Best Ortho Fellowship

[deleted421268]

How difficult is it to land any fellowship in Ortho. Also what fellowship is the best for avoiding the trauma cases. Is there any certain fellowship that would allow you to live the best lifestyle. By lifestyle I mean work to life balance. {hobbies/family time}

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[Jeff Smoker]

Do all future orthopedists a big favor, and apply to something else. I'm really tired of this attitude, which I've had the opportunity to watch flourish in the past five years or so. We have enough people going into ortho who want the fruits/prestige/money/insert motivation here of being an orthopod, but don't want to put in the work. They don't put in the effort in residency, and are always weaseling out of work/call. It doesn't get any better as an attending, as these same people are always weaseling out of call cases/work. At least when there were no work hour restrictions, the riff-raff stayed out, knowing they couldn't handle the boot to the ass.

Now before you accuse me of being a d*ck, which I'll freely admit that I am, the answer to your question is the best fellowship is the one that interests you the most.

 

[skiz knot]

How difficult is it to land any fellowship in Ortho. Also what fellowship is the best for avoiding the trauma cases. Is there any certain fellowship that would allow you to live the best lifestyle. By lifestyle I mean work to life balance. {hobbies/family time}

It is easy to obtain a fellowship in all of the subspecialties of orthopaedics.

In terms of "avoiding the trauma cases" it will depend on who you are employed by, and what kind of call schedule you have worked out. It is likely that you will have to take some general orthopaedic call, at least until you gain some senority. The one caveat is spine surgery. You may not be expected to take general orthopaedic call and some spine surgeons do not see acute trauma by choice or as a result of being based out of a small hospital that sees little trauma. If you do not like trauma, do not do orthopaedics. There is very little orthopaedic trauma that necessitates rushing into the hospital at 3 a.m., but sometimes you will have to.

Almost all orthopaedic surgeons enjoy a relatively good work to life balance, especially when compared to other surgical subspecialties, however you will have to work hard to get to that point. Keep in mind you will have to work hard to maximize your earnings and you aren't likely to make partnership or be offered a renewal contract if you aren't making your employer money.

 

[jaguarms]

Do all future orthopedists a big favor, and apply to something else. I'm really tired of this attitude, which I've had the opportunity to watch flourish in the past five years or so. We have enough people going into ortho who want the fruits/prestige/money/insert motivation here of being an orthopod, but don't want to put in the work. They don't put in the effort in residency, and are always weaseling out of work/call. It doesn't get any better as an attending, as these same people are always weaseling out of call cases/work. At least when there were no work hour restrictions, the riff-raff stayed out, knowing they couldn't handle the boot to the ass.

Now before you accuse me of being a d*ck, which I'll freely admit that I am, the answer to your question is the best fellowship is the one that interests you the most.

I think the statement above reflects a real concern for the field. However, Mr. Smoker, you are projecting your frustrations onto someone else. Keep it professional and just answer the question in the future. Orthopedics is an awesome field, and any person seeking to be educated about it merits respectful treatment.

 

[skiz knot]

How difficult is it to land any fellowship in Ortho. Also what fellowship is the best for avoiding the trauma cases. Is there any certain fellowship that would allow you to live the best lifestyle. By lifestyle I mean work to life balance. {hobbies/family time}

Do a Sports Medicine fellowship after your Family Practice residency if you want to be involved in non-trauma related orthopaedics, and work a light schedule. After your lazy ass spends four years in medical school complaining about how much you have to work, and how unfair it is (see http://forums.studentdoctor.net/showthread.php?p=11555950#post11555950). I'm sure you'll be a future contributor. a FP residency is also "easier" to obtain.

 

[basupran]

Do all future orthopedists a big favor, and apply to something else. I'm really tired of this attitude, which I've had the opportunity to watch flourish in the past five years or so. We have enough people going into ortho who want the fruits/prestige/money/insert motivation here of being an orthopod, but don't want to put in the work. They don't put in the effort in residency, and are always weaseling out of work/call. It doesn't get any better as an attending, as these same people are always weaseling out of call cases/work. At least when there were no work hour restrictions, the riff-raff stayed out, knowing they couldn't handle the boot to the ass.

Now before you accuse me of being a d*ck, which I'll freely admit that I am, the answer to your question is the best fellowship is the one that interests you the most.

Weaseling out of work/call? If you mean that most won't volunteer for extra call, yes....I weasel myself out of call. For the most part, our residents put in their hours. Starting rounds at 530 am and staying until 9 on average day and often till 1-2am on non-call days is not weaseling out of call cases/work. Perhaps your program needs to re-evaluate resident selection.

 

[Green Grass]

Weaseling out of work/call? If you mean that most won't volunteer for extra call, yes....I weasel myself out of call. For the most part, our residents put in their hours. Starting rounds at 530 am and staying until 9 on average day and often till 1-2am on non-call days is not weaseling out of call cases/work. Perhaps your program needs to re-evaluate resident selection.

The average day is from 5:30AM - 9PM? Where the hell do you go?

 

[GAdoc]

The average day is from 5:30AM - 9PM? Where the hell do you go?

There seem to be two extremes going on here. On one hand, as an ortho intern I am certainly familiar with the decision of whether my love for ortho was worth the sacrifice on my personal life. On the other, I can understand the need to go "all in" once the decision to pursue ortho has been made.

Because ortho is competitive it self-selects for not only the smartest, but also the most hard working and dedicated. In fact, if residents always had the final say, they'd probably take hard workers over braniacs any day (which is why away rotations are so important in ortho). Ortho guys also tend to be team players which is why they take such offense at people who look for ways to get out of work. Furthermore, ortho guys tend to have the best reputation in the hospital and most of them want to pick guys who continue that tradition.

I agree that you don't need to go looking for extra call days or extra cases to be a hard worker. In fact, that can get obnoxious really quick. But, you should let two principles guide your work ethic: 1. your patients should always be taken care of regardless of what time that means you come in to round, or how late you stay 2. you take care of your fellow residents by helping them if they're getting slammed with call, personal issues, etc.

Because ortho is competitive, people get the idea that it's lifestyle friendly (like uro or ent). The only sense I can think of where ortho is more "lifestyle friendly" than a specialty like general surgery is the NATURE of the trauma. Certainly, there will be as much (if not more) trauma. However, very few times will the orthopaedic injuries take precedence. Of those that do, few need immediate intervention. That can translate into less being up all night when on call. Other than that, ortho surgeons work as hard as any other surgeon.

The other big difference with ortho is the job itself. If you ever rotate on a gen surg trauma service, you'll understand why general surgeons can be so crabby. The patients suck the life out of you. Not so with ortho. And, with the power to tailor your practice, you could conceivable spend the whole day doing total joints or any number of other procedures with great outcomes.

Sorry so long-winded - bottom line: make sure you know what you're getting into if you go for ortho

 

[Green Grass]

bottom line: make sure you know what you're getting into if you go for ortho

Thanks for the great response. I think you nailed it.

I was just surprised by the previous poster's remark. Not once have I been on a service where the average hours are 5:30am - 9pm. That's ridiculous and most likely fabricated. There are few things that annoy me more than the stereotypical ortho guy who brags about how much he works or how late he stays.

I'm all for working hard, taking care of your patients, and helping out the team. But you don't need to exaggerate your work hours or dedication to the field.

 

[Jeff Smoker]

I agree that my post was harsh, however, if you look at the OP's history of recent posts, the near totality have been "I want to do ortho, I don't want to put in the work."

I also agree that most of the time we aren't at the hospital from 530-2100 hours. But it does happen, especially at a level one trauma center. And when that time comes I need soldiers. I want, as a previous poster alluded to, an esprit de corps if you will. No one leaves until the work is done. Many hands make light work, and all that. What I don't want is "I need to go pick my kid up." Or "my flow is heavy today, I need to go lie down."

It seems that especially with the new work hour restrictions, we're cultivating a shift worker mentality. I despise that. I want someone whose priority is ortho.

I may come off as a curmudgeon but so be it. Maybe when we're all working for the government and putting in 40 hours a week, it won't make a difference. Until then, I will fight tooth and nail to keep med students who don't want to put in the sacrifice and work hours out of the field.

 

[kdburton]

When I was doing trauma earlier this summer the chiefs showed up between 5-6am to round, went to the OR at 7:30 and the on-call chief was regularly operating nonstop until at least 9pm sometimes after midnight. Granted this is only a couple months out of their entire year and was probably dependent on the time of year and the fact that my program is based out of a major metropolitan level 1 trauma center with many fast-moving freeways/bullets. The other 10 months of the year are relatively benign for the seniors...

 

[GAdoc]

When I was doing trauma earlier this summer the chiefs showed up between 5-6am to round, went to the OR at 7:30 and the on-call chief was regularly operating nonstop until at least 9pm sometimes after midnight. Granted this is only a couple months out of their entire year and was probably dependent on the time of year and the fact that my program is based out of a major metropolitan level 1 trauma center with many fast-moving freeways/bullets. The other 10 months of the year are relatively benign for the seniors...

There's no doubt an orthopod has the capacity to stay as busy as he/she wants. Most traumas have some orthopaedic component though often not the top priority. A couple of things separate us from general surgeons, however, and I think they have given some med students the impression that ortho is "lifestyle friendly".

1. There are FAR fewer slots for ortho than GS yet the need is just as great. That means we are always needed, and it has meant we are reimbursed well.

2. The NATURE of the trauma often is not something that requires immediate action meaning it can be "splinted and seen in the morning". Unlike an acute abdomen, orthopods can often avoid being up all night.

Now, as far as residency, all bets are off. At my program, our ortho guys pride themselves in seeing every consult no matter how trivial. We work our tails off, but that's how you learn. None of us chose ortho because we thought it would be "lifestyle friendly". Once we're out in practice, we may have more flexibility to create a practice that fits our lifestyle instead of having it dictated to us, but that's certainly not the case now!

 

[Tig2575]

I think that relative to residency and internship, most ortho practices are "lifestyle friendly." That's more than enough for me.

 

[GAdoc]

I think that relative to residency and internship, most ortho practices are "lifestyle friendly." That's more than enough for me.

It's the balance between work hours and compensation that decides how "lifestyle friendly" any specialty is. In many fields, the ratio is fairly fixed. For example, in most primary care fields, the docs max out the number of patients they see in a day and can't do much to change how they are reimbursed for each visit. Thus, they have little control over their work hours or income.

Surgeons and other specialties that are heavy on interventions have more control of compensation - do more procedures, make more money. The other side of that coin is HOW MUCH time they have to put in to get the compensation they want. For specialties such as gen surg and neurosurg the amount of life-threatening trauma guarantees them a nice income, but not necessarily a nice lifestyle.

What's nice about ortho is there is plenty of work to do, but not necessarily emergently. That allows the individual surgeon more control over their ratio of work to compensation. Other fields are also this way: ENT, urology, plastics, etc.

You may still hear orthopods complain about how much they work, but on some level, they choose it based on how much they want to make (and occasionally their choice of sub-specialty - i.e. ortho trauma).

 

[kfi4463]

How difficult is it to land any fellowship in Ortho. Also what fellowship is the best for avoiding the trauma cases. Is there any certain fellowship that would allow you to live the best lifestyle. By lifestyle I mean work to life balance. {hobbies/family time}

I am actually thinking about starting an Orthopaedic Fellowship out of my own house. I do not imagine it would be to difficult to get into, but at the same time, i don't think my fellowship will rank so high.

 

[Tig2575]

It's the balance between work hours and compensation that decides how "lifestyle friendly" any specialty is. In many fields, the ratio is fairly fixed. For example, in most primary care fields, the docs max out the number of patients they see in a day and can't do much to change how they are reimbursed for each visit. Thus, they have little control over their work hours or income.

Surgeons and other specialties that are heavy on interventions have more control of compensation - do more procedures, make more money. The other side of that coin is HOW MUCH time they have to put in to get the compensation they want. For specialties such as gen surg and neurosurg the amount of life-threatening trauma guarantees them a nice income, but not necessarily a nice lifestyle.

What's nice about ortho is there is plenty of work to do, but not necessarily emergently. That allows the individual surgeon more control over their ratio of work to compensation. Other fields are also this way: ENT, urology, plastics, etc.

You may still hear orthopods complain about how much they work, but on some level, they choose it based on how much they want to make (and occasionally their choice of sub-specialty - i.e. ortho trauma).

This sounds well put to me. One thing that surprised me was the physician compensation study put out by Medscape this year that shows that Orthopods have one of the lowest rates of feeling they're compensated fairly of all specialties. Why do you think that is?

 

[DHT]

This sounds well put to me. One thing that surprised me was the physician compensation study put out by Medscape this year that shows that Orthopods have one of the lowest rates of feeling they're compensated fairly of all specialties. Why do you think that is?

Probably because we are the ones smart enough to realize that everyone in medicine is underpaid for what they do and the amount of sacrifice it takes.

 

[Tig2575]

Probably because we are the ones smart enough to realize that everyone in medicine is underpaid for what they do and the amount of sacrifice it takes.

What an ignorant response.

 

[DHT]

What an ignorant response.

Ok, how about this:

After reviewing the data, I determined that you are clearly a troll.

Urology, Cardiology, Endocrine, General Surgery, Nephrology, Pulmonology are all equal to or lower rates of feeling adequately compensated. Furthermore, what do you think the statistical significance is between them and almost all the others hovering around 50%. There are only a few outliers (Derm, Anesthesia, Rads, EM). All the rest feel right about the same as ortho...thus confirming my statement that all medical specialties are underpaid.

Go start fights elsewhere.

 

[Tig2575]

Ok, how about this:

After reviewing the data, I determined that you are clearly a troll.

Urology, Cardiology, Endocrine, General Surgery, Nephrology, Pulmonology are all equal to or lower rates of feeling adequately compensated. Furthermore, what do you think the statistical significance is between them and almost all the others hovering around 50%. There are only a few outliers (Derm, Anesthesia, Rads, EM). All the rest feel right about the same as ortho...thus confirming my statement that all medical specialties are underpaid.

Go start fights elsewhere.

You're right, I didn't notice the other sub-specs on the next page. Still, your initial response was obtuse at the absolute best.