I was in the same position as you when I was a third year. I'm now a fourth year applying to Uro. Short answer to your question is which bone do you want to work with NAMSAYIN???
Long answer, I ended up choosing Urology, so take everything I say with that in mind. I think I can remain pretty unbiased, but I may not be as knowledgable about ortho specifics and I have my own biases just like everyone else does. So with that said, let's get to it. I mean this with all due respect, but I don't think answers to any of the questions you're asking will help you beside between these two fields. Keep in mind that there are of course going to be anecdotes that are contrary to what I write; I don't know everything and there always are exceptions, but I'm doing my best to speak in generalities.
Lifestyle: they're both surgical subs. You're gonna work, especially in residency. If I had to, I would say that Ortho probably has longer hours, but both of my aways on Urology were easily pushing the hours limits (and I didn't even take call). Additionally, although Urology does have fewer overnight emergencies, most programs have home call, meaning no post call day and you likely will get destroyed on some of those home call nights with a full day of work afterwards. With that said, I'm guessing that Ortho still can have a more brutal call schedule/resident lifestyle. I don't know for sure, and it doesn't really matter. You're not comparing derm with Ortho, you're comparing two surgical subs. The marginal difference in hours is going to be so minuscule in affecting your quality of life. Far greater on the QOL scale will be working in the field you love and working with people you really get along with. Attending lifestyle? I've seen enough to realize that it's largely going to be what you make of it. There is a greater opportunity in Urology to do more clinic and less OR as you get older, but I am not in a position to say how important that is in terms of lifestyle. Maybe an older attending can speak to that.
Flexibility: Uro does have a greater mix of OR and clinic time, and fewer Urologists do a fellowship, if that's what you're getting at. In terms of schedule, it's again largely what you make of it. In residency, you don't have a lot of flexibility in schedule/life, but that's not unique to either field.
Demand in future: no one can predict the future (duh), but both fields likely will still be in demand. Many patients in both fields tend to be older, and the population ain't getting younger, that's for sure. Maybe Ortho will be in slightly greater demand? I don't know. There's obviously a lot of discussion about prostate cancer screening and treatment, but I find it hard to believe we're going to come to a solid consensus either way soon. My opinion is that the difference between Uro and Ortho is likely not big enough that it should sway you one way or the other.
Compensation: Ortho makes more. If I remember from the CIM website correctly, median Uro salary was in the low $400,000's, and Ortho was in the mid $500,000's? I think someone posted a first year out of residency salary somewhere too, and that had Ortho starting at $400,000 and Uro at $300,000. Significant? Totally depends on you. I think Ortho will likely still make more depending on what you specialize in (great outcomes with joint replacement, and I think recently their median salary was higher than spine), but it's up to you how significant a difference that is. I know for myself that the "cost" of $100,000/year (again, every person's situation is unique and who knows what kind of job I'll ultimately find when it's all said and done) is worth it for me to do Uro instead of Ortho.
So to everything that you asked, there are minor differences between the two fields, but in my opinion they are MINOR differences. Not enough for me personally to make a career decision on. I understand where you're coming from and why you're asking, but if you take a step back, you'll see that you're nit picking between two awesome fields. Don't lose the forest for the trees. It's not like you're choosing between something like peds and Ortho (these are just two vastly different fields, I'm not saying one is better than the other).
My advice would be to look at this differently. Despite the many similarities between these fields in terms of basic comparisons, these are still very different in day to day experiences. I'm sure that there are things that you like about both, but odds are that you like one field more. Identify what it is that you like about both fields. Rotate in both, live the lifestyle as much as you can for each field. Most importantly, read some of the journals in each field. For Uro, look at European Journal of Urology and Journal of Urology. For Ortho, I don't know, maybe JBJS? JSES? Hopefully an Orthopod can comment. You're going to be studying this stuff for the rest of your career. I couldn't read more than a few lines (hyperbole) in an Ortho journal before my eyes started glazing over. I freaking loved reading Uro stuff. I couldn't get enough of it. Combine that with just absolutely loving my Uro rotation, and my decision was pretty much made for me.
Other reasons why I chose Uro: you don't need to do a fellowship if you don't want to (I think about 50% of Uro residents do fellowship vs ~90% of Orthopods); mix of surgery and clinic; operations ranging from life saving (huge onc whacks) to lifestyle saving (TURPs, AUS, stuff like that) and everything in between; super interesting subject matter (obviously a personal preference); dick jokes; patient population and illnesses (I find men's health super interesting and gratifying to treat). There are probably more reasons I can't think of now, but this at least is enough for interviews. Again, I think Ortho is still a great field and I really had an awesome time hanging out with the residents there, but the core subject matter and all of that just wasn't for me.
If you think through all of that and it's still too close to call (which I doubt will happen if you're truly honest with yourself), then just identify what's more important to you, lifestyle or money. GENERALLY (huge caveat that there are exceptions to everything) Uro can have a slightly better lifestyle while Ortho will tend to make a little more. I again doubt it's that big of a difference in the long run, so I would still recommend you go by what patient population/ailments/procedures you like better. Don't hesitate to ask if you have any more questions, or feel free to PM me.
