So you want to be an orthopaedic surgeon. You like the idea of fixing broken bones and
bro-ing out. Let’s debunk the public perception myths of what it means to be an orthopaedic
surgeon, and give it to you straight. This is the reality of orthopaedic surgery.
Dr. Jubbal, MedSchoolInsiders.com.
Welcome to our next installment in So You Want to Be. In this series, we highlight a
specific specialty within medicine, such as orthopaedic surgery, and help you decide if
it’s a good fit for you. You can find the other specialties on our So You Want to Be
playlist. A lot of you asked for orthopaedic surgery in our poll, so that’s what we’re
covering here. If you want to vote in upcoming polls to decide what future specialties we
cover, make sure you’re subscribed.
If you’d like to see what being an orthopaedic surgeon looks like, check out my second channel,
Kevin Jubbal, M.D., where I do a second series in parallel called a Day in the Life. We’ve
already covered two episodes on orthopaedic surgery, so check them out after this video.
show footage from Randy McKnight’s and Daniel Choi’s”`
Ortho, coming from Greek orthos, meaning “straight or to correct” and paideia, meaning “rearing
of children”, was originally concerned with treating children with skeletal deformities
like bow legs or knock knees. In essence, orthopaedic surgery focuses on the musculoskeletal
system. This translates to fractures, meaning broken bones, but also surgeries involving
tendons, ligaments, and sometimes nerve or vascular injuries.
The sports injuries you see on TV of your favorite athletes, like ACL tears, Achille’s
ruptures, or rotator cuff issues are handled by orthopaedic surgeons. But there’s much
more to it than that.
There’s a variety of ways to categorize orthopaedic surgery. You can look at interventions
that deal with fractures of bones versus soft tissue ligamentous and tendinous repair. You
can look at non-acute versus acute surgery, such as trauma. Outpatient versus inpatient.
Arthroscopic minimally invasive versus open surgeries. Adult versus pediatrics. Or regionally,
you can look at orthopaedic surgery as spine versus pelvis versus extremities.
To become an orthopaedic surgeon, you’ll have to complete a 5-year orthopaedic surgery
residency after medical school. A single research year is generally optional and can be pursued
by those interested in becoming surgeon scientists.
In terms of competitiveness, orthopaedic surgery is consistently in the top five, in most recent
years being ranked fourth, only behind dermatology, plastic surgery, and neurosurgery.
To be considered at an orthopaedic surgery program, your Step 1 score and 1 rep max on
bench press must exceed 500, otherwise your application will be tossed out. I’m kidding
obviously, but only sort of. Orthopaedic surgery candidates are top students, with very high
Step 1 and Step 2 scores. The field is highly dominated by men, at approximately 95%, however
that’s changing for the better, and I’ve worked with several talented female orthopaedic
surgeons during my training.
Like all surgical residencies, orthopaedic surgery residency will be incredibly taxing.
There will be a significant amount of time on inpatient services compared to outpatient,
which translates to earlier and longer hours.
After completing residency, you can choose to subspecialize further with a fellowship,
most of which last 1 year. While there are some general orthopods, over 80% decide to
subspecialize, and some even complete two separate fellowships.
In trauma, you’ll be dealing with fractures of the long bones of the extremities, such
as the femur, tibia, forearm, and humerus, as well as fractures of the pelvis and hip
socket. Often times these fractures will be “open” meaning the bone came through the
skin and was exposed to the outside world. You’ll often be managing intra-articular
fractures at joints such as the elbow, shoulder, knee, and hip. Intra-articular refers to fractures
extending into the actual articulating surfaces of the joint.
Many of the patients will have multiple, if not all, extremities injured in some way necessitating
planning and coordination of multiple surgeries. You’ll be working side by side with general
surgery trauma surgeons, as these patients often have accompanying intra-abdominal and
intrathoracic injuries.
This is the subspecialty for you if you don’t mind irregular and unpredictable hours while
on call. You will often see patients on the worst day of their lives, but help them recover
from debilitating injuries in order to get back to a normal life. The surgeries that
you do each day will be diverse and unpredictable, but are often times very rewarding. The pay
is not as high compared to other orthopaedic subspecialties because many traumatologists
treat uninsured patients and are employed by hospitals instead of being in private practice.
Of all the subspecialties, pediatric orthopaedic surgery is the most broad, as you’ll be
operating on a variety of conditions in patients less than 18 years of age.
Most commonly, this includes trauma since kids love breaking things. But it also includes
sports injuries, like ACL tears, spine surgeries to correct scoliosis deformity, and deformity
correction of congenital limb defects. You’ll see everything from healthy kids who broke
their wrist to kids with multiple congenital syndromes who need multiple procedures throughout
their lives.
A great deal of pediatric orthopaedic surgery is nonoperative. This is the subspecialty
for orthopods that enjoy a broad scope of practice and have the patience to work with
both children and their parents.
Spine includes surgical interventions to correct spinal deformity, trauma, degenerative disease,
and nerve compression.
Spine surgeons are consistently among the highest compensated orthopaedic surgeons.
You’ll be dealing with multiple areas of the axial skeleton, operating primarily on
the cervical, thoracic, and lumbar spine, and occasionally the sacrum.
There is some overlap between orthopaedic spine surgeons and neurosurgeons – both
operate on the spine with similar indications and techniques. However, neurosurgeons will
also operate on lesions that effect the actual spinal cord that extend into the dura, which
is the outermost layer of the meninges. As an orthopaedic surgeon, you’ll stick just
to the bony spine and leave the spinal cord to the neurosurgeons.
Hand surgery obviously includes the hand, but also the forearm, wrist, and sometimes
up to the elbow or higher! Approximately 70% of fellowship-trained hand surgeons first
completed a orthopaedic residency, but 25-30% of the time it’s plastic surgeons. General
surgeons can train in hand fellowship as well, although it’s quite rare.
This is the subspecialty for the cerebral and intellectual orthopods. It’s the second
most competitive fellowship and deals with incredibly complex anatomy. You have to find
enjoyment in the nuances and esoteric variations of anatomy and function. Given the highly
complex anatomy, you’ll be doing a lot of microsurgery, operating under microscopes
or using surgical loupes to better visualize the tendons, nerves, vessels, and bones.
The pathology treated is extremely broad. You’ll be dealing with fractures, infections,
nerve compression, degenerative disease, overuse injuries, congenital defects, and traumatic
amputations of the fingers, wrist and hand. Hand surgeons also deal with revascularization
of amputated digits or limbs with repair of the peripheral nerves.
Hand surgeons also do targeted muscle reinnervation, which is straight science fiction. This provides
patients with traumatic amputations to the upper extremity with the ability to use myoelectric
prostheses with more intuitive function. In short, nerves that would have innervated muscles
that no longer have function can be rerouted such that a prosthetic limb can perform more
complex movements. Magic baby.
For example, the starfish procedure allows for independent digital flexion and extension
through a myoelectric prosthesis. Straight craziness. I’ll have a link to this paper
in the description.
While hand deals with several bony and soft tissue pathologies, foot and ankle surgery
is comprised of mostly bony and only some soft tissue work.
Most of foot and ankle surgery is outpatient, but you’ll still be dealing with very serious
pathologies, like post-traumatic arthritis and pain, degenerative pathology, cosmetic
surgeries, and lots of trauma ranging from ankle fractures to the notorious calcaneus
(or heel) fractures that no other orthopaedic surgeons like to treat. Unfortunately, you’ll
also be dealing with diabetic foot infections and stinky feet.
You may be wondering how this compares to podiatry. Podiatry generally deals with more
nonoperative treatment of calluses, corns, bunions, and the like. Some would argue that
orthopaedic surgeons are better equipped for more complex surgeries as they completed a
5 year residency after medical school learning to fix the entire musculoskeletal system with
a one year fellowship in foot and ankle surgery.
Orthopaedic oncology, also known as ortho tumor, is a tiny specialty, with only a couple
hundred trained across the country.
Cardiothoracic surgeons deal with intrathoracic tumors. General surgeons specializing in oncology
deal with primarily intra-abdominal tumors. As an orthopaedic surgeon specializing in
tumor, you’ll be dealing with both soft tissue and bony tumors in the extremities,
spine, and pelvis. If you are an orthopaedic tumor surgeon you’ll likely work in a major
city at a major hospital in coordination with many other cancer doctors, such as medical
oncologists, radiology oncologists, surgical oncologists, pathologists, and more.
Sports is by far the most common fellowship for orthopaedic surgeons, but they treat far
more than athletes. While they treat sports related injuries like tendon and ligament
tears, they are also generalists. They deal with ligamentous injury, tendinous injuries,
shoulder and elbow disease, and foot and ankle overuse. Often times their focus is on the
knee and shoulder joints, whether it is replacing these joints, called arthroplasty, or treating
pathology surgically with the use of a small camera, called arthroscopy. The more serious
trauma is reserved for trauma orthopods, but sports orthopods also handle a good amount
of orthopaedic trauma work.
When your favorite athlete tears their meniscus, ACL, or rotator cuff, these are the surgeons
to find. These procedures all pay well, but you won’t be as highly compensated as a
spine surgeon. And as a sports orthopaedic surgeon you can work anywhere from the smallest
town to the largest city.
Joints primarily comes down to hip and knee replacements, also known as arthroplasty.
Joints surgeons also perform some procedures to help delay hip or knee replacements in
younger patients, but the majority of their practice is becoming the best at hip and knee
replacements. As a joints surgeon, you’ll also do revision surgeries meaning when something
goes wrong with a hip or knee replacement (infection, fracture, loosening), you’ll
be the person to go in and remove any implants that need to come out.
This is one of the most competitive fellowships, as the field is highly desirable due to arthroplasty
being a predictable lifestyle and hip replacements being one of the most successful surgeries
that exist. Patients come in having pain with every step and walk out the hospital the next
day. It is an extremely rewarding field. If you like repetition and becoming really good
at a few different procedures, this is the subspecialty for you.
There’s a lot to love about ortho.
First, you’ll actually be fixing pathologies, rather than just managing them as you do in
many other medical specialties. Patients come in with a distinct problem and you have a
way of fixing it. Also, orthopaedics usually has good outcomes, with most patients having
substantial improvement to their condition after surgery.
Second, the surgeries are fun! Scopes and minimally invasive surgeries are becoming
more widespread in all surgical specialties, and while they are great for patients, they
aren’t as fun to perform. Orthopaedic surgery still has plenty of open cases with amazing
exposure and anatomy to appreciate.
Third, it’s a team sport. The personalities within orthopaedics vary widely from the days
of everyone being massive bros. However, the common theme remains that most orthopaedic
surgeons are team-players. There is a sense of camaraderie amongst orthopods and they
generally will work hard for each other. At the end of the day, orthopods know how to
work hard but also have a good time.
Fourth, you’ll be well compensated. Orthopaedic surgeons are consistently the number 1 or
number 2 highest compensated physicians, duking it out with neurosurgeons.
Lastly, you get to focus on a particular system. You won’t have to do much medical management,
which is what you spent so much time and effort learning in medical school. Some medical students
are disappointed by this, and others consider this a unique benefit. Whether it’s a feature
or a bug is for you to decide.
As with many surgical specialties, orthopaedic surgery can have challenging hours. That being
said, be thankful those long hours are in the emergency department and operating room
doing procedures, and not so much in clinic.
Diversity in the field has historically been lacking, both in gender and background. The
field is 95% dominated by men, one of the most skewed of any surgical specialty. The
good news is that it’s slowly changing for the better with women making up at least 14%
of residents in 2016-17, and that number is growing every year.
For better or worse, it will be difficult to escape the bro stereotype. All personalities
are welcome and present, but some dominate.
And lastly, often times it’s not very precise or meticulous. When I was weighing neurosurgery
versus orthopaedic surgery versus plastic surgery, it was readily apparent that most
orthopaedic surgery is not as concerned with finesse, precision, and nuance. However, hand
and tumor subspecialties within ortho are big exceptions. Depending on your personality,
this can be a good or bad thing.
How can you decide if orthopaedic surgery is the right field for you?
The stereotype is if you say “dude” frequently, can bench at least 2 plates, and are prone
to fist bumping over handshakes, you may be an orthopaedic surgeon at heart. With that
said, anybody can be an orthopaedic surgeon.
If you love musculoskeletal anatomy — meaning bones, nerves, and muscles then it may be
for you. If lots of effort, hammers, drills, scopes, and big incisions aren’t enticing
for you, then consider looking elsewhere.
And finally, orthopaedic surgery is a highly competitive specialty, so you’ll need to
be willing to work your tail off in medical school. That translates to more than just
high board scores, but also playing the research game, being a leader, and crushing your clinical
rotations beyond just surgery.
And who better to learn from and be mentored by than orthopaedic surgeons themselves. Big
shout out to the orthopaedic surgeons from Med School Insiders that helped me in the
creation of this video. If you need help acing your MCAT, USMLE, or other exams, our tutors
can maximize your test day performance. If you’re applying to medical school or orthopaedic
surgery residency, our orthopods can share the ins and outs of what it takes and how
to navigate the highly competitive process most effectively. We’ve become the fastest
growing company in the industry, and it’s no surprise. Our customers love us because
we’re committed to delivering results, period. Learn more at MedSchoolInsiders.com.
Thank you all so much for watching! What specialty do you want me to cover next? Leave a comment
down below, and make sure you’re subscribed to vote in the upcoming polls. If you enjoyed
the video, hit that thumbs up button to keep the YouTube gods happy. Much love to you all,
and I will see you guys in that next one.