ortho attending AMA

[OrthoTraumaMD]

Not sure what Godinez is, never heard of it within orthopaedics.
As for your question, it is hard to answer because it depends on the grade of open injury, the extent of other injuries, physiologic status etc. Generally the answer is yes. Temporization can be done for as long as you need. You want to do definitive fracture fixation within 2 weeks, but if the soft tissues do not allow, then you can wait longer. Wounds should be debrided in the OR if large/contaminated, and then wound vacs can be used indefinitely as long as the wound is assessed. The most recent data shows no benefit of antibiotics past 24 hours.

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[Bancrofti]

@OrthoTraumaMD What would your retort be to physicians from other fields who make fun of how "simple" Ortho is? I'm assuming you don't really get this to your face as an attending. Slightly annoying to be at the tail end of 4th year, so all physicians ask what we're going in to as the first question, and all (esp. general surgeons) seem to take pleasure in pointing out how it takes no thought and how reimbursement will be going down as it should, so smart people shouldn't go in to it.

I disagree, at least on the simplicity of the field. If you're joints, maybe. Other than that I think it has a lot to offer. I'm not sure if you've developed a reply to these types of comments or if you don't even have to deal with them.

 

[OrthoTraumaMD]

@OrthoTraumaMD What would your retort be to physicians from other fields who make fun of how "simple" Ortho is? I'm assuming you don't really get this to your face as an attending. Slightly annoying to be at the tail end of 4th year, so all physicians ask what we're going in to as the first question, and all (esp. general surgeons) seem to take pleasure in pointing out how it takes no thought and how reimbursement will be going down as it should, so smart people shouldn't go in to it.

I disagree, at least on the simplicity of the field. If you're joints, maybe. Other than that I think it has a lot to offer. I'm not sure if you've developed a reply to these types of comments or if you don't even have to deal with them.

I used to respond that ortho is an iceberg. If you are just looking at the surface, you are missing the point. (If the person had a sense of humor, I also added that I preferred to make people better with my own hands rather than perform mental masturbation.) Next time someone does that to you, ask them what they think ortho is really about. The reason people say those things is either a) they're jealous, in which case you should laugh at them, or b) they are grossly misinformed and uneducated, in which case you should pity them. Orthopaedic surgeons go through med school and are the top students typically, which means they know as much as any IM doc or general surgeon-- but like any knowledge, if it is not used, it is forgotten. Same as a cardiologist trying to diagnose knee pain... I would laugh my ass off whenever I saw some consult for a "fibia fracture." Ortho is also one of those specialties where you have to go through med school and THEN go through school again, only this time as a resident. The skills and knowledge you acquire in ortho residency are almost nonexistent in standard med school curricula. Therefore it's like going to school twice. We are paid exactly what we deserve. Point out that you can't know ortho without anatomy, physiology, and neurology. It is a fascinating and complex specialty, with at least eight known major subspecialties. An orthopaedic surgeon can dissect a tumor from the dura, take out half a pelvis from the human body and replace it with allograft, correct hip dysplasia in a child, repair a digital nerve under a microscope, nail a comminuted fracture through tiny incisions, use biomechanical principles to plate a bone in at least 15 different ways depending on patient's soft tissues, physiologic parameters, comorbidities etc. We treat babies, olympic athletes, 95 year old nursing home patients, fat alcoholics, and everyone in between. We restore function to the body, and that never happens in isolation--- orthopods work in interdisciplinary environments, more so than most other specialties. Anyone who thinks that all this is "simple" is delusional, or just an idiot.

 

[tymont12]

Do you have any specific advice for someone from a newer MD school? Or one without an ortho program? At first glance, both would seem to be hindrances in the match.

 

[OrthoTraumaMD]

Do you have any specific advice for someone from a newer MD school? Or one without an ortho program? At first glance, both would seem to be hindrances in the match.

Do away rotations as early as possible and try to get letters from people there. It's a disadvantage not to have an ortho program at your school, but it's not a match killer. New schools are popping up everywhere, so we are expecting some applicants to come from there. Also try to do research in those places if possible, so you get to know the people. I did summer ortho research for a few weeks and it went well.

 

[Waterskier15]

@OrthoTraumaMD There has been a bit of talk of taking call on this thread. Can you go more into detail of what "taking call" typically entails for you? How often do you get called? How often do you have to return to the hospital to evaluate the patient/perform surgery? Lastly, are your experiences with taking call pretty standard throughout the ortho community, basically I am not sure if being at an academic trauma center and being a trauma specific surgeon changes things?

Thanks in advance!

 

[OrthoTraumaMD]

@OrthoTraumaMD There has been a bit of talk of taking call on this thread. Can you go more into detail of what "taking call" typically entails for you? How often do you get called? How often do you have to return to the hospital to evaluate the patient/perform surgery? Lastly, are your experiences with taking call pretty standard throughout the ortho community, basically I am not sure if being at an academic trauma center and being a trauma specific surgeon changes things?

Thanks in advance!

Taking call is definitely not "standard." It depends entirely on what type of job you have, what assistance you have, and what the level of your hospital is. Most orthopods take trauma call, even if it is not their primary specialty. If they are part of a large group, they may not be on call for weeks. Trauma people are different. I take more call than the others, simply because it is my bread and butter-- so I am on call one day/week and one weekend/month, as well as being available for helping my partners if they have a problem basically 24/7 unless I am traveling. As far as coming in, there are only a few things you really need to come for at night in ortho -- compartment syndrome, Grade 3 open fracture, something limb-threatening, or a native hip or knee dislocation. Most other things can be left until the am. A Level I trauma center may get more severe injuries, but you also have residents to see and temporize things for you. A busy level II may have PAs, but they may not be as comfortable handling procedures overnight, so you may need to come in to do certain things yourself (like put in traction pins). Trauma is very unpredictable. Depends on the season (summer is worst because of the car and motorcycle injuries).

 

[OrthoTraumaMD]

What do you think of elseviers "review of orthopeadics"

AKA Miller's. It is only good for ortho chief residents who are reviewing for the boards. Everyone else should be reading textbooks and obtaining a more solid base.

 

[Sthpawslugger]

@OrthoTraumaMD Thank you for hosting this thread. I'm just over the mid-30s male entering a fairly new D.O. school this year. My background is unique in that I've had a plethora of medical exposure on the front end: long-term employment in a cardiology clinic as a tech throughout undergrad, an Athletic Trainer for several years working anything from middle-school to semi-pro sports, an ER Tech, cardiology research internship, and, presently ER Scribe, part-time Ortho MA(under a very good total joint doc) as well as part-time research asst at a GI clinic (yes, all 3 at once! Lol, but ONLY until June and it's vacation time). For some time, I've been sitting at 95+% certainty that ortho is what I want to pursue(~5% ER because I do enjoy the variety). Here are my questions:

1) My school(which btw, is in a fairly small, southern town on the campus of a large university with big-time D1 athletics) is expanding their number of clerkship sites. One is within the city, another not much further away affiliated with a nearby D.O. ortho residency, another in a large city with potential overlap from an MD program, one in my hometown that is a Level II hospital but smaller than than the Level I one I currently work at(said MD program above has some 3rd/4ths rotating here), and others to boot. Would clerkships selection matter that much when it comes to core rotations?

2)Although no residency programs exist in my hometown, would it be just as beneficial to rotate at the smaller hospital and use my connections at my current employer, the Level I hospital and ortho clinic, to do trauma and ortho?

3)Lastly, I'm desiring to remain in the south due to family and comfort with the region. My fiancée and I can eventually see ourselves returning to our hometown once I'm ready to practice. Roughly 400k+ people already in the metro area, only 2 ortho practices, strong biotechnology nearby and tons of engineering. Cost of living is amongst the lowest in the country. Also, as someone who spent time as a sub-teacher for many years, I've liked the idea of teaching as a physician one day and collaborating with biotech/engineering for R&D purposes. With that said, how difficult would it be to establish an ortho residency when we are split bout 2 hrs each way from major medical universities with strong residency programs? I feel like the potential is here.

Thank you so very much for your time☺

 

[DarkHorizon]

@OrthoTraumaMD Thank you for hosting this thread. I'm just over the mid-30s male entering a fairly new D.O. school this year. My background is unique in that I've had a plethora of medical exposure on the front end: long-term employment in a cardiology clinic as a tech throughout undergrad, an Athletic Trainer for several years working anything from middle-school to semi-pro sports, an ER Tech, cardiology research internship, and, presently ER Scribe, part-time Ortho MA(under a very good total joint doc) as well as part-time research asst at a GI clinic (yes, all 3 at once! Lol, but ONLY until June and it's vacation time). For some time, I've been sitting at 95+% certainty that ortho is what I want to pursue(~5% ER because I do enjoy the variety). Here are my questions:

1) My school(which btw, is in a fairly small, southern town on the campus of a large university with big-time D1 athletics) is expanding their number of clerkship sites. One is within the city, another not much further away affiliated with a nearby D.O. ortho residency, another in a large city with potential overlap from an MD program, one in my hometown that is a Level II hospital but smaller than than the Level I one I currently work at(said MD program above has some 3rd/4ths rotating here), and others to boot. Would clerkships selection matter that much when it comes to core rotations?

2)Although no residency programs exist in my hometown, would it be just as beneficial to rotate at the smaller hospital and use my connections at my current employer, the Level I hospital and ortho clinic, to do trauma and ortho?

3)Lastly, I'm desiring to remain in the south due to family and comfort with the region. My fiancée and I can eventually see ourselves returning to our hometown once I'm ready to practice. Roughly 400k+ people already in the metro area, only 2 ortho practices, strong biotechnology nearby and tons of engineering. Cost of living is amongst the lowest in the country. Also, as someone who spent time as a sub-teacher for many years, I've liked the idea of teaching as a physician one day and collaborating with biotech/engineering for R&D purposes. With that said, how difficult would it be to establish an ortho residency when we are split bout 2 hrs each way from major medical universities with strong residency programs? I feel like the potential is here.

Thank you so very much for your time☺

OrthotraumaMD is an MD, I'll answer this as a DO Ortho resident.

1) Given that you're gonna be a DO, you should focus on DO programs, as you stand higher chance of matching. With that said, there are a lot of changes currently with DO programs going through ACGME accreditation, with 5 programs already accredited and many on the verge. Currently, 1/5 accredited is participating in NRMP match, but eventually all of the DO programs that become accredited will participate in NRMP match - at least in theory. The timeline for all DO programs to become ACGME accredited is summer of 2020. With your graduation in 2021, it's hard to predict what will happen. I am somewhat familiar with the ACGME requirements as my program is currently going through the application process for accreditation, and I can tell you that research and board scores will become even more prominent. Historically, DO programs only take candidates that rotate with them, and I don't think that will change, but they will now take students that are more academic, kind of in line with MD programs. Having said of all that, I would focus on crushing med school and getting a solid step 1 score, and then involve in a meaningful research project or two. You'd be surprised how easy these are to find if you email around, many programs even have summer research programs for med students. Once everything is line, you can then decide where to rotate as a 4th year med student, go where you want to match.

2) You should take advantage of whatever resources that are available to you, even if it's a small community hospital. I am sure you can still learn a ton about basic fracture care and learn a lot. Seek out a mentor locally, see if they can take you under their wing. Of course do this in your free time, do not compromise your academic performance for this.

3) Did you just ask whether you can start your own residency program?! lol, I would say it's not easy..... to say the least.

 

[Sthpawslugger]

OrthotraumaMD is an MD, I'll answer this as a DO Ortho resident.

1) Given that you're gonna be a DO, you should focus on DO programs, as you stand higher chance of matching. With that said, there are a lot of changes currently with DO programs going through ACGME accreditation, with 5 programs already accredited and many on the verge. Currently, 1/5 accredited is participating in NRMP match, but eventually all of the DO programs that become accredited will participate in NRMP match - at least in theory. The timeline for all DO programs to become ACGME accredited is summer of 2020. With your graduation in 2021, it's hard to predict what will happen. I am somewhat familiar with the ACGME requirements as my program is currently going through the application process for accreditation, and I can tell you that research and board scores will become even more prominent. Historically, DO programs only take candidates that rotate with them, and I don't think that will change, but they will now take students that are more academic, kind of in line with MD programs. Having said of all that, I would focus on crushing med school and getting a solid step 1 score, and then involve in a meaningful research project or two. You'd be surprised how easy these are to find if you email around, many programs even have summer research programs for med students. Once everything is line, you can then decide where to rotate as a 4th year med student, go where you want to match.

2) You should take advantage of whatever resources that are available to you, even if it's a small community hospital. I am sure you can still learn a ton about basic fracture care and learn a lot. Seek out a mentor locally, see if they can take you under their wing. Of course do this in your free time, do not compromise your academic performance for this.

3) Did you just ask whether you can start your own residency program?! lol, I would say it's not easy..... to say the least.

Thank you for the response. I've been in touch often with a biomechanics professor who now has a lab at the medical school for possible research opportunities. I've considered asking the Orthos there if I can assist with any case studies. Will most definitely dominate those exams and step 1.

With regards to starting a program, that's a good 11 or so years away for me...but, hey, doesn't hurt to at least have an idea to pitch down the road or to the clinic physicians and CEO, right? Lol

Thanks again

 

[DarkHorizon]

Also happy to let ya'll know that I recently matched in an Orthopedic Trauma fellowship earlier this week. Although this is not my thread, but will be happy to answer any questions regarding trauma, DO ortho, or ortho in general.

 

[Dr. Callie Torres]

.

 

[OrthoTraumaMD]

@OrthoTraumaMD Thank you for hosting this thread. I'm just over the mid-30s male entering a fairly new D.O. school this year. My background is unique in that I've had a plethora of medical exposure on the front end: long-term employment in a cardiology clinic as a tech throughout undergrad, an Athletic Trainer for several years working anything from middle-school to semi-pro sports, an ER Tech, cardiology research internship, and, presently ER Scribe, part-time Ortho MA(under a very good total joint doc) as well as part-time research asst at a GI clinic (yes, all 3 at once! Lol, but ONLY until June and it's vacation time). For some time, I've been sitting at 95+% certainty that ortho is what I want to pursue(~5% ER because I do enjoy the variety). Here are my questions:

1) My school(which btw, is in a fairly small, southern town on the campus of a large university with big-time D1 athletics) is expanding their number of clerkship sites. One is within the city, another not much further away affiliated with a nearby D.O. ortho residency, another in a large city with potential overlap from an MD program, one in my hometown that is a Level II hospital but smaller than than the Level I one I currently work at(said MD program above has some 3rd/4ths rotating here), and others to boot. Would clerkships selection matter that much when it comes to core rotations?

2)Although no residency programs exist in my hometown, would it be just as beneficial to rotate at the smaller hospital and use my connections at my current employer, the Level I hospital and ortho clinic, to do trauma and ortho?

3)Lastly, I'm desiring to remain in the south due to family and comfort with the region. My fiancée and I can eventually see ourselves returning to our hometown once I'm ready to practice. Roughly 400k+ people already in the metro area, only 2 ortho practices, strong biotechnology nearby and tons of engineering. Cost of living is amongst the lowest in the country. Also, as someone who spent time as a sub-teacher for many years, I've liked the idea of teaching as a physician one day and collaborating with biotech/engineering for R&D purposes. With that said, how difficult would it be to establish an ortho residency when we are split bout 2 hrs each way from major medical universities with strong residency programs? I feel like the potential is here.

Thank you so very much for your time

1. I don't think clerkship selection matters unless you want to end up as a resident at those places. Just look for the place that gives you the most broad experience--not just trauma or joints, but all subspecialties.

2. If you don't think you are a strong candidate otherwise, then use your connections. Otherwise go with the place that gives you the most bang for your buck in terms of experience.

3. Very, very difficult. You need institutional support, funding, appropriate amount and training in terms of faculty, a full-time residency coordinator, a ton of extra non-clinical time you're willing to burn on this, and ACGME approval which is not easy to get. Especially if there are two major residencies nearby.

 

[OrthoTraumaMD]

Thank you (and DarkHorizon) so much for doing this! Female OMS II here at a newish DO school. Diligently studying for Level and Step 1 as I type . My entire CV screams ER, from undergrad, to research, to med school clubs. Then I shadowed an ortho last summer and found out I *really* like it. (ironically I chose an ortho SDN name years ago... self-fulfilling prophecy I guess or maybe I subconsciously knew all along) I own/use all the power tools and enjoy woodworking so maybe I should've known. The trauma aspect of it really intrigues me because of the new experience and puzzle solving but I haven't actually seen any. I joined ortho club and I'm planning to do 1 month ortho rotation next year, but its not at a residency program, and its only 1 month to decide my whole future.

Sorry about the life story, but I'm wondering if schools would look at me and cross me off immediately? My school literally has never had someone match Ortho. I'm a physically strong woman, a little masculine and crude, but I'm afraid that I will schedule my aways and find out I dont fit in with the academic side. Is it ok to not have that experience? Should I get in contact with the closest program to me before 4th year and shadow there before then or will my month next year tell me enough? Also, I read about your "love affair with vascular" and changing goals, but does it hinder me that ER isn't a surgical field?

Thanks again.

I wouldn't be discouraged. Lots of people find out that they want to switch specialties. ER isn't such a stretch because they still do many "surgical" procedures, so it is very understandable to go from that to ortho. I don't think any school would cross you off, BUT I definitely think if you have misgivings or questions (such as what you mentioned about the academic side), you should seek to have them answered as soon as possible. If you have the time before 4th year, I would definitely seek them out. It can only help you.

 

[Bancrofti]

At what point post-residency did you feel confident in your ability to handle whatever comes in the door? Part of what makes me shy away from doing something like Trauma is that if I haven't seen something in a while, I'd definitely need to take a look at it again before being able to describe it or talk about it. It kind of blows my mind when people speak about a case they had 2 years ago and can describe it in great detail. I did well in school and on exams, but my memory doesn't work like that. I barely remember people's names until I hear them for the 3rd time. I'm just worried some crazy trauma will come in that needs to go to the OR immediately (I know this isn't that significant a % of patients) that I might want to escape really quick to review management or technique... but obviously this is med student mentality and that isn't something you can do as an attending. Do you feel that anyone (or most) people who do trauma have the ability to take any case back? Like, should I be worried about my ability to be effective or as long as I'm at a solid residency/fellowship then I shouldn't have any reservations about that career choice?

 

[masaraksh]

I'm finishing 3rd year and preparing for Ortho Sub-Is and aways.

I've been reading the resident work hours thread in this forum and from what I've heard from 4th years who have gone through the ortho process I am a little scared of just not cutting it physically and 'dying' of sleep deprivation. It seems that Q3 call is common and it seems like thats how it is at my school for the residents - and it seems like its with no post call day. Which can translate to approx 6a-6p(next day), so like 36hrs, correct me if i'm wrong? On my surg rotation, I had approx 1 overnight call a week and we had to get there at 5 and would leave next day at 8/9 which ended up being 26ish hrs. But I was pretty zoned out by the end. I mean, I didn't mind the work as I've really enjoyed surgery, but I'm worried I'll be too much of a zombie to make a good impression on the attendings and be falling asleep the whole time. Any comments? Any chance I'm over reacting (I had the same type of worry when starting med school that I'd be sleep deprived and tired from studying during preclinical, but then managed to get 6+hrs/night years 1-2 and stay at the top of the class).

What are the best tips you have for aways?

And in terms of your expertise - what do you expect from a stellar med student during traumas? What should we do, what not to do, how to help and how to not get in the way? understand it depends on the nature of the case but curious about general advice. I am thinking of an away month on Ortho Trauma.

 

[OrthoTraumaMD]

At what point post-residency did you feel confident in your ability to handle whatever comes in the door? Part of what makes me shy away from doing something like Trauma is that if I haven't seen something in a while, I'd definitely need to take a look at it again before being able to describe it or talk about it. It kind of blows my mind when people speak about a case they had 2 years ago and can describe it in great detail. I did well in school and on exams, but my memory doesn't work like that. I barely remember people's names until I hear them for the 3rd time. I'm just worried some crazy trauma will come in that needs to go to the OR immediately (I know this isn't that significant a % of patients) that I might want to escape really quick to review management or technique... but obviously this is med student mentality and that isn't something you can do as an attending. Do you feel that anyone (or most) people who do trauma have the ability to take any case back? Like, should I be worried about my ability to be effective or as long as I'm at a solid residency/fellowship then I shouldn't have any reservations about that career choice?

I can't give you a "time it took to get comfortable," because I still "sneak away" often to read. Fortunately, as you said, in trauma, few things require immediate action. But any monkey can learn to put on an ex-fix and wash things out, and the basics of nail placement. After about 5 cases, you feel pretty good about your competence with those simple things. Otherwise, everything else can be pushed off to a time when you are more comfortable. There is no shame in delay for surgical planning--if you don't go in prepared, you will hurt your patient. Everything else comes with experience and repetition. If you feel that way as a student or even a senior resident, that is totally normal. Your feelings are good, not bad. My mentor taught me that. Fear is healthy. Much healthier than being a cowboy and winging it. 90% of trauma is knowing IF you should operate, when to operate, and preoperative planning. The actual surgery (what you're worried about) is 10%. If you have a well-executed plan A, with backup plans B, C, and D, you'd be surprised how much of the anxiety disappears. And you need time to make those plans. In the beginning you will be making those plans for simple things, ankles etc...and then as you become more skilled, the plans (at least written-out ones) will be reserved for more complex things. I have an acetabulum case tomorrow. I still will have poor sleep tonight, worrying about how it will go, planning the approach, considering what I will do if it fails, etc etc. It never ends, and it never should. That's how you get better.

 

[OrthoTraumaMD]

I'm finishing 3rd year and preparing for Ortho Sub-Is and aways.

I've been reading the resident work hours thread in this forum and from what I've heard from 4th years who have gone through the ortho process I am a little scared of just not cutting it physically and 'dying' of sleep deprivation. It seems that Q3 call is common and it seems like thats how it is at my school for the residents - and it seems like its with no post call day. Which can translate to approx 6a-6p(next day), so like 36hrs, correct me if i'm wrong? On my surg rotation, I had approx 1 overnight call a week and we had to get there at 5 and would leave next day at 8/9 which ended up being 26ish hrs. But I was pretty zoned out by the end. I mean, I didn't mind the work as I've really enjoyed surgery, but I'm worried I'll be too much of a zombie to make a good impression on the attendings and be falling asleep the whole time. Any comments? Any chance I'm over reacting (I had the same type of worry when starting med school that I'd be sleep deprived and tired from studying during preclinical, but then managed to get 6+hrs/night years 1-2 and stay at the top of the class).

What are the best tips you have for aways?

And in terms of your expertise - what do you expect from a stellar med student during traumas? What should we do, what not to do, how to help and how to not get in the way? understand it depends on the nature of the case but curious about general advice. I am thinking of an away month on Ortho Trauma.

36 hours is illegal. 30 is maximum you can do. Any residency that doesn't follow that rule will get ripped a new a-hole by the ACGME. The only caveat is when you are postcall as a senior and have an interesting case that you CHOOSE to stay for. Perhaps that is why it seems to you like people are taking 36h calls. Call must be averaged to have no more than 80h/wk averaged over 4 weeks, and that includes home call.
Anyway, 30 hrs is no picnic either. So let me say this now: you won't die. Thousands have done this before you, even prior to the 80hr restriction, and they are alive. I survived on 5 hrs of sleep for years, and so will you, because you must. There is no choice. It's like the military--I often wonder how people can march for miles with 50 lbs of gear. The human body and mind have an amazing adaptive capacity. You will be fine. I have few reserves because I'm so thin, so I often felt like I was surviving on strength of will alone, and the drive to do well (and to some extent fear of being chastised for doing poorly) will keep you awake and alert for far longer than you imagined. And if you love what you do, the time flies like crazy.

Tips for aways--in terms of what? Choice? (I've addressed in this thread) Success? If the latter, then it ties in to your next question about what a great med student does. To me, the perfect med student meets with me/talks to me before the case (and not like 5 min before when I'm stressing out about getting things done), to show their interest. Ideally they would have read something about the topic and want me to discuss something specific about the plan--what made me choose ORIF? What would be my approach and why? Etc. I want to see interest, not a mindless retractor monkey. During the case, the perfect med student has a gauge for when it's good to ask questions and when to be quiet. Residents can help you with that--they know the nuances of each attending and what they like. Some people don't like to be asked things during surgery, others are more comfortable. Others, like me, have "tells"--if things aren't going well, I become less talkative and more abrupt, and that's not a good time to ask questions. Wound closure is a good time for questions because that's typically a low stress time. Otherwise, help the residents with "stupid" tasks like scutwork. They appreciate it, and so will I--once I ask them how you behave when you're out of my sight. And if interested in the med student, I ask everyone--nurses, techs etc. I've caught so many students being dinguses when they think my back is turned. And lastly, for god's sake, be yourself and don't conform to the "bro" stereotype unless that's actually what you're like. We don't like fake people. Unless of course you're a serial killer, then please don't be yourself.

 

[masaraksh]

Thanks! Very helpful! I'm not very worried now, the 24hr call w/o post call day was kind of based purely on rumor. I don't think I'll die just this easily.

 

[OrthoTraumaMD]

Thank you for your response. I won't be a complainer. Mind if I ask some more questions since you've been through everything? It's just really difficult to get good advice..

When do people start looking for jobs? after matching to fellowship during chief year? or during fellowship? What's the timeline like? Through what avenue do people usually get jobs?

What's the hour like in general for different ortho subspecialties for attendings?

Also, I've seen that some fellowship applications require MSPE and medschool transcripts, which I'm not too proud of.. What's the chance of this affecting my application? I had no idea they would come haunt me again.. How would you rank the importance of components that go into fellowship application?

I'm asking lots of questions.. Thanks in advance.

I moved this question from another post since it belongs here.

I will preface this by saying that many of these can be answered by your program once you get there---it's too soon to be asking these when you don't even know what subspecialty you will go into, or even IF you will do a fellowship. Relax. it's way too soon.

People look for jobs in chief year or fellowship, depending on competitiveness of the subspecialty. People get jobs through their connections in residency, research connections, or (mostly) from their fellowship director's phone calls.

Hours for various subspecialties are extremely dependent on the type of practice you're in, what kind of partners you have, what state you are in, etc etc. avg 50-60 for most, trauma a bit more.

I have never seen a fellowship require MSPE or Med school transcripts, ever. The most important things are the letters of recommendation and research, if the fellowship is competitive. That's pretty much it.

 

[orthobone7]

I moved this question from another post since it belongs here.

I will preface this by saying that many of these can be answered by your program once you get there---it's too soon to be asking these when you don't even know what subspecialty you will go into, or even IF you will do a fellowship. Relax. it's way too soon.

People look for jobs in chief year or fellowship, depending on competitiveness of the subspecialty. People get jobs through their connections in residency, research connections, or (mostly) from their fellowship director's phone calls.

Hours for various subspecialties are extremely dependent on the type of practice you're in, what kind of partners you have, what state you are in, etc etc. avg 50-60 for most, trauma a bit more.

I have never seen a fellowship require MSPE or Med school transcripts, ever. The most important things are the letters of recommendation and research, if the fellowship is competitive. That's pretty much it.

Thank you so so much again for your reply. It seems like for certain ortho specialties (peds ortho), MSPE is required unfortunately.

Just one more question if you don't mind. I know that OITE is important for ABOS prep. But is OITE important for the fellowship application? Does it come up in the LOR? Thank you again!

 

[DarkHorizon]

Thank you so so much again for your reply. It seems like for certain ortho specialties (peds ortho), MSPE is required unfortunately.

Just one more question if you don't mind. I know that OITE is important for ABOS prep. But is OITE important for the fellowship application? Does it come up in the LOR? Thank you again!

Just went through the fellowship application process, my understanding is that it's against the rules to ask your specific OITE scores, some people do put it on their CVs if they do well. This is what I was told by a PD. Doubt they make any difference. It's all about who wrote your letters and made calls for you, along with research.

 

[OrthoTraumaMD]

Thank you so so much again for your reply. It seems like for certain ortho specialties (peds ortho), MSPE is required unfortunately.

Just one more question if you don't mind. I know that OITE is important for ABOS prep. But is OITE important for the fellowship application? Does it come up in the LOR? Thank you again!

No. OITEs do not come up in the fellowship application. Certainly not for me, or anyone I know.

 

[orthobone7]

Just went through the fellowship application process, my understanding is that it's against the rules to ask your specific OITE scores, some people do put it on their CVs if they do well. This is what I was told by a PD. Doubt they make any difference. It's all about who wrote your letters and made calls for you, along with research.

Thanks for your reply. So it boils down to who's vouching for me and research I guess. I am not sure if the attendings at my future residency program has lots of connections. Sigh

 

[orthobone7]

No. OITEs do not come up in the fellowship application. Certainly not for me, or anyone I know.

I'm looking to stay in academic medicine, so I'd like to get into a good fellowship program. If the application boils down to who's writing my LOR, who's making the calls, and research, I don't know how this bodes for me as I don't think people at my future residency has good connections..

 

[DarkHorizon]

Thanks for your reply. So it boils down to who's vouching for me and research I guess. I am not sure if the attendings at my future residency program has lots of connections. Sigh

Rest assured, I'm a resident at a lowly DO program and I matched at a very good fellowship with history of sending their grads into academic practice. You'll be fine, get some research, if not at your own program then collaborate with other programs in the area. Perhaps do an elective at a high powered place if your program allows it and get some good letters.

 

[OrthoTraumaMD]

I'm looking to stay in academic medicine, so I'd like to get into a good fellowship program. If the application boils down to who's writing my LOR, who's making the calls, and research, I don't know how this bodes for me as I don't think people at my future residency has good connections..

Again. You matched ortho. The major battle is over. Now your goal should be mastering your craft, not getting fellowship. Everything else will sort itself out in time.

 

[broken_gymnast]

@OrthoTraumaMD and @DarkHorizon Thank you guys for answering questions! Is there anything that you guys wish you knew ahead of time during medical school to better prepare your future for ortho??

 

[OrthoTraumaMD]

@OrthoTraumaMD and @DarkHorizon Thank you guys for answering questions! Is there anything that you guys wish you knew ahead of time during medical school to better prepare your future for ortho??

I think I had a sense of how difficult a surgical residency would be on my personal life, but nothing can really prepare you for living it. If you don't have physicians in your family, make sure they are aware that for five years, you may not be attending all the gatherings, holidays, etc. It is particularly tough for non-medicine spouses. They "go through" residency almost as much as you do, and you need to keep sight of that, so you don't end up resenting them for complaining that you are never home. You need to be emotionally supportive of them just as much as they are of you. It is a tough road; keep your eyes on the prize.

 

[DarkHorizon]

@OrthoTraumaMD and @DarkHorizon Thank you guys for answering questions! Is there anything that you guys wish you knew ahead of time during medical school to better prepare your future for ortho??

I was somewhat of an orthogunner, so I followed the basic formula (boards/research/hanging out with Ortho residents on call in my free time/reading up netters/handbook for anatomy classifications). In the end, it worked out fine. I knew I wanted Ortho pretty early on so I focused in early, perhaps even had a tunnel vision. In retrospect, I wish I had paid more attention in my other rotations and learned a bit more of medicine and general surgical patient management. I guess that's the price you pay for trying to get into a hyper competitive field. If I were to do it again, I would try to be more well rounded as this is your only chance to learn any thing other than Ortho, because once residency starts, it really is just Ortho. They are not kidding when they say you'd feel uncomfortable even using a stethoscope.

 

[CHICK-FIL-A>POPEYES>KFC]

How realistic or hard is it that an ortho surgeon with a sports medicine fellowship would be able to work with either a college or professional team? Thanks in advance!

 

[Frogger27]

I was somewhat of an orthogunner, so I followed the basic formula (boards/research/hanging out with Ortho residents on call in my free time/reading up netters/handbook for anatomy classifications). In the end, it worked out fine. I knew I wanted Ortho pretty early on so I focused in early, perhaps even had a tunnel vision. In retrospect, I wish I had paid more attention in my other rotations and learned a bit more of medicine and general surgical patient management. I guess that's the price you pay for trying to get into a hyper competitive field. If I were to do it again, I would try to be more well rounded as this is your only chance to learn any thing other than Ortho, because once residency starts, it really is just Ortho. They are not kidding when they say you'd feel uncomfortable even using a stethoscope.

Hanging out with ortho residents on call?? Haha when did you start that? Did you just tell them you wanted to come in and shadow them regardless of time?

 

[DarkHorizon]

Hanging out with ortho residents on call?? Haha when did you start that? Did you just tell them you wanted to come in and shadow them regardless of time?

If you start attending grand rounds and doing research as an M1, you get your foot in the door. Once you're closer to some of the residents, they are more than happy for you to hang out when they are on call. It wasn't to brown nose, was truly an opportunity for me to learn.

 

[OrthoTraumaMD]

How realistic or hard is it that an ortho surgeon with a sports medicine fellowship would be able to work with either a college or professional team? Thanks in advance!

College team, likely, especially if you work for an academic practice. Professional, very rare, and definitely not gonna be "team doc" if you're just starting out.

 

[Astra]

top 5 music albums.

top 5 tv shows

top 5 movies?

 

[OrthoTraumaMD]

top 5 music albums.

top 5 tv shows

top 5 movies?

Happy to answer personal qns, but only if relevant to ortho somehow.

 

[porc]

Do you see orthopaedic surgery changing in the next 5-10 years and if so, how?

 

[OrthoTraumaMD]

Do you see orthopaedic surgery changing in the next 5-10 years and if so, how?

It is always changing. I see a great deal of implant innovation, smaller incisions, biological adjuvant development. Within trauma, more Level 2 centers with ortho trauma staffing, so the level 1 centers' trauma volumes will likely decrease overall because there are not enough cases to go around. I also see increasing levels of specialization, where generalists are being phased out.

 

[barack_yomama]

I'm an incoming medical student, and I'm interested in ortho (as well as other types of surgery). My undergraduate degree is in math, and I also have experience in programming/computer science.

Are there areas of ortho research (accessible to students) in which these skills might be useful?

 

[OrthoTraumaMD]

I'm an incoming medical student, and I'm interested in ortho (as well as other types of surgery). My undergraduate degree is in math, and I also have experience in programming/computer science.

Are there areas of ortho research (accessible to students) in which these skills might be useful?

Many orthopaedic departments have a biomechanics lab. Those projects typically use/involve engineering and mathematical principles. I think that's your best bet.

 

[YoungDoc25]

As an incoming M1, what are some things that you would encourage to get started on if interested in ortho? I have a home program with 4 spots and 2-3 of those have historically gone to in house students over the last 4 years. I have planned on attending some conferences to begin hopefully making some connections and being a familiar face. Maybe shadowing as well (not trying to get pimped as an M1 though )? Other than that and research, is there anything you did or wish you would have done to make yourself competitive?

 

[OrthoTraumaMD]

As an incoming M1, what are some things that you would encourage to get started on if interested in ortho? I have a home program with 4 spots and 2-3 of those have historically gone to in house students over the last 4 years. I have planned on attending some conferences to begin hopefully making some connections and being a familiar face. Maybe shadowing as well (not trying to get pimped as an M1 though )? Other than that and research, is there anything you did or wish you would have done to make yourself competitive?

Definitely attend conferences. Also meet with the program director and ask them what you can do in terms of helping out. Other than research, usually people have QI projects that residents don't want to do, and med students can be really helpful. Also ask if there are any faculty members who are busy and could use an extra hand in the OR. But as an M1, I wouldn't worry too much. Just get yourself set up for some research, and keep your mind open.

 

[YoungDoc25]

Definitely attend conferences. Also meet with the program director and ask them what you can do in terms of helping out. Other than research, usually people have QI projects that residents don't want to do, and med students can be really helpful. Also ask if there are any faculty members who are busy and could use an extra hand in the OR. But as an M1, I wouldn't worry too much. Just get yourself set up for some research, and keep your mind open.

Thank you! Definitely keeping my mind open! By QI projects, you mean quality improvement, right? There's so many abbreviations used on here, and it's hard to keep them all straight sometimes

 

[GonefromTX]

I might be getting a short break and a psych rotation before my M3 ortho elective. I would like to use this time to pre-read materials for ortho. Is there any text you'd recommend that can help me better answer your pimping questions and doing well on the boards?

 

[OrthoTraumaMD]

Thank you! Definitely keeping my mind open! By QI projects, you mean quality improvement, right? There's so many abbreviations used on here, and it's hard to keep them all straight sometimes

Yes quality improvement. Sorry

 

[OrthoTraumaMD]

I might be getting a short break and a psych rotation before my M3 ortho elective. I would like to use this time to pre-read materials for ortho. Is there any text you'd recommend that can help me better answer your pimping questions and doing well on the boards?

I answered this elsewhere on this thread, but it depends on what subspecialty you're rotating with. I would actually recommend the OrthoBullets website, quick and easy reference. Otherwise Hoppenfeld's physical exam book, it's gold.

 

[Jalby]

Do you hate the fact radiologists get paid to read X-rays when you get the reports a long time after you already reviewed it yourself and decided what you are going to do???

Asking for a friend.

 

[OrthoTraumaMD]

Do you hate the fact radiologists get paid to read X-rays when you get the reports a long time after you already reviewed it yourself and decided what you are going to do???

Asking for a friend.

Haha, no. I actually talk to radiologists quite a bit, especially on more nuanced things like MRIs. A good MSK radiologist is invaluable as a resource; plus, they can aspirate/inject things under fluoro or CT, something I frequently take advantage of.
However, I will say I always get a good laugh from reviewing xray reports that are read as either negative or totally different from the actual orthopaedic read. My favorite is when things are clearly not healing and the plate/screws are all pulling out... "no change in alignment, healing well." Or "maybe fracture, maybe not, please correlate clinically."

 

[yoyoni]

Hi @OrthoTraumaMD! What sorts of cases are most common for you as an orthopedic trauma surgeon? And what drew you to ortho?