Programs not trauma heavy?

Look at programs that are not at trauma 1 centers. Most of these are community programs. It sounds like a community program is what you might be looking for. My program does 3 months at a level 1 center but get plenty of bread and butter trauma fractures at our hospital so you can handle everything that you would want. I also feel we get great general ortho as well as our chiefs going to fellowships where they want including joints this year.

Thank you for the quick reply and your input. I am definitely looking into community programs, to your knowledge are most university based programs level 1? Also, I have a question about a “Gentleman’s program”. I have heard the term used on this forum, specifically in regards to Rush and HSS (I think Harvard too), but what exactly does this mean and are there more of these programs than what I just listed? Thanks.

I've heard "gentlemans" group talked about more with fellowships. But others might be a ble to give you better input on that. The programs you mentioned are all great but as you go on interviews you will get a better feel for the program that fits you.

If you are considering New York as a potential area of interest, most of the programs in Manhattan have a relatively large proportion of elective ortho to true trauma. Oftentimes, Manhattan trauma is either low-energy or penetrating, as opposed to the high-speed, high-energy, blunt trauma you get with MVC's on large interstates. I think that, as a group, those programs could be a good fit for you in terms of giving you the necessary trauma exposure, and would be overall less trauma heavy. Similarly, programs which are isolated, Level 1 centers, specifcally those next to large, busy highways can sometimes tend to be heavy on the trauma end.

That being said, ask any number of trauma specialists and they are likely to tell you that trauma is the way you learn to operate, and to function in the OR... they will often suggest that having too little trauma can have effects beyond that specific subspecialty. I know many residents would agree with this. Whether you agree with that or not is your call.[/i]

while i agree with Dr hibbert somewhat. you learn to operate by performing the procedure repeatedly. Performing 15 ORIF of acetabulums doesn't teach you how to put a scope in a knee or shoulder. While i believe the trauma gives us all the first opportunity to get our "hands dirty" and subsequently learn how the OR works, how to position, fluoro, approaches, etc. IMO rodding, plating, wiring, etc provides only some crossover of motor skills, especially for the most common procedures that you will be doing in practice (assuming you go into private practice).
I think you have to look at what you want to get out of residency and what/where you want to practice after.

Northwestern is a university based level-1 trauma center in a big city but is not dominated by trauma at all, though you still see plenty bread and butter cases.

Another thing to remember is the system/call schedule. I am at a very busy Level I trauma center, but the Ortho 2 learns to take care of pretty much everyhting and that is definitely a hellish year, but by your 3rd year things are very light and you are thankful for that year you invested. I know other programs where the call is light in the beginning but unfortunately you still have to take annoying phone calls as a chief. I have always been of the mindset that I would rather shovel dung for 1 hour versus dig holes for 8.........

I'm going to get a little idealistic here, so I hope I don't offend anyone. Regardless of what specialty we all decide to go into, I feel that we have an obligation to take ER call in one form or another. When we decided to go to become orthopaedic surgeons, we accepted a responsibility to provide care to the people who need our help. That doesn't mean that we have to kill ourselves with call, but I think that we have to provide the care that ER doctors cannot. There is already a shortage of community orthopaedic surgeons (as we are all probably well aware of by the dumps we get from hospitals without ortho coverage) and the call pools are shrinking as fewer and fewer ortho docs are providing ER coverage. So if that doesn't sit well, think of this. Many general surgeons believe that they can provide better emergency care than we can and they are pushing to get their foot in the door and take over much of the care of orthopaedic patients. What this means is that as general surgeons take more of the load, our lives become easier but our case load goes down, reimbursement falls, and our expertise is deminished. We have to step up to "own the bone" as the Academy is pushing for us to do. That doesn't mean that a spine or hand surgeon should be keeping themselves busy putting in nails, but they can certainly cover ER call specific for their specialty.

This is just my 2 cents and hopefully gives a different perspective to the concept of choosing a program that is not trauma heavy. You certainly don't have to log 2000 trauma cases to get comfortable with bread and butter ortho, but having a solid foundation is important so that when you are confronted with a unique injury or a complex case, you can tackle it with confidence and provide the best care for the patient.

I agree with the ongoing/worsening problem of ortho ER coverage. A lot of orthpods these days want to just sit out at their surgery centers doing scopes all day and not perform any sort of service to the community by covering a ER. The calls I get wanting to transfer pts make me soooo mad sometimes. I have had a orthopods who have been in practice 15 years (so they should konw what they are doing by now!) call to request a transfer on a simple closed tibial shaft fracture with no signs of compartment syndrome b/c he "only does sports these days". Same goes for almost ANYTHING pediatric (even straightforward greenstick forearms that just need a little push and a cast). I dont expect these guys to take care of pelvic or complex periarticular trauma, but EVERY orthopod should be able to take care of basic fractures the same as they would basic arthroscopy and joints. It taxes our healthcare system and creates more costly care (another ambulance trip, another ER visit, etc) not to mention that it forces some of these patients to drive HOURS to recieve care that they should have been able to get locally. Incoming orthopods should remember that you do have a "debt to society" as a physician. Each person has to determine what that means to them and what they can "live with". I for one think it is selfish and short-sighted to neglect one of our basic responsibilities as orthopedic surgeons. Even if you label yourself as a "arthroscopist" or a "joint surgeon" you are still first and foremost an orthopedic surgeon

Amen to those last two posts. Everybody seems to forget that our government has invested a TON of money into educating us during residency. It really pisses me off to hear people whine that they can't take a job with any ER call. When we entered training, we accepted an unwritten social contract with society. Everyone's hard earned tax dollars supported our education with the hope that there would be a return on their investment (basic orthopaedic care without having to drive 4 hours and go through 3 ERs). To absolutely turn your backs on basic orthopaedic care just makes us all look like money hoarding dicks.

Some community programs have a ton of trauma but if you are looking for little trauma then find one that is close to another larger ortho program. My impression of a Gentlemen's programs are those that are considered somewhat of a boys club, country club type of program that is not that busy or difficult for the resident and mostly white-collar type of attendings that do mostly elective cases. Typically if you go to one of these places you won't operate that much but you will get hooked up with the alumni network. I have heard UCLA described as a Gentleman's program.

I'm pretty familiar with the philly programs and one of the best setups in terms of not getting killed on a DAILY basis with trauma is probably Jeff. Being that there are several hospitals in the city (penn, drexel, temple, einstein) and Jeff lies in the best part of town comparatively (center city) at the main hospital they get a lot of hip fractures/ankle fractures. They dont get much penetrating trauma or high energy stuff. That doesn't mean they dont get ANY, but its rare that the chiefs have to come in for open fractures, etc. I think the way it works there based on my buddy whose a pgy-4 that matched there (im at temple, where we get more than our share of trauma on a daily basis) is that the pgy-2's cover the in-house shifts with a night-float resident (a 7 week rotation), and the pgy-5's are backup for operative stuff (home call). I think the PGY-5's RARELY have to come in at night.

But I think the residents have a great setup because my buddy tells me they get a phenomenal trauma experience at lehigh valley in allentown. Apparently they do a rotation as a pgy-3 and pgy-4 in allentown where they get boatloads of trauma - pelvis's/high energy stuff. And at this hospital they have a great setup with NP's/PA's doing all the scutwork and their only duties being essentially operative. My boy says its unbelievable -- they are "treated like attendings out there." sounds great to me, but i dont know much else outside of temple. I can tell you its painful to have lots of trauma all the time, and having a setup where you can just do specific trauma rotations is the way to go.