The hardest part of being an orthopedic surgeon


Being an orthopedic surgeon is far from easy — the job is filled with tough calls and hard truths. 

Five orthopedic surgeons connected with Becker's to answer, "What is the hardest part about being an orthopedic surgeon?"

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

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Please send responses to Riz Hatton at by 5 p.m. CST Thursday, Nov. 30.

Note: These responses have been lightly edited for length and clarity.

Aimee Hachigian-Gould, MD. Orthopedic Surgeon (Ulm, Mont.): Dealing with the sometimes not so hidden misogynistic mentality of "The Old White Boys Club" for nearly 40 years. Although I knew it was there when I decided to become an orthopedic surgeon, I always hoped the situation would improve faster than it has. Hopefully, it will get better with the next generation of orthopedic surgeons. Conversely, during my residency in Michigan and while practicing here in Montana, my patients never seemed to care about the gender of their surgeon, and I will forever be grateful to them for their trust and acceptance.

Laura Keeling, MD. Orthopedic Surgeon at the Centers for Advanced Orthopaedics (Bethesda, Md.): To me, the hardest part about being an orthopedic surgeon is the process of dealing with a complication or an undesirable outcome. One of the central tenets of orthopedics is returning patients to their desired level of function, and it can be devastating, both for the patient and the surgeon, when this outcome is not achieved. We are trained and make every effort to avoid complications, but recognize that they are — at times — inevitable. That doesn't make it any easier when they occur. In many cases, the instinctive reaction is to withdraw from the situation in an effort to lessen the fear or embarrassment that it engenders, which is, of course, detrimental to the patient, and to the patient-physician relationship that we as private practitioners value so much. One of the hardest things to do as a surgeon is to take ownership of an undesirable situation, comfort the patient, and coach them through the process. It is also one of the most valuable things a surgeon can do and is the mark of a truly invested and compassionate physician. Orthopedics is a challenging field, but a rewarding one for those who remember that their ultimate duty is to the patient.

Anthony Melillo, MD. Founder of Bay Oaks Orthopaedics & Sports Medicine (Houston): That is a difficult question, since orthopedic surgery encompasses an eclectic body of work and responsibilities. For me, emergencies are the most demanding part of the field. Orthopedic surgeons are very busy with routine and elective duties: office consultations, fracture management, joint replacements, arthroscopic procedures, etc. These demands on our time can usually be scheduled into our long days from Monday through Friday. However, orthopedic emergencies take priority. They usually happen after hours, weekends, holidays and/or in the middle of a packed week day. Management of these emergencies requires an all-hands-on-deck mentality. Your office staff needs to clear your schedule; the hospital staff needs to provide operating room services; your family needs to be understanding and flexible; and you need to be calm. You have to be able to muster up energy if fatigued; get knowledgeable if unfamiliar with an emergency; and rely on your training and experience. Thankfully, I don't take ER calls anymore, so most of these challenges now fall to younger orthopedic surgeons.

Brett Shore, MD. Orthopedic Surgeon at DISC Sports & Spine Center (Marina del Rey, Calif.): While the practice of orthopedic surgery has numerous challenges, at our core we are pain and function doctors. The hardest thing about being an orthopedic surgeon is that we sometimes see patients with pain and/or functional limitations that we cannot make better. In my practice, the most difficult (and often the longest) patient encounters are with patients that have chronic, debilitating pain that does not have an effective surgical solution. These encounters can feel frustrating and pointless once we identify that their problem does not have an orthopedic answer, but in these situations we can help our patients by being empathetic humans rather than problem-solvers. Those in our profession are almost universally fixers, but we must accept that sometimes we cannot fix our patients' problems, and the best that we can do is to sit with them and bear witness to their pain.

Matthew Siljander, MD. Orthopedic Surgeon with Hoag Orthopedic Institute (Newport Beach, Calif.): Orthopedic surgery is a very rewarding yet challenging profession. Perhaps the hardest part of being an orthopedic surgeon is the constant urge and pressure to keep giving more. It can become too easy to add another five patients on in clinic, another elective case on in surgery, dictating notes and bringing work home, after-hours meetings, going to that extra conference, teaching that extra course, missing that family event because of that add-on case on the weekend, answering patient calls at all hours, and the list goes on. Orthopedic surgeons are constantly on-call in some fashion. In a profession where we consistently and daily improve the quality of life of others, this can too easily come at a sacrifice of our own.

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