ortho attending AMA

[oshanimalia]

What if you have failed one of your pre clinical courses, remediated it successfully, and have excellent board scores? Would it still be out of reach?

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[pbrocks15]

I would say stick with the publications you already have. But again, I can’t gauge their quality...


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Do you mean that the studies themselves might be poor, like a poorly controlled study, or more like the topic of the paper isn't a quality paper (such as something that really won't further insight into the field)?

Thanks again!

 

[OrthoTraumaMD]

Do you mean that the studies themselves might be poor, like a poorly controlled study, or more like the topic of the paper isn't a quality paper (such as something that really won't further insight into the field)?

Thanks again!

A little bit of both. Is it a tiny case report in a no-name journal? Or is it a pretty decent retrospective review in a known journal? That sort of thing.


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[OrthoTraumaMD]

What if you have failed one of your pre clinical courses, remediated it successfully, and have excellent board scores? Would it still be out of reach?

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It is a reach, but nothing is out of bounds. It would depend on the rest of your application. I had said earlier that I prefer not to answer “what are my chances” type of questions, and it is exactly for this reason. Everybody is very different.


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[Chillbo Baggins]

Usually everyone ranks the same set of 10-15 people highly since they interview at many programs, so it's not unusual to have those people all go elsewhere and then you end up starting with #15 on your own list.

Interesting. Do you think programs care more about getting these "top shelf" applicants versus people they think have a stronger connection to the program and would be more likely to rank it highly? Say someone isn't an from an Ivy league school with 10 pubs, but has very competitive scores and is from the program's corresponding med school or city/state or was a beast rotator, would they not get a little more love? I do know some programs take pride in "We went to our 6th rank for our 4 spots," though whether that is true applicant desire or very good salesmanship is another matter, lol.

 

[OrthoTraumaMD]

Interesting. Do you think programs care more about getting these "top shelf" applicants versus people they think have a stronger connection to the program and would be more likely to rank it highly? Say someone isn't an from an Ivy league school with 10 pubs, but has very competitive scores and is from the program's corresponding med school or city/state or was a beast rotator, would they not get a little more love? I do know some programs take pride in "We went to our 6th rank for our 4 spots," though whether that is true applicant desire or very good salesmanship is another matter, lol.

Ideally we would have a nice mix of both. But if we know the person well and they rotated with us, that usually takes precedence. A “beast rotator” can easily edge out a “great on paper” applicant that we do not know. Why not have the sure thing?


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[halfwaycrooks]

Were there fellows at your residency program and did you ever feel like that got in the way of your learning or operative experience?

 

[OrthoTraumaMD]

Were there fellows at your residency program and did you ever feel like that got in the way of your learning or operative experience?

Without compromising my anonymity, I will say that I have had many experiences with fellows. In my opinion, fellows can be helpful because they can take a junior resident through a case. Where you run into issues is if you are a chief or senior going into a certain specialty, and the fellow in that specialty is doing all the cases because they have to. I would say that if you go to a place with fellows, make sure there aren't too many of them, and that if there are, the program has a plan for making sure that both the fellow and the resident get the experience they need. Often, the chief resident will be in one room and the fellow in another.

 

[GonefromTX]

VSAS applications are opening up soon and I'm looking for some mid-competitive blue collar programs to do aways at. My stats are 250 step 1, mix of honors, high passes and passes in 3rd year clerkships, decent research (5 non-ortho related papers published).

Currently I'm looking at UAB, Emory, Dell (family reasons), JPS and Scott & White Temple. What are your thoughts on those and any other suggestions for mid-competitive, blue collar programs? Also, would I be stretching my luck at Emory (heard they are super competitive)?

 

[OrthoTraumaMD]

VSAS applications are opening up soon and I'm looking for some mid-competitive blue collar programs to do aways at. My stats are 250 step 1, mix of honors, high passes and passes in 3rd year clerkships, decent research (5 non-ortho related papers published).

Currently I'm looking at UAB, Emory, Dell (family reasons), JPS and Scott & White Temple. What are your thoughts on those and any other suggestions for mid-competitive, blue collar programs? Also, would I be stretching my luck at Emory (heard they are super competitive)?

I had said in my first post I would not answer individual “what are my chances” type of questions. Unfortunately I don’t know much about these programs, but I do know Emory is competitive, and therefore if you rotate you will basically be ”auditioning.”


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[Chillbo Baggins]

VSAS applications are opening up soon and I'm looking for some mid-competitive blue collar programs to do aways at. My stats are 250 step 1, mix of honors, high passes and passes in 3rd year clerkships, decent research (5 non-ortho related papers published).

Currently I'm looking at UAB, Emory, Dell (family reasons), JPS and Scott & White Temple. What are your thoughts on those and any other suggestions for mid-competitive, blue collar programs? Also, would I be stretching my luck at Emory (heard they are super competitive)?

I rotated at 2 of the programs you listed, so feel free to PM for more specific Qs.

 

[ERDOC555]

There was just a study on this. AOA/class rank and Step 1 scores are the highest predictors of a match.

Hi there! Not sure if you already linked that study in an earlier post, but I would love to see it if you had a link.

 

[OrthoTraumaMD]

Hi there! Not sure if you already linked that study in an earlier post, but I would love to see it if you had a link.

You know, the study I’m thinking of may not be published yet. I think it was presented at one of our meetings recently which is why I know it. But here’s a similar study which shows that step one, aoa, and research is significant. When I get home I will try and find my meeting abstracts to see if I can find the one I was thinking of.
A Comparison of Matched and Unmatched Orthopaedic Surgery Residency Applicants from 2006 to 2014: Data from the National Resident Matching Program. - PubMed - NCBI


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[OrthoTraumaMD]

You know, the study I’m thinking of may not be published yet. I think it was presented at one of our meetings recently which is why I know it. But here’s a similar study which shows that step one, aoa, and research is significant. When I get home I will try and find my meeting abstracts to see if I can find the one I was thinking of.
A Comparison of Matched and Unmatched Orthopaedic Surgery Residency Applicants from 2006 to 2014: Data from the National Resident Matching Program. - PubMed - NCBI


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@Dermpire
I couldn’t find it in my notes, but the above article was good, as was this one:
Survival Guide for the Orthopaedic Surgery Match. - PubMed - NCBI


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[OrthoTraumaMD]

I was asked on PM about research and how much is enough. Based on a study in JAAOS, the average step 1 score for a matched applicant is 245. The average number of projects/research experiences is 6-7. Just as an FYI for those who are wondering.


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[DarkHorizon]

VSAS applications are opening up soon and I'm looking for some mid-competitive blue collar programs to do aways at. My stats are 250 step 1, mix of honors, high passes and passes in 3rd year clerkships, decent research (5 non-ortho related papers published).

Currently I'm looking at UAB, Emory, Dell (family reasons), JPS and Scott & White Temple. What are your thoughts on those and any other suggestions for mid-competitive, blue collar programs? Also, would I be stretching my luck at Emory (heard they are super competitive)?

Emory is a great program, pretty blue collar tho. Need 250+ just to be able to rotate, from what I heard from their residents, last class were all 260+. Heavy on rotating students, seemed like half of the residents rotated at the program.

 

[bonemann]

I still work 80 hours/week but much of it consists of admin/research/educational efforts. Clinically it's anywhere from 40-50 depending on how much trauma comes in. Trauma is seasonal so summer is worse for the polytraumas, winter worse for fragility fx (wrists, ankles, hips). Changes from week to week. Some days I have lots of free time, other days I work all day. Not predictable, unlike the rest of ortho.

Sorry if this has been answered before, but if you decided to maximize time spent outside of work, how many of those hours per week would you be able to shed without uncompromising your job? Could you get it down to 50 if you wanted? I'm assuming you're in academics.

 

[OrthoTraumaMD]

Sorry if this has been answered before, but if you decided to maximize time spent outside of work, how many of those hours per week would you be able to shed without uncompromising your job? Could you get it down to 50 if you wanted? I'm assuming you're in academics.

Yes, I’m in academics. Some weeks are easier to do this than others. I would say an easy week could be definitely down to 50. But I have a lot of plates spinning all at once, and I prefer it that way. It also depends on what you mean by “compromising your job.” I would not get fired obviously, but professionally I would not be as satisfied. I work the way I do because I want to, not because I have to. I have many additional responsibilities which are not required but which I took on voluntarily.


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[xochitl]

@OrthoTraumaMD
Do you think ranking (medical school) matters when trying to match into ortho? say in the 30ish range vs 60ish? all else being equal because I understand that step scores, rotation grades and research are the most important.

 

[OrthoTraumaMD]

@OrthoTraumaMD
Do you think ranking (medical school) matters when trying to match into ortho? say in the 30ish range vs 60ish? all else being equal because I understand that step scores, rotation grades and research are the most important.

Not as much as the other things do. If you were gunning for a big-name orthopaedic residency, then it may matter more. But for most places, it does not.


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[ihadahamsandwich]

It seems like orthopods generally tend to have type A personalities. How do you think type B personalities fare in the field and how common are they?

Another question: What are the differences between ortho trauma and general surgery trauma and have you ever considered the latter?

 

[OrthoTraumaMD]

It seems like orthopods generally tend to have type A personalities. How do you think type B personalities fare in the field and how common are they?

Another question: What are the differences between ortho trauma and general surgery trauma and have you ever considered the latter?

I would say type A vs type B is about 50/50 actually. It’s just that the type Bs can still work like type As do while remaining chill. I don’t see any difference, except the types tend to gravitate toward certain specialties: As go to trauma, joints, and spine, and Bs to sports hand and peds. Of course that’s not a hard and fast rule.

As for your other question, they are very different. Ortho trauma is only fracture work. General surgery trauma deals with viscera and also does quite a bit of critical ICU care type stuff. I never considered general surgery trauma because they are underpaid, work like dogs, have to be in-house when they’re on call, and I hate the bowels.


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[The Physician Philosopher]

@OrthoTraumaMD

Full disclosure, I am a regional anesthesiologist.

Curious to know your thoughts on regional anesthesia for your work. Are you a fan?

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[OrthoTraumaMD]

@OrthoTraumaMD

Full disclosure, I am a regional anesthesiologist.

Curious to know your thoughts on regional anesthesia for your work. Are you a fan?

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I’ve used it, but only at times when patient is too ill to do general. In my place it takes too long to do blocks and it delays me. Plus there’s the whole risk of masking compartment syndrome afterwards... and the last time they did regional, the patient was wiggling around the entire time and it was really annoying for all involved. I think in a place like let’s say HSS where anesthesia runs like clockwork, it can work well, but I think it’s mostly for elective stuff and not trauma.


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[The Physician Philosopher]

I’ve used it, but only at times when patient is too ill to do general. In my place it takes too long to do blocks and it delays me. Plus there’s the whole risk of masking compartment syndrome afterwards... and the last time they did regional, the patient was wiggling around the entire time and it was really annoying for all involved. I think in a place like let’s say HSS where anesthesia runs like clockwork, it can work well, but I think it’s mostly for elective stuff and not trauma.


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Sounds like a rough set up. We have a dedicated regional area where we block prior to OR while your current case is going on. Whole different anesthesia crew than the intraoperative team. Makes it pretty efficient and the patients like the blocks (usually... Some rare people like one I saw today think their arm being numb is just too strange of a feeling).

Do you find your patients have a high opioid usage post surgery?

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[OrthoTraumaMD]

Sounds like a rough set up. We have a dedicated regional area where we block prior to OR while your current case is going on. Whole different anesthesia crew than the intraoperative team. Makes it pretty efficient and the patients like the blocks (usually... Some rare people like one I saw today think their arm being numb is just too strange of a feeling).

Do you find your patients have a high opioid usage post surgery?

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Depends on the fracture, but yes pretty much everyone gets narcotics. But I have a very strict narcotic policy. I don’t prescribe it beyond 6 weeks postop.


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[The Physician Philosopher]

Depends on the fracture, but yes pretty much everyone gets narcotics. But I have a very strict narcotic policy. I don’t prescribe it beyond 6 weeks postop.


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We had a really interesting visiting prof recently who did a lot of work looking at how many pills people used. At first they started with current prescribing patterns, then started decreasing the scripts. They found that decreasing the scripts to even a week or two post surgery did not cause more call backs for refills or decreased satisfaction. Was really interesting stuff.

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[OrthoTraumaMD]

We had a really interesting visiting prof recently who did a lot of work looking at how many pills people used. At first they started with current prescribing patterns, then started decreasing the scripts. They found that decreasing the scripts to even a week or two post surgery did not cause more call backs for refills or decreased satisfaction. Was really interesting stuff.

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Yeah, I try to limit as much as I can… But fracture patients are a special breed. Everything is 10 out of 10 pain...


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[RTD]

As a trauma doctor you see some of sickest patients. How do you deal with patient loss?

 

[masaraksh]

As a trauma doctor you see some of sickest patients. How do you deal with patient loss?

Having rotated on ortho trauma and applied into ortho, I would say that trauma/ortho is actually not the worst part of the hospital in terms of seeing patient loss. That would be like ICU, Medicine, EM, Heme/Onc, Neurosurgery, Neurology...

 

[masaraksh]

I was asked a question anonymously about why orthopods make so much compared with other specialties, whether I expect it to change, and why spine makes a lot in particular. I thought it was useful so I’m posting my answer here.

Neurosurgery makes more than ortho on average, but some orthopods make more than neurosurgeons. The main reason is that ortho surgeries are lucrative for hospitals. Not only do we use implants, which cost a ton of money, (an average pedicle screw in a spine case can cost 300 dollars, and they use dozens), but we also use many ancillary services (PT/OT, orthotics, Xray, etc). All of that is paid by insurance to the hospital. It feeds people. So no, I don’t expect it to change much beyond what’s already been done in terms of bundling care (for joints)...trauma won’t be bundled because the cases are not as predictable as joint replacement. The changes in our healthcare system will kill private practices, but not hospital based people like me.

In terms of spine, there are two answers. 1) they deal with ****ty patients who are always in pain and never get better and their surgeries are very high risk due to risks like paralysis, and 2) the aforementioned implants. A long time ago, spine surgeons were smart enough to unbundle their payments, so they get paid for each thing they do separately. For example if I spend 6 hours doing a blasted pilon, plus or minus fibula etc, I get paid for one cpt code because it’s all counted as single procedure even if the thing is in a million pieces. A spine surgeon who is doing a 45 minute ACDF can bill for each level separately. So three disc levels pays as three separate surgeries essentially.

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Do you think its unreasonable. Just looking at it seems that the +/- fibula is counted as different codes

27826 ANKFRAC Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only
27827 ANKFRAC Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only
27828 ANKFRAC Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilo

However, I guess its tough since a pilon can be hard af or easier and its the same code regardless. But I guess the same is true for any individual spine level. right?

 

[OrthoTraumaMD]

As a trauma doctor you see some of sickest patients. How do you deal with patient loss?

You learn to. I have treated some severe injuries resulting in limb loss, which were traumatizing to me. Some of those patients ended up dying. I’ve also seen patients with seemingly benign injuries deteriorate and die. You just have to accept that sometimes you win, and sometimes the trauma does.


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[OrthoTraumaMD]

Do you think its unreasonable. Just looking at it seems that the +/- fibula is counted as different codes

27826 ANKFRAC Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only
27827 ANKFRAC Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only
27828 ANKFRAC Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilo

However, I guess its tough since a pilon can be hard af or easier and its the same code regardless. But I guess the same is true for any individual spine level. right?

But it’s still one code. Either tibia only, or fibula, or both. You can only bill one of those codes for a case. And yes, a blasted pilon can take 8 hours. An individual spine level (usually) doesn’t have that length/complexity.


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[masaraksh]

But it’s still one code. Either tibia only, or fibula, or both. You can only bill one of those codes for a case. And yes, a blasted pilon can take 8 hours. An individual spine level (usually) doesn’t have that length/complexity.


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spine patients doe

 

[OrthoTraumaMD]

spine patients doe

Oh yes, I would not do spine no matter how much you paid me.

 

[masaraksh]

Oh yes, I would not do spine no matter how much you paid me.

Oh I love it. It’s like a psych rotation figuring out who actually has radiculopathy. Then just like Jerry springer whips out a paternity test you pull out the MRI and see what’s really going on. Plus you get to operate and torque in pedicle screws.

 

[Bones Bones Bones]

This is kind of a strange question...do you think females with very long hair should get a haircut before aways/interviews? Of course, my hair is always tied back in clinic and up in a bun in the OR. I've seen ortho residents and attendings with hair as long as mine, but someone suggested I should get my hair cut for aways/interviews so I would really appreciate another perspective. Thank you!

 

[OrthoTraumaMD]

Oh I love it. It’s like a psych rotation figuring out who actually has radiculopathy. Then just like Jerry springer whips out a paternity test you pull out the MRI and see what’s really going on. Plus you get to operate and torque in pedicle screws.

And have chronic pain patients that you own for life because you operated on them. Shudder. I feel like that entire rotation was like a Jerry springer show.


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[Chillbo Baggins]

Oh I love it. It’s like a psych rotation figuring out who actually has radiculopathy. Then just like Jerry springer whips out a paternity test you pull out the MRI and see what’s really going on. Plus you get to operate and torque in pedicle screws.

Hope that you and any other 4th years in this thread got good news today!

 

[masaraksh]

Hope that you and any other 4th years in this thread got good news today!

Thanks, all I can say now is that I matched. But I also ranked a back-up specialty so its basically a waiting game to see what I do for life.

 

[pDeluxe]

Thanks so much for doing this! I lurked and followed a lot of the advice in this thread... today I found out i matched ortho!

 

[OrthoTraumaMD]

Thanks so much for doing this! I lurked and followed a lot of the advice in this thread... today I found out i matched ortho!

Congratulations!


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[OrthoTraumaMD]

Thanks, all I can say now is that I matched. But I also ranked a back-up specialty so its basically a waiting game to see what I do for life.

Congrats. I had the same sort of wait; hope it’s good news for you.


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[Psai]

Thanks so much for doing this! I lurked and followed a lot of the advice in this thread... today I found out i matched ortho!

 

[FutureOncologist]

My fiancé is a PGY-1 doing her prelim in gen surg this year finishing up her rotations. She will be staying at the institution for her remainder of her training for ortho surgery. What I want to know, as an IM PGY-2,

1. What should she expect as far as training going from gen surg prelim to ortho year 1 (essentially a second intern year from what she describes?)
2. What should I expect and how can I best support her?

 

[Bones Bones Bones]

OK, so first of all, I assume you are a female, so my answer applies with that assumption. (Dudes should lose the man bun for interviews.) That said.... Hell to the no. Unless you’re going for a butch look. Lots of people will assume you’re a lesbian because you’re a woman in orthopaedics, and I personally don’t see the need to perpetuate stereotypes, unless you have a good reason for doing so. I had a short cut for a time in residency, for other reasons...but for most of my professional life, I have had long hair. It’s always cut, styled, and blowdried. I wear makeup daily and high heels if I’m in clinic. If you like the girly stuff, don’t ever feel the need to stifle yourself, for anyone or anything. (Just don’t wear too provocative or cleavage-baring stuff.)
Additionally, and this may not be a popular opinion in the sjw-riddled world, but I am a big believer that women should use everything we have to our advantage. Long hair is attractive to men, it’s a fact. Obviously, no level of attractiveness can make up for a crappy personality or laziness at work, but you will have an advantage in how you are viewed by men, unconsciously. And there is nothing wrong with that. Men employ the same strategy in the way they act, dress, handshake, etc, to sway people to their cause and view them favorably. Nothing wrong with utilizing your assets (carefully/conscientiously). Women have charm, sociability, and, in this field, rarity. Use it.

Wow, I totally forgot to mention I’m a female! No man bun here haha…context definitely matters! Thanks so much for your honest opinion.

 

[OrthoTraumaMD]

Wow, I totally forgot to mention I’m a female! No man bun here haha…context definitely matters! Thanks so much for your honest opinion.

All my opinions are honest. That’s what gets me into trouble sometimes!


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[Bones Bones Bones]

All my opinions are honest. That’s what gets me into trouble sometimes!

haha I know what you mean! Thanks again!

 

[OrthoTraumaMD]

I was asked another question on DM about reps and what influences surgeons to choose one company over another, and whether perks like dinners influence us.

Essentially, physicians make the decision based on a few things:
1. Comfort level - if you used the same equipment in residency, and know it well.
2. Money - if you’re in private practice, some products are cheaper for the patients and that may matter to you.
3. Hospital rules - implant companies often have agreements with hospital systems. So as a surgeon, you may be forced to use a certain type of company. For example you could be 80% Stryker, 20% everything else in terms of what you use during your cases.

As for the dinners, they don’t usually have any effect, but they are nice and help you get to know the reps.


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[ekmf27050]

My husband used to pack me little Post-it notes with my lunch with words of encouragement on them. I didn’t always have time to eat lunch, but I looked at the notes.

That's so cute