Torn: Orthopedics vs Radiology

[@#Frogthejam#@]

Hey guys, I'm a third-year student at a low-tier MD school. I was originally very committed to going for Orthopedics (I had a thread earlier this year) but, I've recently discovered radiology and it sounds all too attractive. Before I elaborate more here are my stats.

Male URM Non-Trad
Low Tier MD School (Midwest) Undergrad in the east coast, from the east coast.
AOA - Junior Year Selection
Clerkship Grades: Honors in IM and Surgery, HP in Peds and OBGYN. Still, Have to take Psych and FM
Step 1: Pass
Step 2: Not Yet Taken but I've been >97 Percentile on all my shelf exams so far so I think I can pull off a good score with consistency.
Research: 2 1st Author Clinical Ortho Pubs, 3 Case Reports, 3 Basic Science Pubs (Middle Authorship), 20+ Posters/Presentations/Abstracts
Leadership: Decent but not ground-shattering leadership
Service: I have been tutoring since college, here in Med school I tutor the 2 classes below me for modules and for Step 1 with some volunteer services and events sprinkled in.


I was very much all in for Orthopedics from mid-M2 year up until my OBGYN rotation where I saw how beat down the residents in surgical specialties are. They're there working 70- 90 hours a week, missing important time with family. I had a terrible experience in OBGYN but, I still kept an open mind However, that was the first time lifestyle or the hours I'd be working as a resident came into the forefront of my mind. I was previously of the opinion that as a single guy, I could afford to no life 5 to 8 years of a residency + research year if necessary to match into the specialty that I desired. However, the deeper I got into M3 year, and with the death of my father and going back to my home country, seeing family etc, the more I realized that this may not be the case.

I discovered Radiology on accident sometime in November or late October during my OBGYN rotation and the more I've talked to applicants, residents and attendings on the radiology discord, the more attractive radiology is. Personality-wise and how I work cerebrally, Rads is in my wheelhouse. I spent most of my free time sitting behind a computer most days, the humor and and mental makeup of the Rads crowd from just talking to them daily on Discord seems to vibe with me. On top of that, the idea of not having those brutal hours during residency is very appealing. I've realized or rather now fully accept something I've known before even coming to medical school that Medicine as much as I've so far thrived in it and as much fun as it can be sometimes, is far from the most important thing to me. There are several things I'd rather be doing with my time if medicine was not such a secure and safe career for those willing to work for it.

Then to further complicate things, I recently just finished my surgery rotation and my attending surgeons were very honest with me about their lifestyle, about the good and the bad. However, I had an absolute blast during my surgery rotation. Even when I was just doing scut work and just watching not scrubbed in, I loved being in the OR. I love how technical and surgery is and the level of skill and knowledge that one has to build up to be a competent surgeon is intriguing and exciting. I loved my week rotating with the Ortho Residents. Despite not doing much since there were SUBI's during my week, I enjoyed Ortho even more than I thought I would. I felt truly stupid and the level of knowledge that the residents were showing was utterly intimidating and it felt like they were speaking a totally different language. The last time I felt like this was the start of my master's year before medical school. But, unlike then, I've learned that this intimidation is a good thing because it fueled me to rectify that feeling. I'm excited at the prospect of coming in with no skills and limited knowledge and eventually becoming a master like the attendings or joining that path like the residents. I truly loved Ortho and surgery in general.

However, my fear is that I may not feel this way once the hours become a grind. When I'm sleeping 3-4 hours a night on call, will I still feel excited to come to the hospital at 4 or 5 am and leave at 8 or 9 pm?

Lastly, a minor consideration is the path to the match for either specialty is more straightforward for Rads than Ortho in regards to being able to go to the region I want to for residency (back to the east coast near family). I've been told that thus far assuming my STEP 2 trends how my performance from M1 to M3 year has trended so far, that I have a competitive application for both specialties. However, historically at my school, most people that match do so in the Mid-West which is not something I'd like to ideally do but, In a field like Ortho, you signal in the area that will give you the most chances and you go where they take you. But for Radiology, there's a clearer path toward securing an east coast residency. And most importantly, the path to almost guarantee a match (assuming no red flags or jarring personality issues) is very clear for Rads (260 on STEP 2). While for Ortho, great applicants slip through the crap every year.


Going for Ortho will guarantee that I'll be quite stressed up until the match of next year. I already had a good deal of anxiety about the match process, away rotations, etc. For Rads, that stress would be presumably lower once I take STEP 2 since away rotations aren't taken as seriously.

I know my thoughts aren't very organized but i just needed to put this out there to hear some thoughts....

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[VincentAdultman]

Hey guys, I'm a third-year student at a low-tier MD school. I was originally very committed to going for Orthopedics (I had a thread earlier this year) but, I've recently discovered radiology and it sounds all too attractive. Before I elaborate more here are my stats.

Male URM Non-Trad
Low Tier MD School (Midwest) Undergrad in the east coast, from the east coast.
AOA - Junior Year Selection
Clerkship Grades: Honors in IM and Surgery, HP in Peds and OBGYN. Still, Have to take Psych and FM
Step 1: Pass
Step 2: Not Yet Taken but I've been >97 Percentile on all my shelf exams so far so I think I can pull off a good score with consistency.
Research: 2 1st Author Clinical Ortho Pubs, 3 Case Reports, 3 Basic Science Pubs (Middle Authorship), 20+ Posters/Presentations/Abstracts
Leadership: Decent but not ground-shattering leadership
Service: I have been tutoring since college, here in Med school I tutor the 2 classes below me for modules and for Step 1 with some volunteer services and events sprinkled in.


I was very much all in for Orthopedics from mid-M2 year up until my OBGYN rotation where I saw how beat down the residents in surgical specialties are. They're there working 70- 90 hours a week, missing important time with family. I had a terrible experience in OBGYN but, I still kept an open mind However, that was the first time lifestyle or the hours I'd be working as a resident came into the forefront of my mind. I was previously of the opinion that as a single guy, I could afford to no life 5 to 8 years of a residency + research year if necessary to match into the specialty that I desired. However, the deeper I got into M3 year, and with the death of my father and going back to my home country, seeing family etc, the more I realized that this may not be the case.

I discovered Radiology on accident sometime in November or late October during my OBGYN rotation and the more I've talked to applicants, residents and attendings on the radiology discord, the more attractive radiology is. Personality-wise and how I work cerebrally, Rads is in my wheelhouse. I spent most of my free time sitting behind a computer most days, the humor and and mental makeup of the Rads crowd from just talking to them daily on Discord seems to vibe with me. On top of that, the idea of not having those brutal hours during residency is very appealing. I've realized or rather now fully accept something I've known before even coming to medical school that Medicine as much as I've so far thrived in it and as much fun as it can be sometimes, is far from the most important thing to me. There are several things I'd rather be doing with my time if medicine was not such a secure and safe career for those willing to work for it.

Then to further complicate things, I recently just finished my surgery rotation and my attending surgeons were very honest with me about their lifestyle, about the good and the bad. However, I had an absolute blast during my surgery rotation. Even when I was just doing scut work and just watching not scrubbed in, I loved being in the OR. I love how technical and surgery is and the level of skill and knowledge that one has to build up to be a competent surgeon is intriguing and exciting. I loved my week rotating with the Ortho Residents. Despite not doing much since there were SUBI's during my week, I enjoyed Ortho even more than I thought I would. I felt truly stupid and the level of knowledge that the residents were showing was utterly intimidating and it felt like they were speaking a totally different language. The last time I felt like this was the start of my master's year before medical school. But, unlike then, I've learned that this intimidation is a good thing because it fueled me to rectify that feeling. I'm excited at the prospect of coming in with no skills and limited knowledge and eventually becoming a master like the attendings or joining that path like the residents. I truly loved Ortho and surgery in general.

However, my fear is that I may not feel this way once the hours become a grind. When I'm sleeping 3-4 hours a night on call, will I still feel excited to come to the hospital at 4 or 5 am and leave at 8 or 9 pm?

Lastly, a minor consideration is the path to the match for either specialty is more straightforward for Rads than Ortho in regards to being able to go to the region I want to for residency (back to the east coast near family). I've been told that thus far assuming my STEP 2 trends how my performance from M1 to M3 year has trended so far, that I have a competitive application for both specialties. However, historically at my school, most people that match do so in the Mid-West which is not something I'd like to ideally do but, In a field like Ortho, you signal in the area that will give you the most chances and you go where they take you. But for Radiology, there's a clearer path toward securing an east coast residency. And most importantly, the path to almost guarantee a match (assuming no red flags or jarring personality issues) is very clear for Rads (260 on STEP 2). While for Ortho, great applicants slip through the crap every year.


Going for Ortho will guarantee that I'll be quite stressed up until the match of next year. I already had a good deal of anxiety about the match process, away rotations, etc. For Rads, that stress would be presumably lower once I take STEP 2 since away rotations aren't taken as seriously.

I know my thoughts aren't very organized but i just needed to put this out there to hear some thoughts....

First of all I think you’re probably competitive for ortho but I haven’t seen charting outcomes in awhile so take that with a grain of salt.

I won’t lie and say surgery residency can’t be a grind With long hours. Do bear in mind though that when you’re on services like hand or sports the hours are a bit more predictable and you’re out of the hospital at more predictable times. Trauma of course is a different story.

Even so rarely have I seen ortho residents beat down. It’s not OB and it’s not Gen surg. And the culture across programs varies so it really comes down to where you find the best fit if you choose ortho.

Finally what you select is what you’re going to be doing for the testing your life which is assume is a 30 plus year career. That time dwarfs the time
You send applying and in residency. Once you finish training you can go wherever you want.

Good luck with your choice sounds like you can’t go wrong either way

 

[Dral]

I think you meant 'slip through the cracks every year', but I kinda like how you said it. 😆

One thing I might suggest is to see if you can get some exposure working with some community rads folks. I think you're seeing a lot of what the residents go though (in both rads and surgery) and thinking less of what it might be like on the other side (both good and bad).

I know you talked to surgeons, but I think they have a little bit more control over their schedule compared to residents. Rads attendings are doing a lot of reads constantly throughout the day. I don't know for sure, but I worry that if you got exposure in an academic center, it might not be the same as it might be if you worked somewhere else.

 

[nibhighfootballrules]

I'm an M4 applying for orthopedic surgery this cycle. During my M3 year, I considered radiology due to lifestyle concerns (in orthopedics), particularly work-life balance and its impact on my family. So, take everything I say from that perspective.

What ultimately solidified my decision to pursue ortho were my away rotations. They reinforced my passion for the field and confirmed how much I loved being in the OR—along with the other aspects of orthopedic surgery. I also completed an MSK radiology rotation afterward and, while residency in radiology initially seemed much more relaxed, I realized that in the long run, I would regret not pursuing ortho.

An orthopedic attending once told me, "Attending life can be whatever you want to make it—private practice vs. academic, elective vs. non-elective subspecialties, etc." They also emphasized that work hours improve significantly after training and that you can shape your career to align with your life goals. He said barely anyone loves being in the hospital for 80-100 hours a week and its just a moment in time during residency. That perspective stuck with me.

I also believe that a student’s experience on a radiology rotation is far from the reality of being a practicing radiologist, whereas an ortho rotation gives you a much clearer picture of what life in the field is like. In radiology, as a student, you don’t fully appreciate what it’s like to sit and read scans for 30 years straight—especially since these rotations are often pretty chill, with little hands-on work. That said, radiology offers a variety of career paths; some radiologists work from home and focus solely on reading scans, while others in academic settings balance reading with procedures and teaching, which helps break up the monotony.

Regarding competitiveness, AOA carries significant weight in the ortho match process. If you can achieve AOA for your clerkship year (depending on how junior AOA works at your school), that would be a major advantage, along with a strong Step 2 score. Fortunately, there are plenty of ortho programs on the East Coast, particularly in the Northeast. I was told that 88% of applicants last cycle matched at either their home institution or an away rotation site. So, if you excel during your away rotations, relocating to the East Coast is definitely a possibility. Another key factor is obtaining stellar letters of recommendation—ideally, your home program should make it clear that they want you to stay.

My advice: Do your home ortho Sub-I first, then schedule away rotations strategically in locations where you’d be happy to train for the next five years. Ortho Sub-I’s are tough, and after completing your home rotation and at least one away, you'll get a real sense of the lifestyle and workload. At that point, you should have clarity—whether that’s feeling confident in pursuing ortho or realizing that it's not for you. If the latter happens, and your school is supportive, you should still have time to pivot. You could complete a radiology and IM rotation before applications are due, secure the necessary letters, and apply for radiology instead.

Goodluck!

 

[VincentAdultman]

I'm an M4 applying for orthopedic surgery this cycle. During my M3 year, I considered radiology due to lifestyle concerns (in orthopedics), particularly work-life balance and its impact on my family. So, take everything I say from that perspective.

What ultimately solidified my decision to pursue ortho were my away rotations. They reinforced my passion for the field and confirmed how much I loved being in the OR—along with the other aspects of orthopedic surgery. I also completed an MSK radiology rotation afterward and, while residency in radiology initially seemed much more relaxed, I realized that in the long run, I would regret not pursuing ortho.

An orthopedic attending once told me, "Attending life can be whatever you want to make it—private practice vs. academic, elective vs. non-elective subspecialties, etc." They also emphasized that work hours improve significantly after training and that you can shape your career to align with your life goals. He said barely anyone loves being in the hospital for 80-100 hours a week and its just a moment in time during residency. That perspective stuck with me.

I also believe that a student’s experience on a radiology rotation is far from the reality of being a practicing radiologist, whereas an ortho rotation gives you a much clearer picture of what life in the field is like. In radiology, as a student, you don’t fully appreciate what it’s like to sit and read scans for 30 years straight—especially since these rotations are often pretty chill, with little hands-on work. That said, radiology offers a variety of career paths; some radiologists work from home and focus solely on reading scans, while others in academic settings balance reading with procedures and teaching, which helps break up the monotony.

Regarding competitiveness, AOA carries significant weight in the ortho match process. If you can achieve AOA for your clerkship year (depending on how junior AOA works at your school), that would be a major advantage, along with a strong Step 2 score. Fortunately, there are plenty of ortho programs on the East Coast, particularly in the Northeast. I was told that 88% of applicants last cycle matched at either their home institution or an away rotation site. So, if you excel during your away rotations, relocating to the East Coast is definitely a possibility. Another key factor is obtaining stellar letters of recommendation—ideally, your home program should make it clear that they want you to stay.

My advice: Do your home ortho Sub-I first, then schedule away rotations strategically in locations where you’d be happy to train for the next five years. Ortho Sub-I’s are tough, and after completing your home rotation and at least one away, you'll get a real sense of the lifestyle and workload. At that point, you should have clarity—whether that’s feeling confident in pursuing ortho or realizing that it's not for you. If the latter happens, and your school is supportive, you should still have time to pivot. You could complete a radiology and IM rotation before applications are due, secure the necessary letters, and apply for radiology instead.

Goodluck!

I was told a long time ago to do surgery if you couldn’t stand to never be in the OR again.

I couldn’t…so here I am..

 

[nibhighfootballrules]

I was told a long time ago to do surgery if you couldn’t stand to never be in the OR again.

I couldn’t…so here I am..

Thank you for sharing this. I’ve heard various iterations, such as, "Only pursue surgery if you'd rather be in the OR than anywhere else." This can be interpreted as, "I must prioritize operating over spending time with my family or enjoying my hobbies." However, many attendings have reassured me that this isn’t the case. There are plenty of surgeons who highly value their lives outside the hospital. While their schedules may not be as predictable as a typical 9-to-5 job, they still find time for the people and activities that matter to them

 

[VincentAdultman]

Thank you for sharing this. I’ve heard various iterations, such as, "Only pursue surgery if you'd rather be in the OR than anywhere else." This can be interpreted as, "I must prioritize operating over spending time with my family or enjoying my hobbies." However, many attendings have reassured me that this isn’t the case. There are plenty of surgeons who highly value their lives outside the hospital. While their schedules may not be as predictable as a typical 9-to-5 job, they still find time for the people and activities that matter to them

My office hours are 8-5. On OR days if it’s just elective cases I’m done by 3-4 or I see patients until five. I take call one week every six at a small hospital.

It’s not bad but yeah if I’m on call I’m probably putting hip fractures on at the end of my day so there are definitley nights I’m not back home until 8 or 9. And complications don’t always happen during regular hours.

The other thing is that as I’m private practice and get paid for call I’m trying to take as much as I can at the moment since you eat what you kill.

 

[DarkHorizon]

You clearly want to do ortho and are worried about the lifestyle.

You’ll grind in residency but attending life ain’t bad. I’m really busy, productivity wise, but work about 50 or so hours a week when not on call. Extend it to 55-60 if on call. I’m ortho trauma so I’m busier than most orthopods. I make it home almost every day for dinner with my family and the gym 5-6 times a week. Have an awesome spouse who supports me and our family as a SAHM.

I can’t imagine doing anything else but ortho. Not a day I don’t look forward to going to work. I’m so thankful that I get to do this. I highly recommend that you reconsider your decision.

 

[RangerBob]

I would pursue whatever your heart calls you too (if you have that luxury), as you're talking about the rest of your life. Ortho surgeons can have great/phenomenal lifestyle/pay, albeit after residency. Or they can work insane hours, like other physicians. But ortho makes so much you have more flexibility to work "part-time" and still make an insane amount to support your family on.

Do you have a wife/kids? That's what really changes things at this point in the game, as a surgical residency is a slog and requires buy-in and commitment from your SO. It helps surgeons dramatically if they have a very supportive spouse, who either is interested in pursing their own career/putting kids on hold, or is interested in being a full time stay-at-home spouse. The reality is a surgery resident doesn't have as much family time as non-surgical residents. What matters is the quality of the time you give, but with the length/commitment of a surgical residency, you do have to be ok missing out on quite a bit of your kid's childhood.

If you're single, then that's where you're really free to do whatever you like more. At that point, anyone you meet in the future (as a resident or attending) will understand more or less what they're in for, and you can adjust things as you go forward (take trauma call, not take trauma call).

 

[DOVinciRobot]

It’s pretty clear you want to do ortho and are just nervous about the lifestyle. It isn’t as brutal as many of the online spheres would have you believe (ie reddit), and residency is also a brief moment. Our ortho 4s and 5s have a much better lifestyle than they did when they were juniors, and honestly I do too and I’m Gen Surg which commonly gets claimed as the worst offender for emotional beat downs lol (I don’t think it’s that bad).

I’ve done it with kids and would do it again in a heart beat. The OR is the best place in medicine

 

[deleted1208015]

The OR is the best place in medicine

LOL

 

[RangerBob]

LOL

Let's be thankful many people love the OR. To me the ED is the 9th (or is it 7th?) circle of Hell. And to most ED physicians, my home base of inpatient rehab is the slooooowwweeest and most boring place they could be.

We all have our own place.

To each their own.

 

[GadRads]

From reading your post, it appears that you have more of a passion for orthopedic surgery. Don’t do radiology because it is easier to match into. I am a radiologist, and there are miserable and burnt out radiologists out there, although many docs are burnt out due to systemic issues in healthcare.

While the lifestyle in radiology residency seems more controlled, there is a lot of studying that happens at home after regular work hours. At the majority of programs, the workday can be exhausting. I was more tired in my first two years of radiology residency than in my internal medicine preliminary year, even though I worked more hours (80 hrs per week) on paper during my medicine year. There is A LOT to learn in radiology. It is very easy to be a bad radiologist, and hard to be great at it.

As an attending radiologist, your workload increases substantially compared to training. We read a lot of volume as attendings while bearing liability for bad calls or misses. To give you an example, I read 200 to 300 x-rays in a 9 hr workday when I am on x-ray modality, in addition to 20-30+ other random cross-sectional imaging and ultrasounds.

One of my close friends is an orthopedic surgeon, and we work about the same hours. He probably works a little less than I do. If you pick the right job, you can customize your attending lifestyle within reason. But I work from home sometimes, and that is a nice.

Regardless of what you do, prepare to work hard during training and try to find a good support system. That will make training more palatable.

Also, an uncomfortable truth is that as a URM (especially in a competitive field), you will encounter some bias or prejudice during training. I never used to believe these things existed, but my views have changed. I am friends with lots of high-performing URMs (AOA, excellent board scores, publications, etc.), and we all all have at least one episode of being at the negative end of being treated unfairly. So try very hard not to be a marginal resident. Be very mentally tough and be ready to advocate for yourself. You also owe it to yourself and patients. On average, you will not be able to get away with what white or ORM residents can. Be extra prepared before any case and read often.

 

[Bestaidreviews]

Try an IR Rotation because it’s the best of both worlds: procedural but not surgical, and a mix of clinical decision-making and imaging.

 

[Ho0v-man]

You clearly want to do ortho. Rads, derm, and anesthesia get lots of attention for lifestyle and can be great. But they’d all suck if you want to be in the OR.

You really gonna go as far as this and then settle because it seems hard?

 

[CJhooper123]

Current ortho PGY2 coming off trauma consults. Averaged like 100-110 hours/week for 12 weeks
Yeah, I'm dead lol. Yeah, those were 12 of the worst weeks I've endured in this journey so far.
Would I have changed anything? Hell nah. It can really suck when you are stuck at the hospital late writing notes, finishing consults... but if you enjoy the work you do it's worth it.

I'm still all in on ortho. It's the best specialty.
Feel free to reach out with any questions. It's OK to be imbalanced for a temporary part of your life. I have so many hobbies / relationships outside of this that are my life.

 

[voxveritatisetlucis]

Current ortho PGY2 coming off trauma consults. Averaged like 100-110 hours/week for 12 weeks
Yeah, I'm dead lol. Yeah, those were 12 of the worst weeks I've endured in this journey so far.
Would I have changed anything? Hell nah. It can really suck when you are stuck at the hospital late writing notes, finishing consults... but if you enjoy the work you do it's worth it.

I'm still all in on ortho. It's the best specialty.
Feel free to reach out with any questions. It's OK to be imbalanced for a temporary part of your life. I have so many hobbies / relationships outside of this that are my life.

Yes I think this is key. On surgery I worked like 13 hours a day but the days went by very fast. Compared to inpatient IM where I only worked 7 hours on average and the days moved like a turtle

 

[deleted1208015]

Yes I think this is key. On surgery I worked like 13 hours a day but the days went by very fast. Compared to inpatient IM where I only worked 7 hours on average and the days moved like a turtle

Your medical school is clearly doing you a disservice if that's your IM experience.

 

[voxveritatisetlucis]

Your medical school is clearly doing you a disservice if that's your IM experience.

It’s not a very busy service. If your school’s home hospitals are community hospitals then the private groups want most of the patients and give the scraps to the med school teams. Even interns work about 7 hours per day. Very boring stuff. Always talking the particulars of CHF or AKI without actually doing anything for the patient

I think it’s different for surgery because every attending would prefer a fifth year resident to an rnfa jackass with 500 hours of online credits so even the private groups rely heavily on residents

 

[deleted1208015]

It’s not a very busy service. If your school’s home hospitals are community hospitals then the private groups want most of the patients and give the scraps to the med school teams. Even interns work about 7 hours per day. Very boring stuff. Always talking the particulars of CHF or AKI without actually doing anything for the patient

I think it’s different for surgery because every attending would prefer a fifth year resident to an rnfa jackass with 500 hours of online credits so even the private groups rely heavily on residents

Yeah this is the number 1 reason why I tell med students to avoid community non-surgical residencies if they can.

But your experience at a community hospital doesn’t apply to IM as a whole.

 

[@#Frogthejam#@]

Thanks everyone for all your input! After talking to family and some surgical mentors, they've all echoed what most have echoed here. My heart is for Ortho. I haven't fully come to my decision but, I am going to start looking for places for my Ortho Sub-Is