Orthopaedic lifestyle is not appealing to young doctors

Cynthia Vezina
Canadian Orthopaedic Association

If you ask a ten-year-old what they want to be when they grow up, they likely won't say an orthopaedic surgeon. If you ask medical students what specialty they're planning to pursue after graduation, they'll likely not say orthopaedics. And, if you ask current orthopaedic residents if they're content with having chosen orthopaedics as their specialty, they actually might tell you that they're not. Orthopaedics is becoming less and less appealing to young med. students and residents and the big bad monster that is scaring everyone away is unanimous: lifestyle.  

There are increasing factors making orthopaedics a less than savory career choice for young doctors. Poor remuneration, high work load, heavy call schedules, high liability, limited access to resources and OR time and far too much evening and weekend work do not seem to be the lifestyle that today's young doctors are looking for. The evidence that there seems to be a fleeting interest in orthopaedic surgery is becoming painfully obvious.

After this year's first iteration of the Canadian Resident Matching Service (CaRMS) process, eight orthopaedic residency positions were left unmatched. After the second iteration, one spot remains unmatched. For the first time in over 20 years, there were more positions available than there were applicants interested in trying to fill them. The statistics offered on CaRMS web site show that unmatched orthopaedic positions have not been a running trend in past years. Though some programme directors are crossing their fingers hoping that this year's situation is an isolated case and the unmatched spots are strictly programme based, many do fear that we might be faced similar results in the future.

The COA's own numbers show that our membership is aging. The average age of an active COA member is 49 years old. In the year 2001, we'll have approximately 267 members who are over 65 years old. This year's lack of residency applicants, coupled with the fact that in the past four years, several training programmes have lost an average of one to two orthopaedic residents to other specialties, indicate that the orthopaedic profession is not being replenished by enough young surgeons.

The majority of Canadian programme directors agree that the lifestyle associated with orthopaedics is not appealing to young doctors. According to Dr. Daniel Squire, Programme Director at Memorial University in Newfoundland, "medical students are more aware of the imbalance between orthopaedics and other specialties in the financial rewards for the workload required." This financial imbalance can greatly affect what kind of career they end up choosing.

Hard work for little pay is only one of the unpleasantries now associated with an orthopaedic lifestyle. Limited resources and the battle for OR time aren't very inviting to young doctors either. Dr. Cecil H. Rorabeck points out that "orthopaedic cases continually get bumped by 'more urgent' cases" which leave orthopods performing all too many mid night procedures. The lengthy waiting times that patients are asked to endure for orthopaedic procedures is also a deterrent from this specialty. This lack of resources is making it increasingly difficult for anyone to do their jobs. Practising orthopods have grown frustrated and understandably can't sugar coat the situation for their med. students and residents any longer. "Having adequate resources to do our work would be a good start (to remedy the situation) as it would stop us from complaining all of the time, which, I'm sure, some students find discouraging," states Dr. William Dust, Programme Director at the University of Saskatchewan.

"The lifestyle of work in a particular specialty is an important factor along with the clinical and scientific aspects of a residency," states Dr. Vincent Gabriel who was seriously considering orthopaedics during his 3rd and 4th year of medical school but chose and matched to another Royal College specialty in the first round of the 2000 match. "Orthopaedics has a reputation of being a demanding specialty because of the combination of dexterity and determination required to be a successful orthopod." Young surgeons today want something of a life outside of their medical careers.

Lifestyle was the number one factor why one resident (who prefers to remain anonymous) recently chose to withdraw from an orthopaedic training programme. A better lifestyle is being offered by other specialties that orthopaedics cannot seem to compete with. "Less work from a time commitment point of view without significant financial penalties makes any specialty more alluring to today's med. grads," he claims.

Whether this year's unmatched residency positions is an isolated case or not, solutions are necessary to better the lifestyle for today's and tomorrow's practising orthopod. "Increasing remuneration, increasing OR time and lowering the amount of administrative work" would potentially improve the lifestyle of Canadian orthopods according to Dr. Michael Tanzer, Programme Director at McGill. Another potential solution that hospitals could offer, as Dr. Rorabeck points out, is orthopaedic extenders. "Orthopaedic extenders, which are, in effect, an expanded role nurse" could assist the over-worked orthopod by lifting some of the burdens of paperwork, discharge planning, ER visits etc. The Canadian Medical Forum (established through the Canadian Medical Association) is working around the clock at trying to resolve the physician shortages all specialties are facing in this country (see COA Bulletin #52 pg. 17).

Perhaps another solution could be simply a question of better exposure. Dr. Rorabeck points out that the applicant pool from the University of Western Ontario has definitely declined since orthopaedic surgery was lifted from the clinical clerkship's mandatory requirements. These students are "not getting exposed to orthopaedic surgery except through lectures and seminars" which Rorabeck thinks might one of the culprits behind the drop in applicants that Western has seen in the past two years. Proper exposure early on in the curriculum could very well raise interest in the specialty. "I think that a wider range of medical students may be drawn to the specialty if a broader exposure to orthopaedics was presented in the curriculum that included metabolic bone diseases, malignancies biomechanics and paediatrics for example," says Gabriel.