(pasted from other forum)
I'm an ortho pg3 right now. Just finished my spine rotation (first of 2) and loved it, looking for fellowships right now. I'll give my meandering opinions of some of the things I've read here.
In college I thought I wanted to be a neurosurgeon. It seems glamorous, cool surgeries, operate on the brain (oooohhhh woww!). Then I got to med school and met some neurosurgeons. Probably the most miserable group of people I've ever met personally. Not that they weren't cool guys, many of them are. But they never leave the hospital and they get their dicks kicked in constantly while there, both from their attendings and their patients and families. Some people can tolerate that, I found I was not one of them. Then there is the whole "brain surgeon" thing. Unless you do academics, you won't be a brain surgeon. Almost all private practice neurosurgeons do a lot of spine to pay the bills while waiting for that next craniotomy to come around. If you don't like spine surgery, run from neuro or do it and go into academics. The other things I got tired of in neurosurg were: patients really sick, requiring lots of attention (i.e. not operating), patients frequently die as noted by others here, patients who are "successes" still fare pretty poorly as human beings they're just not dead in many cases.
The things I liked about ortho have already been noted: healthy patients in general, they get better in general, very problem focused (if it's broke fix it, if not then break it and fix it), lots of cool technology and toys to play with, the money is great, the lifestyle can be great.
Since I'm half way done with my residency I'll share some of the good and bad that I could not have known prior to matching in ortho.
Bad: people with orthopaedic problems hurt, and will use their voices/family/attorneys/work comp agents to hurt you. Contrary to some people's beliefs this is in NO way isolated to the spine clinic. Old people with arthritic hips complain and many continue to complain after they get a shiny new one. Athletes complain. I laugh my ass off at all these guys who drool over the opportunity to take care of athletes. If you want unrealisitic, noncompliant, whiny little pains in the ass in your clinic then pursue athletes as patients. They always expect their limb/joint to function as "new" in a very short time without putting forth all the rehab effort they should. Personally I have found these people to be very ungrateful and not fun at all to care for. Obviously not everyone feels this way.
All areas of ortho see the work comp/disability crap. You can't avoid it. You just have to decide if you're going to deal with it or not. You CAN flatly refuse to see work comp and simply refuse to do disability assessments. It's easy, just say no. Work comp pays really well though, so if you can tolerate those people then ring the cash register and buy that bigger boat you've been looking at.
Malpractice for ortho is terribly expensive and worsening in most geographic areas similar to neuro.
Good stuff: we are in huge demand and it is only going to increase in coming years. The supply of orthopedists has been tightly regulated for decades by some very savvy dudes, and the job market is incredibly good. There are opportunities virtually everywhere in the US.
The surgery is really fun. If you like anatomy and understanding how to reconstruct aberrant anatomy to near normal with all sorts of tools and implants, then you'd have fun in ortho.
If you like research, there is limitless opportunity for ortho research. The literature in ortho is relatively young with few good controlled trials to rely on in many areas. An interested researcher could go far easily.
As for spine:
There is a great deal of overlap in Neuro and Ortho spine practice. In general ortho guys don't go in the blue water balloon (there is nothing worth seeing in there any way). So if intradural tumors are your thing then don't do ortho. Ortho guys are generally more comfortable with instrumentation, at least at first, because of their background with hardware going into bones. But now most neuro residencies probably have spine guys doing a lot of instrumentation. Overall the difference in practice probably breaks down to: neuro does more tumor, ortho does the vast majority of deformity cases (scoliosis, spondylolisthesis, kyphosis, etc). If you're doing private practice this difference is negligible.
Some people point to "bread and butter" as the difference. I'm not sure that is true. Sure, if you are in a small group of orthopods and take call at a busy trauma center you'll have to do the occasional femur or washout in the middle of the night. But most community surgeons arent covering the war zone type ERs that we do in training. If you do a spine fellowship in ortho and join a group with a big enough referral base, you can distill down to almost 100% spine fairly quickly. Or if you like general practice with some spine you can do that. The more frequent complaint I have heard from guys is that once you are labeled as the spine guy you get all spine and your general practice dries up. I would say that post residency the lifestyles of NSG vs ortho are very close except in bigger cities with level I/II trauma centers. In those centers the private orthopedist can get spanked with trauma where the NSG would not.
One last thing. There is no question whatsoever that ortho residencies offer better lifestyles than Neurosurg. There will be isolated examples where that is not the case, but across the board neurosurg residents grab their ankles for 6 or 7 years. My own residency is very kind and gentle since the 80 hour thing. I am averaging in the 50s this year, but it has hurt our case experience some. That is a whole different topic.
Not sure if any of this was helpful, but I'm on call and bored.
