Orthopaedic Spine Surgeon - ask me anything

[orthos]

Is student loan debt a significant burden for you, your colleagues, or other doctors you may know? What would you say to someone about to apply for med school who wants to become a physician, but is having second thoughts because he/she is terrified of 300k+ debt?

For myself, it is not a burden per se. I am able to make decent payments on my and my wife's student loans, while maintaining everything else I need to cover (clinic overhead, employee salaries, malpractice, etc.) I started to pay my debts down in residency and had many factors working for me: my wife was working, I was moonlighting when able, we lived frugally, etc. I anticipate to be done with student loans relatively soon. Of course, it's easier for me than some of my friends from school who went into less lucrative specialties, but then again, we all selected our paths because of the work we do, not the money we make. While it may take them longer to be free of the debt looming overhead, they are enjoying the same satisfaction that I am today.

It is completely normal to see the huge sum and be scared or overwhelmed; trust me, I felt the same. However, I likened it to "betting" (for lack of a better term) on myself. Moreover, there is no other career I would envision for myself, and I was willing to take on the burden to obtain my goals. Just make sure you have a solid plan B, C, D, etc. in case your goals change.

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[SushiCupcake]

Have you come across any osteopathic physicians in your specialty? I know DOs generally go into primary care but I'm just wondering if you've seen any specialize into more competitive specialties like surgery.

 

[Leoz M Jiliums]

Are there opportunities for you to get involved in teaching in your setting? Is this common?

Ortho is the reason I decided to go into medicine (I did research in an ortho-related field, and worked with a few surgeons, I fell in love with it), but I'd like a realistic impression of downsides of Ortho. What are your least favorite aspects of the field?

Finally, do you have any advice about maintaining a family life during residency and beyond?

 

[RueTay]

Sweet thread. It took me until 3rd year in med school to figure out the difference between ortho spine and neurosurg spine.

I'm doing my ortho residency at a large academic center with a big spine department. We see a lot of complicated cases and sick pateints so our hospital stays are long and our complication rates are high. It is a very challenging service to be on. The spine practice we have here is not what I am looking to do, but I am interested a community-based spine practice. Problem is I won't see much of those bread and butter /MIS cases durring residency. Could you talk about your practice and how the cases you do differ from the ones you refer to the big academic centers.

 

[orthos]

Oldest/youngest patients you have ever had? How fast does your Ferrari go?

Ever? Oldest was 104 years old, I think. Did not operate on her. Youngest was newborn on my OB/GYN rotations.

If you're asking about a Ferrari, you would laugh at me with what I drive. Let's just say I've had it since beginning medical school, and I'm going to run it into the ground before I purchase another.

 

[orthos]

Have you come across any osteopathic physicians in your specialty? I know DOs generally go into primary care but I'm just wondering if you've seen any specialize into more competitive specialties like surgery.

One of the best orthopaedic surgeons I have ever worked with had a DO degree. His skill in the OR is otherworldly, and his patients absolutely adore him.

Honestly, the degree does not matter, so long as you're hard working and can prove your mettle. There is some bias, but the majority of places will not care. I am not sure how the merger of residencies (last I heard it was still a thing) will affect things, but I suspect good candidates will still achieve their goals.

 

[FlatFour]

In regards to the general process of becoming an attending physician, what would you say was the most challenging part (e.g. getting into medical school, attending medical school, matching, residency, etc)? Do you have any advice for humble pre-meds such as myself to prepare for such difficulties ahead?

Thanks!

 

[orthos]

Are there opportunities for you to get involved in teaching in your setting? Is this common?

Ortho is the reason I decided to go into medicine (I did research in an ortho-related field, and worked with a few surgeons, I fell in love with it), but I'd like a realistic impression of downsides of Ortho. What are your least favorite aspects of the field?

Finally, do you have any advice about maintaining a family life during residency and beyond?

In a formal setting, no. However, I have taken on one enterprising student as a mentee. He is the one who introduced me to this forum. I very much enjoy teaching, but there is only so much time in the day and unless students come to me, I have no real way to reach out to them. There is no nearby medical school either, so I have no access to med students or residents.

Downsides are a matter of perspective. I was wary of the 5 years residency (vs 3 years, though in the end, other subspecialists end up spending the same amount of time in training). There are some patients who have unrealistic expectations (ex. want to get back to hiking they used to do, but you know that they won't be able to). With spine, some of the cases can go very long, which is taxing on the surgeon, the team, and the patient. There's also malpractice costs, which are higher than a lot of other specialties. Back pain is notorious for drawing narcotics seekers. I do a lot of worker's compensation cases (most WC cases involve back injuries) and those can be a pain to deal with for my staff.

The truth with ortho is that the downsides are pretty limited relative to the benefits. Moreso with spine, but compared to specialties that handle vital organs, we have it pretty good.

 

[TheWeeIceMan]

I may have missed this, but is your wife also a physician?

 

[orthos]

Sweet thread. It took me until 3rd year in med school to figure out the difference between ortho spine and neurosurg spine.

I'm doing my ortho residency at a large academic center with a big spine department. We see a lot of complicated cases and sick pateints so our hospital stays are long and our complication rates are high. It is a very challenging service to be on. The spine practice we have here is not what I am looking to do, but I am interested a community-based spine practice. Problem is I won't see much of those bread and butter /MIS cases durring residency. Could you talk about your practice and how the cases you do differ from the ones you refer to the big academic centers.

My practice is very much geared to bread-and-butter cases. As mentioned, my scope of practice is somewhat limited by the resources we have and the current abilities of the OR team. Currently, I do a lot of spine fusions, lammys, and SI fusions. I do a fair number of ACDFs and kyphos.

The ones I refer are usually the highest risk cases, ones that require special neuromonitoring/imaging, or ones that I simply don't feel comfortable with. For example, one patient came in after sudden weakness & numbness, inability to walk, severe pain. Upon reviewing the cervical MRI, he had almost complete compression of the spinal cord due to herniation. He was a walking time bomb and I felt that it would be better for the patient to have the skill and resources of a surgeon and medical center beyond my own capabilities. While I am confident, I am not arrogant in my abilities; that is something you should always keep in mind if you don't already.

This may be a good time to mention that if anyone has specific questions they'd like to address to me in private or would like a more personal/specific answer, feel free to use the message system.

 

[orthos]

I may have missed this, but is your wife also a physician?

My wife is not a physician. Though she had another career before, she manages my practice now.

 

[kreme]

Where do you see yourself in 10 years? Continuing to practice in the same clinical setting/area?

 

[E27]

In regards to the PA that you employ, do you find that you can trust his abilities to run clinic while you're in surgery? How does that relationship work for you?

 

[orthos]

In regards to the general process of becoming an attending physician, what would you say was the most challenging part (e.g. getting into medical school, attending medical school, matching, residency, etc)? Do you have any advice for humble pre-meds such as myself to prepare for such difficulties ahead?

Thanks!

Every step was a challenge, but I believe just getting into medical school is the hardest part. It's certainly more difficult than when I applied roughly 10 years ago. Medical school was challenging, but with the support of your classmates and the faculty, it is easier to manage. I've mentioned that I did one year prelim. surgery due to not matching on my first try; it certainly is discouraging, but medicine is meant to test your willpower and determination. Residency was extremely trying in terms of hours, but time flies when you're doing something you love.

The best advice I can give before you commit is to absolutely know yourself. Know your honest motivations, goals, reasons for doing what you do. It may take some reflection, even if you think you know now. Once you understand yourself, achieving your goals is a matter of time.

 

[Etorphine]

^Thanks for your response! It is a question I've had for a long time.

 

[orthos]

In regards to the PA that you employ, do you find that you can trust his abilities to run clinic while you're in surgery? How does that relationship work for you?

I am very fortunate in that regard as well; my PA actually completed his MD degree, but due to unfortunate circumstances with his family, he did not do residency. That is in addition to the two years he spent at PA school, which he aced due to his training. In short, I completely trust his judgment.

He runs clinic when I am doing non-surgery procedures (epidurals, facet blocks, etc.). He is my assistant in every surgical case.

 

[orthos]

Where do you see yourself in 10 years? Continuing to practice in the same clinical setting/area?

In 10 years, I hope to be doing the exact same thing: serving a community that needs me the most. Whether or not that will be the one I am currently in, I cannot say. Given that I am the go-to physician for any and all back issues in the area, I enjoy the relationships I've formed with community physicians and the impact that I have on the well-being of their patients. The only detriment is those of a classic small town setting; it gets pretty boring here sometimes.

 

[rkmoto121]

Did you find it difficult to start up and maintain a solo private practice? Do you have a ton of paperwork to do? And how does vacation work for you as the only spine surgeon in the area? When I was seeing my ortho surgeon for injuries a while back he always had his partner take over his cases when he went on vacation but I don't see what your patients would do if you took some time off.

Thanks so much for doing this.

 

[orthos]

Did you find it difficult to start up and maintain a solo private practice? Do you have a ton of paperwork to do? And how does vacation work for you as the only spine surgeon in the area? When I was seeing my ortho surgeon for injuries a while back he always had his partner take over his cases when he went on vacation but I don't see what your patients would do if you took some time off.

Thanks so much for doing this.

It was not particularly difficult for me. I had a contract with the hospital, so they already had work for me to do. Last year, I shared an office with 3 other ortho docs who were all generalists. It was my solo practice, one doctor's solo practice, and a two-doc partnership practice. This reduced the cost of my overhead (since I used their MAs and we split office space costs) and I got a lot of my first physician referrals from them. They also helped by informing the primary care physicians about my new services and put me in touch with a lot of them. Eventually, the logistics of our varying practices forced me to consider other options, and I opted to find my own office space and hire my own staff. So I had a sort of jump start on my solo practice, and with my wife now running the show, everything has been going smoothly.

When I first started, I had mountains of paperwork. Often I would be late with notes and dictations due to the volume of patients I was seeing. However, fortune would once again favor me, as I was able to hire my student-mentee as a scribe during his gap and application year. He is another reason why my transition to solo office was successful; he was able to pick up a lot of the slack during this time, functioning as part-MA, part-scheduler, part-medical biller, until our new staff was fully trained in their new positions. He still does a lot to help out around the office; I'm actually surprised that his application cycle has been full of waitlists when I compare him to myself at that stage. Such is the admissions process though. Back to your question, I have a lot of paperwork, but most of that is taken care of by my scribe; I just review and sign if everything looks good.

Funny you should mention vacations, as I am in the middle of taking a week off while I attend to other matters. When it comes to spine, many of the cases are not urgent enough to interfere with any vacation plans I have. My PA is more than capable of managing the conservative care that we do and all of my staff is allowed to contact my cell if necessary. Another thing is that primary care physicians in this area are used to not having a back specialist around, so they help patients manage until I return from my breaks. Anything that needs absolute immediate attention is transferred via helicopter to the next available facility, about 50 miles from our location. Some patients don't like waiting, and I don't like to keep them waiting, but for the most part, as long as they have their medications, a couple weeks wait is an acceptable time frame.

 

[loltopsy]

Roughly speaking, how big is the city you work in? Are we talking small city or rural area?

 

[orthos]

Roughly speaking, how big is the city you work in? Are we talking small city or rural area?

Small for a city, large for a town. The county is largely rural.

 

[jdj16]

Thanks for doing this thread and taking time out of your schedule...this is great. I'm an M2 (thankfully almost done with M2) and in the past couple months I've really discovered ortho as pretty much the most awesome specialty that I've been around. I grew up playing sports and I guess have the stereotypical gym/athletic history that made me think ortho before I got to med school, but then I kind of thought about it less as I looked into other stuff during last year and the first part of second year. I did some research on an osteoarthritis project this summer that might get published but my work was really just as a lab tech and the pub might not come about till five years down the road anyway. I guess my question is...did you do any research in third year? How is there time for that? With your match experience, do you think that research is really something that you can never have enough of? I'm hesitant to look for another project to jump on due to step 1 this june and then starting third year after that. Do you have any recommendations about how my CV would look if I were to apply with a research "experience" but no real tangible product from that?

 

[orthos]

Thanks for doing this thread and taking time out of your schedule...this is great. I'm an M2 (thankfully almost done with M2) and in the past couple months I've really discovered ortho as pretty much the most awesome specialty that I've been around. I grew up playing sports and I guess have the stereotypical gym/athletic history that made me think ortho before I got to med school, but then I kind of thought about it less as I looked into other stuff during last year and the first part of second year. I did some research on an osteoarthritis project this summer that might get published but my work was really just as a lab tech and the pub might not come about till five years down the road anyway. I guess my question is...did you do any research in third year? How is there time for that? With your match experience, do you think that research is really something that you can never have enough of? I'm hesitant to look for another project to jump on due to step 1 this june and then starting third year after that. Do you have any recommendations about how my CV would look if I were to apply with a research "experience" but no real tangible product from that?

I worked on a summer project after my second year, but nothing really came of it. In my third year, I helped with some projects but did not have a formal position in a lab. I did not get have anything published until residency, and even then it was nothing significant in the academic world. Speaking from the point of view of someone solely trying to match and not necessarily gunning for a big name residency, I think that research is more about showing how you can apply yourself to an project moreso than the publications you get. You may get questions at residency interviews about your projects; be ready to explain what reasons/challenges you faced that prevented you from publishing. We all learn something from research even if you're just doing busy work (unless you really are just zoning out while filling spreadsheets or whatever). Focus on why you're doing the project and what you hope to learn.

Of course, I think competition for residency spots is steadily on the rise, so it would help to have concrete examples of your successful projects, but I don't think that lack of them will hinder you.

 

[jdj16]

I worked on a summer project after my second year, but nothing really came of it. In my third year, I helped with some projects but did not have a formal position in a lab. I did not get have anything published until residency, and even then it was nothing significant in the academic world. Speaking from the point of view of someone solely trying to match and not necessarily gunning for a big name residency, I think that research is more about showing how you can apply yourself to an project moreso than the publications you get. You may get questions at residency interviews about your projects; be ready to explain what reasons/challenges you faced that prevented you from publishing. We all learn something from research even if you're just doing busy work (unless you really are just zoning out while filling spreadsheets or whatever). Focus on why you're doing the project and what you hope to learn.

Of course, I think competition for residency spots is steadily on the rise, so it would help to have concrete examples of your successful projects, but I don't think that lack of them will hinder you.

Thanks for responding! I'd love to be able to work on something that would lead to some results, but I'm really unfamiliar with what to expect schedule wise in the next year so I'm not sure if I'll get around to it.

One last question for you-ideally I'd like to practice in a community similar to what you've described. Can you describe what your family life is like? I know you said you're on vacation now, but during a regular day/week, are you able to be home for dinner with the kids most nights? I'm not afraid of working hard but I also want to be present in my kid's lives and not only see them during my yearly vacations.

 

[orthos]

Thanks for responding! I'd love to be able to work on something that would lead to some results, but I'm really unfamiliar with what to expect schedule wise in the next year so I'm not sure if I'll get around to it.

One last question for you-ideally I'd like to practice in a community similar to what you've described. Can you describe what your family life is like? I know you said you're on vacation now, but during a regular day/week, are you able to be home for dinner with the kids most nights? I'm not afraid of working hard but I also want to be present in my kid's lives and not only see them during my yearly vacations.

Sure. My typical schedule is as follows:

Monday: Free clinic day. Up around 6:30am, at the clinic for uninsured/insurances I don't see in my private office by 7:45. Brief overview of my schedule, then I see patients until lunch. Every first and third Monday are my surgery center days, so by 1 I am over there doing epidurals, nerve blocks, and other such procedures. On the days I'm not at the surgery center, I do afternoon at my regular clinic. Either way, usually done by 5pm, and home for dinner and family time.

Tuesday: Full regular clinic day. Start seeing patients around 8-830. Go until my hour lunch. Back to seeing patients from 1-5pm. Usually done around 430pm, rarely do I get backed up and reach 5pm with patients still in the rooms. Go to the gym for swimming or tennis or basketball, usually with my PA or other friends. Home for dinner and family time again.

Wednesday: Surgery day. In the OR for my first case at 7:30am. Depending on the lineup, my lunch might run later at about 1, or I might not even get a lunch (just a break for a quick bite then back to OR). Afternoon session is about the same. Most days I finish on time around 5-5:30. Sometimes I go until after 6. Rarely, I go beyond that (those are usually cases where we have set backs and they start later than anticipated, or complications arise during the surgery, or we find something during surgery that needs additional time to correctly repair).

Thursday: Same as Tuesday.

Friday: Another surgery day. Usually the smaller cases, but more of them. Usually home before 6.

Then when I'm on-call, any given day can be subject to additional time, if not operating then at least consulting. In addition, I round at the hospital either in the mornings or on my lunch, but usually only for specific post-op patients that I have concerns about. Our hospitalist is pretty good at taking care of the rest.

Ultimately, I have a ample time to spend with my wife and kids (plus my wife and I share an office in my practice). I'm able to make most after school activities that are in the evenings; things like soccer games that happen at 3pm are out of my reach, unfortunately. One of the biggest contributions to my free time is, again, my student-mentee. Before him, I would usually finish my notes and documentations at home or stay late at the office to finish them just to not get overwhelmed. With a scribe, he takes care of all of that during working hours and I have my evenings free.

 

[jdj16]

Man that sounds like you're living the dream. That's encouraging to hear also...in the academic world (at least where I'm at) all I ever hear is surgery will be your spouse and if you're not willing to put in 100+ a week you shouldn't consider it. I have no fantasies about being the next James Andrews or cranking out hundreds of pubs a year...I just want to be able to help my patients and make a difference in their lives while still being present in my family's as well. Thank you again for typing all that up and being so responsive. Good luck in your practice and in the future!

 

[Gust]

tried to private message you, but dont know how

 

[orthos]

Man that sounds like you're living the dream. That's encouraging to hear also...in the academic world (at least where I'm at) all I ever hear is surgery will be your spouse and if you're not willing to put in 100+ a week you shouldn't consider it. I have no fantasies about being the next James Andrews or cranking out hundreds of pubs a year...I just want to be able to help my patients and make a difference in their lives while still being present in my family's as well. Thank you again for typing all that up and being so responsive. Good luck in your practice and in the future!

Your practice is what you make of it. I could probably operate a lot more, make more money, and complicate my life further, but for just starting and where I'm at, I'm happy. That's what matters. In the future, I may want to expand a little, operate more, but I'll make that decision when I get there.

If my goals included becoming the next world famous surgeon at one of the top hospitals, I would likely be operating day in and day out. I'd need that experience and that state of mind to succeed in that arena. For me, though, this is what I want and what I worked hard to get. Like I said in an earlier post, the best thing you can do is know yourself truly and honestly, and then your goals will line up. There will undoubtedly be roadblocks and detours that arise, but you'll get there.

Good luck to you in your studies and future career as well.

 

[WestCoastNative]

It is possible. Again it depends on the location and community, whether or not you join an established practice or start your own, what other types of income you are able to generate, etc. For example, I am in the unique position of being in an underserved community where the pain management doctors are backed up in appointment days, so I am able to do procedures that would normally be referred out and thus generate additional procedural income. I also employ a PA who helps to increase our patient load (ex. I do procedures at the surgery center while he sees patients in my clinic).

Thanks for taking the time to reply Orthos. Might sound a bit naive, but what exactly would an orthopedic surgeon do that didn't specialize further in spine, hand, joint & hip, ...? Would they work on all cases, just not as much in depth?

 

[orthos]

Thanks for taking the time to reply Orthos. Might sound a bit naive, but what exactly would an orthopedic surgeon do that didn't specialize further in spine, hand, joint & hip, ...? Would they work on all cases, just not as much in depth?

General orthopaedic surgeons work on anything that comes their way, but usually refer out to a subspecialist for the complicated cases or things they don't feel comfortable with. For instance, I can perform total hips just fine, but I don't perform enough of them to be really comfortable with anything beyond the simple cases. When there are additional risks or complications, I would inform the patient of the situation, and then refer them to an orthopaedic surgeon that does 90% of his/her cases as hips, who may know all the subtleties that may not be immediately recognized by me.

As a specific example, I was once on-call and summoned to evaluate an elderly woman after fall and fracture of her hip. However, after discussing with the anesthesiologist, we determined she would not likely tolerate a long surgery. I kindly asked another physician who I knew was much faster at total hips than I am to perform the surgery and he agreed. If he had not, I could have done the procedure, but at greater risk to the patient.

 

[rkmoto121]

Was getting a spine fellowship difficult? Did you have to relocate around the country for the fellowship? Also, did you know from the beginning of residency that you would eventually go into a spine fellowship? And did you receive a lot of other offers for jobs?

Thanks!!!

 

[orthos]

Was getting a spine fellowship difficult? Did you have to relocate around the country for the fellowship? Also, did you know from the beginning of residency that you would eventually go into a spine fellowship? And did you receive a lot of other offers for jobs?

Thanks!!!

Not as difficult as getting into medical school and residency. I think that my setback with matching showed my willingness to do whatever it takes and never give up, and that helped when it came time for fellowship selection. I did relocate across the country for fellowship.

In the beginning of residency, I was just thankful to have finally been matched. It was toward the end of my second/beginning of third that I started working with a spine surgeon proper. Talks with him lead me to realize how many people have back issues, and that served as a sort of challenge to help as many people as I could. Additionally, the field was/is steadily progressing in terms of technology, surgical technique, etc. In the end, spine care just felt right for me. I never gave much consideration to other fellowship options, though if any was a runner-up it would have been sports med.

I received quite a few job offers. My fellowship was very good about helping with that aspect. I chose based on the community, location, certain terms of the contract, and pay.

 

[WestCoastNative]

General orthopaedic surgeons work on anything that comes their way, but usually refer out to a subspecialist for the complicated cases or things they don't feel comfortable with. For instance, I can perform total hips just fine, but I don't perform enough of them to be really comfortable with anything beyond the simple cases. When there are additional risks or complications, I would inform the patient of the situation, and then refer them to an orthopaedic surgeon that does 90% of his/her cases as hips, who may know all the subtleties that may not be immediately recognized by me.

As a specific example, I was once on-call and summoned to evaluate an elderly woman after fall and fracture of her hip. However, after discussing with the anesthesiologist, we determined she would not likely tolerate a long surgery. I kindly asked another physician who I knew was much faster at total hips than I am to perform the surgery and he agreed. If he had not, I could have done the procedure, but at greater risk to the patient.

It's interesting how it all works. I'm enjoying this thread, thanks a lot Orthos After years of performing surgeries, what's it like? Do you still get a rush from time to time? How hard is it to get a job in competitive areas? If your lifelong dream is to work as a physician/surgeon in Manhattan, how realistic is that goal?

 

[Uafl112]

I could have shadowed one of you guys but I let the opportunity slip. Should I regret it? Also, how is your Brazilian Jiu Jitsu? or are you more so a stand up fighter?

 

[orthos]

It's interesting how it all works. I'm enjoying this thread, thanks a lot Orthos After years of performing surgeries, what's it like? Do you still get a rush from time to time? How hard is it to get a job in competitive areas? If your lifelong dream is to work as a physician/surgeon in Manhattan, how realistic is that goal?

Surgery still has that spark for me. With even the most routine cases, I'm on my toes in case anything goes awry. I think that letting yourself get too comfortable - letting your guard down - is a slippery slope. Though orthopaedics is usually not a life or death situation, you are still being trusted with a patient's quality of life. With spine, there is more danger and risks, including death or paralysis, simply due to working so closely to the nerves and spinal cord. Then there is my own personal desire to improve, to do my next surgery better than the last. That's not always possible, but the challenge helps my attitude. Lastly, I absolutely love the feedback I get from my patients and their families. It makes everything worth it. The combination of responsibility for the patient, readiness to adapt to complications, hint of inherent danger, personal challenge to do good work, and even the "glory" of being thanked by the patient later, are all factors that get me psyched for going into the OR.

In competitive areas, there are many things that come into play. Is there a need for your services in that area? What do you bring to the table that nobody else does? What dedication have you shown to that community that makes you better suited to practice there than anyone else? Are you willing to compromise your salary, hours, etc. to be a team player? Will you mesh well with the current way things are run, or are you the type of person who will want to shake things up/introduce change? How good is your business acumen if you plan on private practice? Who do you know that is trusted by established providers in the area that can vouch for anything you say? It's tough to say how "realistic" working in a specific city will be, but I tend to be the type of person who thinks anything is achievable if you work hard enough.

 

[orthos]

I could have shadowed one of you guys but I let the opportunity slip. Should I regret it? Also, how is your Brazilian Jiu Jitsu? or are you more so a stand up fighter?

Regret nothing if you make your decisions carefully. If you let opportunities pass you by without definitively declining to pursue them, reevaluate how you are making your decisions.

What makes you think I wrestle or fight at all?

 

[Uafl112]

Regret nothing if you make your decisions carefully. If you let opportunities pass you by without definitively declining to pursue them, reevaluate how you are making your decisions.

What makes you think I wrestle or fight at all?

Well I let it slip on purpose so I could evaluate other options. Im now shadowing an ENT surgeon which is pretty cool. And I asked about the second part mainly because I wanna keep up with jiu jitsu when I practice

 

[orthos]

Well I let it slip on purpose so I could evaluate other options. Im now shadowing an ENT surgeon which is pretty cool. And I asked about the second part mainly because I wanna keep up with jiu jitsu when I practice

With purpose, I wouldn't regret it. ENT is a pretty cool field, with a good balance of medicine and surgery. Generally good patients and outcomes too. As long as you're exploring your options, you're doing the right thing.

You'll be able to keep up with any hobby, depending on how you manage your time and prioritize your activities. If you ever become a surgeon, I would be wary about practicing any martial arts. Anything high impact or similarly dangerous is an unnecessary risk your livelihood. If you go to train and your shoulder is tweaked by a Kimura lock, it could impact your performance in the following days surgery. Or if you happen to be training with a makiwara board and fracture your hand, you lose time and money while you recover, and either your patients are in pain longer or the cases go to other doctors. Of course, there are risks in other sports (jamming your finger during a basketball game) and even other activities (amputation secondary to cutting vegetables for dinner). It's all about weighing risks vs. benefits, just like in medicine.

 

[WestCoastNative]

Surgery still has that spark for me. With even the most routine cases, I'm on my toes in case anything goes awry. I think that letting yourself get too comfortable - letting your guard down - is a slippery slope. Though orthopaedics is usually not a life or death situation, you are still being trusted with a patient's quality of life. With spine, there is more danger and risks, including death or paralysis, simply due to working so closely to the nerves and spinal cord. Then there is my own personal desire to improve, to do my next surgery better than the last. That's not always possible, but the challenge helps my attitude. Lastly, I absolutely love the feedback I get from my patients and their families. It makes everything worth it. The combination of responsibility for the patient, readiness to adapt to complications, hint of inherent danger, personal challenge to do good work, and even the "glory" of being thanked by the patient later, are all factors that get me psyched for going into the OR.

In competitive areas, there are many things that come into play. Is there a need for your services in that area? What do you bring to the table that nobody else does? What dedication have you shown to that community that makes you better suited to practice there than anyone else? Are you willing to compromise your salary, hours, etc. to be a team player? Will you mesh well with the current way things are run, or are you the type of person who will want to shake things up/introduce change? How good is your business acumen if you plan on private practice? Who do you know that is trusted by established providers in the area that can vouch for anything you say? It's tough to say how "realistic" working in a specific city will be, but I tend to be the type of person who thinks anything is achievable if you work hard enough.

That's great to hear. Seems like being a surgeon is one of the rare jobs that just doesn't get "old". What exactly would give someone a better chance at getting hired/making partner in Manhattan? Would attending residency there benefit me in anyway?

 

[Elevencents]

Is spine surgery demanding from a physical standpoint? Is there a standard length of practice for the specialty? I know I have heard of general ortho surgeons focusing more on hand cases as they age.

If for whatever reason you could not have done ortho, what other two specialties would you have liked to do? And if you were not competitive for ortho based on say board scores, what would you have pursued?

Thanks a lot for doing this. A wealth of information here already.

 

[orthos]

That's great to hear. Seems like being a surgeon is one of the rare jobs that just doesn't get "old". What exactly would give someone a better chance at getting hired/making partner in Manhattan? Would attending residency there benefit me in anyway?

I'm not exactly familiar with Manhattan, so I couldn't give you any concrete tips.

In a private practice scenario, if I were looking to hire a new physician to share my patient load with, grow my practice with, etc. I would want someone who could prove that they would be an asset to the community. Someone who has reasons to join the area that go beyond "I think it would be a cool place to live," someone who has an honest investment in improving health outcomes of the patient population. That may be difficult to prove in more affluent areas (ex. trying to profess your dedication to the plight of celebrities as a reason to practice in Beverly Hills may draw some blank stares).

Alternatively, with an academic position or salaried position within a hospital, I would look for a candidate that will bring something special to the staff. This is where publications, networking, pedigree, etc. may come into play. Those extras will never make up for incompetency. You need to be first and foremost a good doctor to get recognized; the rest just seal the deal. Attending a residency in the area may help get your foot in the door networking wise and give you more of a chance to "show your stuff" - impress the local attendings, get out in the community, learn where the opportunities will be when you finish and begin your career.

Be careful about being too specific or limiting with where you want to practice. This is just my personal view, so feel free to disagree, but I would give up my dream location in favor of a less desirable area with a community that needs me more. It's perfectly reasonable to prefer the East coast to West or vice versa, but "Manhattan or bust" seems a little too narrow (not criticizing, just making an example). My happiness is more invested in who I'm serving, rather than where. Maybe in retirement I'll feel like I've earned my spot in that dream location.

 

[NontradCA]

I'm not exactly familiar with Manhattan, so I couldn't give you any concrete tips.

In a private practice scenario, if I were looking to hire a new physician to share my patient load with, grow my practice with, etc. I would want someone who could prove that they would be an asset to the community. Someone who has reasons to join the area that go beyond "I think it would be a cool place to live," someone who has an honest investment in improving health outcomes of the patient population. That may be difficult to prove in more affluent areas (ex. trying to profess your dedication to the plight of celebrities as a reason to practice in Beverly Hills may draw some blank stares).

Alternatively, with an academic position or salaried position within a hospital, I would look for a candidate that will bring something special to the staff. This is where publications, networking, pedigree, etc. may come into play. Those extras will never make up for incompetency. You need to be first and foremost a good doctor to get recognized; the rest just seal the deal. Attending a residency in the area may help get your foot in the door networking wise and give you more of a chance to "show your stuff" - impress the local attendings, get out in the community, learn where the opportunities will be when you finish and begin your career.

Be careful about being too specific or limiting with where you want to practice. This is just my personal view, so feel free to disagree, but I would give up my dream location in favor of a less desirable area with a community that needs me more. It's perfectly reasonable to prefer the East coast to West or vice versa, but "Manhattan or bust" seems a little too narrow (not criticizing, just making an example). My happiness is more invested in who I'm serving, rather than where. Maybe in retirement I'll feel like I've earned my spot in that dream location.

That's inspiring.

 

[orthos]

Is spine surgery demanding from a physical standpoint? Is there a standard length of practice for the specialty? I know I have heard of general ortho surgeons focusing more on hand cases as they age.

If for whatever reason you could not have done ortho, what other two specialties would you have liked to do? And if you were not competitive for ortho based on say board scores, what would you have pursued?

Thanks a lot for doing this. A wealth of information here already.

Like with most surgical specialties, there are very long, complex cases that can be quite taxing. Standing for hours, sweating, with the lead weighing down on you the whole time can be an uncomfortable experience. At times, we will stage a case, doing one part one day and another the next. This helps to cut down on some of the complications that arise with lengthy operations. I anticipate that I may eventually move towards some of the shorter cases and leave the longer ones for someone more physically capable, ego permitting. On the other side of the spectrum, some cases are simple. I have a 3 level kypho on Monday afternoon that will take a couple hours or so.

Alternate specialties I was considering as backups were general surgery and, for a brief time, oncology. Had it been 100% impossible for me to match ortho, I may have pursued general surgery.

 

[PhillyMed777]

With the addition of a fellowship, I can see that your training is long. I have a few questions on this.
1 - Did you find that your fellowship gave you a better lifestyle than residency?
2- Do most ortho residents do a fellowship?
3 - Did you have large student loans?... Did you or any of your colleagues have trouble with loans while their value was increasing with interest over long periods of training?

 

[orthos]

With the addition of a fellowship, I can see that your training is long. I have a few questions on this.
1 - Did you find that your fellowship gave you a better lifestyle than residency?
2- Do most ortho residents do a fellowship?
3 - Did you have large student loans?... Did you or any of your colleagues have trouble with loans while their value was increasing with interest over long periods of training?

1) It varies from program to program, but I felt my fellowship did provide a better lifestyle. The training is still intense - you learn a lot in a short amount of time that you will be expected to know for the rest of your career - but better because it is more specific to my interests. My fellowship was also in a better location with higher pay.

2) I don't believe that most residents do a fellowship. That certainly wasn't the case among my colleagues, both from my residency and from my school who did ortho elsewhere. General orthopaedics is a very rewarding field in itself, and many people are happy and capable without the additional year(s) of training. I would say it kind of depends on whether or not you want to be the go-to person for a certain type of case (hand, spine, hip, etc.).

3) See post #52

 

[rkmoto121]

You said that you did an internship year before starting your residency. How did that work? Like how did you improve your application during that year in order to match?

 

[orthos]

You said that you did an internship year before starting your residency. How did that work? Like how did you improve your application during that year in order to match?

I did my preliminary year at the same place I eventually matched for residency, and though I was not a part of the ortho dept. proper, I did make efforts to get to know the attendings/administration better. I think continually reaching out to them while also proving my dedication helped a lot.

 

[The Buff OP]

While this may be blasphemous to state, I do not weight lift anymore. I did a bit in college, but nothing significant (max at 250ish).
I'll have to ask my wife about that first paycheck...

Did you stop lifting because you lost interest or you had to take care of your hands so you do not receive an injury?

I'm really passionate about bodybuilding and I'm 95% positive I want to go into a surgery specialty. Do you think I would have to give up bodybuilding for surgery?

 

[HopefulReapp]

I took a grad level orthopedics course during undergrad where we learned some background information on bone, cartilage, and pathophysiologies of different conditions. We also had a live feed to an ortho surgery every week at our local academic hospital. Despite researching the etiology, pathophysiology, and procedural steps associated with each surgery, I couldn't help but be bored with the visuals other than hearing the occasional "pop." I felt the same way while shadowing earlier on with a GS attending. There's only so much blunt dissection that I could pay attention to even if I really enjoy what is going on at a physiological level. I really like the biotech applications to this field (NP delivery, NF scaffolding for spinal cord repair, etc.), the immediate outcomes after interventions, and the hands on approach to care.

Would you attribute any of this disconnect in surgeries to a difference between observing and doing? Like you said it is better to get involved earlier in med school rather than later, but I'm not sure if there is any point given my experiences shadowing.

Thank you

 

[Andrew N]

How old were you when you applied to medical school and what was your family status? (ex: how many children and their ages)

I'm 22, married, with 2 children - ages 3 and 1. I'm extremely weary that medical school will be very hard on the family life.

Also - have you ever met any physicians that were prior military before deciding they wanted to be a doctor?

I'd like to thank you for taking the time to do this, these are the kind of Q&A threads that answer a lot of questions and keep inspiring people (especially myself) to keep at it.