What factors influenced your decision to choose this branch of medicine
Surgery always appealed to me because you physically have the problem in your hands and often have an opportunity to make a clear change.
I also like the thought process - a lot of time and thought goes into what to do and whether to go ahead, but for the operation itself you just do your best. In orthopaedics, you develop an excellent rapport with the patients - you do what they feel they want done (eg total hip replacement) to improve their quality of life.
Half the work is trauma, and again you negotiate with the patient about their lifestyle and treatment options. Apart from a few 'set pieces' there is always time to think and plan. Very little operating has to be done immediately at night.
What are the hours like? How intensive is your work schedule?
The hours have a reputation for being tough, but in reality most trauma work is scheduled for an operating list on the following day.
Trainees follow the European Working Time Directive of 48 hours per week: most at 'Core Training' level are on full shifts, often covering many surgical specialties; 'Higher Trainees' (also known as Specialty Registrars) have their weekly training included in the 48 hours, some are on full shifts and some are 'non-resident on-call'.
For a consultant, a typical weekly Job Plan will be:
- Monday: all day operating
- Tuesday: fracture clinic in the morning, trauma list in the afternoon
- Thursday: morning clinic, afternoon: day surgery list
- Wednesday and Fridays free for other interests
Most consultants are on-call 1-in-6 or less frequently, and also you have some administration to do, and (short) ward rounds. Operating days start early, and days after you have been on-call start at 8am. Mostly theatre lists and clinics are finished by 5.30pm.
The 2003 consultant contract acknowledges that consultants do 'Supporting Professional Activities' (SPAs): examining, interviewing, committee work, research, teaching, etc depending on their interests, at other times.
I did my training when hours were 80-110 per week, before rotations, so the work today does not seem as intensive! All the consultants of today are those who survived that gruelling era - I can see how future cohorts of surgeons will be very different.
Is there scope for flexibility, for example part-time work?
As a consultant, there may be no need to work flexibly - if you can manage financially without private practice, the NHS work has a lot of flexibility around where and how you do the 'Supporting Professional Activities'. Consultant posts are advertised for '10 PAs' meaning ten 4-hour sessions, but this can be negotiated up or down with your managers (and includes SPA time). Many consultants work part-time nearing retirement.
All training posts can be done as 'Less Than Full Time Training' posts (LTFT), if there is a reason to work less than full time (family commitments, sporting or educational reasons or disability are common reasons to choose LTFT training). This is arranged through the postgraduate deanery in the area. The training time is lengthened and the salary reduced pro-rata (eg 80 per cent for someone working 80 per cent of normal hours). It is possible that now the hours have reduced to 48 hours per week, this option will be less popular. It can take a while to organise (there is information on deanery websites about this).
What are the highlights and advantages of working in this specialty?
Physically fixing a problem - decompressing carpal tunnels, fixing ankle fractures, fixing hip fractures. Watching a patient walk again. There are many sub-specialties to develop into (paediatric orthopaedics, sports surgery, trauma surgery, revision joint replacement surgery, hand surgery, etc). Good team working. Meeting a huge range of patients (age, lifestyle, etc) and potentially having the ability to help each one.
...and the challenges and disadvantages?
Seeing an operation you have done go wrong - infection in a joint replacement can be devastating for the patient, for example. Seeing someone's life change in an instant due to an injury.
Politics: The relentless demand for orthopaedic surgery - this is sometimes called the 'un-met need'. The old image of the orthopaedic surgeon being a thick-set male who wasn't very clever but was very strong still lingers, despite lovely new kit and very competitive entry.
What are the routine aspects, if any, of your role?
Fracture clinics - these are quite fun - you have a gentle discussion with the patient about the natural history of their injury and spot the few that would do better with an operation. It is very sociable.
...and the more unusual experiences to date?
Seeing people from the same car crash rehabilitate together.
Please describe your duties in a typical day
The following is a typical surgical day:
- 9am - drop kids at school
- 9.15am - fracture clinic
- 1pm - administration and emails in office
- 2-5.30pm - day surgery
- 5.45pm - home
- 9-11pm - hospital emails at home and preparing talk (after kids in bed)
What are the necessary personality characteristics for this career?
A sense of humour, the ability to think of a range of options and the ability to get on with a range of people.
What advice would you give to someone interested in pursuing a career in this branch of medicine?
Don't be put off by other people's stereotypes. Be aware that it is very competitive, so you need to do anything that will look good on your application form. This includes doing audits, getting some abstracts accepted for conferences, getting some management experience, doing relevant courses, learning anatomy and getting a teaching qualification. You should keep a log of operations you have seen, read up about them first and reflect on them afterwards.
How competitive is this specialty?
Very. However, someone has to succeed, and it is a big specialty, so there are more opportunities.
There is some overlap with plastic surgery. It is worth doing a post or at least a 'taster week' to see which you prefer. Some 'core training' rotations are generic for any specialty afterwards, and some are 'themed' for orthopaedics only.