Medical

What Is An Orthopaedic Surgery Residency Really Like?

Orthopaedic surgery is a speciality that has an intense reputation. It’s known for being competitive, for having a grueling training process and incredibly arduous schedule, and for requiring a good deal of personal sacrifice in order to meet the demands of the profession. It’s one of the longest residency programs, often extended by completing a fellowship.

Going into orthopaedic surgery is a commitment for sure, but is it really as bad as people say? What are you really getting yourself into, and is it worth it?

Here’s the hard-line truth: regardless of where you train in orthopaedic surgery, it’s an intense speciality. It requires a significant amount of time, energy, and grit. It’s hard to communicate the level of sacrifice required, and each person will handle the pressures in their own way.

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However, it’s important to not use this sacrifice as a power trip for the ego or to elevate ortho as superior to other specialities. There is a twisted sense of pride that sometimes arises in the medical community when someone says “I sacrificed more than you!” but this is a ridiculous and toxic way to compare ourselves.

Let’s drop any competition with other specialities and focus on this: ortho is demanding on a whole other level compared to medical school. The most successful residents are those who are very regimented, good with time management, self-care, and able to put systems in place to navigate the gauntlet.

Doctors that are drawn to orthopaedic surgery usually can’t imagine doing anything else. The schedule, effort, and commitment are well worth it for them. If you fall into this category, you will figure out how to get yourself through the training process and you will end up loving the work you do. It won’t be easy, but most orthopaedic residents are in accord: it’s incredibly hard, but so worth it because they love the work itself.

So let’s dive into some of the most common questions and concerns for orthopaedic surgery residencies. Many of the details regarding schedule, actual hours worked, and work culture are program dependent, but the basic outline is the same. You’ll have call, various rotations (some of which may be away rotations), and research obligations.

Orthopaedic Surgery Residency: The Basics

Matching

How hard is it to get into ortho? If you want to dive into the exact facts and figures, you can see the NRMP’s current report here. You will find tons of information and discussions on the internet about how to match into ortho. However, instead of spending your time looking at these and getting yourself all worked up, go talk with your ortho attending at your medical school for detailed, specific advice. They know you personally and have the best perspective on how you should prepare your application.

What’s the schedule really like?

Time working in actual hours spent is very program dependent and rotation/service dependent. Some rotations you could be out by 5:00 pm, others will be much later. The golden rule is a 12-hour day is normal and for some rotations, may even be considered a short day (jokingly referred to as “half days”). Trauma rotations and night call are usually considered “the worst.”

Some programs require away rotations for specialized training outside of your base hospital. These rotations are typically for three months and could be a few miles away or hundreds of miles depending on your program. Many programs have apartments or dorms that the residents live in during the away rotations.

How many hours will I really work?

What’s the weekly workload in terms of hours worked for an ortho resident? According to studies and resident reports, 80+ hours per week is normal for this type of residency. Even with caps on hours worked, it’s not uncommon to go beyond this amount.

How would that happen if it’s not allowed? Residents want the work experience, and there are often work cultures that encourage residents to under-report their hours so that they don’t “rock the boat.” Think about it this way: there will be a majority of your days where you will go to work, come home with just enough time to grab a bite to eat and shower, fall asleep, then run back to the hospital to do it all again. And again. And again. Not every rotation is like this, so you will get some breathing room sprinkled in. However, it’s important to understand what’s considered “normal.” For detailed research on this topic, see “Characteristics of highly successful orthopedic surgeons: a survey of orthopedic chairs and editors.”

What’s the program’s reputation?

As you are researching various residency programs, you will want to consider the program’s reputation. Is it known for being intense or more family-friendly/slow? What type of program is the best fit for you and your situation?

Intense programs often have a reputation of academic excellence, but they are not always better. Overwork for the sake of overwork can come with a high cost to mental and physical health of the residents, and for their relationships and their families. Remember that no matter which residency program you attend, you will get solid training.

If you have a family

For those with a spouse and/or children, the age-old phrase “hope for the best, prepare for the worst” is a good motto to embrace. Prepare for very little time with your family during residency. This will require that your spouse and children understand the commitment involved. This is a family decision, as your career choice will greatly affect your family. Make it a point to keep connected by being available when you can and setting up special events, activities, and routines that they can rely upon.

It’s important for your spouse to understand that they will have to be fairly independent and keep themselves busy and supported during your residency. Encourage them to spend time with friends, enjoy hobbies, and also to get help with household responsibilities as necessary. Don’t assume you know what they’re going through, just like your spouse will not fully understand what you are going through. Be supportive, empathetic, and keep your relationship a priority, even when little time is spent together. Texts, surprises, or a warm embrace are just a few ways to stay connected and make them feel special.

Remember that residency is a stepping stone. It won’t always be this way!

Women in orthopaedics

Like many other competitive and male-dominated professions, women in orthopaedics will likely face some unique challenges. Ortho can have a “boys club” mentality and many people in the program (faculty and resident alike) as well as staff and patients themselves may have an obvious or subconscious bias favoring men over women. They may assume that men “know more” than women, are better skilled or capable, or offer surprise when you perform well. Patients themselves may assume their surgeons will be male. It’s unfair and annoying, but something you will have to navigate.

As a female orthopaedic resident, you may experience greater scrutiny from faculty and peers, which shows up as an assumption that you “don’t know what you’re doing.” You may feel like you’re working under a microscope. Males may sometimes try to compensate for gender biases by tilting the other way, trying to be caring by asking if you “need help.” This also shows a subconscious bias—assuming women don’t know as much as men and they need more help. It’s frustrating, but a reality of the field. The good news is that change is slowly happening, especially as more women enter into the profession. We need you!

Navigating this male-dominated profession will take confidence and clarity. You’ll need to focus on measuring your own progress and developing confidence with your own level of skill and knowledge. You also will need confidence to be vulnerable and ask for help or clarification. Seek out an advisor or mentor who you can be most comfortable with and always keep your patients in mind. All this work is for them!

Also, consider that you don’t have to lose your feminine side in order to “fit in.” Often women in male-dominated professions tend to try to act like men. This is not necessary and is actually the opposite of what our work environments need. We need the perspectives that females bring to the workplace. You can be feminine and professional.

Read more about women in orthopaedics and related information here:

Taking care of yourself

Surgery specialties often attract people that are self-driven, routined and regulated, and on the downside, sometimes emotionally detached.

In order to handle the long hours, stress, and physical requirements of the profession, work to avoid diving into residency such that it becomes 100% of your time and energy spent. You will need some downtime when possible. Your key to success will be having some systems in place. It requires excellent time management and self-regulation. You’ll need a regular exercise routine, time to socialize outside of work, and time to read or enjoy things that are not related to your residency.

If you get stressed, you need to be able to process the stress in a healthy way or get support in working through it.

Getting support

If you have a spouse/partner, family and friends, or a group you’re part of, you can lean on them for support. You can also talk to your residency director about programs and resources to help residents handle burnout and stress, or deeper issues like depression, substance abuse, or other unhealthy behaviors.

Orthopaedic surgery is intense and challenging, but incredibly rewarding and enjoyable. For the right person, it’s the right job. I’ll close with a link to Dr. Antonio Webb’s blog. He’s an orthopaedic surgeon and motivational speaker who has numerous YouTube videos talking about all things residency, orthopaedics, and work-life balance. Check it out! Antonio J Webb, M.D.

Enjoy and best of luck to you!

This information was compiled from interviews with current orthopaedic residents and spouses, published articles by orthopaedic surgeons and faculty, and formal research studies. This data was then compared against anecdotal experiences published in online forums, which reflected comparable information.

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Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. She currently resides in Galveston, TX with her husband and two young daughters. She enjoys helping other spouses navigate the world of medicine and actively participates in support groups and activities. Her hus... Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. She currently resides in Galveston, TX with her husband and tw...