Session 5

In this week's episode, Ryan talks with an orthopedic hand surgeon in a hybrid setup. He's in a community-based hospital and program but he has residents he interacts with who rotate through the hospital. He has been practicing for almost two years.

Here are the highlights of the conversation with Ragu:

When he knew he wanted to be an orthopedic hand surgeon:

• Deciding he wanted to be an orthopedic surgeon towards the end of 2nd year medical school
• He chose hand surgery towards the middle of his orthopedic residency after doing some rotations and liking the intricate nature of the hand

What led him to orthopedics vs. general surgery:

• Enjoying the aspect that you focus on the extremities
• It's a specialty with multiple subspecialties - (ex. sports, joint replacements, shoulder, knee, hand, children) so it gave him a lot of options
• General surgery is like a primary care field with no cross-correlation for orthopedics.

Other specialties he was considering:

• Anesthesia
• Radiology
• EENT

Traits that lead to being a good orthopedic surgeon:

• Hardwork
• Dedication
• Desire to work with your hands and doing procedures
• Good motor coordination

A typical day for an orthopedic:

3 days of office

• 1 1/2 days of surgery
• 1/2 administrative work or extra surgery

Office day:

• 8am - 4pm seeing 20 patients
• 20 minutes per patient + 5 minutes to do charting
• Consultations on the floor in between
• Answering calls from patients
• One weekend per month of call

Surgery day:

• 7:30 am to 3-4pm doing 3-6 surgeries a day (depending on the type and length of surgery)
• 75-80% of his surgeries are hand/upper extremity surgeries (hand, wrist, forearm, elbow)
• *Majority of hand surgeons do only hand surgery (90-95%)
• *The average orthopedic surgeon takes 5-6 days of call a month (1 weekday a week and 1 weekend for the month)

Types of patients and cases an orthopedic sees:

• Carpal tunnel syndrome
• Tendonitis
• Hand fractures/injuries
• Traumatic injuries (lacerations on the hand)

Percentage of patients he sees in the office that he ends up taking in the operating room:

1-2 out of 20 people that he sees

Does he have work-life balance?

• He is married and travel once every 3-4 months for a vacation.
• He has a number of hobbies outside of work like basketball and golf.
• Quality time with his wife, friends, and family
• You have a good chance of having a say on who you want to set up your life because you get to pick and choose what is important to you.

What makes a competitive applicant for orthopedics:

• Showing interest in orthopedics (talking to the orthopedic department in your school and talking to some people) and getting involved such as research or lectures
• Good board scores
• Good letters of recommendation
• Good scores on clinical rotations especially those involving surgical stuff (surgery, OB, medicine)

Bias in the orthopedic field towards DO applicants:

In the past, DO applicants were not getting proper consideration. But in the recent years, DOs are starting to get more recognition as being just as competent as MD applicants.

Generally, there is a slight bias against DO applicants applying to MD orthopedic programs.

Residency as an orthopedic surgeon:

• Tough but every year gets better
• He enjoyed it a lot.

Duration:

• 1 year general surgery intern year (half doing orthopedics and half doing general surgery with a potential for a month of elective such as radiology)
• 4 years of orthopedic-only residency

What the orthopedic fellowship looks like:

• 1 year (Others do second year on a different fellowship)
• Orthopedic fellowships are cyclically competitive (every 4-5 years, there's a new, popular fellowship that everybody wants to get into)

Opportunities for females to enter orthopedics:

• There are many females in orthopedics.
• Women can be just as good as men in orthopedic surgery and can do any subspecialty they want. It's just a matter of knowledge and training.
• More and more women are now going into orthopedics and there are now more and more women in orthopedics doing fellowships.

What the orthopedic board exams look like:

• Similar to USMLE only that it's focused on orthopedics
• Multiple choice questions - Parts I and II
• Part I - Test for knowledge of the basic science and orthopedic surgery
• Part II - Oral exam

How the oral exam works:

• Once you're out in practice, you submit 6 months worth of your surgical cases.
• They will review them and pick a number of cases then you discuss it with senior orthopedic surgeons.
• They will ask you numerous questions and they will judge you based on your clinical decisions.

Pass rates for the board exams:

• Part I - US medical graduate from a US orthopedic residency: low 90% range
• Part II - low 90% range

What he wished he knew before starting his orthopedic residency:

• Knowing that time passes by quicker than you think.
• Opportunities don't come about again once you finish your training.
• The whole goal of residency is to see and learn as much as you can.
• You have to go in prepared for those first 2-3 years of residency to miss important life events and not feel bad about it. After that time, things will be easier.

What he wished primary care physicians knew about orthopedics:

Orthopedics are capable physicians and they do and understand some medicine. Hopefully, more of them would give them some credibility in regards to that.

If primary care physicians would take a little bit of initiative to learn the musculoskeletal exam or the basics of it, they can actually examine their patients and be able to direct them to an orthopedic surgeon appropriately instead of just sending them without even having seen the patient.

Other specialties orthopedics work the closest with:

• Emergency room physician or PA
• Internal medicine team
• Rheumatology and Neurology

Other special opportunities outside of medicine:

Research and development of orthopedic implants and products (such as bone cements)

What he likes the most about being an orthopedic surgeon:

Seeing and interacting with patients and giving a solution to a problem that's been plaguing them for months or years

What he likes the least being an orthopedic surgeon:

• Being on call (ex. getting a phone call at 2 am)
• The few patients that are beyond his ability to help

Would he still have chosen orthopedic hand surgery if he had to do it all again?

Yes, because he likes orthopedics and hand orthopedics.

The future of orthopedic surgery:

Figuring out ways to heal the body and improve things without surgical intervention like lasers or nanobots to make the human body better.

The immediate future of orthopedic surgery:

1. They have improved their ability to fix people's broken bones by making smaller incisions and using sturdier implants.

1. They have gotten better with the biologics of bone so they are able to stimulate the bone properly so it heals faster and stronger.

1. They have figured out how to treat tendonitis without traumatizing them with surgery but by way of stem cells or platelet-rich plasma, etc

1. The use of robotics

Some pieces of advice for students interested in orthopedic surgery:

• Don't be daunted by the competitiveness of orthopedics. It's not as bad as people make it out to be to get in.
• Just decide what you want to do and go for it.
• Don't decide on orthopedic surgery for the money, fame, or popularity.
• Look inside yourself and decide on what's going to make you happy. Pick a specialty you can be happy doing 15-20 years down the line. That's what's going to keep you going to work everyday And that's what's going to keep you happy with your work and home life and give you the most success.

Links and Other Resources:

www.mededmedia.com

www.OldPreMeds.org