Orthopedics vs Family medicine with MSK focus

[Conchilardo]

Trying to decide on specialties to apply for and have really narrowed it down to FM and ortho largely due to the patient population (sports medicine type of practice hopefully working with an increasingly active aging population), a strong interest in musculoskeletal cases, and working with my hands to get fast/robust improvements to peoples health. I know primary care and ortho sports med have a lot of differences, but I'd be shaping a primary care sports med clinic to be as close to ortho as insurance would allow based on what I've seen in practice.

I'm currently a 3rd year with average grades, 3 pubs 5 abstracts, letters as needed (no strong ortho yet), overall probably a middle of the road applicant for ortho (no step/level 2 yet).

The problem arises with:

1. strong regional preference: wife is currently practicing on west coast and we want to start having kid(s) soon, being close to family takes priority (Portland OR, Los Angeles CA)... I know west coast is a bit of a residency wasteland compared to the midwest and east coast. When it comes to matching can I rank an ortho program in portland number 1, then an FM residency in portland number 2, then ortho in LA number 3 ... etc?

2. rotations: I've not had an ortho rotation and wont be able to do one until spring (VSLO opens at end of January). Gen surg, FM and sports med were loads of fun, but need to start applying for audition rotations at the end of the month. Think I'm leaning toward applying for ortho auditions, without exp as I did love the OR and the MSK system as a whole, then dual apply FM/ORTHO if all goes well. If not, FM will make me more than happy if I can get it in a place I enjoy. I've considered PM&R but think I can get everything I like about PM&R from FM as well as standing a greater chance of ending up somewhere I want to live (no PM&R in Portland).

Looking for any input from others... just trying to figure out what I'm going to do when I grow up.

---

Members don't see this ad.

 

[Darrow O'Lykos]

You can rank programs however you'd like once you have your interviews, however it will clearly decrease your chance of matching into your preferred field you rank a program in another highly over other programs in the preferred field. You can look at the NRMP outcomes report to see the % likelihood of matching a given field w/ # of continuous ranks within the specialty.

Ortho is also highly competitive and being a middle of the road DO applicant shooting for the west coast is going to be pretty difficult. Also, not having a strong letter might hurt applying for some audition spots. There's going to already be so many other applicants that have the grades and the connections as well as the research to boot.

Not trying to discourage you, as I am in a similar position as you considering ortho vs another field, but it's just a matter of facing reality.

If geographic preference is more important for you (as it is for me), you're better off applying FM and going the Sports Med route with maybe a DPC model of practice. Plus you won't be stuck in the OR for the next 7+ years. There are tons of FM programs along the west coast that would set you up great for this type of practice.

 

[Just D.O. it]

overall probably a middle of the road applicant for ortho (no step/level 2 yet).

I don't want to be rude. Just to help taper expectations to help you make an informed choice.

An "average" DO student is not "middle of the road" for ortho applications, they are more like dead on arrival. Ortho is a highly competitive specialty.

Unless your 3 pubs are breakthroughs, you have reason to believe you're gonna score 270+ on step 2, or you have a strong personal friendship with an Ortho program director, your chances of matching even if you apply broadly are less than 30%. Add in a geographic limitation and your chances of landing an ortho spot are probably somewhere between 0-5%.

For the sake of practicality I'd go full send FM and just do aways at all of the FM residencies in the cities you're interested in.

 

[Angus Avagadro]

FM and Sports Med Fellowship. Lot's of ortho, sports rehab, concussion management, procedures,sounds like it's in your wheelhouse. Good luck and best wishes.

 

[DrMcLovin]

Rotate at prior DO residency programs and perform well. If you want to do ortho you have to be willing to go anywhere. Ortho surgery and FM are completely different. If you don't want to go ‘all in’ on ortho then apply FM and enjoy your 4th year

 

[AlbinoHawk DO]

PMR is the real secret sauce when it comes to MSK. You can do so much more with great fellowships and money. Consider it. Much better than wasting 3 years in FM learning stuff that won't matter to you because you'll do a sports fellowship and never again manage a patient in the hospital or deliver a baby

 

[JBM16BYU]

PMR is the real secret sauce when it comes to MSK. You can do so much more with great fellowships and money. Consider it. Much better than wasting 3 years in FM learning stuff that won't matter to you because you'll do a sports fellowship and never again manage a patient in the hospital or deliver a baby

I agree. If you want to be really good at MSK, both clinically and procedurally, would highly consider PM&R. Diagnostic ultrasound, ultrasound guided injections, fluoroscopically guided spine injections, EMG, etc. Some PM&R residencies train you so well in MSK that technically you wouldn’t even need a sports medicine fellowship to practice how you’d like (except if you want to cover high level college, pro, or Olympics sports). LA does have a PM&R residency in addition to I believe 5 other PM&R residencies in California and 1 in Washington. West Coast adjacent there are residencies in NM, AZ, NV, UT, CO. OHSU does not have a PM&R residency but that doesn’t mean you can’t practice as PM&R in Portland after training. Just some thoughts.

 

[Conchilardo]

You can rank programs however you'd like once you have your interviews, however it will clearly decrease your chance of matching into your preferred field you rank a program in another highly over other programs in the preferred field. You can look at the NRMP outcomes report to see the % likelihood of matching a given field w/ # of continuous ranks within the specialty.

Ortho is also highly competitive and being a middle of the road DO applicant shooting for the west coast is going to be pretty difficult. Also, not having a strong letter might hurt applying for some audition spots. There's going to already be so many other applicants that have the grades and the connections as well as the research to boot.

Not trying to discourage you, as I am in a similar position as you considering ortho vs another field, but it's just a matter of facing reality.

If geographic preference is more important for you (as it is for me), you're better off applying FM and going the Sports Med route with maybe a DPC model of practice. Plus you won't be stuck in the OR for the next 7+ years. There are tons of FM programs along the west coast that would set you up great for this type of practice.

Ya I'm really fond of going DPC... every rotation so far has worked to push me further and further from insurance as possible. Wife is way into cosmetics. It really does just seem to fit well. Any resources you've seen on DPC setup. I actually rotated with a family doc who's partner was weeks away from ditching an insurance based practice (he was a happy guy).

 

[Conchilardo]

I don't want to be rude. Just to help taper expectations to help you make an informed choice.

An "average" DO student is not "middle of the road" for ortho applications, they are more like dead on arrival. Ortho is a highly competitive specialty.

Unless your 3 pubs are breakthroughs, you have reason to believe you're gonna score 270+ on step 2, or you have a strong personal friendship with an Ortho program director, your chances of matching even if you apply broadly are less than 30%. Add in a geographic limitation and your chances of landing an ortho spot are probably somewhere between 0-5%.

For the sake of practicality I'd go full send FM and just do aways at all of the FM residencies in the cities you're interested in.

thanks for the reality check, that is honestly half of the reason I came here. On one hand IDK if I'd regret not trying, but on the other I almost settled for becoming a millwright and to be honest I'm the kind of guy that would have found happiness in that.

Do FM residency applications benefit from away rotations or is it better to go get a bunch of "electives" in to diversify experience before residency?

 

[Conchilardo]

PMR is the real secret sauce when it comes to MSK. You can do so much more with great fellowships and money. Consider it. Much better than wasting 3 years in FM learning stuff that won't matter to you because you'll do a sports fellowship and never again manage a patient in the hospital or deliver a baby

I know! I've worked with and learned from several PM&R docs and they are like ortho-bro had a child with internal med/neuro-brainiac, they were awesome. Outstanding question is I've read that unless you're taking care of elite athletes (and even then) you are still doing a lot of primary care related cases (mental health, simple BP management etc), do you come out less well equipped to handle the average Joe "aging athletes" by giving up more generalist training?

 

[Conchilardo]

I agree. If you want to be really good at MSK, both clinically and procedurally, would highly consider PM&R. Diagnostic ultrasound, ultrasound guided injections, fluoroscopically guided spine injections, EMG, etc. Some PM&R residencies train you so well in MSK that technically you wouldn’t even need a sports medicine fellowship to practice how you’d like (except if you want to cover high level college, pro, or Olympics sports). LA does have a PM&R residency in addition to I believe 5 other PM&R residencies in California and 1 in Washington. West Coast adjacent there are residencies in NM, AZ, NV, UT, CO. OHSU does not have a PM&R residency but that doesn’t mean you can’t practice as PM&R in Portland after training. Just some thoughts.

Ya LA is certainly an option, but I've heard that PM&R is pretty dependent on networking. Is it too late or worth only considering 2 PM&R programs?

 

[JBM16BYU]

It’s not too late, but PM&R does like a commitment to the specialty and not to be used as a backup option. You’d want to jump into all things PM&R soon.

 

[AlbinoHawk DO]

I know! I've worked with and learned from several PM&R docs and they are like ortho-bro had a child with internal med/neuro-brainiac, they were awesome. Outstanding question is I've read that unless you're taking care of elite athletes (and even then) you are still doing a lot of primary care related cases (mental health, simple BP management etc), do you come out less well equipped to handle the average Joe "aging athletes" by giving up more generalist training?

There is no such thing as training you to treat "elite athletes" without learning all steps in between. True expertise is when you can treat everyone across the spectrum of MSK disorders