Session 5

In this week’s episode, Ryan talks with Ragu, an orthopedic hand surgeon who works in a hybrid setup. He’s in a community-based hospital and program, but he has residents he interacts with who rotate through the hospital. He has been practicing for almost two years.

When he knew he wanted to be an orthopedic hand surgeon:

• Deciding he wanted to be an orthopedic surgeon towards the end of 2nd year in medical school
• He chose hand surgery toward the middle of his orthopedic residency after doing some rotations and liking the intricate nature of the hand.

What led him to orthopedics vs. general surgery:

• Enjoying the focus on the extremities
• It’s a specialty with multiple subspecialties (sports, joint replacements, shoulder, knee, hand, children), so it gave him a lot of options.

[Related episode: What Does a Community-Based Joint Replacement Specialist Do?]

Other specialties he was considering:

Each of these specialties are linked to other Specialty Stories interviews we’ve done with physicians in the fields Ragu was considering:

• Anesthesia
• Radiology
• ENT

Traits that lead to being a good orthopedic surgeon:

• Hard work
• Dedication
• A desire to work with your hands and do procedures
• Good motor coordination

A typical day for an orthopedic surgeon:

Office day:

• 8am to 4pm seeing 20 patients
• 20 minutes per patient + 5 minutes to do charting
• Consultations on the floor in between
• Answering calls from patients
• One weekend per month of call

Surgery day:

• 7:30 am to 3-4pm doing 3-6 surgeries a day (depending on the type and length of surgery)
• 75-80% of his surgeries are hand/upper extremity surgeries (hand, wrist, forearm, elbow)
• Majority of hand surgeons do only hand surgery (90-95%)
• The average orthopedic surgeon takes 5-6 days of call a month (1 weekday per week and 1 weekend per month)

Types of patients and cases an orthopedic surgeon sees:

• Carpal tunnel syndrome
• Tendonitis
• Hand fractures/injuries
• Traumatic injuries (lacerations on the hand)

Percentage of patients he sees in the office that he ends up taking in the operating room:

1-2 out of 20 people that he sees

Do orthopedic surgeons have work-life balance?

• He is married and travels once every 3-4 months for a vacation.
• He has a number of hobbies outside of work like basketball and golf.
• Spends quality time with his wife, friends, and family
• If you have your own practice, you can set up your work-life balance how you want.

[Related episode: Interview With a Private Practice General Orthopedist]

What makes a competitive applicant for orthopedics?

• Showing interest in orthopedics (talking to the orthopedic department in your school) and getting involved such as orthopedic research
• Good board scores
• Good letters of recommendation
• Good scores on clinical rotations, especially those involving surgical stuff (surgery, OB, medicine)

Bias in orthopedic surgery against DO applicants?

In the past, DO applicants were not getting proper consideration. In recent years, DOs are starting to get more recognition as being just as competent as MD applicants.

Generally, there is still a slight bias against DO applicants applying to MD orthopedic programs.

Residency as an orthopedic surgeon:

• Tough but every year gets better
• He enjoyed it a lot.

Duration of orthopedic residency programs

• 1 year as a general surgery intern (half spent doing orthopedics, half spent doing general surgery, with a potential for a month of elective such as radiology)
• 4 years of orthopedic-only residency

What the orthopedic fellowship looks like:

• 1 year (some do a second year on a different fellowship)
• Orthopedic fellowships are cyclically competitive (every 4-5 years, there’s a new, popular fellowship that everybody wants to get into)

Opportunities for women to enter orthopedics:

• There are many women in orthopedics.
• Women can be just as good as men in orthopedic surgery and can do any subspecialty they want. It’s just a matter of knowledge and training.
• More and more women are now going into orthopedics. There are more women in the orthopedic surgery fellowships all the time.

What the orthopedic board exams look like:

• Similar to USMLE but focused on orthopedics
• Multiple choice questions in two parts:
• Part I – Test for knowledge of the basic science and orthopedic surgery
• Part II – Oral exam

How the oral exam works:

• Once you’re out in practice, you submit 6 months worth of your surgical cases.
• They will review them and pick a number of cases, then you discuss them with senior orthopedic surgeons.
• They will ask you numerous questions, and they will judge you based on your clinical decisions.

Pass rates for the orthopedic board exams:

• Part I – US medical graduate from a US orthopedic residency: low 90% range
• Part II – low 90% range

What he wished he knew before starting his orthopedic residency:

• Knowing that time passes by quicker than you think.
• Opportunities don’t come about again once you finish your training.
• The whole goal of residency is to see and learn as much as you can.
• You have to go into those first 2-3 years of residency prepared to miss important life events and not feel bad about it. After that, things will get easier.

What he wishes primary-care physicians knew about orthopedics:

Orthopedists are capable physicians, and they do understand some medicine. More primary-care doctors should give them some credit in regards to that.

If primary-care physicians take a little bit of initiative to learn the basics of the musculoskeletal exam, they can actually examine their patients and be able to direct them to an orthopedic surgeon appropriately, instead of just sending them without even having seen the patient.

Other specialties orthopedists work the closest with:

• Emergency room physicians or PAs
• Internal medicine team
• Rheumatology and Neurology

Orthopedics opportunities outside of medicine:

Research and development of orthopedic implants and products (such as bone cements)

What he likes the most about being an orthopedic surgeon:

Seeing and interacting with patients and giving a solution to a problem that’s been plaguing them for months or years

What he likes the least being an orthopedic surgeon:

• Being on call (ex. getting a phone call at 2 am)
• The few patients that are beyond his ability to help

Would he still have chosen orthopedic hand surgery if he had to do it all again?

Yes. He loves orthopedics and hand orthopedics.

The future of orthopedic surgery:

Figuring out ways to heal the body and improve things without surgical intervention, like lasers or nanobots to make the human body better.

The immediate future of orthopedic surgery:

1. Improved ability to fix people’s broken bones by making smaller incisions and using sturdier implants.

2. Improvements in the biologics of bone so they are able to stimulate the bone properly and it heals faster and stronger.

3. Treating tendonitis with stem cells or platelet-rich plasma so it does not traumatize the patient with surgery.

4. The use of robotics.

Advice for students interested in orthopedic surgery:

• Don’t be daunted by the competitiveness of orthopedics. It’s not as bad as people make it out to be to get in.
• Just decide what you want to do and go for it.
• Don’t decide on orthopedic surgery for the money, fame, or popularity.
• Look inside yourself and choose what’s going to make you happy. Pick a specialty you can be happy doing 15-20 years down the line. That’s what’s going to keep you going to work every day And that’s what’s going to keep you happy with your work and home life and give you the most success.

Links and Other Resources:

• Related episode: Orthopedic Surgery Match Data Deep Dive
• Related episode: Interview With a Private Practice General Orthopedist
• Related episode: What Does a Community-Based Joint Replacement Specialist Do?
• Need MCAT Prep? Save on tutoring, classes, and full-length practice tests by using promo code “MSHQ” at Blueprint MCAT (formerly Next Step Test Prep)!