, not how much free time you will have after your residency. Many attendings will misunderstand what you are asking, and will assume you are asking because you don't want to work hard. It's just the knee-jerk reaction. Blame it on those who came before you, whose questions about lifestyle were usually accompanied by a less-than-stellar work ethic on the rotation.

 

[Dr. Death]

Who runs the traumas at your hospital? Are there general surgery trained trauma docs or is it predominantly run by ortho traumas?

 

[OrthoTraumaMD]

Who runs the traumas at your hospital? Are there general surgery trained trauma docs or is it predominantly run by ortho traumas?

Initially, if the patient comes through the ER, the ER physician is the responsible party unless the trauma response is called. And then it goes to the trauma team, headed by a general surgery trauma surgeon. If the determination is made that it's an isolated ortho injury without other stuff going on, then it's me.

 

[AlteredScale]

Did you pursue ortho research early on in medical school? What attracted you to academics?


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[Bancrofti]

2 questions:

1) Where does the stigma against trauma come from and is it something people should still be wary of? I I had been debating peds for a while for the ability to operate all over and general happiness of dealing with kids (tumor as well, but it seems like the job market isn't great) but after doing trauma, I think it bumped up on my list. Just want to make sure my perspective isn't jaded as I haven't had super volume heavy trauma rotations and I was normally out of the OR by 6-7 most days.

2) What's your take on uniquely female experiences in residency, largely, getting pregnant as a resident? I'm assuming it isn't very common, but is this something you've heard of? I believe PDs can't ask you about your plans for family and kids during residency interviews, but did you get the feeling it was something that was looked down upon for female residents? And as an extension... had a resident tell me once, the higher then # of females in a program, the less likely he would have been to go to it. I don't feel that way at all, and actually prefer a diverse atmosphere with respect to sex/race, but what are the general misconceptions you think the "bro" male might have about having female co-residents.

 

[Burla]

1. What aspects of a residency program should I look at when ranking programs to match?
2. Is Doximity a good resource for ranking programs by reputation? https://residency.doximity.com/programs?residency_specialty_id=51&sort_by=reputation
3. Are fellowships essentially required now? At this point, I'm most interested in doing general ortho. A PGY5 at my med school wants to do the same but is doing a fellowship in adult recon "just to be more marketable".

 

[OrthoTraumaMD]

1. What aspects of a residency program should I look at when ranking programs to match?
2. Is Doximity a good resource for ranking programs by reputation? https://residency.doximity.com/programs?residency_specialty_id=51&sort_by=reputation
3. Are fellowships essentially required now? At this point, I'm most interested in doing general ortho. A PGY5 at my med school wants to do the same but is doing a fellowship in adult recon "just to be more marketable".

1) Resident camaraderie, how much and how early you start operating, amount of faculty members and residents present at the interview day (if you don't see any residents, RUN!), and of course things that are important to you, like location. Remember, any ortho residency in the US can train you to be a good orthopod. The match works both ways, the program has to match you as much as you match the program. Do you see yourself going out for a beer with these people after work? That's the ultimate question I ask myself when I do interviews, and it's a question you should be asking yourself when you leave interview day. Ortho residency is 5 years, and these people will become your family, like it or not. I can teach a monkey how to operate. Ortho isn't that hard. Figuring out if this person is a reasonable, honest, normal human who won't push off work on co-residents, who won't lie to me about patient care, and who won't commit mass murder -- now that's what I really want to know when I interview people.

2) I've never used Doximity. Looking at the list now, certainly these programs are impressive, but so are others that are not on the list. It goes back to my first answer. I would never rank a program by reputation. Interview and see what your gut feeling is. I interviewed at an extremely prestigious program, and found them so snobbish and arrogant that I ranked them on the bottom of the list--- below my general surgery backups.

3) You can do general ortho if you want, but if you want to do academics, a fellowship is essentially required. One of my other posts has more info on this but essentially patients and hospitals want fellowship-trained surgeons, so >95% of us do fellowships. Still, I know people who didn't do a fellowship, and they were mostly the types that went back to their small hometown to practice and be the jack-of-all-trades out there.

 

[MarshallW]

Any experiences with older non-traditional students? Do you feel like ortho has an age bias because of the physical nature of the work? Would starting an ortho residency at 35 be crazy?

 

[SilverLining1853]

2B. You are correct in saying that PDs cannot ask you about family plans during interviews, but I've done plenty of interviews and let me tell you, they have ways of figuring it out using more subtle questioning. And I've been asked directly in the past, when I've interviewed. Most people don't have a problem with answering because they don't care. One good way of scoping out if a program is family friendly is asking how many of the residents have families, and how many of them started families during residency.

Thank you for doing this! I'm a female applying to ortho next year so this is awesome.

I had my daughter several years prior to starting medical school. Do you think the fact that I already have a child/family is going to be held against me even though my husband and I have absolutely no intention of having another child during residency? Honestly, I would rather be asked directly than have anyone assume that I would even consider having a child during a demanding surgical residency. Is there anything I can say to make this clear without seeming...well, a little crazy? LOL Thanks in advance!

 

[premed1234567891011]

Do you feel you're fairly compensated?

 

[OrthoTraumaMD]

Do you feel you're fairly compensated?

Yes. Would I like more money? Yes of course, and I could probably argue for more as I become a bit more established academically-- but for right now, I'm getting exactly what I deserve (and to be honest, probably more than I deserve, haha).

 

[FutureDoc1088]

Regarding making rank lists - you say to go with your "gut" feeling about a program, etc. and to not worry about reputation. Do you think reputation plays a bigger role if you want to go into academics as an attending? Does your fellowship reputation matter more for getting an academic job?

Thank you for your time!

 

[OrthoTraumaMD]

Regarding making rank lists - you say to go with your "gut" feeling about a program, etc. and to not worry about reputation. Do you think reputation plays a bigger role if you want to go into academics as an attending? Does your fellowship reputation matter more for getting an academic job?

Thank you for your time!

If your residency has something very specific with big names in the subspecialty you wish to enter (ex. MGH and tumor), then sure, reputation matters. But most people I know got their jobs in academia due to their fellowship connections. All fellowships want their graduates to find jobs, and they will actively work to make it happen because if they don't, they look bad to future applicants. Residencies don't put as much stock in it, in my experience.

 

[Levrone]

I am very interested in ortho

Can ortho be a field where you can make meaningful relationships with patients and spend a decent amount of time with them during appointments? i guess since you're trauma, it'd be pretty different from the other sub specialties. (i was thinking possibly sports med for myself but open to everything)

 

[OrthoTraumaMD]

I am very interested in ortho

Can ortho be a field where you can make meaningful relationships with patients and spend a decent amount of time with them during appointments? i guess since you're trauma, it'd be pretty different from the other sub specialties.

Yes. Tumor most of all, and then peds, but any subspecialty can. The appointment time is more iffy, and varies highly by subspecialty and also by how busy you are. Joints guys hustle patients in and out too. But spending a lot of time with patients does not equal better or more meaningful relationships. Just because I don't spend a lot of time with them in clinic doesn't mean I don't get to know them. I talk to them during their initial hospitalization, when they're inpatients etc. They need to be able to trust me during what may be the most painful and frightening moment of their lives...sometimes quite expediently. Or entrust their family members to me. Either way, I place a lot of value in making sure the patient understands the procedure and why I'm doing, or not doing, the surgery. That actually requires fairly involved explanations and the rationale behind them. I know their names and their families, and I hug them if they had a really bad fracture and I see them in clinic and their wound that I spent a week treating with a vac has stopped draining, or some aspect of their care that I worried about ended up doing well. (I only hug little old ladies though, because they're cute). Patient relationships are really what you make of them. If you choose to allow that into your life (and not everyone does, or should, because it blurs the lines between the personal and professional, and you end up thinking about them much more than you ever expected or wanted), then you will make time for it, even in a surgical field.

 

[porc]

Thank you for writing this!

I am an incoming medical student and I am also interested in ortho. My question for you is, how do I go about finding research opportunities in medical school and what type of research should I be looking for if I am interested in ortho?

Second question: If you could start over, starting at medical school, what would you change and why?

 

[OrthoTraumaMD]

Thank you for writing this!

I am an incoming medical student and I am also interested in ortho. My question for you is, how do I go about finding research opportunities in medical school and what type of research should I be looking for if I am interested in ortho?

Second question: If you could start over, starting at medical school, what would you change and why?

For your first question, ask the Ortho department coordinator to put you in touch with an attending who would like to work on a project. The program director usually has this information as well. And then what will most likely happen is that they will connect you with the resident who is doing that project. After that you help them in any way that you can. As far as the type of research, there is basically clinical and basic science, the latter is mostly bench type of stuff. If you have lots of experience with that and like it, ask if any attendings are also interested. If not, I would suggest clinical because it's easier to complete.

As for your second qn, I would have taken more leadership positions in med school club organizations, maybe not even orthopaedics but something that mattered to me. Maybe even taken a trip abroad. But I generally don't like to think about the past because it cannot be changed, and I don't want to spend my time thinking about things like that. Overall, I would say not much. I'm pretty happy with the way it went.

 

[SilverLining1853]

Having a child actually makes you a safer bet for a program, because unlike a young single woman, your biological clock isn't pressuring you as much, in their eyes. As for your other question, unless you are asked, I wouldn't mention it. If they are willing to discriminate against you based on what they think you MIGHT do, it's not a program worth your time anyway. All programs consider women of childbearing age to be a "risk," but it doesn't deter most of them from hiring women. Plus, anyone can say "oh, I promise I'm not gonna have a kid" and then end up pregnant anyway, by either intent/change of heart or accident. Then you look like a liar at worst or an irresponsible person at best. So just don't worry about it. Worry about making a good impression on the interview trail and working hard at away rotations. This is one thing you can't control. But I understand your concern... so one thing I would say is don't "overdress" for interview day. Don't cake on makeup or bright jewelry, wear heels that are sky-high, or do your hair too elaborately. In other words, to put it bluntly, don't look too high-maintenance or "wifey." Most orthopods (male and female) associate that stuff with femininity and may subconsciously dismiss you as potentially being focused more on yourself/family/outside things than work. That is not to say that you should look sloppy or not wear makeup. Just keep it simple and clean, a la Olivia Benson in Law and Order: SVU.

Thanks for the advice. I've never been a girly girl so fortunately I don't have to worry about coming across as high-maintenance LOL...simple and clean works for me. Thanks again!

 

[Chillbo Baggins]

Thanks in advance. I've got 3 questions that kind of span the entire course of becoming an orthopod:

1. I'm at a mid-tier state school that's definitely not a research powerhouse. However, I've been told by faculty that having done at least some research is essentially a requirement for applicants here to even be considered. So I've got a year and a half until submitting ERAS, but only 2 ortho research experiences, and one school poster. We'll see if I can get something more substantial before applying. My question is how much does your program (or any programs you know of) take into consideration the quantity and quality of research?

2. During my ortho week during surgery I was just with the trauma guys and really enjoyed it. Would you say trauma is the most important subspecialty rotations during residency to become a competent surgeon? And is there a minimum amount you would recommend looking for in a program (12mo, 15mo, etc.)?

3. As above, I'm intrigued by trauma right now, but I also like the idea of owning my own practice or being part of a group in the future, and I'm curious how that could be possible when specializing in trauma. Having OR privileges and taking call at local hospitals and having patients follow up in your off-site clinic?

Thanks again; I could ask questions all day, but I'll keep it manageable.

 

[OrthoTraumaMD]

Thanks in advance. I've got 3 questions that kind of span the entire course of becoming an orthopod:

1. I'm at a mid-tier state school that's definitely not a research powerhouse. However, I've been told by faculty that having done at least some research is essentially a requirement for applicants here to even be considered. So I've got a year and a half until submitting ERAS, but only 2 ortho research experiences, and one school poster. We'll see if I can get something more substantial before applying. My question is how much does your program (or any programs you know of) take into consideration the quantity and quality of research?

2. During my ortho week during surgery I was just with the trauma guys and really enjoyed it. Would you say trauma is the most important subspecialty rotations during residency to become a competent surgeon? And is there a minimum amount you would recommend looking for in a program (12mo, 15mo, etc.)?

3. As above, I'm intrigued by trauma right now, but I also like the idea of owning my own practice or being part of a group in the future, and I'm curious how that could be possible when specializing in trauma. Having OR privileges and taking call at local hospitals and having patients follow up in your off-site clinic?

Thanks again; I could ask questions all day, but I'll keep it manageable.

First of all, love the Tolkien-esque username. As for your questions:

1. Quality is more important than quantity when it comes to research. We don't even truly care if your research is in ortho, although it helps. All we look for is commitment (meaning you stick with the project) and enthusiasm (can you talk about what you did, why you did it, and why you think it was important?)...I only had two research experiences when applying as well. We are not hiring PhDs for benchwork here. If you have 30 publications as a med student, we look at you funny (unless you did some kind of gap year and didn't sleep)--- MEANINGFUL involvement trumps amount of projects every time. And we will ask you specifics if it's an ortho project. An easy trick is to look up the subspecialties of your interviewers before you go in; if you did a trauma project, you can bet I'm going to ask you something about it, and make sure you understand what the purpose of the project was, what the anatomy or disease process involves, etc. Know your **** up and down. Nothing in the application is off limits. I just did an interview where one of the applicants claimed to be fluent in a certain [uncommon] language. I immediately switched to conversation in that language (happens to be my native one). (He passed, haha.)

2. Most programs have set rules about how much time you spend in a certain subspecialty. Trauma is the "bread and butter" of ortho, and most programs will get their fill of it with ER call. I wouldn't worry about the amount of time; all programs must meet ACGME rules anyway. I'm obviously biased in favor of trauma, but I don't think it's THE most important. A well-rounded program to me is much more useful. Of course, every non-trauma guy is in a different boat because unless they land a super cush job, they have to take trauma call, and if they aren't comfortable with it, it can be stressful. But in most big places, there are daily trauma rooms with people like me staffing them, so all the on-call guy has to do is keep the patient alive for the night and wash/ex-fix stuff, which anyone can do in a pinch.

3. I only know of one semi-private trauma practice (Reno, Nevada) and they have a special business model. If you do trauma, it is hospital-based and 99.9999% of the time you are a salaried physician. If you go into private practice or into a group, the group will expect you to make money. Because trauma is seasonal and unpredictable, you need to do other things to supplement it-- joints, hand, etc. Almost every trauma guy I know who practices trauma exclusively works for a hospital system. Otherwise, you're forced to do other things, and I had zero interest in that. If I never do another joint replacement again, it will be too soon. (Although I do hemiarthroplasties for femoral neck fractures-- but some trauma guys give that to their joints partners.)

Hope this helps; feel free to ask as much as you want.

 

[OrthoTraumaMD]

No one has mentioned this yet, but I want to write a post I think is important, because these are so easy to avoid and yet I see every single one perpetrated every year that I've been an attending:

Things that will kill your chances at an ortho program

During your rotation (away or home):
1. Being arrogant to the non-resident staff. Nurses, PAs, NPs, the janitor. Your job is to smile, be helpful, and do whatever they ask, even if it's "scut." You may think it's a no-brainer, but I've seen rotators tell our NPs, "I think you're mean" or "I think you could do better." Oh yes. Treat everyone like an attending, because you never know whose colleague/friend/cousin/wife/secret lover they may be. Shut your trap and keep your opinions to yourself (unless you see a patient being harmed).
2. Being the first to leave at the end of the day. Conversely, staying past the point of comfort and "hovering." To figure out when you can leave, meet with the chief resident on the service on the first day of your rotation and talk about your expectations-- ask "how can I best be of assistance, what are my responsibilities during rounds/conference/consults, and what are your expectations for me in terms of hours?" After that, play by ear-- if the junior resident is slammed, help them out and leave later.
3. Being on your smartphone during conference. It's such a temptation to quickly check your email OR even look stuff up--avoid it at all costs. If you hear a topic in conference, write it down for later, on paper.
4. Stealing cases from your co-rotators. We get it, most of us were gunners, but ortho is collaborative. Make sure the residents assign you somewhere and stick with it (if it's a free-for-all, make a schedule amongst yourselves). Don't fall all over yourself trying to scrub with the "most important," big name guy. It's really not as important as you think; plus, you never know what "little guy" has his ear and who would appreciate some student help in a difficult case.
5. Making fun of residents in front of other residents (this includes joining in when residents are making fun of their classmates)-- just don't say anything, 'smile and nod.'
6. Complaining about cases, length of the day, etc etc. Leave that for your spouse. There is no crying or whining in ortho (at least not at work-- I feel like I must have cried on a daily basis in PGY2, but always at home.)
7. Not preparing for cases. It's okay if you don't know the answer to a question, but no one will ask you super specific things--- basic anatomy suffices. Go over the cases for the next day with the residents and at least read the OrthoBullets section on the topic. Most residents will give you tips on what the attending might ask.
8. Flirting. You're there to work, so be professional. If you find yourself head over heels for someone in the program, leave that for when you're done with the rotation.
9. Lying. Just don't. Ever. Even if you messed up or forgot to do something, just admit to it so it can be fixed. If you didn't check a pulse, don't say that you did-- because if that patient has no pulse, it will make the resident think something happened.
10. A consequence of doing the above things: if you get a bad eval from the residents on any form during your rotation, your chances are almost nil. Most programs don't give residents the power to choose people for the match, but they do have the power of blacklisting-- no matter how good the letters/attending opinions/step scores may be, if the residents put you on their "do not take list," it's over.

During your interview:
1. Lying about anything on your application, including the extent of your involvement in a project.
2. Not knowing what your research involves or why you did it.
3. Saying, "Do I have to answer that question?" Unless they're asking an illegal question, just answer to the best of your ability. Anything else makes you sound shady.
4. Talking **** about your home program or any orthopaedic surgeon or resident (even if they don't come from that program). You would think this never happens, but I guarantee you there's at least one every interview season.
5. Getting drunk during the resident dinner. Bonus points for dancing on the table (yes, this happened too).

 

[Smurfette]

Things that will kill your chances at a program

During your rotation (away or home):
1. Being arrogant to the non-resident staff. Nurses, PAs, NPs, the janitor. Your job is to smile, be helpful, and do whatever they ask, even if it's "scut." You may think it's a no-brainer, but I've seen rotators tell our NPs, "I think you're mean" or "I think you could do better." Oh yes. Treat everyone like an attending, because you never know whose colleague/friend/cousin/wife/secret lover they may be. Shut your trap and keep your opinions to yourself (unless you see a patient being harmed).

This bears repeating for any student doing a rotation. I am not in ortho, but the ortho, ENT, urology and ophtho residents rotated with me as interns and we all knew each other. So when I am in the OR/pre-op holding/PACU and a overzealous student comes by and acts like an obnoxious tool, you bet that I will mention it to the resident/attending/whoever I know on that service to let them know. They would do the same for me. Even if you think somebody has no bearing on your evaluation, you don't really know. You want to stand out as helpful to anyone and everyone around you to make them want to work with you; getting a good reputation in the OR or the floors goes a LONG way.

 

[deleted393595]

I am extremely type A, and work is very fun for me, so my perspective on it is a little different. I enjoy reading ortho journals even in my free time, and our field is growing so fast that as a researcher and educator I won't be able to keep up if I don't. Also, patients need me to know the latest clinical data so I can give them actual percentages etc when discussing different surgical options (you have a X% chance of failure with this procedure, etc). I would say that outside of work, about half my time is ortho-related and half is devoted to "life" - sleep, hobbies, family etc. I will say that you can't have TONS of hobbies as a surgeon, so you have to choose those you care about the most: gym, art, whatever. I write fiction, it gives me pleasure and although i don't have hours and hours every day for it anymore like i did in college, I still devote some time each weekend to write. The key to living life successfully as a surgeon AND not being overwhelmed by work is planning. I plan everything: grocery shopping, date nights. It can feel a bit ridiculous, and the downside is that few things in my life are spontaneous-- but at least I feel like I have time for a little bit of everything, because otherwise work grows like a weed and consumes everything else. It happened to me as a resident, and I make an effort on a daily basis to ensure that I remain "human."
As for whether lifestyle was an important factor--- no. If it were, I wouldn't have chosen a surgical field and would have done pretend surgery (also known as derm).

Is it possible to do shift work or work part time (~50 hours) in ortho?