Elective Orthopedic Practice as an Orthopedic Trauma Surgeon

[marneel]

Is it doable? Pros/Cons?

Incoming PGY-1 here... When I was rotating as a 4th year, Dr. Haidukewych at Orlando Health was an ortho trauma surgeon who had a completely separate elective joints practice (primaries and revisions). I know he is a special case because he was heavily involved in Arthoplasty research over the last 20 years, but is this kind of practice possible to do straight out of fellowship? Or is it more something that you slowly create over your career?

Also - if it is possible, is it even something that is advantageous. To me it sounds awesome, doing those two fields specifically, but am I missing something due to my lack of experience?

Thanks in advanced..

-MN

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[OrthoTraumaMD]

Is it doable? Pros/Cons?

Incoming PGY-1 here... When I was rotating as a 4th year, Dr. Haidukewych at Orlando Health was an ortho trauma surgeon who had a completely separate elective joints practice (primaries and revisions). I know he is a special case because he was heavily involved in Arthoplasty research over the last 20 years, but is this kind of practice possible to do straight out of fellowship? Or is it more something that you slowly create over your career?

Also - if it is possible, is it even something that is advantageous. To me it sounds awesome, doing those two fields specifically, but am I missing something due to my lack of experience?

Thanks in advanced..

-MN

It depends on what your practice expects of you regarding trauma and if you have time to build an elective practice. There are some trauma fellowships that offer a lot of joints experience. That said, most trauma people do only trauma.

 

[DarkHorizon]

Is it doable? Pros/Cons?

Incoming PGY-1 here... When I was rotating as a 4th year, Dr. Haidukewych at Orlando Health was an ortho trauma surgeon who had a completely separate elective joints practice (primaries and revisions). I know he is a special case because he was heavily involved in Arthoplasty research over the last 20 years, but is this kind of practice possible to do straight out of fellowship? Or is it more something that you slowly create over your career?

Also - if it is possible, is it even something that is advantageous. To me it sounds awesome, doing those two fields specifically, but am I missing something due to my lack of experience?

Thanks in advanced..

-MN

I’m a trauma guy who does about 30 percent joints, mainly hips, and some shoulder arthroplasty. A year into practice. I took a level 2 job for this specific reason to be able to have some method to the trauma disease. These jobs are available but mainly at level 2 centers. At level 1 centers, you’re plenty busy with trauma to have an elective practice, at least early on.

while I really enjoy my practice there are pros and cons of this.

Pros:
1. Have more control over your lifestyle
2. A bit more variety in cases
3. THA is a really cool procedure with very high satisfaction rate, also hip anatomy is pretty cool and with your pelvis/tab experience, you can really do some cool cases like post traumatic acetabulum reconstruction and acute THA for femoral neck and acetabular fractures.

4. You also become an expert at periprosthetic fractures by default. This is a gray area as to who really is the expert, trauma guys or joints guys. Your hybrid practice will pretty much set you up for handling any periprosthetic fracture. Not only will you be getting all of these from your own group, but also all the other competing groups in the area.

Cons:
1. Mainly taking a level 2 job, which means you’re definitely going to lose your trauma skills in some aspect. I already don’t feel comfortable with anterior approaches for acetabulum fractures as I barely see any. I live in a large metro area with 8 level 1 centers and they get most high energy stuff. You have to be ok with this, if you’re gonna dabble in joints.

2. Stakes are higher in elective surgery, especially joints. Patients really expect great results and therefore a complication can wear on you, whereas it’s easier to handle trauma complications when they can be attributed to the original trauma.

3. Difficulty in establishing yourself as a joint surgeon in a saturated market. You’ll have dozens of joints guys around you, and people will google your credentials. it’ll take some time to build up and for primaries to refer these patients to you.

 

[marneel]

I’m a trauma guy who does about 30 percent joints, mainly hips, and some shoulder arthroplasty. A year into practice. I took a level 2 job for this specific reason to be able to have some method to the trauma disease. These jobs are available but mainly at level 2 centers. At level 1 centers, you’re plenty busy with trauma to have an elective practice, at least early on.

while I really enjoy my practice there are pros and cons of this.

Pros:
1. Have more control over your lifestyle
2. A bit more variety in cases
3. THA is a really cool procedure with very high satisfaction rate, also hip anatomy is pretty cool and with your pelvis/tab experience, you can really do some cool cases like post traumatic acetabulum reconstruction and acute THA for femoral neck and acetabular fractures.

4. You also become an expert at periprosthetic fractures by default. This is a gray area as to who really is the expert, trauma guys or joints guys. Your hybrid practice will pretty much set you up for handling any periprosthetic fracture. Not only will you be getting all of these from your own group, but also all the other competing groups in the area.

Cons:
1. Mainly taking a level 2 job, which means you’re definitely going to lose your trauma skills in some aspect. I already don’t feel comfortable with anterior approaches for acetabulum fractures as I barely see any. I live in a large metro area with 8 level 1 centers and they get most high energy stuff. You have to be ok with this, if you’re gonna dabble in joints.

2. Stakes are higher in elective surgery, especially joints. Patients really expect great results and therefore a complication can wear on you, whereas it’s easier to handle trauma complications when they can be attributed to the original trauma.

3. Difficulty in establishing yourself as a joint surgeon in a saturated market. You’ll have dozens of joints guys around you, and people will google your credentials. it’ll take some time to build up and for primaries to refer these patients to you.

DarkHorizon,

Great insight! Much appreciated. Did you do two fellowships or did you just start collecting arthroplasty patients straight out of trauma fellowship?

Thanks,

-MN

 

[DarkHorizon]

I’m a trauma guy who does about 30 percent joints, mainly hips, and some shoulder arthroplasty. A year into practice. I took a level 2 job for this specific reason to be able to have some method to the trauma disease. These jobs are available but mainly at level 2 centers. At level 1 centers, you’re plenty busy with trauma to have an elective practice, at least early on.

DarkHorizon,

Great insight! Much appreciated. Did you do two fellowships or did you just start collecting arthroplasty patients straight out of trauma fellowship?

Thanks,

-MN

I did about 500 joints in my residency, 95 percent of which were primary. Also about 80 or so shoulder arthroplasty. Trained at a community program so it was very hands on. I then decided on a trauma fellowship with a lot of post traumatic hip revisions. Did a few TKAs and Post traumatic shoulder arthroplasty, mainly reverses as well.

 

[numberwunn]

Not a traumatologist but I'll add that I think that in many ways going through residency can be like going through medical school - you may go in "knowing" what you want to do but end up realizing that it is not a good fit or that you just don't want to anymore. Just like in med school, I had colleagues who were convinced that they were going to do one subspecialty and realized that they really liked something totally different. I don't think you can really know until you've lived it a bit. You'll also have plenty of opportunities at meetings etc to ask these kinds of questions to folks in a range of practice types. Just keep an open mind, try to learn from everything and have fun in residency! Remember that the days are long but the years are short.