The Possibilities in Pediatric Orthopedic Surgery

Session 111

Pediatric orthopedic surgery is great for inquisitive doctors who love working with kids. Dr. Philip Ashley joins me to talk about subspecialties and more. Out of training for a few years now, he shares his path as he changed careers mid-college and how he reached out to a mentor which changed his trajectory in life.

Are you a premed student? Check out The Premed Years podcast where I feature physicians, medical students, admissions committee members, and more. Everything you need to know about your premed path is right there.

If you’re already a medical student, check out Board Rounds, where I partnered with BoardVitals, a test prep company. We’re breaking down questions to help you with your USMLE Step 1 and COMLEX Level 1 test preparation.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:45] Interest in Pediatric Orthopedic Surgery

Philip went to medical school already wanting to be a pediatric orthopedic surgeon He changed his career track in the middle of college. He initially took engineering and did a summer internship at NASA. At that point, he looked to other options.

He broke his finger bone when he was still a child. The person who operated him ended up being his mentor. He contacted him and consulted him about changing careers so he asked if he could shadow him over the holidays. Philip got hooked after that.

Philip loved the idea of being able to work with hands and do something in the operating room that made an immediate difference in somebody’s life. As a pediatric orthopedic surgeon, he loves being able to develop a relationship with the patient and be an inspiration for them.

[04:15] Traits that Lead to Becoming a Pediatric Orthopedic Doctor

First off, one has to enjoy being around kids. Attention to detail is also required because you will be doing something that could impact the rest of their lives. You will be interviewing and examining children who oftentimes are in pain.

'You have to be creative about dealing with them while paying close attention to detail.'Click To Tweet

Although he also looked into trauma as a subspecialty in orthopedics, he ended up getting into pediatrics.

[Related episode: Orthopedic Surgery Match Data Deep Dive]

[06:17] Types of Patients and Typical Day

Philip gets to be a generalist operating on the spine, hips, feet, and broken forearms. The bread-and-butter is taking care of fractures in kids, the most common is humerus fracture.

You may also be taking care of clubbed foot which involves a lot of casting as well as some procedures down the line. Other common cases include hip dysplasia, herpes, and scoliosis.

His typical day would involve two different kinds. Some days, he’s in the clinic and some days, he’s in the operating room. His clinic starts at 8:30 am. He takes care of any loose ends from the day before. He sees 35-40 patients on any given day.

Usually, he has a resident working with him where they both collaborate and discuss cases. Their clinic days typically end at 4:30 pm and dictate clinic notes until they get home before 5 pm.

On O.R. days, they get in at around 6:30-7am to check people in the operating room. By 7:30, they start with the operation and handle as many as 3-4 cases or 1-2 big cases.

'In pediatric orthopedics particularly, you're going to see a lot more clinic. In fact, 50% of your revenue and 50% of your time are going to be spent in the clinic.'Click To Tweet

1 in 10 patients that he sees on a given day ends up in surgery. Some of them may also be follow-ups from prior surgeries. But for new patients, he estimates 1 in 5 of them end up being in surgery.

In pediatrics orthopedics, it’s a lot more clinic-heavy than adult orthopedics since most kids recover from fractures and can be managed conservatively.

[Related episode: 6 Tips For Improving Patient Communication]

[11:00] Taking Calls and Work-Life Balance

In his practice, Philip has three partners and they share calls in their institutions. They do it one week at a time and take one week every four weeks.

Philip says he has great work-life balance. Part of the reason he went into pediatric orthopedics is that most of the pediatric orthopedic surgeons tend to care a lot about their family life.

'If you look at the numbers on how pediatric orthopedic surgeons get paid relative to other orthopedic surgeons, they actually get paid less.'Click To Tweet

Pediatric orthopedic surgeons get paid less than other orthopedic surgeons. This is because they’re not working as much as their counterparts. They essentially make the conscious decision to spend time with their families.

[12:40] The Training Path

Most orthopedic surgeons finish medical school and then get into a 5-6 year residency program. There are also some programs that give you a year to do research.

After that, you’re going to apply to a one-year pediatric orthopedic fellowship. In some of the bigger centers, you may have to take a second fellowship to subspecialize.

Philip recalls pediatric orthopedic fellowship as one of the less competitive programs to apply for from a fellowship standpoint.

'Once you made it in the door of orthopedics, if you're a U.S-trained orthopedic resident, there's 90% chance you'd get into your top three ranked fellowship programs.'Click To Tweet

Moreover, there are many fellowships that have opened up so you have an almost one-to-one rate of applicants to fellowship positions.

To be competitive as an applicant, some interest in research has been shown to help. Also, be able to work closely with the orthopedic surgeons at your institution and develop relationships with them. Get good letters of recommendation from them. Overall, just make sure that you’re well-respected within your institution.

[15:55] Subspecialty Opportunities

Another area people are interested in is limb deformity. There is only one or two that can do a specific fellowship in limb deformity correction. Other subspecialties include neuromuscular conditions (e.g. cerebral palsy), pediatric hand fellowship.

[18:25] Overcoming Bias Against DOs

Philip thinks there’s a good number of orthopedic residents that get in because they rotated at that institution. And the faculty of that institution got to see their work ethic, their interaction with patients, and their fondness of knowledge. Additionally, your interpersonal skills and your drive can help overcome that.

'Working with and doing things like rotations at institutions is key.'Click To Tweet

[19:55] Working with Primary Care and Other Specialties and Special Opportunities Outside of Clinical Medicine

Philip wished primary care providers knew about tibial torsion where he gets a number of consults for. It’s normal and it will improve on its own. And so they’re more than qualified to see and evaluate that.

'There's a certain number of things that are a part of normal development or within the scope of normal that we get referred.'Click To Tweet

Other specialties he works the closest with include PM&R, Anesthesia, Prosthetics & Orthotics.

In terms of special opportunities outside of clinical medicine, you could do research. In any field of orthopedics, you can deal with the legal side of things.

You could also get involved with companies that sell products specifically for pediatric orthopedics. Currently, people are developing monitoring devices for different orthotics.

[23:05] The Most and Least Liked Things About the Specialty and Major Changes in the Field

Philip loves getting to know families and see how their children grow and respond to their treatment. What he likes the least, on the contrary, is an infection or complication as a result of something they’ve done.

In terms of major changes in the field, there are a lot of research and efforts focused on how to deal with the growing spine and scoliosis. There are now treatments for correcting scoliosis without fusing the spine.

'There's a lot of effort into understanding the 3D nature of scoliosis, figuring out ways we can try to treat that without actually having to do a big surgery.'Click To Tweet

[27:00] Final Words of Wisdom

If he had to do it all over again, Philip would still have chosen the same specialty. Finally, he wishes to impart to students that while it’s worth it in the end, it’s certainly a long road. So you and your family have to be prepared for that.

It’s a big-time commitment on the front end to do orthopedic residency and afterward. Be prepared for a difficult and challenging residency that will test your stamina. But be willing to do it and approach it with a cheerful attitude and inquisitive mind.