ortho attending AMA

[OrthoTraumaMD]

Idk. I was always around and never left and now expect the same of students. I just feel like I vaguely remember at some point in medical school, whether it was on an ortho rotation or at some point during third year, that it was explicitly stated that once med students were allowed to go home, they shouldn't come back for a call situation. Aside from the liability issue of having a student drive back and forth, I'm also just not a fan of making people jump through unnecessary hoops. The med student should be there to learn and to assist the junior on call. If your center isn't even busy enough to have call be in-house, making them come in once during the middle of the night just to see if they do it seems pointless. Half the time you can do things more efficiently without them anyway, especially when it isn't an extremely busy call night.

Granted, if I were at a program where that was the culture, I'd jump without hesitation when called in. I just think there are more effective ways to assess their work ethic while on a rotation. If med students are on call, they should be given a call room in the hospital so that they don't need to leave.

In my mind, the students do whatever the residents do. At some point, you have to assess how willing they are to get after it. In my mind, if you baby them, you don’t give them an opportunity to shine when that call trauma comes in.

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[VincentAdultman]

The med student should be there to learn

I mean you can learn stuff coming in from home in the middle of the night.

 

[OrthoTraumaMD]

I mean you can learn stuff coming in from home in the middle of the night.

Precisely. You also get a taste of what residency is like. It’s amazing how many students reconsider once they figure out how brutal a surgical residency really is. Which is how it should be. You need to know what you are getting into.

 

[Quaper]

There is a program that I am interested in applying to in the future. I just learned that I will be at a conference at that program's institution this summer. As an almost 3rd year student by then do you think it would be advantageous for me to see if I could meet someone in the ortho department while I'm there (introduce myself, let them see a face, network etc...) or would that be too soon and just come across as pushy or be perceived negatively? What is your opinion on this?

 

[OrthoTraumaMD]

There is a program that I am interested in applying to in the future. I just learned that I will be at a conference at that program's institution this summer. As an almost 3rd year student by then do you think it would be advantageous for me to see if I could meet someone in the ortho department while I'm there (introduce myself, let them see a face, network etc...) or would that be too soon and just come across as pushy or be perceived negatively? What is your opinion on this?

Do it. Be proactive. Just make sure you have something to say other than just “hi, I’m here.”

 

[Quaper]

Do it. Be proactive. Just make sure you have something to say other than just “hi, I’m here.”

Ya I figured. Showing up and saying "hey look at me probably won't go over well" as compared to "tell me about your program, and what do you look for in your applicants."

 

[OrthoTraumaMD]

Ya I figured. Showing up and saying "hey look at me probably won't go over well" as compared to "tell me about your program, and what do you look for in your applicants."

I would take it one step further—show up already knowing about the program, where their residents have gone. Ask about nuances, what they think is the program’s strong and weak points, board pass rates, etc. Try to connect your interest to them—if they have a strong arthroplasty program, say you’re interested in research on total hip infections... etc.

 

[Quaper]

I would take it one step further—show up already knowing about the program, where their residents have gone. Ask about nuances, what they think is the program’s strong and weak points, board pass rates, etc. Try to connect your interest to them—if they have a strong arthroplasty program, say you’re interested in research on total hip infections... etc.

Great thanks. I will do my research before then. Thanks for the advice.

 

[lagbydesign]

If you had to pick your favorite bone, what would it be?

 

[OrthoTraumaMD]

If you had to pick your favorite bone, what would it be?

The leg bone. It’s attached to the hip bone.
Seriously though, probably the tibia. It’s very versatile and challenging in so many ways.

 

[lagbydesign]

The leg bone. It’s attached to the hip bone.
Seriously though, probably the tibia. It’s very versatile and challenging in so many ways.

Awesome. Favorite joint? Might as well ask, if you even have one; favorite muscle? Lol.

 

[OrthoTraumaMD]

Awesome. Favorite joint? Might as well ask, if you even have one; favorite muscle? Lol.

Lisfranc joint, which isn’t really a joint in the true sense but it’s treated as such in terms of reduction.
Pronator quadratus. I think it’s cute.
Why, does it matter?

 

[lagbydesign]

Double.

 

[lagbydesign]

Lisfranc joint, which isn’t really a joint in the true sense but it’s treated as such in terms of reduction.
Pronator quadratus. I think it’s cute.
Why, does it matter?

It doesn't. I just think MSK is really cool.

 

[lagbydesign]

What was your first night on call as a PGY-2 like?

 

[OrthoTraumaMD]

What was your first night on call as a PGY-2 like?

I don’t remember the night at the main facility because you’re always on call with an in house senior.
But I vividly remember my first call night alone at our level 2. I got a call for an open “ankle fracture.” I was all pumped like yeah I got this. I go to the ER and the dude was super drunk and tried to jump a fence. He’s like “hey doc you think I’m gonna be ok?”
I looked at the ankle and legit was like, “I don’t even know what bone that is.”
Needless to say, it was not an ankle fracture. It was a talar extrusion, a very rare injury in which the entire talus comes out from under the tibia and out of the skin, without any fracture. So I was staring at the talus, which was just hanging out there in the breeze.
After that it was at least simple in the sense that the attending had to come in and wash it out and reduce it. Took him an hour to do it in the OR, so I’m glad I didn’t try in the ER. Usually those things get hung up on tendons etc, so it’s not easy.
Figures that my first night alone, I get a “case report” level injury.

 

[RocuROMANium]

I don’t remember the night at the main facility because you’re always on call with an in house senior.
But I vividly remember my first call night alone at our level 2. I got a call for an open “ankle fracture.” I was all pumped like yeah I got this. I go to the ER and the dude was super drunk and tried to jump a fence. He’s like “hey doc you think I’m gonna be ok?”
I looked at the ankle and legit was like, “I don’t even know what bone that is.”
Needless to say, it was not an ankle fracture. It was a talar extrusion, a very rare injury in which the entire talus comes out from under the tibia and out of the skin, without any fracture. So I was staring at the talus, which was just hanging out there in the breeze.
After that it was at least simple in the sense that the attending had to come in and wash it out and reduce it. Took him an hour to do it in the OR, so I’m glad I didn’t try in the ER. Usually those things get hung up on tendons etc, so it’s not easy.
Figures that my first night alone, I get a “case report” level injury.

What the hell?!? How does that happen?

 

[OrthoTraumaMD]

What the hell?!? How does that happen?

Yeah it’s pretty rare when it occurs without any fractures. But lo and behold, here it is, from that night.

 

[RocuROMANium]

Yeah it’s pretty rare when it occurs without any fractures. But lo and behold, here it is, from that night.
View attachment 252756

Wow that is awesome in the most medical way possible. So the attending rinsed the wound out, placed the talus, repaired any severed tendons and then closed the wound?Or was there prosthesis involved? What can the patient expect during the recovery process?

 

[OrthoTraumaMD]

Wow that is awesome in the most medical way possible. So the attending rinsed the wound out, placed the talus, repaired any severed tendons and then closed the wound?Or was there prosthesis involved? What can the patient expect during the recovery process?

You put it back and pray it doesn’t die. Most of them die though and then you go on to arthritis and ankle fusion. Some survive and do ok.

 

[DarkHorizon]

Yeah it’s pretty rare when it occurs without any fractures. But lo and behold, here it is, from that night.
View attachment 252756

Surprised to see bone foam was still around when you were a 2. I didn’t see it until I was a 3. That guy/gal must be filthy rich.

Btw, one of the hardest reductions, had a Hawkins 4 once, took over an hour, finally was able to muscle that in. Didn’t matter, patient ended up getting fused a couple of months later.

 

[OrthoTraumaMD]

Surprised to see bone foam was still around when you were a 2. I didn’t see it until I was a 3. That guy/gal must be filthy rich.

Btw, one of the hardest reductions, had a Hawkins 4 once, took over an hour, finally was able to muscle that in. Didn’t matter, patient ended up getting fused a couple of months later.

Private hospital

 

[VincentAdultman]

I had one was I was a 2 or a 3 where the Talus was just chilling there on the ER bed next to her foot. Can’t remember if it was intact or a fracture dislocation but I think it was the latter.

 

[lagbydesign]

Do you think membership in the American College of Surgeons is something worth working towards?

 

[OrthoTraumaMD]

Do you think membership in the American College of Surgeons is something worth working towards?

I think you make that decision for yourself when you get there.
I have it because I’m academic and sit on committees that deal with trauma surgery. But it’s absolutely not necessary, and it is a pain in the butt to get.

 

[ceilingfan019]

The extruded talus picture is fascinating. I was just listening to the orthobullets podcast on talar dislocations. Considering that it is so rare, I appreciate seeing your patient's picture (would love to see post-op films if you took them). Also, I find it interesting that your favorite joint is the Lisfranc joint. Do you think trauma surgeons commonly have a particular interest in the foot and ankle, or are my observations just a matter of coincidence?

 

[OrthoTraumaMD]

The extruded talus picture is fascinating. I was just listening to the orthobullets podcast on talar dislocations. Considering that it is so rare, I appreciate seeing your patient's picture (would love to see post-op films if you took them). Also, I find it interesting that your favorite joint is the Lisfranc joint. Do you think trauma surgeons commonly have a particular interest in the foot and ankle, or are my observations just a matter of coincidence?

We argue a lot about ankles, so I think that’s why it is a point of interest.
I was a resident at the time in a different hospital, it was long ago so I don’t have any films.

 

[lagbydesign]

One question that I have wondered about for a long time is, who do you think is better at fracture care for a given region, the traumatologist or the region subspecialist (hand, F/A, joints for periprosthetic fxs, etc)?

 

[OrthoTraumaMD]

One question that I have wondered about for a long time is, who do you think is better at fracture care for a given region, the traumatologist or the region subspecialist (hand, F/A, joints for periprosthetic fxs, etc)?

Trauma. Unless it’s something extremely hand specific (fractures that also need ligament stuff done) or tumor related.

 

[lagbydesign]

Echoing a post from /r/medicine, what are the most common musculoskeletal issues that arise secondary to being an orthopod?

 

[OrthoTraumaMD]

Echoing a post from /r/medicine, what are the most common musculoskeletal issues that arise secondary to being an orthopod?

You mean for the surgeon personally?
Back/neck pain, fatigue related ailments, carpal tunnel.
Much more likely than physical issues however, are depression, anxiety, suicide, and interpersonal problems liken cheating and divorce.

 

[membername24]

Could you name some of the biggest (top 5?) names in the ortho trauma space? Like people who you'd see an LOR from and be intrigued about? Just trying to get a sense of the connectedness of the trauma world

 

[pbrocks15]

You mean for the surgeon personally?
Back/neck pain, fatigue related ailments, carpal tunnel.
Much more likely than physical issues however, are depression, anxiety, suicide, and interpersonal problems liken cheating and divorce.

Do you notice the latter (depression, anxiety, suicide and interpersonal problems) less so in the orthopaedic world?

It usually sounds like they have it better but curious how you feel it relates to perhaps your peers in other specialities.

 

[OrthoTraumaMD]

Could you name some of the biggest (top 5?) names in the ortho trauma space? Like people who you'd see an LOR from and be intrigued about? Just trying to get a sense of the connectedness of the trauma world

Oh man. That’s a tough one. I could name about 50 but just off the top of my head...
Andy Burgess
Bruce Browner
Paul Tornetta
Charles Court-Brown
Margaret McQueen
Jesse Jupiter (also works for hand)
Bob O Toole
Tracy Watson
Peter Giannoudis
Mike Bosse
Mo Bhandari
Hans Pape
Chip Routt
Heather Vallier
Mike Gardner
Bill Ricci
George Haidukewych
Mike McKee
Claude Sagi
Toney Russell
Don Wiss
Roy Sanders

And me.... (hashtag anonymous)

 

[Lawpy]

And me.... (hashtag anonymous)

Saving the best for last

 

[OrthoTraumaMD]

Do you notice the latter (depression, anxiety, suicide and interpersonal problems) less so in the orthopaedic world?

It usually sounds like they have it better but curious how you feel it relates to perhaps your peers in other specialities.

I’m not too caught up on the data, but to my knowledge the highest rates of suicide occur in psych, anesthesia, and general surgery.
Surgeons in particular don’t really have it “better,” they just have more money to cover their pain up with “stuff”/women/fancy expenses, and more stigma from peers if they speak up—so you don’t always hear about their issues.

I’ve had many ortho colleagues who have had one or more of the above problems. One famous surgeon committed suicide last year. I myself nearly took my life a year ago. Interpersonal problems and divorces are rampant in orthopaedics. I have no actual data for this, but my personal experience is that about 75% of us are on our second or third spouse, and half of those divorces happened due to cheating on the part of the surgeon with either a rep, a secretary, or a nurse. That person then becomes wife number 2 or 3. The most I’ve ever seen is someone who was on his 5th wife. Yes, I know this is reductionist, but it’s my experience of years.... we seem to come in two forms: 1) really straight laced, married/kids since med school.... or 2) lying cheating (and often sexy) dogs.

 

[OrthoTraumaMD]

Saving the best for last

But of course. It’s like the last author on a paper.

 

[membername24]

Oh man. That’s a tough one. I could name about 50 but just off the top of my head...
Andy Burgess
Bruce Browner
Paul Tornetta
Charles Court-Brown
Margaret McQueen
Jesse Jupiter (also works for hand)
Bob O Toole
Tracy Watson
Peter Giannoudis
Mike Bosse
Mo Bhandari
Hans Pape
Chip Routt
Heather Vallier
Mike Gardner
Bill Ricci
George Haidukewych
Mike McKee
Claude Sagi
Toney Russell
Don Wiss
Roy Sanders

And me.... (hashtag anonymous)

I recall you saying you werent a PD but I could be mistaken... but if one of these people called you and said one of their students was really good and hardworking or something like that would you feel more inclined to take them? Or is it more like people you know, such as less-known attendings at other programs? Thanks for taking the time to answer all of our questions!

 

[OrthoTraumaMD]

I recall you saying you werent a PD but I could be mistaken... but if one of these people called you and said one of their students was really good and hardworking or something like that would you feel more inclined to take them? Or is it more like people you know, such as less-known attendings at other programs? Thanks for taking the time to answer all of our questions!

It’s both. So generally, people don’t take the time to call... so if they personally picked up the phone and called me, yes, I would be inclined to take the person over an applicant I didn’t get a call about. But I also know most of the people on this list personally, so I wouldn’t have to pit them against other less-known attendings I know.

Ultimately, it depends on how much I trust their judgment. So for me, it would be, in order of importance: my personal interview and judgment of applicant > recommendation from a big name whom I know personally > recommendation from a non-famous person I know and trust > recommendation of a famous name I don’t know personally > recommendation of a non-famous name whom I don’t know.

Hope that makes sense.

 

[DarkHorizon]

I’m not too caught up on the data, but to my knowledge the highest rates of suicide occur in psych, anesthesia, and general surgery.
Surgeons in particular don’t really have it “better,” they just have more money to cover their pain up with “stuff”/women/fancy expenses, and more stigma from peers if they speak up—so you don’t always hear about their issues.

I’ve had many ortho colleagues who have had one or more of the above problems. One famous surgeon committed suicide last year. I myself nearly took my life a year ago. Interpersonal problems and divorces are rampant in orthopaedics. I have no actual data for this, but my personal experience is that about 75% of us are on our second or third spouse, and half of those divorces happened due to cheating on the part of the surgeon with either a rep, a secretary, or a nurse. That person then becomes wife number 2 or 3. The most I’ve ever seen is someone who was on his 5th wife. Yes, I know this is reductionist, but it’s my experience of years.... we seem to come in two forms: 1) really straight laced, married/kids since med school.... or 2) lying cheating (and often sexy) dogs.

A lot of truth to this statement

 

[Pablo Escobar]

Hi Orthotraumamd, I only got 6 interviews this cycle and could likely go unmatched. I am not sure where I went wrong. How does your program view reapplicants, anything specific they look for? Any success stories you have heard of?

 

[OrthoTraumaMD]

Hi Orthotraumamd, I only got 6 interviews this cycle and could likely go unmatched. I am not sure where I went wrong. How does your program view reapplicants, anything specific they look for? Any success stories you have heard of?

I said in my first post that I would stay away from answering “what are my chances” questions.... but in the general sense of reapplications, the more reapplication cycles you undergo, the less likely your chances. Unfortunately, your best chance is your first. “Success stories” are rare for a reason. I think unless your application changes in an extremely significant way, you should consider another specialty. I recommend a backup specialty to anyone who applies Ortho because it’s not guaranteed to anybody due to competitiveness.

 

[hopeful123456789]

Hi OrthoTraumaMD,
As I am interested in Ortho I decided to take on a job where I would basically be a second assistant/scrub nurse in a hospital that does exclusively ortho (with subspecialists). Do you by any chance have any tips on how best to prepare for this? Probably important to mention, that I am still a preclinical med student. Any advice would be appreciated!

 

[OrthoTraumaMD]

Hi OrthoTraumaMD,
As I am interested in Ortho I decided to take on a job where I would basically be a second assistant/scrub nurse in a hospital that does exclusively ortho (with subspecialists). Do you by any chance have any tips on how best to prepare for this? Probably important to mention, that I am still a preclinical med student. Any advice would be appreciated!

Read the ortho bullets website; and if you are feeling particularly ambitious, get yourself hoppenfeld surgical exposures.

 

[ceilingfan019]

hoppenfeld surgical exposures.

Do you quiz students on the different approaches?

 

[OrthoTraumaMD]

Do you quiz students on the different approaches?

the anatomy of the approach we are doing, yes.

 

[Chillbo Baggins]

Oh man. That’s a tough one. I could name about 50 but just off the top of my head...
Andy Burgess
Bruce Browner
Paul Tornetta
Charles Court-Brown
Margaret McQueen
Jesse Jupiter (also works for hand)
Bob O Toole
Tracy Watson
Peter Giannoudis
Mike Bosse
Mo Bhandari
Hans Pape
Chip Routt
Heather Vallier
Mike Gardner
Bill Ricci
George Haidukewych
Mike McKee
Claude Sagi
Toney Russell
Don Wiss
Roy Sanders

And me.... (hashtag anonymous)

Alas, my chair didn't make the cut.

 

[OrthoTraumaMD]

Alas, my chair didn't make the cut.

Haha that was just off the top of my head—I can come up with others...

 

[membername24]

It’s both. So generally, people don’t take the time to call... so if they personally picked up the phone and called me, yes, I would be inclined to take the person over an applicant I didn’t get a call about. But I also know most of the people on this list personally, so I wouldn’t have to pit them against other less-known attendings I know.

Ultimately, it depends on how much I trust their judgment. So for me, it would be, in order of importance: my personal interview and judgment of applicant > recommendation from a big name whom I know personally > recommendation from a non-famous person I know and trust > recommendation of a famous name I don’t know personally > recommendation of a non-famous name whom I don’t know.

Hope that makes sense.

Extremely thoughtful of you to give such detailed responses, thank you so much!

 

[southpaw3]

Hi SDNers,

I have some free time and so am happy to answer any questions you may have about the myths and realities of orthopaedics, resident life, and general questions. Just avoid the "what are my chances with score X" questions-- so many better posts and options on this site for that. Orthogate is also a good site for their "ask the attending" section.

A bit about me: orthopaedic trauma attending, female, in my 30s, practicing in an academic setting in the US. Did my med school (allopathic/MD, if that matters), residency and fellowship training in the Northeast (though not all in the same place/state). My practice includes admin/research/education/mentorship responsibilities as well.

Ask away.

Hi! Thanks so much for opening this up for questions I'm currently in a situation where I could attend a reputable MD school that is connected with 2 ortho residencies, or I could attend a newer MD school that doesn't have much of a reputation nor connections to any ortho residencies. The only reason I'm considering the latter school is because my husband lives in the same city as that school, and if I go to the first school I'll be living ~1,000 miles from my husband for 2 years or so. Do you think where someone attends medical school (with concern to the school's reputation) is an important factor with matching to an orthopedic residency? Similarly, are medical schools that have an affiliated ortho residencies significantly better for helping students match to those ortho residencies? Thanks!