1. How can I get more exposure to Orthopaedics as a medical student?
Most medical schools have a comprehensive orientation and also many specialty interest groups. In your first two years of medical school, go to the different specialty interest group. Often, they have speakers from that specialty who can answer questions and who later on may become your mentor. Investigate as many of these meetings as you can to help you in securing your career choice.
For more information, see page 17 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
2. What can I do as a medical student to help get into an orthopaedic residency?
Volunteer activities, research experience, good grades and experience will all aid in your application process. During medical school, although your time is busy and may be limited, find some volunteer activities that you are interested in and pursue them. You should aim to have at least one project on your curriculum vitae (CV) that you took a large part in and can talk about on an interview. Research in orthopaedic surgery is preferable, but research in another specialty is better than no research at all. You should aim to get honors (or the equivalent at your medical school) in all clerkships.
Also, it is never too early (or too late) to find a mentor. RJOS has a mentoring program designed to help. Learn how the program can benefit your career advancement and support greater job satisfaction. Mentors can provide you with information about the specialty, as well as medical school and residency.
For more information, see pages 17-19 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
3. What scores do I need to get into an orthopaedic residency
You should aim to get honors (or the equivalent at your medical school) in all clerkships, but some are more important than others. These are surgery and medicine. If your school offers an orthopaedic clerkship during third year, you should take that and get honors. Additionally, if your school has AOA, you should strive to get this distinction.
For more information, see page 19 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
4. How do I get involved with research as a student?
It is never too early to get involved with research. An excellent time to complete research is between your first and second year, and that way you can concentrate completely on your schooling and obtaining good grades and then do research in the summer.
For more information, see page 19 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
5. How do I select a mentor?
You can find a mentor by asking your medical school professors for suggestions of who to contact. Mentors can provide you with information about the specialty, as well as medical school and residency. If you know orthopaedic residents or third or fourth year medical students who are going into orthopaedics, they may be able to offer suggestions.
For more information, see page 18 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
The RJOS mentoring program is another avenue to explore. The program can help you find a mentor according to practice setting, specialty, or geographic area in order to choose mentors who best fit your needs. Learn more about the program and the mentors available.
6. How do I build a successful relationship with my mentor?
Review the RJOS Mentee Guidelines which can help you build a meaningful and productive relationship with your mentor
7. How do I pick away rotations?
Have discussions with older medical students and residents who rotated over the last few years to obtain their recommendations from where they went and what they heard from other rotators.
Refer to Orthogate
Review the location of the program against where you see yourself living in five years
Review program websites
Try a program that is unlike your home program (private vs. academic, small vs. large)
8. How many rotations should I do?
The average currently is 2 to 4 away rotations with 1 or 2 rotations at the home institution. The word from the students is that they believe that somewhere around 85% ending up at one of the programs where they did rotations.
9. How do I shine on an away rotation?
Before you arrive:
Be extremely nice to everyone, and especially the Residency Coordinator (think chocolates and flowers nice)
Email the Residency Coordinator at least two weeks in advance to determine exact first meeting location and time. You may not get an answer at that time, but it you will start the ball rolling to get to the right person who will have the information
Ask the Residency Coordinator for a list of conferences and events during the time of your rotation
Ask the Residency Coordinator if it is possible to give the name/email of residents on rotation, as well as the attending
Ask the Residency Coordinator where to park and live while visiting
Ask whether you need an institutional badgeLook up the attending and residents what you will be working with and try to obtain a CV or learn a little bit of background information.
Try to have an idea what may be seen in the clinic (most common diagnosis) or if in the OR, try to contact a resident to find out about surgeries and then prepare as best as possible
Anatomy, anatomy, anatomy is by far the highest yield information for students
When you arrive:
The early bird catches the worm - know the exact meeting location prior to the actual meeting and be sure to get there early. First impression is key.
Unless told explicitly otherwise, dress in business casual - short clean nails, close-toed shoes, hair in some fashion that you can cast or give an injection easily.
Always keep these in your car - OR shoes, one pair of clean scrubs, socks, toothbrush and toothpaste
Wear your badge from your home institution and a white coat.
In the operating room, make sure to write your name and MS-4 on the whiteboard or make sure the circulating nurse knows this information.
Ask the scrub tech if you may get your gloves and if they would like for you to get them and open them yourself of with the help of the nurse - do not assume your glove and gown will be automatically pulled for you
Scrub in the manner your attending scrubs (When in Rome.....)
Take the initiative to reach something every night about something you saw that day
There is a magical balance with how much to ask, speak and be seen - it varies from situation to situation - occasionally ask how you are doing and if there is something more that you be doing. Try to take the initiative to get supplies for casts, injections.
Remember that you can learn a ton from MA's and nurses - don't be afraid to ask if you can help them too.
Be honest and let the attending know if you will be asking for a letter of recommendation.
Offer a CV. Provide a hard copy and/or email of requests and ERAS forms.
Be positive, be positive, be positive
1. How do I prepare my CV? When should I start?
While your CV nor personal statement are cited as the most important criteria in resident selection, they are still not aspects of your application to be overlooked. Make sure you only put things on your CV that you want to talk about, because everything is fair game. Research will be looked at closely, so what is written should be accurate and honest. Never include activities, interests, or hobbies that are not true.
For more information, see page 24 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
2. How do I obtain letters of recommendation? When should I ask? Who should I ask?
3. Where can I get information about residency programs?
4. What factors should I be looking for in a residency?
5. How many programs should I apply to?
Make sure you apply broadly, but narrow down programs geographically and according to where you are interested in living. Remember, applying broadly is not just location related. You should consider the type of programs that are a good fit for you. While it can be an expensive process to apply broadly, keep in mind that you are investing in your future.
For more information, see pages 24-25 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
6. I am a foreigner. How can I get a residency in the states?
7. What if I do not match in a residency, what can I do?
8. What is ERAS? When should I start? How should I prepare my application?
9. What is VSAS - and the intricacies/nuances associated with that - it's a complicated process
10. How do I pick away rotations? How many should I do? How do I shine on an away rotation?
There are many factors to consider with away rotations for Orthopaedic residency candidates. Some of these are choosing a location, preparing for the rotation, how to impress on your rotation and finally, evaluating the program while you are there.
It has been demonstrated that students who did 2 or 3 away rotations had better odds of matching in orthopaedics.
As a medical student, something easy to do that people will remember is just always be around. Show up early and leave late - be proactive and try to anticipate what you can do to be helpful People remember when medical students go above and beyond to help and will advocate for you when they are making their rank list.
For more information, see pages 21-23 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
1. Do you have to do a fellowship?
Over 90% of residents choose to continue with fellowship training. Many residents use fellowships to flesh out their education to become more well-rounded and confident generalists.
For more information, see pages 38-39 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
2. How do I find information about fellowships?
Visit www.sfmatch.org to obtain specific information on your subspecialty of interest, important dates, deadlines, costs, and other pertinent information
3. What's some important information to consider when selecting a fellowship?
First and foremost, figure out which rotation excites you. When you’re on sports, is it easier to go home at night and read for cases or look up a physical exam finding? Can you not stop thinking about the open fractures you see on trauma? These kinds of questions should help narrow down a few specialties for you.
If you cannot decide between specialties, you can start to consider lifestyle, location, and which specialty fits the best into your vision for yourself. Academics will allow you to teach residents and perform research, but it also requires publications, no reimbursement for the time commitment of teaching, and is often salaried. Private practice groups have potential for better income and ease of making practice decisions, but call coverage may be difficult for a junior partner and internal competition for referrals may occur and impact your economic outlook. Program accreditation and location are two additional factors to consider when selecting a fellowship.
You need to know whether the fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME). This is especially important for hand and sports medicine fellowships because you must complete an ACGME accredited fellowship in order to qualify for the Subspecialty Certificate (formerly CAQ, certificate of added qualification).
Also, Fellowship may be a good opportunity to live in a different area of the country. If you are thinking about a permanent move to an area with a different climate, fellowship gives you a year to consider the area.
For more information, see pages 41-42 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
4. Should I do a fellowship in close proximity to where I think I may ultimately want to practice?
Fellowship may be a good opportunity to live in a different area of the country. Fellowship should be a year where you thrive, not just survive, so you need to be honest with yourself and determine if you can really live here for one year. A resident with a spouse and children may factor cost of living into the decision.
For more information, see pages 42 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
5. What are some helpful resources for finding a job?
The single best resource is word-of-mouth from your mentors. They will know about positions that become available, especially in academics, before these positions become public, as often there are unadvertised jobs that only your mentors will know about.
Additional resources include various websites such as http://careers.jbjsjobs.org/jobs/ and http://www7.aaos.org/member/jobboard/main.aspx.
It can be helpful to contact programs in locations that you are interested in during your final year of residency to make plans to meet during the AAOS meeting in the spring of your chief year. This will open the door to future conversations if/when a job opportunity at that program becomes available. Even if the program that you are interested in does not have a current opening, many programs will be willing to meet with you, and at least they will have your name/CV should anything change within their needs over the coming year.
It is important to know what you want in your job, including an academic position vs. private practice vs. hospital employed vs. some other model. Perhaps the most important aspect is first determining if you have a specific location restriction. If you do, then you need to limit your search strategy to programs within that area. If you do not have a geographic constraint, then you should identify the types of practices that you would be most interested in joining. It’s helpful to do a lot of the work up front to seek out opportunities since in most subspecialties, the demand for jobs is greater than the supply.
6. Should I have a lawyer review my contract?
Yes. It’s very helpful to have a lawyer review your contract to identify inconsistencies or things that can be modified to be more in your favor. Lawyers can also make recommendations on how to appropriately request the incorporation of things that are important to you (e.g. protected time for research, support staff, etc.)
7. What are some important questions I should ask during my interview?
What is the mission statement of the practice/group
What are the research expectations
Is there protected time for research (academic programs)
What are the academic/teaching requirements
What are the call requirements at different hospitals that I will be working at, and is there reimbursement for call, and is there resident/fellow/PA coverage for call
Is there pediatrics call (for non-peds surgeons)
When can I have a PA, and who pays for thisIs there start-up research funding
Are there team coverage responsibilities
Will I have block time and where and when
Where will my clinic locations be
What is the EMR system
What is the compensation model (don't ask this on the first interview, however)
Is there a partnership track and how does this work
Has anyone ever been turned down as a partner
Is there a signing bonus
Is there a relocation bonus
Who covers malpractice
What are the benefits
How many hires have there been within the last five years
What is the faculty/partner turnover
Are there opportunities for ancillary income
How many cases per year is typical for new hires within my specialty during years 1, 2, 3-5, 6-10
Why did the last three physicians who left the group, leave (you can also ask for their contact information)
How are new referrals handled
How is patient education handled
How is patient marketing handled
Is there a non-compete
1. What are some important questions I should ask during my interview?
Type of position the applicant is looking for - private practice, hospital employed, academic, etc)
2. What are some helpful resources for finding a job?
Identifying open positions is a critical step. Common places for employers to advertise for positions include meetings and websites for professional organizations, such as the RJOS Career Center , AAMC CareerConnect, AAOS Job Placement Center, and JBJS Jobs. Specialty societies, like the RJOS may have a job board or site where employers can post announcements and interviews. Many advertisements are found within journals such as JBJS, JAAOS and other subspecialty journals, just as many jobs are unofficially ‘advertised’ through word of mouth and personal networks.
Physician recruiting firms may reach out to you which is a great opportunity to broaden your search by informing them of the type of position you are hoping to find. The advantage of a recruiter is that they often know of practice opportunities in places you may not. You can specify to a recruiting firm your geographic limitations, and the type of practice you are seeking. However, you do not need a recruiter to find a job. You can do much of the legwork and make connections on your own. If there is a specific institution or location in which you are interested but find no advertised positions, you can reach out to these places to investigate the possibility of an open position and acquire information about future recruitment plans. This point of contact will serve as your introduction; approach the situation professionally as first impressions do matter.”
3. When should I start looking for a job?
You should be familiar with the policies of the fellowship regarding time away for job interviews before you start your fellowship. Even if you asked about this during your fellowship interview, it’s a good idea to check in with the current fellow(s) during your chief year to be sure the policies and attitude towards missing time for job interviews have not changed since you matched.
You can maximize one of three things when considering future employment: salary, location, or practice setting. Having a job secured prior to starting your fellowship is one way to maximize the clinical experience of your fellowship because you won’t be spending time away on interviews. For example, if your fellowship is on the east coast, but you really want to live and practice on the west coast, then you have to factor in that additional time away will be needed for travel. It’s more than red-eye flights and jet lag; significant time zone differences can present additional challenges just trying to communicate with a potential employer.
There are also some advantages to delaying your job search until you begin fellowship. You may gain a new perspective of what type of practice you are interested in after seeing a ‘new” way of doing things. Your fellowship director likely receives information throughout the year on employment opportunities. If you do not have a job secured prior to starting the fellowship, ask the director and other faculty members to forward those emails or mailings to you. If the fellowship faculty is familiar with your potential employer, s/he may be able to provide insight as to whether or not your personality will be a good fit.
4. How can I get involved with national societies?
It is never too early to become involved in your national, state, or local society. Many societies, including the AAOS, have opportunities for residents to become involved in committee work. For example, the Women’s Health Initiative Advisory Board has a resident position. These opportunities are obtained through the CAP process, which stands for Committee Appointment Process (www.aaos.org/cap). The AAOS also has a resident’s assembly to facilitate early involvement.Ruth Jackson Society is a special place for resident members, with many opportunities for mentorship and career development.
Check with your society of choice regarding policy for committee work for candidate versus active members. Many societies encourage committee work during candidate membership, reserving board room positions for active membership.
As you become an active member of your society, volunteer for committee work that interests you. If you do not get the position you seek, try again the next year. Societies want to engage their volunteers, and most keep track of the members that were not successfully matched onto a committee. Ask about openings on other committees, and consider applying for those that are less likely to fill. Be the person to volunteer to take on the work, and take the opportunity to engage your committee chair for advice and feedback. Offer to lead projects. As committee chair positions become available, apply and list the work that you have done. Engage the committee chairs that saw you work hard to advocate for you in the positions you seek.
Many societies have positions reserved on the board of directors for surgeons under the age of 40 (or 45) or in the first 5 years of practice. These positions exist both to allow younger/newer members to gain experience, as well as to ground the society in the culture of their newest members. You can best serve in these roles by understanding the view of your peers and advocating for them in the board room.
Lastly, pick volunteer work that you like. If you are not an expert going in, you can educate yourself. Be early on the conference calls. Get to know the society staff. They know the society and can provide continuity. They will have your back and support you if you give them the chance.
5. What are some things that I can do to stimulate growth of my practice early on?
It depends on what type of practice you enter and the referral patterns for the community. Although sometimes the referral patterns are fairly predetermined, knowing how the referral process works will help guide the process of building your practice. It is very valuable to reach out to the community by offering to provide lectures that are relevant to the family practice physicians, internists, or pediatricians who might be referring patients to you. You can similarly reach out to the urgent care and emergency department providers in the region as well.
It is also beneficial to fully understand the templates for the clinics and to help develop the appropriate template that will allow for the most flexibility. For example, there might only be 'fracture slots' or ‘follow-up’ visits available on a certain day, and therefore the registration staff will not be able to enter a 'new patient' visit. Keep tabs on this templating process early on in your practice.
Also, make sure that there are detailed lists of what entities you will manage. For example, if you are a pediatric orthopaedic surgeon, you need to make sure that you have DDH, LLD, club feet, knee pain, hip pain, etc listed as entities you will see. There are examples of surgeons not understanding why they never see entity X, and it is only later that they realize no one who was making those appointments for entity X knew this provider offered those services. If your practice has a website, make sure that your practice information with your specialty details are up to date.
Social media and advertising are also options to establish yourself as a new provider, but make sure you follow the rules and regulations for your group or hospital, and utilize the appropriate channels.
Most importantly, be available to your partners. Offer to take extra call, cover extra cases, or take on more clinics if needed. This is the quickest way to build your practice.
6. If I have an interest in research, should I try to start working on projects right away or should I focus on my practice?
This is a good question with no one 'right' answer. Building your practice should be the first priority and if you cannot juggle both, focus on being the best surgeon you can be. Remember, the first year of practice is a very different experience than residency or fellowship. There is a very steep learning curve. Furthermore, without patients, it is difficult to establish a clinical research program. That being said, if you can dedicate some time to research and there is program support for you to do so, go for it! It is helpful to find a mentor to help you navigate the process. They also can serve as your senior mentor for intramural and extramural grant applications.
7. Part II ABOS- when do I apply? What is the process like? Pearls for preparation?
The detailed information for this exam can be found on the website abos.org, which is a great resource. The Part II oral exam is given in July each year and one is eligible to sit for the boards if she has been in practice for 20 consecutive months.
Checklist for testing as listed on the ABOS website:
1. Pass Part I.
2. Be continuously and actively engaged in orthopaedic surgery in one location for a least 20 consecutive months.
3. Electronically submit a completed application, application fee, a Scribe case list, and names of your peer reviewers by October 31. (Late deadline is November 15.) Available on website beginning April 1.
4. Receive letters of notification to examination in April on abos.org.
5. Receive examination assignments and admission cards in June. View the orientation videos.
6. Take Part II examination at Palmer House in Chicago in July.
7. Examination results are posted online in late August.
The collection period is from April 1 to September 30. Every case that is performed in the operating room during this timeframe must be included. There is an application fee ($975 as of 2016), which is submitted when the case list is submitted the October before the exam. The following April, the letters of notification for the exam are sent along with the case selection. There is a voluntary practice exam that the ABOS offers, which provides the opportunity to review approximately 2 of your cases. It also enables you to observe other examinees present their cases as well.
Notification of pass/fail is provided approximately 2 months after the exam and then you have ten years before re-certification is necessary.
The entire process requires organization. An excel file is a great way to keep track of the individual cases during the board collection timeframe. Items to include are: date of surgery, medical record number, patient initials, patient age, surgery details, CPT codes, ICD-10 codes, and complications. This excel file should be kept up to date- complications should be included the day they present to clinic so they are not forgotten. It is incredibly helpful to upload each case into the ABOS website as they are completed (or at least on a weekly basis), rather than waiting until the end of the board collection period. It is simply too much information to add at the end of six month.
Once the case list has been provided the following April, upload all of the relevant files, including consent forms, operative reports, office notes, radiographs or advanced imaging, arthroscopy images (if applicable), and clinical images (if applicable). It is also the time to start reviewing the literature, anatomy, and indications for each case. If your partners or mentors are willing to go through some or all of the cases with you, this is a very valuable opportunity.
Book your hotel reservation at the Palmer House and your flight (or travel arrangements) well in advance. Make sure you have plenty of time to get to Chicago. Some examinees arrive two days in advance to ensure they do not miss their opportunity to sit for the boards.
Preparation is vital and will make the process smooth instead of stressful. The examiners simply want to be assured that you are organized, have good indications for surgery, and are safe. Complications are going to occur and are expected. In fact, if you have few or no complications listed, that is a red flag. Make sure you list every possible perceived complication, even if it might be 'benign', such as a hypertrophic scar, an anesthetic reaction, or an unplanned clinic visit for whatever reason. Keep in mind that the vast majority of first time examinees pass. Be prepared, confident yet humble, and enjoy the experience!
If I'm considering switching positions, how do I initiate a search? Who should I tell?
There are many factors to consider when changing jobs mid-career such as regulatory changes affecting healthcare, competition for patients and resources, etc. If a job change is being considered to improve the job environment, then sorting out the positive things versus those you would be happier without at the current situation is key to making a positive move.
For more information, see pages 143 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
1. How do I plan for retirement?
2. How do I remain involved in orthopaedics after retiring?
1. What are tips to maintaining a work/life balance?
Finding balance and avoiding burnout are key to a successful career. Women who enter orthopaedic surgery have decided to forgo the instant financial gratification of a job in finance or a lifestyle choice of a less demanding job. The orthopaedic surgery decision is made with the long term in mind. The key is to set short and long term priorities and stick to them.
For more information, see pages 201-207 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
2. When is the best time to have a child?
As orthopaedic surgeons, men and women learn to diagnose and treat the same conditions, perform the same procedures, and are faced with similar choices in many respects. However, as women, we must decide whether and when we would like to become mothers, and then as surgeons, figure out how to make this work with our careers.
There is no ‘best time’. However, there are several factors to consider such as timing, additional stressors during pregnancy and balancing professional/personal obligations.
For more information, see pages 194-200 of the Ruth Jackson Orthopaedic Society Guide for Women in Orthopaedic Surgery, 2nd Edition.
