Would a blog from the attending persective be helpful?

what topics would people be interested in reading about?

yes

From a current MS4/going through the match perspective, this would be an invaluable tool. There was one program director that created a log of all their responses in the past in this forum, perhaps this would give some insight into the issues we typically discuss.

Each year you'll have a new round of applicants that need mostly the same questions answered.
1. Do I have a chance? Always too much focus on Step 1 scores, etc. Eventually, most of us realize it is an overall package and that most of us do, actually, have a decent chance of matching despite the intimidation factor. Unfortunately, there are those who do end up matching with the persistent belief that standardized test scores and other "objective" measures are able to predict who will be a good orthopaedist.
2. How to select program (benefits of academic vs community)
3. How many programs to apply to
4. Various questions about ERAS applications (e.g. what to (not) include)
5. When do interview invitations start to go out for each program
6. What are the interview dates for each program (an excellent resource when trying to plan our interview trails when we receive the first invitations in November)
7. You'll always need to debunk rumors and myths, but occasionally need to confirm suspicions (see recent threads on Detroit program)
8. Currently, most of us are winding down our interview trails or have already done so. We are now getting nervous about hearing other applicants say things like, "XYZ program notified their top so many applicants", when the truth is perhaps they do this selectively, perhaps not at all, perhaps they are honest when doing so, but perhaps not.

I can't speak to further in the process. But one last comment I would like to make is that I have noticed applicants on the interview trail who actually have the nerve to comment on how good an attending surgeon is. This is ludicrous, and it would be nice if they finally acquired this wisdom. Programs have a better ability to rank applicants who all look excellent and would make a good fit with their programs (in other words, it is virtually impossible to do so with any predictive validity) than do we in assessing the competency of someone that is so much further along in their training than are we.

You may also wish to see a recent poll on this site asking people if they would still pursue or continue a career in orthopaedics if the salary were much less. The results are very disappointing, and I only wish there were a way to weed out those applicants who don't answer with a resounding yes. The economics of health care, in particular orthopaedics, will certainly change early in our careers. I'd bet my student loans that orthopaedists income will not go up relative to other physicians.

Thank you for your efforts in advance. I look forward to reading your blog.

We are currently testing a Blog feature on Orthogate.

If you goto the home page you will see a Blog (Beta) link.
Basically you have the ability to create/edit blog posts under your Orthogate profile.

It might be useful to utilize this system to test out the response.

If you need additional features let me know and we might be able to accommodate your requests.

Best regards
Christian

md007,

I see you are bringing your little soap box over to an unrelated thread to continue your quest to preach against the evils of earning a living while practicing orthopedics. I am glad you are so much more noble than your peers and would pursue orthopedics regardless of income, I am just puzzled why you keep insisting to judge those who would consider income as a factor in choosing orthopedic surgery, or any career, for that matter. You almost seem to revel in the face of falling physician reimbursement and not only expect it to occur, but can't wait for it to happen. Maybe that is because it will "weed out" all of us money grubbing ba$tards and you and your noble few who remain can then fix all of the wrongs with the health care system once we are gone.

Please, for one moment, forget the dollar amount assigned in the poll. You seem to be fixating on that set figure, when my assertion in the previous thread is that the concept of being concerned about money is not only acceptable, but necessary. While everybody's threshold may be different, everybody has a certain level of compensation, below which, regardless of how much they love orthopedics and their patients, they would refuse to continue to accept the time commitment, stress, etc involved with their practice and find something else to do. Based on the previous poll, around half of the respondants said that threshold was at least above $125k. If the bar were set at $75k, I would bet even fewer would continue to pursue orthopedics. Unless YOUR particular threshold was exactly $0.00, you have no right to continue to come on this board and judge those whose threshold may be higher than yours, because conceptually, you are no different. You have made your point, so why can't you let it go?

Without giving us a dissertation on the Chicago economic model and pie charts explaining national debt as it relates to the health care deficit, please enlighten us as to exactly what YOUR threshold would be before you chose a different career path. Then, defend yourself for refusing to work for less with the same ferver with which you chastise those who feel the same way about a different dollar amount.

now now earthdawg,

"I'll Be Your Huckleberry" -- Doc Holliday says to Johnny Ringo

pick on someone your own size. you are just looking for a fight. look at the post date for md007. it was prior to our discussion of salaries in orthopaedics.

now, as far as the financial state of medicine, it goes far beyond or poor specialty. the sad thing is that regardless of what you do in medicine, unless you have a buisness mind and have ventures outside of you practice (i.e. surgery center, mri, pt/ot, pharmacy) you probably will not make a incoome comperable to the grey hairs you compared me to ...

i love my specialty, take away the malpractice and my medical school loans, and i would do it for much less ... my price ... i not sure ... but, for me, money was not my reason for attending medical school ...

if money is an issue, medicine is not the career for you (meaning anyone) ... now once you are out in practice ... especially private practice (and even us in the academic centers) you need to look at the bottom line ...

Earthdawg - I am sorry to see that you are still so troubled by my posts. The post to which you are referring was made around the same time, I believe even before, our conversation in the other thread. You continue to take my statements and twist them around like a journalist to be taken completely out of context. For the record, I do not think I am more "noble" than anyone else (using the term noble in place of altruistic here), and I would appreciate it if Earthdawg would acknowledge the distinction between judging the "goodness" of people and judging their actions.

I am not willing to engage in a lively discussion about these topics with someone who can't have a mutually respectful discussion if that is what we are trying to do. In particular, I am still awaiting your response (in the other thread where it belongs) to my question of why it is OK for you to make assumptions about me, but if I were to dare do such a thing I would be the equivalent of the devil. Another (since you brought up economics in the first place) was how a completely free market healthcare system could deliver fair and equitable health services?

I think we can use our different perspectives to help enlighten each of our viewpoints. However, you only seem to want to prove your own points, put me in my place, and not have an honest debate about topics which are very, very complex and about which I, nor anyone for that matter, has all the answers.

I believe having a debate about the topic which you seem to focus on in your post (finding some cutoff point at which it would not be OK) would be difficult. You raise a good point in that there is a continuum, and question how one can use different principles to apply to one situation (orthopods making $600K/year) versus another ($12K/year). I think that is an interesting question, and one that is difficult to answer, but if we are going to try to learn something about it, then we must define our goal in the decision. It depends on which ethical framework you apply to the question. Some believe there are absolute truths to be discovered (and one could find such a magic cutoff point), whereas others apply situationlist ethics (among similar names, and other models).

Again, for the record, I don't think someone willing to practice ortho for $50K / year is any more "noble" than they guy who won't do it for less than $600K / year. I do, however, believe that person, on the average, enjoys their job more. I think you get more than money when you practice medicine, (am pretty sure we can probably agree on that). I would hypothesize, from my perspective, that the people willing to work for less enjoy their "jobs" more. There has to be something else they value to put the balance in favor continuing to work, and as we touched on the other thread, these are "externalities", whether positive or negative. Now, based on that hypothesis, which I don't know if it is true but will extrapolate anyways for the purpose of trying to help you understand where I'm coming from, I would rather work with people who are willing to work for less.

I struggle with keeping all the ethical theories straight to be honest, but find it fruitful to consider these issues when trying to have a debate on such a matter. I would love to talk about this in more depth and analyze the situation, but as indicated above, will await your response to some of my previous questions, and hope you can reply without twisting my words and trying to put me in my place.

Also, for those who are interested in knowing: I readily acknowledged in the other thread that it is merely "wishful thinking" to believe it is possible to just get rid of the bad apples in the bunch, and that, in fact, most of us are very nice ripe apples, but sometimes placed in situations where we flat out stink.[/b]

Ok, I'm done ruffline feathers. I apologize for the timing issue. I did not look at the date of the post before I responded, and I am sorry.

I am only trying to defend the right of orthopedists and physicians in general for actually caring about their compensation. Physicians get enough criticism from others in society so I find it a little disturbing when criticism comes from within the medical community.

I was mainly taking offense to the following statement:

You say on the one hand that we are all basically "good ripe apples" but then in the previous post condemn half of those applying to orthopedics and wish to weed them out from applying. It just comes across a bit judgemental from an applicant standpoint to suggest weeding out half of the applying class because they may not share your opinion.

At any rate, we could debate ad nauseum and this is not the context for such. I apologize for stirring the pot, but only wished to defend those who would defend physicians in the face of falling reimbursement. It is not necessarily "anti-patient" to demand to get paid this year what you got paid last year to work. As pointed out before, physician reimbursement continues to fall while insurance premiums rise at record pace, and insurance company profits increase. It is ultimately the insurance companies we must stand up to and not the patients we care for. I wish you the best with the match and with your career in orthopedics.

Thanks Earthdawg

The comment you referenced was tongue in cheek, the more weeding out I can do in my favor the better
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. As I mentioned, it is wishful thinking. I still do believe I would rather work with people who answer that question affirmatively, on the average, and are willing to work for less. That doesn't mean they can't lobby for higher (or at least constant) wages at the same time, and I don't believe it is anti-patient to do so.

On another note, I've had the opportunity to attend a few large academy type meetings, made up of mostly primary care physicians. What I took home from those experiences is that many of the "average" primary care docs think orthopaedists are ridiculous, vain physicians when they complain about not making $500K/year anymore, because they are working their tails off as well, and for much less. I think that unless we are in a tight knit group of orthopods who think the same, we will continue to have to defend why we should be worth so much more than the next practitioner...

The other point you raise against insurance companies is interesting and extremely challenging. Declining reimbursement with rising premiums. We've probably all heard by now how our system isn't a system and our healthcare system is doomed. I am curious about the other thing though: rising insurance company profits. As you know, rising premiums certainly don't guarantee rising profits, or any profits for that matter. Does anyone have any data showing health insurance company profits over the past, say, 30 years? I would be interested to see this. Of course profit or a lack thereof isn't necessarily intimately correlated with expenditures or denials of claims (after all, they aren't perfect at predicting costs). But then again, some of the ridiculous stories we all hear and experience ourselves make us wonder how we got to this sad, sad point.

Aren't the insurance companies just responding to the market which has been created? Could it be that the "system" itself is immoral (and not the insurance companies), by making healthcare a privilege?

PS - sorry staff, I know we should probably start another thread for this, or give up on fixing the healthcare system for the moment and get those rank lists done!

please take a look at this

see if some of this is helpful ... comment welcome



i have also made a group on google if you have some questions that i will answer directly



thanks

staff

so i started this blog ... like the Gen x'er i am ... i need a little feed back ... what you would like to hear about ... what was possibly a good thought ... and bad ... it's ok, my mom likes me
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something i am going to do is talk to several of my friends from across the contry to get them to do a month in the life of an orthopod private practice, university, single specialty, multispecialty etc.

most of my thoughts come from my aggrivations from the day ... frustrations or elations with residents ...

let me know... take a look ... give me crap ... it's ok ....

Nice blog, staff. You really seem to care about the education of the residents you teach instead of worrying about the amount of work they can do for you, which, unfortunately, is how some of my staff came across during residency. Keep it up.

Alright Staff I'll bite. I've been reading the blog for the last week and love it. I find it highly entertaining, while being extremely informative with excellent reflection on the current training going on in orthopaedics today.

I am currently a MS-I attending a DO school. For the record I practiced orthopaedics as a physician assistant for over three years before returning to medical school to become a physician and ultimately an orthopaedic surgeon. Perhaps you could delve into the thoughts of having DO's attending a ACGME orthopaedic residency verses there "own" orthopaedic programs.

Please keep the blog up, i have it as a RSS feed even.

capneedle thanks for the feedback .... i will keep going ... that's what folks form my generation like (see )... the feedback helps justify the time effort .... i know sometimes it get off track a little ... we look at everything from our own perspective, so sometime we lose track of what is important to others ...

as far as the DO / MD thing ... i actually wrote a little about this on SDN

i work with both DO resident and MD residents .... i would say this ... there is still such a bias, and most programs (especially the big names) will not interview you ...

and from what i understand from speaking with my DO residents ... the DO match is before the MD match ... which is intentionally done so people don't enter both ...

i would recommend you make it easier for yourself by staying in a DO residency .. and if you chose a fellowship, you can usually get an allopathic fellowship ...

most of the DO's I work with are very good ... the DO programs tend to be a little more community based than university based ... most of the residents that I have worked with are not as up literature as many of ours (this may be a bias) but they are good hard worker in general with generally good surgical skills ...

as hard is it is to get into an orthpaedic residency as it is, you will really place yourself in a bind should you go for an MD residency and not match ....

again thanks for the props ... i will keep writing ... got a lot of ideas out there .... i will try my best to be current and pertinent

SAFF