Ortho Oncology

[jls34]

Hi all, I'm currently a 3rd year med student exploring different possibilities for a career in oncology. Amongst the different forms of surgical oncology (i.e. neurosurgery, surg onc, ENT, gyn onc, etc.), ortho onc seems to stand out in the "fun" factor of the cases in the sense that you're not just popping out a tumor (a gross simplification I know...), but that you also have to reconstruct joints and do a variety of cool things to preserve the limb you're operating on. It seems like it'd be a pretty gratifying surgical career for someone interested in oncology.

That being said, I've never actually had any firsthand exposure to a case. I was wondering for those in this forum who have had some exposure, are the ortho onc cases as cool as they sound on paper? Also, if someone completes an ortho onc fellowship, can they operate on both kids and adults without a formal peds fellowship given the rarity of musculoskeletal tumors? Finally, I've heard anectdotally that ortho onc is a bit less lifestyle friendly than some of the other ortho sub-specialties. Does anyone have insight into the kind of work-life balance ortho onc attendings in academic centers are able to have?

I understand that to really get a grasp of the field I'll probably need to do an elective rotation. In the meantime I'd really appreciate any insight that you all have. Thanks in advance!

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[DHT]

Tumor cases are badass. They do operate on both children and adults (at least at my institution) without a peds fellowship. I think the lifestyle for ortho onc is pretty good (as far as ortho goes) because there are not very many oncologic emergencies. I think they are typically as busy as they want to be (or can be). I find onc patients to be extremely grateful for your services as they have a different outlook on life now that their mortality is in question. Also, if you like trauma surgery but don't like trauma patients (you'll know what I mean when you do your trauma rotations), ortho onc does trauma like cases for pathologic fractures and impending fractures which are pretty fun too.

Drawbacks for ortho onc: There are only a few jobs available each year and are always at big academic centers. This means that you need to be flexible on where you live and want to live in big cities or near hospitals with LARGE catchment areas. If you are someone who must live around family, it may not be the specialty for you. Also, occasionally kids die, which sucks (but in general the outcomes are pretty good as far as cancer surgery goes).

 

[ddmo]

I'm definitely biased, since I am an orthopaedic oncology fellowship applicant currently, however orthopaedic tumor is the coolest surgical onc field.

As mentioned above, the cases can be totally bad ass. It is nice because there is a lot of variety. Everything from small lumps and bumps like lipomas, to hemipelvectomy amputations and complex reconstructions. It takes true ingenuity to try to find solutions to orthopaedic oncology problems, many times there is no technique guide. Getting the tumor out is only part of the problem in regards to limb preservation.

All orthopaedic oncologists operate on children and adults. Also, they operate all over the body. Limbs, pelvis, and some even do spine.

Regarding lifestyle, I would say it is one of the more lifestyle friendly fields in orthopaedics. There are few reasons to need to operate urgently, and as mentioned most jobs are academic type positions. There is a disproportionate number of ortho oncologists who are program chairmen or residency program directors, likely as a result of this.

Of course your patients may die, however this field of orthopaedics really is about saving lives and lifestyles. The bond between a tumor doctor and their patients is unparalleled in my experience.

 

[corona 247]

what about reinbursement/annual salary of ortho onc docs vs other ortho subspecialists?

I'm definitely biased, since I am an orthopaedic oncology fellowship applicant currently, however orthopaedic tumor is the coolest surgical onc field.

As mentioned above, the cases can be totally bad ass. It is nice because there is a lot of variety. Everything from small lumps and bumps like lipomas, to hemipelvectomy amputations and complex reconstructions. It takes true ingenuity to try to find solutions to orthopaedic oncology problems, many times there is no technique guide. Getting the tumor out is only part of the problem in regards to limb preservation.

All orthopaedic oncologists operate on children and adults. Also, they operate all over the body. Limbs, pelvis, and some even do spine.

Regarding lifestyle, I would say it is one of the more lifestyle friendly fields in orthopaedics. There are few reasons to need to operate urgently, and as mentioned most jobs are academic type positions. There is a disproportionate number of ortho oncologists who are program chairmen or residency program directors, likely as a result of this.

Of course your patients may die, however this field of orthopaedics really is about saving lives and lifestyles. The bond between a tumor doctor and their patients is unparalleled in my experience.

 

[ddmo]

Regarding reimbursement, it depends a lot on your practice. Private vs academic and whether you limit your practice to tumor.

Many tumor people are academic since orthopaedic oncology is a very specialized field that requires a large referral base and is academically oriented. In an academic setting they make less than private, but equal to what other academic surgeons make.

In a private type setting, many will supplement their income by doing either joint replacements or trauma in addition to tumor.

 

[anon311]

How about in terms of job prospects? Do you feel that deciding on tumor is more or less tantamount to giving up control over where in the country you'll live afterwards? It seems like there are only a handful of jobs in each city and I would guess that people would all prefer to live in the same ones.

 

[ddmo]

Correct, you are limited in locations for tumor. Since you only need a couple per state, most tend to live in urban or metropolitan areas. At any given time there are only a handful of positions in the country. But the pipeline to tumor is small with only 14 fellowships in the country +- a couple in a given year.

 

[maxheadroom]

Non-BoneDoc here, so take my advice with a grain of salt. I'd advise you find the area of surgery (Neurosurg, Ortho, ENT) that you like before you decide on the Onc subcategory.

 

[coastal]

How competitive are the fellowships to obtain?

I'm intrigued by oncology - I love trauma but have determined working with those patients would turn me into an a-hole. I'm also more of a cold trauma guy - there's nothing appealing about putting on an ex-fix at night.

We don't rotate through oncology at my institution so our exposure is limited. The limited cases I have seen though seem to indicate that it would certainly provide complex cases that require ingenuity to do well - this appeals.

 

[skiz knot]

How competitive are the fellowships to obtain?

I'm intrigued by oncology - I love trauma but have determined working with those patients would turn me into an a-hole. I'm also more of a cold trauma guy - there's nothing appealing about putting on an ex-fix at night.

We don't rotate through oncology at my institution so our exposure is limited. The limited cases I have seen though seem to indicate that it would certainly provide complex cases that require ingenuity to do well - this appeals.

Trauma patients can be extremely demanding/entitled/non-compliant, especially the ones that don't have jobs/insurance/intelligence. They can be difficult to get along with at times, however those are truly the minority. You can absolutely make a huge difference in somebody's life after saving their life/limb, and most are very appreciative.

Also, the number of middle of the night ex-fixes continues to go down, and in our residency (a busy level 1 center) they have become relatively rare.

 

[ddmo]

It's usually not too difficult to get a fellowship in whatever ortho field interests you. The difficult thing may be getting a good program.

The competitiveness of onc depends on how many people apply in a given year since there are not many positions. Usually US grads don't have a problem matching.

 

[Green Grass]

It's usually not too difficult to get a fellowship in whatever ortho field interests you. The difficult thing may be getting a good program.

The competitiveness of onc depends on how many people apply in a given year since there are not many positions. Usually US grads don't have a problem matching.

Are all 14 onc fellowships created equal (i.e. are some better than others)?

 

[corona 247]

Academic vs private positions? I would imagine most or academic. What are all your experiences with private ortho oncs in terms of practice setup, and case load/diversity (onc vs non-onc type cases).
Thx

 

[coastal]

Trauma patients can be extremely demanding/entitled/non-compliant, especially the ones that don't have jobs/insurance/intelligence. They can be difficult to get along with at times, however those are truly the minority. You can absolutely make a huge difference in somebody's life after saving their life/limb, and most are very appreciative.

Also, the number of middle of the night ex-fixes continues to go down, and in our residency (a busy level 1 center) they have become relatively rare.

Agree, ex-fixes are going down where I'm at too. I find when I'm on trauma that, for whatever reason, it becomes much less about the patient and more about how well I can fix something. It does something to me, brings out more OCD than usual, and it carries over into my personal life (as per my wife). I guess that's why oncology has an appeal because I can be as OCD as I want and it is still 100% about the patient not about my technical skills. Anyways, we'll see.

 

[coastal]

It's usually not too difficult to get a fellowship in whatever ortho field interests you. The difficult thing may be getting a good program.

The competitiveness of onc depends on how many people apply in a given year since there are not many positions. Usually US grads don't have a problem matching.

Okay, thanks. I'm from up north, but we tend to do okay when we try to match stateside. Good luck in the match this year.