How common is switching from ortho?

[grayman]

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I have discovered that the swell of pride I felt from matching ortho has been replaced by the pain of becoming one, and I don't get the sense that attendings are nearly as happy as the EM attendings I frequently see when I'm doing consults. I entered medical school largely because of my interactions with EP's, through 10 years in the fire service and EMS, and I already miss the acuity.

I also think my soul and the health of my family would benefit from a more structured work schedule that affords easier opportunity for locums work or moonlighting. The portability appeals to me. If I put the effort into building an ortho practice, it would be insane to leave.

It is trite, but getting to work with my hands was a big draw. EM still offers AMPLE procedures, some that I am familiar with, and I can build furniture on my days off if I get the itch to drill something/get in touch with my neanderthal side.

Any advice would be greatly appreciated. I think I am late to the party this year, as it sounds like pgy2 spots are not offered outside of 2-4 programs, and 1-3 programs can't give the usual 6 mos of advanced placement without having completed 2 pgy's. So I am at a loss with regard to applying.

 

[boo2]

There are probably a lot more people more suited to reply, but anyways a couple things...
1. The pain of residency will end- that is different from attending life. Whether you enjoy the scope of orthopedics is up to you. EM is a great field if you love it, but its definitely not as rosy as you paint it. I spent the last year doing clinical orthopedics- the satisfaction from my ortho experience having 80-90% patient satisfaction after addressing their problem(often fixable with casting, PT or surgery), vs <10% of gratitude patients show you in the ED(pts with often undiagnosable/unfixable issues) was shocking and so refreshing to me.

2. In terms of your comment about portability of practice vs building a practice you are absolutely correct. However I disagree on your thoughts that EM offers "a more structured work schedule". Our constantly variable schedule is one of the most painful(and sometimes nice) aspects of our job. As a surgeon you will have call and rounds, but otherwise typical hours. Also some locums jobs and moonlighting may give you flexibility choosing your shifts(maybe) but then you lack guaranteed hours.

3. Procedures. We do procedures, however out in the community I find that a lot of simple procedural stuff gets done by PA's because you don't have time. Depending on the acuity of where you work, you aren't intubating, doing LP's, chest tubes, reductions, etc on a daily let alone weekly basis. This is nothing compared to what a surgeon will do.

4. In terms of acuity, a lot of stuff becomes routine, with the added headache of liability with the stuff that does make your blood pump(ie the crappy intubation with no anesthesia in house).

The grass can always be greener, and you likely have to go with your gut with which field resonates with you, but you have to see past the pain of residency.

The orthopedic attendings I know work hard, but live a very nice life, vacationing often and golfing with their joint replacement reps....
ps- where I trained ortho got paid more to take call at home in bed than an EM attending would make working their butt off in a shift.

Good luck!