Aaron Brandt, MD | Cara A. Cipriano, MD, MSc, FAAOS | Bonnie Gregory, MD | D. Joanna Kim, MD | Liana J. Tedesco, MD
August 25, 2023
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Members of the Sounds From the Training Room Consortium will be giving readers a peek into their daily lives as busy surgeons. Here are some stories from a few members – stay tuned for more!
Learn more about the Consortium here.
Aaron Brandt, MD
Approaching 2 years in and my days have never been the same, which has been both challenging and amazing. Like any stage in this process, our day to day is often out of our control. As an attending, we become the boss, right? Well not quite. Don’t worry, you do gain more control over your schedule; but that control comes with responsibility and deciding where you put your time and energy has become even more critical.
I am a pediatric orthopaedic surgeon, so my weeks are more clinic heavy than many other subspecialties. I usually have 2-3 days in clinic, but clinic days do provide more predictable hours. I see children of all ages and even young adults, so there is good variety and it is always lively. I am in the OR at our trauma center or community hospital 1-2 days a week. Trauma call is where things are unpredictable and just this weekend, I was in the hospital from 6 am until 4 am the next day operating. Outside of my clinical responsibilities, I am involved in education with our residency and medical school. I also hold a few leadership positions at the hospital and in organizations which require a few hours of time each week.
Cara A. Cipriano, MD, MSc, FAAOS
My day starts early, though not as early as it did when I was in training. Now, post pandemic, most of our morning meetings are virtual, so I leave for work at 6 AM on OR days. On clinic days I see my four-year-old daughter before leaving around 7 AM, and I try to pick her up from daycare once per week. My practice as an orthopedic oncology and adult reconstruction specialist allows me to work with a wide variety of patients and pathologies. However, being in academic medicine, my job involves much more than patient care, and every day is different. Before, during, and after clinical activities, I carve out time to give lectures, work on research, and take care of administrative duties. In addition to training residents, I am the Director of Undergraduate Medical Education for our department, which means I oversee our efforts to teach and support students throughout their time in medical school. I often meet with students about potential interest in orthopedics, getting involved in research, plans for applying into the field, and other advising matters. Occasionally I stay at work late to finish a case, participate in a resident journal club, or help with an event for the orthopaedic student interest group. However, these activities need to be balanced against having dinner with my family, reading to my daughter, or making it to the gym for an hour. One way or another, everything seems to get done – but not all in the same day!
Bonnie P. Gregory, MD
As an early-career, academic sports medicine surgeon my days are filled to the brim with clinical responsibilities, team physician duties, academic and leadership commitments, and research endeavors. If it sounds like a lot, it is! Like every orthopedic surgeon, I spend most of my week in clinic and the OR treating patients who come to see me for their acute or chronic injuries, many of which have nothing to do with sports.
However, a lot of my time is also spent caring for athletes, as I work as a team physician with two professional sports teams, a Division 1 university, and a large area high school. This care includes being on the sidelines of games in case of injury, weekly training room (i.e. clinics on-location with just athletes from those teams), and generally being available to the athletic training staff for injuries that arise during practice or on the road. My academic commitments include sitting on several departmental/system committees, as well as a few national subspeciality society committees. Teaching is another big aspect of my academic role, as I often have medical students, athletic training students, physical therapy residents and fellows, orthopedic residents, and sports medicine fellows with me in clinic/OR and on the sidelines, as well as giving lectures/grand rounds. Finally, I squeeze in research and writing when I can!
D. Joanna Kim, MD
As a PGY2 on night float (my shift starts at 6:30PM), my schedule is a bit different from everyone else’s on this blog. This is an example of what my day looked like one day in August 2023:
4:30PM: I wake up and head straight to the gym. Despite it being technically 4:30AM for me (aka my days and nights are changed), the gym is packed full of students/residents finishing up their day. After a quick workout, I head home to shower and get ready for work!
6:30-7PM: Sign-out time. I receive my daily sign-outs from the day team. I familiarize myself with all orthopedic patients that are in-house – what happened during the day, any to-dos (compartment checks or overnight lab results).
6:30PM: I am signed into the pager (I cover both adult ED and children’s ED), and answer all consult questions from this point forward. I always prioritize/triage based on urgency (i.e. septic knee and compartment syndrome consults are more urgent/emergent consults to see).
7:30PM: I see couple consults in the adult emergency room. For one patient, based on labs and clinical presentation, I am concerned about a septic knee. I proceed with aspiration and run it up to the lab. I have a notification on my phone to go off when the lab result is ready (streamline everything!)
8PM: We have a both bones fracture in the children’s emergency room. I coordinate with the emergency department for a conscious reduction of the forearm. There are a number of coordination links between orthopedics, emergency room physicians, nurses, child life, pharmacy and XR techs for these types of consults. I loop everyone in so that we can coordinate a time that works best for all of us.
9PM: Couple more consults come in from the adult emergency room – a felon, a tibial plateau fx, CMC dislocation, femoral neck fx and distal radius fracture. Since most require procedures, I communicate with the ED to coordinate meds/imaging/procedures. I first see the patient with a femoral neck fracture and get labs and XRs going for a full workup. I then go to reduce the CMC dislocation, place them in a cast with a nice dorsal mold. I then perform an I&D of a felon, which expressed gross purulence; I send cultures off to lab and place wick in for drainage, advise patient to follow-up for a wound check. For my tibial plateau fracture patient, I place them in a bulky jones dressing and get them going for a CT, while I head over to perform a closed reduction of distal radius fracture.
11PM: At the children’s hospital, the patient, staff, myself, and ED are ready for the reduction. We always wait our emergency department colleagues to time out their first part of the procedure (conscious sedation), and I perform my reduction afterwards. We are blessed with amazing staff here, so someone always volunteers to help hold countertraction during a reduction maneuver and hold the arm in 90 degrees during long arm cast placement. I remind myself to get them a snack one day for all the work and coordination they do.
1AM: I grab a quick food break – it still feels weird having “lunch” at midnight.
2AM: After all procedures are performed, I sit down to check in on both inpatients and consult patients. Are labs back? Post-reduction XRs? CTs that are pending? I go through charts and start working on documentation.
4AM: All my notes are done by this time; I sit down for a sec to work on emails and do some orthobullets questions (if I have time).
5AM: Morning team starts to come in! Always good to see familiar faces after a night alone. My co-residents are so great, and I am blessed to be working with such a wonderful group of people.
6AM-8AM: There is learning/morning conference daily, whether it is fracture conference or trauma rounds (I present all my fractures and reductions here!).
9AM: I head home to have breakfast (?) / dinner (?) and head to bed!
Liana J. Tedesco, MD
The day starts early! I wake up at 5 AM most days to start my routine of breakfast and, more importantly, coffee! If there is time, I will head to the gym to get some exercise in. I am typically out the door by 6:30AM. On my commute to the hospital, I will review cases for the day, read a chapter in Green’s operative hand, or catch up on emails. Once a week, we have our educational conference, where we discuss topics in hand surgery, review pre- and post-operative cases, discuss new research ideas or ongoing projects. As a fellow, I am responsible for preparing case presentations and generating new research ideas.
Once we finish this, it is time to head to the operating room or the clinic. There really is no such thing as a typical OR day for hand surgeons as the breadth of pathologies is wide, but there is always a great mix of bony and soft tissue procedures. Most commonly, we will do carpal tunnel releases, trigger fingers, phalanx/metacarpal/distal radius fractures. Sometimes, we will do free flaps for lower extremity soft tissue defects, silastic arthroplasty for rheumatoid patients, or tendon/artery/nerve repairs in patients who have sustained gunshot wounds to the upper extremity. Between cases, I am taking notes on the cases – always at least one pearl.
If it is a clinic day, I will work closely with an attending in their office. We will see new and follow up patients with a variety of hand and upper extremity pathologies. This is a great time for me to hone my physical exam skills, learn about non-operative management, and sharpen my understanding of surgical indications. For hand and upper extremity surgeons, the clinic is also a time to perform injections, whether it be for trigger finger, CMC arthritis, or TFCC injuries. Always a busy day, the clinic is a critical part of training and I always learn something new.
When all the patients have been seen and the operations completed, I head home to see my family. On my commute, I will read up on the following day’s clinic patients or OR cases. Once I am home, I take a real break. I will have dinner with my husband and daughter before going for a walk in our neighborhood. Once bath and bedtime are complete, I will finish reviewing for the following day or work on research before heading to bed. A day in the life of a fellow is busy and it seems impossible to get it all done, but diligent planning has been key. To make it work, I try not to be too hard on myself if something isn’t complete. At the end of the day, I love my job and my family, and these things need to take priority!
DISCLOSURES: Dr. Brandt This individual reported nothing to disclose. Dr. Cipriano KCI: Paid consultant, Link Orthopaedics: Paid consultant, Musculoskeletal Tumor Society: Board or committee member. Dr. Gregory This individual reported nothing to disclose. Dr. Kim This individual reported nothing to disclose. Dr. Tedesco This individual reported nothing to disclose.
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