Making an Impact as a Pediatric Orthopedic Surgeon

Session 115

Dr. Matthew Dobbs is a pediatric orthopedic surgeon specializing in foot deformities.

Several weeks ago, I had a pediatric orthopedic surgeon on the show but someone specialized more in spine care and spine surgery. 

Today, we get a somewhat different point of view from someone who went through the same training path of becoming an orthopedic surgeon specializing in pediatrics, just a liking to a different part of the body.

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[01:48] Interest in Pediatric Orthopedic Surgery

Matthew got initially exposed to pediatric orthopedics earlier on in medical school. He went to the University of Iowa and met people who later on were going to be his mentors, some giants in the field of Pediatric Orthopedics.

He still didn’t know what he was going to do but he was able to work alongside one of them on a research project. This piqued his interest and this really took him into orthopedics after medical school. 

Once within orthopedics, he spent more time with those particular mentors. He soon developed a love for the field and respect for what his mentors were able to accomplish on a daily basis.

What he loved about his mentors was that they were able to embody everything he wanted to be as a physician. They were caring and inquisitive. They combined a clinical career with never stopping to ask questions and have the curiosity. They always wanted to figure out what they could do better for their patients. Moreover, he likes the interaction with not only with patients but also with the parents. 

'In all of my route through medical school and training, never is so strong as it was within pediatric specialists.'Click To Tweet

[Related episode: The Possibilities in Pediatric Orthopedic Surgery]

[04:38] Interest in Foot Deformities

Matthew’s greatest mentor was a fellow named Ignacio Ponseti. He was a faculty member at the University of Iowa orthopedics. He was already semi-retired when Matthew came into residency. 

Ignacio came out of retirement to go on and train a group of people that could “spread the word” on a nonoperative method for clubfoot treatment.

Matthew was very fascinated by this technique that was developed back in the 1960s and published in a journal. But it didn’t change anyone’s practice. The surgeons wanted to keep operating on clubfeet. 

'He showed that this method of gentle manipulation, casting, and non-surgery led to feet that were mobile, functional, and pain-free long term.'Click To Tweet

Matthew saw this as a beautiful, artistic process that he wanted to be a part of. And so this was led him into this specialized area. Currently, much of his career is spent on going out and teaching this particular method on clubfoot treatment to others.

[06:40] Types of Patients

Matthew loves the fact that he gets to treat his patients as babies which he finds to be so much fun. 

'The best patient population in the world is treating a group of babies.'Click To Tweet

He treats infancy all the way through young adulthood. He treats patients with clubfeet that are already in adulthood as well. So he gets the whole gamut, further adding that he treats foot from birth to the grave.

Aside from clubfoot, they see a lot of other foot deformities. They see flatfoot, which is common in the general pediatric population. Another condition is the cavus feet, which is a more problematic issue that requires surgery.

They also deal with other congenital foot deformities such as children born with extra toes or missing toes, and the congenital fusion of bones of the bones.

[Related episode: 5 Traits Patients Want Their Doctors to Have]

[08:30] Academic vs. Community Setting

Matthew chose the academic route over the community setting and it wasn’t difficult for him to make this decision. He was able to combine his love of taking care of patients while also having the ability to ask questions and do something about it through research. He enjoyed the combination of patient care and translational research.

[Related episode: 6 Tips For Improving Patient Communication]

[09:55] Typical Day/Week and Percentage of Patients for Surgery

Half of his week is spent on the operating room and half in the clinic. Then he spends a little bit of time from each half on academic work and research. But mostly, his time is between the two.

They roughly take one patient to the operating room every 15-20 patients they see. 

[11:10] Taking Calls and Work/Life Balance

Matthew handles calls covering everything in pediatric orthopedics so it’s not just isolated to the foot. There’s a lot of trauma. 

They’re a Level 1 trauma center so they encounter cases like high-speed car accidents with broken bones as well as injuries from sporting events. They also see bone and joint infections. These are the majority of things they see on call.

'The calls are pretty busy at a Level 1 Trauma Center.'Click To Tweet

Matthew finds trauma very interesting. It’s fun to take care of the kids that are hurt. In general, the bodies of kids know how to heal. All they want to do is get back to playing so they’re very motivated patients. You treat them, fix their bones, and they get back to doing what they want to do.

'It's very rewarding to see a deformity with fracture, fix it, and see them return to function.'Click To Tweet

Matthew explains that you can strike that balance with pediatric orthopedics. The calls can be out of your hands but you can control your clinic schedule, you’re elective ORs, and how much you work to some extent. 

'Calls are less predictive. Kids can get hurt at odd times and so they have to fix those.'Click To Tweet

But the nice thing about the children is that you don’t have to come in the middle of the night for the most part. So it’s very conducive for you to plan out your family time. Those fractures are typically splinted in the emergency room and you’re able to take care of them the next day or the next week in the office. 

[14:10] The Training Path

After medical school, you take a 5-year orthopedic surgery training. This is general orthopedics, which covers everything within the field of orthopedic surgery, including pediatrics. Then you do one more year of strictly Pediatric Orthopedic fellowship. So it’s six years in total. Foot is covered within that training. 

But in this day and age of increasingly subspecialization training, there needs some additional training in these other areas. 

Many people are now doing a six-month extra fellowship in Foot or in Sports or in Spine. All these things are strictly within peds because it’s hard to dive deep into one particular area within a period of one year.

[15:45] Residency in Orthopedic Surgery

The first two years of training are the busiest as it’s the adjustment period. You’re still learning and everything is new to you at that time. And that’s the most overwhelming part as you’re trying to learn everything. 

For Orthopedics, on your 3rd to 5th year, it just gets better and better each year. You know what you’re doing more and you get more comfortable. You gain more independence. You’re building your confidence and skillset as you go along. 

By the time you’re a chief resident in your 5th year, you’re really comfortable and independently handling many of the common things you see in Orthopedics. 

'It's fun to see your own personal growth during that process.'Click To Tweet

[Related episode: Orthopedic Surgery Match Data Deep Dive]

[16:45] How to Be a Competitive Applicant and Finding Mentors

The biggest thing to do as a medical student is to have some elective rotations so you could meet professors and get a feel for the specialty itself. 

'What helps you stand out is spending extra time with a mentor.'Click To Tweet

You can do a clinical research project. It doesn’t have to be basic science research. Get involved with developing a relationship with somebody that can write you a letter of recommendation. 

We’ve heard time and time again from other physicians on this podcast that mentorship is the driving force behind a lot of specialty choices. And it’s a common dilemma for many students to find a mentor and reach out to someone. 

How do you begin that relationship?

Matthew points out that there’s no one recipe for that but you will find that the people you’re associated with are at these institutions for a reason. They enjoy teaching. They want to be approached.

If a student shows interest, then you’re going to see the professors open up their doors and welcome you. It’s just about being willing to take that step. Know that you’re going to have an open door and that’s the key.

Additionally, there are so many interesting things to do in medicine that you’re going to run across those mentors. You’re going to figure out an area that piques your interest and those relationships tend to blossom.

Your calling can be so many different things. So it’s really about what path you happen to go down. 

'Don't feel like you have to find this one magical path and if you don't find it, that's it. Because it's just not the case.'Click To Tweet

[Related episode: Getting a Mentor to Guide Your Premed Path]

[19:34] Overcoming Negative Bias Against DOs

Matthew has many good orthopedic colleagues who are osteopaths as well as fellows who are osteopaths in their own pediatric program. So don’t think there are going to be balls in front of you.

That being said, it all comes down to relationships. If you find mentors within that field, whether they’re osteopaths or MDs, develop those relationships. They’re going to know people in the field. They’ll write you letters and give you opportunities for projects. Do the best you can in school and extra projects hold the same. 

'Do those extra steps and you're going to stand out.'Click To Tweet

[20:30] Working with Primary Care and Other Specialties

25% of primary care practice are orthopedic complaints so they’re really huge in primary care. So they really want to encourage primary care physicians to get more of that training within medical school. That’s because orthopedics is not always even in the medical school curriculum. 

Matthew strongly encourages students to take electives in an orthopedic area because they’re going to have orthopedic patients in their practice. 

Other specialties Matthew works the closest with include Pediatric Neurologists and Pediatric Geneticists. 

They try to figure out whether these congenital deformities in the legs and the feet have any underlying cause for them. They try to figure out whether there’s a syndrome or a peripheral nerve disorder or central nervous system disorders. 

Those are really two groups he works with the most in terms of medicine. He also works a lot with physical therapists and physiatrists and other specialties.

[22:26] Special Opportunities Outside of Clinical Medicine

There are not so many industry opportunities with pediatric foot as much as some other fields within orthopedics. They don’t use as many implants among the kids. They basically take advantage of the fact that kids could heal in casts.

Being an entrepreneur himself, he developed a clubfoot brace that’s now used in over 100 countries. There are opportunities to do these things and be innovative in the industry side. There are also consulting opportunities that are possible.

[23:43] What He Wished He Knew About Pediatric Orthopedics

Matthew would tell his old self to pay attention to the long-term effects. How you do in a specialty has a long-term outcome. There’s long-term stuff they don’t know about such as the effects of the surgeries you do or the natural history of conditions. There’s just not much many studies out there that show these things.

So he would tell himself to be one of those people that gets involved in trying to develop level 1 evidence data. Give good, long-term data to know the effects of what we do today and how that impacts a child’s life as an adult. Try to really understand the natural history of, not only the disorder but the treatments as well.

'When they graduate from childhood, they go onto adult orthopedic surgeons and you may not know the effects of what you've done – either good or bad.'Click To Tweet

[25:05] Most and Least Like Things

Matthew loves being able to see a clinical deformity and be able to address this in some magical way with casting, gentle manipulations, minimal surgery, and create feet that fit well on the ground. You get to see feet that are mobile and you get to watch the children you’ve developed relationships with over time.

'You can see what an impact you can have on their life and function.'Click To Tweet

What he likes the least are the things that they can’t fix. And they all have those sad stories in their specialty. These could be things that involve tumors or injuries beyond repair and long-term physical deficits. And it’s hard to deal with that on a regular basis.

[26:30] Major Future Changes in the Specialty

Matthew does basic science research, specifically genetics research. He studies and identifies genes for different pediatric conditions. So he absolutely can see changes in the future. 

We’re actually seeing personalized medicine now among adults. They can get their blood pressure medicine now based on their own genetic profile. They want to take this to the orthopedics standpoint in personalized treatment.

'We're moving toward an era of personalized medicine.'Click To Tweet

After they’ve casted and corrected clubfeet, they wear braces worn at nighttime for four years. And they know all kids don’t need braces for that long but they also know that some kids need it longer.

They’ve gotten down with a ten-year clinical trial over randomized children in the different links of bracing. They’re developing a new classification system that’s now prognostic. 

So you can see a baby at birth and based on clinical exam findings, you can now tell how long should they be wearing the brace. It’s a much better, personalized treatment that what they currently offer.

[27:45] Final Words of Wisdom

If he had to do it all over again, Matthew would still have chosen the same specialty without a doubt. Ultimately, he wants to tell students interested in this path to definitely explore and follow your interests and passions. 

Do readings on this. Find mentors within your training facilities, within pediatric orthopedics. Go for a research opportunity. Develop that interest and good things will happen.


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