Ortho vs Rads

[PrideOrPanthers]

Hi everyone,

MS3 here. Coming to the crucial time in third year where I need to start committing to a field as I make my schedule for 4th year. I’ve narrowed it down to radiology and Ortho and I’m struggling a lot to choose. I would say I’m leaning slightly towards ortho right now. I come from a highly regarded school and have a great step score(>260). Research/volunteering is average-below average for ortho.

Ortho:

Pros:
I am a big sports guy, love lifting and I feel restoring function would be extremely gratifying. I also think that thinking about sports related injuries is interesting
Favorite rotation so far was surgery by far. I hated IM and every other rotation
Surgery is a gratifying field where you can feel tangible results of your work

Cons:
Lifestyle. I’m planning to have a kid in intern year or 2nd year of residency and know I’ll be sacrificing time with family for work. I also have a lot of hobbies outside of medicine(working out, watching football, etc)
Manual labor wearing down on my body(although it’s not that big of a deal)
Risk of going unmatched

Radiology:
Pros:
I think radiology as a practice is interesting. I did a radiology case report and thinking through the radiological differential was cool
Lifestyle is much better than any surgical field, more time for family/hobbies
Much easier on the body and much more sustainable to practice with age.

Cons:
No patient interaction. I don’t think this is a deal breaker but being in the reading room all day isn’t something I pictured for myself when I started med school.
Worried that I would be bored as a radiology and wouldn’t feel as much fulfillment in my work as a radiologist

Ultimately, things that are most important to me are family and being happy with my career. I don’t want to just choose something based on lifestyle if I’m not passionate about it because I would probably end up more burned out and less happy in the long run. I think I’m more passionate about ortho, but I do like radiology and think it’s a cool field, but I’m not sure if I would be bored and want to switch. Really feeling lost on what field is for me. Any input is appreciated.

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[Matthew9Thirtyfive]

No patient interaction.

Not an expert here, but many radiologists get patient contact. My mentor is a general radiologist and interacts with them a lot doing biopsies, injections, arthrograms, etc. It’s not the same as most specialties, but you can definitely interact with them.

 

[theonlytycrane]

For ortho, aways are huge and your step 1 is super good. Even if aways are cancelled again for next year, coming from a highly regarded school is gonna give you a huge advantage over applicants who come from mid/low tier schools (without aways). If you crushed step 1 like that and got into a great school, I'm sure you'll bust your ass on aways and do great on step 2 etc. So I wouldn't worry about not matching.

I was also debating between a surgical subspecialty last year and ended up applying radiology because even though I loved the OR and would rather be in the OR doing cases over anything else in the hospital, I would even more so rather be off/enjoying time with friends/family than at the hospital. I feel honored to be able to help people and I put my heart on the line for pts when I do care for them, but medicine is just one part of my life (that I'm grateful for), but it doesn't define me at all and I felt surgery required a much more serious time/personal commitment throughout residency and in the longrun vs. radiology which seemed more lifestyle friendly.

I felt that the decision really came down to, do you need to be in the OR / be a surgeon to feel happiness in your career/life? If so, there's no replacement for the OR. For me, I think the OR is such a cool experience, but I'd rather be exploring my interests outside of medicine.

If you have elective time in your 3rd year / early 4th year, maybe do an ortho sub-i early on and also a radiology elective and see how you feel during both experiences. I'm sure you'll do great in either field (theres also IR in case you want to explore that route!)

 

[PrideOrPanthers]

For ortho, aways are huge and your step 1 is super good. Even if aways are cancelled again for next year, coming from a highly regarded school is gonna give you a huge advantage over applicants who come from mid/low tier schools (without aways). If you crushed step 1 like that and got into a great school, I'm sure you'll bust your ass on aways and do great on step 2 etc. So I wouldn't worry about not matching.

I was also debating between a surgical subspecialty last year and ended up applying radiology because even though I loved the OR and would rather be in the OR doing cases over anything else in the hospital, I would even more so rather be off/enjoying time with friends/families than at the hospital. I feel honored to be able to help people and I put my heart on the line for pts when I do care for them, but medicine is just one part of my life (that I'm grateful for), but doesn't define me at all and I felt surgery required a much more serious commitment vs. radiology which seemed more lifestyle friendly.

I felt that the decision really came down to, do you need to be in the OR / be a surgeon to feel happiness in your career/life? If so, there's no replacement for the OR. For me, I think the OR is such a cool experience, but I'd rather be exploring my interests outside of medicine.

If you have elective time in your 3rd year / early 4th year, maybe do an ortho sub-i early on and also a radiology elective and see how you feel doing both experiences. I'm sure you'll do great in either field

Thank you for the insight and positivity. I’m really stressed about it right now. I’m happy for you that your happy with your choice. I wish the same for myself, to make the best decision for my future and be happy with that decision

 

[You shall know the Truth]

DR -> IR!!!!

 

[IMGASMD]

Look at your attendings. Do you like the radiologist or orthopedist more? That may offer you some clue as well.

 

[Qwerty122]

Rad --> MSK rads fellowship is a great alternative pathway as well. You'll get patient contact and do procedures to restore mobility and function.

 

[AnatomyGrey12]

Ortho. Everything you said makes me think ortho. Go for it and don't look back. Life as an attending will be different than life as a resident, and the ortho residents I know are still able to have hobbies and a life outside of work.

 

[Matthew9Thirtyfive]

Look at your attendings. Do you like the radiologist or orthopedist more? That may offer you some clue as well.

I would hesitate to pick a specialty that way, though it can be a place to start.

 

[IMGASMD]

I would hesitate to pick a specialty that way, though it can be a place to start.

If op already narrow down to two, I’d say this is where he wants to end up.

Personality/stereotype exist for each speciality exist for a reason.

 

[RunsOnCaffeine]

Ortho is a tough residency...if you don't think you're up for that lifestyle, then I would recommend you think about something else. That said, 2 residents in my ortho program have had kids this year, so it's doable. Can honestly say they don't see their kids very much though. Need a tough spouse and good family support.

 

[PrideOrPanthers]

Ortho is a tough residency...if you don't think you're up for that lifestyle, then I would recommend you think about something else. That said, 2 residents in my ortho program have had kids this year, so it's doable. Can honestly say they don't see their kids very much though. Need a tough spouse and good family support.

Are there rotations you guys have that offer somewhat of an easier time. Like trauma I’m sure your over 80 each week, but does hand/sports provide 60-70 hour weeks?

 

[slowthai]

Are there rotations you guys have that offer somewhat of an easier time. Like trauma I’m sure your over 80 each week, but does hand/sports provide 60-70 hour weeks?

Sports is typically one of the less time-intensive rotations

 

[OrthoTraumaMD]

Only one question you must answer for yourself.
Can you live the rest of your life without ever setting foot in the OR again?
If yes, choose rads.
If no, choose ortho.

I cannot stress this enough— No surgical residency (especially ortho) is worth it unless you cannot live without the OR. Lack of understanding that is why surgery residency has such huge attrition rates. Especially if you are concerned about work life balance/hours— that goes out the window for 5 years in a surgical residency (and forever for me— my life is 65% work, that IS the balance.)

 

[OrthoTraumaMD]

posted in error, see above post for response

 

[stickgirl390]

The ortho I worked with while on clinical rotations only worked mon-thurs, and one of those days was 100% clinic. She told me once you get past residency, you are a desirable hire and there are many opportunities to negotiate your schedule when signing contracts.

 

[PrideOrPanthers]

Only one question you must answer for yourself.
Can you live the rest of your life without ever setting foot in the OR again?
If yes, choose rads.
If no, choose ortho.

I cannot stress this enough— No surgical residency (especially ortho) is worth it unless you cannot live without the OR. Lack of understanding that is why surgery residency has such huge attrition rates. Especially if you are concerned about work life balance/hours— that goes out the window for 5 years in a surgical residency (and forever for me— my life is 65% work, that IS the balance.)

Thank you as always for the insight

 

[OrthoTraumaMD]

The ortho I worked with while on clinical rotations only worked mon-thurs, and one of those days was 100% clinic. She told me once you get past residency, you are a desirable hire and there are many opportunities to negotiate your schedule when signing contracts.

5 years out, sure. But not when you’re starting out. Your negotiating power is slim to nonexistent at that point. Also no one works 4 days a week unless they are doing some kind of academic stuff— which is not most practices (most orthopods go into private or privademics). You have to make more money for a private practice than you’re worth— giving you a “free” day has zero benefit for the practice. Even in academia it’s not guaranteed.

 

[BarcaBest23]

Gotta think of it as a career/calling versus a job. If medicine is just a job and you want somewhat of a 9 to 5, then choose rads. If medicine is a passion/career/calling then do ortho. Gotta do whatever makes you happy

 

[RunsOnCaffeine]

Are there rotations you guys have that offer somewhat of an easier time. Like trauma I’m sure your over 80 each week, but does hand/sports provide 60-70 hour weeks?

Absolutely there are. Trauma rotations are the busiest, but "average business" also depends on your year. As an intern, it varies monthly depending on having a crazy rotation or a relaxed one. I have had months near 80s/week every week, and I've had months with a very relaxed schedule comparatively.

2nd year in ortho is generally considered the hardest year in most programs, and 3rd year is only a notch easier. You are under a lot of focus in academics and expected to progress rapidly. Also usually are taking primary call those years.

4th and 5th year usually you aren't taking primary call anymore on most rotations (I know of exceptions), but trauma rotations will be very busy. Other rotations are not terrible especially hand, sports, etc. Usually by this point you have ancillary duties, but still comparatively easier than earlier years.

If you know you want to have a baby at a certain time, trying to get your schedule for a easier rotation at that time is not a bad idea, but it will still be a hard road. Kids are little for a long time...

 

[Neopolymath]

For ortho, aways are huge and your step 1 is super good. Even if aways are cancelled again for next year, coming from a highly regarded school is gonna give you a huge advantage over applicants who come from mid/low tier schools (without aways). If you crushed step 1 like that and got into a great school, I'm sure you'll bust your ass on aways and do great on step 2 etc. So I wouldn't worry about not matching.

I was also debating between a surgical subspecialty last year and ended up applying radiology because even though I loved the OR and would rather be in the OR doing cases over anything else in the hospital, I would even more so rather be off/enjoying time with friends/family than at the hospital. I feel honored to be able to help people and I put my heart on the line for pts when I do care for them, but medicine is just one part of my life (that I'm grateful for), but it doesn't define me at all and I felt surgery required a much more serious time/personal commitment throughout residency and in the longrun vs. radiology which seemed more lifestyle friendly.

I felt that the decision really came down to, do you need to be in the OR / be a surgeon to feel happiness in your career/life? If so, there's no replacement for the OR. For me, I think the OR is such a cool experience, but I'd rather be exploring my interests outside of medicine.

If you have elective time in your 3rd year / early 4th year, maybe do an ortho sub-i early on and also a radiology elective and see how you feel during both experiences. I'm sure you'll do great in either field (theres also IR in case you want to explore that route!)

Couldn't agree more. There is more than enough patient interaction in radiology, if desired. This field is an undercover gem for the people who went into medicine to help people but not necessarily spend all day in clinic talking to patients. It's similar to anesthesiology in that the patient interaction is brief but can be meaningful and important.

Edit: I will say I worked with many orthopedic surgeons in my life before school and all of the attendings had very chill schedules once they hit about 40 years old besides the trauma folks. If you can survive the residency, you can find a job that fits what you want IMO. If you are geographically restricted then this will be harder and take longer.

 

[Matthew9Thirtyfive]

Couldn't agree more. There is more than enough patient interaction in radiology, if desired. This field is an undercover gem for the people who went into medicine to help people but not necessarily spend all day in clinic talking to patients. It's similar to anesthesiology in that the patient interaction is brief but can be meaningful and important.

My mentor said when he left his last command, he had a bunch of patients show up to his farewell to thank him personally for helping them (or in some cases, catching their cancers and saving their lives). I was asking him about rads because the science of it is fascinating to me, as well as the other cool aspects of the specialty (like the ones the op lists, but also the significantly reduced paperwork, getting to “see” a lot more patients, and having to know about so many fields in medicine), but I was hesitant because I want patient contact.

 

[Kuratz]

Had the same decision and chose Rads. No regrets. See plenty of patients and the work is interesting.

However myself along with many of Rads colleagues see it as just a job, albeit an interesting one. I did a surgical internship and anecdotally many surgeons tied their identity to the OR, and derived much happiness from that even if it meant staying late to finish a surgery.

I won't speak on why to do Ortho, others can offer much better perspective. But for Rads if you want something that is stimulating, mostly interesting without nonsense at work, do a smattering of short procedures throughout the day, get paid well (not Ortho $), and have a reasonably 8-5 job then it's great.

I have had a ton of time to pursue outside interests in Rads. My former surgery categorical residents were much more limited and N=2 experience is the ortho residents get crushed pretty hard too. Are patients going to seek you out as their doctor and give high praise? No. Are you going to "wow" someone by telling someone you are a Radiologist? Ha no. But its a nice career and a partial escape from clinical medicine while still having daily patient contact.

 

[Splenda88]

Radiology:

Cons:
No patient interaction. I don’t think this is a deal breaker but being in the reading room all day isn’t something I pictured for myself when I started med school.
Worried that I would be bored as a radiology and wouldn’t feel as much fulfillment in my work as a radiologist

Ultimately, things that are most important to me are family and being happy with my career. I don’t want to just choose something based on lifestyle if I’m not passionate about it because I would probably end up more burned out and less happy in the long run. I think I’m more passionate about ortho, but I do like radiology and think it’s a cool field, but I’m not sure if I would be bored and want to switch. Really feeling lost on what field is for me. Any input is appreciated.

As an IM guy, I must say that can be a plus...

 

[Skullcutter69]

Hi everyone,

MS3 here. Coming to the crucial time in third year where I need to start committing to a field as I make my schedule for 4th year. I’ve narrowed it down to radiology and Ortho and I’m struggling a lot to choose. I would say I’m leaning slightly towards ortho right now. I come from a highly regarded school and have a great step score(>260). Research/volunteering is average-below average for ortho.

Ortho:

Pros:
I am a big sports guy, love lifting and I feel restoring function would be extremely gratifying. I also think that thinking about sports related injuries is interesting
Favorite rotation so far was surgery by far. I hated IM and every other rotation
Surgery is a gratifying field where you can feel tangible results of your work

Cons:
Lifestyle. I’m planning to have a kid in intern year or 2nd year of residency and know I’ll be sacrificing time with family for work. I also have a lot of hobbies outside of medicine(working out, watching football, etc)
Manual labor wearing down on my body(although it’s not that big of a deal)
Risk of going unmatched

Radiology:
Pros:
I think radiology as a practice is interesting. I did a radiology case report and thinking through the radiological differential was cool
Lifestyle is much better than any surgical field, more time for family/hobbies
Much easier on the body and much more sustainable to practice with age.

Cons:
No patient interaction. I don’t think this is a deal breaker but being in the reading room all day isn’t something I pictured for myself when I started med school.
Worried that I would be bored as a radiology and wouldn’t feel as much fulfillment in my work as a radiologist

Ultimately, things that are most important to me are family and being happy with my career. I don’t want to just choose something based on lifestyle if I’m not passionate about it because I would probably end up more burned out and less happy in the long run. I think I’m more passionate about ortho, but I do like radiology and think it’s a cool field, but I’m not sure if I would be bored and want to switch. Really feeling lost on what field is for me. Any input is appreciated.

Congrats on doing so well in school and having some great options. Radiology sounds like a great field (especially to medical students) and I totally understand the appeal (my dad is actually a radiologist). In this case however, you should really think about doing what you yourself said you're most passionate about, which is ortho surgery. Residency is temporary (in your case a short 5 years + a fellowship where you very rarely take call or are paid handsomely for doing so). The job market and the way your career will unfold afterward is honestly night and day. In ortho, you can essentially walk into any city in America and make 500K. You're a specialist and patients come and seek you out. You bring tremendous value to hospitals and often have ownership in your own ASCs. Your lifestyle is what you make of it (depending on where you practice and how much you want to earn). What most medical students don't realize about radiology is that in huge swaths of the country (and unfortunately most parts that are desirable to live in) true private practice where you own equity is completely dead and instead dominated by corporate entities (like Radiology Partners and others) who pay you a fraction of your collections to work for them. Just like in other specialties where you don't own patients, you're essentially a commodity to hospitals (patients have no idea and couldn't care less who reads their scans - IR/mammography). This problem has been compounded by teleradiology, since RP can buy out groups in entire cities and then correct any staffing shortages with teleradiology to maintain hospital contracts. Finally, be aware that radiology might be the only specialty (except for maybe derm) where being an attending (in PP) is a worse lifestyle than being a resident. A lot of the guys making money in rads are *grinding* tons of RVUs/day to make that income. In every surgical specialty it's the exact opposite.

Don't get me wrong, if you're most passionate about image interpretation you should definitely do radiology. I'm only saying that in your case where you said you're more passionate about ortho, you should consider all the other advantages of the specialty.

 

[OrthoTraumaMD]

Some of the above post is accurate but some of it is a bit of “grass is greener on the other side.”

In ortho, you can essentially walk into any city in America and make 500K. You're a specialist and patients come and seek you out. You bring tremendous value to hospitals and often have ownership in your own ASCs.

In big desirable cities, starting salary for ortho is 250-300K. Have several friends who made that for years before they got high enough down the partner track to be more reasonable. Ownership in an asc is also not guaranteed as predatory private practices can hire you then let you go for not meeting your rvu quotas before that happens. The 500+ is only once you’ve been out a while or if you’re going to the middle of nowhere.

Your lifestyle is what you make of it (depending on where you practice and how much you want to earn).

A lot of the guys making money in rads are *grinding* tons of RVUs/day to make that income. In every surgical specialty it's the exact opposite..

This is inaccurate. If you’re private or privademics (most ortho jobs) and especially if you’re just starting out, RVUs are the determinant for everything and you’re incentivized to make as much as possible, otherwise you are penalized by loss of bonuses, non-renewal of contracts, etc. I thankfully don’t have to do the RVU grind (I’m academic), but I know many who still work 80 hour weeks (I do so by choice). Maybe it’s not as obvious as in radiology (and I don’t know much about the latter), but the grind is 100% there and is exactly the reason I didn’t go private.

 

[rulerkk]

N=1, but I have a family member doing adult reconstruction in Ortho. Residency was “the hardest part of his life”. They were juggling new marriage, eventually three youngins, and at one point that journey led them to pursue fellowship many states away so they endured disruptive movement away from family on top of everything else.

First job in PP in a up and coming area? 60 hour weeks, 750k.
Now about 6.5 years in, owner in ASC, has multiple clinics, still contributes to research coming from the practice, still working about 60 hour weeks (but also getting a nighttime MBA), has endless patients expressing gratitude in person and over social media on a daily basis for relieving their years of pain. $1M+.

It is difficult to get into residency, and incredibly burdensome to survive residency with your mental health in tact, but most students and residents make it. Afterwards, life is pretty golden and importantly your commitments to work are choices which makes all the difference. Their family never wavered in their support and still have plenty of time to enjoy with them. So I support the passionate ortho mission.

 

[Skullcutter69]

Some of the above post is accurate but some of it is a bit of “grass is greener on the other side.”



In big desirable cities, starting salary for ortho is 250-300K. Have several friends who made that for years before they got high enough down the partner track to be more reasonable. Ownership in an asc is also not guaranteed as predatory private practices can hire you then let you go for not meeting your rvu quotas before that happens. The 500+ is only once you’ve been out a while or if you’re going to the middle of nowhere.



This is inaccurate. If you’re private or privademics (most ortho jobs) and especially if you’re just starting out, RVUs are the determinant for everything and you’re incentivized to make as much as possible, otherwise you are penalized by loss of bonuses, non-renewal of contracts, etc. I thankfully don’t have to do the RVU grind (I’m academic), but I know many who still work 80 hour weeks (I do so by choice). Maybe it’s not as obvious as in radiology (and I don’t know much about the latter), but the grind is 100% there and is exactly the reason I didn’t go private.

I apologize, I can see how what I wrote at the end sounds kind of funny. When I wrote "In every surgical specialty it's the exact opposite" I was referring to the fact that life as an attending generally gets better than as a chief resident vs. radiology where the lifestyle in residency can be better than once you get out in the real world, not that surgeons don't chase RVUs. I was making the point that radiologists who make that kind of money aren't sipping coffee in the reading room listening to Pandora. People like my dad are ripping through hundreds of studies (including cross sectional) at breakneck speeds with not a ton of breaks. With more groups taking back their nights/weekends from Nighthawk to fight off competitors, you'll also have weekends/nights in radiology where you're also cranking through scans. This isn't necessarily a bad thing if you like the field, I was just saying that you should think about all of these things to make an informed decision (especially thinking about life after residency).

I can only personally speak to spine surgery (having just gone through the job search myself) and a little on joints (one of my family members got a job a few years ago). For spine (albeit as a neurosurgeon) I was offered 600-850 starting at most private practices (income guarantee), with a 1-2 year partnership track and ASC buy in (these ranged from solely spine ASCs to general ASCs used by a bunch of different specialties). When you interview at practices you usually get all their data regarding RVU minimums and what the rest of the partners/associates generate. I interviewed all over (not NYC, but South Florida, major TX cities, Scottsdale, Santa Barbara, Portland, etc.) The median RVUs (actually obtained) at most places was 9,000-10,000/year, which typically generated 730-760 in income. Just to highlight for people not very familiar with this, CPT=22612 (single level posterior arthrodesis) generates 23.52 RVUs. You have 52 weeks in a year, - 6 weeks for vacation with your family = 46 weeks of work. 9,500 RVUs/ 23.52 = 404 cases in 46 weeks = 9 cases/week. Typically, you have 2-2.5 days of clinic/week and 2.5-3 OR days/week. In this scenario, you'd bang out ~3-4 cases/day. This is extremely simplified (likely underestimating since most posterior fusions are multilevel with additional codes) and doesn't take into account conversion factors, case mix, etc. In reality, you're going to have a mix of ACDFs, larger fusions, and single level lamis/microdiscs. Call pay is also very complicated and I won't bore you with the details. I was just illustrating that yes, at most practices your income will be related to your productivity. However, it's really not THAT crazy. I personally would find the research requirements of academics to be much more painful (the people I know in it are either grinding on the tenure track trying to write grants or are stuck in a dead end "clinical assistant professor" job basically as an employee forever). I'm sure there are unscrupulous practices out there, but out of the N=12 people, 3 classes ahead of me, 11 are still on the first job they took. The key is finding a place where you're needed and can build a successful practice (this is why NYC is a tough place to start out for people). I don't know all the details for my brother in law, but he took a joints job in Naples, knocks out primary THA/TKA 3 days/week, home by 6 almost every day, 600K/year, lives on the beach (N=1 obviously). I know that lifestyle and what constitutes grinding is very specific to different people, so I'm just highlighting my own personal experience.