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Best surgical lifestyle?

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  • Avatar Scarftheverb 
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    Ortho residency is brutal (at least at the places I trained), but lifestyle after residency seems to largely be dictated by the surgeon’s preference in all fields. More work=more money, and the private practice guys I know work about as much as they want to and no more. Employed or academic guys probably have less say over their lifestyle.

    #215706 Reply
    IntensiveCareBear IntensiveCareBear 
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    Ortho residency is brutal (at least at the places I trained), but lifestyle after residency seems to largely be dictated by the surgeon’s preference in all fields. More work=more money, and the private practice guys I know work about as much as they want to and no more. Employed or academic guys probably have less say over their lifestyle.

    Click to expand…

    This “surgeon’s preference” just isn’t reality, though. By its very nature, a lot of the pathology in some specialties is non-elective. Vascular will have bleeds and emergency amputations, ortho compound fractures and compartment syndrome and dislocations and septic joint I&D and spanning frames, CT has penetrating chest traumas, neurosurg has hemm strokes. You can’t simply “surgeon’s preference” out of those.

    Bad hours are simply part of the specialty in ortho (or vasc, neuro, CT surgery)… lots of night/weekend emergencies and early rounds, and those will generally be split among all in the group (possible exception of senior partners/owner). Hospitals generally won’t allow a group to be on staff unless they take some call. If you mean to say you can work decades in private practice to try to become one of those senior partner docs taking a bit less call than new hire associates, I’d agree… or you could simply choose a more lifestyle friendly specialty from the onset.

    Private practice docs are “employed” docs. No ortho practice or hospital hires a new associate who won’t take call or wants to work 0.75 FTE. Neither would OB, cardiology, etc. Usually, private practice can be the worst for hours since younger associates often take their own call plus a portion of seniors who have cut back/out of the call rotation. If you pretend that all young orthos want to work ultra-hard by choice, you are shooting the arrow first and then painting the bullseye around it. Some might want it or enjoy it that way, some don’t… but it’s required nonetheless.

    There are some surg specialties with few/no emergencies (the ones I listed), and ortho’s simply is not one of them. Again, it is a very good specialty for people who like prestige and being busy. Life is about health, relationships, and doing meaningful work; different people will prioritize those things in different orders. Ortho is great for the work part but can be rough on the others. It’s not for everyone… even if you are ortho onco or hand or highly research/teaching or design consultant for devices or something, it’s still definitely not a lifestyle specialty by any stretch. GL

     

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    #215709 Reply
    Avatar G 
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    It is basically between URO, ORTHO, and Plastics or ENT for me

    Click to expand…

    Add anesthesia and trauma, parts of CC, FM and OB, and desire for mobility (no office) and that is what brought me around to EM…the classic choice for somebody who prefers knowledge of ten boxes wide as opposed to ten boxes deep.  20 years later, I recognize the superficiality of that statement, for better AND worse.

    My town is a good example of how different call can be.  For ortho: At one spot, the EM guys do the reductions, hospitalist admits stuff like hips or infections, with ortho seeing the next day.  At another spot, the guys/gals are up all night operating on complicated injuries, open fractures, etc.  But even at that place, there are some orthopods who I haven’t seen in the ER in YEARS.

    #215719 Reply
    Liked by Tim
    Avatar Anne 
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    Like MPMD said, there is a selection bias when it comes to the happiness level you see in orthopedic surgeons. People who want to go into ortho tend to be happy, get it done, don’t worry about the things you can’t fix, sort or people. And the specialty allows them to get it done and not worry about the things they can’t fix.

    The question to ask before you go into a surgical subspecialty, in my opinion, is not whether you like the OR more than clinic, but do you like the OR more than sleep, your best friend’s wedding, your 3 year anniversary reservation. Because at least in residency, the OR is going to have to come before those types of things sometimes, and if you don’t love it you will grow to resent it. Preferring the OR to clinic is liking the OR. If you prefer the OR to sleep, at least when you are in your late 20s/early 30s, you know you love the OR.

    #215731 Reply
    Liked by LizOB, Zaphod
    Lordosis Lordosis 
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    My first 3rd year rotation was gen surge.  I was somehow paired with the chief of surgery and well established surgeon and senior of his group.  Spending 4 weeks on his schedule made surgery seem great.  My next 4 weeks was with the residency.  I was a lick-spittle for the senior resident and had to memorize patient vitals for her before rounds and unwrap and rewrap dressings for her.  I spent my time finding ways to get away so I could sneak into surgeries.  It was one of those programs that make it miserable because they were miserable.  It turned me off from surgery which was stupid because that was just one program.  In all honesty the peds residents were much worse.

    Anyways this is my way of saying your views might change.   Try to get perspective in early and mid career.  Find a program that does not suck.

    “Never let your sense of morals prevent you from doing what is right.”

    #215739 Reply
    Liked by Tangler, Tim
    Avatar Roentgen 
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    Consider Interventional Radiology.

    #215751 Reply
    Avatar Tim 
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    Observation about ortho residency:
    1) The sleep factor significantly lessens once oncall drops the in hospital requirement.
    2) The better you train your “munchkins”, the fewer sleep interruptions occur for “reassurance”. A wake up call means, get dressed and go in.
    3) One skill I observed that seems to be required.
    Catnapping!
    Anytime, anyplace, any break available. When needed, the eyes close and the zzz’s are virtually immediate. I picked up 3 from the airport who were discussing the evenings plans. The silence began before I got out of the airport. All 3 out like a light for the 30 minute ride home.
    It might be an acquired skill.
    4) Have someone you can call at odd hours. It helps keep you awake when driving.
    5) Some oncall is a fact. However, trades can be made depending on your specialty. For example, sports would most likely have game coverage types of responsibilities.
    Residents, partners and attendings all have events that are special. Your relationship with colleagues will have a big impact on your flexibility.
    6) The debate is usually which sub specialty. The post fellowship path and lifestyle have substantial differences.
    7) A previous poster gave advice “If you can be talked out of ortho, do the other one”.
    8) Anecdotally, never heard an ortho seriously lamenting a career choice that was a mistake.
    9) Anecdotally, virtually every resident debates the merits of which sub specialty is best for fellowship.
    10) It’s common for ortho to have a countdown app on the phone. Days, hours, minutes until graduation. The sacrifices are real but complete. It’s a whole new world.

    Good luck if you have problems with delayed gratification or think moonlighting is in the cards. No way.

    #215761 Reply
    Liked by Eye3md
    Avatar Eyedentist 
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    Surprised very few votes for ophtho. Total banking hours, sit down for surgeries, fast cases, cool tech, light call, happy patients for the most part. Tougher to make bank as compared to hospital based specialities, but with the right mindset and surgery center, sky is the limit. Demand should also sky rocket as baby boomer ophthalmologists retire.

    Click to expand…

    Honestly think optho suffers from isolation, its easy to forget it exists in med school since its so outside of hospital, etc….

     

     

    Click to expand…

    And that is exactly why we shouldn’t discuss it. Shhhhh……

    #215772 Reply
    ACN ACN 
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    Joined: 01/08/2016

    Interesting. Thank you all for the insight.

     

    It is basically between URO, ORTHO, and Plastics or ENT for me. My gut has me leaning towards URO but I will def give ortho some serious thought. I always kind of dismissed it because I thought they had the worst call.

     

    Mohs isnt an option because my school doesn’t match well for it and I also probably won’t be AOA because I don’t have enough community outreach, it isnt just based on grades at my school.

    Click to expand…

    Ortho call can be hard depending on where you are practicing, however, for example, our community level 3 call is split EVENLY amongst all the surgeons in our group and a few solo orthopods.  It ends up being like 3-5 call days a month.  You can take staff call at the level 1 in town along with trauma call 1 if you want.  Level 1 staff call is almost as similar as the level 3 call, however, trauma call can be rough.

    As a young partner, you’ll be taking more call to build your practice anyways.  Our senior partners basically take 0 call as the junior guys take it all.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #215774 Reply
    abds abds 
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    Ortho residency is brutal (at least at the places I trained), but lifestyle after residency seems to largely be dictated by the surgeon’s preference in all fields. More work=more money, and the private practice guys I know work about as much as they want to and no more. Employed or academic guys probably have less say over their lifestyle.

    Click to expand…

    This “surgeon’s preference” just isn’t reality, though. By its very nature, a lot of the pathology in some specialties is non-elective. Vascular will have bleeds and emergency amputations, ortho compound fractures and compartment syndrome and dislocations and septic joint I&D and spanning frames, CT has penetrating chest traumas, neurosurg has hemm strokes. You can’t simply “surgeon’s preference” out of those.

    Bad hours are simply part of the specialty in ortho (or vasc, neuro, CT surgery)… lots of night/weekend emergencies and early rounds, and those will generally be split among all in the group (possible exception of senior partners/owner). Hospitals generally won’t allow a group to be on staff unless they take some call. If you mean to say you can work decades in private practice to try to become one of those senior partner docs taking a bit less call than new hire associates, I’d agree… or you could simply choose a more lifestyle friendly specialty from the onset.

    Private practice docs are “employed” docs. No ortho practice or hospital hires a new associate who won’t take call or wants to work 0.75 FTE. Neither would OB, cardiology, etc. Usually, private practice can be the worst for hours since younger associates often take their own call plus a portion of seniors who have cut back/out of the call rotation. If you pretend that all young orthos want to work ultra-hard by choice, you are shooting the arrow first and then painting the bullseye around it. Some might want it or enjoy it that way, some don’t… but it’s required nonetheless.

    There are some surg specialties with few/no emergencies (the ones I listed), and ortho’s simply is not one of them. Again, it is a very good specialty for people who like prestige and being busy. Life is about health, relationships, and doing meaningful work; different people will prioritize those things in different orders. Ortho is great for the work part but can be rough on the others. It’s not for everyone… even if you are ortho onco or hand or highly research/teaching or design consultant for devices or something, it’s still definitely not a lifestyle specialty by any stretch. GL

     

    Click to expand…

    I’d stick to what you know. In private practice, a younger associate or partner may indeed take more group call (although a good group will split it evenly regardless of seniority). What you don’t seem to understand is that group call consists largely of fielding patient calls. If a patient you get on group call requires urgent intervention the patient can be sent to the ER. At that point whoever is on call for the ER has an obligation to manage it, at least acutely, regardless of the group affiliation of the surgeon covering the ER, even if someone else has established care with or even already operated on the patient.

    Group call is completely different than ER call, and ER call is what can result in overnight/emergent cases. ER call is nearly 100% elective in private practice. If you don’t want to take ER call, don’t sign up for it. Even for groups that have contracts with a hospital to cover all the ER call, young guys will often do so electively, both to build a practice and because higher level call is paid (often quite well). If a hospital requires you to take call to be on staff, you can often give that call to others who will willingly take it for the reasons in my last sentence. Or you could just not get privileges at said hospital. In many environments, hand/foot & ankle/sports surgeons can operate solely at ASCs and don’t technically need any inpatient hospital privileges.

    #215855 Reply
    Liked by Zaphod, G
    Avatar Tangler 
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    I think you need to do more rotations. Also, shadow a resident/attending for a weekend and try to see what it is like. The sad thing is how fast you must decide on a path. Seems like you have less and less chance to observe before deciding.

    #215862 Reply
    Liked by Strider_91, Tim, Zaphod
    Avatar Tim 
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    “The sad thing is how fast you must decide on a path. Seems like you have less and less chance to observe before deciding.”
    Year 3 scheduling of rotations greatly impacts the residency applications. It’s ready, shoot, aim. Factor in the personalities of the attending and residents on that rotation, it’s kind of aiming with a blindfold.
    Probably the weakest link in med education. Data based decision making? Really? But, it seems to work.

    #215870 Reply
    Liked by abds, Zaphod
    Avatar bonebrokemefix 
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    Ortho residency is brutal (at least at the places I trained), but lifestyle after residency seems to largely be dictated by the surgeon’s preference in all fields. More work=more money, and the private practice guys I know work about as much as they want to and no more. Employed or academic guys probably have less say over their lifestyle.

    Click to expand…

    This “surgeon’s preference” just isn’t reality, though. By its very nature, a lot of the pathology in some specialties is non-elective. Vascular will have bleeds and emergency amputations, ortho compound fractures and compartment syndrome and dislocations and septic joint I&D and spanning frames, CT has penetrating chest traumas, neurosurg has hemm strokes. You can’t simply “surgeon’s preference” out of those.

    Bad hours are simply part of the specialty in ortho (or vasc, neuro, CT surgery)… lots of night/weekend emergencies and early rounds, and those will generally be split among all in the group (possible exception of senior partners/owner). Hospitals generally won’t allow a group to be on staff unless they take some call. If you mean to say you can work decades in private practice to try to become one of those senior partner docs taking a bit less call than new hire associates, I’d agree… or you could simply choose a more lifestyle friendly specialty from the onset.

    Private practice docs are “employed” docs. No ortho practice or hospital hires a new associate who won’t take call or wants to work 0.75 FTE. Neither would OB, cardiology, etc. Usually, private practice can be the worst for hours since younger associates often take their own call plus a portion of seniors who have cut back/out of the call rotation. If you pretend that all young orthos want to work ultra-hard by choice, you are shooting the arrow first and then painting the bullseye around it. Some might want it or enjoy it that way, some don’t… but it’s required nonetheless.

    There are some surg specialties with few/no emergencies (the ones I listed), and ortho’s simply is not one of them. Again, it is a very good specialty for people who like prestige and being busy. Life is about health, relationships, and doing meaningful work; different people will prioritize those things in different orders. Ortho is great for the work part but can be rough on the others. It’s not for everyone… even if you are ortho onco or hand or highly research/teaching or design consultant for devices or something, it’s still definitely not a lifestyle specialty by any stretch. GL

     

    Click to expand…

    I’d stick to what you know. In private practice, a younger associate or partner may indeed take more group call (although a good group will split it evenly regardless of seniority). What you don’t seem to understand is that group call consists largely of fielding patient calls. If a patient you get on group call requires urgent intervention the patient can be sent to the ER. At that point whoever is on call for the ER has an obligation to manage it, at least acutely, regardless of the group affiliation of the surgeon covering the ER, even if someone else has established care with or even already operated on the patient.

    Group call is completely different than ER call, and ER call is what can result in overnight/emergent cases. ER call is nearly 100% elective in private practice. If you don’t want to take ER call, don’t sign up for it. Even for groups that have contracts with a hospital to cover all the ER call, young guys will often do so electively, both to build a practice and because higher level call is paid (often quite well). If a hospital requires you to take call to be on staff, you can often give that call to others who will willingly take it for the reasons in my last sentence. Or you could just not get privileges at said hospital. In many environments, hand/foot & ankle/sports surgeons can operate solely at ASCs and don’t technically need any inpatient hospital privileges.

    Click to expand…

    You would send one of your partner’s patients to the ER to get managed by someone from another group? I would argue the opposite, ER call or not. “I’m sorry, you said this was Dr. X’s patient? I’d call the person taking group call for him/her.” I’ve taken care of someone else’s postop hip dislocation one time, and that was only because I was standing right there in front of the patient when I found out who did the surgery. ED doc was a locums person not in touch with the local groups. I was too new to realize I had already missed the “Is this your problem?” fork in the algorithm. I had already spent my time, so I just took care of it. Not gonna fool me twice though.

    In my shop it’s almost the opposite, you have to be on staff to be allowed to take call. Because like you said, it pays well. But you definitely need inpatient privileges, regardless of sub-specialty. I have them at multiple hospitals I don’t operate at; since my partners do and group call being what it is, there is a chance I could. Not to mention rounding if that’s your setup.

     

    True or not, as a student I heard that Urology is one of the few specialties that you can make as much in the clinic/procedure room as you could in the OR. Although, I know now that you can do very well as a private orthopod and not operate very much at all.

    #215936 Reply
    Avatar snowcanyon 
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    Plastics, no? And they won’t get screwed by this no-surprise medical bill kerfuffle since they can opt out.

    #215941 Reply
    Liked by Zaphod
    Zaphod Zaphod 
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    “The sad thing is how fast you must decide on a path. Seems like you have less and less chance to observe before deciding.”
    Year 3 scheduling of rotations greatly impacts the residency applications. It’s ready, shoot, aim. Factor in the personalities of the attending and residents on that rotation, it’s kind of aiming with a blindfold.
    Probably the weakest link in med education. Data based decision making? Really? But, it seems to work.

    Click to expand…

    Absolutely agree.

    #215964 Reply

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