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Ask the Resident: Orthopedic Surgery

Ugonna Ezeh, DO, is a first year resident in MountainView Regional Medical Center’s new orthopedic surgery residency program. He answered some of the BCOM students’ questions about what it really takes to be an orthopedic surgeon.

What are the hours really like in an orthopedic surgery residency program?
Expect long hours. It can be brutal physically and mentally taxing, but it’s also very, very rewarding. You have to be flexible in order to fit into this type of program. With something like internal medicine, you might have a set number of patients to see. With orthopedics, a two-hour surgery could easily become four hours. You just have to go with it.

How much time do you spend in clinic versus surgery?
There are a set amount of hours we have to spend in each according to standards laid out by the Accreditation Council for Graduate Medical Education. The idea is to balance it out as much as possible. Currently in my first year, I probably spend 60 percent of my time in surgery and 40 in clinical.

When did you know that this was the specialty you wanted to pursue?
When I first started medical school, I considered internal medicine. Orthopedic surgery came up down the road when I started my third year and began doing my clinical rotations and walking with different specialists. That’s when the appeal of orthopedics started to grow. Cardiology was also in my top three, but by the time I’d finished medical school I was set on ortho surgery.

What advice do you have for medical students hoping to match into an orthopedic surgery residency?
It’s the entire package, but I think the most important ingredient is a desire deep down in your heart to be an orthopedic surgeon. You have to forget about the financial compensation that comes with it, forget that it’s one of the top paying specialties in the country today and just be in love with orthopedic surgery. To gain that appreciation, you have to get some experience by walking with surgeons and shadowing. So that’s number one, but you also have to be hardworking and stay awake for long hours. Academic performance is of course going to play a huge role in matching successfully. Do your mandated clinical rotations every month and do them well. Excel in them and get very good letters of recommendation. Board scores matter too, and your own personal statement that really attests to what you want to do and why you want to do it. Above all, you’ve just got to be true to yourself.

What types of clubs or volunteer work were you involved in?
When I was in medical school, I helped set up an anesthesiology club, something completely unrelated to orthopedic surgery. I was one of the founding members. We set it up and helped run it for the whole four years of medical school and handed it over successfully to the newer students. I also did a lot of volunteering in the community. We had so many events that we ran trying to raise funds that we’d give out to the less privileged in society and to create awareness about the school.

What are the downsides to orthopedic surgery?
Just like any surgical specialty, you should be prepared for the unexpected. The patient outcomes might not be as desired as you’d hope them to be. Of course, the work hours can be long and if you have a family attached to that then you have to figure out how to manage it all. It can be grueling physically and mentally. You have to always be up to date on what you’re doing. You have to study a lot, pretty much every single day.

Do you see yourself going into private practice?
That’s difficult to say right now because the operating environment changes day-to-day and year-to-year. Definitely there’s going to be an element of private practice, especially since I’m thinking of a small to medium sized city as a practice location. Having said that, if I look at my mentor, Dr. Romanelli, he has a private practice and he also has a surgery center. That’s certainly in the picture.

How are you preparing to run a business?
That’s a very, very important aspect of medicine, and there’s definitely been a deficit in physicians who also have that business acumen. It’s something that I intend to focus on when I’m studying for my fourth and fifth years of residency. I’m planning on taking a self-led, program-driven curriculum that introduces that business element. As the end of the day, yes we want to care for the health of our community, but there’s a business aspect that you cannot ignore no matter how charitable you want to be. It has to make business sense, so yes, I plan on introducing that curriculum into my learning.

How do you manage patient pain levels without the over prescription of opioids?
When someone is in pain, there has to be a generator of that pain—a cause. Most pain medications are just there to manage the symptoms, but the source of the pain is still there. It’s like putting a Band-Aid on a leaky tire—you have to change the tire to fix the source of the problem. If you don’t fix the pain generator, no matter how much opioids or narcotics you throw at them, it’s just a matter of time before they get used to them and it becomes ineffective. So, we need to re-educate our patients by letting them know that we can give pain medications to manage things in the temporary setting, but until we address the key factor that’s causing the pain, they’re never going to get better. We also have to manage that expectation. There are some pain generators that you will never be able to treat completely. It’s all about moderation and being realistic about expectations, and you need to share that with your patients clearly at the start of treatment. Figure out expectations and how can you meet them. Can you meet them halfway? Can you meet them fully? You have to compare that with the technology and knowledge that you have available. You have to keep your patients informed from the get go and every step of the way so they don’t feel disappointed.

What is the current attitude towards women in orthopedics?
To be frank, from my experience doing rotations in several programs across the country and from interaction with both female and male candidates, I still think there’s a huge discrepancy in the way women are treated in orthopedic surgery. It is program specific however. There are some programs that are female friendly. There are some that don’t care what you’re gender is and some that actually discriminate against females. It’s certainly an outdated mentality, but discrimination does still exist. I think that wall is being broken gradually. I can attest that the MVRMC program is gender neutral. It doesn’t matter whether you are male or female. As long as you’re ably qualified, you’ll fit in quite nicely.

Is it true that you have to have special hands to be an orthopedic surgeon?
I’ve heard about that. I don’t think that is a 100 percent requirement. More so, you need to have a steady mind to start with. The hand finesse, the skills that you need for surgery, you will develop those over time. Some people are naturals, but I’m of the philosophy that you can develop any skill that you want as long as your mindset is there. If you do have a physiological issue that makes your hands shake, then that’s a different issue. But otherwise, I think you can learn it and master that as a skill.

What’s the best advice you would give to first year medical students?
I would just remind them of the reason they actually went to medical school. They should remember what they put in their letters of intent and what their aspirations are. Remember that it’s the patient first and that the patient is an entire unit. Whether you’re an orthopedic surgeon, a cardiologist, a pulmonologist, you’re treating one person as a whole individual. Don’t just focus on the bone and forget everything else. Also, humility counts. Hard work counts. Focus on your academics the first two years, get the good grades. Maintain your relationships with your attendants and your fellow students, and build your resume from there. If you do that, I think at the end of the day, you’ll do pretty well in whatever specialty you want to go into.

Ugonna Ezeh
Orthopedic Surgery Resident
Born and raised in Nigeria, emigrated to the United States in 2009
Medical School: Philadelphia College of Osteopathic Medicine, Georgia Campus,
Suwanee, Georgia
Medical School Awards: PCOM Board of Trustees Merit Scholarship
Member: American Osteopathic Association
Georgia Osteopathic Medical Association
American Medical Student Association
Student American Academy of Osteopathy
American Academy of Family Physicians
Radiological Society of North America
American Urological Association
American College of Physicians
Anesthesia & Critical Care Medicine Interest Group – founding member, served as
Volunteer work: Rainbow Village Thanksgiving Dinner Organizing Committee, Gwinnett County Community Health Fair, ”Lift Up Atlanta” Homeless Shelter, GA-PCOM International Medicine Club, ACCMIG Hemodynamics & IV Fluid Management workshop, ACCMIG Bake Sale Fundraiser Committee, ACCMIG Airway Management & Intubation workshop, ACCMIG Operating Room Simulation tour, ACCMIG Patient Monitoring workshop
Hobbies: Playing soccer, investigative journalism, war history (WW2), lost civilizations, astronomy, the role of material science in medicine