ORTHOPAEDIC SURGERY: WHAT IS IT?
ORTHOPAEDIC SURGERY: THE SUBSPECIALITY
Orthopaedics is a medical specialty concerned with the diagnosis, care and treatment of patients with musculoskeletal disorders. The physicians who specialize in treating injuries and diseases of the musculoskeletal system are called orthopaedic surgeons or orthopaedists.
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.
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).
THE CENTER FOR ORTHOPAEDICS & SPORTS MEDICINE
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Marietta, GA 30068