Here are some considerations from one with 25 years of experience of practicing orthopedics.
For the young resident, learning the new procedures is understandably exciting and all seems to be fun and games, but the realm of private practice is much different.
Unless you practice in academic medicine, you won't have fellows, residents and medical students assisting. It will be you and a scrub nurse. The emergency room will not respect the limits of your expertise and often times you will not have the option of transferring the patient. You will have to perform emergency surgery in the middle of the night (despite a full schedule the next day), you might not get paid to do so. Perhaps unique to orthopedics is the patient mindset that the problem is "fixable" creating expectations for a perfect outcome. There is also a lot of emotional baggage that attends an acute injury or chronic pain condition and it is my experience that orthopedic patients relative to patients with medical afflictions are more demanding and less pleasant to deal with. This should come as no surprise considering that the malpractice liability for orthopedics is exceeded only by neurosurgery and OB.
No one can know what the future holds, but trends would indicate that all future trauma surgery and joint replacements might be performed by hospital-employed docs and I suspect this trend with extend to sub-specialties.
To summarize, orthopedics is a demanding profession with demanding patients and future practitioners may experience a loss of autonomy. Nevertheless, orthopedics remains one of if not the most lucrative fields in medicine, and the outcomes of intervention are much more immediate than other specialties.
