MS3: Considering/conflicted ortho & Questions

[MrRed]

I'm an MS3/4, starting a research year in biomedical engineering. My current project uses immunology/neoantigens to develop osteosarc & CRC therapies using novel vectors in animal models.

Strongly considering ortho, - I love surgery and can't see myself without it. Love sports and management of joint/msk injuries, big into weightlifting & powerlifting for about 10 years now, enjoy working with athletes. I actually run my school gym, and coach people in weightlifting, as well as compete myself. As an aside, I came to medical school initially with the goal of doing spine work because those I cared about were profoundly affected. The thing is, the other half of me enjoys basic science (molecular mechanisms/virology/immunology), and I really came to find a passion in oncology. The thought that I could help improve one of the most heartbreaking ailments I've seen, by combining several things I'm interested in.

I'm torn between gen surg -> surg onc, or ortho. Leaning towards ortho, probably with the goal of eventually going into orthopedic oncology.

Stats: 100th% Step 1, 4H (H in surg). Didn't take Step 2 yet.

Questions:
1. Does my research year being focused in immunologic/neoantigen/biological cancer therapy in osteosarc & CRC - limit me in terms of competitiveness for good ortho residencies? Should I be pursuing stricter, clinical orthopedic research concurrently, or is my basic science research enough? Ideally, I'd have a 1st author paper and a 3rd author accepted by the time I apply, but it might be after I apply.

2. Is the goal of going into ortho, to eventually have a significant portion of my practice focus on ortho-onc, realistic? In that I can say: Ok I'd like my practice to be X% orthopedic onc, and X% general ortho/joint/msk? I have no idea if this is possible.

3. Any other things I should consider/do now if I'm strongly thinking of ortho vs. gen surg?

Thanks a bunch for your help. Ortho has always been on the table, but it's only been recently I've started to feel I'd like to go into it strongly.

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[Miles Gloriosus]

I'm an MS3/4, starting a research year in biomedical engineering. My current project uses immunology/neoantigens to develop osteosarc & CRC therapies using novel vectors in animal models.

Strongly considering ortho, - I love surgery and can't see myself without it. Love sports and management of joint/msk injuries, big into weightlifting & powerlifting for about 10 years now, enjoy working with athletes. I actually run my school gym, and coach people in weightlifting, as well as compete myself. As an aside, I came to medical school initially with the goal of doing spine work because those I cared about were profoundly affected. The thing is, the other half of me enjoys basic science (molecular mechanisms/virology/immunology), and I really came to find a passion in oncology. The thought that I could help improve one of the most heartbreaking ailments I've seen, by combining several things I'm interested in.

I'm torn between gen surg -> surg onc, or ortho. Leaning towards ortho, probably with the goal of eventually going into orthopedic oncology.

Stats: 100th% Step 1, 4H (H in surg). Didn't take Step 2 yet.

Questions:
1. Does my research year being focused in immunologic/neoantigen/biological cancer therapy in osteosarc & CRC - limit me in terms of competitiveness for good ortho residencies? Should I be pursuing stricter, clinical orthopedic research concurrently, or is my basic science research enough? Ideally, I'd have a 1st author paper and a 3rd author accepted by the time I apply, but it might be after I apply.

2. Is the goal of going into ortho, to eventually have a significant portion of my practice focus on ortho-onc, realistic? In that I can say: Ok I'd like my practice to be X% orthopedic onc, and X% general ortho/joint/msk? I have no idea if this is possible.

3. Any other things I should consider/do now if I'm strongly thinking of ortho vs. gen surg?

Thanks a bunch for your help. Ortho has always been on the table, but it's only been recently I've started to feel I'd like to go into it strongly.

100th percentile on step 1? Did I read that right?

1. I think your research interest will be helpful, not hurtful for your ortho application. Let's be real with your step 1 score and published basic science stuff, your looking pretty good.
2. I am only speaking from the people I know or have worked with. The Ortho Tumor people I know work at academic centers and do another ortho things like do ortho tumor but also do trauma or do ortho tumor but also do joints etc... The only Ortho tumors who do pure onc work at major referral centers, are well established and have leadership positions in their departments. If you are wanting to do community practice, then I don't think you'll have the support staff/referrals to do an ortho tumor practice.
3. I can't speak for gen surg onc, but I know that those guys do training for a long long long time. The gen surg residents where I worked did 5 years clinical +2 years research. Now add on a couple extra years of surg onc fellowship and you are looking at 10 years training post medical school. Pick the one that you could see yourself doing bread and butter stuff if you end up not doing onc stuff. Want to rod femurs or resect dead bowl instead? I think the answer is clear haha.

 

[DNC127]

I second the above ^^

 

[MrRed]

100th percentile on step 1? Did I read that right?

1. I think your research interest will be helpful, not hurtful for your ortho application. Let's be real with your step 1 score and published basic science stuff, your looking pretty good.
2. I am only speaking from the people I know or have worked with. The Ortho Tumor people I know work at academic centers and do another ortho things like do ortho tumor but also do trauma or do ortho tumor but also do joints etc... The only Ortho tumors who do pure onc work at major referral centers, are well established and have leadership positions in their departments. If you are wanting to do community practice, then I don't think you'll have the support staff/referrals to do an ortho tumor practice.
3. I can't speak for gen surg onc, but I know that those guys do training for a long long long time. The gen surg residents where I worked did 5 years clinical +2 years research. Now add on a couple extra years of surg onc fellowship and you are looking at 10 years training post medical school. Pick the one that you could see yourself doing bread and butter stuff if you end up not doing onc stuff. Want to rod femurs or resect dead bowl instead? I think the answer is clear haha.

Thanks so much for your valuable input.

I'm really glad you think my research would be received well, that was one of my biggest concerns. I see many people going into ortho (at my school in particular) focusing solely on "strict" orthopedic clinical research, if you will.

Nearly 100%, could see myself working more bread-and-butter ortho cases for my career, much more-so than what might be the equivalent gen surg cases. I haven't reached out to the head of ortho at my school yet but I think I will reach out now, and speak with them about what the rest of this year, and then my "MS4" (MS5 technically) should look like to pursue ortho.

And yes, I'm very fortunate for my Step 1 score. Studied for a long-time, gave it all I had and it definitely paid off. Hopefully I'll be able to do well for Step 2 also. Many people at my school who go into ortho have between 6-8H (of 8), albeit lower board scores, and I was worried that might hold me back even with the Step 1, with only 4H. I would be in the bottom 25% of ortho applicants from my school in terms of number of honors I believe. The way I imagine it, I would like to go to a research-heavy institution for residency (to help with therapeutic/device design along the way slowly), but I think those would be some of the most competitive positions in the match.

I didn't know it was more of the norm to actually have a mixed practice re: ortho-onc/general ortho. That's awesome, and really pushes my decision far in favor of ortho. My follow-up would be, do people convey potential fellowship interests on their residency app? It seems premature, but with my research centered in this mix of oncology/immuno/BME [though in osteosarc 50%], and my desire to help with device/therapeutic design?

Thanks again, this is extremely helpful.

 

[Miles Gloriosus]

Does your school have an ortho tumor person? Maybe reach out to them as well? How time intensive is your basic science research? Might be worth it (if time allows) to help some of the ortho faculty or residents with their ongoing projects.... that could go a long way getting to know people in the department/make a good impression.

About the fellowship interests in your app, that is tricky. A fair amount of ortho programs don't have a ortho tumor service and farm their residents to academic centers for a few months to meet the requirements. You'd potentially be shutting yourself out of those programs. But would be better to talk to a mentor at your school what they think.

 

[MrRed]

Does your school have an ortho tumor person? Maybe reach out to them as well? How time intensive is your basic science research? Might be worth it (if time allows) to help some of the ortho faculty or residents with their ongoing projects.... that could go a long way getting to know people in the department/make a good impression.

About the fellowship interests in your app, that is tricky. A fair amount of ortho programs don't have a ortho tumor service and farm their residents to academic centers for a few months to meet the requirements. You'd potentially be shutting yourself out of those programs. But would be better to talk to a mentor at your school what they think.

Research isn't so time intensive that I couldn't do some things on the side/weekends for sure. I'll reach out to the ortho advisor at my school next week and meet with them.

Funny enough, I know a lot of the orthopedic residents & fellows here (from running the gym), but not many of the attendings. I will have to start asking around - maybe I can try to help with a few manuscripts or something, or a smaller clinical study that could publish in hopefully a shorter amount of time.

That makes sense re: tumor programs. I'll have to ask what the advice would be. I very much appreciate all of your advice & help.

 

[DrMcLovin]

It does sound like ortho could be a good fit for you. The research and step score will only help your application.

I dont have much oncology experience or interest but one of our orthopedic oncologists is based at a community hospital and does big oncology cases (total femurs etc.) but also has a thriving joints practice.