ORTHOPAEDIC SURGERY: WHAT IS IT?
ORTHOPAEDIC SURGERY:
THE SUBSPECIALITY
Although orthopaedists may perform surgery to restore function lost as a result of injury or disease of bones, joints, muscles, tendons, ligaments, nerves, or skin, they are involved in all aspects of health care pertaining to the musculoskeletal system. They employ medical, physical and rehabilitative methods as well as surgical methods. Typically, as much as 50 percent of the orthopaedist's practice is devoted to non-surgical or medical management of injuries or disease and 50 percent to surgical management.
The orthopaedist also works closely with
other health care professionals and often serves as a consultant
to other physicians. Orthopaedists, in particular, play an important
role in the organization and delivery of emergency care and work
as a team player in the management of complex multi-system trauma.
THE SCOPE OF ORTHOPAEDICS
Orthopaedics is a specialty of immense breadth
and variety. Orthopaedists treat a wide variety of diseases and
conditions, including such common injuries as fractures, torn
ligaments, dislocations, sprains, tendon injuries, pulled muscles,
and ruptured discs. They also treat conditions such as low back
pain, sciatica, scoliosis, knock knees or bow legs, bunions and
hammer toes. More recently great advances have occurred in the
surgical management of degenerative joint disease with the replacement of the diseased joint by a prosthetic device (total joint replacement). Similarly, the application of visualizing instruments to assist in the diagnosis and surgical treatment of
internal joint diseases (arthroscopy) has opened new horizons of therapy.
The Greek roots of orthopaedics are
"ortho" (straight) and "pais" (child), and
much of the early work in orthopaedics involved treating children
who had spine or limb deformities. Orthopaedists continue to
treat children with bone tumors and neuromuscular problems such as muscular dystrophy and cerebral palsy, as well as to correct birth abnormalities such as club foot, hip dislocation and abnormalities of fingers and toes and growth abnormalities such as
unequal leg length. Orthopaedists also treat diseases prevalent in the elderly, such as osteoporosis, as well as arthritis and bursitis.
Some orthopaedists confine their practice
to specific areas of the musculoskeletal system, such as the spine, hip, foot, or hand, knee, sports medicine, or arthroscopy. However,
41 percent of orthopaedic surgeons designate themselves as "general
orthopaedic surgeons", 36 percent consider themselves as
"general orthopaedic surgeons with specialty interest",
while 23 percent consider themselves as "specialists within
orthopaedic surgery". Many generalists may have a special
interest in a specific area, but still treat most injuries or
diseases of the musculoskeletal system.
THE CAREER PATH
Those considering a career in orthopaedics
should have a high scholastic aptitude, mechanical ability, a
high degree of manual dexterity and excellent three-dimensional
visualization skills. In addition, orthopaedists generally are
action-oriented individuals. Furthermore, many have an interest
in athletics and are team physicians at the high school, college
or professional level.
To become an orthopaedic surgeon requires
completion of four years of college, four years of medical school and five years of accredited graduate
medical education after medical school. The majority of approved
orthopaedic residency programs now provide for four years of training
in orthopaedic surgery and an additional year of training in a
broadbased accredited residency program such as general surgery,
internal medicine, or pediatrics; however, a small number of programs
require two years of general surgery prior to three clinical orthopaedic
years. Salaries of orthopaedic residents are similar to other
graduate medical education opportunities. To be certified as
an orthopaedic specialist by the American Board of Orthopaedic
Surgery, a candidate must complete the orthopaedic residency,
practice orthopaedic surgery for two years and pass written and
oral examinations offered by the Board.
Each year, the orthopaedic surgeon spends many hours studying and attending continuing medical education courses to maintain current orthopaedics knowledge and skills. Orthopaedics is an extremely competitive field.
There are approximately 650 residency positions available annually
in the 170 accredited programs. Candidates for orthopaedic residencies
generally graduate at the top of their medical school class.
Most have completed a full orthopaedic rotation in medical school.
Historically, few women have chosen to enter surgical careers;
however, there has been an increase in the number of women entering
orthopaedic residency programs in recent years.
Research experience is encouraged in many
programs and clinical rotations may occur in one or more affiliated
hospitals for basic or special educational needs; e.g., pediatric
orthopaedics or rehabilitation. There are many areas of special
interest upon which orthopaedists choose to focus their practice,
and many physicians spend an additional six to 12 months of training
in a particular field of interest. Fellowships of six months
to one year are available in hand surgery, pediatric orthopaedics,
reconstructive surgery, spine, foot and ankle, shoulder, and sports
medicine to mention a few.
Practice Patterns
Orthopaedists typically practice in one
of three settings. Solo practitioners work for themselves, although
they may share office space and clerical help with other orthopaedists
or other physicians. A large number practice in orthopaedic groups. In
most cases, two to six orthopaedists work together, sharing costs
for the office, seeing each other's patients, and providing continual
"coverage" in hospital rounds, as well as other means
of working together. In many groups, there may be a number of
generalists and a number of other orthopaedists who do most of
their work in a particular area such as the hand or spine. The
third typical practice setting is in multi-specialty groups, where
a number of orthopaedists work together with other specialists,
such as internists, family practitioners and cardiologists. Generally,
the larger the multi-specialty group, the larger the number of
specialties are represented. An increasing number of orthopaedists choose
to practice in managed health care and alternative health care
delivery systems such as health maintenance organizations (HMOs),
independent practice associations (IPAs), and preferred provider
organizations (PPOs). Such health care options provide physician
services for a fixed or an agreed upon rate rather than the traditional
fee-for services arrangement.
Many orthopaedists are also involved in
education-either as full-time members of a medical school faculty,
treating patients, supervising resident education and conducting
research, or as part-time teachers of medical students and residents
in the private practice setting. Other career choices selected
by members of the American Academy of Orthopaedic Surgeons include
military orthopaedists and those who work in administrative capacities
for government or health care providers. For additional information: http://www.aaos.org
(American Academy of Orthopaedic Surgeons).
