Private Practice General Orthopedics and More

Session 69

Dr. Pamela Mehta is a general private practice orthopedic surgeon. She has been out of training now for ten years and has been in private practice for two years. We get into a great discussion about what led her to private practice, post-training, types of patients, and what she likes about orthopedics. We talk about what it’s like to a be a woman in a male-dominated specialty and much more.

By the way, The Premed Playbook: Guide to the MCAT is going to be available very soon. Written with Blueprint MCAT (formerly Next Step Test Prep), we will soon be putting it up on Amazon and other stores as soon as possible. Go to MCATbook.com to sign up and be notified. Also check out our other books The Premed Playbook: Guide to the Medical School Interview and another one coming up in August is The Premed Playbook: Guide to the Medical School Personal Statement.

If you have any suggestions for physicians whom you think would make great guests (only attending physicians), shoot me an email at ryan@medicalschoolhq.net.

[02:00] An interest in Orthopedics

Initially, Pamela didn’t expect she wanted to be a surgeon because she expected she was going to find herself in primary care, her primary reason she went to medical school. In fact, she saw herself as either a pediatrician or family medicine doctor. And during her third year rotation, she put trauma surgery first, with the intention of just getting it out of the way since she wanted to practice so when she gets to the family medicine, internal medicine, and pediatric rotation, she will be in good position to get good letters.

During her first day at the trauma surgery rotation, she just couldn’t believe how excited she was. She was amazed by how the ER doctors, surgeons, and nurses were working together to get the patient up into the operating room as efficiently as possible. And when she was asked to scrub in, Pamela says she will never forget that feeling. From that day on, she made a complete switch and decided she was going to do surgery.

[Tweet “”I could not believe how excited I was and just the adrenalin that was pumping when trauma came into the trauma bay.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

It was actually a blessing in disguise when she had the whole year to figure out where she was going to do her fourth year sub-I’s in. This gave her time to choose which clinical subspecialty she wanted to do.

[06:15] Pushback as a Female Surgeon

Pamela admits that when she was still attending USC, she got told many times by other orthopedic surgeons, residents to instead do other specialities like radiology or anesthesia or PM&R. And she she didn’t really understand why she can’t do it as well. And she was told orthopedics was difficult in terms of lifestyle or having a family.

Good thing, she went to a very supportive residency in Columbia University in New York City and out of the six people in her class, two of them were women and the class right before them, four were women out of the six.

She felt really protected in that she never felt she was a woman there in terms of feeling discriminated against or not taken seriously. However, it was a different case when she began entering into the workforce. When she started interviewing for jobs, she faced a lot of the discrimination.

[Tweet “”If you are a female and you want to go into a male-dominated specialty, you absolutely should but you do have to have a thick skin. That’s life.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

Pamela adds that having a thick skin is important being in a male-dominated specialty. In fact, sometimes you even have to be more perfect than your male counterparts. Because when you slip on something as a female, there are those that will think it’s because your’e a girl.

[09:00] Patient Types and Her Choice to Do General Orthopedics vs. a Subspecialty

Part of the reason she loves orthopedics is she loves taking care of children, young adults, and seniors. She treats fracture work when people break their bones and they have to go to the ER and can’t walk. She handles patients with sports injuries as well as arthritis patients, especially older patients that can’t walk or are debilitated, for which she does joint replacement surgery as well.

Pamela thinks it’s rare for a resident to graduate and not do a fellowship especially in the more competitive environments like the bigger cities. But she just likes general orthopedics. She likes the bread and butter orthopedics. She likes taking care of all kinds of issues from sports injuries to fracture work to arthritic patients. So she took the leap and decided not to do the subspecialty. Finding a job wasn’t that much of a difficulty for her too.

[Tweet “”Once you’re in your job, you really learn so much on the job in your first couple of years as an attending and a brand new surgeon that the fellowship stuff doesn’t matter as much.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

From a marketing standpoint, once you’re out of practice, Pamela suggests it’s in your best interest that if you’re in a big city, you have to be able to market yourself as a certain subspecialist.

[11:35] Private Practice

Pamela recalls being in a large group composed mostly of men. And once she had children, she realized it was very difficult to work in a large group of men. They didn’t seem to understand if she needed to drop or pick up her kids. So she was looking for that flexibility to do what she wants and when she wants it on her own terms.

[Tweet “”I just really wanted the flexibility to do what I want, when I want on my own terms.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

Ultimately, she made her decision after her second child to go out into private practice. Not an easy decision to make though considering she already had a job that had a stable paycheck and great benefits. It was definitely a risk she decided to take, considering too she was confident that she had several years of experience and the surgical volume under her belt. And so the rest is history as she’s now practicing for about two years. Being her own boss, she calls the shots as to when she wants to see patients and when she wants to do cases. She may be a lot busier than she was before, but it’s all on her own terms (and she’s making more money now than she did as well).

[13:40] Diagnosis in Patients Coming to Her

Pamela says mostly anyone that comes to them still needs a diagnosis. She often has patients that have been either to the primary care doctor, a chiropractor, a physical therapist, etc. Oftentimes, they’d come up with some idea but they don’t have the answer yet.

Pamela says that they mostly have to diagnose the patient from beginning to end. In orthopedics, Pamela explains that there’s not a lot of non-operative care that you do before you actually do any kind of surgery.

Additionally, Pamela explains that because orthopedics is not a big part of medical school and a lot of primary care doctors don’t actually know how to diagnose these problems. So there are patients coming in diagnosed with carpal tunnel syndrome in their hand, for instance, and really, what they have is a trigger finger.

In some ways, it’s always much more complex because sometimes you’re being led in a different direction from what says on the referral than when the patient comes in and you have to start from the beginning and not really trust anyone else’s diagnosis.

[Tweet “”There are patients coming in diagnosed with carpal tunnel syndrome in their hand and really what they have is a trigger finger.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

Pamela recommends to primary doctors to carry with them The Handbook for Fractures. Also, it would be better to shadow an orthopedist at some point in your residency training. She has tried as a private practitioner to go out in the community and give out her numbers, telling primary are doctors that they can always reach her if they have any questions.

Building a relationship with an orthopedist in town as a primary care doctor is a good idea too to have someone to pick their brain and ask things.

And out of the percentage of patients they end up taking to the operating room, Pamela would say 70% when she used to work with that large group. There were a lot of layers of primary care/physical therapy/PM&R that was seeing the patient before they finally got to orthopedics. On the other hand, Pam thinks that if you’re in private practice or in academics, the percentage can be at 30% to 40%. This being said, she explains you never say no. You see anyone and everything. So you’re less protected when you’re out in private practice and not part of the large multi-specialty group.

[17:50] Typical Week, Taking Calls, and Work-Life Balance

Now that she can do whatever she wants, she has a set schedule. Mondays would be her OR days. Tuesdays to Fridays would be clinic days with a mix of procedure work, doing injections and regenerative medicine like PRP and stem cells. Then closer at the end of the week, she will do a second OR slot where she’ll take some fractures that have come through on call or thru the ER.

In terms of taking calls, Pamela says that if you decide to affiliate with certain hospitals and usually they’d ask you to take ER calls. This means you’re on call a few nights of the month. Although you can do as little or as much as you want. If you’re a part of the group in private practice, you will join up with some other colleagues and take group call for your private patients that come through your office. Pamela is part of a larger call group of eight but she considers this as pretty light and not anything too crazy. Although it becomes a little bit more intensive if you’re affiliated with a large trauma hospital where you’re in-house and doing a lot of fracture work over night.

[Tweet “”Usually when you’re brand new, you want to take that ER call because that’s how you get some patients into your office.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

Pamela believes she has enough family time. Her husband is an ortho spine surgeon so he thinks there’s balance that comes with that. They work together in terms of fitting their schedules in. They also make sure they block weekends for family time. She takes her partnership with her husband some credit for being able to manage their work-life balance.

[21:30] The Path to Being an Orthopedic Surgeon

It basically takes four years of undergraduate training and then four years of medical school. Usually in the end of your third year and beginning of fourth year, you have to do an orthopedic rotation usually your home program. Then you can choose to do a couple sub-I’s away.

Pamela applied to about ten orthopedic programs and went on about six or seven interviews. She matched to Columbia where she did a five-year program. Their first year was a mix of general surgery and orthopedics. Then PGY-2 year is what they call their ortho intern year so you’re like the scut monkey and you do all the consults in the ER. Pamela describes this as your most work-intensive year. The rest of your three years are focused on operating and operative skill.

You can then choose to do a fellowship. All orthopedic fellowships take one year. Pamela thinks this is good since it shouldn’t really be that long. Examples of fellowships available are spine, sports, joint replacement, hand, foot and ankle, and peds.

Pamela explains that if you want to be competitive in residency since this field is highly competitive, you have to honor your rotations in your third year as they look at that. Then get good letters of recommendation. Do well on your boards. In fact, when Pamela had pretty average board scores and when she got those board scores back, many people told her to take a year off and do some research or switch gears. But she was pretty determined so she pit three places to do her sub-I’s and really hustled her way through to leave a good impression on people. Hence, she was able to get more letters.

If you have good board scores, that doesn’t make you a shoe-in but it does help you chances quite a bit. But if you don’t have good board scores, it’s that much more important to just impress people a lot and get really good letters.

[Tweet “”If you don’t have good board scores, it’s that much more important to just impress people a lot and get really good letters.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

[24:30] Bias Against DOs

Pamela says that that one of the best orthopedic surgeon in that big group she used to be a part of was a DO. He operated better and more efficient than any of the rest of them. He was the most revered and the go-to guy for questions and opinions. Currently, she works with an orthopedist in town who’s also very well-trained. All this being said, she really doesn’t think there’s much bias at this time. It really doesn’t matter that much anymore once you’re out in practice.

[Tweet “”Any place that is that unaccepting, whether you’re a female or you have children or you’re a DO, then that’s not really a place you want to be at.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

She adds that people could be caught in the idea that we have to be in the best place, but it doesn’t work like that. It has to be a place that’s going to support you in your endeavors.

[26:20] Working with Primary Care and Other Specialties

Pamela recommends to primary care physicians is to get the x-rays done as it’s very hard for them to evaluate patients without them. You can also get someone started on physical therapy unless it’s a broken bone. It’s nice to get knocked out of the few non operative treatments before sending them to a specialist. It’s all about making a little effort to give patients a little bit of treatment before they get to the specialists.

Other specialties they work the closest with are pain management, PM&R, and internal and family medicine.

Whether there are special opportunities outside of clinical medicine, Pam says there’s the whole medical legal world where people ask for you to review charts. So there’s a lot of personal injury work you can do. It can run a whole gamut of doing an independent examination. There’s a lot of things you can do outside of clinical medicine in terms of just dealing with traditional insurance companies.

Another nice things with orthopedics is they have a lot of sports games so you can go to the local high school and junior high schools or community colleges and ask if they need someone to come and be there on the sidelines for the games.

[29:20] What She Wished She Knew and Her Advice to the Male Doctors

What she knows now that she wished she knew back then was that Pamela found herself so naive and energetic in medical school. She thought it wasn’t a big deal she was a female even if people were hesitant about it. It was okay for the most part but she did wish she had more female colleagues instead of all men colleagues all the time. There’s only 5% of them female orthopedic surgeons practicing outside residency. In training it’s about 14% and they dropped down to 5%. She sometimes feels this is a little bit of a struggle, not feeling the camaraderie that many female-dominated specialties have.

But in terms of the actual work, she is happy about it. In fact, she couldn’t imagine doing any other field. That said, she thinks that when you’re in medical school and one specialty is not working out for you, keep an open mind to think about two or three other different specialties.

[Tweet “”Keep an open mind to think about two or three other different specialties.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]

Pamela says that the deterioration in numbers in female orthopods from residency to practice is more of a system problem. And unfortunately, there’s still a lot of discrimination in medicine more so in the surgical field. This said, the way to do it is for men to really accept females into their “circle” and recognize they’re a large part of the workforce and they have something to contribute. Pam suspects because this is the age people start their family and if people in the workforce aren’t more open to that, this is something people need to accept. And we need to nurture that. People from training to stopping work is just a scary number and odd.

[33:20] Things She Likes the Most and Least

What Pamela likes most about being an orthopod is the variety of the things she gets to do. She gets to do big open surgeries and fixing things with plates and screws. She also gets to do smaller surgeries like just playing video games.

On the flip side, what she likes the least as with any other surgical field is infection and pus.

In terms of the major changes coming to the field, Pamela says orthopedics is a very dynamic field that there’s new stuff coming all the time. They’re improving all the implants they put in. There’s a huge wave of regenerative medicine with stem cells and the different ways to garner those stem cells.

If she had to do it all over again, Pamela would still have done the same. Lastly, she wishes to tell students that this is a great field with a lot of variety. You get to operate and get to see patients in the office. You get to have fun with your colleagues. You get to treat patients that really want to get back to their active lifestyle. For the most part, they’re generally healthy. Just show your passion and dedication for the field and you can achieve anything you want.

[Tweet “”If you’re a medical student that struggles with low board scores, don’t let it get in the way. You can do it. It’s very possible to do it and even without taking the time off.” https://medicalschoolhq.net/ss-69-private-practice-general-orthopedics-and-more/”]