Orthopaedic Spine Surgeon - ask me anything

[orthos]

Would you recommend not getting into a serious relationship until your are in residency since many say it is all about getting into residency and when your in your pretty much set.

I am of the opinion that when it happens, it happens. Know thyself, know where your priorities lie and what you can and cannot (or will and will not) afford to sacrifice. For myself, I would not have made it without the strong support of my wife. For others, they may be perfectly fine with less-serious relationship, especially if they have a strong support network through family, friends, and mentors. If someone had asked me to choose between my wife and my career, she would win hands down. Some may think that foolish, others may think it romantic. Either way, it worked for me. Residency is definitely a lot more demanding than medical school, and you may find it more difficult to cultivate a new, serious relationship relative to having an established, supportive relationship. However, you will have the benefit of having the most options for your future career by not having to consider a significant others needs and feelings.

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[woltej1]

Hello everyone,

About me: I am an attending physician specializing in orthopaedic surgery with fellowship in spine surgery. Currently in solo private practice, on staff at a community hospital. I don't have much experience with academic medicine, but I maintain research projects based on my community setting.

An employee of mine who is a medical school applicant suggested I create an account on this website to try helping others who are going into the medical field. I'll be answering questions when I have free time, and I'll try to answer all questions as best I can.

Thanks

How long ahead of time did you set yourself up to become an ortho spine? I'm going to start med school in 2015 and am very interested in orthopedics right now, but there's a lot I haven't seen so I don't want to commit too early to a specialty.

 

[jram2323]

Thanks for making this thread. Few questions

1) Why not neurosurgery?In your opinion what are the biggest differences between NS & ortho spine a med student should consider when picking a career?

2) Do you see any trauma/take any trauma call?

3) Any opinions on general surgery?

 

[orthos]

How long ahead of time did you set yourself up to become an ortho spine? I'm going to start med school in 2015 and am very interested in orthopedics right now, but there's a lot I haven't seen so I don't want to commit too early to a specialty.

My initial interest in medicine occurred after being treated by an orthopod when I was young. I had extensive experience shadowing in ortho in undergrad, and in medical school, I got involved with the orthopaedic department from my first year. So I was highly interested in orthopaedics for a long time. As I've already mentioned, I was first interested in spine specifically in residency.

Just a note: I think orthopaedics has one of the highest number of "initially interested as first years," with most of those losing interest by the end. There is no reason to commit to any specialty early. Wait until 3rd year rotations. Even then it's not too late to find your passion (even for competitive specialties). Sure you may be behind some of your peers and they may be more competitive in the "bigger name" residencies, but you shouldn't care. Any match is a good match.

Thanks for making this thread. Few questions

1) Why not neurosurgery?In your opinion what are the biggest differences between NS & ortho spine a med student should consider when picking a career?

2) Do you see any trauma/take any trauma call?

3) Any opinions on general surgery?

1) Short answer: orthopaedics in general interested me more than neuro. Nobody (at least that I know) thinks as a first-year "Oh I want to do spine surgery, so I need to choose either neuro or ortho." Instead, you think "Wow, the field of orthopaedics is awesome" or "Neurosurgery is the best fit for me." Most of the students who feel that they want a career in spine care without any real experience are usually the students who see the $$$ associated with spine.

2) I take trauma call, but my hospital is not a level 1 trauma center. It's mostly simple fracture care.

3) General surgery is a great field. I did it for a year. I think they work a lot harder than what they're compensated.

 

[Xenoblade]

My initial interest in medicine occurred after being treated by an orthopod when I was young. I had extensive experience shadowing in ortho in undergrad, and in medical school, I got involved with the orthopaedic department from my first year. So I was highly interested in orthopaedics for a long time. As I've already mentioned, I was first interested in spine specifically in residency.

Just a note: I think orthopaedics has one of the highest number of "initially interested as first years," with most of those losing interest by the end. There is no reason to commit to any specialty early. Wait until 3rd year rotations. Even then it's not too late to find your passion (even for competitive specialties). Sure you may be behind some of your peers and they may be more competitive in the "bigger name" residencies, but you shouldn't care. Any match is a good match.



1) Short answer: orthopaedics in general interested me more than neuro. Nobody (at least that I know) thinks as a first-year "Oh I want to do spine surgery, so I need to choose either neuro or ortho." Instead, you think "Wow, the field of orthopaedics is awesome" or "Neurosurgery is the best fit for me." Most of the students who feel that they want a career in spine care without any real experience are usually the students who see the $$$ associated with spine.

2) I take trauma call, but my hospital is not a level 1 trauma center. It's mostly simple fracture care.

3) General surgery is a great field. I did it for a year. I think they work a lot harder than what they're compensated.

Money is associated with the spine? Lol...shows how little I know.

 

[orthos]

Money is associated with the spine? Lol...shows how little I know.

Spinal surgeons are often touted as the highest paid medical specialties on average.

 

[Xenoblade]

Spinal surgeons are often touted as the highest paid medical specialties on average.

WHAT? what? what?! I thought that honor went to plastics.

All I ever hear about from everyone is how plastics makes bags of money.

 

[SushiCupcake]

It's good to be interested; it's foolhardy to be "dead set" on anything. And your handiness due to familiarity with construction is good for you to have an inclination toward ortho, but those direct skills will likely not matter for matching. Residency programs are built on the foundation that they will teach you to operate, whether you've been working with your hands for 15+ years or not. They do not select candidates based on "this person has a lot of experience working with their hands so it will be easier to teach them," but instead, "this person will make a great surgeon, and they will work extra hard to meet our standards."

Congratulations on your interviews. If you attend a DO school that doesn't have an affiliated ortho residency program, it will be more difficult but not impossible. Like I mentioned earlier, focus on your academics above all else. Apply for a summer research position at the NIH or a similar program. Pick up some away rotations and go above and beyond in your assignments (note: that does not mean brown-nosing the attendings). Just because a school doesn't have resources readily available does not mean that there aren't people there willing to help if you show interest, and it does not mean that you're "screwed" - you might just have to put forth extra effort to explore those options.

In general, I don't think allopathic residency directors have a bias against DO students, at least not in recent years. They may have a bias against certain DO schools, but those tend to be the institutions that are under scrutiny by their accreditors. The case is the same with MD schools. Your class grades and performance on the USMLE will prove your capabilities; it then becomes a matter of how well you mesh with the atmosphere of the program.

Western is a solid program, from what I understand. One of the residents in my allopathic program was from there, and the doctor I talked about in an earlier post (#57) was also a Western graduate. Additionally, the father of one of my close friends was a member of the charter class at Western.

I'm also interested in attending Western U in Pomona and am possibly interested in choosing a surgical specialty as well. Any chance you could PM me with more info about your friend/his email? I am interested to hear about his path to orthopedic surgery from Western.

 

[orthos]

WHAT? what? what?! I thought that honor went to plastics.

All I ever hear about from everyone is how plastics makes bags of money.

That's also true, and you're right that probably your average person would likely identify plastics as the money makers. Admittedly, I'm not sure about how high their average discretionary income is either, but I know that spine surgeons often are listed as the highest salary.

 

[orthos]

I'm also interested in attending Western U in Pomona and am possibly interested in choosing a surgical specialty as well. Any chance you could PM me with more info about your friend/his email? I am interested to hear about his path to orthopedic surgery from Western.

I am not at liberty to provide others' contact information, but if you have private questions, you may message me and I can try to answer from what I've been told.

 

[The Buff OP]

I am not at liberty to provide others' contact information, but if you have private questions, you may message me and I can try to answer from what I've been told.

An option to send you a msg doesn't appear.

 

[orthos]

An option to send you a msg doesn't appear.

Apologies to all who tried to message me in the past. I had turned off that option, but it is now enabled. Thank you for letting me know.

 

[Dr. Bob Doe]

Why private practice and no academia?

 

[pbrocks15]

With an interest in Ortho, what would you recommend someone to do on their gap year before medical school?

 

[orthos]

Why private practice and no academia?

I think I mentioned this partially in an earlier post, but I never had any intention of going into academics when I became interested in medicine. I am much more fond of the direct impact I have by being 100% focused on community-based patient care. I was never that big on research, nor did I care about the prestige that is associated with being part of a big academic institution. The only part of academic medicine I truly enjoy is teaching, and perhaps one day I can figure out a way to have that in addition to my current practice.

 

[orthos]

With an interest in Ortho, what would you recommend someone to do on their gap year before medical school?

I recommend you focus solely on how you can make yourself the best possible applicant for medical school, interests in residency aside. If you are planning to use the gap year for MCAT, devote your life to it. If your numbers are already established and decent, volunteering, employment, and research are all great options. Just do something with the goal of serving or bettering your understanding of your fellow human.

 

[pbrocks15]

I recommend you focus solely on how you can make yourself the best possible applicant for medical school, interests in residency aside. If you are planning to use the gap year for MCAT, devote your life to it. If your numbers are already established and decent, volunteering, employment, and research are all great options. Just do something with the goal of serving or bettering your understanding of your fellow human.

Would you recommend finding an unpaid internship where i can possibly get publications versus working as a scribe and continuing being an EMT?

Thanks for all your time.

 

[orthos]

Would you recommend finding an unpaid internship where i can possibly get publications versus working as a scribe and continuing being an EMT?

Thanks for all your time.

If you desire to attend a research-heavy school, and you have the numbers to support your competitiveness for such an endeavor, then it may be worth your while to go for a research position. However, with no guarantee that you will get published (often times, most people do not), I believe that the income and experience from a job outweighs any benefit you might gain from the unpaid internship.

 

[acslater99]

Thinking back to the first time you did your very own surgery, were you nervous at the time? Do you still get nervous from time to time now? Thanks for doing this.

 

[orthos]

Thinking back to the first time you did your very own surgery, were you nervous at the time? Do you still get nervous from time to time now? Thanks for doing this.

For my first solo case, I was nervous in the same way that a famous entertainer may get nervous before every show. The truth is that I felt very comfortable and confident due to my training. It helps that my first solo case was a simple two level fusion and not a super complex case.

Nowadays, my nerves are about the same. I do a lot of routine cases, and refer out anything I feel uncomfortable with. I do get more nervous during proctored cases, or cases where I am using a new instrument or trying a new technique.

 

[reedsposer22]

More than that number all total. Of course, that is without subtracting things like overhead for my clinic and paying back my own and my wifes student loans. My contract does not also cover 100% of my malpractice, so there is that too. My situation is unique, given that I was recruited to an underserved area, so do not let that influence your views too much.

neat! thanks for the insight

 

[reedsposer22]

.. Respect personal boundaries; if you're so intent to know, Medscape has data on physician salaries, their regional distribution, variation, satisfaction, etc. by specialty. More data than you could ever want.

My thought is this...if you are going to do an ask me anything on these forums, salary should not be off limit or taboo. I agree with person who asked for a ballpark, it is a fair question, we don't need exact numbers, the OP can just say "over 300,000 " even if he make 600,000. There is no need to say he is not respecting personal boundaries. OP is anonymous on the forum, if you do an ask me anything, expect questions about wages, it is a given.

 

[orthos]

My thought is this...if you are going to do an ask me anything on these forums, salary should not be off limit or taboo. I agree with person who asked for a ballpark, it is a fair question, we don't need exact numbers, the OP can just say "over 300,000 " even if he make 600,000. There is no need to say he is not respecting personal boundaries. OP is anonymous on the forum, if you do an ask me anything, expect questions about wages, it is a given.

Right, it's ask me anything, not answering anything.

 

[halfwaycrooks]

My thought is this...if you are going to do an ask me anything on these forums, salary should not be off limit or taboo. I agree with person who asked for a ballpark, it is a fair question, we don't need exact numbers, the OP can just say "over 300,000 " even if he make 600,000. There is no need to say he is not respecting personal boundaries. OP is anonymous on the forum, if you do an ask me anything, expect questions about wages, it is a given.

All I got from this post is an overwhelming sense of entitlement. His ama, his rules.

Sent from my SGH-I747 using Tapatalk

 

[Leoz M Jiliums]

I have alot of ortho-related research (and a 2nd author pub) during undergrad, do you think that being able to show long term interest in ortho would help when building an application for residency?

 

[orthos]

I have alot of ortho-related research (and a 2nd author pub) during undergrad, do you think that being able to show long term interest in ortho would help when building an application for residency?

It will amount to icing on the cake. You will be able to show dedication and enthusiasm for the field, which many PDs love, but ultimately, it will be your grades and scores that make or break your application.

 

[pbrocks15]

Is it true that now a days you need much more than just the grades and love of the field to get into orthopedic residency? Like you would need publications or research?

 

[Llorensrh]

I am a premed transferring to a university as a junior, and am about to take the MCAT in the fall. I have a couple good transfer offers already, and the major difference between two campuses I like is the math/physics requirements for the bio degree.

So, I am inclined to attend the university that doesn't require extra phys/math beyond what's needed to get into med school. It will be faster, and possibly easier on my GPA.
My only concern: would I ever need to go back and take linear algebra for anything medicine related? I wouldn't want to limit myself.

I am interested in surgery, and possibly some research also. I would love to work for an institution. I have taken stats and calc 2.

Thanks!

 

[tn4596]

It will amount to icing on the cake. You will be able to show dedication and enthusiasm for the field, which many PDs love, but ultimately, it will be your grades and scores that make or break your application.

Hi doc, first of all, thanks for doing this.
I've heard,from several attendings, that the reason that they place a big emphasis on step 1 scores is because it correlate well with board exams performances. Can you confirm this? Also, during residency, did you have to "cram" before your boards?

 

[orthos]

Is it true that now a days you need much more than just the grades and love of the field to get into orthopedic residency? Like you would need publications or research?

When I applied, research was highly valued, but not necessary. That may have changed with the competitiveness in applicants over the past ~7 years. I would say that you probably do need something beyond grades/scores to stand out and increase your chances, but all that is secondary to getting competitive numbers.

 

[ChEMD]

Just curious, what topics interested you the most/least back in your first 2 years of medical school?

 

[orthos]

I am a premed transferring to a university as a junior, and am about to take the MCAT in the fall. I have a couple good transfer offers already, and the major difference between two campuses I like is the math/physics requirements for the bio degree.

So, I am inclined to attend the university that doesn't require extra phys/math beyond what's needed to get into med school. It will be faster, and possibly easier on my GPA.
My only concern: would I ever need to go back and take linear algebra for anything medicine related? I wouldn't want to limit myself.

I am interested in surgery, and possibly some research also. I would love to work for an institution. I have taken stats and calc 2.

Thanks!

I have never encountered a time when I needed advanced mathematics to treat patients. It may help in some fields/concepts that use a lot of modeling (like medical imaging or biosensors), but my math skills definitely got rusty throughout medical training.

If you find it interesting, it may be better to explore the topic on your own and take a class later.

 

[orthos]

Hi doc, first of all, thanks for doing this.
I've heard,from several attendings, that the reason that they place a big emphasis on step 1 scores is because it correlate well with board exams performances. Can you confirm this? Also, during residency, did you have to "cram" before your boards?

I'm not sure if my situation is a good representation of Step 1 to boards correlation. I was definitely motivated to work harder and do better when I got my Step 1 scores (lower than I expected of myself). Not sure how that stacks up against others. I was a much better studier when it came to everything post-Step 1, and didn't really "cram" for any tests.

 

[orthos]

Just curious, what topics interested you the most/least back in your first 2 years of medical school?

I was very interested in the surgical fields, particularly orthopaedics due to my experiences prior to medical school. I still kept an open mind with regards to all specialties, however. Through shadowing, rotations, and discussions with senior med students/residents/advisors, I determined that areas like dermatology, ophthalmology, ob/gyn, etc. were not really for me for various reasons.

I was least interested in fields that traditionally had little to no patient contact, like pathology and radiology.

 

[The Buff OP]

@orthos How often does an orthopedic surgeon send their patients to go see a physical therapist?

 

[pbrocks15]

Have you heard of the book: HOT LIGHTS, COLD STEEL: Life, Death and Sleepless Nights in a Surgeon's First Years

It's about ab Ortho Surgeon during his residency years.

Also, what books would you recommend reading that are similar to the one above, if you've read it/heard of it? If not, what books do you think an undergrad should read if they're interested in surgery and medicine?

How many days a week do you perform surgery?

Do you do research? Is it possible to do research while in ortho? Or does being an ortho not leave you any time for research?

Thanks!

 

[Cyberdyne 101]

Thanks @orthos. Do you see artificial disc technology improving anytime soon (to the point to where it's as effective as a hip, knee, or shoulder implant)?

 

[orthos]

@orthos How often does an orthopedic surgeon send their patients to go see a physical therapist?

Quite often. Many insurances require you exhaustive all non-operative measures before they will approve procedures/surgery anyway. That often includes home exercises, medication, physical therapy, orthotics, injections, and more.

 

[orthos]

Have you heard of the book: HOT LIGHTS, COLD STEEL: Life, Death and Sleepless Nights in a Surgeon's First Years

It's about ab Ortho Surgeon during his residency years.

Also, what books would you recommend reading that are similar to the one above, if you've read it/heard of it? If not, what books do you think an undergrad should read if they're interested in surgery and medicine?

How many days a week do you perform surgery?

Do you do research? Is it possible to do research while in ortho? Or does being an ortho not leave you any time for research?

Thanks!

I have heard of that book, but have not read it. I was never into reading books by physicians, so I would probably defer to the top sellers on Amazon under medicine or doctors or whatever other keyword.

I have two surgery days at the hospital, plus call.

I do some clinical research. It definitely is possible, but the type and scope of research you do is governed by the setup of your practice, your affiliations with hospitals and/or academic centers, how much you value your free time, etc.

 

[orthos]

Thanks @orthos. Do you see artificial disc technology improving anytime soon (to the point to where it's as effective as a hip, knee, or shoulder implant)?

I know quite a few companies that have come to me with their TDR technologies, and I haven't been very impressed. However, I remain optimistic that it's only a matter of time before such types of technologies are vastly improved, allowing us more treatment options for individual patients.

 

[halfwaycrooks]

Hey thanks for doing this thread. How does one obtain a position as 'team physician' for a NFL or nhl team? Do you know anyone that has done this and more importantly do they get box seats to every game?

 

[pbrocks15]

What are the benefits of performing a fellowship?

 

[Nakazima]

What are the benefits of performing a fellowship?

$$$

 

[orthos]

Hey thanks for doing this thread. How does one obtain a position as 'team physician' for a NFL or nhl team? Do you know anyone that has done this and more importantly do they get box seats to every game?

Often times, it's climbing the ladder and making connections. Team physicians will recruit people who come from their residency program, managers will ask someone they know in medicine for a recommendation, etc. I don't know any sports med guys that are at the national professional level personally, but I imagine they get box seats for their families at home games while they sit on the sidelines.

 

[orthos]

What are the benefits of performing a fellowship?

Generally, to make yourself more marketable and to receive additional, advanced training on a specific body part, which will influence how you shape your practice.

 

[pbrocks15]

Do orthos tend to do some academic medicine? Or teach at medical schools? Or is there not enough time for that?

Also, do orthos generally have most of the operations memorized or do you still tend to look through your books to refresh your memory?

 

[orthos]

Do orthos tend to do some academic medicine? Or teach at medical schools? Or is there not enough time for that?

Also, do orthos generally have most of the operations memorized or do you still tend to look through your books to refresh your memory?

Academic roles are largely determined by the specific persons interests and whether there are sufficient resources available. You certainly can do a lot as an orthopaedist in an academic setting, including research and teaching, but since that time will take away from your case load, you will be earning less.

For bread-and-butter cases, we certainly do have most of the operations memorized in general; however, adaptation is still needed on a case by case basis. For anything that I don't feel comfortable with (that would give me reason to look through books), I would likely refer to another physician.

 

[pbrocks15]

Is there a possible way to teach and maintain the same load of patients or is this unrealistic?

Also, do you have trouble getting insurance to pay for operations? My dads friend is a pulmonary cardiologist and tells me that he struggles with insurance since they attempt to pay him for the least of everything.

Also, what is paperwork required for each pateint? Is it just the dictation? Or is there paperwork beyond that?

Thanks!!

 

[The Buff OP]

@orthos Did you ever had to do amputations in your residency? Who does the amputations most of the time GS or ortho?
Just a random question that came into my mind.

 

[OrgasmicChemistry]

@orthos Thank you for doing this thread. You mentioned earlier that fellowship training for orthopaedics is generally not as competitive as matching into the ortho residency. I'm wondering, could you comment on how competitive ortho fellowships generally are to match into? I know there is a wide variety of them. Is there a wide variety of competitiveness as well?