Ortho Resident AMA

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Chillbo Baggins

Chillbo Baggins

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With the end of the ortho attending AMA thread (RIP), I thought it might be a good idea to let any curious souls pose their bone Qs here.

Feel me to ask about anything regarding me personally, or ortho in general. And of course, you should check out OrthoTraumaMD's thread for lots of additional info.

forums.studentdoctor.net

ortho attending AMA

Hi SDNers, I have some free time and so am happy to answer any questions you may have about the myths and realities of orthopaedics, resident life, and general questions. Just avoid the "what are my chances with score X" questions-- so many better posts and options on this site for that...
forums.studentdoctor.net forums.studentdoctor.net
 
what do you think is the most effective way to signal interest in a place we really would want to be at, ie would've rotated at if we could do 3 aways, but cant rotate at this year?
 
Type2Fiber said:
what do you think is the most effective way to signal interest in a place we really would want to be at, ie would've rotated at if we could do 3 aways, but cant rotate at this year?
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I think to an extent it depends on the reasoning of why it's high on your list. If for instance it's a location that's close to family/hometown, part of that would probably be evident on your application itself. If it's for program credentials/prestige, it may be worth looking into if anyone from your home program might have a connection there. I'm sure programs know away rotations are in flux again this year, so they may not factor it against you.

And of course, reaching out to the program's coordinator with your interest could give you some more consideration. I want to say some programs last year were doing like virtual away rotations, but I don't know any details.
 
Member10billion said:
How does it feel being so buff?
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I wish I could remember, at this point I've just succumbed to the dad bod.

Roxas said:
You neglected to mention that's 195 kg
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Shocked Oh My God GIF
 
Has your residency crushed you to the point where you are no longer "Chill"bo Baggins?

Also, a real question. How would you advise the classes of 2024 and later who will be taking PF Step1 for ortho matching?
 
ChymeofPassion said:
Has your residency crushed you to the point where you are no longer "Chill"bo Baggins?

Also, a real question. How would you advise the classes of 2024 and later who will be taking PF Step1 for ortho matching?
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I still try to be a go with the flow type. Residency is a beat down, but overall it's definitely more rewarding/fulfilling than med school. I am a lot more jaded now though and all the little junk irritates me more, but I still give the patients their due respect and treat them equally and appropriately. Residency has also created quite the potty mouth! But (as they always say) things get better the further along you go.

As for your second Q, I see only one objective measure remaining: Step 2. Until that moves to P/F as well, that's where the gold is gonna be. It sucks because it removes the chance for a bounce back if you didn't get where you wanted for Step 1. And then of course not knowing your competitiveness until halfway through 3rd year at the earliest.

The key now will be to get in on research early, form relationships in your home program so they'll be able to vouch for you and write awesome letters, and crush Step 2.
 
Is ortho residency conducive to starting a family? How much sacrifice would a couple have to make in order to start a family with no relatives nearby to support them? (Assuming only one is a resident)
 
Chillbo Baggins said:
Figured I'd give this a little bumpity bump. Coming into the home stretch of fourth year and the light at the end of the tunnel is growing brighter.
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Also serious question, did you feel you had to sacrifice everything during med school since ortho is so competitive?
 
ChocolateChipCookiez said:
Is ortho residency conducive to starting a family? How much sacrifice would a couple have to make in order to start a family with no relatives nearby to support them? (Assuming only one is a resident)
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Part of it will be program dependent, but from my own program and what I've seen from buddies, yes it is.

I had my first kid as an MS4 and had 2 more since then. We don't have any family nearby, but they do come visit fairly often. It is important to try to create a good social support network wherever you go, both within the residency and in the community. Obviously kids take a lot of time and you'll be busy (for example, I haven't seen my kids awake at all this week due to late cases), but then you prioritize the time you do spend with them. It's also important that your SO is fully on board and they understand you won't always be able to help with everything taking care of kids.
 
chemistry hahgdgjjhdf said:
If I bench over 350, will I be automatically accepted into an ortho residency?
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Absolutely.

chemistry hahgdgjjhdf said:
Also serious question, did you feel you had to sacrifice everything during med school since ortho is so competitive?
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Not really. I just made some extra time to shadow and do research the first two years, but otherwise that was comparable to my classmates. 3rd year sucked a lot because our evals were worth a disproportionate amount of our grades, so there was a lot of butt kissing, extra work, and stress relating to clerkships compared to my friends who were doing less competitive specialties. I did a bunch of away rotations at the start of 4th year that were a grind, but otherwise that was a great year.
 
How early on did you decide to pursue the ortho route?

1st year here pretty confident of wanting to do something surgical. Came in like many fascinated with the idea of doing ortho, but our cardiac block caught my interest (and the musculoskeletal block left me less interested than I expected; but I know preclinical blocks are hardly a fair measuring stick for the differing fields). Now I'm contemplating building up a strong ortho app or a strong I6-CT app w/ a more likely GS backup (given the dearth of I6 CT programs compared to ortho programs). I shadowed a bunch of different surgeries in my youth/undergrad years ago (but surprisingly no ortho, just a GS ankle plate case). I'm currently working on an ortho research project and am scheduled to help on a heart surgery project this summer, so I'm trying to explore both paths as best I can, but I know soon enough the tracks will diverge if I want to be as competitive as possible in either arena. Would you suggest just shadowing more surgeries in each and find out as soon as possible which one piques my interest more? Or is it unrealistic to expect shadowing to galvanize that decision prior to rotations?

Thanks in advance for your time.
 
How do you feel about your rehab/pain colleague
 
Darrow O'Lykos said:
How early on did you decide to pursue the ortho route?

1st year here pretty confident of wanting to do something surgical. Came in like many fascinated with the idea of doing ortho, but our cardiac block caught my interest (and the musculoskeletal block left me less interested than I expected; but I know preclinical blocks are hardly a fair measuring stick for the differing fields). Now I'm contemplating building up a strong ortho app or a strong I6-CT app w/ a more likely GS backup (given the dearth of I6 CT programs compared to ortho programs). I shadowed a bunch of different surgeries in my youth/undergrad years ago (but surprisingly no ortho, just a GS ankle plate case). I'm currently working on an ortho research project and am scheduled to help on a heart surgery project this summer, so I'm trying to explore both paths as best I can, but I know soon enough the tracks will diverge if I want to be as competitive as possible in either arena. Would you suggest just shadowing more surgeries in each and find out as soon as possible which one piques my interest more? Or is it unrealistic to expect shadowing to galvanize that decision prior to rotations?

Thanks in advance for your time.
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I knew early in MS1. Coming into med school I knew I wanted to go the surgical route, and just some simple browsing of the subspecialties led me to looking into ortho (recreational sports background, growing up playing with construction sets, etc.). During first year itself I pretty much just focused on coursework, then between 1 and 2 got involved in some research and then started hanging out with the ortho residents more and scrubbing cases. At that point, seeing how well I vibed with them and the enjoyment of the cases, I knew ortho was the way to go.

That said, I did have a buddy who didn't commit to ortho until 3rd year and was deciding between another surgical sub, so it's not a death sentence to figure it out later. If you can swing doing research in multiple specialties, that's totally fine, and you don't need to report everything on your CV if you don't want.
 
Chelsea FC said:
How do you feel about your rehab/pain colleague
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They're great. Where I'm at we don't have a ton of interaction tho. A lot of our coordination is trying to get people to IPR. Otherwise I think our biggest overlap is for spine patients that don't have any surgical problem and they help them out with medication/injections/stimulators/whatever
 
have 2 questions as a soon to be 4th year applying ortho

1. what does a typical day look like for you in terms of when you get there and when you get off and how much time you have outside of the hospital to actually enjoy with family. My biggest drawback to ortho is that there is little time to spend with your family and of the time you have off you still need to be studying so would love to hear your thoughts about that. Also do yall get days off without asking for time off (like non-meds do with the weekend if that makes sense) or how does that work in residency

2. what can a 4th year do on an away to look good. just be on time and be normal or any other things we can do to look good

appreciate the help!
 
giguerex35 said:
have 2 questions as a soon to be 4th year applying ortho

1. what does a typical day look like for you in terms of when you get there and when you get off and how much time you have outside of the hospital to actually enjoy with family. My biggest drawback to ortho is that there is little time to spend with your family and of the time you have off you still need to be studying so would love to hear your thoughts about that. Also do yall get days off without asking for time off (like non-meds do with the weekend if that makes sense) or how does that work in residency

2. what can a 4th year do on an away to look good. just be on time and be normal or any other things we can do to look good

appreciate the help!
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1. One thing is no matter which specialty you do, you're gonna get way more control of your schedule once you reach attending status, so I wouldn't focus just on the workload as a resident. At my program, all in all, we have a good gig and a great work-life balance. Part of it is dependent on which service you're on, but even the busy services sound very reasonable compared to what I hear about from other places.

Our sign out is at 6:30, with a virtual option. I usually show up around 6 to make sure nothing crazy got added overnight or anything. ORs start at 7:30 and clinics at 8, so the in-between time is for rounding and breakfast. If people don't have anyone to round on, they're free to show up at 8 for clinic or a few minutes early for all their outpatient cases. This part's resident dependent: I usually show up for in-person sign out even if I don't have any work to do beforehand. Very rarely someone will have a ton of people to round on and they'll show up before signout to round,

OR days are very service dependent. Hand/joints/sports usually are finishing up by around 3, sometimes later. Trauma fluctuates but the busy days can go to 7. Clinics are usually your standard 8-5.

We do night float we a single in house resident, so no burdensome mid-week calls. Weekends are primarily handled by interns and 2s, with senior resident backup for cases. So interns and 2s usually work 2 weekends a month, and seniors ~1 per month. Plenty of time for resident wellness/hangout and family time!


2. Away rotations are like clerkships on steroids. To an extent, I say that people either "get it" or they don't. You need to be early, always enthusiastic (without being too much) even if you're rolling out your 5th ankle splint at 3am. You need to be able to read people and fit in (though also use this as a barometer about how well you truly fit in with the program while you're auditioning). Being normal is key, but also being a person they want to hang out with for 5 years. You also have to be reading a ton, be knowledgeable, and have good anticipation and initiative, like when it comes to grabbing the suction in the OR or getting the bed and blankets to help move the patient.
 
What were your stats like STEP/grades/research wise when you applied? And what advice do you have for matching?
 
MilesDavisTheDoctor said:
What were your stats like STEP/grades/research wise when you applied? And what advice do you have for matching?
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250ish Step 1, 260ish Step2, AOA as a senior. Honored 4/6 clerkships, high pass the other two (FM and IM). I think I had like 6 "research experiences" and the abstract/pub thing was probably like 10. But this was really bloated with things like school poster days. I had 2 case reports submitted at the time of applications, nothing accepted I don't think.

I don't think there's any secret recipe to getting in, just know that it's competitive and you have to be honest with your application and/or have a back up plan ready. Getting involved in your ortho department early and trying to forge connections is important, one, so they can vouch for you, and two, to make sure it is want you want to do. Early on, trying to get plugged into some easy research will be useful because that stuff takes time, but then they also will keep you in mind if any chip shot stuff comes around and they can pass it along to you.

With Step 1 becoming P/F, Step 2 is really gonna become the new measuring stick. Maybe there will be some increased emphasis on pre-clinical grades or clerkships, but those are all so variable from school to school it's hard to use them objectively. Letters and MSPE comments will also become more important, and AOA if your school has it. And then assuming away rotations become a real thing again, working your butt off on those, and carefully choosing those to be places you really have an interest in, not just trying to "open up a region," though that can still be a valid reason.

The whole process is crazy. I'm on our interview committee now, and it seems like the majority of people we interview are rockstars.
 
Chillbo Baggins said:
Scramble into an ortho spot if possible, lol. Otherwise delay graduation, do research (which as I alluded to above, was the weakest area of my CV), possibly do some more aways. Then the next cycle I would've also applied to a back up, likely OB.
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As someone that is interested in ortho and OB, but not sure about my ortho chances, what was it about OB that interested you as a second choice?
 
cjmurph14 said:
As someone that is interested in ortho and OB, but not sure about my ortho chances, what was it about OB that interested you as a second choice?
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In 3rd year, my two allocated weeks of ortho during surgery block were my favorite, of course, but my overall favorite block was OB.

I think it was a combination of things: the residents and attendings were all very good and let you do a lot, the residents didn't fall into the stereotype of being catty that I'd been warned about by med students from years before, and I enjoyed the procedures and cases. The patient population was also very enjoyable: half of your patients are the only people in the hospital happy to be there, and like how in ortho people are usually healthy with an injury, or they're sick but under the medicine team and we just focus on the problem, most OB/GYN patients are reseaonably healthy so there's not a lot of medical management.
 
are rank lists typically finalized the day of the last interview of the season?
 
Has residency forced you to be efficient with your time outside of work, especially with a wife and 3 kids? Do you have time to have and work on goals outside of medicine?
 
Anakinmemer said:
About how many hours were you working per week each year of residency? I've heard ortho is one of the most brutal residencies with regular violations well above 80 hours.
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As far as the ACGME hour tracker knows I've just been working 6-5 without weekends for the past 4 years haha; it's such a terrible way of trying to keep track of your work.

I definitely work fewer hours as a senior because you're more likely to get administrative days and not be compelled I to going and helping cover clinics, but even as an intern and junior resident it wasn't onerous, at least at my program. Again, our sign out's at 630, and in general you could expect to leave by 5-6. I think the only thing that would get you close to 80 hours is when you include weekend call, but the thing is you're hopefully sitting around/sleeping for a good chunk of that.

We definitely work harder than a lot residencies in terms of hours spent at the hospital, but we have it way easier than Vascular, NSG, and Gen Surg.
 
iforget2 said:
Has residency forced you to be efficient with your time outside of work, especially with a wife and 3 kids? Do you have time to have and work on goals outside of medicine?
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For sure. Gaining efficiency is one of the biggest goals early in residency. Family obviously takes up a lot of free time, but there's still time for a handful of hobbies and hanging out with co-residents without too much difficulty. I tell applicants that one of my biggest surprises in residency is how much more time I get to spend with my family than I thought I would.
 
Is 4-5 ortho matches per year out of 70 students a good rate and or indicator that a school’s tier would not hold one back from doing ortho if they met all the requirements. Ostensibly, the school is mid or lower tier according to rankings but past 5 match lists have been pretty solid in ortho (in addition to a few others like uro, optho, ent but not plastics or derm, which I assume are the traditional bell weathers for a school’s match competitiveness)

Also is there any benefit in ortho to networking through alternative avenues (ie. using a UG alumni network to connect with residents and attendings from other ortho departments). The alumni network is robust and I would say that there are ~2000 profiles of physicians across the country, but I don’t know how weird it would be to reach out (currently in finance where active networking and cold calling happens all the time) but I’m not familiar with how it works in medicine (or insular specialty communities)
 
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voxveritatisetlucis said:
Is 4-5 ortho matches per year out of 70 students a good rate and or indicator that a school’s tier would not hold one back from doing ortho if they met all the requirements. Ostensibly, the school is mid or lower tier according to rankings but past 5 match lists have been pretty solid in ortho (in addition to a few others like uro, optho, ent but not plastics or derm, which I assume are the traditional bell weathers for a school’s match competitiveness)

Also is there any benefit in ortho to networking through alternative avenues (ie. using a UG alumni network to connect with residents and attendings from other ortho departments). The alumni network is robust and I would say that there are ~2000 profiles of physicians across the country, but I don’t know how weird it would be to reach out (currently in finance where active networking and cold calling happens all the time) but I’m not familiar with how it works in medicine (or insular specialty communities)
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Definitely. With a smaller class size like that (I assume small? No idea what the average class size is around the country, mine was like 170+ lol) it's also more vulnerable to being skewed by that particular classes interests, so I wouldn't even be surprised if it was a bit lower most years, but yeah, 4-5 is certainly a reasonable amount coming out.

I'm more of the opinion that, besides the top 10-15 whatever schools that match people based on name, that if you have the innate ability and drive, you can match into a competitive specialty from any school. Maybe not into a top name program, but personally that's not the goal. I had zero interest into going to a place where they have a million fellows and you're primarily holding retractors as a senior resident. My goal was go to a blue-collar program where I could learn to operate and be damn good at it.

Regarding your second point, I think there would be a definite benefit. Again, I don't think you *have* to network to find success, but it's not going to hurt you. With as small of a field as it really is, having someone name drop you down the road could be a big boost.
 
Chillbo Baggins said:
Definitely. With a smaller class size like that (I assume small? No idea what the average class size is around the country, mine was like 170+ lol) it's also more vulnerable to being skewed by that particular classes interests, so I wouldn't even be surprised if it was a bit lower most years, but yeah, 4-5 is certainly a reasonable amount coming out.

I'm more of the opinion that, besides the top 10-15 whatever schools that match people based on name, that if you have the innate ability and drive, you can match into a competitive specialty from any school. Maybe not into a top name program, but personally that's not the goal. I had zero interest into going to a place where they have a million fellows and you're primarily holding retractors as a senior resident. My goal was go to a blue-collar program where I could learn to operate and be damn good at it.

Regarding your second point, I think there would be a definite benefit. Again, I don't think you *have* to network to find success, but it's not going to hurt you. With as small of a field as it really is, having someone name drop you down the road could be a big boost.
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To add to that. Do you think there is a huge advantage attending a medical school like Jefferson (Sidney Kimmel Medical College) where their ortho residency program is ranked top 5 (Rothman)? While it is a mid tier school, they had 13 ortho matches last year (large class size though 200+). Every year it seems there is 10+ ortho matches. Do you think there is an inherent advantage where maybe not everyone has to be a test score superstar because of the mentorship and research opportunities available being affiliated with Rothman or it just student self-selection?
 
effectedtag said:
To add to that. Do you think there is a huge advantage attending a medical school like Jefferson (Sidney Kimmel Medical College) where their ortho residency program is ranked top 5 (Rothman)? While it is a mid tier school, they had 13 ortho matches last year (large class size though 200+). Every year it seems there is 10+ ortho matches. Do you think there is an inherent advantage where maybe not everyone has to be a test score superstar because of the mentorship and research opportunities available being affiliated with Rothman or it just student self-selection?
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Doesn’t Jeff rank in quartiles? I would assume that ranking would allow one to punch above their weight in regards to matching competitive specialties. That being said, it is probably more important to be a test score superstar at any program that releases ranks.
 
effectedtag said:
To add to that. Do you think there is a huge advantage attending a medical school like Jefferson (Sidney Kimmel Medical College) where their ortho residency program is ranked top 5 (Rothman)? While it is a mid tier school, they had 13 ortho matches last year (large class size though 200+). Every year it seems there is 10+ ortho matches. Do you think there is an inherent advantage where maybe not everyone has to be a test score superstar because of the mentorship and research opportunities available being affiliated with Rothman or it just student self-selection?
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There is a slight advantage if you have a home ortho program immediately available next door if you get involved and are a good student also, however, if Jeff had 0 ortho matches next year, what does that mean? It means nothing.

Match lists are what students WANT to do. If no one wants Derm, Ortho, NSX, then what? Is that match list bad?

Having a home program won't make up for you being a below-avg student or ortho candidate
 
How much have your perceptions of ortho/medicine changed throughout the years? Do you still find the day-to-day of residency enjoyable, or do you find yourself wanting more of a life outside of medicine once residency ends? As a first year student who is interested in ortho, I'm mostly worried about residency outlasting my priorities in terms of work life balance. I do genuinely enjoy the grind of medical school, but I'm also well aware that people and their priorities change over time — which makes it especially difficult to choose how you want to spend your life after medical school. Thanks for taking the time to answer our questions!
 
What are your thoughts, or what's the chatter in the Ortho community regarding heavy lifts, particularly heavy squats and deadlifts from a long term perspective?

I've heard from an orthopod at my institution (going over a case) that barbell bench press is just not worth it based on motion and the strain it puts on several shoulder muscles via awkward mechanics, muscle imbalances, etc.

But what about the deadlift and squat?

Thanks 🙂

Edit to add: Not trolling. Personally used to shoot for a 1000 triple lift but over the COVID years, and looking at CT Fletcher / Ronnie Colemans old age, decided to work on longevity and perhaps forgo the heavy stuff. Not asking for medical advice, just a hunch, opinions on the matter.

Also hopefully going for a surgical sub but not ortho cause I feel like someone could wonder this based on my post.
 
effectedtag said:
To add to that. Do you think there is a huge advantage attending a medical school like Jefferson (Sidney Kimmel Medical College) where their ortho residency program is ranked top 5 (Rothman)? While it is a mid tier school, they had 13 ortho matches last year (large class size though 200+). Every year it seems there is 10+ ortho matches. Do you think there is an inherent advantage where maybe not everyone has to be a test score superstar because of the mentorship and research opportunities available being affiliated with Rothman or it just student self-selection?
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I agree with ChiDO's post. Additionally, I think programs with good programs are probably more likely to inspire more students to pursue those specialties. But yeah, in the end it still comes down to individual effort.
 
Derz said:
How much have your perceptions of ortho/medicine changed throughout the years? Do you still find the day-to-day of residency enjoyable, or do you find yourself wanting more of a life outside of medicine once residency ends? As a first year student who is interested in ortho, I'm mostly worried about residency outlasting my priorities in terms of work life balance. I do genuinely enjoy the grind of medical school, but I'm also well aware that people and their priorities change over time — which makes it especially difficult to choose how you want to spend your life after medical school. Thanks for taking the time to answer our questions!
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In general I'm much more jaded, both from patient experiences and dealing with the bureaucracy of medicine. However, I still love doing surgery, and most of the time I enjoy helping the patient's with their problems. Even if I'm getting woken up at 2am to reduce some fracture, I find that even though I might be grumbling all the way to the ER and whatnot, as soon as I'm talking with the patient I enjoy explaining the issues and how we're gonna fix it.

I think everyone enjoys their life out of the hospital. I think the old-school stigma of "you must make surgery your life and love being in the hospital more than anything" is no longer accurate at all and I don't know of any residents or young attendings who feel that way. We love what we do and a day of cool cases operating to 9pm may make me feel invigorated, at the end of the day it's a job. A badass job, but job nonetheless.
 
catnip12 said:
What are your thoughts, or what's the chatter in the Ortho community regarding heavy lifts, particularly heavy squats and deadlifts from a long term perspective?

I've heard from an orthopod at my institution (going over a case) that barbell bench press is just not worth it based on motion and the strain it puts on several shoulder muscles via awkward mechanics, muscle imbalances, etc.

But what about the deadlift and squat?

Thanks 🙂

Edit to add: Not trolling. Personally used to shoot for a 1000 triple lift but over the COVID years, and looking at CT Fletcher / Ronnie Colemans old age, decided to work on longevity and perhaps forgo the heavy stuff. Not asking for medical advice, just a hunch, opinions on the matter.

Also hopefully going for a surgical sub but not ortho cause I feel like someone could wonder this based on my post.
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I think if you adhere to good form and work up to higher weights appropriately, it shouldn't be any issue. I haven't had seen/read much about this specifically within the confines of residency, but based on my research in the past on weightlifting when I would actually go to the gym, lol.

I'm a fan of the big 3 lifts since they are compound and hit a ton of stuff at once. I had had a goal of reaching the thousand pound club, but only ever made it to around 800 haha.
 
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