Orthopedic Surgery, ask a resident anything

[RueTay]

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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

 

[HopefulReapp]

Many of the ortho attendings/residents that I've talked with have said that they love ortho because of the instant gratification in procedures-- the patient can be "fixed" in many cases. Was this also your motivation for going into the field?

What has been your favorite procedure so far? Are you afraid of becoming bored with the redundancy of procedures that you will do in your career?

I took a grad level course in orthopaedics where once a week we had a live feed in to surgeries and could talk with the surgeon while he was performing. Easily my favorite class during undergrad and it definitely got me interested in the field.

 

[rudziutki]

How much do you bench? Squat? Why ortho? When did you know ortho was what you wanted to aim for? Did you do ortho research in medical school?

 

[icevermin]

How important is research for an Ortho residency? When should you start research? How are Osteopathic applicants perceived for ACGME residencies?

 

[Brownshorts]

The only question that matters. Do you even lift?

 

[RueTay]

Many of the ortho attendings/residents that I've talked with have said that they love ortho because of the instant gratification in procedures-- the patient can be "fixed" in many cases. Was this also your motivation for going into the field?

What has been your favorite procedure so far? Are you afraid of becoming bored with the redundancy of procedures that you will do in your career?

I took a grad level course in orthopaedics where once a week we had a live feed in to surgeries and could talk with the surgeon while he was performing. Easily my favorite class during undergrad and it definitely got me interested in the field.

Great questions. I definitely was attracted to the outcomes in Ortho. There is a huge variety of procedures and most of them are very good at alleviating pain and restoring function. That being said we do our share of life saving when it comes to tumor surgery.

In medical school I was bogged down by all the chronic disease that is really just "managed" by internal medicine. I never got a kick out of optimizing patients diabetes, COPD, CHF, CAD, etc. In Ortho we see a lot of bad problems that are fixable. The decision making that gets interesting is HOW to best fix the problem. Proper surgical indications, how to pick the best procedure, and then making sound intro operative decisions based on the patients anatomy and pathology. This is the art of Ortho. You also have a lot of biomechanical considerations in Ortho, which is not true of most fields.

So far I really like shoulder arthroplasty. Reverse, hemi, and total shoulders are all very neat procedures that are difficult to do well. I also like unicompartmental knee arthroplasty.

 

[RueTay]

Consider Ortho if any of the following interest you: surgery (obviously), musculoskeletal anatomy/physiology, sports and sports related injuries, avoiding bowel, miscrosurgery, a huge variety of patients (think peds clubfoot, Athlete with torn ACL, grandma with arthritis, sick dude with chondrosarcoma), smart sterile carpentry, implanting cement, trauma, arthroscopic surgery, big open whacks, fast paced clinics, interpreting radiology, being in the ED, surgical subspecialization

 

[RueTay]

Do you weight train? Do you play any sports? How much money will you make?

Nobody knows how much anyone will make 10 years from now. Right now Ortho is real good, especially high volume private practice and spine.

 

[RueTay]

How important is research for an Ortho residency? When should you start research? How are Osteopathic applicants perceived for ACGME residencies?

We have DOs in my program and they are some of our best residents. It is very hard for them to match ACGME right now, but they also have plenty of strong DO residencies.

I started research between M1 and M2 year, it is important. Not as important as step 1, letters, and away rotations.

 

[SnakeOilForSale]

What do you think is the biggest determinant in landing an othro residency? Any general advice for someone interested in the field?

Thanks a lot!

 

[RueTay]

Well, you need to get a lot of interviews in order to confidently know you will match (12+) and that means having 240+ step 1, at least some research, and most importantly strong letters from well known attendings. The latter will happen if you do well in away rotations as a 4th year med stud.

Once you get the interviews you just need to go on them and show programs that you are a reasonable, hardworking, we'll balanced person who they can stand to work with and be around for the next 5 years.

We just interviewed our applicants and you would be SURPRISED how many people don't realize how crazy they are. You wonder how they ever got so far. Being a pleasant, likeable, and professional person is not taught in med school or anywhere really. Some have it, some do not, but it is a very important part of matching in Ortho. Most programs are pretty small (4-6 residents/year) and tight knit and they try their hardest to weed out the gunners and nut jobs.

 

[karayaa]

What else did you consider/how did you finally decide on ortho!

Thanks for doing this! <3

 

[RogueUnicorn]

Do you do any sort of medical management of your surgical patients or is everything turfed to the medicine guys? Do the ortho trauma guys manage the medical aspects of the trauma like the gen surg guys?

 

[Postictal Raiden]

As a future physician, I'm very interested in the field, so forgive me for asking many questions.

Does the profession take toll on your body as you get older (ie. lifting patient's limbs)?
Does the job require natural good eye-hand coordination, or are these skills acquired through residency?
How long on average do Ortho surgeons practice?
Do you miss diagnosing patients?
Could you describe a day-in-life of an ortho resident/attending?
Lastly, where do you see the profession in the next few decades (aging population, technology, ACA, etc...)?

Thank you very much!

 

[Leoz M Jiliums]

Hi Rue,

What is the normal scope of practice of a sports medicine specialist? Is it mostly arthroscopy or do they also do open procedures in normal practice? Do they work on all joints?

What was your favorite moment as an ortho resident? What was your worst moment?

I am 100% percent set on doing ortho, and I'm thinking about applying to NYU's 3 year program for entry into an ortho residency. When did you feel that you fully decided to do ortho, did your tastes change over time as a medical student or did you know what you want from the outset?

If you could change one thing about the specialty, what would it be?

Sorry if there are too many questions, I've been waiting for a long time for one of these threads for ortho.

Edit: I noticed that you also review applicants for residency, how much does school prestige matter to you and your colleagues in deciding interviews/match lists? I am currently deciding between my state school (very low ranking) and some private schools which are higher ranking.

 

[The Buff OP]

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

By any chance do you know if military orthopedic residencies differ from civilian ortho residencies?
If you know the answer to my first question are civilian ortho residencies better than military residencies?
Edit: lol of course doing a residency at a well known hospital like Johns Hopkins would be better than a VA hospital.

 

[Gauss44]

1. I scored above the 95th percentile on an IQ test in geometry and had a hobby of building things: skateboard ramps, tree houses, toy bridges that won competitions for carrying lots of weight, etc. Does any of this suggest that I would make a good orthopedic surgeon?
2. How's the job market?

 

[Elizabeth Estrada]

When did you know ortho was what you wanted to aim for?

 

[WestCoastNative]

What's lifestyle like? Can you work 4/5 days a week and make 500k+?
Is it possible to open a successful private practice as an orthopedic surgeon?
What's competition like to get into an orthopedic residency/fellowship?

 

[solitarius]

Is there a bias in favor of former jocks? (Be honest).

 

[Ailleurs]

You said you saw lots of applicants who were obviously crazy. What were the telltale signs that they were crazy or gunner? I feel like that information would be applicable to all interviews.....Thanks for doing this! Happy holidays.

 

[Elevencents]

I'm assuming you did well on Step 1. What resources did you use to prepare for it? For how long?

Were you set on ortho from day one or did it attract you later on?

What makes ortho more appealing to you in comparison to other surgical subspecialties?

Thanks so much for doing this. Looking forward to all the responses.

 

[username456789]

Hands down the best specialty.

Guess your school forgot to tell you about Derm. Shame.

Kidding. Sort of. Glad you're having fun.

 

[RueTay]

Do you do any sort of medical management of your surgical patients or is everything turfed to the medicine guys? Do the ortho trauma guys manage the medical aspects of the trauma like the gen surg guys?

This will be very program specific. At my program we take care of the basics and get medicine consults for anything more. This works great because while we certainly could manage more than we do, reality is that we are in the OR all day most of the time and our med consult service has more time

Guess your school forgot to tell you about Derm. Shame.

Kidding. Sort of. Glad you're having fun.

My two weeks on derm were the most boring and meaningless weeks of med school. You guys have to memorize the most worthless stuff. Scraping at old flakey skin and rashes and pus all day... No thanks 🙂 Kidding, sort of.

 

[RueTay]

Do you do any sort of medical management of your surgical patients or is everything turfed to the medicine guys? Do the ortho trauma guys manage the medical aspects of the trauma like the gen surg guys?

Yes, but not nearly as much as the gens surg folks. This is program dependent. Where I am we take care of the simple stuff and consult med for the rest. This gives me less floor work and more time in the OR, which is great. I am not in residency to become board certified IM. I just need to know postoperative and of SICU care. Med consults are my friend.

 

[Status Sciaticus]

how extensive was your research and how much influence do you think it played into being selected at your residency program?

 

[RueTay]

What do you think is the biggest determinant in landing an othro residency? Any general advice for someone interested in the field?

Thanks a lot!

Sorry for the long delay in responses

Unfortunately the biggest determinant is still step 1 score. At least for getting the interview. After that it really becomes all about fit. Every program Sid ifferent and there so dents have a huge say in who "fits" well at a given program

 

[RueTay]

how extensive was your research and how much influence do you think it played into being selected at your residency program?

Every program will want you to have done some research and the more the better. Some programs are very academic and the research will be a BIG factor. That's not the case at UTSW tho.

 

[RueTay]

1. I scored above the 95th percentile on an IQ test in geometry and had a hobby of building things: skateboard ramps, tree houses, toy bridges that won competitions for carrying lots of weight, etc. Does any of this suggest that I would make a good orthopedic surgeon?
2. How's the job market?

1. No

2. Good, there are plenty of jobs, but big cities are saturated and it has become more competitive

 

[RueTay]

As a future physician, I'm very interested in the field, so forgive me for asking many questions.

Does the profession take toll on your body as you get older (ie. lifting patient's limbs)?
Does the job require natural good eye-hand coordination, or are these skills acquired through residency?
How long on average do Ortho surgeons practice?
Do you miss diagnosing patients?
Could you describe a day-in-life of an ortho resident/attending?
Lastly, where do you see the profession in the next few decades (aging population, technology, ACA, etc...)?

Thank you very much!

Who ever said you stop diagnosing patients?

 

[RueTay]

As a future physician, I'm very interested in the field, so forgive me for asking many questions.

Does the profession take toll on your body as you get older (ie. lifting patient's limbs)?
Does the job require natural good eye-hand coordination, or are these skills acquired through residency?
How long on average do Ortho surgeons practice?
Do you miss diagnosing patients?
Could you describe a day-in-life of an ortho resident/attending?
Lastly, where do you see the profession in the next few decades (aging population, technology, ACA, etc...)?

Thank you very much!

In response to your other questions...

Surgery in general takins it's toll on your body, but many surgeons alter their practice when they get older. The do more clinic and more consulting, or they do shorter/ less invasive procedures and take less call in order to make life more manageable .

Day in the life:

Yesterday I woke up at 4:10, I was on the wards seeing inpatients by 5:00. I wrote around 15 progress notes, then rounded with our fellow at 6:15. We had conference at 7-8 (and had some coffee). Made incision on our first case at 8:30, got out of the OR at 6pm after our last case (my service had 2 rooms and we did 6 cases: two primary TKAs, a revision hip, a periacetabular osteotomy, a primary hip, and a unicompartmental knee arthroplasty. Did postoperative rounds and orders, home at 7. This is an average day if you are not on call. Of course some days are shorter, some longer.

 

[RueTay]

Is there a bias in favor of former jocks? (Be honest).

Not a bias, but I think former jocks gravitate toward the field because it's very mechanical, hands on, and there are a lot of of sport- related pathologies. Trauma is a big part of sports, and an even bigger part of Ortho.

 

[Postictal Raiden]

In response to your other questions...

Surgery in general takins it's toll on your body, but many surgeons alter their practice when they get older. The do more clinic and more consulting, or they do shorter/ less invasive procedures and take less call in order to make life more manageable .

Day in the life:

Yesterday I woke up at 4:10, I was on the wards seeing inpatients by 5:00. I wrote around 15 progress notes, then rounded with our fellow at 6:15. We had conference at 7-8 (and had some coffee). Made incision on our first case at 8:30, got out of the OR at 6pm after our last case (my service had 2 rooms and we did 6 cases: two primary TKAs, a revision hip, a periacetabular osteotomy, a primary hip, and a unicompartmental knee arthroplasty. Did postoperative rounds and orders, home at 7. This is an average day if you are not on call. Of course some days are shorter, some longer.

Ortho rocks!

Thank you,

 

[RedWedding]

I've been interested in ortho since high school. (Starting med school next year, so things might change obviously.) I knew that ortho was a male-dominated field, but I recently discovered that only four percent of orthopedic surgeons are female. Are women discouraged from pursuing ortho, do ortho residents purposefully make them uncomfortable, or what? Why is that number so low? And will this be problematic for me?

 

[nychila]

Relatively-speaking, how important is AOA for ortho residency applications? Does not being AOA significantly hinder an applicant's chances at an academic program in a large city on either coast, eg. Manhattan, Philly, DC, Boston, SF, Seattle, LA?

 

[Staffsy77]

When you were going through the match process, did you apply to only ortho programs? If not, what was your second choice?

 

[miss chievous]

What if you're interested in sports medicine and ortho but hate research with a passion (e.g. rather get stabbed in the arm than go through a week of research)

 

[Lord Osis]

Have you saved a life with your medical practice?

 

[RueTay]

I've been interested in ortho since high school. (Starting med school next year, so things might change obviously.) I knew that ortho was a male-dominated field, but I recently discovered that only four percent of orthopedic surgeons are female. Are women discouraged from pursuing ortho, do ortho residents purposefully make them uncomfortable, or what? Why is that number so low? And will this be problematic for me?

Not sure where you got that number but it's probably close to accurate, unfortunately. The good news is this is trending upward. Women are on the rise in Ortho and other traditionally male-dominated specialties. This is both a good thing for the for the field and a great opportunity for you. There are probably four or five programs left out of the 100+ orthorhombic residencies that still have the "good ol boys" mentality and are not receptive to women. However the vast majority of programs are very welcoming and are even actively recruiting qualified women to the field. I personally have not seen anything in med school or residency that discourages woke from the field, but once oust something does. Not sure what it is to tell you the truth

 

[RedWedding]

Not sure where you got that number but it's probably close to accurate, unfortunately. The good news is this is trending upward. Women are on the rise in Ortho and other traditionally male-dominated specialties. This is both a good thing for the for the field and a great opportunity for you. There are probably four or five programs left out of the 100+ orthorhombic residencies that still have the "good ol boys" mentality and are not receptive to women. However the vast majority of programs are very welcoming and are even actively recruiting qualified women to the field. I personally have not seen anything in med school or residency that discourages woke from the field, but once oust something does. Not sure what it is to tell you the truth

Thank you!
I got the number here btw: https://www.aamc.org/download/313228/data/2012physicianspecialtydatabook.pdf

 

[Life Sucks]

Thank you!
I got the number here btw: https://www.aamc.org/download/313228/data/2012physicianspecialtydatabook.pdf

I hope you don't let that discourage you.

 

[LostinLift]

Did you consider other surgical subspecialities? What ruled them out for you?

 

[SunsFun]

How would I know if I have good or bad manual dexterity? I am good at some things, bad at others. Is there anything that can help someone figure this out at least to some degree?

 

[RueTay]

When you were going through the match process, did you apply to only ortho programs? If not, what was your second choice?

Yes, I only applied for Ortho. You have to apply to Many MANY programs if you are going after a competitive specialty, I applied to around 70 and I know some who applied to 100+. I can't imagine applying to another specialty on top of that, and most people don't. I was prepared to do a research year if I went unmatched

 

[QuinnTheEskimo]

How important is med school reputation when it comes to matching? i.e., does a Harvard student with a 240-250 step have an advantage over a Drexel student with a 260+ step?

 

[RueTay]

How would I know if I have good or bad manual dexterity? I am good at some things, bad at others. Is there anything that can help someone figure this out at least to some degree?

You will figure this out on your 3rd year surgery rotations. The residents will show you how to throw sutures, tie knots, etc. if you find you like doing these things and working with your hands, then you will gravitate toward a procedural field. For Ortho we use a lot of powered drills, saws, and burrs. if you have experience with carpentry and/or enjoy being in a workshop, then Check out Ortho.

These skills are learned , but it definitely comes more naturally to some

 

[orangeman25]

How important is med school reputation when it comes to matching? i.e., does a Harvard student with a 240-250 step have an advantage over a Drexel student with a 260+ step?

Bump! Very interesting point.

 

[RueTay]

How important is med school reputation when it comes to matching? Does a Harvard student with a 240-250 step have an advantage over a Drexel student with a 260+ step?

For some of the top academic programs your school prestige and personal pedigree will make a big difference. However in terms of your overall chance at matching I think much more depends on who you are then where you are coming from. How well did you rotate, how strong are your LORs, step scores, 3rd year grades, etc.

In regards to the scenario you proposed, all else being equal the Harvard dude would probably have a better chance at some programs because of the name. Take a look at the residency websites, many of them list their residents and where they are from.

 

[RueTay]

Bump! Very interesting point.

Also, the difference between a 250 and 260 is not big. The difference between 230 and 240 is much bigger. I myself had a below average Ortho USMLE, I came from a mid tier state school, and was able to match at a big name place so there is much more to it than scores and where you are from.

 

[RueTay]

Have you saved a life with your medical practice?

So one thing I really like about Ortho is that most of what we do focuses on pain relief and improving function. We make patients very happy by improving their quality of life, usually not by saving their life. Other than in trauma and in orthopedic oncology, most of what we do does not deal with life and death situations.

That being said I have helped out in some big trauma cases with open pelvic fractures and hemipelvectomies for malignant bone tumors. These were without a doubt life saving surgeries.