Ortho in the Military

[OrthoDreamer]

I am currently a 2nd year medical student and am looking into the HPSP, FAP and STRAP programs. I am really interested in orthopedic surgery, and have always wanted to serve in the military. I am curious to what life is like for an orthopedic surgeon in the military in terms of hours worked each week, how often they are deployed (away from family), and the training I would recieve in the military. I am a woman interested in ortho/military, probably puts me into a minority group, so I am particularly interested in opinions about how any of the treatment would be different or the same for women.

I definitely want to have a family, and the payback with HPSP seems very long, but am curious if having a family is very doable in the military setting and how it might compare to a civilian residency or job (post-residency). Would I be better off completing my residency, and then joining the military? Any thoughts at all?

I also thought that by trying in the military match might open up so more possibilities to get an ortho spot, considering how competitive the field has been in recent years. It also seems that ortho training is pretty good in the military. Do people tend to agree or disagree with this?

At the moment I am most interested in the Army, but am not entirely opposed to the Navy or the Air Force (getting to work with Marines sounds very appealing to me), so I would really like to hear feed back from the Army folks. Don't get me wrong though, I'll take any info I can get

Thanks for all the good advice I have seen on this forum, and I hope I can get a little more!

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[cyclegirl]

I completed a undergrad internship at a Naval Hospital in the orthopedic clinic. All of the DR in this clinic have completed ther residencies. They started clinic at 8:30 and saw their last patient at 3:30. They were in the OR two days a week and did one maybe two days of call a week. Except for being deployed once for the war on terror ( not all left just two of the DR) they have on average more time with their families than a civilian might. There was one female ortho DR there and she loved it. All of them did the HPSP scholarship and would not change a thing.

 

[Mirror Form]

I'm an intern in an army med center and I've rotated through the orthopedic service. These attendings (and esp residents) are extremely busy. The waiting list for elective procedures is very long, so there are always more cases to do. Plus the deployments are tough on them as well.

Personally, I'd hesitate to recommend ortho to any women who feels that having a family is a priority. It would be very difficult to start a family until you finished residency. Plus, you'd probably get deployed fairly soon after finishing residency too. So, it's not a great situation.

 

[Thomas90]

There are several women who are residents in Army ortho programs right now, and you might try to contact them directly to ask about their experiences. The clerkship directors at each program could put you in touch with them, and I'm sure they would be happy to talk to you.

There are six Army ortho programs, and together they take around 18 new residents per class. The number of applicants changes every year, but in general ortho is one of the more competitive specialties. There is a powerpoint presentation on the HPSP website which seems to indicate that almost none of the specialties are competitive (low ratios of applicants to positions available), but Sledge helpfully explained what those numbers meant:

http://forums.studentdoctor.net/showthread.php?t=240601

There are other good discussions on the board about the advantages/disadvantages of enrolling in HPSP vs joining the military following residency. Good luck!

 

[OrthoDreamer]

Thanks for the advice. I really appreciate it. Does anyone else have any thoughts?

Thanks again!

 

[edmadison]

If I were you, I would consider doing a civilian residency and consider FAP. I rotated at several army ortho programs as well as a civilian one. The most striking thing I observed was the low case volume compared to a civilian program. At one program a ortho subspecialist noted that when he went to fellowship his co-fellow had had 3x as many resident cases. You can learn some medicine out of a book, but you can't very much surgical technique.

Ed

 

[Mirror Form]

If I were you, I would consider doing a civilian residency and consider FAP. I rotated at several army ortho programs as well as a civilian one. The most striking thing I observed was the low case volume compared to a civilian program. At one program a ortho subspecialist noted that when he went to fellowship his co-fellow had had 3x as many resident cases. You can learn some medicine out of a book, but you can't very much surgical technique.

Ed

At least now a days with the war goingon, most army ortho residents have no trouble getting more then enough OR time. Although, the types of cases might be a different from what an ortho resident would typically see. For example, the ortho residents in the army probably do more ORIF's, but see less congenital dz.

 

[R-Me-Doc]

I am currently a 2nd year medical student and am looking into the HPSP, FAP and STRAP programs. I am really interested in orthopedic surgery, and have always wanted to serve in the military. I am curious to what life is like for an orthopedic surgeon in the military in terms of hours worked each week, how often they are deployed (away from family), and the training I would recieve in the military. I am a woman interested in ortho/military, probably puts me into a minority group, so I am particularly interested in opinions about how any of the treatment would be different or the same for women.

I definitely want to have a family, and the payback with HPSP seems very long, but am curious if having a family is very doable in the military setting and how it might compare to a civilian residency or job (post-residency). Would I be better off completing my residency, and then joining the military? Any thoughts at all?

I also thought that by trying in the military match might open up so more possibilities to get an ortho spot, considering how competitive the field has been in recent years. It also seems that ortho training is pretty good in the military. Do people tend to agree or disagree with this?

At the moment I am most interested in the Army, but am not entirely opposed to the Navy or the Air Force (getting to work with Marines sounds very appealing to me), so I would really like to hear feed back from the Army folks. Don't get me wrong though, I'll take any info I can get

Thanks for all the good advice I have seen on this forum, and I hope I can get a little more!

You will probably be fairly busy as an Army ortho resident, since the residencies are at major med centers (and now with the war, there are lots of ortho cases to be seen, especially at Walter Reed). Once residency is over, however, it is a totally different game. You will most likely get sent to be the staff ortho doc at my hospital here at Camp Swampy, where the ortho docs are in the OR 2 half-days a week, rarely do total joints, mostly scopes, and for every surgery they actually do, they see about 500 patients with chronic back pain that is completely untreatable by anyone and they have to do med boards on them. Sure, the hours are cushy compared to civilian life, but I suspect your skills slowly (or maybe not so slowly) atrophy. Also, you will be VASTLY underpaid compared to a civilian orthopod. Also, as with any Army surgeon, you are HIGHLY deployable and can pretty much count on a little trip somewhere (consider that when thinking about family -- of course, not to be too cynical, and I'm sure this comment will get me flamed by someone but I will make it anyway -- a woman always has the option of being more or less perpetually pregnant while on active duty, thereby avoiding deployment. Not to say that perpetual pregnancy is a breeze, but I'd say it happens.). Of course, this is all "now" and you will be an attending "someday" when things may be very different, so it's all pretty much a big gamble on your part. Feel free to roll the dice, but realize they're loaded in the Army's favor.

RMD 0-5-16

 

[chopperdoc]

Could anyone speak to the strengths/weaknesses of the army ortho residency programs? Would an orthopaedic surgeon in the army be more deployable than say a urologist or other surgical subspecialist?

 

[dyk33]

can't speak for other places but the ortho docs (staff and residents) at BAMC are busy as hell.

 

[edmadison]

At least now a days with the war goingon, most army ortho residents have no trouble getting more then enough OR time. Although, the types of cases might be a different from what an ortho resident would typically see. For example, the ortho residents in the army probably do more ORIF's, but see less congenital dz.

I did my rotations during the war, prior to the new techniques for armouring and detecting IED -- we had plenty of case come our way. Of course not too many of those OIF acute trauma cases are going to MAMC and TAMC. I certainly noticed an odd distribution of cases. At one medcen, the total joint surgeon was deployed to Iraq so the upper level on that service got skunked. I'm sure the got him his 5 knees and 5 hips (or what ever the minimum is), but this is a far cry from the 4/day the total joint resident was doing at the civilian center I rotated at. The other thing that blew me away was the lack of efficiency at the medcens. It 60+ minutes to turn over an OR after a case. Think of what that adds up to in a day. They also had to reduce the number of ORs as the day went on due to staffing concerns. I was amazed. Especially after seeing a civilian facility where the were running 46 ortho ORs from 7:00 am to 6 pm. Geez, there were sports guys would do six or seven knee scopes in a day. I never saw anything close to that in the Military.

The only reason I point this out is that its a big deal. It's one of the reasons I decided against ortho, albeit a small one.

Ed

 

[chopperdoc]

Ed,
What did you decide to do and why, if you don't mind me asking? Are you currently doing training at a military hospital?
Thanks

 

[edmadison]

My primary reason I decided not to do ortho was I wanted to focus on medicine. Ortho is cool, they do neat procedures which help people tremendously. My expericience, however, is that most of them are not interested in there patient's well being. Don't get me wrong, I don't mean that they don't wan't there patient's to get better, merely that they do not wished to be bothered by it. On two separate occasions at different programs, one military and one civilian, I have heard an ortho attending say something akin to, "I wish Mr. Smith would get an arrythmia so well can turf him to the medicine service". This is offensive and even if it is a joke and it sets a bad example for residents and medical students. A bit of a generalization, but, PODs want to cut. They don't want to manage patient's on the ward and they don't want to see them in the clinic. I think eventually you may even see their patient's completely managed by medicine services when in the hospital. I believe HSS in NYC already does this.

In any event, I decided that I wanted to think more about disease pathology than what surgical approach to use and what structures may be involved. There are days, however, that I'd love to be in the OR. For those who want to do Ortho, I think that great. I just decided I'd be happier doing something else.

As for the last question, yes, I am training at a military hospital and I like it alot.

Ed

 

[mal]

unfortunately there is a lot of misinformation posted on this site.
I'm a MSIV who just matched into army ortho.
a few quick points:
all army ortho training spots are considered above the average civilian ortho residency, this was the advice given to me by the program director at my school (civ, not ushus).
the OITE (in-service exam that each resident takes each year) are consistently very high, Madigan and Walter Reed score above the 90th percentile each year.
The rotations that are considered to not provide enough experience
are simply farmed out to other hospitals. This means that you have "away" rotations during residency. Every army ortho residency includes this, some are far, some are same city. So for peds or trauma, you may not be at the medical center, you might be going to usually an incredible hospital for the rotation. Madigan goes to Harborview for trauma, the shriner's in spokane for peds, brooke goes to UT-San Antonio for trauma, Denver Children's for peds. It's a great opportunity, but the downside is it's inconvenient. But, they put you up with a place to stay, and most residents love those rotations.
Of course all residencies, civ or military have strong rotations and weak rotations, but the army at least tries to even it out with good outside experiences.
I rotated at Brooke and Madigan. they are both very busy. brooke sees more soldiers returning from iraq due to the army burn center and amputee center being there. i still saw several soldiers from iraq at Madigan. both places operated a ton.
bottom line: if you have further questions you should really talk to a resident, contact the GME office at whatever residency program and just ask to get hooked up with a resident. Most people on these postings don't know enough of the facts you want to know.

 

[Mirror Form]

unfortunately there is a lot of misinformation posted on this site.
I'm a MSIV who just matched into army ortho.
a few quick points:
all army ortho training spots are considered above the average civilian ortho residency, this was the advice given to me by the program director at my school (civ, not ushus).
the OITE (in-service exam that each resident takes each year) are consistently very high, Madigan and Walter Reed score above the 90th percentile each year.
The rotations that are considered to not provide enough experience
are simply farmed out to other hospitals. This means that you have "away" rotations during residency. Every army ortho residency includes this, some are far, some are same city. So for peds or trauma, you may not be at the medical center, you might be going to usually an incredible hospital for the rotation. Madigan goes to Harborview for trauma, the shriner's in spokane for peds, brooke goes to UT-San Antonio for trauma, Denver Children's for peds. It's a great opportunity, but the downside is it's inconvenient. But, they put you up with a place to stay, and most residents love those rotations.
Of course all residencies, civ or military have strong rotations and weak rotations, but the army at least tries to even it out with good outside experiences.
I rotated at Brooke and Madigan. they are both very busy. brooke sees more soldiers returning from iraq due to the army burn center and amputee center being there. i still saw several soldiers from iraq at Madigan. both places operated a ton.
bottom line: if you have further questions you should really talk to a resident, contact the GME office at whatever residency program and just ask to get hooked up with a resident. Most people on these postings don't know enough of the facts you want to know.

I definitely disagree that ALL FIVE army ortho programs are ALL better then the average civilian one. The Army ortho residents I worked with certainly didn't feel that way. Do you really think they're going to give a med student doing audition rotations all the program's downsides? And as far as your cuv program's PD goes, I doubt he's an expert.

Don't get me wrong, the program I rotated through was definitely a good program, and residents got plenty of cases. However, most civilian ortho programs are pretty good as well.

 

[GMO2003]

I rotated through ortho as a transitional intern several years ago and found the interns, residents, and staff very sharp, professional, and courteous...of course there were a couple of wild cards in the mix...they worked like dogs and they seemed to thoroughly enjoy every second of it.