Away sub-specialty rotations as resident

There are a few different types of "AWAY" rotations that residents participate in. Perhaps the most dreaded would be those that involve going to undesireable places. 2 programs come to mind when I think of these types of away rotations. Henry Ford in Detroit and McLaren in Flint. They send their residents to Minnesota (pray you don't go during the winter) and Spokane, Washington respectively. Medical College of Ohio (as if being in "the sticks" isn't bad enough) send you to Kentucky. All of these programs are providing their residents with excellent pediatric ortho experience...but my issue when interviewing was "did they have to go soooooooooo far".
As for nearby rotations vs. home institution providing the total experience? My opinion is based on what I've seen and where I hope to be when I'm done with this residency. Programs with multiple hospitals will provide you with a framework for understanding how varying healthcare systems work. Therefore when you finish training, you'll have some idea of the immense differences between practicing in a VA, University Hosp., Suburban Community, vs. Urban Community hospital. Some of these differences are night and day.
If you train at only one institution that sees a little bit of everything and you never really leave, imagine coming out and starting a practice trying to adapt to a new "style" that had been forbidden in the "ivory towers" that you trained. Sure you'd catch on, but that newly graduated attending who saw multiple health care provider systems probably is working in somewhat familiar territory.
Just my opinions...
Needless to say my program rotates through six different hospitals after the intern year, so maybe I'm a little biased.
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"Away" rotations in the subspeciaties (especially in peds) are not necessarily a bad thing. At UK we send our fours and twos to the Shriner's hospital for pediatric training. (The same one used by the MCO guys). At the shrine it seems that the second years go in as boys and come out as men. Pediatric orthopaedic surgeons operate from the base of the skull to the big toe, a wide range in comparison to most adult pods. It seems to me that this sideof ortho really demands total immersion. There is a definite difference between the residents sho have and have not done to tour of duty at the shrine (the same has been said by the cincy residents who do six straight months of peds as second years).
Once our residents get back from this "away" it makes management of all pediatric problems (common and uncomon) as easy as the run of the mill 80 y/o woman with an intertroch fracture.

on a slightly different topic, I did a peds ortho rotation during an AI and really enjoyed itprecisely because of the large variety of cases from hand to spine to foot/ankle to whatever. However, when I was talking to one of the attendings about my potential interest in it, he said it's really hard to make a good living because most of the pts have chronic conditions and are public aid. Anyone care to shed any light on this? I'm not looking to make a ton of money but I do want to be able to survive comfortably in private practice.

I'll preface this by saying that the peds hospital at my school is a major tertiary care center and one of the best children's hospitals in the country, so interpret my comments accordingly. However, as I am possibly interested in private practice peds ortho, I did ask a lot of questions.

Intelectually and personally, peds ortho seems to be a very satisfying field. However, monetarily, the attendings and residents that I spoke to echoed a lot of the above thoughts. It is very difficult to be a community peds orthopod.

First and foremost, as a surgeon you make money by doing surgeries. Peds ortho is a relatively non-operative specialty within ortho. As a result (excluding the spine/tumor guys), we would see between 60-80 patients in clinic on a given day and schedule, maybe, 5 procedures. Most of our time was spent reassuring parents that their kid's intoeing was nothing to worry about. We also saw a bunch of kids who really had neurological problems, but, since it takes 3 months to get a neurology appt vs. 1 week in ortho, all the primaries would send them to us first. Conversely, on my joint AI we would see 30-40 patients with arthritis and schedule anywhere from 5-15 procedures depending on how many of those patients were post op follow ups.

Second, most (or at least a lot) of the surgeries that you do in kids will be fractures. I can't count how many supracondylar and t condylar fxs I saw, and school was still in session when I did my AI. That means a lot of office time devoted to fracture follow up within 90 days (i.e., you don't get paid) and not much follow up after 90 days (i.e., when you can get paid).

Third, lifestyle as a community peds guy--depending on your situation--can be very difficult. If you live in a state that is at the horrible end of the malpractice spectrum like I do, the trend is for adult orthopods to refuse to touch kids. Hence, the local peds guys get hammered. Conversely, the community hospitals around our children's hospital send all kids here, regardless of severity of injury. As a result, I can't imagine that there is much left over for the community guys.

Finally, there are the issue mentioned of chronic problems (e.g., MRCP, MMC) and patients without insurance. I can't really address the insurance issue. However, I have been told (by an attending on staff at both) that the acute vs chronic balance is very different between a children's hospital and a shriner's hospital. Maybe others who have been at both can comment about which is more similar to community practice.

Again, this is what I've been told by a group of academic attendings. If anyone has info directly from a community peds guy, I'd love to hear it.