ortho attending AMA

[OrthoTraumaMD]

What is clinic like for orthopedic surgeons? I know in other surgical subspecialties there is some (or a lot) of medical management of some diseases, does that translate over to orthopedics as well? Or is ortho clinic more of screening to see who gets surgery or not? And are there any procedures in clinic that you (as an ortho surgeon) do?

I know this may differ since you're a traumatologist, but could you also speak to other aspects of ortho as well?

Thanks!

generally the percentage of what you see and the way you run your clinic depends on:

1. How broad your scope of practice is. I only do trauma, so I only see fractures and emergent consults by choice. I have no interest in non-fracture work. Others would see all different acuity patients.... so a person may do sports, but also see back pain, spine, trauma etc.
2. Your subspecialty— different ones do different things in clinic and see different kinds of patients.

It is usually not broad medical management. It is very problem focused. Preoperative assessments for medical issues are done by the pcp. One exception is osteoporosis, where sometimes depending on your practice surgeons may be more involved in treatment, but most often they just refer to pcp/endocrine.

Some surgeons see everything and then decide if people need surgery. Other surgeons who would be overloaded with unnecessary clinic visits have special people in their practice who see people with issues that may need surgery later but not currently. For example, back pain patients are seen by the non-operative doc who then sends them to the surgeon if they have maxed out on non-operative management. For sports surgeons, a non-operative sports medicine doctor does the same. Other than new visits we see our post operative patients as well as follow up patients. Again depending on your specialty, in office procedures include all kinds of injections, splinting/casting, sometimes fracture reduction.

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[MomJeansandDadJorts]

How accepting are attending and fellow residents to LGBTQ+ coworkers? From what ive heard, it seems to only be a problem with the older attendings and a lot of the younger individuals dont care so much.

 

[OrthoTraumaMD]

How accepting are attending and fellow residents to LGBTQ+ coworkers? From what ive heard, it seems to only be a problem with the older attendings and a lot of the younger individuals dont care so much.

No more and no less than anyone else.

 

[Freshley Snipes]

generally the percentage of what you see and the way you run your clinic depends on:

1. How broad your scope of practice is. I only do trauma, so I only see fractures and emergent consults by choice. I have no interest in non-fracture work. Others would see all different acuity patients.... so a person may do sports, but also see back pain, spine, trauma etc.
2. Your subspecialty— different ones do different things in clinic and see different kinds of patients.

It is usually not broad medical management. It is very problem focused. Preoperative assessments for medical issues are done by the pcp. One exception is osteoporosis, where sometimes depending on your practice surgeons may be more involved in treatment, but most often they just refer to pcp/endocrine.

Some surgeons see everything and then decide if people need surgery. Other surgeons who would be overloaded with unnecessary clinic visits have special people in their practice who see people with issues that may need surgery later but not currently. For example, back pain patients are seen by the non-operative doc who then sends them to the surgeon if they have maxed out on non-operative management. For sports surgeons, a non-operative sports medicine doctor does the same. Other than new visits we see our post operative patients as well as follow up patients. Again depending on your specialty, in office procedures include all kinds of injections, splinting/casting, sometimes fracture reduction.

Thank you so much! Another question:

In other specialities you'll see surgeons start off their careers with big whacks, and then, as they get older they will start tapering off their practice and doing smaller more routine cases/more clinic (specifically ENT and Urology I have seen this happen). Is this something that you see in Orthopedics as well?

Thanks again!

 

[OrthoTraumaMD]

Thank you so much! Another question:

In other specialities you'll see surgeons start off their careers with big whacks, and then, as they get older they will start tapering off their practice and doing smaller more routine cases/more clinic (specifically ENT and Urology I have seen this happen). Is this something that you see in Orthopedics as well?

Thanks again!

Not usually. It depends on specialty. Some cases (sports) never have “big whacks” in the first place. Some (joints) always do. Orthopedic surgeons generally take less call as they age but their cases remain the same.

 

[eggeggeggegg]

Is ortho out of the question if lifestyle is a consideration?

I've been reading conflicting anecdotes on this forum/reddit so more opinions would be nice. I'm most interested in ortho, but do want to make sure there is enough time left for family, health, and other endeavours. At the end of the day, I could also be happy doing other fields in medicine.
How realistic is a 60 hour week be for an attending? I saw a few other posts that seemed to imply you would take a large pay cut but does that mean you go from 500->300k or 400->200k? Or maybe a better question is, how long into your practice before you could set up a stable gig that provides a nice balance of hours and compensation?

Thanks for doing this!

 

[confuzzled10]

This is a very informative thread. This is nice. Thank you for doing this.

 

[OrthoTraumaMD]

Is ortho out of the question if lifestyle is a consideration?

I've been reading conflicting anecdotes on this forum/reddit so more opinions would be nice. I'm most interested in ortho, but do want to make sure there is enough time left for family, health, and other endeavours. At the end of the day, I could also be happy doing other fields in medicine.
How realistic is a 60 hour week be for an attending? I saw a few other posts that seemed to imply you would take a large pay cut but does that mean you go from 500->300k or 400->200k? Or maybe a better question is, how long into your practice before you could set up a stable gig that provides a nice balance of hours and compensation?

Thanks for doing this!

60 hours a week is very reasonable for an attending and you would not take a pay cut for that.

 

[Miles Gloriosus]

Came across this nice review article for ortho applicants:

https://www.utrgv.edu/som/careers-in-medicine/_files/documents/2018/survival-guide-for-ortho-match.pdf

Also, these might be informative (one is from open access so interpret as you will) for those who don’t match:

The Fate of Unmatched Orthopaedic Applicants: Risk Factors... : JBJS Open Access

addressed by the applicant. We aimed to investigate the risk factors and outcomes of unmatched orthopaedic applicants. Methods: This was a retrospective study using a survey-based questionnaire administered electronically to medical students annually from 2016 to 2019 immediately after match...

journals.lww.com

How Should Unmatched Orthopaedic Surgery Applicants Proceed?

Obtaining an orthopaedic surgery residency is competitive. Advisors must understand what factors may help unmatched candidates reapply successfully.We determined (1) the attitude of leaders of orthopaedic surgery residency programs toward interviewing ...

www.ncbi.nlm.nih.gov

 

[Doc mu]

A ton of it is learning on the job. I would say 70%. Particularly the manual things like splints and casts, reductions.

Keep an open mind. Real decisions shouldn’t be made til 3rd year.

I list textbooks and give similar advice in the thread. I know the thread is long, but it’s been running for 2 years now. I try not to answer the same questions over and over as it’s not a good use of time.

I thought the ones listed on the first/second page were only the books you would recommend reading BEFORE residency, are those actually all the books you need to know to become a full fledged ortho surgeon (plus the weisel books are like 5000+ dense pages with multiple volumes can anyone actually commit the entire series to heart?)

 

[DNC127]

I thought the ones listed on the first/second page were only the books you would recommend reading BEFORE residency, are those actually all the books you need to know to become a full fledged ortho surgeon (plus the weisel books are like 5000+ dense pages with multiple volumes can anyone actually commit the entire series to heart?)

stopppp

 

[Doc mu]

stopppp

??

 

[OrthoTraumaMD]

I thought the ones listed on the first/second page were only the books you would recommend reading BEFORE residency, are those actually all the books you need to know to become a full fledged ortho surgeon (plus the weisel books are like 5000+ dense pages with multiple volumes can anyone actually commit the entire series to heart?)

There is no “exhaustive” book list.

 

[Welshman]

@OrthoTraumaMD

What are your thoughts on this? Especially given the stress many students feel about “publishing”

“At the time of application, the median h-index was 0, the median number of publications was 1, and 40% of successful candidates did not hold any publications.”

https://journals.lww.com/jaaos/Abstract/9900/The_Orthopaedic_Match__Defining_the_Academic.21.aspx

 

[OrthoTraumaMD]

@OrthoTraumaMD

What are your thoughts on this? Especially given the stress many students feel about “publishing”

“At the time of application, the median h-index was 0, the median number of publications was 1, and 40% of successful candidates did not hold any publications.”

https://journals.lww.com/jaaos/Abstract/9900/The_Orthopaedic_Match__Defining_the_Academic.21.aspx

“Publication” can mean a lot; this study just looked at published articles indexed by pubmed and scotus, which isn’t always inclusive of all published work... I would call this needing at least one work of quality... but overall it doesn’t mean you can just publish one article and be done, as the average number of “research things” is 7. So more is better, but if you have one quality publication and several other things like posters, abstracts etc, you’re in good shape.

 

[Lawpy]

“Publication” can mean a lot; this study just looked at published articles indexed by pubmed and scotus, which isn’t always inclusive of all published work... I would call this needing at least one work of quality... but overall it doesn’t mean you can just publish one article and be done, as the average number of “research things” is 7. So more is better, but if you have one quality publication and several other things like posters, abstracts etc, you’re in good shape.

Wait do posters/abstracts really matter? What if an applicant has one quality paper and maybe one poster?

 

[OrthoTraumaMD]

Wait do posters/abstracts really matter? What if an applicant has one quality paper and maybe one poster?

These days you ideally need more than that but if your application is strong in other ways (great scores and letters from aways), then you could be ok.

 

[Gilakend]

What are your opinions on (relatively) new residency programs? For someone who is likely not interested in academics is there a downside to choosing one? Maybe a harder time with fellowships? Do you think they should be avoided or is the process of starting a residency program thorough enough you'd feel confident applying there?

I'm thinking of programs that are relatively new, like Dell, where I don't think they've graduated a class yet, but are attached to a large hospital system.

 

[manhattalorian]

Do you mind sharing what city you practice in? If you prefer not to share, is it rural, urban, or big city center?

Do you see ortho kids out of school who want to go to a specific geographic area to practice a specific sub-specialty (Mountain/alpine injury vs. vehicular trauma vs. sports injury). I'm curious how you perceive new guys/girls selecting their specific paths after school and what draws them where if that makes sense.

I'm interested I think in wilderness and austere-setting ortho/trauma; do you have any experience or knowledge in that realm?

Thank you for answering these questions the thread has been really fun to read. I have old school ortho in my family but it's TOO old school if you know what I mean.

 

[OrthoTraumaMD]

What are your opinions on (relatively) new residency programs? For someone who is likely not interested in academics is there a downside to choosing one? Maybe a harder time with fellowships? Do you think they should be avoided or is the process of starting a residency program thorough enough you'd feel confident applying there?

I'm thinking of programs that are relatively new, like Dell, where I don't think they've graduated a class yet, but are attached to a large hospital system.

If not interested in academics and if the faculty are well trained, I wouldn’t worry.

 

[OrthoTraumaMD]

Do you mind sharing what city you practice in? If you prefer not to share, is it rural, urban, or big city center?

Do you see ortho kids out of school who want to go to a specific geographic area to practice a specific sub-specialty (Mountain/alpine injury vs. vehicular trauma vs. sports injury). I'm curious how you perceive new guys/girls selecting their specific paths after school and what draws them where if that makes sense.

I'm interested I think in wilderness and austere-setting ortho/trauma; do you have any experience or knowledge in that realm?

Thank you for answering these questions the thread has been really fun to read. I have old school ortho in my family but it's TOO old school if you know what I mean.

I won’t give specifics about myself.
I can say that there are some residents who want to practice in more rural areas and yes it’s possible. Usually private practice situation as the academic centers are few and likely full. I have friends working in places like Montana and they love it. As long as you’re okay with the environment.

But just as an FYI, as an ortho specialist you’ll need a private practice and not a hospital — a small rural hospital won’t be able to support you on its own. The true “rural” stuff is done by the ER in places where there is no ortho coverage. Then it gets sent out to be seen outpatient. If inpatient it will go to the nearest Level 2. So that’s what you probably will be looking for— a private practice that covers level 2.

 

[manhattalorian]

I won’t give specifics about myself.
I can say that there are some residents who want to practice in more rural areas and yes it’s possible. Usually private practice situation as the academic centers are few and likely full. I have friends working in places like Montana and they love it. As long as you’re okay with the environment.

But just as an FYI, as an ortho specialist you’ll need a private practice and not a hospital — a small rural hospital won’t be able to support you on its own. The true “rural” stuff is done by the ER in places where there is no ortho coverage. Then it gets sent out to be seen outpatient. If inpatient it will go to the nearest Level 2. So that’s what you probably will be looking for— a private practice that covers level 2.

Ok, got it. Thanks dudette!

 

[Type2Fiber]

Thoughts on this article regarding compensation and fellowship training? Do you think there will ever be any change from the trend of 90%+ ortho grads doing a fellowship?

 

[Miles Gloriosus]

Thoughts on this article regarding compensation and fellowship training? Do you think there will ever be any change from the trend of 90%+ ortho grads doing a fellowship?

I don’t see trend changing. If anything, I’ve know more people who did more than one fellowship than those who didn’t do a fellowship at all.

 

[DarkHorizon]

Thoughts on this article regarding compensation and fellowship training? Do you think there will ever be any change from the trend of 90%+ ortho grads doing a fellowship?

I think it’s dishonest to review this article without considering the context. By context I mean the job market. Any job in desirable areas will require a fellowship trained surgeon, even if there’s a large general component to the job. I can say with confidence that most people are doing fellowships to get the jobs they want, and not necessarily to make more money.

 

[medstud2021]

@OrthoTraumaMD

Thank you for all your advice on this thread! I have a question about how MD/MBAs are viewed in terms of resident selection. I know it's not beneficial because it's not directly related to surgery but I was more curious if there is a negative stigma or if it hurts the applicant in any way (assuming the applicant is passionate about surgery, research, scores, etc.)? Thank you in advance!

 

[OrthoTraumaMD]

Thoughts on this article regarding compensation and fellowship training? Do you think there will ever be any change from the trend of 90%+ ortho grads doing a fellowship?

This trend will not change.

 

[OrthoTraumaMD]

@OrthoTraumaMD

Thank you for all your advice on this thread! I have a question about how MD/MBAs are viewed in terms of resident selection. I know it's not beneficial because it's not directly related to surgery but I was more curious if there is a negative stigma or if it hurts the applicant in any way (assuming the applicant is passionate about surgery, research, scores, etc.)? Thank you in advance!

No stigma.

 

[deleted959484]

@OrthoTraumaMD

Hi I’m an incoming M1 and definitely have an interest in MSK issues. However I’m not sure if I want to gun for ortho or just pursue FM/PMR to sports med. Will I naturally discover if I enjoy the OR during M3 rotations or should I pursue ortho opportunities as early as possible?

 

[sylvester500]

Good afternoon. Thanks so much for doing this. I am an incoming M1 who needs to decide on a med school by 4/30 (6 days). At this point, competitive specialties like ortho (and NSGY, Urology) are on my radar, but I can also see myself being happy going down routes like general surgery or IM + fellowship (cardiology, Heme/Onc, ID).

Options for me are Rush and Mizzou (in-state public school, so 20k cheaper). I really only care about being in a city for residency (not necessarily med school). Do you think I could match in a competitive specialty in a big city (Chicago, NY, Boston, etc) equally likely from either of these schools? My concern is that Step 1 is now P/F and Rush is already in one of the aforementioned big cities, so it may provide me better connections. But at the same time, I could end up at Rush and decide I want to do one of the aforementioned less competitive specialties later, rendering my plan to leverage Rush's location pointless.

Again, thank you you very much!

 

[Lem0nz]

Good evening, thank you for doing this! I just bought an adjustable dumbbell set and a bench and a pull-up bar and I want to look like an ortho bro. Where do I start?

 

[sylvester500]

Good evening, thank you for doing this! I just bought an adjustable dumbbell set and a bench and a pull-up bar and I want to look like an ortho bro. Where do I start?

Looks like you already took the right first steps!

 

[Angus Avagadro]

@OrthoTraumaMD

Hi I’m an incoming M1 and definitely have an interest in MSK issues. However I’m not sure if I want to gun for ortho or just pursue FM/PMR to sports med. Will I naturally discover if I enjoy the OR during M3 rotations or should I pursue ortho opportunities as early as possible?

My son is a DO, FM boarded, starting Sports Med fellowship this summer. Non surgical sports med basically handles all of the non operative aspects, concussions, sprains, simple fractures, rehabing injuries and surgeries, attending sporting events, etc.. Some are team physicians. A friend was the team physician for for the Note Dame football team.Being a DO, with an OMM backround dovetails with this specialty. Many orthopaedists maintain these skills as part of their practice, but many are finding it harder to cover the surgical work along with the non operative aspects.

 

[OrthoTraumaMD]

@OrthoTraumaMD

Hi I’m an incoming M1 and definitely have an interest in MSK issues. However I’m not sure if I want to gun for ortho or just pursue FM/PMR to sports med. Will I naturally discover if I enjoy the OR during M3 rotations or should I pursue ortho opportunities as early as possible?

See if you can do some ortho opportunities early on, because unfortunately you need to start early if ortho is to be a viable option. Go shadow on a weekend and see if the OR is something you enjoy.

 

[OrthoTraumaMD]

Good afternoon. Thanks so much for doing this. I am an incoming M1 who needs to decide on a med school by 4/30 (6 days). At this point, competitive specialties like ortho (and NSGY, Urology) are on my radar, but I can also see myself being happy going down routes like general surgery or IM + fellowship (cardiology, Heme/Onc, ID).

Options for me are Rush and Mizzou (in-state public school, so 20k cheaper). I really only care about being in a city for residency (not necessarily med school). Do you think I could match in a competitive specialty in a big city (Chicago, NY, Boston, etc) equally likely from either of these schools? My concern is that Step 1 is now P/F and Rush is already in one of the aforementioned big cities, so it may provide me better connections. But at the same time, I could end up at Rush and decide I want to do one of the aforementioned less competitive specialties later, rendering my plan to leverage Rush's location pointless.

Again, thank you you very much!

I would ask this on the premed forums as this isnt an ortho specific issue and not sure I can help in choosing a med school.

 

[OrthoTraumaMD]

Good evening, thank you for doing this! I just bought an adjustable dumbbell set and a bench and a pull-up bar and I want to look like an ortho bro. Where do I start?

This question is better posed to an athletic trainer or looked up online.

 

[goose471]

The majority of programs on ERAS list that they require 3 LORs however I've found that many if not most applicants submit 4 letters. Are applicants looked at more favorably with this 4th letter? what are your thoughts on 3 vs. 4 LORs?

Also, would you recommend going with a letter from a very well known attending that would likely be pretty average or a stronger letter from an attending only 2 years into practice

 

[OrthoTraumaMD]

The majority of programs on ERAS list that they require 3 LORs however I've found that many if not most applicants submit 4 letters. Are applicants looked at more favorably with this 4th letter? what are your thoughts on 3 vs. 4 LORs?

Also, would you recommend going with a letter from a very well known attending that would likely be pretty average or a stronger letter from an attending only 2 years into practice

Only include a fourth letter if it is from somebody very well known and is a strong letter. Otherwise three is fine.

In terms of the second question, go with the attending who knows you best. We can tell when letters are generic even if they come from a well-known name. The best thing to do is ask the attending you know better to make a phone call for you as well.

 

[Miles Gloriosus]

Only include a fourth letter if it is from somebody very well known and is a strong letter. Otherwise three is fine.

In terms of the second question, go with the attending who knows you best. We can tell when letters are generic even if they come from a well-known name. The best thing to do is ask the attending you know better to make a phone call for you as well.

As senior residents we interviewed applicants. The most memorable cringle worthy letter I remember was from a very well known surgeon. The letter was two sentences. Said he worked with the applicant from date x to date y in the office (it was like 2-3 days). He was satisfactory. It was from one of the applicant’s away rotations.

 

[goose471]

Only include a fourth letter if it is from somebody very well known and is a strong letter. Otherwise three is fine.

In terms of the second question, go with the attending who knows you best. We can tell when letters are generic even if they come from a well-known name. The best thing to do is ask the attending you know better to make a phone call for you as well.

How can we gauge who would be considered a well known attending if we arent sure? Apart from my PD letter, I have one from someone who is clearly well known, another from an attending im unsure (although he is in AAOS and society for his subspecialty) and then one from a younger attending who i believe will write me a very strong letter. Do you recommend not including the younger attending despite it likely being strong because he isnt well known?

 

[OrthoTraumaMD]

How can we gauge who would be considered a well known attending if we arent sure? Apart from my PD letter, I have one from someone who is clearly well known, another from an attending im unsure (although he is in AAOS and society for his subspecialty) and then one from a younger attending who i believe will write me a very strong letter. Do you recommend not including the younger attending despite it likely being strong because he isnt well known?

For being well known you should see if that attending routinely presents at conferences, widely published etc. if you’re not sure ask the residents.
As for the second question I already answered it in my prior post. Not sure what else I can say.

 

[DarkHorizon]

How can we gauge who would be considered a well known attending if we arent sure? Apart from my PD letter, I have one from someone who is clearly well known, another from an attending im unsure (although he is in AAOS and society for his subspecialty) and then one from a younger attending who i believe will write me a very strong letter. Do you recommend not including the younger attending despite it likely being strong because he isnt well known?

This is a game you need to learn how to play unfortunately. I did my fellowship at a place with four previous OTA presidents, three of them still on the faculty and a previous AAOS president on the faculty. We got swarmed with students wanting to rotate my year trying to get a letter from one of these guys. It’s a game you have to play subtly. When a big Whig writes you a letter, people pay attention. But it’s hard to make an impression in a limited time. If I ever saw a letter from a nationally recognized surgeon, I’d definitely paid attention, but mostly they were generic. I paid more attention if it was a well written letter from someone with highest recommendation, even if not a well known surgeon. I valued it more because no orthopedic surgeon will highly recommend someone, unless they really believed the student will make a good surgeon.

 

[Doc mu]

Do fellowship trained trauma orthos do all trauma? I heard trauma surgeons do not do spine cases so the spine surgeons have spine call and the same thing for hand, is it true? are there other ortho areas with their own call? and why don't trauma trained orthos also do those cases?

 

[Miles Gloriosus]

Spine in most places is considered its own specialty. The vast majority of hospitals will only grant privileges to those who are ortho spine fellowship trained or NSGY trained with evidence of a certain number of spine cases done in training or in practice.
For hand, most places are the same as above needing fellowship training but not as strict as the “core ortho privileges” often include hand procedures. So some trauma orthos dabble in hand traumas. Most of the places I’ve trained or worked at have hand call separate from the the trauma call.

with that being said, “trauma/fracture” surgeries are done/can be done by regular orthos. The ortho trauma specialists are mostly at the level 1 or referral centers. The ortho trauma docs who don’t work at the referral centers and are in PP do trauma but supplement their practices with joints etc…

 

[Doc mu]

Spine in most places is considered its own specialty. The vast majority of hospitals will only grant privileges to those who are ortho spine fellowship trained or NSGY trained with evidence of a certain number of spine cases done in training or in practice.
For hand, most places are the same as above needing fellowship training but not as strict as the “core ortho privileges” often include hand procedures. So some trauma orthos dabble in hand traumas. Most of the places I’ve trained or worked at have hand call separate from the the trauma call.

with that being said, “trauma/fracture” surgeries are done/can be done by regular orthos. The ortho trauma specialists are mostly at the level 1 or referral centers. The ortho trauma docs who don’t work at the referral centers and are in PP do trauma but supplement their practices with joints etc…

That is very interesting, why do you think these 2 subspecialties are the ones hospitals decided to single out? also would that mean that spine and hand fellows have worse call and lifestyles than the other ortho subs barring trauma?

 

[Miles Gloriosus]

@DrOrthoSpineMD

 

[DarkHorizon]

That is very interesting, why do you think these 2 subspecialties are the ones hospitals decided to single out? also would that mean that spine and hand fellows have worse call and lifestyles than the other ortho subs barring trauma?

Complexity of hand and spine requires more expertise than general orthopedic residency training. Hand and spine call is separate because both hand and spine have unique and complex emergencies that only hand and spine surgeons can handle. e.g traumatic hand/finger amputations leading to replants, and jumped facets/acute spinal instability leading to acute neurologic Compromise. Hand call at a legit trauma Center is often more brutal than trauma call. Spine emergencies are rather rare, and are often cover by neurosurgeons on call. Most ortho spine surgeons don’t take spine call, as spine call is often mixed with neurosurgery call (due to financial reasons)

 

[Doc mu]

Complexity of hand and spine requires more expertise than general orthopedic residency training. Hand and spine call is separate because both hand and spine have unique and complex emergencies that only hand and spine surgeons can handle. e.g traumatic hand/finger amputations leading to replants, and jumped facets/acute spinal instability leading to acute neurologic Compromise. Hand call at a legit trauma Center is often more brutal than trauma call. Spine emergencies are rather rare, and are often cover by neurosurgeons on call. Most ortho spine surgeons don’t take spine call, as spine call is often mixed with neurosurgery call (due to financial reasons)

Thank you for the thorough reply, one last Q, is hand call also taken by general plastic surgeons spreading the pain a bit? I am currently interested in hand because i really liked some of their procedures but have heard of the lifestyle being tragically bad and the downward trending reimbursment which makes me adamnant on fully commiting myself to it

 

[Miles Gloriosus]

Thank you for the thorough reply, one last Q, is hand call also taken by general plastic surgeons spreading the pain a bit? I am currently interested in hand because i really liked some of their procedures but have heard of the lifestyle being tragically bad and the downward trending reimbursment which makes me adamnant on fully commiting myself to it

Depends by hospital. Some places I worked at only allowed for fellowship trained hand people to take the hand call. Ortho and plastics hand trained both took call. At the community hospitals where I worked, general plastics people took hand call along with ortho. Fellowship was not needed as long as you were ortho or plastics. Hospital had a hard time filling the hand schedule so pretty much any plastics person was taking call. One plastics person did a cosmetics fellowship and only did hand in residency. He/she would take an entire hand call week once a month.

 

[DarkHorizon]

Thank you for the thorough reply, one last Q, is hand call also taken by general plastic surgeons spreading the pain a bit? I am currently interested in hand because i really liked some of their procedures but have heard of the lifestyle being tragically bad and the downward trending reimbursment which makes me adamnant on fully commiting myself to it

This depends on the hospital. A community hospital often won’t even have hand call and would rely on general Ortho call to cover hand. A legit trauma center with a replant program would only allow fellowship trained hand surgeons to take hand call. As a hand surgeon, you have a lot of options. You can just do elective hand and set up shop in the community with taking general Ortho call. I would say 80 percent of hand surgeons are in that set up. They take general Ortho call and would fix occasional tibia or femur, or most likely turf it to their younger partners hungry for business and just do elective CTR, TF, CMC arthroplasties with outpatient hand trauma, I.e Distal radius Fxs, CRPP of fingers, and tip amps/tendon lacs.

Also, just because you’re at a trauma center as a hand surgeon doesn’t mean you have to take hand call. For example, I have a hand partner and we take call at three trauma centers. Two of these places have a hand call pool, however, he doesn’t take any hand call unless they are desperate and pay him to occasionally fill in. He has a robust elective practice and takes Ortho trauma call at two of the three hospitals. He’s arguably the busiest guy in our group with a very good lifestyle with minimal inpatient work.