ortho attending AMA

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ekmf27050 said:
Thanks! I've read back on your previous responses for med student prep to be competitive for ortho residencies. For M1, obviously my first priority will be settling in academically and (hopefully) putting myself in a good position for the boards.
In addition to this, it seems like my focus should be finding ortho clinical research- and hopefully, through that research, a department mentor. Is that accurate? Is there anything else that you would view as very important for M1/M2 to put students on a solid path for residency apps?

(Apologies if previously addressed and I missed it)
Click to expand...

Yes. That’s fairly accurate.


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pbrocks15 said:
@OrthoTraumaMD

I think it would be awesome if a moderator or someone went through and dug all the Q&A's and made them a sticky at the beginning of this thread. This has become so helpful for so many students. Just reading back at your answers and others (@VincentAdultman), there is a lot of wisdom in here.
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Thank you. When I started this thread, I wasn’t sure how it would go, but now it’s been running for more than a year, and is getting up there in views 🙂.... I’m happy to provide some sort of useful service to you guys. As for the sticky, this whole thread is basically Q and A so I’m not sure how that would work...


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OrthoTraumaMD said:
Thank you. When I started this thread, I wasn’t sure how it would go, but now it’s been running for more than a year, and is getting up there in views 🙂.... I’m happy to provide some sort of useful service to you guys. As for the sticky, this whole thread is basically Q and A so I’m not sure how that would work...


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Click to expand...

Even if someone were to pool the questions and answers together and give them to you and you can copy and paste them into the opening post, that would be extremely helpful. If I had more time on my hand (I say this as I procrastinate) I would definitely do it. I think that a lot of what you've said relates to all medical students even though there is a good deal that is ortho specific most can be taken by any student as great advice regardless of their speciality interest.

Maybe someone will read this, be moved and do it... 🙂
 
What is your advice on finding a mentor? I am on a good research project but it is with the chair of a massive department who doesn't have much time for med students so I am hoping to find a mentor with a bit more of an interest in teaching.
 
Arewestilldoingphrasing? said:
What is your advice on finding a mentor? I am on a good research project but it is with the chair of a massive department who doesn't have much time for med students so I am hoping to find a mentor with a bit more of an interest in teaching.
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Ask the residents. They will know which attending is the most interested in teaching. Some residents may even have you tack onto one of their projects and get you connected with their own mentors if they like you.


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Hi @OrthoTraumaMD I have wondered about the use of the lead vests in orthopedic surgery. I get that it protects your torso but with all the x rays that orthos work with dont you need something to protect your head, legs, and arms as well?
 
Aspiring O said:
Hi @OrthoTraumaMD I have wondered about the use of the lead vests in orthopedic surgery. I get that it protects your torso but with all the x rays that orthos work with dont you need something to protect your head, legs, and arms as well?
Click to expand...

Yes, you need your gonads protected too. We wear either aprons or a vest+skirt as well as thyroid shield. My glasses are also lead protected. Otherwise it would be cumbersome to have everything be lead-lined, and impractical, as lead is heavy and you need to move around when you operate. So arms head and lower legs are not protected. We wear radiation badges to make sure that our cumulative dose doesn’t go over limit, but realistically an average surgeon will not accumulate enough radiation in a year to be dangerous as long as sensitive organs (eyes, thyroid, gonads) are protected.


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Hi @OrthoTraumaMD , thank you for taking the time to share your insights with us. I'm a PGY4 going into trauma and was wondering what you thought were the best courses (AO advanced, OTA resident's course, SAIF courses, etc.) for a resident to complete before fellowship. Also, any thoughts as to which courses would be good to attend as a fellow in a few years? Thank you!
 
bonez said:
Hi @OrthoTraumaMD , thank you for taking the time to share your insights with us. I'm a PGY4 going into trauma and was wondering what you thought were the best courses (AO advanced, OTA resident's course, SAIF courses, etc.) for a resident to complete before fellowship. Also, any thoughts as to which courses would be good to attend as a fellow in a few years? Thank you!
Click to expand...

Most trauma fellowships will send you to two courses, usually the AO pelvic course and another course of your choice. Often you will not have much choice in what to attend as a fellow. I would go to any pelvic course that you can, and the Boston fellows course is good too.

As a resident, just make sure you do AO basic because that’s the gateway to a lot of other stuff. Otherwise the saif courses are excellent.


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What are your thoughts on radiation exposure in ortho?
 
Erickem said:
How many weeks vacation do you get a year?
Click to expand...

I am “allowed” 4 because of my status, but I usually don’t take them all. I use vacation days sporadically during the year for small conferences when my CME runs out. Fortunately in my place, vacation days accrue up to a point so I have an extra week left over from last year 🙂


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Last edited:
I don't know why I have tech on the brain, but it brought these questions to mind:

-If you could *magically* create one piece of tech for your field, what would it be for? Ie, where do you find the largest need for a new invention- something surgical, postop, non-surgical patients, etc

-Do you have any opinion on bone stim for fractures? My BME masters friend and I were discussing them the other night and there seems to be a lack of convincing data IMO. Does your department use them much for fractures?
 
ekmf27050 said:
I don't know why I have tech on the brain, but it brought these questions to mind:

-If you could *magically* create one piece of tech for your field, what would it be for? Ie, where do you find the largest need for a new invention- something surgical, postop, non-surgical patients, etc

-Do you have any opinion on bone stim for fractures? My BME masters friend and I were discussing them the other night and there seems to be a lack of convincing data IMO. Does your department use them much for fractures?
Click to expand...

First question: something that could regrow missing bone, like skele-gro in Harry Potter.

Second question: I do not use it. Data is shoddy and no good randomized trials.


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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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What is your opinion on SLAP repairs (glenoid region). Do you feel they’re significantly more effective for recreational athletes relative to physical therapy?
 
Syncrohnize said:
What is your opinion on SLAP repairs (glenoid region). Do you feel they’re significantly more effective for recreational athletes relative to physical therapy?
Click to expand...

I am not a sports surgeon, so I’m not sure. I asked my friend who is, and he said: “Yes. Slap in a young person needs to be fixed. Very controversial if you fix and tenodesis as well. In young people I do fix only.”


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A couple more questions for when you have time 🙂

1) Do you perform a significant amount of revision-type surgeries for things like failure to heal or excess scar tissue that limits function?

2) If you had to put a rough estimate to it, in your current position, what % of your surgeries are:
emergent trauma/operating right now
vs.
outpatient/less critical trauma
vs.
repeat/revision surgeries for previous traumas?

3) I'm curious about the spectrum of surgical cases going to trauma ortho vs. other subspecialties like foot/ankle or hand. For example, the circumstances in which a trauma surgeon would handle an ankle fracture instead of the foot/ankle surgeon, and vv. Does that depend on surgeon preference and institutional protocol, or is it more of a clinical guidelines based decision?

Also, thanks for continuing to answer these questions!!
 
OrthoTraumaMD said:
The changes in our healthcare system will kill private practices, but not hospital based people like me.
Click to expand...

Do you think this also holds true of large multispecialty practices that own their own ASCs and have economies of scale to afford the burdensome regulatory requirements? If I took the plunge to do ortho rather than something that requires much less commitment like EM or hospitalist medicine, I'd definitely want to be in for a penny in for a pound, in other words have ownership of the facilities and ancillary streams that bring in the bulk of the revenue, not just the professional fee. If private practice becomes entirely impossible then obviously such aspirations are moot, but I'm hoping that in some parts of the country the more resilient PP models will be able to survive. What are your thoughts on that?
 
When people in your field refer to the unhappy triad do they mean ACL, MCL, medial meniscus (O’donoghues) or the more common ACL, MCL, and lateral meniscus?

My school taught us it as the ACL, MCL, medial meniscus, but from what I’ve read the lateral meniscus is apparently more common. Or is the term “unhappy triad” not really used in the clinical setting?

Also as a first year if you had to choose between getting involved in biomechanics research or more clinical research/case write ups. Which would you choose and why?
 
Brahnold Bloodaxe said:
Do you think this also holds true of large multispecialty practices that own their own ASCs and have economies of scale to afford the burdensome regulatory requirements? If I took the plunge to do ortho rather than something that requires much less commitment like EM or hospitalist medicine, I'd definitely want to be in for a penny in for a pound, in other words have ownership of the facilities and ancillary streams that bring in the bulk of the revenue, not just the professional fee. If private practice becomes entirely impossible then obviously such aspirations are moot, but I'm hoping that in some parts of the country the more resilient PP models will be able to survive. What are your thoughts on that?
Click to expand...

I think the era of the single private practice orthopod hanging his shingle is over. The big multispecialty groups can still survive as long as they, as you said, own the facilities and ancillary services. But I am seeing a strong push by big health systems (Pitt comes to mind) to absorb these practices as they partner with insurance companies to create these conglomerates. I'm sorry, I don't know enough about private practice, but I think in some parts of the country it will be easier to do than others.
 
Scrubs101 said:
When people in your field refer to the unhappy triad do they mean ACL, MCL, medial meniscus (O’donoghues) or the more common ACL, MCL, and lateral meniscus?

My school taught us it as the ACL, MCL, medial meniscus, but from what I’ve read the lateral meniscus is apparently more common. Or is the term “unhappy triad” not really used in the clinical setting?

Also as a first year if you had to choose between getting involved in biomechanics research or more clinical research/case write ups. Which would you choose and why?
Click to expand...
I have no idea what that is, stop asking sports questions, haha! Not a sports doc. So no, I've never heard that term in clinical practice.
All my research is clinical because it is, in my mind, more interesting. If it's a relatively short biomechanics project, like with cadavers, that doesn't drag on forever I think it's good, but it would depend on the project. I would try to understand each option and get a projected timeline so that I wouldn't be working on something that would not yield a meaningful publication by the time I applied.
 
ekmf27050 said:
A couple more questions for when you have time 🙂

1) Do you perform a significant amount of revision-type surgeries for things like failure to heal or excess scar tissue that limits function?

2) If you had to put a rough estimate to it, in your current position, what % of your surgeries are:
emergent trauma/operating right now
vs.
outpatient/less critical trauma
vs.
repeat/revision surgeries for previous traumas?

3) I'm curious about the spectrum of surgical cases going to trauma ortho vs. other subspecialties like foot/ankle or hand. For example, the circumstances in which a trauma surgeon would handle an ankle fracture instead of the foot/ankle surgeon, and vv. Does that depend on surgeon preference and institutional protocol, or is it more of a clinical guidelines based decision?

Also, thanks for continuing to answer these questions!!
Click to expand...

1) None of my patients have failed, what are you talking about? ^_^ Jk.... the real answer is <0.5% on my own cases, thankfully. I am of the opinion that to know WHEN to be in the OR is vastly more important than knowing how to operate. Thus, I treat many fractures nonop, even if it's not "in vogue." Clavicles come to mind. I think I would have more complications if I didn't consider each patient carefully, and only take them to surgery if I felt I would somehow improve function more than nonop. Sometimes I will see patients who come to me for second opinions and I'm like, why the f--- did they get operated on in the first place?
2) emergent 89.5% (including staged procedures or what you call "repeat surgeries"), outpatient 10%, revision 0.5%. Never for "scar tissue." That's solved with PT, unless it's a really busted quadriceps that needs release, and I've only seen that a few times in my life.
3) It depends on the practice. I take control of all fractures and give away things I don't think I can handle. I do basically anything except the really smashed up feet (multiple midfoot fractures, fusions etc), and smashed up hands (ligamentous injuries, carpus, and some fingers). The reality is that foot and ankle guys are better suited/trained to do elective stuff, and the fractures should be left to us. But not all foot and ankle guys feel that way obviously.
 
OrthoTraumaMD said:
I have no idea what that is, stop asking sports questions, haha! Not a sports doc. So no, I've never heard that term in clinical practice.
All my research is clinical because it is, in my mind, more interesting. If it's a relatively short biomechanics project, like with cadavers, that doesn't drag on forever I think it's good, but it would depend on the project. I would try to understand each option and get a projected timeline so that I wouldn't be working on something that would not yield a meaningful publication by the time I applied.
Click to expand...
Haha will do, thank you! I dont have any options on the table just yet but have a history in biomechanics projects so i figured it might be easier for me to get involved. From what I can tell the biomechanics people at my school publish much less frequently than those pushing out clinical papers. But still decently active to the point where spending the rest of my pre-clinical years doing a biomechanics project i may be able to produce something. Currently in a research elective where at the end of the semester they try and set us up with a researcher and the rest of the class throughout preclinical is just credits for research hours and ive never really done official research before so in the end ill probably just end up taking what i can get haha both seem interesting to me so that wont really be an issue
 
Scrubs101 said:
Haha will do, thank you! I dont have any options on the table just yet but have a history in biomechanics projects so i figured it might be easier for me to get involved. From what I can tell the biomechanics people at my school publish much less frequently than those pushing out clinical papers. But still decently active to the point where spending the rest of my pre-clinical years doing a biomechanics project i may be able to produce something. Currently in a research elective where at the end of the semester they try and set us up with a researcher and the rest of the class throughout preclinical is just credits for research hours and ive never really done official research before so in the end ill probably just end up taking what i can get haha both seem interesting to me so that wont really be an issue
Click to expand...

The other thing you may consider is that unless a residency interviewer is very familiar with biomechanics, they may not be able to ask you a lot of questions about your research. At least try to have one clinical project under your belt so that you have something to talk about with them. Just based on my own experience both as an interviewee and an interviewer.


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OrthoTraumaMD said:
The other thing you may consider is that unless a residency interviewer is very familiar with biomechanics, they may not be able to ask you a lot of questions about your research. At least try to have one clinical project under your belt so that you have something to talk about with them. Just based on my own experience both as an interviewee and an interviewer.


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Click to expand...

I will keep that in mind! Thanks for the advice, as always its greatly appreciated 👍🙂
 
Lawper said:
Which term do you prefer (besides "ortho"): orthopedics or orthopaedics?

What about pediatrics or paediatrics?
Click to expand...

I can’t comment on peds cause I’m not in that field.
As for ortho, it’s orthopaedics. End of discussion. Orthopedics is only if you’re ignorant or can’t spell.


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OrthoTraumaMD said:
1) None of my patients have failed, what are you talking about? ^_^ Jk.... the real answer is <0.5% on my own cases, thankfully. I am of the opinion that to know WHEN to be in the OR is vastly more important than knowing how to operate. Thus, I treat many fractures nonop, even if it's not "in vogue." Clavicles come to mind. I think I would have more complications if I didn't consider each patient carefully, and only take them to surgery if I felt I would somehow improve function more than nonop. Sometimes I will see patients who come to me for second opinions and I'm like, why the f--- did they get operated on in the first place?
2) emergent 89.5% (including staged procedures or what you call "repeat surgeries"), outpatient 10%, revision 0.5%. Never for "scar tissue." That's solved with PT, unless it's a really busted quadriceps that needs release, and I've only seen that a few times in my life.
3) It depends on the practice. I take control of all fractures and give away things I don't think I can handle. I do basically anything except the really smashed up feet (multiple midfoot fractures, fusions etc), and smashed up hands (ligamentous injuries, carpus, and some fingers). The reality is that foot and ankle guys are better suited/trained to do elective stuff, and the fractures should be left to us. But not all foot and ankle guys feel that way obviously.
Click to expand...
Believe it or not, I actually was talking about second opinion cases... 😉 And/or ones where people had a trauma surgery years back but are now having new or recurrent problems.

And thanks for the info! I'm getting a better picture of what trauma ortho encompasses and it seems really interesting.
 
Scrubs101 said:
When people in your field refer to the unhappy triad do they mean ACL, MCL, medial meniscus (O’donoghues) or the more common ACL, MCL, and lateral meniscus?

My school taught us it as the ACL, MCL, medial meniscus, but from what I’ve read the lateral meniscus is apparently more common. Or is the term “unhappy triad” not really used in the clinical setting?

Also as a first year if you had to choose between getting involved in biomechanics research or more clinical research/case write ups. Which would you choose and why?
Click to expand...
I would argue that any knee with multiple ligament tears is an unhappy knee :laugh:

(but yes, I know it's an actual thing... my admittedly inexperienced understanding from working in a sports ortho office was ACL+MCL+medial meniscus)
 
ekmf27050 said:
I would argue that any knee with multiple ligament tears is an unhappy knee :laugh:

(but yes, I know it's an actual thing... my admittedly inexperienced understanding from working in a sports ortho office was ACL+MCL+medial meniscus)
Click to expand...

Haha i would definitely agree with that! And awesome thank you!!
 
ekmf27050 said:
Believe it or not, I actually was talking about second opinion cases... 😉 And/or ones where people had a trauma surgery years back but are now having new or recurrent problems.

And thanks for the info! I'm getting a better picture of what trauma ortho encompasses and it seems really interesting.
Click to expand...

Haha... for revision, my number still stands. It includes second opinions


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How many pubs would you consider to be "enough" for ortho? And do they have to be in orthopaedics?
 
Dr. Scribe said:
How many pubs would you consider to be "enough" for ortho? And do they have to be in orthopaedics?
Click to expand...

Depends on the program. Most people don’t publish in journals, they count presentations or abstracts as research. But if actual article, then 1-3 is good. At least one in Ortho, preferably all of them.


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OrthoTraumaMD said:
Depends on the program. Most people don’t publish in journals, they count presentations or abstracts as research. But if actual article, then 1-3 is good. At least one in Ortho, preferably all of them.


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Click to expand...
Thanks for the reply.

What sort of background is usually required for a med student to conduct ortho research? I’m assuming one wouldn’t be doing things like PCR and cell passaging, right?

I’m just sort of confused as to what clinical research entails and what skills one needs to play a role in it.
 
Dr. Scribe said:
Thanks for the reply.

What sort of background is usually required for a med student to conduct ortho research? I’m assuming one wouldn’t be doing things like PCR and cell passaging, right?

I’m just sort of confused as to what clinical research entails and what skills one needs to play a role in it.
Click to expand...

No major skills. Drive. Knowledge of excel perhaps. Statistics helps but most places have a statistician that calculates those things. Clinical research for a student usually includes data collection, mining charts... or maybe some cadaver work, which they will teach you/tell you what to do. It’s easy.


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OrthoTraumaMD said:
Depends on the program. Most people don’t publish in journals, they count presentations or abstracts as research. But if actual article, then 1-3 is good. At least one in Ortho, preferably all of them.


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Click to expand...

Would you look at someone who has three papers where they're burried in the author list weaker than someone who has one first author study?
 
pbrocks15 said:
Would you look at someone who has three papers where they're burried in the author list weaker than someone who has one first author study?
Click to expand...

I think first author is good, but more important is that you can accurately define your role in the project, and seem informed about the topic.


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OrthoTraumaMD said:
Haha... for revision, my number still stands. It includes second opinions


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Click to expand...
Thankfully, most of the time bones heal, and patients, even if they have occasional pain now and then, usually don't want to go through surgery again, so second opinions are rare. More often, people see me when "routine" things don't heal. That's usually due to inadequate fixation, or, more often, a poor metabolic state (smoking, vitamin D deficiency, malnutrition, infection).
 
How far down the rank list does your program usually go?
 
iceman55 said:
How far down the rank list does your program usually go?
Click to expand...

To maintain anonymity, I will respond as an average of the programs where I've been involved in residency selection. Every program is different... on average they go down to #20 or so. Occasionally in the 30s. 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.
 
OrthoTraumaMD said:
To maintain anonymity, I will respond as an average of the programs where I've been involved in residency selection. Every program is different... on average they go down to #20 or so. Occasionally in the 30s. 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.
Click to expand...

So match day can be pretty stressful for PDs too, just like us applicants haha
 
]
OrthoTraumaMD said:
I think first author is good, but more important is that you can accurately define your role in the project, and seem informed about the topic.


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Click to expand...

I get the sense you have run into some students who know nothing at all about the papers that they're on, is that correct or far fetched?

I'm trying to gauge my research involvement because I don't go to a school that is incredibly research heavy and although I'm involved in research, I'll only have a few pubs under my belt come application time. I could though get more pubs if I tried but it has been an absolute pain in the butt trying to work with the people here. Should I take it a little easier and coast with the 2-3 ortho pubs, or continue really pursuing it and try to reach for me? Will it make a difference? I really enjoy research, just recently been fed up with the people at my institution not knowing or willing to really do anything (or they're incredibly slow).
 
pbrocks15 said:
]


I get the sense you have run into some students who know nothing at all about the papers that they're on, is that correct or far fetched?

I'm trying to gauge my research involvement because I don't go to a school that is incredibly research heavy and although I'm involved in research, I'll only have a few pubs under my belt come application time. I could though get more pubs if I tried but it has been an absolute pain in the butt trying to work with the people here. Should I take it a little easier and coast with the 2-3 ortho pubs, or continue really pursuing it and try to reach for me? Will it make a difference? I really enjoy research, just recently been fed up with the people at my institution not knowing or willing to really do anything (or they're incredibly slow).
Click to expand...

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


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