I am typing this on the plane to San Diego for the AO Basic Fracture course. This is a course hosted by the AO Foundation to teach residents the fundamentals of fracture fixation. Most orthopaedic residents go to this course during this PGY-2 year, but at Hopkins we have very little free time to do anything but work, piss, and sleep during our second year, so my whole class is going during our PGY-3 year. Its actually kind of cool this way because I have already done a significant amount of trauma, so most of what I go over in this course will hopefully be tips and tricks to tighten up my skills and knowledge. Or I could be totally wrong and end up learning all new stuff.
In terms of work, I am currently at the Bayview Hospital which is comprised of mostly Joints and Trauma. My joints attending runs two rooms and once he is confident that you know what you are doing, he lets you do much of the case. He likes doing the anterior approach for his total hips which has pretty cool anatomy. After about 5 weeks now on the Joints service I can confidently say that I do not want to be a Joints guy. Here are my pros and cons:
|Very regimented and predictable||Not enough variety. Every day I know that I either going to do a knee or a hip and I’m going to do it the same way I did it yesterday and the day before|
|Patients do extremely well often postop||Reimbursement not rising, meaning you have to do more cases to maintain salary|
|Growing patient base as babyboomers retire||When joints get infected that really sucks|
|Pretty good lifestyle as often times you can be done with 5-6 cases by 5pm (good for family)||You don’t get to operate on kids usually. Everyone is old|
What I can say that I have taken away from my time on joints is really solidifying my approaches to the hip. I’ve become quite comfortable with the anterior and posterior approach and I am starting to cozy up to the lateral approach. Knowing this approach and anatomy well will aid in a variety of cases that I might do in the future, even if I’m not putting in a total joint.
My next block is my first research block and I am so freaking pumped!!!! At Hopkins, Orthopaedics is the only surgical department that doesn’t require 1-2 years of research as part of residency. This is great in that I can go right into practice or fellowship after 5 years, but it is not great in that they still expect you to be productive academically. So in reality, much of our research is actually done when we get home on any normal night and then we really hit it hard during our research block. I really like the academic environment in that it keeps you on your toes as you are constantly challenged with tough cases or by questions from your residents or medical students. Like I have said before, I have had so many amazing mentors who have brought me to my current position, that I feel an obligation to follow the same path, particularly for minorities who may not have any attendings who look like them and understand their world view.
I have about 4 projects that I’m actively working on. My hope is that by the time I graduate I would have about 6-7 publications, with about 4 being first author. Some residents in my class are much more diligent with research and will likely graduate with 20 publications. Initially I was really perplexed by this and felt inadequate, but just recently actually I came to realize that for what I want to do I can’t look to others or else I will always come up short. I have 2 young kids and a wife who is also a resident. When I come home there is no silence; I am constantly pulled in multiple directions whether it be pillow talk with my wife (which I want to do), reading to my kids, playing with my kids, studying for cases the next day, reading articles for journal club, working on research projects, taking out the trash, etc. Which one of these activities do I do first when I get home? I really envy the single guys who can come home to relative silence and just read or knock out another paper. I suppose the grass is always greener and some single residents would prefer to come home to a full house, but there is no question that from a residency standpoint you have the capability to be extremely productive academically if you are single. Us married guys do our best to keep up, and folks with kids have to try even harder. My hope is that whatever I get done will be enough to give me a strong CV by the time I apply during my PGY-4 to fellowships.
The fact that I’m even mentioning fellowship is crazy to me, but by this time next year I would have already submitted my applications for whatever subspecialty I decide on. It was just yesterday that I was jazzed about having a long white coat for the first time, lol. When people ask what I want to specialize in I still say that I’m between spine and peds. I’m hoping that by the end of this year, when I have done a little Hand and a little Foot and Ankle and a little bread and butter Spine I will have a good Idea of what I want to be when I grow up.