Originally posted by EidolonSix
...The sad thing is that a good percentage of these patients have comorbidities that need to be addressed before and immediately after surgery which end up prolonging their hospital stays...in their training, unlike esteemed general surgeons, these guys get no encouragement or instruction to learn basic medicine, which is the foundation for all that we do as physicians. As a result, orthopods are left without training to handle medical issues and be it out of a lack of confidence with their knowledge, a frank lack of understanding of basic medical principles and/or a disinterest in patient welfare beyond their torn ACL, have a very low threshold with which to dump patients...
I will not try to say ortho residency is easy, because from what I have seen it is very tough. Having said that, I will make a few points and observations.
First, the year before my first Gsurge internship ALL the ortho residents during their obligatory year of GSurge deliberately tanked the Gsurge inservice exam!!!
Second, the ortho residents and staff during my first Gsurge internship made it very clear they wanted to be in ortho to do the "simple saw and hammer thing". I have no doubt otho doctors are smart. However, if faced with the opportunity to only do high paying "saw & hammer" jobs and dump the "medical management" tasks onto someone else, I too might be tempted...hell it would make life and career easier. Let's face it, it would be nice as a surgeon to know the late night call on a post-op patient with a blood sugar of 250 is going to the "other doctor".
Third, I am presently completing my FP internship before returning to Gsurgery. Without exception, if a patient falls and breaks something, ortho has refused to admit the patient. Instead, they have insisted FP admit and consult ortho. Short of the OR time, the only group in the hospital that has in my experience had less inpatient contact on their patient other then ortho has been radiology!!!
Fourth, ortho often requires Gsurge or vascular for some of their approaches, i.e. anterior retroperitoneal approach for disckectomy and spacer placement.
I close by saying, yes Ortho doctors are intelligent. Yes their residency is very rigorous and specialized. However, If ortho doctors insist on limiting their level of patient management to the OR, you might want to just admit and accept that limitation and not use a "fighter pilot" analogy. Someone in this thread has talked about the "no micro" aspect of ortho but rather the "macro" nature of ortho. That does of course add a degree of ease in your job. Gsurgeons, CT surgeons and even neurosurgeons have in my experience both as a surgical resident and FP resident demonstrated a significant willingness and ABILITY to manage patients beyond the OR. That is not to say ortho is incapable of this level of management, but Ortho has in my experience at the very least failed to do so be it by choice or inability. Ortho has refused to manage controlled diabetics post-operatively, ortho has refused to manage TPN, in fact ortho has on occasion refused manage post-op pain.
Be smart, enjoy your job, you earned it and worked hard to get there, but understand the limitations either self-imposed by choice or by lost skills. Given those limitations, I advise you to place your ego in check.
to answer the original poster's question, IMHO I believe ortho is attractive because it is surgical, it pays well, lifestyle after residency can be quite good, and if you choose to have a "traditional" ortho practice, most pre & post-op care is someone else's problem. Also, I do believe a major factor is the satisfaction of being able to say a patient walks because of your efforts. You just can't discount the gratification you get from increasing a patient's quality of life by replcing a knee or hip!!!
