Jun 29, 2020
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Hi everyone,

These forums were incredibly helpful to me when I was applying to med schools about 10ish years ago. I learned so much and I just wanted to give back.

Brief background.
About to start my spine surgery fellowship. Just finished ortho residency last week.

Undergrad: State School
MD: Private School
Ortho Residency: Midwest
Spine Fellowship: West

Happy to answer any questions or just help out in any way.
 
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Jun 29, 2020
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its the greatest of all specialties!
You have trauma, tumor, degenerative, deformity, peds all in 1!
I also think each patient is like a puzzle and I love that. You have to be a good diagnostician first and foremost. The procedures are technically challenging. You can ask 20 different spine docs an opinion on how to manage something and get 20 different responses.
 
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What made you choose ortho over other surgical specialties?

What can ortho applicants without a home program do to be competitive for the match? Is ortho specific research necessary to match or is research in other fields sufficient?

How rough were residency hours compared to what you read about online?
 
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Jun 29, 2020
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What made you choose ortho over other surgical specialties?

What can ortho applicants without a home program do to be competitive for the match? Is ortho specific research necessary to match or is research in other fields sufficient?

How rough were residency hours compared to what you read about online?
I actually really liked every rotation I was on. When I was on peds I wanted to do peds, when I was on OB I could have sworn i'd be an obstetrician. I really thought I wanted to be a cardiologist too. I just loved everything. When I got into the OR I really liked it and I felt like I could understand ortho the most. I probably would have been just as happy in ENT, plastics, or Ophthalmology honestly. I also had a really good mentor who was in ortho and he took me under his wing and that kind of steered the ship so to speak.

I had 0 pubs going into the match. I did ortho research but it was eh... mediocre at best. I did interviews for future residents at my residency program and I can say most people had research, some had pubs, and alot of research was in other fields.

I had a home ortho program so I am not 100% sure how to address that one... but I'd definitely do aways and crush it. Really work hard and impress the residents. At our program the residents had a lot of say (usually good) about our rotators.

Residency hours were fine. I heard horrible, i expected horrible, and I got decent. Some days I got home at 10pm, some days I got home at 1pm (rare). I was home by 5-8pm most days on average. Probably averaged working every other weekend in some form or fashion (call or rounding). We had a night float system which really helped our junior years. I think most programs are going towards a nightfloat system as well for duty hours.
 

Miles Gloriosus

“ME-lace” not “Miles”
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Why spine?
its the greatest of all specialties!
You have trauma, tumor, degenerative, deformity, peds all in 1!
I also think each patient is like a puzzle and I love that. You have to be a good diagnostician first and foremost. The procedures are technically challenging. You can ask 20 different spine docs an opinion on how to manage something and get 20 different responses.

I think he also wanted to say that it’s the most $$$ of all the ortho specialties . The only one where doing fellowship will increase your income. All other fellowship choices either break even or lose money as compared to going straight general practice after residency
 
Jun 29, 2020
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I think he also wanted to say that it’s the most $$$ of all the ortho specialties . The only one where doing fellowship will increase your income. All other fellowship choices either break even or lose money as compared to going straight general practice after residency
the job market for spine in bigger cities is actually not great right now. Joints, F&A, Trauma jobs are everywhere. It's not always about making the most money. But thank you for quoting a recent paper without mentioning the nuances.
 

Miles Gloriosus

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Job market in all big cities is not great in general, spine is not an exception.

Sorry, here the paper.

 

slowthai

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In my gaff
I think he also wanted to say that it’s the most $$$ of all the ortho specialties . The only one where doing fellowship will increase your income. All other fellowship choices either break even or lose money as compared to going straight general practice after residency
Lol. If it's the same figure I'm thinking of, joints wins out too. Spine and joints were the highest by a significant amount.

Edit: Yeah, that's the one
 
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njtrimed

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I think he also wanted to say that it’s the most $$$ of all the ortho specialties . The only one where doing fellowship will increase your income. All other fellowship choices either break even or lose money as compared to going straight general practice after residency
I can’t imagine that a rising fellow in the field who is taking the time for a Q&A with current med students is in this for the money. Show some respect to those further along in their career who are offering real, pragmatic advice from experience.
 

Miles Gloriosus

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I can’t imagine that a rising fellow in the field who is taking the time for a Q&A with current med students is in this for the money. Show some respect to those further along in their career who are offering real, pragmatic advice from experience.
Apologize if it came out that way. Wasn’t implying OP was out for money alone. Just presenting a fact.
 

Frogger27

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Aug 2, 2016
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Hi everyone,

These forums were incredibly helpful to me when I was applying to med schools about 10ish years ago. I learned so much and I just wanted to give back.

Brief background.
About to start my spine surgery fellowship. Just finished ortho residency last week.

Undergrad: State School
MD: Private School
Ortho Residency: Midwest
Spine Fellowship: West

Happy to answer any questions or just help out in any way.
Thanks for doing this. Starting my Home Ortho AI in a couple of weeks. Obviously due to the lack of away rotations with COVID this is even more important given it is the only opportunity for letters this upcoming application cycle. What is your advice on how to rock it? Any tips/tricks you picked up both from the medical student and also the resident side?
 
Jun 29, 2020
19
56
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Fellow [Any Field]
Thanks for doing this. Starting my Home Ortho AI in a couple of weeks. Obviously due to the lack of away rotations with COVID this is even more important given it is the only opportunity for letters this upcoming application cycle. What is your advice on how to rock it? Any tips/tricks you picked up both from the medical student and also the resident side?
Oh wow, didnt realize they had cancelled away rotations! Sorry to hear that.
From a resident perspective here is how to shine and this is the stuff we would discuss as residents about rotators/home students.

1. Be nice. Orthopedic residency is 5 years. You can "learn" ortho in 5 years, you cannot learn how to not be an a***hole in 5 years. either you know it or not.
2. Be helpful. What I hate "can i roll out a splint for this ankle fracture you are going to reduce?" You already know the ankle fracture needs a splint, it is more helpful and proactive to say "I'm going to go roll out the splint in the ER for bed 2 if thats ok". Both demonstrate knowledge of what needs to happen, one is a bit more proactive and it shows.
3. Know about the floor patients and cases for the day. Likely you will get the schedule in advance, if you're on a busy service (trauma, joints, spine) - atleast where I trained, then you should show up early, round, and know about the patients. Print the list, etc. For cases, attendings usually arent going to ask you questions that you have no business knowing like what implant to use or how to balance a TKA. What they will ask you is anatomy. We had a med student who did not know the compartments of the leg - just to name them, not even the contents. Did not know the arteries of the leg...these are bad. These you should be able to know cold because you learn it in med school.
4. Research - you may as well do research since its your home program. Find an attending that pumps out papers, usually every academic institution has atleast one of these guys. Find them and latch on to them if you can. Say yes to every paper and work on them over the weekend.
5. Don't be late, dont ask to leave early.
6. in your pocket always have tape, trauma scissors, pen for consents.
7. Learn the workflow, likely you'll be shadowing or working with the junior resident the most. Especially if you are seeing ER consults. Learn the workflow. Do they do consents? if so, why not have the consent form available and in your pocket (unfilled out). Have a pen, maybe have the patients sticker available. Same with other small workflow items. The med students I really vouched for are the ones I missed when they left service just because they were so helpful and made my life easier. When I was on nightfloat my life was horrible, so anyone that made it easier I loved. Be loved.

Good luck!
 

cke11

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I was wondering if at your residency you had any rotations on orthopedic oncology. I know it’s a very niche field with not too many doctors in the country, but is something I’m interested in. I’m lucky to have an ortho onc at my home institution and wanted to know the types of cases that are their bread and butter? (I heard lots of amputations?)
 
Jun 29, 2020
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I was wondering if at your residency you had any rotations on orthopedic oncology. I know it’s a very niche field with not too many doctors in the country, but is something I’m interested in. I’m lucky to have an ortho onc at my home institution and wanted to know the types of cases that are their bread and butter? (I heard lots of amputations?)
We did have tumor. It's a great field and very niche. Essentially locking yourself into academics or big city jobs with a tumor fellowship. A lot of tumor docs I know ended up doing 2 fellowships. Obviously tumor but usually also either peds, joints, or trauma. You'll notice that alot of the bad tumors occur around joints (around the knee is super common), and reconstruction (joints) is super helpful here. They also occur a lot in kids, so you'll see peds/tumor. And trauma tumor because of the pelvic work and reconstruction/out of the box thinking.

Bread and butter cases are usually biopsies (there is an art to this), some amps - but not as common as you're thinking I imagine. And moreso small curettage/grafting/adjuvants for things like giant cell, or big whacks of osteosarc, ewings, chondrosarcs etc which would then require subsequent reconstruction in some form or fashion.

Its also one of the ortho fields where you tend not to "forget" medicine.
 
Jun 29, 2020
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Are you worried about increased cancer rates in your specialty due to use of fluoro
personally, no. I'd say that is a concern for trauma, hand, maybe foot and ankle. they use fluoro all the time, hand especially is very up close to the machine.

In Spine I can navigate which requires a preop ct + intraop 2 shots of fluoro OR intraop CT. All of which I'd be out of the room for. And other procedures dont require me to be standing next to the machine as much. Sports, joints, tumor rarely use intraop imaging.

Is it a concern, yes definitely. For me personally, less so.
 

ChymeofPassion

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From what you've seen from attendings, is it possible to maintain a relatively chill lifestyle as an Ortho? Something like 45-55 hours a week, minimal call, etc. Especially in private practice. Or is it still 60-70+. I've been told by attendings that medicine is changing in that way.
 
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Jun 29, 2020
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From what you've seen from attendings, is it possible to maintain a relatively chill lifestyle as an Ortho? Something like 45-55 hours a week, minimal call, etc. Especially in private practice. Or is it still 60-70+. I've been told by attendings that medicine is changing in that way.
yes and no. in PP you still have to produce for the group.No one likes a partner that wants to skate by with the minimum. WIth that in mind it is possible to have a reasonably good lifestyle. 1/2 days off per week, 2 OR days, 2 clinic days. Work 1/6 weekends, q6 call. probably average 55-60 hours a week. I have numerous friends/coresidents who have signed contracts like this (including myself). They exist, just likely not in the big cities.

Minimal call depends on what you consider minimal. I know someone in a small town thats Q1 call but rarely has any consults because his town is just so small. And I know people who are q6 or q7 who are slammed when they are on call. It depends.
 
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ChymeofPassion

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yes and no. in PP you still have to produce for the group.No one likes a partner that wants to skate by with the minimum. WIth that in mind it is possible to have a reasonably good lifestyle. 1/2 days off per week, 2 OR days, 2 clinic days. Work 1/6 weekends, q6 call. probably average 55-60 hours a week. I have numerous friends/coresidents who have signed contracts like this (including myself). They exist, just likely not in the big cities.

Minimal call depends on what you consider minimal. I know someone in a small town thats Q1 call but rarely has any consults because his town is just so small. And I know people who are q6 or q7 who are slammed when they are on call. It depends.
By 1/2 days off per week, I assume that is including the weekend. 1/6 weekends sounds sweet, so does q6 call.
 
Jan 9, 2019
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What kind of personalities do you think would excel in ortho? What qualities would you discourage? I'm not necessarily asking in the context of good or bad, more in terms of the right fit for the specialty. What are some things a medical student should consider when evaluating if ortho would be right for them?
 
Dec 26, 2018
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Current incoming ortho resident starting tomorrow... what are some things you recommend doing to get the most out of residency?
Also, did you have any time to exercise in residency? If I made it a priority would i be able to go 2-3 times a week .


Thanks!
 
Jun 29, 2020
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Current incoming ortho resident starting tomorrow... what are some things you recommend doing to get the most out of residency?
Also, did you have any time to exercise in residency? If I made it a priority would i be able to go 2-3 times a week .


Thanks!
Good luck! You'll love it. I would just say be prepared and read before cases. Its overwhelming but read as much as possible. When I was an intern one of the chiefs told me "do 20 questions of orthobullets a day" and I thought to myself how dumb that sounded. But I did it and it definitely helped for the OITE and general knowledge. Definitely worth it.
Also if you can listen to cornerstonecourses its super helpful as well.
Take notes after every case. I have a onenote file for every common surgery and I update it with notes, pictures etc. Helps to reference when you are left on your own to do a case towards the end of residency.

I definitely made it to the gym 3-4x a week all of residency except trauma.


What are your thoughts on choosing where to do away rotations?
I did mine exclusively based on cities. It worked for me. I would say if you want to live in a certain city then aim for that. Everyone has different strategies but I was happy with the way it worked out for me.

What kind of personalities do you think would excel in ortho? What qualities would you discourage? I'm not necessarily asking in the context of good or bad, more in terms of the right fit for the specialty. What are some things a medical student should consider when evaluating if ortho would be right for them?
I think the notion of an "ortho personality" is silly. I've met athletes, bros, bookworms, introverts, and any other personality type you can think of in EVERY FIELD of medicine. I've def met introverted orthopods and not "bro" orthopods. Yes ortho requires some force (think getting on top of the table/bed and reducing a hip in the ER) but technique wins over brute force every time. We've had athletic individuals in our program and less athletic. So anyone can succeed.
Ortho is right for you if you enjoy thinking of the MSK system and want to work with your hands. There is definitely a preconceived notion that all ortho is is fixing bones. While we do that, it definitely isn't ALL we do. There is a lot of nuances to ortho and to every subspecialty. Hand and spine you are working in millimeters (if not smaller for micro stuff in hand). Joints is big whacks but a lot of thought about angles and vectors. If you watch a good ortho trauma surgeon operate on blitzed intraarticular tibial plateau fracture you will be in awe of the amount of thinking and planning that goes in to it.
Watch a good spine deformity doc work and you will be amazed at the amount of correction they can achieve.
It truly is an incredible field and it is definitely not all "bone broken fix" that people think about.
To succeed you have to work hard and want it. If you are passive about your education you wont learn anything.
 
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By 1/2 days off per week, I assume that is including the weekend. 1/6 weekends sounds sweet, so does q6 call.
Sorry I missed this one.

half a day off during a weekday. Most weekends off unless you are on call or rounding. On call usually 1/6days or 1/6 weekends. Ive seen totally different. It just depends on the size of the group and what call expectations are. If the group is huge and you cover 1 hospital, you may be on call once a month. If the group is small or covers multiple hospitals you may be on call more.
There are no generalizations. But most ortho attendings I know have a pretty good lifestyle, and the ones that dont, do it by choice.
 

stickgirl390

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Do you think low 230s on Step 1 completely closes the door for ortho? Does having a home program like you mentioned really help balance a score that much?
 
Jun 29, 2020
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Do you think low 230s on Step 1 completely closes the door for ortho? Does having a home program like you mentioned really help balance a score that much?
I personally know 4 people sub 220 who matched into ortho. I'm sure there are a bunch of people 220-230 and 230-240 as well. It doesn't "completely" close the door but it does make it harder. you really have to stand out during your rotations or publish a lot.
 
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After training how many hours a week do you think you'll be working? I've heard of some spine surgeons who have really good lifestyles.
Hard to say. I imagine about 55-60 hours a week and who knows with call and covid. Thats my guess. I'm sure some weeks will be more and some less. I dont really keep track of the hours...even during residency I never paid attention to it. I just worked till I finished what I needed to get done.
 
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