Family life of an orthopod

[OrthoDoc]

In an academic center you may see attendings taking call a week at a time b/c they have residents to do most of the work for them. In the private world, rarely are there residents to do your work. Therefore, taking call a week at a time would be a killer unless you're in a place where call is extremely quiet.

Most groups divide call by weekdays and weekends. So if you have a group of eight docs that all share call, then each doc takes one weekday every two weeks and one weekend every other month. Of course, different groups do different things so this can vary, but this is a very common way to setup the call schedule.

In our group, you can only take call on the days you are operating since our clinic is a few miles from the hospital. It would be too hard to cover the ER when you're in clinic and disrupt your clinic schedule.

Sounds to me like you need to go chat with some of your local orthopods in the community so you can see what the real world is like outside of an academic institution.

[JBrown]

In an academic center you may see attendings taking call a week at a time b/c they have residents to do most of the work for them. In the private world, rarely are there residents to do your work. Therefore, taking call a week at a time would be a killer unless you're in a place where call is extremely quiet.

Most groups divide call by weekdays and weekends. So if you have a group of eight docs that all share call, then each doc takes one weekday every two weeks and one weekend every other month. Of course, different groups do different things so this can vary, but this is a very common way to setup the call schedule.

In our group, you can only take call on the days you are operating since our clinic is a few miles from the hospital. It would be too hard to cover the ER when you're in clinic and disrupt your clinic schedule.

Sounds to me like you need to go chat with some of your local orthopods in the community so you can see what the real world is like outside of an academic institution.

you are correct, i definitely would appreciate speaking to a community orthopod. is this a common thing for med students to do? i feel like a big part of matching is convincing programs that you love research and are committed to academics. i really appreciate your advice and experiences.

[OrthoDoc]

If you are interested in orthopedics, you should definitely go out and chat with the community orthopods and see what their lifestyle is like. Some medical schools have interest groups set up with contacts you can use. Just remember that only 10% of trained orthopedists go into academics.

[WildcatDeac]

Bump for those currently convincing spouses/SOs that they really want to do this.

[mwsortho]

also, don't forget about how much a PA can help you out. if you are out in the community, a good PA will do all of your busy work for you (H&P, notes, discharge summaries, floor callls, prescriptions) granted to have to pay their salary, but if you use them correctly in the OR and the office, they can make you money in the long run and be a huge impact on your life. they can even take call for you once you are comfortable with them and do things for you at night and let you sleep...

[dm2536]

Thanks OrthoDoc, very informative

[orthogirlusa]

hello everyone, I noticed most of these answers/replies are about guys in ortho. I am a female medical student in MS3 with a recently discovered adoration for ortho. Unfortunately I am not a youngling and the only thing holding me back from totally jumping into the field and applying to every program known to man is the fact that I want to have children (plural) in the next 5 years. I was wondering if there are any women out there in ortho that have any experience with this?! If yes, is it feasible? Or should I just go into FM and then sports med and fuel my love for ortho that way minus the surgery? Thanks

[GAdoc1982]

Being a guy, I am definitely not the most qualified to answer this question. However, we have two females (including one chief) in our program and since we're a pretty tight-knit bunch the topic of women in ortho has come up.

First, the two females in our program are two of my absolute favorite to work with. The have great attitudes, work hard, are smarter than most of the guys, and most importantly, they put up with all the crap the guys say without getting offended. In return, I think everyone respects them. I never hear any of the guys say things about their gender behind their backs.

In talking to one of the girls at our program the topic of children once came up. She said she would've loved to have gotten started but she knew going into ortho that it would be nearly impossible. As women are already uncommon in ortho, she knew she would be closely scrutinized - had she gotten pregnant and starting asking for maternity leave, etc it would've caused the guys to have to pick up a lot of the work. Though she was well within her right to do this, she made up her mind to place her job above family for now.

At the end of the day, this is a personal choice. The law being what it is, no one can discriminate because you are a female. However, ortho spots are coveted, especially among women. And whether fair or unfair, you will be judged by your fellow residents and attendings for the choices you make in residency. Having had many female friends in med school and now residency, I feel terrible for the choices you guys are faced with. Unfortunately, its the reality. Many women do manage both family and career but it's very tricky. Good luck!

[orthogirlusa]

Thanks GAdoc for being bluntly honest proves to me more that I fit in this field.

[Jimmy Chipwood]

Family life will be determined by practice selection and not necessarily subspecialty. For example, I am a sports doc/arthroscopist. I have two full clinic days a week which keep me busy starting at 8 and usually home by 5 or 5:30. I operate two days a week and usually try to get out of the hospital around 3. I also have a day off every week. In addition, I practice out of a hospital that takes very little trauma. So my call days are usually benign. An occasional trip to the ER, an occasional evening case. But I only take call about 3 or 4 days a month and one weekend every other month.

Practice selection is key. If you are looking for a good lifestyle, you need to live close to where you work (so your not stuck in your car). You need to join a group that has one clinic location or very few and also only work out of one hospital. It also helps if the hospital has a very low trauma load.

This is one example of a typical week. Probably a much better lifestyle than some of my friends. So there is light at the end of the tunnel. The question will be if you can find a nice practice opportunity in a place you want to live.

Orthodoc, thanks for addressing this topic that is often on the minds of residents and their spouses who ask themselves if life will eventually get better. With the understanding that each private/community practice situation is unique, I was hoping that you could make some comments on what it was like for you during your first 1-5 years in practice. Did you have the same schedule as above during those years or has your schedule evolved into what it is now? Were you taking more call at that time to try to fill up your surgery schedule and/or get your name known in the community? Could you give some advice on how to succeed when you first start out in a private community practice setting? In general terms, is it best to be upfront with your future partners that family is very important to you and you would like one day off per week OR is it better to hit the ground running and then slowly lighten your schedule over time? Thanks again for addressing this topic.

[OrthoDoc]

My schedule really hasn't changed in 11 years of practice except that we have an ASC now, so I'm home even earlier on my operative days due to efficiency. I was fortunate to join a group that loved their time off. Lots of hunters in the group. So everyone was already taking a day off and it was expected that I would do the same. Now I had the opportunity to do a satellite clinic on that extra day, but I was busy enough as it was and had no desire to do any traveling.

I never took more call to get busier, but I have a partner who did that for a while. I have never enjoyed call, so the extra money to take more was never worth it for me. I do take call less now only because our group is twice the size that it was when I started.

If you want to be successful coming out, you need to take the time to get to know the area and the referring doctors. Go around on your own time, maybe with the office manager, and go out and meet docs. Offer to give some lectures on basic orthopedic care for the internists/pediatricians. Be nice to every doc who asks for a consult no matter how trivial. You'll get a lot of business early if your partners are not the friendliest to other specialties. It's also helpful to promote a niche that you have that maybe none of your partners are doing like arthroscopic cuffs, etc.... You'll need to some how differentiate yourself from your partners to change some of the referral patterns. Hopefully, you'll join a group that needs some help and you'll be surprised how busy you get quickly, which was my case.

I would definitely be up front about your work habits, but make sure you join a group that has similar desires. If you join a busy group and no one takes time off, your not going to look good to them especially if you split overhead equally.

I would warn you that it's very hard to slow down once you get up to speed. Suddenly, you'll be use to that cashflow and the lifestyle that comes with it. To avoid some of those issues, try to live on a set portion of your guarantee and stick with it even when you are making more. The extra income above that is then just funneled away for buyins and debt reduction. It will lead you to an earlier retirement.

[orthoislander]

Hey Orthodoc,
Thanks for all your insight. 100% appreciated by an M3 who has taken a serious interest in ortho. Knowing how late into the game it is for me to make a career decision, I'm wondering about lifestyle as well.

Do you think the opportunities to choose a practice/ lifestyle will still exist for future ortho docs (who will potentially finish residency in 6 years from now)? Where do you see ortho going (as far as lifestyle) in the future?

Also, can to touch on what the lifestyle of the different ortho specialties are like? (or rank them from most time demanding to least?)

Thanks a bunch. Really appreciate your time and help.

[OrthoDoc]

My observations over the last several years is that new docs don't want to work as hard as the older generation. They are more on the "shift" mentality. So, I believe over time, the lifestyle of orthopods will be easier and more standardized hours especially if the full force of Obamacare comes down.

There is a slow shift from owning your own practice to being an employee to embrace more of that mentality. Letting someone else deal with the process of running the business and headaches allows more time for you to do the things outside of medicine that you want to do.

However, with that shift comes loss of some control as well as loss of income.

[jdoc]

This topic is always fascinating. You have the "older generation" who see themselves as hardworking and dedicated to the practice of orthopaedics in a way that the "younger generation" simply cannot or does not want to match. On the other hand you have the "younger generation" who look at the demands of the specialty and aren't sure they want to sign up for it, many of them not willing to put in what is needed to become a great orthopaedist.

I agree with the previous poster that the specialty will follow in large part those who make it up, and as the "younger generation" begins to take over the specialty the work conditions will reflect their goals. This may cost some income. It may be seen by the "older generation" as not working hard. However, the benefits will likely be mothers and fathers in ortho who are part of their children's lives. Maybe we we'll have more orthopods in public office to avoid future failures like Obamacare. Maybe we'll have more orthopods in ACGME so if people don't like the 80 hour work week or similar things they can be part of avoiding it. Most of the "younger generation" was in high school when that whole thing started and didn't have anything whatsoever to do with it.

Just a thought.

[Wife_of_an_Orthopod]

I've been reading these boards on and off since my husband was in his residency almost 10 years ago, though it has been years since I have been on here. A little bit about me and my experiences- I have been married to an Orthopod for 12 years. By his side from Med school on and always very involved in his career decisions. I worked in Healthcare Admin, but haven't worked in 6 years.

First off, OrthoDoc is an incredible resource. He has been here forever, always posting realistic, practical information.

I would echo what PP's, esp OrthoDoc, has said about lifestyle. You absolutely can get a very reasonable lifestyle in Ortho. And, depending on how you frame your schedule and practice, that does not necessarily have to mean that you give up income. My husband specializes in F&A and we were in private practice in a small city of about 100K in our home state of Texas. His income was very, very good, largely because he owned 1/3 of the PT and MRI in town. His 2 partners were wonderful. He worked about 35 hours per week from Day 1. However, we just left and started at an Academic program in a highly desirable city in the West where we will probably make half the money. Why would we leave such a wonderful practice arrangement? Because my husband was not busy enough in his specialty in that sized community and felt his skills were not being fully utilized. He did not feel challenged. There was nothing to do in the community. So far, we have been here in our new location 3 months and there are things he likes- and many he does not. Time will tell if this was the right decision. In any event, it positions us well to continue on with Academics, or go back into private practice.

Never Say Never. When my husband started, he said he ONLY wanted to be in private practice, and now he is in Academics. Sometimes, your wants and needs change. To the OP, you said you did "not care about job satisfaction", but that will change. If he is not being challenged, if he has issues with his partners, the hospital etc, this will adversely impact his satisfaction, and he will start finding reasons to not be happy. Remember, this is a job, and you are not always 100% happy with any job.

Pick your community carefully. A community the size we were in of 100K was just not large enough to support someone who wanted to do 100% subspecialty work, at least not in F&A. I am surprised OrthoDoc said there are 10 Orthopods in his group. That seems like a lot for such a market, but perhaps Iowa City's catchment area must be larger. Find out about where you will be working. How many hospitals will you cover? What is their reputation? Will it be easy to get block time? I could go on and on.

Pick your partners carefully. You are in business with them. Depending on your legal entity, LLP, PC etc, things they do can affect you for good or bad. My husband's partners in private practice were wonderful. The hardest part about leaving was leaving them. On the flip side, there are still a lot of shady people out there. We encountered several as we interviewed in the past year.

OK, I know I strayed a bit from the original question about lifestyle, but I hope this helps a bit.