Specialty Spotlight Podcast, Episode 3: Orthopaedic Surgery

Introduction to Orthopedic Surgery and Career Path

[00:00] Welcome to the WMed Specialty Spotlight, your virtual mentor for choosing a medical specialty and

[00:20] planning a career in medicine. On this podcast, we probe practicing physicians with questions about their specialty, the decision algorithm that helped them determine that the specialty was right for them, and then for advice about long-term planning irrespective of the field they went into. I'm your host,

Guest Introduction: Dr. Karen Bovid’s Background

[00:40] Dr. Brent Shaw, WMed Assistant Dean for Career Development. Just a quick reminder that the show notes for this episode and all episodes can be found on our website, wmed.edu forward slash specialty spotlight. The specialty of today's show

[01:00] orthopedic surgery and the physician here to tell us about it is Dr. Karen Bovid. Dr. Karen Bovid is a residency program director of the Orthopedic Surgery Program at Western Michigan University, Homer Streicher, MD, School of Medicine. She is an associate professor in the Department

[01:20] departments of orthopedic surgery and pediatric and adolescent medicine. Dr. Bovid completed her undergraduate degree at Hope College in 2003. After completing her medical degree at the University of Michigan Medical School in 2007, Dr. Bovid completed an orthopedic

[01:40] residency from the University of Michigan in 2012. She then went on to do a fellowship in pediatric orthopedic surgery from the Children's Orthopedics and Sports Medicine of Atlanta at Scottish Rite in 2013. Dr. Bovid is

Overview of Orthopedic Surgery: Scope & Responsibilities

[02:00] and has been heavily involved with the professional organizations in her field since the beginning of her career. Dr. Bovet has served and held leadership roles on numerous national committees. In addition to being a reviewer for several journals, Dr. Bovet is also

[02:20] associate editor of the Journal of Bone and Joint Surgery. Dr. Bovid has been academically active. Her CV lists 14 peer-reviewed publications and 19 book chapters and invited review articles and over 40 abstracts reflecting presentations at

[02:40] at local and national meetings. She completed three research grants. Among her many honors and awards, Dr. Bovid is a fellow of the American Orthopedic Association and has been an award recipient of the Excellence in Teaching Award from the WMed Orthopedic Surgery Residence

[03:00] program. So without further ado, Dr. Karen Bovid. Dr. Bovid, welcome to the show. Thanks so much for having me. This is exciting. Well, thank you for being here. I'm looking forward to hearing the ins and outs of orthopedic surgery and what you do in the life

Daily Routine and Work-Life Balance in Orthopedic Surgery

[03:20] lifestyle that surrounds it. An orthopedic surgeon is educated in the preservation, investigation, and restoration of the form and function of the extremities, spine, and associated structures by medical, surgical, and physical means. This

[03:40] specialist is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries, and degenerative diseases

[04:00] of the spine, hands, feet, knee, hip, shoulder, and elbow in children and adults. An orthopedic surgeon is also concerned with primary and secondary muscular problems and the effects of central and peripheral nervous system

[04:20] lesions of the musculoskeletal system. Dr. Bovin, how much do you agree with what would you add or subtract to ensure that anyone listening was well informed of the practice of orthopedic surgery? Yeah, so I think that's a good description. Basically, we are taking care of all kinds of musculoskeletal

[04:40] problems in all areas of the body in patients of all ages, which makes the field incredibly broad and varied, but also really interesting. And I think probably the most fun part of it for me is just how much of an impact you're able to have on the quality of life of your patients.

[05:00] Occasionally, it's pretty rare. We have the opportunity to save a life or a limb, but most of the time we really have the opportunity to impact a patient's quality of life and their function, which is pretty gratifying. Thank you. Yeah. It sounds like a great specialty and one that requires a

Differences in Orthopedic Practice Across Various Settings

[05:20] lot of training. What does a typical weekly routine look like and what is the typical series of patients you would see and what is the typical outcome for these patients? Orthopedic surgery training for residency is five years and at the end you are trained to be a general orthopedic

[05:40] therapeutic surgeon. So you can go out into general practice or you can choose to get some subspecialty training in any one of multiple fellowship areas. That's usually another year. So exactly what types of patients you see and how your day looks will probably change a bit depending on which subspecialty you choose or if you're in

[06:00] general practice and what your practice environment is. I suspect that almost everybody in orthopedic surgery splits their time between taking care of patients in the operating room and taking care of patients in the office. And then usually there's some amount of on-call coverage, usually for the emergency department or

[06:20] for patients that are already a part of your practice. The exact number of days of in the week in the office versus the operating room would probably change a little bit depending on which subspecialty you are in. But often it's somewhere in the neighborhood of two days a week in the OR and two and a half to three in the clinic and then call coverage will

[06:40] change based on the size of your practice and how often you're the person that's on call. You may also if you're providing sideline coverage or sports medicine coverage for teams, you may be doing that on nights and weekends when sports contests are happening or seeing patients in the

[07:00] training room. One of the reputations for orthopedic surgery is that if you break a bone you can fix it and you can take a patient from a terrible quality of life right after breaking that bone and give it 95% of that quality life back in a

[07:20] about eight weeks. Would you say that is characteristic of most outcomes for most patients in orthopedic surgery? I think that's one of the great things about our specialty is that the vast majority of patients do well and we really do have the ability to influence their outcome. Not everybody

[07:40] right, not every situation. But bone is very cool. It's the only thing in your body that heals with new bone. Everything else heals with scar tissue. And I think that's one of the things that's really great about the specialty of orthopedic surgery is just how tangible it is. So I can look at my preoperative X-rays in the morning before an operating

Challenges and Future Trends in Orthopedic Surgery

[08:00] day and say, well, that's broken, that's crooked, that foot's got too many toes on it, you know, whatever it is. And at the end of the day, I can say, well, that's fixed, that's straight, that's going to be a functional foot that this patient can use to go out and do things in the world. Of course they have to heal, right, and recover.

[08:20] But it's pretty tangible and it's pretty satisfying. How does the practice of your specialty change based on setting? Impatient versus outpatient, academic versus private versus public, urban versus suburban versus rural, civilian versus

[08:40] military versus government and then international. So this is a great thing about orthopedics is you can practice in any and all of those settings and so you have the ability to really create the practice that you are most interested in and I suspect that many people will have some of all of

[09:00] those or at least some of those different settings involved. There are certain subspecialties where there's a lot more inpatient care. So if you are taking care of orthopedic trauma patients, if you are doing a lot of spine surgery, if you're doing a lot of joint replacement, although that's shifting some to the outpatient world, you will probably

[09:20] spend more time in the hospital and you will probably have more time in rounding as part of your daily schedule. If you are taking care of sports medicine patients or hand patients or foot and ankle patients, you may be spending a lot more time in the outpatient world and maybe you're operating at a hospital or maybe at set of surgery

[09:40] center. And since most of your patients would go home after surgery, you probably have less time rounding or seeing patients in the hospital. You probably don't get out of it entirely because you probably need to see patients on call and take care of any emergencies that come up. But this is one of those things that will vary depending on how you

[10:00] decide you want to practice and what areas you're most interested in. You can certainly be in an urban setting, rural, suburban, all of those things. I spend a fair amount of time and effort dedicated to global health and there are a lot of people who spend way more time than I do going to places overseas and partnering with surgeons

[10:20] there to help provide care and really to provide education. But I think you can really turn this into something that matches your interests. For international, how do you do it if you don't have – do you find it difficult not having all the tools?

[10:40] accessible to you because many, at least when I was a student and I rotated through orthopedics, there are quite a lot of cool tools that you guys have. But do you find it very difficult and challenging in places that you go abroad and maybe

[11:00] countries that just don't have the resources? In some ways that is one of the challenges that makes orthopedics fun. We have a bunch of cool technology and we have lots of really interesting high-tech tools and imaging and all kinds of things that help us provide care for patients.

[11:20] But we also do some things that are very simple. Like lining up a closed reduction of a broken bone and putting a cast on. That's a very classic thing that's been going on for hundreds of years and works pretty well. And we have a lot of fancy plates and rods and things, but you can also do

[11:40] Some, you know, I think if you understand the principles of, you know, the patient's problem and the biomechanics and what you're trying to achieve. There are lots of ways to get that done. One of the things that you really need to be cognizant of when you are practicing in an environment without the resources you're used to having is

[12:00] what is available, what do you need to do things safely. And I will say if some of the international surgeons that I have worked with who practice all the time in a resource-limited environment are some of the smartest and most creative people figuring out how to solve problems with what's available to them in their environment.

[12:20] And I've learned a ton from those surgeons. I want to ask you this question. I feel that this is not unique to orthopedic surgery, but the more rural that you get, the more general you have to be. It might be routine for a specialist, but

[12:40] the breath of routine procedures becomes much broader in a rural area. I feel like this is the case in many specialties of medicine because if you're the only doc in town, well then you're the only doc that can treat the condition. Therefore, you become a generalist.

[13:00] But with orthopedic surgery, more than other specialties, do you think that if you move away from the rural setting that you have to sub-specialize? So I think your perception is absolutely right. You know, if you are the only doc, the only orthopedic surgeon in, you know,

[13:20] know, a five county area in maybe say North Dakota or someplace where you have to be a generalist. You cannot be a second toe surgeon there because the patients need a lot more than that and there won't be enough second toe problems to keep you busy. So I think it's actually hard to be a good general orthopedic

[13:40] It takes a lot of work and a lot of training and you have to be very smart to be good at all of these areas. I think there are a lot of reasons to do a fellowship or to sub-specialize. One of those reasons might be you're just fascinated by a certain area of orthopedics and you want to learn more. If you are wanting to practice in a place that already has a lot of

[14:00] surgeons, you want to go to New York or Chicago or LA, you probably need some kind of niche to help build your practice. I think sometimes people come out of general orthopedic surgery training and they just don't quite feel ready to go into practice yet. And so they'll do a fellowship to get that extra exposure and extra

[14:20] I don't think that happens in our residency program here. We have a number of, so the vast majority of orthopedic residents go on and do fellowships. But we've had one resident every several years who wants to go home to a more rural community and practice in that community and they from the beginning of their residency program

[14:40] have been very focused on learning all the general skills they need to be good in general practice. And they've been able to do that very successfully. What's the biggest challenge facing your specialty? And where do you predict your specialty to be in 10 or 20 years?

Diversity and Breaking Stereotypes in Orthopedic Surgery

[15:00] The clinical challenge is that there is a huge and growing need for orthopedic surgical care, especially joint replacements. You know, as our population ages, there are a lot of people with painful arthritis that's limiting their function. The person who figures out how to regrow good hyaline or

[15:20] cartilage will probably win a Nobel Prize. Until that happens, we've been giving people new surfaces for their joints made out of like metal and plastic, which works pretty well. But I think that's an ongoing challenge and I think where the frontier is is the biologic

[15:40] and healing part of what we can influence. So there's lots of cool research going on there and probably we'll get better and better at facilitating healing not just with metal and structural things, but trying to harness some of the biology that goes into healing musculoskeletal tissues. I think from a culture and work

[16:00] standpoint, orthopedic surgery is the least diverse subspecialty in medicine, which is a terrible distinction to have. And I think there's a lot of work going on to change that, but progress is really slow. So there are definitely more women in orthopedic

[16:20] surgery than there ever have been and more surgeons of color and people from various backgrounds and various gender identities and all of the different ways that we describe diversity. And I think the culture of orthopedic surgery is working hard at becoming more welcoming and more inclusive.

Advice for Medical Students Interested in Orthopedics

[16:40] But it's been a slow process and we've got a lot more work to do. The stereotypical person, it's often said for orthopedic surgery and that personality that goes with it is that former male athlete who goes into orthopedic surgery. How about that?

[17:00] true is this stereotype. And the second question is, if you don't fit this stereotype, can you still fit in orthopedic surgery? Yeah, so absolutely you can. There certainly are a lot of men, mostly white, who were successful collegiate athletes who've chosen to go on and become orthopedic

[17:20] That's great. That's one path. You don't have to do that. I think part of the misconception is that you need to be really strong. And there are some things that require strength. I'm not a particularly big person. I've never had trouble doing the things that I need to do for my job. I mean, we have power tools. So if you can pull a trigger, right, you can use it to pull a trigger.

[17:40] drill you can use a saw. It is important to think about leverage and what anatomic structures might be causing a deformity or preventing you from getting a reduction. Muscle relaxation is key. You can be the biggest, strongest offensive lineman there ever was and you won't reduce the dislocated hip in a little old lady if her muscle

[18:00] muscles are spasm. Also, you need to put everything back together so it works at the end. So just hitting it with a bigger hammer might not be the best choice and probably some finesse and some anatomic knowledge will get you a lot farther than just brute force. So I had

[18:20] a mentor when I was an orthopedic resident who fit that stereotype. Great guy, played collegiate football, collegiate rugby, was the team doc for the University of Michigan football team and for USA Hockey and he looked the part. He's also a great surgeon and a great mentor. But when we would be covering the football games and the quarterback would go down on the field,

[18:40] I always kind of felt like they wanted to see him running out there to help and maybe they didn't really want to see me. Nobody ever said that to me. That was just kind of my perception. And I said, you know what? That's okay. I'm going to work really hard. I'm going to do a really good job. They're going to get used to me. And I think to some extent that's probably true.

[19:00] What I did not realize until much later, so I was in practice here and the chair that hired me was a guy named Dale Rowe and Dr. Rowe is an amazing physician and surgeon. He took care of patients here in Kalamazoo, adults and kids with spine surgery problems for 37 years. When he retired,

[19:20] he asked if I would take over his pediatric scoliosis practice. And I did. And a lot of patients with idiopathic scoliosis are young girls, adolescent girls. That's the classic patient with idiopathic scoliosis. So I would be seeing these patients in the office for follow-up. Several of them, kind of a bunch of them were like,

[19:40] I'm so glad you're my doctor now. And I was like, really? Because you had the best. Like, Dr. Rowe was amazing. And now you're stuck with me. And I'm okay, but I'm kind of young in practice and all those things. But I think, you know, if you are a 12 year old girl and you have to stand in a hospital gown without your bra on and have somebody pick apart all of

[20:00] things that make you really self-conscious about the way that your back looks. Maybe having someone else who was an adolescent girl once do that is less uncomfortable than someone who wasn't. And I started to have a lot of teenage girls and I took care of their knee injuries and they're getting ready to go back to their sport.

[20:20] And oh, you know what, this is this seems like a cool job. Maybe I could do that. Like, absolutely. It's a great job. But, you know, I think there are all kinds of different patients. And so we need all kinds of different surgeons. Not that you can't learn how to interact with and take good care of patients from all kinds of backgrounds. But sometimes when you share some.

[20:40] whether it's your heritage or your language or your culture or your experience or whatever it is, it can make a patient feel more comfortable seeing you and then that ends up with a better therapeutic alliance in the end. So we definitely need all kinds of physicians in general and really in orthopedics. We have three

[21:00] women who are hand surgeons here in town that are on our faculty. And then there's me. So I take adult call and then I see kids. But I will occasionally see adult women with knee arthritis who culturally are not comfortable seeing a male provider. Even though I don't treat adults and I don't do knee replacement

[21:20] because I'm an acceptable person for them to see. And I can start the non-operative treatment of their knee arthritis and if they get to the point where they need surgery, we can look to find them a surgeon that's culturally appropriate for them. But that's silly that the pediatric orthopedic surgeon in town is the one seeing adult women.

[21:40] because I'm the only woman who's safe for them to see. Any resources that you would turn a student to go toward? I think there's lots of ways to learn about orthopedics as a field. It usually starts with anatomy, right? Orthopedics is basically just applied anatomy.

Choosing Orthopedics: Dr. Bovid’s Personal Journey

[22:00] So in your M1 anatomy course, learn as much as you can. There are a lot of resources on the library webpage. We have a clerkship page for the M4 orthopedic clerkship, but there's a bunch of great orthopedic textbook resources there that can be really useful. The American

[22:20] Academy of Orthopedic Surgeons has a journal, has a yellow cover, so we call it the yellow journal, but it's J-A-A-O-S, and there's a lot of good review articles there, which is a nice place to kind of start when you're trying to learn about a specific problem or a specific condition. The other thing I would say is try to meet some people in the field.

[22:40] And so you could come to our conferences or grand rounds there on Thursday mornings at 6 15am in TBL to thoroughly, but you're welcome to join. And and I think mentorship is huge. So getting to know some orthopedic surgeons, getting to know our attendings, getting to know the residents. We have both the orthopedic

[23:00] student interest group and the women in orthosurgery interest group are kind of nice formal structures for meeting people. Sometimes getting involved in a research project is a good way to meet people. We have some medical student focused programming at the American Academy of Orthopedic Surgeons

[23:20] meetings every year. Also the Ruth Jackson Orthopedic Society is sort of for women in orthopedic surgery, although men and all sorts of people are welcome to join. But they have some nice resources available for medical students who are interested in orthopedics as well. So there's tons of ways to kind of start to find out

[23:40] more. And then I think that you'll go down a rabbit hole of good things as you find things that interest you. If you could tell us how you decided that orthopedic surgery was right for you. So I think some people are under the impression that you have to have made this decision like very early in life and build

Final Thoughts and Resources for Aspiring Orthopedic Surgeons

[24:00] your whole career toward it. I did not. So when I went to medical school, I didn't, frankly, I didn't know that much about medicine. I had a family doctor. I thought maybe I would do that. But I really didn't even know all the options that were available to me. I think in retrospect, my friends knew that I was going to do orthopedic surgery before I did.

[24:20] I'd always enjoyed anatomy. I participated in sports all through high school and college. And so, you know, I enjoyed the training for that and enjoyed the structure function aspect of that. I learned a lot in the training room, both from my own injuries, thankfully nothing too terrible, and my teammates. So I knew I was interested in those things.

[24:40] And I had always enjoyed procedural hands-on things. So my third year of medical school, I really tried every single specialty. I just put that hat on and for the weeks that I was on that rotation, I was trying those things out. And I learned a lot doing that. And I think

[25:00] And I think there's family medicine is an awesome field. And you can do a lot of procedural stuff there. And you can make such a difference for people controlling their blood pressure and blood sugar and cholesterol and all those things. And I just I was so impatient, waiting to see the results of these things was really hard for me.

[25:20] And when I was in the OR, that felt very immediate. It was exciting to see what was possible there. But I wasn't entirely sure if general surgery was the right fit for me. I think in retrospect there are patients who are quite sick and then there are patients who are

[25:40] injured and I was most excited taking care of patients that were injured as opposed to having so many challenges with physiology and doing a bunch of ICU management. It was really the orthopedic patients that I was most interested in their problems and the possible surgical solutions.

[26:00] So I ended up thinking that maybe I would do orthopedic surgery or maybe general surgery. And so my first month of fourth year, I did an orthopedic clerkship and I loved it and it was awesome and I learned a ton of things and I thought it was really great. And then the second month of fourth year, I did a general surgery sub eye, which was cool and I learned a lot there.

[26:20] But it wasn't the same types of diagnoses or surgeries that I had really enjoyed on the orthopedic rotation. So then finally, halfway through the summer of M4 year, I had decided that orthopedic surgery was what I wanted to do and went through the whole application.

[26:40] process and thankfully it worked out so here I am. Oh great. Are we electives in orthopedic surgery necessary? I would encourage students who are interested to do them. Actually when I was applying I was not savvy at all about the process or I didn't even know there was a game

[27:00] and I wasn't playing it. And our medical school general advisors and counselors kind of advised against away rotations. We all met with the chair because you had to have a letter of recommendation from the chair and so you're supposed to come and spend some time talking so that could be a more personal letter. And so when I met with the chair

[27:20] care, Dr. Carpenter, he asked me, okay, are you going to do any away rotations? And I said, nope, I can't go to all the places I want. And they said it's not worth it. And he said, well, have you had the chance to be exposed to orthopedic surgery anywhere else besides here? And I realized I hadn't. And he said, before

[27:40] you decide to do this for a career, you might want to see how it's done somewhere else. Oh, that's probably good in place. And so I ended up doing an array rotation pretty late in the schedule of things, but I think it was useful. I think in the current application environment, orthopedic applicants are almost

[28:00] expected to do about two to three away rotations. It's a good chance to learn more and see how orthopedics is practiced in a different place. It's also a great chance to be known and for you to know that program. So sometimes these are thought of as audition rotations, right? You know, you're showing up to do a good

[28:20] job and show what you're able to do. It is challenging when you apply for orthopedic residency and you're in a stack of 800 applications for three spots. But if you have worked with the people that you're hoping to train with before and they know that you did a really great job, that makes you a

[28:40] known quantity and so I think that's really helpful in the application process as well. And how important is research or scholarly activity to get into orthopedic surgery? I think you should have some. You know when you are thinking about your ARIS application you kind of want

[29:00] have something in every bucket. So you need to have good academics, right? You've done well with your medical school grades, you've done well in your M3 clerkships, you've done well on your boards, whichever ones that we have scores for. So you want to have a good academic profile. You want to have something that shows

[29:20] that you understand the research process. Right? You've participated in doing a research project. It also shows some grit and some stick-to-tiveness to finish a research project because we all know that can be pretty challenging. I don't think you have to do a full research year. Sometimes that idea is

[29:40] suggested to students as they're getting ready to apply. If you are really interested and you think you might want to be a clinician scientist and you really want to learn a lot more about research methodology or a certain area of orthopedics, by all means go for it. But if you don't actually enjoy research and you're just doing this because someone told you you have to,

[30:00] I don't know that that's the best use of a full year, especially if you're not going to receive a stipend or if you're going to kind of be a cog in a wheel and not necessarily be getting a lot out of it in terms of your own personal growth and knowledge. The last bucket is showing that you

[30:20] care about someone other than yourself. And so that could be super broad in terms of what sort of work you've done or organizations you've been involved in it. Ideally it'd be something that you're passionate about and maybe even had a leadership role in doing and that you've got some kind of long-term commitment to. But

[30:40] what exactly that service is could be anything that you're passionate about. Is there anything else you think that a student should or can do to be a competitive applicant? Yeah, I think some of these things are universal.

[31:00] You want to have a strong academic record regardless of what specialty you choose to go into. You want to have some community service and some leadership. You want to have some research. I don't know for orthopedics that your research projects have to be in orthopedics. You know, sometimes you've done a bunch of good work in other fields before you knew

[31:20] interested in orthopedics or just it was a cool opportunity and you learned a ton, I think that's fine. It is nice if you're doing work in orthopedics because of the people you meet and the relationships that you get to develop and that can kind of confirm your your interest in the field which I think can be helpful. But I don't know that in an

[31:40] has to be all orthopedic research all the time. If you could go back and do it all again, what would you do differently and what would you do the same and why? You know, I'm not sure there's anything in particular I would change. I was not very savvy about the

[32:00] process or how to do that and I benefited a ton from my classmates that were going into orthopedics and had a better sense of all the ins and outs of the application process and for sure from the guidance from mentors about things to consider and what you should be doing. So definitely admire

[32:20] people to lean on those around them. But I learned a lot through those processes that I think helped me get to where I am and kind of confirmed that I was on the right track. For me, this is a great career and I really enjoyed taking care of patients and being involved in education and I

[32:40] would I would choose it all over again. What is a career mistake that you've seen other physicians make? I think a common one in orthopedics is actually when you choose your first job, which is a little farther down the line than students choosing a specialty. But there are

[33:00] a lot of practice environments where you could be supported and have great partners and have it be a great experience. And there are a lot of practice environments that are not that way. And they need a more junior person to take all the call or to other things in a way that's probably not fairly distributed and you don't have a lot of support.

[33:20] So there and depending on where you're looking for your first job, the entity that's trying to hire you may offer you an obscene amount of money to take this job and it can be really enticing. But there are a large number of orthopedic surgeons who leave their first job. They stay long enough you have to pay for it.

[33:40] to practice in one place for a period of time to be able to take the second part of your board examination. So basically stay long enough, stick it out until you can finish your boards and be board certified and then look for another position. So I would say when you get to that point and you're evaluating jobs, think really critically about the structure

[34:00] of the place and probably most importantly about who your partners will be and if those are people that you are excited to build a career with and who will support you and help you be successful or not. What is something that you've seen another physician do well that has made you want to emulate this?

[34:20] You know, I have learned so much from other physicians and mentors who are master communicators. They're good at talking to patients, understanding what they're going through, teaching their patients so they understand what options are available to them. There are some surgeons that are just masterful at leading a team.

[34:40] We do that all the time in orthopedics. You have a team in the clinic, you have a team in the operating room, and how you take on those leadership roles and help the people around you grow and always be getting better and so that you function well as a group, I think is really important. And that's not necessarily

[35:00] necessarily a skill that is always taught directly in medical school. I think you can learn a lot by observation. But I've actually benefited from some opportunities to have like formal leadership training, which I think is really valuable and maybe not as emphasized in the middle of learning all the other things you have to learn.

[35:20] medical school. But they're for sure communication and leadership and teamwork kind of factor into the art of medicine that I think we all strive for. What is one thing that you're struggling with or lamenting about your career today and what are you doing to remedy it in

[35:40] And what would you encourage a medical student to do right now to help avoid this problem entirely later? Oh, I don't know if it's completely avoidable, but there's just not enough hours in the day. There's always more clinical care patients who need things that

[36:00] you're trying to get to and do a very good job. There's always educational things. There's always things for the national committees and societies that you're a part of. There's the all-important things that are happening at home with your family and your kids if that's part of your family that make juggling all those things

[36:20] really challenging. I suspect most if not all of the students are already really good time managers. You sort of have to be to get into medical school and to be successful. That's a skill that I'm always continuing to develop and try to make better. I think there's a lot to be said for

[36:40] long-term planning and being intentional about how you're going to use your time that can be really useful. I would say, you know, sometimes people talk about work-life balance. I don't know if there's an exact balance and I think it shifts over time and maybe work-life integration is a better term for that.

[37:00] It is easier once you're in practice and you have more autonomy over your schedule to decide when you will be doing things that are work related and when you're going to protect some time to take your kids to the first day of school or to go to the fifth grade concert or whatever it is that is important.

[37:20] important to you. And you just have to plan ahead. Our office manager needs 90 days if you're not going to be in clinic. So you're always looking at the school schedule, you're looking at the meeting schedule for the different organizations that you're a part of. You're thinking about that family reunion that you want to be a part of in the summer and all those things.

[37:40] You can usually make that stuff work. It just takes some planning ahead and coordination. It also takes a really incredible support system. And so in our family, my husband has much more flexibility with his job. And so he has been willing to use that flexibility to help do

[38:00] do the things that we need to do to get our kids fed and clothed and to where they need to be on time. And I'm incredibly grateful that he is willing to do those things to kind of make our make our life work. Everybody needs their village. However that looks for you. Yes, something I kind of struggled with is how do you

[38:20] spell orthopedics. Do you use an A? So I use the A and the reason I do that is orthopedics with the A, the root of that is straight child and that is the history of orthopedics, you know, helping kids with deformity.

[38:40] as opposed to just the E, which is foot. And feet are incredibly important and we do a lot of those in orthopedics, but I think that it's a bigger picture for the whole kid than just the feet. But I think it's technically acceptable to spell it either way. Okay. When I spell it on words

[39:00] document. I'll get a little squiggly if I use the EA. So thank you for that. That's wonderful to—I ignore all every document that I type. My next question is, do you worry about overexposure from interoperative X-ray as an orthopedic

[39:20] surgeon? Do you wear lead glasses? Because with radiation, with the eyes, cataracts can come up. What are your thoughts? So this is really important, right? I mean, there's occupational hazards regardless of what job you choose to do.

[39:40] But they exist for orthopedics and they're real. And so we're always, for ourselves, and teaching our residents about radiation safety, and you should wear a thyroid collar and an aplet apron that shields your trunk and at least the top half of your lower extremities when you are

[40:00] using fluoroscopy, you should be smart about where you're positioning yourself, where you're positioning the beam, where your hands are. The exposure drops off by the square of the distance, so it doesn't take much space to make the risk much lower. But you should certainly shield yourself. You should think about how you're using the tools at your disposal.

[40:20] actually cataracts are the only linear dose response for radiation exposure, right? Like all of the cancer risk and things, that's stochastic. But cataracts are linear, so you definitely should have lead glasses. And we wear eye protection anyway in the operating room, so having lead glasses is mainly a good thing.

[40:40] makes tons of sense. And I would encourage all of our residents to do that. And you could think about doing that as a medical student too. Our residents can use their professional development funds to invest in those things. But I think understanding what the risks are with whatever tools you're using or for

[41:00] physical parts of the job, thinking about your lifting mechanics, how are you moving a patient, how are you doing a reduction, how are you positioning yourself and using retractors during the surgery to protect yourself. Because there's things you can do when you're 20-something and young and strong that get a lot harder when you get older.

[41:20] And if you're planning to practice into your 60s or 70s, you're going to have to take care of yourself. What is one book, medical or non-medical, that you think every person pursuing a career in medicine should read? So I was thinking of a couple. I think

[41:40] Atul Gawande is an incredibly insightful person and has written a lot of great things. So his book, Complications, I think is worth a read, especially if you're going to be doing a surgical subspecialty, but really any career in medicine. You know, I think one of the really hard things about medicine is that complications happen regardless of how hard we

[42:00] try to prevent them and we try very hard. Always thinking what we can do to practice better and to be safer and better in our care. But someday you're going to be trying your hardest to take good care of somebody and you're going to hurt them and that is horrible. So having good partners and a good support

[42:20] network for that is really important. And I think things that you can read like Atul Gawani's book are helpful. I also think books that just take a step back and make you think about humanity and medicine are helpful. And so I was given a book called Kitchen Table Wisdom. It's

[42:40] by Dr. Rachel Raymond. But actually when I was thinking of applying to medical school, there was a physician in town who was willing to talk to me about what that might mean and gave me that book, which I thought was really helpful. And I think, you know, Tuesdays with Morrie is another classic Mitch Albohm book that is a great perspective read.

[43:00] Is there anything that you think that we haven't discussed or anything that you want to add that you think our listeners should know? I know I think orthopedics is an awesome field. It's so varied. You can take care of all ages of patients with all different kinds of problems and you can really make

[43:20] a lasting impact. And sometimes it's big and complicated and sometimes it's so simple. You know, I can do a series of plaster casts for a club foot, which, you know, takes a few weeks, but it wasn't that big of a deal. And that kid comes running into my office like every year for the next five years being a normal kid.

[43:40] That's pretty awesome that you can have that sort of impact on someone or help them get back to work or help them be able to play with their grandkids or whatever important thing is for them to function in their lives, which is an amazing privilege and a really cool thing to be a part of. There's also like a ton of ways to learn more.

[44:00] If there are students that have questions, we have all sorts of faculty in our department that are super willing to help and very accessible and same with our residents. I'm happy to meet with anybody. I do a lot. So if there are students that are thinking orthopedics might be pretty interesting or they have questions, please reach out to any of us.

[44:20] We're happy to talk and sometimes I think it's hard when orthopedics doesn't have a required M3 rotation. So sometimes it can be hard to know how to seek that out. But really, everyone in the department is friendly and happy to talk with you. So let us know if you have questions. Dr. Bovid, I really appreciate you taking the time.

[44:40] out of your busy schedule to talk to me. I hope you enjoyed the conversation with Dr. Karan and Bovid. For the resources and other tidbits that were mentioned in this episode, you can find them in the show notes on the WMED website, wmed.edu forward slash specialty spotlight. If you

[45:00] If you liked what you heard, please share this episode with your fellow medical students, especially if they're having some career anxiety. It truly is my hope that these conversations with physicians who've been there and done that will help you move forward with your own career choices. For any questions

[45:20] where if you'd like to reach out to me for any reason, which I encourage you to do, you can email me at brendatshaw at wmed.edu. But until next time, take care.

[45:40] you