Matched Ortho this year, ask away

[PL198]

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interesting discussion

 

[massmocha]

Just finished fourth year, matched into ortho. All of that just fell right out of my thought process. Step 3 might be painful.

I'm planning to take it as soon as possible, hopefully on my first free weekend

 

[jdh71]

Because you're field agrees to manage them for me while I practice within the scope of medicine I find more interesting. Said beautifully in another thread:

He's wrong though. Your patients can be a ton of work and work that none of us needs - the hopsitalist doesn't *need* the extra ortho patient bill, I promise.

Maybe you should all learn to be big boys and do both like decent people.

I'll still be here to pull your ass out of the fire when a patient crashes and burns. Let me know how to help hoss.

 

[giantswing]

He's wrong though. Your patients can be a ton of work and work that none of us needs - the hopsitalist doesn't *need* the extra ortho patient bill, I promise.

Maybe you should all learn to be big boys and do both like decent people.

I'll still be here to pull your ass out of the fire when a patient crashes and burns. Let me know how to help hoss.

But... I don't want to medically manage my patients. That's why I picked ortho!

 

[KinasePro]

He's wrong though. Your patients can be a ton of work and work that none of us needs - the hopsitalist doesn't *need* the extra ortho patient bill, I promise.

Maybe you should all learn to be big boys and do both like decent people..

It's not that we don't know how to do it, it's that your colleagues have agreed to do it for us. Big difference.

I'll still be here to pull your ass out of the fire when a patient crashes and burns. Let me know how to help hoss.

lol @ the sanctimony. When an open book pelvis rolls into the ED, no one will be paging the pulmonologist to definitively fix it. Funny, it's almost like we all have separate roles in the hospital and work together as a team to care for the patient...

 

[massmocha]

How much will honors in psych hurt my app? It was an accident.

Edit: Seriously though... What are the top-15 programs I should look into. Goal is excellent operating experience and enough research to get a good fellowship.

Operative experience: any busy community or state program will give you crazy operative experience. Top research programs (according to Doximity, for what reputation rankings are worth to you): HSS (Cornell), HCORP (Harvard), UPenn, HJD (NYU), Pitt, Mayo, Rush, UCLA, Duke, UChicago, Wash U, Emory, Iowa, UCSD, Northwestern, Jefferson, Hopkins, UCSF. Which ones of those will give you a combo of the best operative experience with tons of research? Not really sure, I know that HSS is not really known for trauma. But any of those programs will give you a excellent sampling of subspecialty training.

Of course you also want to think about geographic location, and I assume you're a strong candidate (Step 250+, AOA?) if you're asking about the top 15 programs.

Anyone else have thoughts on this? I'm sure I'll get backlash on this as most people deplore making lists since it is such an personal choice. Obviously you have to go by fit and what type of person you are. If you are a Miama kind of work hard play hard guy, then a lot of those programs might not be what you're looking for.

 

[Tired]

...

 

[KinasePro]

Operative experience: any busy community or state program will give you crazy operative experience. Top research programs (according to Doximity, for what reputation rankings are worth to you): HSS (Cornell), HCORP (Harvard), UPenn, HJD (NYU), Pitt, Mayo, Rush, UCLA, Duke, UChicago, Wash U, Emory, Iowa, UCSD, Northwestern, Jefferson, Hopkins, UCSF. Which ones of those will give you a combo of the best operative experience with tons of research? Not really sure, I know that HSS is not really known for trauma. But any of those programs will give you a excellent sampling of subspecialty training.

Of course you also want to think about geographic location, and I assume you're a strong candidate (Step 250+, AOA?) if you're asking about the top 15 programs.

Anyone else have thoughts on this? I'm sure I'll get backlash on this as most people deplore making lists since it is such an personal choice. Obviously you have to go by fit and what type of person you are. If you are a Miama kind of work hard play hard guy, then a lot of those programs might not be what you're looking for.

I would generally agree with those top "academic" programs, with the exception of northwestern, UCSD, Emory, UChicago, and Penn. All of those programs have cardinal weaknesses excluding them from the "top" but don't get me wrong they are still very, very solid programs.

Doximity's ranking is a mess in my opinion (rush in the top 10?!?) bc it samples practicing physicians who are out of touch with what these programs are like in 2015. So much has changed in the 20 years when the survey respondents trained. I like the classic orthogate ranking set up:

Best Operative experience: Strong community programs (soo many...Union Memorial, Summa, JPS, Allegheny, Geisinger, Carolinas), Campbell Clinic, Miami, Baylor
Best Mix of operative + academics: Iowa, Vanderbilt, Pitt, Case Western, Utah, Minnesota, UCSF
Best Academic/Didactics/Research: HSS, Harvard, Mayo, Wash U, NYU, UW, Duke, Jefferson

 

[massmocha]

Hmm.. interesting list. I would generally agree with those top "academic" programs, with the exception of northwestern, UCSD, Emory, UChicago, and Penn. All of those programs have cardinal weaknesses excluding them from the "top" but don't get me wrong they are still very, very solid programs.

Doximity's ranking is a mess in my opinion (rush in the top 10?!?) bc it samples practicing physicians who are out of touch with what these programs are like in 2015. So much has changed in the 20 years when the survey respondents trained. I like the classic orthogate ranking set up:

Best Operative experience: Strong community programs (soo many...Union Memorial, Summa, JPS, Allegheny, Geisinger, Carolinas), Campbell Clinic, Miami, Baylor
Best Mix of operative + academics: Iowa, Vanderbilt, Pitt, Case Western, Utah, Minnesota, UCSF
Best Academic/Didactics/Research: HSS, Harvard, Mayo, Wash U, NYU, UW, Duke, Jefferson

I was looking for the list of highest funded ortho research departments. Does that exist anywhere? Programs all said we are #X in ortho research funding this year, but I never found a comprehensive resource for that.

 

[KinasePro]

I was looking for the list of highest funded ortho research departments. Does that exist anywhere? Programs all said we are #X in ortho research funding this year, but I never found a comprehensive resource for that.

Here is the NIH funding rank list from 2013 (found here:http://www.brimr.org/NIH_Awards/2013/NIH_Awards_2013.htm). Problem with this is that it does not take private funding into account (prob why Rush is absent and Jeff is ranked below UConn).

Rank Name Orthopedics
1 WASHINGTON UNIVERSITY $6,113,194
2 UNIVERSITY OF ROCHESTER $4,895,625
3 JOHNS HOPKINS UNIVERSITY $3,815,332
4 UNIVERSITY OF CALIFORNIA SAN FRANCISCO $3,695,186
5 UNIVERSITY OF PENNSYLVANIA $3,063,417
6 UNIVERSITY OF CALIFORNIA LOS ANGELES $2,707,227
7 UNIVERSITY OF IOWA $2,483,016
8 UNIVERSITY OF PITTSBURGH AT PITTSBURGH $2,017,975
9 UNIVERSITY OF CALIFORNIA SAN DIEGO $2,009,013
10 MOUNT SINAI SCHOOL OF MEDICINE $1,769,781
11 UNIVERSITY OF MICHIGAN $1,607,734
12 UNIVERSITY OF WASHINGTON $1,533,656
13 CASE WESTERN RESERVE UNIVERSITY $1,473,475
14 DUKE UNIVERSITY $1,318,324
15 YALE UNIVERSITY $1,280,039
16 UNIVERSITY OF CONNECTICUT SCH OF MED/DNT $1,274,993
17 THOMAS JEFFERSON UNIVERSITY $1,259,903
18 INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS $1,214,445
19 UNIVERSITY OF UTAH $1,014,588
20 UNIVERSITY OF FLORIDA $1,004,565
21 NEW YORK UNIVERSITY SCHOOL OF MEDICINE $994,288
22 COLUMBIA UNIVERSITY HEALTH SCIENCES $751,432
23 UNIVERSITY OF SOUTHERN CALIFORNIA $711,408
24 UNIVERSITY OF CALIFORNIA DAVIS $673,165
25 UNIVERSITY OF MARYLAND BALTIMORE $631,540
26 BOSTON UNIVERSITY MEDICAL CAMPUS $607,906
27 UNIVERSITY OF KANSAS $603,641
28 PENNSYLVANIA STATE UNIVERSITY $592,417
29 OREGON HEALTH & SCIENCE UNIVERSITY $477,914
30 UNIVERSITY OF VIRGINIA $466,105
31 UNIVERSITY OF MINNESOTA $446,642
32 UPSTATE MEDICAL UNIVERSITY $372,788
33 STATE UNIVERSITY NEW YORK STONY BROOK $334,578
34 UNIVERSITY OF CALIFORNIA IRVINE $316,514
35 UNIV OF ARKANSAS FOR MED SCIS $300,543
36 LOYOLA UNIVERSITY CHICAGO $217,063
37 Ohio State University $171,648
38 UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL $169,931
39 DARTMOUTH COLLEGE $146,923
40 UNIVERSITY OF TENNESSEE HEALTH SCI CTR $126,302
41 UNIVERSITY OF KENTUCKY $98,149
42 UNIV OF MASSACHUSETTS MED SCH WORCESTER $89,448
43 WEST VIRGINIA UNIVERSITY $74,000

 

[jdh71]

It's not that we don't know how to do it, it's that your colleagues have agreed to do it for us. Big difference.

No. That isn't how it went down. Medicine was told they would manage. It's a luxury of fixing bones which is a big money maker.

lol @ the sanctimony. When an open book pelvis rolls into the ED, no one will be paging the pulmonologist to definitively fix it. Funny, it's almost like we all have separate roles in the hospital and work together as a team to care for the patient...

Not to fix it for sure. I plan to be managing the the respiratory failure, pressors, blood, possible abx, electrolytes, and that is appropriate. We do have separate jobs in that case.

Your planned knee fix on metformin, linsinopril, and a baby aspirin?? Your lack of shame, reminds me of someone who lives in a trailer and says, "Yeah I smoke when I'm pregnant! What?!?"

Ok. There is a bone . . . you will fix it. Got it.

 

[jdh71]

They may not need it, but they sure seem to want it.

I have yet to run into a hospitalist who "wants" it.

We can do both, but it takes a really long time. I've got better things to do.

Everyone else has "better" things to do too.

And before you get all worked up, just remember your (original) specialty does the same thing. You really need me to manage a non-operative fibula fracture? You can't do follow-up on finger fractures? Do you know how often I get told, "We don't keep splinting materials in a primary care clinic"?

It's okay, I just roll my eyes and take care of the patient.

Why did you sign up for ortho if it wasn't to take care of BONEZ?!?!

Aren't you critical care? You don't even have a dog in this fight. If your colleagues don't want to manage my patients, tell them to go do a fellowship like you did.

It's a principled moral outrage.

 

[tiedyeddog]

This is getting so good.

I love the ortho vs hospitalist debates.

 

[massmocha]

Here is the NIH funding rank list from 2013 (found here:http://www.brimr.org/NIH_Awards/2013/NIH_Awards_2013.htm). Problem with this is that it does not take private funding into account (prob why Rush is absent and Jeff is ranked below UConn).

Rank Name Orthopedics
1 WASHINGTON UNIVERSITY $6,113,194
2 UNIVERSITY OF ROCHESTER $4,895,625
3 JOHNS HOPKINS UNIVERSITY $3,815,332
4 UNIVERSITY OF CALIFORNIA SAN FRANCISCO $3,695,186
5 UNIVERSITY OF PENNSYLVANIA $3,063,417
6 UNIVERSITY OF CALIFORNIA LOS ANGELES $2,707,227
7 UNIVERSITY OF IOWA $2,483,016
8 UNIVERSITY OF PITTSBURGH AT PITTSBURGH $2,017,975
9 UNIVERSITY OF CALIFORNIA SAN DIEGO $2,009,013
10 MOUNT SINAI SCHOOL OF MEDICINE $1,769,781
11 UNIVERSITY OF MICHIGAN $1,607,734
12 UNIVERSITY OF WASHINGTON $1,533,656
13 CASE WESTERN RESERVE UNIVERSITY $1,473,475
14 DUKE UNIVERSITY $1,318,324
15 YALE UNIVERSITY $1,280,039
16 UNIVERSITY OF CONNECTICUT SCH OF MED/DNT $1,274,993
17 THOMAS JEFFERSON UNIVERSITY $1,259,903
18 INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS $1,214,445
19 UNIVERSITY OF UTAH $1,014,588
20 UNIVERSITY OF FLORIDA $1,004,565
21 NEW YORK UNIVERSITY SCHOOL OF MEDICINE $994,288
22 COLUMBIA UNIVERSITY HEALTH SCIENCES $751,432
23 UNIVERSITY OF SOUTHERN CALIFORNIA $711,408
24 UNIVERSITY OF CALIFORNIA DAVIS $673,165
25 UNIVERSITY OF MARYLAND BALTIMORE $631,540
26 BOSTON UNIVERSITY MEDICAL CAMPUS $607,906
27 UNIVERSITY OF KANSAS $603,641
28 PENNSYLVANIA STATE UNIVERSITY $592,417
29 OREGON HEALTH & SCIENCE UNIVERSITY $477,914
30 UNIVERSITY OF VIRGINIA $466,105
31 UNIVERSITY OF MINNESOTA $446,642
32 UPSTATE MEDICAL UNIVERSITY $372,788
33 STATE UNIVERSITY NEW YORK STONY BROOK $334,578
34 UNIVERSITY OF CALIFORNIA IRVINE $316,514
35 UNIV OF ARKANSAS FOR MED SCIS $300,543
36 LOYOLA UNIVERSITY CHICAGO $217,063
37 Ohio State University $171,648
38 UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL $169,931
39 DARTMOUTH COLLEGE $146,923
40 UNIVERSITY OF TENNESSEE HEALTH SCI CTR $126,302
41 UNIVERSITY OF KENTUCKY $98,149
42 UNIV OF MASSACHUSETTS MED SCH WORCESTER $89,448
43 WEST VIRGINIA UNIVERSITY $74,000

nice find!

 

[PL198]

No. That isn't how it went down. Medicine was told they would manage. It's a luxury of fixing bones which is a big money maker.



Not to fix it for sure. I plan to be managing the the respiratory failure, pressors, blood, possible abx, electrolytes, and that is appropriate. We do have separate jobs in that case.

Your planned knee fix on metformin, linsinopril, and a baby aspirin?? Your lack of shame, reminds me of someone who lives in a trailer and says, "Yeah I smoke when I'm pregnant! What?!?"

Ok. There is a bone . . . you will fix it. Got it.

why do you think this developed though? like if it was considered unreasonable for ortho not be able to manage meds, then they'd all manage meds, yet it became accepted that they really don't, so what is the reason behind that

 

[jdh71]

why do you think this developed though? like if it was considered unreasonable for other to not be able to manage meds, then they'd all manage meds, yet it became accepted that they really don't, so what is the reason behind that

Ortho gets away with what they want largely because they swing a large "we make you guys a lot of money" hammer. So. If they don't want to manage medicine on their own patients in the hospital, they don't have to.

Hate the game not the player I guess . . .

 

[giantswing]

Why did you sign up for ortho if it wasn't to take care of BONEZ?!?!
.

Why sign up for medicine if it wasn't to take care of medicine type things?

 

[jdh71]

Why sign up for medicine if it wasn't to take care of medicine type things?

It was a question asked to me earlier above. Which is why the retort.

Though taking care of a non-operate broken bone is more the baliwick of ortho than just continuing someone's home meds is the baliwick of an internist. Changing meds for sub-acute to acute medical conditions is an appropriate role for medicine. Blood pressure out of control? Glucose out of control? Having a heart attack? Can breathe good? Consult a homie. You should have some shame is not actually trying yourself first. YMMV. (obviously)

 

[giantswing]

It was a question asked to me earlier above. Which is why the retort.

Though taking care of a non-operate broken bone is more the baliwick of ortho than just continuing someone's home meds is the baliwick of an internist. Changing meds for sub-acute to acute medical conditions is an appropriate role for medicine. Blood pressure out of control? Glucose out of control? Having a heart attack? Can breathe good? Consult a homie. You should have some shame is not actually trying yourself first. YMMV. (obviously)

Haters gonna hate.

 

[jdh71]

Haters gonna hate.

That's one response.

Though, maybe assuming "hate" is one person thinking perhaps too highly of oneself. One possibility. Of many.

Hater's going to hate is too often the response of those lacking any selfawareness. Another possibility. Many here.

 

[giantswing]

That's one response.

Though, maybe assuming "hate" is one person thinking perhaps too highly of oneself. One possibility. Of many.

Hater's going to hate is too often the response of those lacking any selfawareness. Another possibility. Many here.

Surgeons would never...

...oh wait.

Surgeons.

 

[massmocha]

That's one response.

Though, maybe assuming "hate" is one person thinking perhaps too highly of oneself. One possibility. Of many.

Hater's going to hate is too often the response of those lacking any selfawareness. Another possibility. Many here.

 

[Stagg737]

I hate to interrupt the entertainment, but I have one more ignorant M1 question for the ortho guys that matched this year. OP already chimed in on this, but I'd like some more insight.

What was everyone's back-up plan? Obviously most people that know what they're doing apply wisely and match, but what if you didn't? Did you only rank ortho and planned to scramble if you didn't match? Did you rank pre-lim programs or other specialties after ortho? Or did some people just assume that they were going to make it and didn't bother thinking about it?

Obviously it doesn't matter if you matched, and congrats to all who did, but just curious to hear what the game plan was if the worst had happened.

 

[giantswing]

I hate to interrupt the entertainment, but I have one more ignorant M1 question for the ortho guys that matched this year. OP already chimed in on this, but I'd like some more insight.

What was everyone's back-up plan? Obviously most people that know what they're doing apply wisely and match, but what if you didn't? Did you only rank ortho and planned to scramble if you didn't match? Did you rank pre-lim programs or other specialties after ortho? Or did some people just assume that they were going to make it and didn't bother thinking about it?

Obviously it doesn't matter if you matched, and congrats to all who did, but just curious to hear what the game plan was if the worst had happened.

Some scramble into prelim surg, most do a research year (scramble/apply into those after you find out you don't match). I've heard research is better, but do what's best for you especially if money is an issue. Dual applying isn't ideal and some programs can you the second they find out you dual applied.

 

[Indecisor]

On a scale from EC's to board scores, how much priority do Ortho PD's give to baseball swing?

 

[massmocha]

I hate to interrupt the entertainment, but I have one more ignorant M1 question for the ortho guys that matched this year. OP already chimed in on this, but I'd like some more insight.

What was everyone's back-up plan? Obviously most people that know what they're doing apply wisely and match, but what if you didn't? Did you only rank ortho and planned to scramble if you didn't match? Did you rank pre-lim programs or other specialties after ortho? Or did some people just assume that they were going to make it and didn't bother thinking about it?

Obviously it doesn't matter if you matched, and congrats to all who did, but just curious to hear what the game plan was if the worst had happened.

I didn't have a back-up, I felt I was a strong candidate and would likely match. My fallback if I hadn't matched would have been to do an extra research year to increase my publications (I didn't have any ortho pubs as I decided on ortho at the end of my 3rd year). I was told by my advisor that applying as a medical student (which you are as a research extended MS5) is better odds than as an "independent applicant" if you choose to graduate and do a prelim year. Fortunately it didn't come to that for me.

 

[Sam212]

You mean when we are asked to do the job of a doctor by another doctor? Geez. I don't know. What could possibly be bothersome about that?

Though when patients occasionally try to crash and burn, I'm always there to pull an orthopedic surgeon's ass out of the fire.

I think this is exaggerated, we always start home meds and don't consult medicine for healthy patients. We admit all of our joints and only consult medicine if there's some concern. You don't expect me to carry my stethoscope around and listen for heart murmurs and breathing sounds, do you? I have even ordered Lopressor and clonidine when taking Ortho call.

While managing BP and diabetes may be redundant and dull, think of it as that knee pain consult on an 85 y/o who's in the ICU for a STEMI and has arthritis in every joint. I mean is that necessary? but I sure see one almost every day.

Point being, while we're both physicians, we signed up for completely different jobs.

 

[KinasePro]

You should have some shame is not actually trying yourself first.

You seem to have the opinion that there is some type of honor or pride to be had in handling medical floor issues.... there isn't. It's just one more thing keeping ortho out of the OR. At most institutions the ortho volume is absurd, and the best way to utilize orthopaedists is to have them operating and evaluating patients in clinic.

I have yet to run into a hospitalist who "wants" it.

I've met plenty. At our hospital we have a 3 hospitalists who exclusively manage ortho medical problems and cooridnate care. They seem to be enjoying themselves and are a pleasure to work with. Our quality outcomes are among the best in the hospital, so the patients are benefiting immensely. The same can't be said for some of our gen surg services who are "managing their own medical problems" themselves...

It's a principled moral outrage.

Ortho gets away with what they want largely because they swing a large "we make you guys a lot of money" hammer. So. If they don't want to manage medicine on their own patients in the hospital, they don't have to.

This is either tin foil hat talk or something specific to your hospital environment. The only people who seem to hate ortho consults are residents, and as stated earlier, I have a hard time mustering sympathy for them when they knew what they were signing up for by going into a specialty who's core function is managing medical problems on the floor.

 

[KinasePro]

I hate to interrupt the entertainment, but I have one more ignorant M1 question for the ortho guys that matched this year. OP already chimed in on this, but I'd like some more insight.

What was everyone's back-up plan? Obviously most people that know what they're doing apply wisely and match, but what if you didn't? Did you only rank ortho and planned to scramble if you didn't match? Did you rank pre-lim programs or other specialties after ortho? Or did some people just assume that they were going to make it and didn't bother thinking about it?

Obviously it doesn't matter if you matched, and congrats to all who did, but just curious to hear what the game plan was if the worst had happened.

I also didn't have a back up plan, mostly because my advisors were pretty comfortable with my chances.

Had I not matched, I wouldn't have tried again. Ortho has become so competitive, that I thought I would compromise too much of my sanity & financial resources by trying again next year. I would've instead jumped ship into EM, anesthesia, or radiology... would've had to think pretty hard about which field to go with.

 

[giantswing]

On a scale from EC's to board scores, how much priority do Ortho PD's give to baseball swing?

I know several people who were asked to do push ups at their interview.

 

[jdh71]

I think this is exaggerated, we always start home meds and don't consult medicine for healthy patients. We admit all of our joints and only consult medicine if there's some concern. You don't expect me to carry my stethoscope around and listen for heart murmurs and breathing sounds, do you? I have even ordered Lopressor and clonidine when taking Ortho call.

While managing BP and diabetes may be redundant and dull, think of it as that knee pain consult on an 85 y/o who's in the ICU for a STEMI and has arthritis in every joint. I mean is that necessary? but I sure see one almost every day.

Point being, while we're both physicians, we signed up for completely different jobs.

Sounds like you guys have some shame. Nice to hear.

 

[jdh71]

You seem to have the opinion that there is some type of honor or pride to be had in handling medical floor issues.... there isn't. It's just one more thing keeping ortho out of the OR. At most institutions the ortho volume is absurd, and the best way to utilize orthopaedists is to have them operating and evaluating patients in clinic.



I've met plenty. At our hospital we have a 3 hospitalists who exclusively manage ortho medical problems and cooridnate care. They seem to be enjoying themselves and are a pleasure to work with. Our quality outcomes are among the best in the hospital, so the patients are benefiting immensely. The same can't be said for some of our gen surg services who are "managing their own medical problems" themselves...

This is either tin foil hat talk or something specific to your hospital environment. The only people who seem to hate ortho consults are residents, and as stated earlier, I have a hard time mustering sympathy for them when they knew what they were signing up for by going into a specialty who's core function is managing medical problems on the floor.

You mean having pride in being a real doctor? Yeah. I think one should have that kind of pride. I mean if you guys just want to be glorified ophthalmologists, I guess that is your business.

Don't forget to let me know when you **** up and need some help from someone who knows what they are doing.

 

[Tired]

...

 

[volcomx]

Sounds like someone has an inferiority complex.

 

[VA Hopeful Dr]

You seem to have the opinion that there is some type of honor or pride to be had in handling medical floor issues.... there isn't. It's just one more thing keeping ortho out of the OR. At most institutions the ortho volume is absurd, and the best way to utilize orthopaedists is to have them operating and evaluating patients in clinic.



I've met plenty. At our hospital we have a 3 hospitalists who exclusively manage ortho medical problems and cooridnate care. They seem to be enjoying themselves and are a pleasure to work with. Our quality outcomes are among the best in the hospital, so the patients are benefiting immensely. The same can't be said for some of our gen surg services who are "managing their own medical problems" themselves...

They enjoy it because its stupidly easy work and they get paid for it. Hospitalists that also see sick patients hate having to take the time to write "Continue home meds" on the stable HTN patient you're operating on.

This is either tin foil hat talk or something specific to your hospital environment. The only people who seem to hate ortho consults are residents, and as stated earlier, I have a hard time mustering sympathy for them when they knew what they were signing up for by going into a specialty who's core function is managing medical problems on the floor.

There is a difference between managing medical problems and being an H&P monkey for surgeons.

As my learned CC colleague has stated, someone with uncontrolled sugars/pressure/chest pain is a fine and dandy consult. The person on HCTZ who you consult because you don't feel like doing that admission H&P is different. If you personally don't do that, then you have my completely sincere appreciation and respect.

 

[jdh71]

You're grumpy today.

FWIW - I never wanted to be a "real doctor" in the way you're specifying, so none of this really bothers me much

You let me know. I'm just the consultant. It's your patient.

I'm always grumpy.

I suppose the world needs all kinds. Like podiatrists and chiropractors.

Where I work . . . You'll let me know if YOUR patient is on fire and you want me to put it out. I'm just a consultant.

 

[KinasePro]

They enjoy it because its stupidly easy work and they get paid for it.

Interesting way to describe your own specialty. Your words, not mine.

You mean having pride in being a real doctor? Yeah. I think one should have that kind of pride. I mean if you guys just want to be glorified ophthalmologists, I guess that is your business.

Funny, the "real doctor" tasks we're discussing are done by NPs/PAs 99% of the time anyway. You live in a strange version of reality, my friend.

 

[jdh71]

Sounds like someone has an inferiority complex.

Was that a passive aggressive stab at me?

At least if you're going to try for the I insult, you should really have the decency to quote me. Or maybe send me a tag.

Because I'm the last house on the block. The marine on the wall. I exist so everyone else can sleep, eat turkey dinner, and go to soccer games. I don't see myself as in anyway inferior. Hell, I'll not go onto describe how I really think because folks might get ever further angry about my opinion.

All I've done in here is have a bit of moral outrage. Some folks cannot be shamed. Their business not mine.

Though maybe your theory is correct. It's one of those neat possibilities.

 

[jdh71]

Interesting way to describe your own specialty. Your words, not mine.

Funny, the "real doctor" tasks we're discussing are done by NPs/PAs 99% of the time anyway. You live in a strange version of reality, my friend.

They at least try their best to be real doctors and it's all done under the direction of a doctor. Can hardly say the same thing about you guys. I mean if it's easy enough for an NP/PA to do then what is your excuse??

 

[Tired]

...

 

[jdh71]

Open ICUs? Interesting. My hospital used to have that. Not anymore. Guess it was one fire too many.

Yeah. Outside of academia weird things happen.

 

[Slack3r]

why do you think this developed though? like if it was considered unreasonable for ortho not be able to manage meds, then they'd all manage meds, yet it became accepted that they really don't, so what is the reason behind that

Think of it this way: if hernias and appendectomies reimbursed like total joints, the general surgeons wouldn't be managing their own floor patients either.

 

[jdh71]

Think of it this way: if hernias and appendectomies reimbursed like total joints, the general surgeons wouldn't be managing their own floor patients either.

That is apparently tin foil hat talk.

Hospital politics don't actually exist.

 

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[PL198]

Think of it this way: if hernias and appendectomies reimbursed like total joints, the general surgeons wouldn't be managing their own floor patients either.

do you foresee ortho reimbursements getting cut

 

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[KinasePro]

They at least try their best to be real doctors and it's all done under the direction of a doctor. Can hardly say the same thing about you guys. I mean if it's easy enough for an NP/PA to do then what is your excuse??

One could argue it's not "real doctor" work if mid levels are doing it competently every day... Then again, this "real doctor" business seems like something they debate about in pre-allo. Personally I think everyone with an MD is a real doctor-- derm, optho, radiology, etc... -- they just do different but equally important things.

We already tried to explain why we don't always do this work-- division of labor

Think of it this way: if hernias and appendectomies reimbursed like total joints, the general surgeons wouldn't be managing their own floor patients either.

You're oversimplifying. Gen sug spends far more time in managing the floor in residency. As a field, they decided to beef up man power instead of leveraging other services. They also have much lower operative volume and, especially on trauma, do a lot of non-op managment. It's apples and oranges and not just about the money.

Yes, politics exist. But to pretend there aren't other major factors at play is putting your head in the sand.

 

[jdh71]

Out of curiosity, do the Medicine folks admit Ortho patients to your unit, with the Intensivists as consultants? Or Ortho admits their own?

So. Basically either ortho or medicine will transfer the ortho patient to my unit and I get an automatic consult and primary generally fades into the background while the patient is in the ICU. Though if they show up at the hospital and need my services but also have a broken bone I admit and consult ortho during business hours because there is just a lot of crap you really don't need to wake people up for. As far as the basic ortho admits. Ortho admit their own elective joints and non complicated fracture patients. And medicine usually admit them if there is anything medical going on despite the broken bone.

 

[jdh71]

One could argue it's not "real doctor" work if mid levels are doing it competently every day... Then again, this "real doctor" business seems like something they debate about in pre-allo. Personally I think everyone with an MD is a real doctor-- derm, optho, radiology, etc... -- they just do different but equally important things.

We already tried to explain why we don't always do this work-- division of labor

You're oversimplifying. Gen sug spends far more time in managing the floor in residency. As a field, they decided to beef up man power instead of leveraging other services. They also have much lower operative volume and, especially on trauma, do a lot of non-op managment. It's apples and oranges and not just about the money.

Yes, politics exist. But to pretend there aren't other major factors at play is putting your head in the sand.

Hm. So maybe it not just "fleas whining" but colleagues who do a very important job for you? Interesting.

 

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