Year off for medical reasons - advice requested
By Guest on Thursday, 16 September 2010
Posted in Match Center
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Hello,

I'm currently an MSII interested in ortho after a sweet ortho research summer that allowed me to get a decent amount of both clinical and basic science research under my belt. I haven't taken Step 1 yet (and I understand that doing well here is my #1 priority), but I feel I'm on the right track to hopefully be competitive for ortho in a couple of years.

I have a long history of knee problems and was recently told I should have bilateral distal femoral osteotomy to correct my genu valgum and delay the onset of inevitable OA. I would also have to take a year off of med school to do this. Thinking my surgical experience as a patient was behind me, this was quite a blow.

I'm not seeking medical advice on this thread, but I'm hoping some of you could offer some help as to how I can make good use of my time off so that I can stay competitive for ortho. Here are my ideas:

1) Research year - I know it's risky and I'd have to really work to make sure I have some pubs to show for it

2) MBA or MPH year - not sure if this would be useless, especially in ortho

3) MD/PhD - it has come to my attention that, if I'm taking one year, I could just go ahead and take three to get my PhD - again, not sure if this would be a waste of time (although I do love research and would like to continue to do research throughout my career)

4) Something else entirely?


I'm sorry for the long post, but I'm really confused as to what I should do - this was quite the curveball to be thrown at me. I've also been told that I shouldn't talk about the DFO procedures to residency directors because they won't think I can handle the residency - is this true? Man, this sucks.

Any advice would be greatly appreciated.

Bro
That's an interesting problem. What kind of way are they going to do the osteotomy? Will you be permitted to bear any weight? And, if not, for how long? Could you get one done now and another in a few months so that you could hobble around with crutches?

I remember one of the medical residents at my med school who was wheelchair bound for life and he seemed to do just fine. I mean, it's probably illegal to discriminate against a health care professional with reduced WB status, right?

Basically, you're looking at 2 paths: graduating on time (which would require your completing rotations during your recovery) or bagging a year. I think programs would probably be okay with either path. The point of your procedure is to get walking normally again, and so I can't believe that that would be a weakness for a PD. On the other hand, if a PD would blacklist an applicant for bilat DFOs, then you probably don't want to be at that program. I mean, the same could be said for female applicants who are potential maternity-leaves.

With all of that said, if you were going to be sitting for a couple of months, some sort of computer research/chart review would probably be your best bet. HINT: if you did this for a surgeon nearby who had a ton of cases and wanted to do some research, you'd probably get a hefty LoR...
Guest
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15 years ago
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Hello and thank you for your response.

I'm still gathering opinions and looking into cost with my particular health insurance, but I've had three orthopods tell me I should have it done, and sooner rather than later. They all agreed that each procedure would be around 2 months non weight-bearing, and that I should do them 6 months apart. So yeah, I'm thinking the year off unfortunately would be a smarter choice than graduating on time - I thought about doing them now during MSII, but I really don't want to interfere with Step 1 studying.

Good call on the LoR. A large part of the research I did over the summer was using one surgeon's shoulder surgery database, mainly comparing outcomes and complications following TSA and reverse TSA, so maybe I could do something similar again for him (as it was mostly sitting at a desk doing lit searches and wading through computerized patient charts).

So you think the one year off for research would be best? No combined degree program necessary? Thanks again for your input, I really appreciate it.
Guest
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15 years ago
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If you're asymptomatic.. I would suggest doing your third year first.. getting some medical rotations under your belt..be sure you want to do ortho, etc. etc. and then take the year off to do research.

You can always schedule for the end of your third year (maybe) an elective that is a stay at home (like, write a paper..) and have the surgery while you're still in school (hence still having medical insurance). Your recovery will take place while you're not in school..but then you can do research.

2 months nwb sounds a little much in my opinion. Have you spoken with anyone regarding bilateral ex fixes which would allow you to be fwb pretty quickly?
Guest
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15 years ago
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Thanks for your response.

I hadn't thought of taking a year between 3rd and 4th - that's an interesting idea. Would you take Step II first, right after rotations?

Good call on the health insurance; it probably sounds stupid, but I hadn't even considered that fact that not being enrolled would probably mean I wouldn't have student health insurance. Certainly something I need to check into...

Also, I thought two months was pretty standard, based on three different opinions, but I don't know. By how much would you expect ex fix to shorten the nwb duration? Some papers I've read online have recommended as long as 3 months nwb for the dfo procedure, so I was thinking 2 months would be pretty good. Thanks for bringing this to my attention.
Guest
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15 years ago
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Dont make yourself crazy about the medical side of it. 8wks NWB is perfectly reasonable, the frame people want you to WB right away but they all seem to be blissfully unaware of the realities-like you cant wear pants and you cant round with draining pin sites. But I digress...

As a program director- gaps are bad. As an advisor to med students- dont stop your momentum (you did well on Step 1-right?). It might make sense to stay on the same path you are on, do well in 3rd year and tinker with your 4th yr schedule so you are light in February/March. Interviews are done by the first week in Feb (at the latest)- get your surgery done and you can participate in nonpatient care rotations for 8 weeks or more.

Plus- if things do not go well in the match you could prolong medschool for a year- do research and a handful of electives and reapply. To all of the passive readers out there- this was an ingenious trick a few years ago, ie. for the price of an additional years med school tuition you could appear 'undamaged' and reapply a 2nd time. The Dean's hate it and now we are all aware of it, but I have to be honest- you have to really be looking for it to identify the applicants who played games with their graduation date.

Just a thought. Best of luck with ortho and your procedure.
Guest
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15 years ago
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I second what SB was saying. The only rotation in 3rd year that requires that you can stand for a period of time is General Surgery (and at times, Ob-Gyn).

We had a guy who spent 4 months in a wheelchair due to an injury and he did fine. It's not ideal, but I think you would have a much better story come interview time, i.e. I had this major procedure done and made it through anyway than if you were to take a year off.

Whatever you decide, getting an interview will come down to Step 1 scores, research, 3rd year grades etc. and taking a year off or not will be somewhere way down the list.
Guest
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15 years ago
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Thank you both, SB and Orthotography.

I understand what you're saying, and certainly I would prefer not to take a year off and delay graduation and residency. The problem is that it is two surgeries and not one, and I was told they need to be done about 6 months apart. Do you think it would still be possible to do both without taking time off?

I just figured that certainly with only one procedure I could make it work, but two? I'm just not sure. It almost seems like I should do one this year, but I also don't want to do anything to risk my Step 1 score (SB, I'm in my second year now and haven't yet taken Step 1).

Thanks again to all of you for your feedback.
Guest
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15 years ago
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bah.. There's no sense rushing into things. I think it will give you something to talk about, beef up your CV, beef up your step i score. There's no sense in suffering during your rotations..and yes, you can handle doing most rotations with crutches or whatever..but who in this world wants to? It's not worth the machismo story And worse yet, being tired, etc. etc. from surgery could leave you not wanting to do your work, jeapordizing your scores..which will do more harm than good.

You need to be on your game for rotations. Sympathy points come last from evaluators.
Guest
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15 years ago
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Pretty sure you could be back to work in less than 8 weeks each time. I think a reasonable time for you would be 2-4 weeks and then start some crappy 4th year subI after each one. You may be NWB but you will be able to move. With this you lose a month or 2 months tops. I would not sit out a year for this.
INtj
Guest
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15 years ago
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Can't speak for every program, but I wouldn't stress about it. Do it when it is the right time for you. Take the appropriate time you need to recover.

You're undergoing orthopaedic surgery and applying into orthopaedic surgery. We're going to understand what you're doing. Better to get the procedure done in med school than as a resident.

If you had bilateral open pilon fractures in a car accident and had to take time off, we wouldn't fault you for that. If that means that you have to take anti-inflammatories at the end of the day due to pain, that's OK as long as you can perform your job. If your pilon fx's resulted in such catastrophic pain that you required chronic fentanyl patches, then you're right -- it would be a red flag.
Guest
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15 years ago
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I agree with everyone above ... you could be as machismo as you want and do your rotations on cruthes or tough it out without surgery... but you got to do what's best for you. Plus, it would be infinitely harder to honor all your clinical rotations with difficulty walking... and it's not worth it to suffer now to have your career shortened due to long term issues.

Some thoughts

1. you get an awesome/easy personal statement topic
2. I think the research thing would be a good idea, pubs never hurt anyone
3. most school, if you are taking medical leave of absense, will allow you to technically "stay enrolled" for medical insurance reasons
4. I would recommend going and talking to an orthopaedic surgery program director to get his take on it. If you don't have one at your school, try to find one to get their take on it. Plus, if you do that, you could have an in with a program...not a bad idea.

Oh, and kill step 1...

1
Guest
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15 years ago
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Sweet. Thanks for the replies - I really appreciate all of you taking the time to answer this. You guys are all swell.
Guest
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15 years ago
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I had a tibial tubercule osteotomy during 3rd year after my hard rotations (medicine, surgery, ob/gyn) and had to do 6 weeks non weight bearing. It sucks. I toughed it out but I had a ton of support (my mom came to live with me). I don't think it's feasible to do 3rd year on crutches..except for psych (the rotation in which I was non weight bearing; you only need to be able to speak to a patient)
Guest
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15 years ago
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Thanks for your reply, Tablet. I've had bilateral tibial tubercle osteotomy procedures already, and I think you're right - it doesn't seem feasible to me either to this or DFO with third year rotations. My doctor suggested I take a half-year off, but I don't really see how this would be possible just because of the academic year set-up and scheduling logistics.

Thanks again.
Guest
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15 years ago
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