Clinic

[coolioyo]

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What percentage of patients seen in the clinic/outpatient setting do orthopods operate on? Are there chronic patients like those seen in IM, i.e. the shoulder pain patient that requires multiple steroid shots through multiple visits. Or are these sort of patients seen as a referall and then referred to other docs (like rheumatology) for subsequent visits? How often is imaging done on patients with symptoms such as joint pain/tendonitis (I know x-ray is almost exclusively done, but I'm talking about MRI) to clinch the diagnosis or is a H+P enough for most patients?

Answering these questions will help me decide of ortho is right for me. Thank you.

 

[DHT]

This is kind of an odd criteria for deciding if ortho if for you, but to each his own.

The answers to your questions are EXTREMELY variable. There is such a wide variety in ortho that clinics can be wildly different based on your specialty and quality of your referral base.

Based on my experience, I would say that Joints and Trauma tend to operate on the highest percentage of their patients. Usually if a patient has been referred to you for a total joint, they have exhausted NSAIDs and injections prior to seeing you and are there specifically to have a joint done if they are a proper candidate. Pediatrics tends to operate the least and utilize lots of casting.

You will probably have a few chronic patients in your practice (ie. the infected total joint) however I felt that ortho had fewer chronic pains in the ass than most other specialties. Remember you are a surgeon. If there is nothing surgical you can do for a patient there is no reason for them to keep seeing you (unless your surgery gave them the chronic issue). You can tailor you practice to be what you want. If you want to be the guy that does shoulder injections, you can do it. If you don't you don't have to because many FPs will be happy to do them. If you want to be a spine surgeon that does steroid injections you can. Its all up to how you want to make your practice.

Imaging is very variable as well. Spine/Sports/Tumor tend to order the most MRI, where as peds/joints tend to order the least advance imaging. Spine is a good example of how orthopods use imaging. You do a careful history and physical exam and by the end you should have a good idea of what the cause of the patient's symptoms are (ie. L4 Radiculopathy). You get the MRI to confirm that there is pathology there worth operating on. You do NOT blindly order an MRI and look for things to operate on because the general population will show pathology but be asymptomatic.

There is so much variety in ortho that I can not imagine that you could not find something that fits what you are looking for in a practice. If you are a med student spend some time in ortho clinics and see the kind of patients they deal with and this will give you a better idea than anything anyone here will tell you. The clinics in different specialties can be very different so try and spend some time in different areas.

 

[orthodoctfemur]

Hi DHT,
do you know if most programs have a resident clinic? Or do the residents go to clinic with the attendings? Ive been told this is a huge part of the training and many of the programs I've looked into seem to lack much clinic time. thanks.