ortho attending AMA

[leagueofDravenMD]

Hi @OrthoTraumaMD! I was curious about your insights in orthopedic hospitalist work if this exists? Would it be feasible to specialize in ortho but not practice and see regular patients? I have been scribing in an ortho clinic for about a year and have loved it, though seeing many patients with mild symptoms ultimately treated with RICE was not the reason why.


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[slowthai]

Hey @OrthoTraumaMD, I wanted to get your take on this question I saw in a Healio round table discussion about resident education.

"There has been a national increase in the percentage of residents applying for fellowships as well as a trend of residents pursuing two fellowships. Is this a reflection of the 80-hour work week? What is your comfort level with your residents’ proficiency as they graduate and start fellowships?"

Here's a link to the rest of the discussion: Resident education and training: Preparing our residents for the road ahead

 

[OrthoTraumaMD]

Hi @OrthoTraumaMD! What sorts of cases are most common for you as an orthopedic trauma surgeon? And what drew you to ortho?

The bread and butter of operative ortho trauma are ankle fractures, hip fractures, and long bone fractures (mostly tibia and femur).
As far as what drew me to orthopaedics, it was that you can operate on all ages/walks of life, there is lots of variety in terms of how you want to structure your career (you can do similar cases all day like knees/hips, or have a vast amount of variability like tumor or trauma), you get to "fix" things with your own hands and often make an immediate difference in people's lives, and heck, it's just plain fun.

 

[yoyoni]

The bread and butter of operative ortho trauma are ankle fractures, hip fractures, and long bone fractures (mostly tibia and femur).
As far as what drew me to orthopaedics, it was that you can operate on all ages/walks of life, there is lots of variety in terms of how you want to structure your career (you can do similar cases all day like knees/hips, or have a vast amount of variability like tumor or trauma), you get to "fix" things with your own hands and often make an immediate difference in people's lives, and heck, it's just plain fun.

Thanks!!

 

[OrthoTraumaMD]

Hi @OrthoTraumaMD! I was curious about your insights in orthopedic hospitalist work if this exists? Would it be feasible to specialize in ortho but not practice and see regular patients? I have been scribing in an ortho clinic for about a year and have loved it, though seeing many patients with mild symptoms ultimately treated with RICE was not the reason why.


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I'm not sure what you mean by specializing in ortho but "not practice." Nonoperative orthopaedic stuff like sports medicine can be achieved through a non-orthopaedic residency (ex. rehab), but if you're an orthopod, you should be operating. In terms of a "hospitalist" lifestyle, you can do "locums" work where you just take call at random places and do whatever comes in, but it does not pay as much. Part of the reason to become an orthopod is the patient care and continuity. You watch them get better as a result of what you have done, and it is very rewarding.

 

[OrthoTraumaMD]

Hey @OrthoTraumaMD, I wanted to get your take on this question I saw in a Healio round table discussion about resident education.

"There has been a national increase in the percentage of residents applying for fellowships as well as a trend of residents pursuing two fellowships. Is this a reflection of the 80-hour work week? What is your comfort level with your residents’ proficiency as they graduate and start fellowships?"

Here's a link to the rest of the discussion: Resident education and training: Preparing our residents for the road ahead

There are many factors other than the 80 hour workweek that are contributing to this phenomenon. I won't get into all of them, but basically there is a demand for fellowship trained surgeons, particularly in academic centers. It pays more and gives you more opportunity. And yes, part of it is that many residents may not get the exposure they want in their subspecialty, and want to see more complex cases and focus on specific things. Many of these cases are difficult and need an extra year to "practice" and see enough of them (like acetabulum fractures). In terms of resident comfort level, I expect them to know how to do basic trauma stuff, reductions, nails etc. Proficiency is very dependent on the person - some are more gifted than others, some require a different way of learning etc. But for the most part, if the residents don't slack, pretty much all of them are trained to take care of basic problems, and go into fellowship due to the desire to achieve proficiency in their subspecialty.

 

[Dr Blue]

How many weeks vacation do you get a year?

 

[OrthoTraumaMD]

How many weeks vacation do you get a year?

It varies by surgeon, hospital, state, years in practice, what you negotiate, etc. I get 4, but I've never taken them all because I go away to conferences and see that as a mini-vacation, so I don't see the need.

 

[augeremt]

It varies by surgeon, hospital, state, years in practice, what you negotiate, etc. I get 4, but I've never taken them all because I go away to conferences and see that as a mini-vacation, so I don't see the need.

How many conferences does the average attending attend each year? I assume it varies based on private practice v. academia, but it seems orthopods go to a fair amount of them.

 

[OrthoTraumaMD]

How many conferences does the average attending attend each year? I assume it varies based on private practice v. academia, but it seems orthopods go to a fair amount of them.

Again, completely based on interest, ability to leave (how nice your partners are in terms of coverage), type of practice you're in. No set number. We usually try to attend at least our own specialty society meeting if possible (OTA for me), and maybe the AAOS. More so if we do research or teach. I have known some who attend 15, and some who don't attend any. I would say 2/year on avg. I do around 3.

 

[slowthai]

@OrthoTraumaMD, after you developed a solid working knowledge of the musculoskeletal system, did your everyday experience observing people change? Like did you find yourself subconsciously assessing people's gait, hip alignment, and things like that?

 

[Bancrofti]

You probably don't do much floor work these days, but any recommendation for durable shears? I ended up buying a new pair every month for aways, because they'd be great for about a month, then inevitably dull out.

 

[OrthoTraumaMD]

You probably don't do much floor work these days, but any recommendation for durable shears? I ended up buying a new pair every month for aways, because they'd be great for about a month, then inevitably dull out.

Haha, I actually do carry them, because my staff never seems to have them when I need some.
Beg your OR for one of these. They last forever and you can sharpen them too. Their formal name is lister scissors.

 

[OrthoTraumaMD]

@OrthoTraumaMD, after you developed a solid working knowledge of the musculoskeletal system, did your everyday experience observing people change? Like did you find yourself subconsciously assessing people's gait, hip alignment, and things like that?

Absolutely. I've been caught staring at people trying to figure out the cause of their limp. It's kind of fun, actually.

 

[OrthoTraumaMD]

@OrthoTraumaMD, after you developed a solid working knowledge of the musculoskeletal system, did your everyday experience observing people change? Like did you find yourself subconsciously assessing people's gait, hip alignment, and things like that?

Not to mention the innumerable times I get asked for "consults" at family gatherings, parties (I had an incident where a guy was trying to chat me up at a party and when it became clear I wasn't interested, ended up asking me about his back problems...sigh)... So even if I am not working, people always seem to want me to look at some random body part. We have a holiday gathering and my friends joke that I should just open up a room upstairs for the "yearly checkups."

 

[Chillbo Baggins]

This question has been covered for pre-meds applying to med school, and for various other specialties, with differing opinions, but not for ortho:

What is the perception of well trimmed facial hair when receiving applications and during interviews? Assuming the rest of the outfit and hygiene is tip-top.

 

[OrthoTraumaMD]

This question has been covered for pre-meds applying to med school, and for various other specialties, with differing opinions, but not for ortho:

What is the perception of well trimmed facial hair when receiving applications and during interviews? Assuming the rest of the outfit and hygiene is tip-top.

If you're interviewing in a more rural area, it's fine. Big cities, I would avoid if possible. You can always grow the beard after you get into residency.

 

[Chillbo Baggins]

If you're interviewing in a more rural area, it's fine. Big cities, I would avoid if possible. You can always grow the beard after you get into residency.

Hmm, I'm not planning on applying anywhere in CA or the northeast, but most other places, with the South/Plains being my most likely interview regions. Still risky? My reservation is that clean-shaven I look 12.

 

[OrthoTraumaMD]

Hmm, I'm not planning on applying anywhere in CA or the northeast, but most other places, with the South/Plains being my most likely interview regions. Still risky? My reservation is that clean-shaven I look 12.

If it is neatly trimmed I think it's ok.

 

[masaraksh]

I'm doing a Sub-I right now. I'm tired

 

[OrthoTraumaMD]

I'm doing a Sub-I right now. I'm tired

Wait til residency.

 

[Chillbo Baggins]

I'm doing a Sub-I right now. I'm tired

I'm looking forward to 4 months of that much more than I am the remaining 5 weeks of IM.

 

[Dr. Death]

Thank you for doing this. I'm a rising M2 and this fall I'll be presenting a poster at an ortho conference. What should I be looking to accomplish as far as networking goes? Am I just there to meet people or should I try to ask about visiting their program or setting up an away rotation? And how do I transition from talking about research to asking about rotating with them/visiting their program? Thanks again, this whole thread has been so helpful.

 

[OrthoTraumaMD]

Thank you for doing this. I'm a rising M2 and this fall I'll be presenting a poster at an ortho conference. What should I be looking to accomplish as far as networking goes? Am I just there to meet people or should I try to ask about visiting their program or setting up an away rotation? And how do I transition from talking about research to asking about rotating with them/visiting their program? Thanks again, this whole thread has been so helpful.

Depends on the conference. Since you said it is in the fall, it is a specialty conference and not the AAOS mtg. But I think you can still get something out of it. In terms of networking, as an MS2, you should be focusing on trying to find rotations. Start with the person who is the supervisor for your poster. If they are going to the conference too, ask if they can introduce you to people who may be able to tell you about their own programs, and might be able to act as references when it comes time to secure your rotations. The best way to succeed in our field is to get to know the right people. That sets you apart from others who have the exact same scores and letters as you. The only people who can help you do that are those who are already there. If your supervisor for the poster is not going to the conference, ask them if they could connect you with people there. Even a brief coffee and a casual chat is good. Start off asking them about themselves, how they got to where they are, etc. Then transition into your own aspirations, and ask them if it would be OK for you to contact them in the future with questions, or when it comes time to rotate at their program. If they see that you are motivated, they should have no problem doing that for you. We are pretty direct for the most part, and if somebody reaches out to us, we will support them.

 

[slowthai]

One complaint that I've seen med students have about ortho is that it's too repetitive. Is there any truth in that statement? If so, what makes it anymore repetitive than other surgical fields?

 

[slowthai]

Yes, it does. Thank you. I'm in full agreement as well.

 

[masaraksh]

Do you think there is a positive correlation between the amount of protein an orthopaedic resident consumes and their propensity to pursue a trauma fellowship?

 

[OrthoTraumaMD]

Do you think there is a positive correlation between the amount of protein an orthopaedic resident consumes and their propensity to pursue a trauma fellowship?

FWIW, I've never met a vegetarian ortho trauma person. But in my experience, most of us subsist on OR saltine crackers and coffee.

 

[yersinia_pestis]

Not necessarily ortho specific, but do you know and/or work with any surgeons in wheelchairs? Or any with other physical disabilities? Surgery has always been on my list of specialty choices (particularly hand) but I've had to start using a wheelchair so...


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[OrthoTraumaMD]

Not necessarily ortho specific, but do you know and/or work with any surgeons in wheelchairs? Or any with other physical disabilities? Surgery has always been on my list of specialty choices (particularly hand) but I've had to start using a wheelchair so...


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Not personally. It would be quite difficult, if not impossible, in surgery, as running around on call and standing for long periods in the OR really cannot accommodate a wheelchair situation. Perhaps ophthalmology might be a possibility, as they have to sit in order to operate. In terms of other physical disabilities, I cannot think of any in orthopedics. There is a surgeon at Hopkins who is an achondroplastic dwarf, but that's not really a disability per se, just a limitation because of the height issue, which it sounds like he has conquered.

 

[bobjonesbob]

Roughly what percent of your surgical volume stems from car accidents? I know you mentioned there are already less pelvis cases because cars are safer. I'm curious how the increasing prevalence of self driving cars and their potential for significantly increased safety might affect the field.

 

[cellsaver]

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[OrthoTraumaMD]

I have some sincere questions about the AMA. Since you attended their conference, I'd like to ask you:

• What value do you see in belonging to the AMA?
• What do you make of the sheer drop in member rolls, accounting for less than 40% of physicians, if not less?
• What tangible results do you receive from belonging to the AMA?
• Given where our profession is today, why continue to support an organization that led our ship to the bottom of the sea?

My AMA membership is about to expire. I have found JAMA articles to be disheartening as to their political slant (like every other periodical these days). Plus AMA positions on various issues strike me as heavy handed and over the top: immigration, guns, federal budget, Trump this, Obama that.... They seem more like a PAC and less evidenced based data as to their focus

I'm open to being persuaded to stay with the AMA but...for now, i'm discouraged with the "leaders" in medicine who were at the helm and helped drive our profession to where it is today.

thanks

I've never been an AMA member. It has no relevance to me. I've never attended their conference, not sure where you got that. The Academy I was referring to is the only one that matters to me--the American Academy of Orthopaedic Surgeons.

 

[cellsaver]

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[OrthoTraumaMD]

Roughly what percent of your surgical volume stems from car accidents? I know you mentioned there are already less pelvis cases because cars are safer. I'm curious how the increasing prevalence of self driving cars and their potential for significantly increased safety might affect the field.

Blunt trauma is 95% of what I do. Out of that, I would say about 50% is from vehicles, but that percentage is larger if you're in a place surrounded by highways where the speeds are higher. In a city, the issues with cars mostly involve people being hit by them at low speeds and also the low speed car accidents. Major polytrauma needs highways.
I don't worry about self driving cars. Stupid people are everywhere and they give me plenty of business. What we lack in pelvic cases we make up in other ways. Plus, there are motorcycles, which are a never ending source of fractures. The trauma teams where I trained called them "donorcycles" (as in organ donation).

 

[OrthoTraumaMD]

subject of the thread says "Ortho attending AMA" hence my queery

never mind LOL

best

AMA is a common acronym for "ask me anything"

 

[cellsaver]

AMA is a common acronym for "ask me anything"

 

[nonamesleft]

oops.

 

[Frogger27]

subject of the thread says "Ortho attending AMA" hence my queery

never mind LOL

best

Edit: didn't see AMA was already addressed

 

[Ninefingers]

Why does "be on time" mean "arrive minimum 30 minutes early"?

 

[OrthoTraumaMD]

Why does "be on time" mean "arrive minimum 30 minutes early"?

Hahaha. Because there are unforeseen events that happen to trauma patients that take up time and delay rounds, etc. The extra time is needed to make up the difference. Generally though, it's always a good idea to arrive a little earlier if you're a med student. I expect mine to get there either on the dot or a few min early so that we start exactly on time.

 

[OrthoTraumaMD]

That totally makes sense. And thanks for doing this AMA. Really a treasure trove of information for people interested in ortho trauma.

No problem. happy to help

 

[slowthai]

I know that many premeds like myself tend to dislike the physics (mechanics) courses that we took in undergrad. Am I right to assume that learning physics in orthopaedics is different and a lot more enjoyable since it has a direct impact on patient care?

 

[OrthoTraumaMD]

I know that many premeds like myself tend to dislike the physics (mechanics) courses that we took in undergrad. Am I right to assume that learning physics in orthopaedics is different and a lot more enjoyable since it has a direct impact on patient care?

Absolutely. Biomechanics is fascinating and a big part of trauma. I wasn't mechanically minded at all before residency, and did well in physics (but not out of any love for it)...seeing the clinical application made it very interesting. Look up Radin's "practical biomechanics for the orthopaedic surgeon." It's out of print but I'm sure some copies are floating around somewhere. Great little book and should be required reading for anyone going into our field.

 

[slowthai]

Absolutely. Biomechanics is fascinating and a big part of trauma. I wasn't mechanically minded at all before residency, and did well in physics (but not out of any love for it)...seeing the clinical application made it very interesting. Look up Radin's "practical biomechanics for the orthopaedic surgeon." It's out of print but I'm sure some copies are floating around somewhere. Great little book and should be required reading for anyone going into our field.

Awesome. That's great to hear. I will definitely check that out, thanks.

 

[slowthai]

What orthopaedic subspecialty would you have chosen if you hadn't chosen trauma? What field would you have gone into if you hadn't chosen ortho?

And a related question, what made you rule out the other orthopaedic/surgical subspecialties? I know you wouldn't have done joints because of the "doing the same thing over and over again", lol.

 

[jcorpsmanMD]

Hahaha. Because there are unforeseen events that happen to trauma patients that take up time and delay rounds, etc. The extra time is needed to make up the difference. Generally though, it's always a good idea to arrive a little earlier if you're a med student. I expect mine to get there either on the dot or a few min early so that we start exactly on time.

If you're 15 minutes early you're on time, if you're "on time" you're late. Motto to live by!

 

[slowthai]

I decided on trauma as an intern and never wavered. That's unusual, as many ortho residents are seduced by trauma early on, but most eventually decide to switch into something else. I never did, and knew I would not, but I also have that type of personality.
As for the other Ortho subspecialties:
-peds: hate the parents
-tumor: depressing, young people dying, made me want to kill myself
-hand: too finicky; hate loupes, nerves, etc; also the "stereotypical" subspecialty female orthopods go into, and I didn't want to do that
-joints: you said it, too repetitive
-sports: "voodoo" (outcomes and indications are questionable), hate scopes
-foot and ankle: feet are gross
-spine: chronic pain patients suck

If I hadn't gone into ortho, I would perhaps have become a vascular surgeon, as I had dallied in that field for a while in med school; but honestly, I don't think I could have survived in medicine if I hadn't matched ortho. I would likely leave and go into something completely different.

Lol, those are very reasonable reasons for not pursuing those specialties. Ortho or bust for sure. Thanks for your perspective.

 

[OrthoTraumaMD]

Lol, those are very reasonable reasons for not pursuing those specialties. Ortho or bust for sure. Thanks for your perspective.

I wrote "Ortho or bust" on a piece of paper when I was studying for Step 1. It kind of started out as a joke, but then ended up hanging on my wall, right above my desk, for years, so that every time I lifted my head from the book in exasperation, I'd see it. It stayed there all the way until the end of residency. I saved it and framed it, and still have it at home as a testament to my perseverance during the bad times when I thought I wouldn't make it.

 

[slowthai]

I wrote "Ortho or bust" on a piece of paper when I was studying for the MCAT. It hung on my wall right above my desk for years, so every time I lifted my head from the book in exasperation, I'd see it. It hung there all the way until the end of residency. I saved it and framed it, and still have it at home as a testament to my perseverance during the bad times when I thought I wouldn't make it.

Wow! That's an awesome story! So you wanted to do ortho from the beginning? What caused you to pick ortho that early?