The future job market of Ortho

[VoiceofReason]

According to the AAMC careers-in-medicine website, there is currently a glut of Ortho Surgeons and it is only projected to get worse. So the first question that popped into my mind was: will it start to become annoying or even difficult for Orthos to find a job? Where they want? At the pay they want? I'm not entirely sure how to interpret that statement there on the website. Anyone want to weigh in on the future of Ortho?

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[Castro Viejo]

According to the AAMC careers-in-medicine website, there is currently a glut of Ortho Surgeons and it is only projected to get worse. So the first question that popped into my mind was: will it start to become annoying or even difficult for Orthos to find a job? Where they want? At the pay they want? I'm not entirely sure how to interpret that statement there on the website. Anyone want to weigh in on the future of Ortho?

Don't know a thing about the Orthopedic job market. How about posting the question over in the Ortho section of S&SS?

 

[OHMAN0125]

According to the AAMC careers-in-medicine website, there is currently a glut of Ortho Surgeons and it is only projected to get worse. So the first question that popped into my mind was: will it start to become annoying or even difficult for Orthos to find a job? Where they want? At the pay they want? I'm not entirely sure how to interpret that statement there on the website. Anyone want to weigh in on the future of Ortho?

That's an old study isnt it? But still it says there will be an even worse surplus by 2010. I don't see orthopedic surgeons out of jobs though. Lol. Maybe just wont be able to get a job in the best locations, or if you do the pay won't be as high. That's my take on it.

 

[VoiceofReason]

It's about 9 years old, yeah. But thats the most current information on that site as far as I can tell. Seems like this is a non-issue at least among people on this board, judging from the response (or lack thereof) my post has gotten so far.

Edit: Which is a positive thing. I don't like to hear about any specialties facing bleak or troubled futures.

 

[BlackSails]

As the baby boomers age, their knees will need replacing, they will fall and need new hips, etc, etc.

 

[paintballdoc]

I am not an Ortho MD, but according to the hospital administrator in my hometown, it is the most recruited physician for a hospital. Again, I don't know the exact specifics, but it still seems to be a pretty needed specialty.

 

[ddmo]

It's nonsense. The orthopaedic job market continues to be hot as hospitals and groups clamour for new surgeons, as it is one of the fields with the highest reimbursements and lowest costs. Every ortho department I know is actively recruiting. Think about it, they are expensive proceedures but the vast majority of patients are relatively healthy and suffer few complications. Compare this to say heart patients who often have a variety of medical illnesses that can lead to costly and lengthy hospital stays.

That study the AAMC mentions was the belief about 10 years ago, but it was realized that the data was wrong shortly after. In fact, its now believed there will be a significant shortage in the future. As mentioned above total joint replacements is the perfect example. Its believed that the number of patients in need of new joints will be 600% higher than current levels within the next 15 years, but they certainly aren't training 6X the surgeons, although most residency training programs are adding 1-2 residents per year.

So, the issue is not whether you will have patients or a job, it's how much money you will be reimbursed.

 

[registered user]

It's nonsense. The orthopaedic job market continues to be hot as hospitals and groups clamour for new surgeons, as it is one of the fields with the highest reimbursements and lowest costs. Every ortho department I know is actively recruiting. Think about it, they are expensive proceedures but the vast majority of patients are relatively healthy and suffer few complications. Compare this to say heart patients who often have a variety of medical illnesses that can lead to costly and lengthy hospital stays.

That study the AAMC mentions was the belief about 10 years ago, but it was realized that the data was wrong shortly after. In fact, its now believed there will be a significant shortage in the future. As mentioned above total joint replacements is the perfect example. Its believed that the number of patients in need of new joints will be 600% higher than current levels within the next 15 years, but they certainly aren't training 6X the surgeons, although most residency training programs are adding 1-2 residents per year.

So, the issue is not whether you will have patients or a job, it's how much money you will be reimbursed.

Sshhh.... let's keep this quiet.

 

[-Goose-]

Sshhh.... let's keep this quiet.

Riiight.

Ortho is probably the most competitive field in medicine. Derm and PRS are up there with it.

If ortho's what you want, be prepared to fight like hell to get it. Getting tougher and tougher every year.

(see 05 AAMC's Charting outcomes in the match vs 2007)

 

[Winged Scapula]

It's about 9 years old, yeah. But thats the most current information on that site as far as I can tell. Seems like this is a non-issue at least among people on this board, judging from the response (or lack thereof) my post has gotten so far.

Edit: Which is a positive thing. I don't like to hear about any specialties facing bleak or troubled futures.

The reason for the lack of response (at least at the time you posted this) is because you posted in the General Surgery area rather than the Ortho Forum. I'll move this to the Ortho forum where you'll get more responses.

 

[VoiceofReason]

We really ought to rename the forum General Surgery and Surgical Subspecialties or something... Besides I posted it there for a reason: everyone reads that forum, I see orthos posting in it. Figured I'd get the best answer from polling the most people.

 

[Carpenter]

I've read that study..it's more like an example of persuasive writing than EB journal article..he talks about numbers, but he sounds so biased.

looking at the data out there, my interpretation is that ortho won't be the most sought after residency in future..but there is no way it is going to be like family medicine in near future, unless of course we get rid of capitalist medicine. The average initial pay for residencies like ortho, cardiology and anesthesiology is going down all over the country, while initial pay for urology, ENT and radiology is going up. in the end, i think it is good for specialties like ortho..the last thing you want is someone getting into specialties like ortho for money and lifestyle.. if u r an orthopod and are called to r/o septic joint at 2 in the morning, i think you have an obligation to go..and most fellas coming in for money and lifestyle won't do that..so little surplus will keep them away.

 

[OHMAN0125]

I've read that study..it's more like an example of persuasive writing than EB journal article..he talks about numbers, but he sounds so biased.

looking at the data out there, my interpretation is that ortho won't be the most sought after residency in future..but there is no way it is going to be like family medicine in near future, unless of course we get rid of capitalist medicine. The average initial pay for residencies like ortho, cardiology and anesthesiology is going down all over the country, while initial pay for urology, ENT and radiology is going up. in the end, i think it is good for specialties like ortho..the last thing you want is someone getting into specialties like ortho for money and lifestyle.. if u r an orthopod and are called to r/o septic joint at 2 in the morning, i think you have an obligation to go..and most fellas coming in for money and lifestyle won't do that..so little surplus will keep them away.

Lifestyle? I thought Ortho's lifestyle is poor compared to other surg specialties like ENT, plastics, and urology. Is this not the case?

 

[maxheadroom]

All of my ortho friends are finding lots of job opportunities when they finish. Most seem to be picking between specialty practice (after fellowship) in a larger group or joining a multi-specialty practice. Everyone seems to be happy about their prospects.

 

[JosephFaecesMD]

Lifestyle? I thought Ortho's lifestyle is poor compared to other surg specialties like ENT, plastics, and urology. Is this not the case?

It is. Orthopods work like dogs. Only rivaled by neurosurgery and some GS subspecialties (transplant, trauma, CT, peds (maybe))

 

[Herman Bloom]

It is. Orthopods work like dogs. Only rivaled by neurosurgery and some GS subspecialties (transplant, trauma, CT, peds (maybe))

Complete misconception. I personally know a couple of orthopods who work 4 or 4.5 days a week and are doing just fine, thank you. You won't do that right out of the box, but it is reasonable to expect such a schedule (if you want it) within a few years. Most don't come anywhere close to general surgeon hours, let alone neurosurgery. Those docs have very sick patients in the hospital; orthopods typically do not (exception may be spine and/or onc).

That said, you really shouldn't consider orthopaedics (or any surgical specialty) unless you really love the work and are excited about doing a lot of it.

 

[OHMAN0125]

Complete misconception. I personally know a couple of orthopods who work 4 or 4.5 days a week and are doing just fine, thank you. You won't do that right out of the box, but it is reasonable to expect such a schedule (if you want it) within a few years. Most don't come anywhere close to general surgeon hours, let alone neurosurgery. Those docs have very sick patients in the hospital; orthopods typically do not (exception may be spine and/or onc).

That said, you really shouldn't consider orthopaedics (or any surgical specialty) unless you really love the work and are excited about doing a lot of it.

Haha....kinda like a disclaimer. I heard the opposite, that spine ortho has a decent lifestyle, but the other ones work pretty dam hard, unless you don't care that you make less money.

 

[pagemmapants]

Also I've heard that more private practices are moving toward a "job sharing" type of situation; 2 full-time positions split among 3 people or something similar. 2/3 the hours, 2/3 the pay . . . but in this case, I don't think that's necessarily such a bad thing depending on your golf game or your other priorities. I have also heard that at our institution even the "academic" attendings work about 60 hours, which is in stark contrast to the attendings in other specialties/subspecialties/general surgery services on which I rotated.

Then again, I'm just an M2 so this is all hearsay. . .

 

[discontinuebed]

So would I be correct in assuming that ortho will continue to remain among the highest paid specialties in the future?

Halfway through my ortho rotation right now and am enjoying the work. Wanted to find out more about the lifestyle/salary issues. (e.g. things you can't so readily approach the attendings about)

 

[skiz knot]

So would I be correct in assuming that ortho will continue to remain among the highest paid specialties in the future?

Halfway through my ortho rotation right now and am enjoying the work. Wanted to find out more about the lifestyle/salary issues. (e.g. things you can't so readily approach the attendings about)

I disagree. During some downtime you can tactfully inquire about lifestyle as an attending orthopod. Just make it known that you are possibly interested in the field and keep it to general questions, nothing personal. You can ask for the attendings position on the future of reimbursements, job market, need for fellowships etc... Don't ask about salaries, size of their mansion, how long until you can buy your first Porche, etc... You may be surprised how much they are willing to share and how opinionated they are

 

[cofcemt]

It is. Orthopods work like dogs. Only rivaled by neurosurgery and some GS subspecialties (transplant, trauma, CT, peds (maybe))

Don't believe this for a second, the docs that I work with (both Knee and shoulder orthos) work 4-5 days a week 9-5 and make >300K a year. Of course this is after about a decade out of residency, but still, what a great lifestyle. The guy I work closely with does surgery 3 days a week at about 8 procedures a day. He is the man.

 

[discontinuebed]

So in general, what is the lifestyle like?

Practice-dependent? Usually light? Usually heavy?

 

[-Goose-]

Don't believe this for a second, the docs that I work with (both Knee and shoulder orthos) work 4-5 days a week 9-5 and make >300K a year. Of course this is after about a decade out of residency, but still, what a great lifestyle. The guy I work closely with does surgery 3 days a week at about 8 procedures a day. He is the man.

This seems to be the exception rather than the norm. All the orthopods I know that work for medium to larger groups work a lot. To me, its less about how many hours or how much you make (these are subject to change considerably over your career), its more about how much you enjoy the nature of the work you do.

 

[dropout]

the average ortho attending works about 60 hours per week (higher in the first 5-10 years as you're trying to establish yourself, taking a lot call, inpatient consults etc), but just like anything else in medicine, it's all self-inflicted. you can work less if you don't care about the reduced income, the slower ramp in your private practice, the lower bonus in your hospital group etc etc.

as for the future of the job market, while some of it is dictated by demand for ortho procedures and supply of the surgeons, the biggest driver is medicare and private insurance reimbursement. it has held up well for spine, but been decimated for joint replacements. scopes could be hit at some point.

 

[DrDre311]

Riiight.

Ortho is probably the most competitive field in medicine. Derm and PRS are up there with it.

If ortho's what you want, be prepared to fight like hell to get it. Getting tougher and tougher every year.

(see 05 AAMC's Charting outcomes in the match vs 2007)

There's a thread in the PRS forum which extensively details this very topic--however, by the NRMP definition of competitiveness, medicine-family medicine combined residencies are actually the most competitive!

If that seems strange and you'd like details then check out the "stats don't make plastics seem THAT competitive" thread on the PRS forum, or go to nrmp.org and check the "Charting Outcomes in the Match" and their "Advanced Data Tables 2008" section for a clear mathematical delineation of just how competitive each specialty is.

 

[gmacpac]

Hi,

I apologize in advance if my question is not exactly topic specific. I have an acceptance into a DO med school and a UK (allopathic med school).

I am very happy with both choices, but I want to base my final decision based on the type of residency match each route offers/limits.

I was pretty much confirmed to go to the DO program because of its reputatioon and its proximity to my social support system, but one of my co-workers told me to consider foreign MD only because DO's dont usually match into surgical specialties. I know this sounds a bit stretched, but given the situation, I just wanted to see what some other folks on SDN had to say about this considering most of you have already been though this process.

Any help and guidance will be greatly appreciated.

 

[Tired]

Don't believe this for a second, the docs that I work with (both Knee and shoulder orthos) work 4-5 days a week 9-5 and make >300K a year. Of course this is after about a decade out of residency, but still, what a great lifestyle. The guy I work closely with does surgery 3 days a week at about 8 procedures a day. He is the man.

So he does 8 procedures in 8 hours? And his OR start time is 9am?

Just stop.

To make the kind of money you're talking about, you have to operate all day on your OR days. You may not have to come in in the middle of the night very often, but you do have to crank out the operative cases all day long and often extend into the night. Nobody's working 8hrs a day, especially when you factor in the administrative and hospital responsibilities of the attendings that you're not seeing while you shadow him.

 

[ddmo]

Hi,

I apologize in advance if my question is not exactly topic specific. I have an acceptance into a DO med school and a UK (allopathic med school).

I am very happy with both choices, but I want to base my final decision based on the type of residency match each route offers/limits.

I was pretty much confirmed to go to the DO program because of its reputatioon and its proximity to my social support system, but one of my co-workers told me to consider foreign MD only because DO's dont usually match into surgical specialties. I know this sounds a bit stretched, but given the situation, I just wanted to see what some other folks on SDN had to say about this considering most of you have already been though this process.

Any help and guidance will be greatly appreciated.

I would go DO, if I were you. You may have a hard time getting an allopathic Ortho spot, but no more so than a foreign MD. Plus, there are lots of osteopathic Ortho residencies.

 

[gmacpac]

Thanks for your post.

 

[ItalianMD]

Given the low birth rates in North America and the enormous aging population, orthopaedic surgeons will certainly be needed across North America.

And with the rise of type 2 diabetes in youth, there's sure to be a rise in SCFEs too! Go Ped-a-pods!

We MUST remember that most of the expirience we gets as medical students come in tertiary care teaching institutions. The demand for these jobs is high because of the benefits associated with academia, teaching etc as well as being located in an urban center.

However, the community orthopedic demand is HUGE! If you get into the smaller communities, you may only find 1-2 orthopods per 10-20,000 people. And dont think that the pay is any worse just because you live outside the city!

Orthopaedic surgeons should NOT be worried about supply and demand! What may be a concern is the eventual decline in surgical interventions because of advances in osteogenesis, fracture healing. If we can regrow cartilage with an intraarticular injection, you can forget all those hips and knees!!

 

[dropout]

you guys have to be very careful in the assumptions you're making for the future of ortho salaries. Demand for procedures is not necessarily a good predictor of reimbursement trends. If that were true, no procedure or specialty in medicine would have a cut in pay.

 

[dobonedoc]

Medicine is changing all the time. Who knows what it will look like in 10 years? Who knows what it will look like in January after the liberals take the remainder of Washington?

People are getting older, living longer, and wanting to live better. If you think there will be a lack of demand, you're crazy.

Ortho will be hot for generations to come. If you want it, come and get it! It's a devastating track to take through the best years of our lives, but once you get through it, it is, and always will be, worth it.

 

[leagueelbow]

Medicine is changing all the time. Who knows what it will look like in 10 years? Who knows what it will look like in January after the liberals take the remainder of Washington?

People are getting older, living longer, and wanting to live better. If you think there will be a lack of demand, you're crazy.

Ortho will be hot for generations to come. If you want it, come and get it! It's a devastating track to take through the best years of our lives, but once you get through it, it is, and always will be, worth it.

It's that bad? I was told ortho residency can be quite tough but I've never heard anyone describe it as brutal or devastating. I guess my home program isn't that rough?

 

[psi1467]

I can confidently say at my program, we are easily the hardest working residency department. We are at a busy urban level 1 which adds to our workload, but if you stack us next to general surgery it's comical as to how much less they do. And I consider them quite busy.

 

[DrDre311]

I can confidently say at my program, we are easily the hardest working residency department. We are at a busy urban level 1 which adds to our workload, but if you stack us next to general surgery it's comical as to how much less they do. And I consider them quite busy.

Surgery is surgery. People's experiences are different from program to program because patient populations differ, and department dominance varies. When I was a med student, ortho and trauma surgery were 2 very dominant departments/divisions. Easily the 2 busiest services in the hospitals we worked at but I wouldn't say 1 outshone the other; maybe because they collaborated on many patients. At my current program GS is probably a little busier than ortho, depending on the service and time of year.

Unlike my med school, at my current institution plastics is a stronger/more aggressive department than ortho is. There are times when the plastics service is huge, our list is several pages long, and we're busier than other surgery services. The converse is true, and there are times when we're lighter also and I get to go home early, but some of my roughest months have been plastics months (in addition to traditional ass-kickers like vascular/neurosurg/transplant).

Obviously attending lifestyle is very different than residency, but: although there are some sweet programs for any surgery specialty where you work less, and some situations where residents are just abused/killed, surgery residency is surgery residency by and large. Cases, clinic, patients in the hospital, patients in the ICU. Common to all specialties.

If you love being in the OR then it's all worth it.

 

[psi1467]

I agree DrDre. I was just touching on reference to the brutality of ortho programs. Everything is taken with a grain of salt, b/c as you've mentioned they are all completely unique. It just so happens that at our institution we are much busier than the general guys, by a long shot. Which is substantiated in our #'s. The general guys are certainly busy but to a lesser extent. We do not have a plastics program here, but if so those guys would probably be housed. Our plastics trauma guy is insanely worked. This is all from a trauma perspective as well. The punishment we personally receive on trauma is more than made up with our free time on subspecialty months.

 

[Carpenter]

Physician payments are decided by legislatures. They decide on medicare/medicaid payments and insurance companies base their payments based on medicare. The other factor that compounds physician payments is technology. Government wants to encourage use of newer and better technology and so there are perks (higher payments) for use of new technology. Companies also lobby for this so that demand for their products go up.

Orthos have seen a huge raise (or decreased rate of fall depending on how you see it - weakening dollar, $300-600K salaries 10-20 years ago, inflation) in their incomes because of new types of screws, joints and bone adhesives. All that is changing now. Technology pipeline is slowing down and companies are coming up with new versions of old ideas (lucrative for companies but no higher payments for physician to use). So payments for ortho will see a big drop in next few years with medicare cuts. Having said that, ortho remains a surgical specialty at the end of the day. We work like dogs (lifestyle comment in earlier post referred to porche, not hours) and undergo 5 years of brutal training. Ortho salaries may go down compared to other specialties, but they will remain higher than family medicine and general internal medicine.

 

[leagueelbow]

as for the future of the job market, while some of it is dictated by demand for ortho procedures and supply of the surgeons, the biggest driver is medicare and private insurance reimbursement

any possibility of a cash-based practice in ortho like there is in plastic surgery?

 

[-Goose-]

I have wondered how much "destination" surgical endeavors will affect the future of orthopaedics. It seems that people would be much more willing to go to India to get their TKA than a CABG.

http://www.wockhardthospitals.net/general/joints_replace.asp

 

[DrDre311]

any possibility of a cash-based practice in ortho like there is in plastic surgery?

Maybe some ortho attendings can comment on this issue but I wouldn't think so, at least not nearly like plastics.

Most ortho procedures I'm aware of are based on medical need, even the elective ones (i.e. debilitating arthritis --> elective total joint or something similar).

The reason aesthetic surgery is cash-only is because there is no concrete, definite medical need for a facelift or an abdominoplasty. So nobody gets up in arms about people having to pay for the service, since patients don't technically need it. Not that aesthetic surgery doesn't serve a purpose, because it definitely does--but you won't die without a rhinoplasty, and unless you're a stripper/hooker, you can probably continue to work without that breast aug.

I'm not sure orthopods as a group could get away with denying operations dealing with pain/function/ability to work (to people who need them) on a direct fee-for-service type thing. At least not on a large scale.

 

[pancakesyrup]

Given the low birth rates in North America and the enormous aging population, orthopaedic surgeons will certainly be needed across North America.

And with the rise of type 2 diabetes in youth, there's sure to be a rise in SCFEs too! Go Ped-a-pods!

We MUST remember that most of the expirience we gets as medical students come in tertiary care teaching institutions. The demand for these jobs is high because of the benefits associated with academia, teaching etc as well as being located in an urban center.

However, the community orthopedic demand is HUGE! If you get into the smaller communities, you may only find 1-2 orthopods per 10-20,000 people. And dont think that the pay is any worse just because you live outside the city!

Orthopaedic surgeons should NOT be worried about supply and demand! What may be a concern is the eventual decline in surgical interventions because of advances in osteogenesis, fracture healing. If we can regrow cartilage with an intraarticular injection, you can forget all those hips and knees!!

Bump.

If such advances were to occur, who would be doing those intraarticular injections?