The Student Doctor Network was recently lucky enough to track down Orthopaedic Surgeon Carlo Bellabarba, who has subspecialty training in Spine and Trauma, and works at the Harborview Medical Center at the University of Washington School of Medicine in Seattle.

SDN: Describe a typical day at work

C: At 7 a.m., I meet with the team (residents, fellows, ARNPs, Pas, etc.) for rounds to discuss the status of patients who came in overnight and to go over pertinent imaging studies, lab results and patient care issues for new admissions and other inpatients. I prioritize patients with regard to the upcoming OR day based on urgency of their condition, readiness for surgery and available OR resources on that day. I also review postoperative imaging studies from recent procedures.

At about 7:45 a.m., I’m in the Operating Room, which generally consists of decompression / realignment / stabilization of spine fractures (anywhere from occiput to sacrum, with varying degrees of neurological compromise), fixation of extremity fractures, and elective spine procedures.

On clinic days, my clinic normally starts at 8 a.m. and ends around 5 or 6 p.m. Clinic mainly consists of evaluation of patients with elective spine conditions (degenerative, neoplastic, infectious, etc.), follow-up evaluation of patients with non-operatively treated fractures of the spine and extremities, and evaluation of patients who have had surgery.

I normally have one to one-and-a-half clinic days per week and anywhere between three and six OR days a week (including weekends when on call).

SDN: Why did you select academics over private practice?

C: My academic practice allows me the opportunity to treat among the most complex conditions, which tend to get referred to tertiary care academic institutions. I enjoy the opportunity to work with residents and fellows and am motivated by the opportunities for collaboration that are available in an academic setting. The academic environment provides many opportunities and resources to help us answer some of the many questions pertaining to the treatment of orthopaedic conditions and to help improve the treatment of these conditions.

SDN: What mix of clinical/research/teaching work do you do? How much power do you have to change that mix?

C: It is difficult to distinguish these three entities, as they often occur simultaneously. Any patient in clinic or the operating room may provide a valuable teaching opportunity for the medical students, residents and fellows who are assisting with their care. The desire to evaluate the results of any given treatment approach provides research opportunities.

If I had to parcel them out individually, I would estimate that I spend 70 percent of my time doing clinical work (with teaching involved), 15 percent performing primarily teaching duties (lectures, didactic conferences, writing chapters, etc.) and 15 percent doing research, which is mainly clinical research. I am given considerable leeway in deciding how my time is distributed.

SDN: What are the advantages/disadvantages to academic medicine?

C: To paraphrase what I mentioned above, the opportunity to remain constantly challenged by being able to treat complex conditions, to investigate the nature of these conditions and the most appropriate treatment options, and to collaborate with colleagues in various specialties to optimize these goals in an environment that emphasizes the need for learning and investigation are the main advantages.

In contrast, one of the complaints I have heard from some of my colleagues in private practice is that they tend to feel like they are isolated and that their clinical skills stagnate once they leave the academic environment.

The disadvantages are that academic institutions tend to have somewhat onerous and politically motivated bureaucracies and that they tend to compensate less than private practice environments.

SDN: If you had it to do all over again, would you still become a Doctor? (Why or why not? What would you have done instead?)

C: Yes, I can’t imagine myself doing anything else. It is a personally rewarding and intellectually fulfilling profession.

SDN: Why did you choose your specialty?

C: I like working with my hands and am mechanically minded. Anyone who likes working with tools or in their shop at home would enjoy orthopaedic surgery. I am also somewhat impatient and enjoy seeing at least some short-term results from my work.

SDN: Did you plan to enter your current specialty prior to med school?

C: No. I had no idea what an orthopaedic surgeon was before med school.

SDN: Now that you’re in your specialty, do you find that it met your expectations?

C: Absolutely.

SDN: Are you satisfied with your income?

C: Yes.

SDN: What do you like most and least about your specialty?

C: What I like most is that we truly have the ability to positively impact our patients’ quality of life in an immediate and tangible manner. We tend to get fairly early, (usually) positive feedback on our treatment of patients.

What I like least is that there remain a considerable number of painful musculoskeletal conditions for which we have no effective treatment.

SDN: If you took out educational loans, is paying them back a financial strain?

C: I was fortunate in that I had very little in the way of educational loans, primarily because I attended medical school in Canada. Paying them back was not a large burden.

SDN: On average: How many hours a week do you work? How many hours do you sleep each night? How many weeks of vacation do you take?

C: I work anywhere between 40 to over 100 hours a week depending on factors such as call obligations and the complexity of my surgical cases on any given week. We take spine call in one-week blocks, and these weeks, particularly in summer, tend to be very busy. Also, not all operative procedures are similar in length and complexity. There may be weeks where most operative procedures are quicker and more straightforward than others. Many factors can impact how many hours I work in a week.

With regard to the busier weeks, fortunately, as many surgeons would probably tell you, time goes by very quickly in the OR.

SDN: Do you have a family and do you have enough time to spend with them?

C: My wife and I have a very lively and beautiful two-year-old daughter and we are expecting another daughter in May. Whether I feel that I have enough time for them varies on a week-to-week basis according to the factors I have mentioned above. Ultimately, I’m not sure anyone with a full-time job thinks they spend enough time with their family. I’d like to be with them all the time, but I do feel like I get to spend plenty of time with them.

SDN: In your position now, knowing what you do – what would you say to yourself 10 years ago?

C: Just worry about learning as much as you can about your field of choice and becoming a good doctor while still enjoying life. The rest will sort itself out.

SDN: What information/advice do you wish you had known when you were a premed? (What mistakes or experiences have you encountered that you wished you had known about ahead of time so you could have avoided them?)

C: Find one or more mentors in the medical field early on who can help guide you through the many decisions you will face during your training and even early in your career. They will likely be able to make you aware of opportunities you may not otherwise have known about, help you focus on what is of particular importance to you when making career decisions, and give you some perspective on the implications of some of these decisions.

I also regret not taking the time to work in a medical system abroad during my training. I think that working in a different clinical and cultural environment would have been extremely valuable.

SDN: From your perspective, what is the biggest problem in healthcare today?

C: Access to healthcare for the disadvantaged is without a question the biggest healthcare problem in the U.S. today. It is not simply a political or media “buzz” word. Working at an indigent care hospital in a major urban center, I am exposed to this problem every day. My perspective is that the problem is getting worse rather than better.

SDN: From your perspective, what is the biggest problem within your own specialty?

C: The same as above. Access to care for uninsured or “underinsured” patients is a real problem.

SDN: What impact do mid-level providers have on your day-to-day practice?

C: They are having a greater impact due to recent restrictions on resident work hours. ARNPs and PAs assist us with the care of inpatients as well as in outpatient clinics and may assist during surgical procedures.

SDN: Where do you see your specialty in 10 years?

C: With the aging of our population, I see orthopaedics as having an even greater role in our society. I also foresee an increasing role for more biological solutions to problems we are currently treating with hardware (e.g. arthritis, degenerative spine problems, etc.).

SDN: What types of outreach/volunteer work do you do, if any? Any international work?

C: My community service includes giving lectures to help train other healthcare providers including local paramedics, treating the underserved in Seattle/Puget Sound/Pacific Northwest, and some preliminary involvement with injury prevention programs in the community.

My international work has been restricted to giving lectures on the treatment of traumatic and spinal conditions to orthopaedic surgeons overseas, primarily in Latin and Central America.

SDN: Favorite TV Show?

A: Hockey night in Canada.