Orthopaedic Spine Surgeon - ask me anything

[orthos]

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Hello everyone,

About me: I am an attending physician specializing in orthopaedic surgery with fellowship in spine surgery. Currently in solo private practice, on staff at a community hospital. I don't have much experience with academic medicine, but I maintain research projects based on my community setting.

An employee of mine who is a medical school applicant suggested I create an account on this website to try helping others who are going into the medical field. I'll be answering questions when I have free time, and I'll try to answer all questions as best I can.

Thanks

 

[NontradCA]

How much do you make?
How many hours do you work?
How many hours of sleep do you get?

 

[SIGINT]

1. What drew you to ortho?
2. What advice would you give to med students interested in the field?

 

[orthos]

How much do you make?

I won't disclose the exact number, but I was recruited by the community hospital out of fellowship with a guaranteed salary above average for those with my level of experience. I will mention that I am in my second year out of fellowship. I also maintain auxiliary income from in office billings/procedures, as well as income from doing procedures at an ambulatory surgery center.

 

[gumdrops]

I think orthopedics is a remarkably cool field but have terrible spatial reasoning skills. Would I be shot in this field if I'm not someone who is good at 3-D visualization? Thanks so much.

 

[Lucca]

How does your training and responsibility differ from a neurosurgeon who does spines? Is there any practical difference? How closely are the two fields connected?

Thanks a lot for doing this, by the way! 🙂

 

[butchmfjones]

I always thought spine was part of neuro. Is there a difference between ortho and neuro that specialize in spine?

 

[orthos]

1. What drew you to ortho?
2. What advice would you give to med students interested in the field?

1) There are many, many things that drew me to orthopaedics, many of which are pretty common. I grew up loving sports (tennis, soccer). I enjoy being able to work on many parts of the body (despite now subspecializing in spine, I do general ortho when I take call). I also enjoy the see-it, fix-it kind of work I do, instead of take-this-and-call-me-in-a-week feeling that I got while doing rotations in other areas. Speaking to spine specifically, I chose to sub-specialize because back pain is one of the most common reasons for doctor visits, and I really wanted to be able to help as many people as I can. Lastly, the field is very well compensated, and personal satisfaction, at least for myself, is very high.

2) For current medical students, get good grades, do well on step 1, and get exposure to ortho early if you even think you might consider it (research, volunteering, etc.). Put in the extra time and effort to get experience with what orthopaedics really is (that applies to any field really) and keep notes of what you like and don't like before you commit. And don't focus on what other people are doing relative to you - just focus on yourself and what your goals are.

 

[orthos]

I think orthopedics is a remarkably cool field but have terrible spatial reasoning skills. Would I be shot in this field if I'm not someone who is good at 3-D visualization? Thanks so much.

It may be difficult, but with training, experience, and extra effort, I think anyone can do it.

 

[gumdrops]

It may be difficult, but with training, experience, and extra effort, I think anyone can do it.

Thanks so much for answering questions and for being so encouraging!

 

[orthos]

How does your training and responsibility differ from a neurosurgeon who does spines? Is there any practical difference? How closely are the two fields connected?

Thanks a lot for doing this, by the way! 🙂

I always thought spine was part of neuro. Is there a difference between ortho and neuro that specialize in spine?

Similar questions, so I will group them. There can be a lot of crossover when it comes to neuro and ortho spine. I will say that neuro has a lot more to offer when it comes to pathologies that involve the nerve roots beyond things like stenosis due to the actual bony structures or spinal cord. However, I feel like ortho has better training dealing with things like compression fractures, and more experience when performing surgeries that involve reshaping bone (laminectomies, fusions). That's not to say neuro spine can't or won't be better than an ortho doc doing the same procedure - it depends largely on the physician and his training. For all the cases that I feel are too complex or that I lack the equipment to do in my community hospital, I refer to a neurosurgeon who does spine at a large academic center.

In addition, I don't know of many neurosurgeons who deal with disorders of the sacral spine.

 

[UMU1030]

You say that you are on staff at a community hospital, which I assume to be a small hospital. Would you say the hospital is in a rural or sub-urban area? What led you to work in a community hospital rather than a large metropolitan medical center?

 

[BestDoctorEver]

I won't disclose the exact number, but I was recruited by the community hospital out of fellowship with a guaranteed salary above average for those with my level of experience. I will mention that I am in my second year out of fellowship. I also maintain auxiliary income from in office billings/procedures, as well as income from doing procedures at an ambulatory surgery center.

We don't need an exact number; you can say for instance 250k-300k so we can have a ballpark....

 

[Euxox]

Which kinds of people/personality types do you think are a good fit for orthopaedics, and which ones do you think are probably not a good fit?

 

[aspirantmed]

We don't need an exact number; you can say for instance 250k-300k so we can have a ballpark....

.. Respect personal boundaries; if you're so intent to know, Medscape has data on physician salaries, their regional distribution, variation, satisfaction, etc. by specialty. More data than you could ever want.

 

[orthos]

You say that you are on staff at a community hospital, which I assume to be a small hospital. Would you say the hospital is in a rural or sub-urban area? What led you to work in a community hospital rather than a large metropolitan medical center?

The hospital is small, located in a suburban community. However, outside of my city is a largely rural area, and my hospital experiences a significant intake of patients from these areas.

I chose to work in a community setting because that's where my heart lies. I do not enjoy the hustle and bustle of big cities except when I'm visiting, and I did not want to work at an academic center where I have less autonomy than I do with my current setup. While I enjoy research, I am a clinician first and foremost, and so the required research of many academic centers did not appeal to me.

In addition, and I hope this does not give away my location, I was recruited to the area because there is no physician that specialized in spine and back pain within 50-ish mile radius, so I knew that I would be a great asset to the community. Already, I've treated people who have been dealing with back pain for years and years and years because there was no provider who could give them proper treatment. When you have severe back pain, traveling to distant places to seek treatment is just not an option.

Finally, the contract I was offered was a great pay given the location and opportunities in the area. Pay is not everything, but it made the choice easier.

 

[orthos]

We don't need an exact number; you can say for instance 250k-300k so we can have a ballpark....

More than that number all total. Of course, that is without subtracting things like overhead for my clinic and paying back my own and my wifes student loans. My contract does not also cover 100% of my malpractice, so there is that too. My situation is unique, given that I was recruited to an underserved area, so do not let that influence your views too much.

 

[touchpause13]

What types of spine surgery do you typically do? Is there one that you specialize in? Have you performed surgery to correct scoliosis?

 

[BestDoctorEver]

What was your step1 score?

 

[TheWeeIceMan]

How much do you bench?
Did you make any cool purchases with that first attending paycheck?

 

[gumdrops]

What was your step1 score?

Are you a troll or an idiot? Just stop.

 

[BestDoctorEver]

Are you a troll or an idiot? Just stop.

Both...

 

[orthos]

Which kinds of people/personality types do you think are a good fit for orthopaedics, and which ones do you think are probably not a good fit?

I've seen all types personality wise. The majority are outgoing people; however, there are some I've worked with that are the "strong & silent" type.

The ones that I feel probably not a good fit are people who are unsure of themselves, constantly second guessing and anxious people. Not that they could not be great at surgery and doing what they do, but because as a surgeon you are expected to lead the team, and if you are unable to take a commanding presence in the OR, your team may lack confidence in you. That's not so bad in some cases, but when you deal with things like trauma, you need to be able to lead confidently.

 

[Lucca]

Similar questions, so I will group them. There can be a lot of crossover when it comes to neuro and ortho spine. I will say that neuro has a lot more to offer when it comes to pathologies that involve the nerve roots beyond things like stenosis due to the actual bony structures or spinal cord. However, I feel like ortho has better training dealing with things like compression fractures, and more experience when performing surgeries that involve reshaping bone (laminectomies, fusions). That's not to say neuro spine can't or won't be better than an ortho doc doing the same procedure - it depends largely on the physician and his training. For all the cases that I feel are too complex or that I lack the equipment to do in my community hospital, I refer to a neurosurgeon who does spine at a large academic center.

In addition, I don't know of many neurosurgeons who deal with disorders of the sacral spine.

Interesting, thanks for the info. Do you have a favorite procedure?

 

[orthos]

What types of spine surgery do you typically do? Is there one that you specialize in? Have you performed surgery to correct scoliosis?

My typical cases for ACDFs, TLIFs/PLIFs, SI Fusions, laminotomies/laminectomies, microdiscectomies, decompressions, and kyphoplasties; I have a good balance of each.

I have performed scoli cases in residency/fellowship, but currently I do not due to lack of equipment and a trained scoli OR team.

 

[NontradCA]

I won't disclose the exact number, but I was recruited by the community hospital out of fellowship with a guaranteed salary above average for those with my level of experience. I will mention that I am in my second year out of fellowship. I also maintain auxiliary income from in office billings/procedures, as well as income from doing procedures at an ambulatory surgery center.

Cool, thanks. I don't know if you saw my other two questions because I put them in an edit. I was asking how much you sleep and how many hours a week do you work? I guess what I really want to know is what drives you to put in all the training you did/work you do? Was there ever a point in your medical career where you thought: ok this is what I'm going to dedicate my life to, or have you always been self driven?

 

[BlackBox]

Are those skull/spine combos in Predator anatomically correct?

 

[orthos]

Interesting, thanks for the info. Do you have a favorite procedure?

My favorite procedures are the ones that go well with no complications. To be honest, I like them all.

 

[touchpause13]

My typical cases for ACDFs, TLIFs/PLIFs, SI Fusions, laminotomies/laminectomies, microdiscectomies, decompressions, and kyphoplasties; I have a good balance of each.

I have performed scoli cases in residency/fellowship, but currently I do not due to lack of equipment and a trained scoli OR team.

Thanks for the reply! What type of equipment is needed?

 

[NontradCA]

Here's a broad question: will we see the ability to reattach the spinal column or cure paralysis of this nature in our lifetime?

 

[orthos]

Cool, thanks. I don't know if you saw my other two questions because I put them in an edit. I was asking how much you sleep and how many hours a week do you work? I guess what I really want to know is what drives you to put in all the training you did/work you do? Was there ever a point in your medical career where you thought: ok this is what I'm going to dedicate my life to, or have you always been self driven?

Sorry, I did not see them. I sleep well, about 8 hours a night, unless I'm on call and have to go to the hospital. I work a standard 8-5 on clinic days, surgery days vary depending on the cases scheduled and whether or not complications arise, and I'm on call a 1:4-5 call schedule typically. I also do clinical research and have other business dealings outside of medicine. Total, I probably work 50-60 hours average, but there are times when I can go 80 hours or more.

My motivation is largely based on the feedback I get from patients and their families. Every day I wake up knowing that I am making a difference in the community and improving the lives of people who were in sore need of my services.

There were many times in my training that I fell short of my expectations, but I had a great mentor and supportive wife who pushed me when times were tough. I realize that not everyone is so fortunate, but if you find a mentor, significant other, friend, anything that will help pick you up when you're down, do everything in your power to stick close to those people.

 

[orthos]

Are those skull/spine combos in Predator anatomically correct?

Everything in that movie is both anatomically and historically correct.

 

[SIGINT]

Thanks for answering these questions.
There have been some concerns about orthopedic surgeons not finding work after residency. How do you see the future of the field? Will it get better or worse?

 

[orthos]

Thanks for the reply! What type of equipment is needed?

For this hospital specially, I'm pushing to get a better C arm

 

[orthos]

Here's a broad question: will we see the ability to reattach the spinal column or cure paralysis of this nature in our lifetime?

I am confident that the advances in regenerative medicine will offer a vast array of new treatment options for such kinds of problems. Though that will probably go towards neuro instead of ortho.

 

[orthos]

How much do you bench?
Did you make any cool purchases with that first attending paycheck?

While this may be blasphemous to state, I do not weight lift anymore. I did a bit in college, but nothing significant (max at 250ish).
I'll have to ask my wife about that first paycheck...

 

[orthos]

Thanks for answering these questions.
There have been some concerns about orthopedic surgeons not finding work after residency. How do you see the future of the field? Will it get better or worse?

I believe that ortho is a field that will see growth, especially with the whole "baby boomers generation" approaching seniority. There will always be trauma, people falling, kids playing sports, etc. that will require treatment. I'm not aware of our field approaching saturation, and I'm not aware of any fields that are intruding on what we have to offer (such as the case with CT surgery and the advent of noninvasive cardiology).

 

[WestCoastNative]

Could you at least tell us the first digit in your salary? I was wondering if it'd be possible to work 5 days a week with weekends off, and make 400k+. Don't hate me for the question SDN'ers. I know we're all wondering.

 

[orthos]

What was your step1 score?

Not high enough to match directly from medical school. I did a year of preliminary surgery before matching to orthopaedics. The key is perseverance and determination; it is a marathon, not a race.

 

[Lucca]

Me again. @orthos why did you choose Spine as a fellowship? What were other specialization opportunities that attracted you but eventually lost?

 

[orthos]

Could you at least tell us the first digit in your salary? I was wondering if it'd be possible to work 5 days a week with weekends off, and make 400k+. Don't hate me for the question SDN'ers. I know we're all wondering.

It is possible. Again it depends on the location and community, whether or not you join an established practice or start your own, what other types of income you are able to generate, etc. For example, I am in the unique position of being in an underserved community where the pain management doctors are backed up in appointment days, so I am able to do procedures that would normally be referred out and thus generate additional procedural income. I also employ a PA who helps to increase our patient load (ex. I do procedures at the surgery center while he sees patients in my clinic).

 

[orthos]

Me again. @orthos why did you choose Spine as a fellowship? What were other specialization opportunities that attracted you but eventually lost?

I chose spine because back pain is one of the most common reasons for doctor visits. I figured I could help the most people by dealing with the most common problem. Moreover, I enjoy the types of surgeries I do, both open and MIS. If I had not done spine, I may have stuck with general ortho or sports.

 

[NontradCA]

Sorry, I did not see them. I sleep well, about 8 hours a night, unless I'm on call and have to go to the hospital. I work a standard 8-5 on clinic days, surgery days vary depending on the cases scheduled and whether or not complications arise, and I'm on call a 1:4-5 call schedule typically. I also do clinical research and have other business dealings outside of medicine. Total, I probably work 50-60 hours average, but there are times when I can go 80 hours or more.

My motivation is largely based on the feedback I get from patients and their families. Every day I wake up knowing that I am making a difference in the community and improving the lives of people who were in sore need of my services.

There were many times in my training that I fell short of my expectations, but I had a great mentor and supportive wife who pushed me when times were tough. I realize that not everyone is so fortunate, but if you find a mentor, significant other, friend, anything that will help pick you up when you're down, do everything in your power to stick close to those people.

I am confident that the advances in regenerative medicine will offer a vast array of new treatment options for such kinds of problems. Though that will probably go towards neuro instead of ortho.

Thanks for the replies!

 

[malaika]

Thank you for taking the time to do this @orthos

 

[orthos]

Can you tell me about any factors which made you second-guess ortho, if at all? Or about any aspects of the field or nature of the job which you'd specifically like to change or remove?

I was fortunate to have been drawn to orthopaedics even before applying to medical school. After my rotations in other specialties, I knew that I wanted to do surgery, and of the varying surgical fields, ortho was the one I had the most experience in and the one that I felt most comfortable with. There was no real second guessing myself, but I was well aware of the drawbacks of orthopaedics - intense 5-year residency, trauma call schedule, etc. Plus I had to care for my wife and kids. Yet in the end, I would do it all again in a heartbeat.

 

[WolfofSDN]

Hi Doctor, thanks for doing this.
I have a strong interest in ortho, and I am starting medical school this fall. What can I do during my first year to help me match in the future?

 

[orthos]

Hi Doctor, thanks for doing this.
I have a strong interest in ortho, and I am starting medical school this fall. What can I do during my first year to help me match in the future?

As soon as you can after matriculation, e-mail the orthopaedics department at your school and see if there are any upcoming opportunities for you to volunteer or shadow or help out in anyway. Let them know you're interested, and that you're just starting medical school - the department will probably be willing to work with you, or tell you to contact them later when you've gotten more experience under your belt. Either way, they'll take note of your interest.

Of course, the #1 priority is your grades and exam scores. Do not give up so much of your time to impress the department that it negatively impacts your academics.

 

[Etorphine]

How often do you think about the possibility of getting sued on a daily basis as a spine surgeon? Are there some areas of ortho that get sued less, and some that get sued more? (relative to other surgical sub-specialties). I am enamored with orthopedic surgery, but I have concerns about that aspect, and would like to know more. I know about the importance of communicating well with patients, setting realistic expectations about outcomes, and above all being nice, but at the end of the day, the statistics are the statistics, and they make me have second thoughts.

 

[amad01]

Is student loan debt a significant burden for you, your colleagues, or other doctors you may know? What would you say to someone about to apply for med school who wants to become a physician, but is having second thoughts because he/she is terrified of 300k+ debt?

 

[orthos]

How often do you think about the possibility of getting sued on a daily basis as a spine surgeon? Are there some areas of ortho that get sued less, and some that get sued more? (relative to other surgical sub-specialties). I am enamored with orthopedic surgery, but I have concerns about that aspect, and would like to know more. I know about the importance of communicating well with patients, setting realistic expectations about outcomes, and above all being nice, but at the end of the day, the statistics are the statistics, and they make me have second thoughts.

It's always in the back of my mind, especially when I'm in the OR. I'm very meticulous when it comes to my work, part of which can be attributed to not wanting to create a reason to sue due to my or my team's errors. Thankfully, I can say that I have never been threatened with a lawsuit. As you mentioned, happy and informed patients are less likely to want to go that route. Whenever we begin to discuss surgery, I make patients fully aware of their diagnosis and reasons for suggesting surgery, what I do in the OR step-by-step, likely and not-so-likely complications that may arise (risks), reasonable expectations post-op (benefits), and what to expect if they do not proceed with surgery (alternatives). I also have patients sign a form in my clinic, separate from that done in the hospital, that basically protects me from any legal recourse except in the event that me or my team err. Regardless, my malpractice insurance costs are high.

I will say that any patients I discern are actively seeking to sue, I will not operate on. Those are usually the people who exaggerate their problems, demand surgery that I believe is unnecessary, talk about how other physicians have caused their problems, etc. Not to say I do not believe my patients, but you can always tell when something's up. And documentation is everything.