how similar can ortho and general surgery be?

[raosen]

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So I have been debating the various surgical subspecialties for a while now, and really haven't done much in the way of a decision. I am in my third year, almost halfway through, and have gone through gen surg and several of the subspecialties, but am still lost.

My perception of general surgery (correct me if I am wrong):
I like thinking about pathophysiology, I like big time procedures, like Whipples and transplants and CABGs. I know minimally invasive is on the rise, but I'd like to see a world that still has open field. I also like the adrenaline rush of timed procedures, when procedures really make a difference between life and death (ie trauma, transplant, etc). General surgeons seem intense, and I can be too, but sometimes, malignancy runs rampant, and the hierarchy is very well defined. The lifestyle, of course, is horrendous.

My perception of ortho surgery:
I like orthopods that I have met. They seem to be the kind of guys that are like me, ie they are normal. They kick back and relax, are approachable, make funny jokes even while rounding, and are generally easy to get along with. At the end of the day, maybe less procedures are life v. death, but this also allows some semblance of a better life in terms of less emergencies. Clinic is extremely rewarding as well; physical exam closely correlates to diagnosis and plans for further treatment. Unfortunately, bones and joints lack a little bit of the cerebral aspects of medical management; few of my ortho attendings knew much in depth about bread/butter medicine like heart attacks, HTN, stroke, etc.

When I spoke to a friend of mine matching in ortho, he said that he had similar issues in thinking gen v. ortho. He decided that joints, while inherently not as interesting, could be rewarding as well (he is thinking ortho onc). He also decided that the people he met in ortho were a much better fit, and I guess the balance for him swung in the ortho direction.

I was personally thinking that ortho trauma might involve aspects of general surgery that I enjoy, but I have little experience in this realm. If I could train as an orthopod and still do some of the general surgery procedures that trauma surgeons do, then I think I would have a great blend of both worlds. The question is, do ortho trauma surgeons handle the same kinds of cases that general trauma surgeons do? Do they get to tie vasculature, and fish for various bleeds, handling internal organs, etc? What exactly do they do in the trauma world?

And more importantly, how off am I on these perceptions? Can I find aspects of each in the other?

Appreciate any insight that can be offered.

 

[Bones2008]

I'm only a M4 right now, but I guess I have some thoughts, and I'll do my best to articulate what I can.

I think your generalizations (and that's all they are -- generalizations) are fairly accurate in terms of the personalities you encounter. It's also true that many ortho procedures are not "life or death," but I think almost all orthopods are totally fine with that. I've started saying that ortho usually doesn't save someone's life, but it can sure save their quality of life.

You are right that general surgeons tend to have a more robust knowledge of internal medicine than do orthopods. This more due to the fact that you "know what you do, and lose what you don't" more than anything else. One of the things I've really come to appreciate after doing a few orthopaedic clerkships is just how much there is to know. I mean, for example, let's say someone breaks his distal radius. There are so many factors to consider when repairing the fracture (e.g. palmar tilt, radial inclination, ulnar variance, etc.) that are not immediately obvious to the casual observer. I think a common misperception of ortho is that it is not "cerebral" because we consult medicine all the time and spend our days hammering things in the OR. In reality, there is lots to think about, it's just that most people never learn orthopaedics in medical school and thus don't have an appreciation for it.

I've had limited experience in terms of trauma surgery for ortho and gen surg. However, orthopods absolutely get to "tie vasculature" and "fish for bleeds," among many other things, including nerve repair. It depends on the institution, but my perception is that gen surg will often handle trauma with no bony involvement, whereas ortho will operate on those case with bone or joint injury.

I think ortho is a great field. Good luck in figuring out what you want to go into.

 

[Pir8DeacDoc]

Don't lump the idea of an orthopedic trauma surgeon with a general trauma surgeon.


I have limited exposure but my thoughts are:

No orthopedic surgeon will be handling internal organs. This is strictly the domain of the trauma surgeon. Orthopedic trauma surgery tends to involve a different mechanism of injury than "regular" orthopedics. I.e. they deal with injuries that would occur as the result of high speed injuries. As you can imagine, this entails a different type of pathology than osteoarthritis of the knee or lumbar disc herniation. I.e. you're trauma ortho doc won't be dealing with more chronic problems.

 

[Wahoos]

Hey Roasen, here is my take on things. I have done my internship in general/orthopedics surgery, now in my 3rd year as a orthopedic surgery resident. Also I done enough enough general surgery rotations in medical school to get a feel for the speciality.

General Surgery has its pluses and minuses, just like every other medical speciality. First about the misconception of general surgery trauma surgeons, it is a field that has min operations. I spent 2 months as a trauma surgery intern during my first year and I can count how many times that cases that had to go into the OR "emergently". Maybe 10 times total in the 2 months that I spent on that service and I am in one of the busiest level I trauma center in the country. The trauma surgery service had more ortho and neurosurg patients than pure "trauma" surgery patients. Majority of the trauma surgery patients were in fact operated on by orthopedics. About the other things, yes you do deal with more acute cases in general surgery than that of orthopedic surgery. The difference is that in Orthopedic surgery, you do more in terms of improving the "quality" of people's lives than to "save" their lives. You also do not deal with a lot of the crap that general surgeons have to deal with on a daily basis. Majority of your patients in ortho are healthy with a specific problem. But if you like the diabetics with peripheral vascular disease, CAD, that weight 400 lbs and smokes 2pks per day, then general surgery will give you plenty of those pts. 😀

About the knowledge base, general surgeons knows more about the medicine of patient management, ICU knowledge, fluid electrolyte management, etc, etc. Orthopods knows enough to manage the patients safely and we ask for help when things are not going great. In terms of knowledge base, orthopods have to learn everything from hand surgery, spine, trauma, pedi ortho, reconstruction, shoulder/elbow, sports medicine, ortho tumor, basic science, foot/ankle, etc, etc. I can tell you that just hand surgery alone, there is a book called Green's operative Hand that is about 3000 pages. We don't know alot of the medicine of patient management, but we do need to know a ton of other knowledge.

About orthopedic trauma, our program have 4 dedicated ortho trauma surgeons that do everything from distal radius repair to complex acetabulum repair to foot/ankle procedures to total knee/hips to the bread + butter of fracture management, to soft tissue procedures, to nerve transpositions, to knee/shoulder arthroscopy, etc. So a ortho trauma surgeon can do a wide variety of procedures not just ortho trauma.

However the open fracture that go to the OR emergently is pretty fun procedures.

Hope this helps a little.

 

[OHMAN0125]

I know ortho residency is horrendous. What about life after residency? I'm guessing 60hrs avg??
general surg hours are more than likely worse.

 

[SoFlaKnight]

I know ortho residency is horrendous. What about life after residency? I'm guessing 60hrs avg??
general surg hours are more than likely worse.

Bump...also interested in hearing the answer to this

 

[ddmo]

I think the main misconception most people have is that orthopaedic trauma is similar to general trauma in that it is a high pressure, fast paced field. When you think of general surgery trauma you think of bullet wounds to the chest and shouting off orders in the ER, getting an airway, cracking the chest in the ER, running to the OR, etc. Trauma in surgery implies crazy penetrating wounds and such. Whereas orthopaedic trauma is mainly fractures, the vast majority of which are not medical emergencies. Your typical ortho trauma case doesn't have that sense of urgency to it. Typically you will stabilize the fracture in the ER, then the next day fix it. In most places this means the residents spend all night stabilizing (reducing, casting, traction, etc.) and the attendings come in the next morning, look at the board, and go to work fixing them all day in the OR. Of course there is crazy stuff like traumatic amputations, but even most of those can be initially tamed with the use of a temporary tourniquet. Not to mention the other orthopaedic emergencies like compartment syndrome and open fractures, which are certainly interesting cases as alluded to above, but don't have that adrenaline rush associated with them like cracking a chest or having the time clicking on someones life.

I think for the most part what you will find is that most orthopaedic surgeons prefer not to be dealing with those type of scenarios. It's one thing to enjoy the hectic life of trauma for 2 months during medical school, but another to be a trauma surgeon and taking overnight q5-6 call for the rest of your life while babysitting sick neuro and ortho patients in between. Or, watching and managing patients who are in comas or die.

I thought General Surgery Trauma was a lot of fun. But, I have to think about what I want to be doing when I'm 40 or 50 years old, and that's not it.

 

[discontinuebed]

I know ortho residency is horrendous. What about life after residency? I'm guessing 60hrs avg??
general surg hours are more than likely worse.

Can anyone comment on this?

What are the hours like during residency? And after?

 

[skiz knot]

Can anyone comment on this?

What are the hours like during residency? And after?

The following are GENERALIZATIONS:

As residents, GS probably works longer overall. Much will depend on individual programs and specific rotations. You will not likely work >80 avg hrs/wk in either so who cares.

As attendings, there is probably little difference between the two (specialty dependant, of course). As a rule, you would expect to work ~60 hrs per week minimum as a new attending. Many CHOOSE to work more. Personal goals, practice type all play into it.

Honestly, if you are that concerned about hours, maybe GS or ortho is not for you (Urology maybe? 😉 )??? There will definitely be long hours and sleep deprived periods of your life in either.

 

[ORS]

Gs and Ortho are worlds apart.

Both have their benefits.

GS: Residents (and attendings) feel comfortable with ICU and polytrauma pts. They can specialize and just do breast lumps, trauma, big oncology cases, vascular, CT, etc. They are much more comfortable with general medical conditions than most orthopods I know.

Ortho: Great if you like to work with your hands. Like minimal management of medical problems on the floor (except in residency). Great if you want to save lifestyles, not (in general) lives. You can specialize in Onc, hand, FA, sports, trauma, spine, etc. Most work 50-70 hrs per week. Call depends on your practice. I know two academic orthopods that work 40 hrs per week (not in my program). SO you can have a more laid back time if you want.

Both are great fields and you will find the one that fits you better.

 

[Tired]

Ortho: Your patients will stop you in the mall 10 years after you fixed their fracture/replaced their knee, and thank you for giving them their life back.

General Surgery: Your patient will have Alzheimer's and forget your name by postop day 2.