Orthopedic Surgery, ask a resident anything

[RueTay]

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If time permits, I was wondering if you might be able to shed some light on how orthopaedic residency programs look at applicants who have graduated from US MD schools with pass/fail (no AOA or class rank) grading systems. I know that some programs require AOA for an interview, but how does this work if one's medical school does not have AOA?

Thank you for your time and advice!

To be honest with you I have no idea. Sorry. Program directors aren't stupid tho and they seem to know which schools have pass/fail, AOA etc. Keep in mind that only 1/3-40% of matched Ortho applicants are AOA. I don't know of ANY programs that strictly require AOA for interview.

I would talk to the senior medical students at your school who are applying Ortho and ask them what they think and if has changed their approach to applying.

 

[MDsomeday88]

Thank you for your honest advice!

 

[KinasePro]

What are some of the better topics you've seen rotators present for the standard end-of-sub-i presentation? I know a lot of places ask you to do a 10-30 minute spiel on an ortho topic.

 

[Willy38]

Hands down the best specialty. I'll try to answer whatever question you have, unless it's a stupid question.

Sorry if it takes a while to respond

How much does where you went to med school have an impact on getting into a ortho residency?

 

[RueTay]

What are some of the better topics you've seen rotators present for the standard end-of-sub-i presentation? I know a lot of places ask you to do a 10-30 minute spiel on an ortho topic.

Compartment syndrome is a popular one for trauma. PS vs CR TKA is a good one if you are on a joints service. Best to do something that relates to the service you are rotating on.

 

[RueTay]

How much does where you went to med school have an impact on getting into a ortho residency?

Less than you might expect is my opinion, presuming you are applying from a US allopathic school. Just to match at all, your school has zero to do with it. It is nobody's fault but your own if you don't match at all.

If you are shooting for a competitive academic program, school prestige does start to play a role. Fortunately you do have some control over this by where you rotate. If you have strong scores but are coming from a mid or low tier med school, you can always rotate at a couple big name places and get some powerful LORs. This will make your application look good for top tier programs if you do a good job in your rotations. In other words, if you go impress HSS or Mayo on a rotation, this will be conveyed in your letters and other top tier programs will be interested in your application even if your home med school is not a big name.

If you are concerned about a specific school getting students into Ortho, just take a look at their match lists over the last few years. That is a small sample size but you will definitely get an idea of how many are matching and you will be surprised to see people from mid tier schools matching at top programs.

Also, There are a lot of region considerations you need to make when you are deciding where to rotate and apply.

 

[MDsomeday88]

Not to beat a dead horse or anything, but do you think that this new merger that all of the DO students are talking about will affect the competitiveness of ortho programs in the future for MD students? I ask primarily because I am hoping to match in a state where there are A LOT of DOs.

 

[RueTay]

Not to beat a dead horse or anything, but do you think that this new merger that all of the DO students are talking about will affect the competitiveness of ortho programs in the future for MD students? I ask primarily because I am hoping to match in a state where there are A LOT of DOs.

At least initally not much will change because the bias against MDs and DOs in alot of programs won't change just because they merge. MDs will have a lot more programs to apply to and DOs will have a unified match so they won't have to choose one match or the other and risk not matching at all if they wan to go for an MD programs. In that sense both groups win. Of course this means spending even more money on applications if you want to apply broadly. MDs will also have a tough time figuring out which of the former AOA programs will be receptive to ranking MDs.

Maybe DO schools become more competitive as a result of the merger now that they will have better access to higher quality postdoc training. If not then in the long run MDs will benefit more because I think as a whole MDs are the stronger applicant pool. For this reason it is more likely that as the biases fade, MDs will take more spots than DOs in ortho. It sort of goes without saying but if you are a strong applicant, you will have more options because of the merger. If you are weaker applicant you run the risk of a more competitive degree counterpart (MD or DO) taking your spot.

There are some very good DO ortho programs and they will do fine, but this merger really puts the pressure on the handfull of bad DO programs to improve their caseloads, didactics, research, etc so they don't get shut down.

 

[hubriz]

Less than you might expect is my opinion, presuming you are applying from a US allopathic school. Just to match at all, your school has zero to do with it. It is nobody's fault but your own if you don't match at all.

If you are shooting for a competitive academic program, school prestige does start to play a role. Fortunately you do have some control over this by where you rotate. If you have strong scores but are coming from a mid or low tier med school, you can always rotate at a couple big name places and get some powerful LORs. This will make your application look good for top tier programs if you do a good job in your rotations. In other words, if you go impress HSS or Mayo on a rotation, this will be conveyed in your letters and other top tier programs will be interested in your application even if your home med school is not a big name.

If you are concerned about a specific school getting students into Ortho, just take a look at their match lists over the last few years. That is a small sample size but you will definitely get an idea of how many are matching and you will be surprised to see people from mid tier schools matching at top programs.

Also, There are a lot of region considerations you need to make when you are deciding where to rotate and apply.

Hello RueTay - thanks for your time. I hope this is not too far off topic, because it probably isn't specific to ortho but your "region consideration" brought to light an issue that I have been wondering about for a while.

In general, how important is consideration of regional bias when choosing a medical school. For example, say I hope to end up in Boston for residency, because that's where my family is located. Would attending Mayo Medical School put me at a disadvantage relative to attending Boston University?

 

[RueTay]

Your question is valid but your example is definitely an exception. Attending Mayo will not hurt your chances of going anywhere. In fact You will probably be more competitive in the Boston area if you go to mayo and then do an away rotation in Boston and tell the residency programs that you are looking come home for residency training.

If you were choosing between a several mid tier med schools you would be best off going to the one in the region that you want to end up in.

Of course you ability to hand select the program/region you want for residency will depend the most on how competitive your application is and how competitive your field of interest is. Many people who match Ortho end up going places they didn't plan on, but are happy to do so in order to get the training they want. There were a lot of places on my rank list that I wouldn't have wanted to go to, but Not matching would have been waaaaaaaaaay worse.

 

[DermViser]

I thought the Neuro Surgery Residents were the arrogant ones. Guess not

The question i'm asking is 100% serious, answer it if you'd like my feelings won't get hurt if you don't. Do you think you're better than other people because you're a doctor now? I don't want to ever attain a complex like that, I doubt I ever will. I will be the most humble resident there ever was in history. I know i've got to get into Medical School first. And here comes the bashing

You'll learn when you get to medical school and do rotations, that unlike in college where you're coddled by your professor, in real life, there is such a thing called asking a stupid question.
Also, speaking of arrogance, your question reeks of it. Also, those who are humble, don't have to state "I will be the most humble resident there ever was in history", when your other posts are anything but humble.

 

[hubriz]

Your question is valid but your example is definitely an acceptation. Attending Mayo will not hurt your chances of going anywhere. In fact You will probably be more competitive in the Boston area if you go to mayo and then do an away rotation in Boston and tell the residency programs that you are looking come home for residency training.

If you were choosing between a several mid tier med schools you would be best off going to the one in the region that you want to end up in.

Of course you ability to hand select the program/region you want for residency will depend the most on how competitive your application is and how competitive your field of interest is. Many people who match Ortho end up going places they didn't plan on, but are happy to do so in order to get the training they want. There were a lot of places on my rank list that I wouldn't have wanted to go to, but Not matching would have been waaaaaaaaaay worse.

Great - thank you for the speedy response and helpful information.

 

[RueTay]

I just injected a subscapular bursa, which I didn't even know existed before today. Thank you google at the bedside for showing me how to do that on the fly!

 

[Bbroush]

RueTay, thanks for doing this. What year are you in your residency? And seeing your above comment is great. I've heard from others ortho can be repetitive, but how often do you find yourself learning new surgical procedures and techniques? And how much of your time is spent practicing and honing your craft? (Sorry if that's difficult to answer.)

I know for ortho residents you aren't only spending time in the OR, so there is probably only so many surgeries you can do in a year and so much you can master.

 

[blimpflimp]

I recently met a doctor who had to switch his specialty from surgery to internal medicine because he realized that he has hand tremors. As someone interested in going into general / orthopedic surgery, I tried to see if I have hand tremors as well. I currently work in a lab, and I noticed that my hand shakes when I pipette small volumes, e.g. when I am loading 15 µL samples into PCR gels. So my question is, how much hand tremor is too much for someone aspiring to go into surgery? Do you get any hand tremors when you do surgical procedures that require a lot of precision? Thanks.

 

[RueTay]

RueTay, thanks for doing this. What year are you in your residency? And seeing your above comment is great. I've heard from others ortho can be repetitive, but how often do you find yourself learning new surgical procedures and techniques? And how much of your time is spent practicing and honing your craft? (Sorry if that's difficult to answer.)

I know for ortho residents you aren't only spending time in the OR, so there is probably only so many surgeries you can do in a year and so much you can master.

Surgical residencies need to be repetitive or else you won't learn how to operate. That being said I think there is more variety in Ortho than most surgical sub specialties. We operate all over the body.

I'm a junior resident now there is always something new to learn with every consult and every surgical case. Even if you are doing the same procedure over and over you learn different techniques from different attendings. Once you are a chief things hopefully do get repetitive so you can hone your craft, develop confidence and independence, etc so you are ready to go out and practice when u r done.

 

[RueTay]

I recently met a doctor who had to switch his specialty from surgery to internal medicine because he realized that he has hand tremors. As someone interested in going into general / orthopedic surgery, I tried to see if I have hand tremors as well. I currently work in a lab, and I noticed that my hand shakes when I pipette small volumes, e.g. when I am loading 15 µL samples into PCR gels. So my question is, how much hand tremor is too much for someone aspiring to go into surgery? Do you get any hand tremors when you do surgical procedures that require a lot of precision? Thanks.

Everyone has some tremors. If you are nervous, hypoglycemic, or highly caffeinated they get worse. Some people just aren't good with their hands either because of tremors, bad hand-eye coordination, trouble understanding how 3d objects move in space, poor dexterity, fat fingers... whatever. Best to wait until you get to med school and start assisting with procedures before you decide.

 

[FSP-2014]

Congrats and good luck! Even if you are set on Ortho, you would be wise to keep your eyes open to other specialties as you go through med school. I wouldn't commit to Ortho until you have some tangible Ortho research and clinical experience that occurs in med school. Truth is you have a lot more info you need to gather before you make this big decision.

It's Hard to give advice on specific schools without knowing what they are. Feel free to pm me if u like. I would take a look at the match lists for the different schools over the last few years to see how many match into Ortho and where they are going (regions, big names, community programs, etc). Also look at the Ortho residency websites for the schools so you can compare program size, where they go for rotations, and read about the faculty. There are pretty extensive residency reviews on the orthogate.org forums, which may be interesting to you. At the end of the day your performance and stats in med school will be far more important that the school you are coming from (with a few exceptions of course).

When you get to school just find out when/where the Ortho conferences are and showing up to a few. You will meat some residents, they will get to know you a little bit early which is great because no one will expect anything of you. They will just be glad you are interested. You may score some good advice on which faculty to seek out for research and mentorship and more importantly who to avoid. A really great time to get involved in research is summer after m1 year.

Just make sure they see you as someone who is hardworking, easy going, and not annoying. Do this and you will be fine.

Don't read into stereotypes.

 

[ajin]

Hey RueTay,

I am so happy to read this thread and see you say all the things I tell people when they say "aren't you worried you wont have any free time", etc, etc

So I have a few questions:
1) What year resident are you? (just for general info)
2) I have wanted to go into ortho surg since I started med school. I feel more comftorable in gen surg operations than ortho....but I have done 3 months of gen surg vs 1 month of ortho.......i just wanna make sure, the ortho comfort will come with time im assuming...right? I love the OR, love MSK stuff...always have.
3)I did my undergrad in England, so couldn't apply to US med schools (and I wanted to practice over here), so took the route of the Caribbeam med school... (i had no idea how much i was hurting myself by doing this). Because of this my ortho rotations are at programs that do not have residency programs...but are with influential surgeons (according to a residency chairmen I know personally through my dad who is an ortho surgeon...so i know quite a few ortho people). Assuming I get LOR's from these guys and I have decent step 1 and ck scores (245 on both)....what do u think odds on getting an interview r? (I hav no published research, but am expecting at least 1 publication just before applications are sent off...i did help with some clinical research pre-med, but there was no publication out of it)
4) From your view....is it better to take a yr and do research if u dont match or hav a back up such as a pre-lim gen surg year if you dont match?

Thanks for taking a look at these questions for me....its getting near application time and im sure you remember how much anxiety you get

 

[RueTay]

Hey RueTay,

I am so happy to read this thread and see you say all the things I tell people when they say "aren't you worried you wont have any free time", etc, etc

So I have a few questions:
1) What year resident are you? (just for general info)
2) I have wanted to go into ortho surg since I started med school. I feel more comftorable in gen surg operations than ortho....but I have done 3 months of gen surg vs 1 month of ortho.......i just wanna make sure, the ortho comfort will come with time im assuming...right? I love the OR, love MSK stuff...always have.
3)I did my undergrad in England, so couldn't apply to US med schools (and I wanted to practice over here), so took the route of the Caribbeam med school... (i had no idea how much i was hurting myself by doing this). Because of this my ortho rotations are at programs that do not have residency programs...but are with influential surgeons (according to a residency chairmen I know personally through my dad who is an ortho surgeon...so i know quite a few ortho people). Assuming I get LOR's from these guys and I have decent step 1 and ck scores (245 on both)....what do u think odds on getting an interview r? (I hav no published research, but am expecting at least 1 publication just before applications are sent off...i did help with some clinical research pre-med, but there was no publication out of it)
4) From your view....is it better to take a yr and do research if u dont match or hav a back up such as a pre-lim gen surg year if you dont match?

Thanks for taking a look at these questions for me....its getting near application time and im sure you remember how much anxiety you get

 

[RueTay]

I'll answer your questions in order of importance...
3) I don't have good news for you here. Caribbean grads are historically VERY unsuccessful in the Ortho match. You said you have connections and that, my friend, you will need. I know carib applicants with 250s who applied to every freaking program and got no interviews.
4) this is a complicated question to answer without knowing a lot more about your application. The answer for most US grads who fail to match and have decent scores is to do a year of research. This improves your application as viewed by all residencies and proves your value to the program you are doing research for. However, the only Carib grad I know who matched Ortho did so after doing a prelim year at a top program and just dominating the year. He also got to do one or two elective months in Ortho during that year, which was critical. He basically worked so hard and impressed so many people over the course of the year that they had no choice but to take him. This is a back door way in and in my opinion is pretty much the only way overcome the stigma of being a Carib IMG. Unless your dad is the president of the academy or something. In your case if gen surg is your backup it may be the way to go.
2. Yes. This will come. It sounds like you should definitely pursue a surgical career.
1. I'm a PGY-2

 

[Xenoblade]

Quick questions.

Do people pull muscles while on the job?

If someone does, then are they given time off of surgery, or do they just do consults/see patients? What is the procedure?

And if you do pull a muscle, do they yell or get mad at you?

 

[ajin]

I'll answer your questions in order of importance...
3) I don't have good news for you here. Caribbean grads are historically VERY unsuccessful in the Ortho match. You said you have connections and that, my friend, you will need. I know carib applicants with 250s who applied to every freaking program and got no interviews.
4) this is a complicated question to answer without knowing a lot more about your application. The answer for most US grads who fail to match and have decent scores is to do a year of research. This improves your application as viewed by all residencies and proves your value to the program you are doing research for. However, the only Carib grad I know who matched Ortho did so after doing a prelim year at a top program and just dominating the year. He also got to do one or two elective months in Ortho during that year, which was critical. He basically worked so hard and impressed so many people over the course of the year that they had no choice but to take him. This is a back door way in and in my opinion is pretty much the only way overcome the stigma of being a Carib IMG. Unless your dad is the president of the academy or something. In your case if gen surg is your backup it may be the way to go.
2. Yes. This will come. It sounds like you should definitely pursue a surgical career.
1. I'm a PGY-2

thanks for the quick and honest replies!

 

[RJGOP]

Hands down the best specialty. I'll try to answer whatever question you have, unless it's a stupid question.

Sorry if it takes a while to respond

I'm going into M1 so I have quite a while to make my decision, but I'm interested to know the perspectives of both an orthopedic surgeon/ resident and radiologist. Obviously, you can provide the ortho perspective. Just wanted to know the pros and cons, perhaps the less known or more overlooked pros and cons specifically. Thanks.

 

[mph88]

Hi Rue Tay,
Thanks again for having this forum. It's great to see someone so positive on ortho. I have a strong interest in ortho for a lot of reasons, and I am pretty excited about the possibility of pursuing it. I do have a few questions you might be able to answer. 1) During your residency, how many days/week or days/month are you working 24+ hours with no sleep? What is your call like? and 2) do the hours get substantially better over time? and is it possible to have small children and not be completely overwhelmed? about how many hours/week do you have "free"? 3) do you feel like ortho is also creative and analytical, or is it more just working with your hands. I am looking for something with a hands on AND an intellectual side. Thanks in advance!

 

[RueTay]

I'm going into M1 so I have quite a while to make my decision, but I'm interested to know the perspectives of both an orthopedic surgeon/ resident and radiologist. Obviously, you can provide the ortho perspective. Just wanted to know the pros and cons, perhaps the less known or more overlooked pros and cons specifically. Thanks.

Of course alot of my pros might by your cons and vice versa....

Pros:
- Surgical subspecialty, but still very broad. You operate all over the body and have the oportunity to stay general or continue to subsecialize. Alot of big whacks, alot of small same day procedures, even microsurgery.
- Staying away from bowel
- You aren't usually bogged down by chronic disease. You see a problem, fix it and move on. However, you do have long term follow up on your surgical pateints so there is continuity of care. The patients love you if you are good.
- While the complications of most bread and butter ortho surgery can be devastating, they are pretty rare.
- Job security is great (NPs and PAs can't touch orthopeduc surgery), and its currently one of the more lucrative fields.
- Great people in the field
- You give up doing alot of medicine (a pro for me)
- Broad spectrum of patients (peds ---> elderly)
- You rely heavily on physical exam and radiology interpretation skills

Cons:
- Physically demanding feild, most ortho surgeons work very hard
- Very phiscally demanding residency with lots of trauma and call
- You run into some very high maintenance patients (not really ortho specific)
- You give up doing alot of medicine (a con for some)
- Alot of us think spine and tumor is a drag (long cases, sicker patients)
- I'm sure there are many more

 

[RueTay]

Hi Rue Tay,
Thanks again for having this forum. It's great to see someone so positive on ortho. I have a strong interest in ortho for a lot of reasons, and I am pretty excited about the possibility of pursuing it. I do have a few questions you might be able to answer. 1) During your residency, how many days/week or days/month are you working 24+ hours with no sleep? What is your call like? and 2) do the hours get substantially better over time? and is it possible to have small children and not be completely overwhelmed? about how many hours/week do you have "free"? 3) do you feel like ortho is also creative and analytical, or is it more just working with your hands. I am looking for something with a hands on AND an intellectual side. Thanks in advance!

1. Our 24 hr trauma call is Q4 when on trauma (ends up being more like 30 hr call after rounds). The junior resident rarely sleeps and the Chief probably gets a few hours if it isnt busy. This is very institution specific. More trauma = more call = less sleep
2. Yes, intern year is a breeze because of work hour restrictions. 2nd year of residentcy is usually the most demanding because you are in the ED doing consults all the time. Call schedules in most programs are easier for the 4s and 5s and I know of some programs where the 5th years take No call unless they are on a trauma rotation. If you have a family/kids you should look into the more "family friendly" ortho residency programs. But still expect to work hard. The actual hours you work are highly variable and depend on your call schedule and how busy your rotation is. Ave at our program is probably 70-80 hours/wk with a big standard deviation.
3. Definitely creative/analytical. Alot of physics actually which I like. Ortho surgery is sometimes like being an architect. There are many ways to fix a fracture, many ways to do a total knee. It is a very intellectual field, but its very different from the other fields of medicine. To other feilds we just "fixed the fracture" or "did a THA". In reality there is a lot of templating that goes on, intraoperative decision making on how to get the best fixation given a particular unique fracture pattern or patient habitus. The diagnosis is rarely tricky in ortho, our decision making comes in how best to fix the problem. People always say that smart people go into ortho and then become dumb... and thats true if your refering to knowlege of IM. Our knowlege base base is huge in an area of surgery that other docs know absolutly NOTHING about. That being said I think ALL areas of medicine have a big intellectual side, its what you make of it.

 

[RJGOP]

Of course alot of my pros might by your cons and vice versa....

Pros:
- Surgical subspecialty, but still very broad. You operate all over the body and have the oportunity to stay general or continue to subsecialize. Alot of big whacks, alot of small same day procedures, even microsurgery.
- Staying away from bowel
- You aren't usually bogged down by chronic disease. You see a problem, fix it and move on. However, you do have long term follow up on your surgical pateints so there is continuity of care. The patients love you if you are good.
- While the complications of most bread and butter ortho surgery can be devastating, they are pretty rare.
- Job security is great (NPs and PAs can't touch orthopeduc surgery), and its currently one of the more lucrative fields.
- Great people in the field
- You give up doing alot of medicine (a pro for me)
- Broad spectrum of patients (peds ---> elderly)
- You rely heavily on physical exam and radiology interpretation skills

Cons:
- Physically demanding feild, most ortho surgeons work very hard
- Very phiscally demanding residency with lots of trauma and call
- You run into some very high maintenance patients (not really ortho specific)
- You give up doing alot of medicine (a con for some)
- Alot of us think spine and tumor is a drag (long cases, sicker patients)
- I'm sure there are many more

Thank you so much for the insight. I appreciate you going into detail about the pros and cons of the specialty. As previously stated, I have a while to decide what I want to do, but this gives me a great perspective about ortho. Thanks again.

 

[Lawgiver]

Did you are others you know have to deal with being squeamish? Is so, how did u overcome it. I'm asking because currently this is my biggest weakness I believe. The idea of drilling or using a saw on a living human makes my stomach churn.

*Personal weakness not academic or related otherwide

 

[pbrocks15]

Thanks for doing this! Ortho surgery is my dream.

1. Just curious, have you read Hot Lights, Cold Steel by Dr. Michael Collins.

2. What do you find most intriguing about Ortho Surgery? Did you shadow a surgeon before your rotation?

3. What operations do you perform most regularly?

4. During what time did you publish? Was it later in medical school that you published? Also, what topics are you interested in if you do research?

5. What do you believe impacted your acceptance into Ortho residency the most? You mentioned that you had a lower than average USMLE.

6. What do you like to do in your free time?

7. Do you see MD/PhDs in Ortho?

Thanks again for doing this! I was waiting for an ortho one!

 

[heatfan]

Do you have much free time at all? For hobbies, friends, etc. Thanks for answering all of these questions. Very helpful!

 

[Mmedran]

Hi RueTay,

Really digging the thread! Thanks for your time!

So, I'm currently an M1 at an MD school with an interest in surgery, with a pull towards ortho... For the record, I root for my local sports teams, but otherwise, not really into professional sports. But! I do enjoy lifting heavy things on a regular basis.

Ive read that something like only 14% of ortho applicants are female and an even smaller percentage (like 4%) are women of color. With the reputation of orthopedic surgery as an "old boys club", would you say that (all other parts of the application looking good) being a woman of color helps in the application process or makes applying a fruitless endeavor? Are there women (of color) in your program? If there are women in your program, are they viewed/treated differently?

 

[RueTay]

Did you are others you know have to deal with being squeamish? Is so, how did u overcome it. I'm asking because currently this is my biggest weakness I believe. The idea of drilling or using a saw on a living human makes my stomach churn.

*Personal weakness not academic or related otherwide

Sorry for the delay in response

It's a real eye opener the first time you ever see an Ortho surgery with the drills, saws, and reamers. No doubt. I remember being amazed that a patient could bounce back so quickly from such debauchery. For me and for most that fades quickly. However, we do quite a bit of cadaver work at my program and when the bone mist hitting you in the face is from a dead dude, that still makes you churn.

 

[RueTay]

Thanks for doing this! Ortho surgery is my dream.

1. Just curious, have you read Hot Lights, Cold Steel by Dr. Michael Collins.

2. What do you find most intriguing about Ortho Surgery? Did you shadow a surgeon before your rotation?

3. What operations do you perform most regularly?

4. During what time did you publish? Was it later in medical school that you published? Also, what topics are you interested in if you do research?

5. What do you believe impacted your acceptance into Ortho residency the most? You mentioned that you had a lower than average USMLE.

6. What do you like to do in your free time?

7. Do you see MD/PhDs in Ortho?

Thanks again for doing this! I was waiting for an ortho one!

1. Yes

2. I like surgical principles behind orthopedic surgery. Being a good Ortho surgeon is all about your ability to get good fracture fixation, handle soft tissues with care,restore joint biomechanics, water tight closure of the fascia, getting the right exposure, etc. Once you learn these principles you can apply them all over the body.

3. Hip fractures, wrist fractures, TKA, THA, shoulder and knee arthroscopy, cuff repair, ACL repair, carpal tunnel, joint fusions in the hand/ankle, lumbar decompression. That's some of the bread and butter, but we do a lot more than that very routinely. Most sub specialize because the field is so broad and realistically you can do a fellowship and still have a broad scope,to your practice.

4. I published during my masters work before medical school. Then I did some projects and a poster between m1-2 year. Now I'm not doing any basic science research anymore (thank The Lord). I do a lot of retrospective reviews now using our institution's joint registry. I'm looking at functional outcome and overall survivorship of rotating platform vs traditional posterior stabilizing TKA right now.

5. Performance on away rotations was definitely the most important for me. This got me good LORs, which can also make or break you big time. I think having some research is important. Obviously you have decent scores etc to get in the door but after that I think your performance on away rotations and the interview is most important.

6. I don't have free time. Jk. Golf, make beer, drink beer, fish, be with family, watch sports, play sports.

7. You do, but I wouldn't recommend it unless you want to be in an academic setting and focus at least 1/3 of your time on research.

 

[RueTay]

Do you have much free time at all? For hobbies, friends, etc. Thanks for answering all of these questions. Very helpful!

See #6 above

 

[RueTay]

Hi RueTay,

Really digging the thread! Thanks for your time!

So, I'm currently an M1 at an MD school with an interest in surgery, with a pull towards ortho... For the record, I root for my local sports teams, but otherwise, not really into professional sports. But! I do enjoy lifting heavy things on a regular basis.

Ive read that something like only 14% of ortho applicants are female and an even smaller percentage (like 4%) are women of color. With the reputation of orthopedic surgery as an "old boys club", would you say that (all other parts of the application looking good) being a woman of color helps in the application process or makes applying a fruitless endeavor? Are there women (of color) in your program? If there are women in your program, are they viewed/treated differently?

Thankfully you do see diversity with gender and race more and more these days. We are not to the point where it should be yet. There are still some programs out there that have the "good ol boys" reputation, but these are on the way out I hope. At this point with all things being equal I think being female, URM, or both will help your application to MOST programs. As far as being viewed/ treated differently, I don't know. That would be a good question for a female resident.

 

[jagster92]

Thanks a ton for your time here. Is the trade-off of not doing a lot of medicine something across the board in surgery from your experience? I ask because I've thought about surgery myself, but I think it would be hard for me to give up that side of practice, especially after putting the time in to get a PharmD prior to med school.

 

[pbrocks15]

1. Yes

2. I like surgical principles behind orthopedic surgery. Being a good Ortho surgeon is all about your ability to get good fracture fixation, handle soft tissues with care,restore joint biomechanics, water tight closure of the fascia, getting the right exposure, etc. Once you learn these principles you can apply them all over the body.

3. Hip fractures, wrist fractures, TKA, THA, shoulder and knee arthroscopy, cuff repair, ACL repair, carpal tunnel, joint fusions in the hand/ankle, lumbar decompression. That's some of the bread and butter, but we do a lot more than that very routinely. Most sub specialize because the field is so broad and realistically you can do a fellowship and still have a broad scope,to your practice.

4. I published during my masters work before medical school. Then I did some projects and a poster between m1-2 year. Now I'm not doing any basic science research anymore (thank The Lord). I do a lot of retrospective reviews now using our institution's joint registry. I'm looking at functional outcome and overall survivorship of rotating platform vs traditional posterior stabilizing TKA right now.

5. Performance on away rotations was definitely the most important for me. This got me good LORs, which can also make or break you big time. I think having some research is important. Obviously you have decent scores etc to get in the door but after that I think your performance on away rotations and the interview is most important.

6. I don't have free time. Jk. Golf, make beer, drink beer, fish, be with family, watch sports, play sports.

7. You do, but I wouldn't recommend it unless you want to be in an academic setting and focus at least 1/3 of your time on research.

Thanks for your response!

I am still considering MD/PhD because of my interest in research but my love for surgery outweighs my love for research.

I want to go into acadmeic medicine but I don't know if I want to perform bench research as a surgeon.

I also find the full ride plus stipend to be attractive.

Do you think that it's a waste if you don't wish to do basic science research in the future? Does the monetary savings from the program really help in the long run for a surgeon or do you think that you will make enough for it not to be worrisome at all?

I also hear how its important for surgeons to practice a lot and that's what makes a good surgeon. Do you think that residency would not favor a MD/PhD because they feel that they won't put as much time in?

I really would appreciate your opinion!

Thanks again for all the help!

 

[RueTay]

Thanks a ton for your time here. Is the trade-off of not doing a lot of medicine something across the board in surgery from your experience? I ask because I've thought about surgery myself, but I think it would be hard for me to give up that side of practice, especially after putting the time in to get a PharmD prior to med school.

Not across the board no. General surgeons have to know/do a lot of medicine, especially in the SICU setting. Some surgical subspecialties like urology does quite a bit of medicine. In ortho we definitely give up most medicine... happily

 

[NYCdude]

How many of the procedures that you do are elective surgeries vs. ones that are medically necessary?

 

[RueTay]

Thanks for your response!

I am still considering MD/PhD because of my interest in research but my love for surgery outweighs my love for research.

I want to go into acadmeic medicine but I don't know if I want to perform bench research as a surgeon.

I also find the full ride plus stipend to be attractive.

Do you think that it's a waste if you don't wish to do basic science research in the future? Does the monetary savings from the program really help in the long run for a surgeon or do you think that you will make enough for it not to be worrisome at all?

I also hear how its important for surgeons to practice a lot and that's what makes a good surgeon. Do you think that residency would not favor a MD/PhD because they feel that they won't put as much time in?

I really would appreciate your opinion!

Thanks again for all the help!

Don't do MD/PhD for the stipend or upfront savings. Only do it if the idea of focusing a major part of your medical training and practice on research appeals to you. If this is the case you may still end up going into ortho eventually, but most MD/PhD types end up in more research focused fields. To your last point, if you YOURSELF want to spend alot of time doing research then yes your surgical skills will likely suffer. However alot of the well published/well known ortho surgeons are also known to be great surgeons and that is because most of the research is done by their residents, they just guide the ship in the right direction.

 

[RueTay]

How many of the procedures that you do are elective surgeries vs. ones that are medically necessary?

define medically necessary

 

[RueTay]

Tumor and trauma are obveously medically necessary. If you don't operate the patient will die from cancer, get infected, get a nonunion etc. But in most ortho surgery the "medical necessity" is difficult to define. Nobody dies from arthritis, an ACL tear, or a frozen shoulder that is refractory to physical therapy. However, they can become debilitated with pain to the point that they cannot ambulate or enjoy a functional extremity. They become sedentary, gain weight, loose interest in activities, etc. Herin lies what is great about orthopedics and why our patients are usually very pleased with us. A total joint replacement certainly isnt NECESSARY for the patient, but they can't believe how great they feel after a successful operation and so in their eyes it is a life saver.

This is why we counsel our pateitns only to undergo surgery after all the nonoperative treatment modalities have failed and their pain/function has gotten bad enough to warrant surgery and accepting the risks associated with surgery.

 

[NYCdude]

define medically necessary

"Necessary surgery refers to surgical procedures that pertain to a condition that cannot be treated by other methods and, if left untreated, would threaten the life of the patient, fail to repair or improve a body function, increase the patient's pain, or prevent the diagnosis of a serious or painful condition.

http://www.surgeryencyclopedia.com/La-Pa/Necessary-Surgery.html#ixzz3BG4rD14t"

 

[ridethecliche]

A large majority of ortho procedures are quality of life surgeries. No one would die if the procedures wouldn't be performed. This is true for hip replacements, most elective spine procedures, etc etc etc.

 

[RueTay]

"Necessary surgery refers to surgical procedures that pertain to a condition that cannot be treated by other methods and, if left untreated, would threaten the life of the patient, fail to repair or improve a body function, increase the patient's pain, or prevent the diagnosis of a serious or painful condition.

http://www.surgeryencyclopedia.com/La-Pa/Necessary-Surgery.html#ixzz3BG4rD14t"

Using this very inclusive definition, all orthopedic surgeries (assuming the surgeon has a correct understanding of the surgical indications) are medically necessary. Based on the " fail to repair or improve a body function" clause.

 

[NYCdude]

Tumor and trauma are obveously medically necessary. If you don't operate the patient will die from cancer, get infected, get a nonunion etc. But in most ortho surgery the "medical necessity" is difficult to define. Nobody dies from arthritis, an ACL tear, or a frozen shoulder that is refractory to physical therapy. However, they can become debilitated with pain to the point that they cannot ambulate or enjoy a functional extremity. They become sedentary, gain weight, loose interest in activities, etc. Herin lies what is great about orthopedics and why our patients are usually very pleased with us. A total joint replacement certainly isnt NECESSARY for the patient, but they can't believe how great they feel after a successful operation and so in their eyes it is a life saver.

This is why we counsel our pateitns only to undergo surgery after all the nonoperative treatment modalities have failed and their pain/function has gotten bad enough to warrant surgery and accepting the risks associated with surgery.

That's a good point. My orthopedist was telling me that if I didn't get ACL reconstruction, then I would be playing "Russian roulette" with the rest of my ligaments and so it would be wise to get it. To me it seemed like a bad idea to not get surgery. Would that qualify as a necessary surgery (since other aspects of my health might have been compromised)?

 

[ridethecliche]

That's a good point. My orthopedist was telling me that if I didn't get ACL reconstruction, then I would be playing "Russian roulette" with the rest of my ligaments and so it would be wise to get it. To me it seemed like a bad idea to not get surgery. Would that qualify as a necessary surgery (since other aspects of my health might have been compromised)?

Probably not. Medically necessary often means that it would cause significant comorbidity or death if it is not addressed.

 

[RueTay]

The opposing argument is that NOT reconstructing a torn ACL can lead to recurrent knee instability, injury to other structures in the knee, abnormal knee kinematics, and early onset of post traumatic arthritis. The significance of those potential comorbidities down the road need to be considered by the patient.


For the record, I am not giving you medical advice and these forums are not for medical advice.

 

[ridethecliche]

Hah, interesting.