Professional Development Goals to Pursue at Various Stages in an Orthopaedic Career

 

  • Medical Student
    • Practice
      • Shadow: spend time with surgeons in the office and OR
    • Academic
      • Study, focus on task – performing well on USMLE Step 1 is critical, “goal” score changes year to year
      • Work hard, be savvy – M3 clerkship grades are critical for your residency application. Shelf exams vs evaluations. Learn how you are graded.
      • Pick M4 rotations wisely – go to places you’d want to match.
      • Residency Search: go where you can excel
      • Volunteer – hospital clinics; go to OR in free time to help out. It will be remembered.
    • Research
      • assist or own project – don’t start what you cannot finish
    • Advocacy
      • It is never too early to understand how politics will influence your profession and your livelihood. Learn about issues that will affect you and your patients.
    • Leadership
      • Join the interest group for the specialty(ies) that interest you
    • Networking
      • Discover what you want to do/enjoy
      • Assist with Residency applications - ask people to read these!
      • Find Mentors, advisors, champions
      • Apply to RJOS mentorship program and medical student scholarship program, seek other mentorship programs
    • Family
      • Do what is best for you and your situation
      • Don’t let others dictate when you should be single/family/married/have a family/etc
      • Understand the overall effects of your decision and choose what is best
    • Financial
      • Be as frugal as possible
        • Use the least amount of loans as possible – this will make a huge difference in your long-term stress and financial health
        • Minimize eating out and purchasing unnecessary things
          • Eg: Buy internet not cable unless there is a promotion where cable is cheaper to have than not have, etc
      • Save up as much as you can
      • Minimize credit card debt (interest rates are much higher on credit cards than student loans)
      • Consider consolidating your student loans, especially if planning to repay them in full (vs Public Service Loan Forgiveness (PSLF) program – see “Resident – Junior (PGY 1-2)” Financial section for more details).
        • Review interest rates and compare to federal rates
        • Likely more beneficial for private student loans, but can have a huge impact on public or private loans depending on situation, loan amount taken, and offered interest rate 
  • Resident – Junior (PGY1-2)
    • Practice
      • Specialty search – begin thinking about which specialty you’d like to pursue (if you want to specialize)
      • Consider requesting instruction on business management from your attending in weekly conferences     
      • Attend specialty conference of interest; Present research at conferences
    • Academic
      • Study – read and prep for cases; take notes after each case to remember the technique. Learn how to be an excellent assistant
      • Patient care – comes first, no matter what. Own each patient. Don’t pass off
    • Research
      • Develop own project or 2 (esp in subspecialty field of interest; can use research to help you learn about different subspecialties in more detail)
      • Identify relevant or interesting conferences and find deadlines to help create timeline for longer term research goals
      • Submit abstracts to meetings
        • Present at conferences (allows going to conferences which makes networking easier/cheaper when project is accepted)
      • Seek grants for residents (e.g. OREF, RJOS, POSNA microgrants for research funding or travel)
        • Many subspecialties also offer resident grants (e.g. AANA), which will often cover the cost of attending the meeting and allow attendance at some instructional course lectures, as well as some resident-specific events
    • Advocacy
      • Join the AAOS PAC. Learn about issues that will affect your profession and livelihood. Do advocacy locally and at the national level.
    • Leadership
      • Get involved in your state society. Lots of networking available.
      • Explore leadership opportunities in your residency, your home institution, and through the AAOS or state society
    • Networking
      • Develop relationships with possible mentors in different subspecialties to discover what specialty/practice type you want to do/like
      • May help with fellowship applications
      • Develop relationships with senior residents that are planning on entering the type of practice you envision and stay in touch!
      • Consider getting involved in AAOS or RJOS committees or local medical societies
    • Family
      • Do what is best for you and your situation
      • Don’t let others dictate when you should be single/family/married/have a family/etc
      • Understand the overall effects of your decision and choose what is best – Especially in terms of the physical/mental/emotional stress of primary call
      • Best not to make too many major life changes at one time (eg new job, moving, marriage, kids, etc)
    • Financial
      • Seek scholarships for international or domestic clinical experiences like mission trips (Health volunteers overseas) or conferences like AAOS resident arthroscopy course, RJOS meeting
      • Consider various Loan Repayment Plans
        • Pay As You Earn (PAYE) – tends to be lowest monthly payment but interest still accrues (best choice if going for PSLF) – 1st year of payments are $0 if income was $0 the previous year (ie most 4th year med students don’t make any money)
        • Income-Based Repayment (IBR) vs Standard repayment (best if trying to pay off loans on own and have the money to afford the monthly payments)
        • Public Service Loan Forgiveness (PSLF) – work for 10 years in a government or Not-For-Profit organization (eg children’s hospital, Academics, etc) and the rest of your loans will be forgiven after the 10 years (120 qualifying payments) up to a specific amount
        • Consolidation of loans to maximize the lowest interest rate to minimize overall repayment
        • Deferment during residency (if needed – not ideal, but many need to on a resident’s salary)
        • Forbearance (ideal to avoid if possible)
        • Talk to a financial/tax advisor for more details 

  

  • Resident – Mid/Senior (PGY3-4)
    • Practice
      • Update and organize your CV
      • Fellowship applications
        • Start the process early
        • Letter of recommendation – ask people who you know can write you a strong letter. If more than one resident in your program is applying for the same field, coordinate letters so that you don’t all have letters from the same faculty, thus forcing the faculty to “rank” you.
        • Research programs ahead of time - fellowship is for you, what fits you best?
        • Talk to faculty and residents who have just gone through the process
      • Job applications (usually begins after matching into fellowship, but can’t ever start looking too early, especially if you have particular regional needs)
        • Don’t hesitate to send cover letter and CV directly to department chair/division head or whoever else is in charge of the practice for places where you are interested
        • Don’t rely only on positions that are posted in journals or on-line; many job opportunities are word of mouth and are unadvertised
    • Academic
      • Study – you should be proactive in templating and planning for cases. Present your plan to the attending, ask for feedback.
      • Draft a 5- and a 10-year plan. Where do you want to be in your practice? Learn about how promotion works in academic departments.
    • Research
      • Publish and continue more studies/projects
      • Academicians have recommended publishing as high as an avg of 1-2 project(s)/year in residency to be competitive for academic fellowships and careers
      • Private practice minded residents may focus on only publishing 1-2 projects in residency to still assist with fellowships & career (and exposure to research in case want to continue in private world)
      • Consider applying for the Clinician Scholar Development Program (CSDP) if interested in doing research during your career
        • Available to PGY 3 up through faculty in first few years of practice
        • Application usually due in March; program is in September annually in Rosemont, IL
    • Advocacy - get more involved. Consider AAOS and other policy fellowships.
    • Leadership
      • Engage in Committees (eg State Society, RJOS, AAOS Resident Assembly, National Orthopedic Leadership Conference [NOLC])
        • Also consider seeking out opportunities for resident involvement in specialty society committees, advocacy
      • Pearls: show your interest, be willing/ready to work, respond quickly & with good quality responses.
        • Helps teach leadership skills
        • Exposes you to different aspects of an Ortho career you may enjoy
        • Aids in Networking
    • Networking
      • Discover what specialty/subspecialty/practice-type you enjoy most
      • Assists with fellowship applications
      • Assists with creating/finding Job opportunities
      • Meet Mentors and develop Mentor-Mentee relationships
      • Attend Specialty conference to learn & Network
    • Family
      • May be a good time to have a family depending on social situation and residency responsibilities. Some residencies are very heavy front-loaded allowing more time in the more senior years that can be beneficial when trying to start a family during the insane training years.
      • Pro: less likely to take time away from starting your practice when leave may financially cost thousands in overhead every week; during peak childbearing years (eg before advanced maternal age/High-risk at 35y+)
      • Con: you don’t control your time or schedule as a resident and this can get very difficult depending on the support of your Chair/PD/Program/Co-Residents
    • Financial
      • Continue living frugally to cover loan repayments and saving up for Interviews for fellowship &/or jobs
      • Ensure have disability/life insurance if you have a family
      • If able, start an IRA or other retirement account – Ask financial advisor for more details 
  • Resident – Chief year
    • Practice
      • Job Applications
        • Start applying, interviewing, and working through some contracts if promising positions arise
        • If doing a fellowship, interviewing for jobs during residency can allow you to preserve fellowship to learn specialty and not take a lot of time away for job interviews
          • Invariably you will be spending a good portion of the year searching and/or fine-tuning job opportunities
          • Additionally, some practices will begin paying you a stipend during residency/fellowship to have you sign early (ie before training completed)
        • On the other hand, waiting for fellowship to start before signing allows fellowship directors, who may have a lot of impact in assisting you getting a certain job of choice (esp in academics), to help you and vouch for you
          • Most people will secure a job during their fellowship
        • Be aware of annual printed statistics MGMA on compensation, which likely live in HR department of your hospital. BORROW this and copy relevant pages to your subspecialty and region.
      • Apply for secondary fellowships or alternative fellowships
        • 1-6mo fellowships overseas or with sub-subspecialist of choice
        • 6-12mo special fellowships (eg Research fellowships, Leadership fellowships, SRS, RJOS, Academy, etc)
        • Pediatric subspecialties are trending toward dual fellowships in major centers
      • Technical
        • Collect specific information on equipment from residency before you go, including info from surgical coordinators on trays
        • Get info from reps on how to get specific industry sponsored training on devices (sports labs, hexapod frames, etc)
    • Academic
      • Study and Pass Boards
        • Register early in chief year – your program will not do this for you
        • Try to attend one review course (AAOS, Miller, Maine, etc)
    • Research
      • Complete and submit projects from Residency: allows fresh slate & more time for new projects during fellowship
      • Contact fellowship to start deciding on project to increase likelihood of finishing 1+ projects during the 1 year time frame
    • Advocacy - get more involved. Consider AAOS and other policy fellowships.
    • Leadership
      • Administrative Chief
        • Develop leadership skills of guiding fellow orthopaedists and coordinating a group of people’s needs & wants, as well as balancing what is best for the individual and the group.
        • Gain insight into the academic world of how a department runs
        • Gain insight into the private world of working as a leader of a group to protect needs of individuals and of the practice as a whole
    • Networking
      • for Jobs, Second Fellowships, Committees, Mentors
      • Committee & Organizational involvement
      • Attend AAOS/RJOS and Specialty meeting(s)
    • Family
      • Be aware of needing protected time to study for Boards
    • Financial
      • Update PSLF annually (if wanting to stay on track for loan forgiveness)
      • Big Expenses to expect: Boards, Moving to Fellowship/Job, recertifying/obtaining DEA, new state licensure if moving to a new state  
    • Fellow
      • Practice
        • Job – decide & sign contract
        • Do as many cases as possible, especially in your “weak” areas. Once you are out in practice, opportunities for supervision and assistance are not as good.
      • Academic
        • Study & Learn Subspecialty
          • Take more notes than you will ever think necessary
            • Images for presentations
            • Equipment info
            • Surgical technique notes
            • Positioning/Room set-up
      • Research
        • Complete 1+ project and submit within the 12 months
        • Some programs require 2-3 projects worthy of submission in that time frame
        • If entering Academics, the more the better
        • Consider applying for the Clinician Scholar Development Program (CSDP) if interested in doing research during your career
          • Available to PGY 3 up through faculty in first few years of practice
          • Application usually due in March; program is in September annually in Rosemont, IL
      • Advocacy
        • Continue being involved with advocacy efforts
        • Engage residents to participate in advocacy and invite them to join you at NOLC, AAOS, Ortho PAC
      • Leadership
        • Committee & Organizational Involvement
        • Consider becoming a reviewer for a journal
          • Information for those interested is available on-line
          • Consider sub-specialty journals
      • Networking
        • For Jobs, Committees, Mentors
        • Mentor a Mentee (medical student or resident)  
        • Family
          • If have family (children and spouse): determine if spouse accompanying you to fellowship and if so, what job they may want/need (including staying home with kids to save on daycare/nanny costs)
        • Financial
          • Expected Expenses: Moving to Job or second fellowship, practice start up fees/costs 
  • Early Career (0-5 years)
    • Practice - Establish your practice
      • Location, staff, getting on insurance panels
      • Be pleasant and be available
        • Remember the 3 A’s: Availability > Affability > Ability
        • Office - see EVERYONE early on; referring docs will get used to sending you patients. Can streamline this as time goes by.
        • Call - Answer your calls. Show up - especially if taking community call. ER docs will know you as “the doc that is always available... call her if the other doc does not answer.”
      • Layout EMR templates - together with your biller - early to improve efficiency as patient numbers climb
      • Develop relationships with your MA/NP/PA/Cast techs/Rad techs/etc
      • Market your practice
        • There should be someone associated with your practice who can help with this (marketing to community; connecting you with referring providers)
        • Social media and internet presence - useful, but beware of what you post.
      • Know the patient subset you ideally want
      • Participate in lots of outreach
        • with help of PR/Marketing, lunch conferences, community lectures, sideline attendance, PCP conferences, etc - be creative
        • If you have a hobby, offer to be on-site medical at their events
      • Attend cadaver and other hands-on courses to continue to develop your surgical skills
      • Learn the Promotion track (to partner, Tenure, etc) & start on it
        • Develop a 5 and 10-year plan early on
        • Set big goals
    • Academic
      • Consider volunteering to be an Early Career NIH Grant Reviewer
        • Great experience
        • Learn about cutting edge, orthopaedic (MSK) related research
        • Teaches you what grant reviewers are looking for
        • Gives you a better understanding of the process
      • Attend Meetings
        • Submit abstracts as often as you can
        • Present at meetings when invited
        • Volunteer to be on committees
        • Late in this career stage (ie around 5 years into practice), begin pushing towards being a leader of a committee instead of just a member
    • Research (especially if in Academics/on Tenure track)
      • Start to develop your own research interests
      • Reach out to medical students/residents who might be interested in helping
      • KEEP TRACK of what you write and participate in. Many papers can get away from you if you don’t send out reminders and have a system
    • Advocacy
      • Stay engaged
      • Encourage fellow practice members to join AAOS PAC
        • Teach others about issues that will affect your profession and livelihood.
      • Do advocacy locally and at the national level.
        • Host an advocacy event in your area
    • Leadership
      • Get engaged in your practice/department
      • Volunteer for committees within your institution (eg. practice management, EMR, resident education, etc)
        • If no committees are available, make your interest known to the Senior Partners/Chair/etc
      • Apply for leadership conferences/seminars, if interested in pursuing leadership roles
        • Eg AAMC Early Career Women Faculty Leadership Development Seminar
        • Apply for AOA Emerging Leaders Program
        • Other programs outside of work
    • Networking
      • Develop a Mentoring relationship within your department
        • Mentors: formal relationships with goals, structure
        • Advisors: Ask for lots of advice from folks who have been there longer
        • Champions: Those with influence who can get you noticed and into places you wouldn’t normally go.
        • Friends: socialize with partners, residents, fellows. Let them know you a bit as a person.
    • Family
      • Support spouse in finding the right career for them and your family (in the home or outside the home).
      • Start or grow your family, if desired
      • Be aware of schools when looking for where to live
    • Financial
      • Live as if on a resident salary to start working on loan repayment/Retirement
      • Ensure you have insurance for disability/life insurance, if you have a family
      • If you have a family, you should have a Will/Advanced Directives
      • Meet with a financial advisor early
      • Automatically put $ into a savings account each month - You should have 6 months of expenses in the bank in case of emergency. 
  • Mid-Career (5-30 years)
    • Practice - Grow, cultivate, and hone your practice into what you want it to be
      • Fine-tune your 10-year plan
    • Academic
      • Attend Meetings
        • Lead committees and organizations
        • Answer email promptly
    • Research
      • Continue progressing in number and quality of research
    • Advocacy
      • Stay engaged
      • Encourage fellow practice members to join AAOS PAC
        • Teach others about issues that will affect your profession and livelihood.
      • Do advocacy locally and at the national level.
        • Host an advocacy event in your area  
    • Leadership
      • Scale promotion tracks
        • Assistant PD, PD, Vice Chair, Chair, Division Head
        • Junior Partner -> Senior Partner -> oligarchy leader partner, etc
      • Take on strategic leadership positions, and consistent group and committee involvement.  For example:
        • If you want to become a Program Director, you might volunteer to be Assistant Program Director. 
        • If you want to be an Editor of a journal, volunteer for lots of reviews, turn them in timely, and do a quality job; inquire about being an Assistant or Associate Editor 
        • If you want to be a managing partner, you might want to take on some business management roles within the group and/or leadership roles on hospital committees. 
        • State Orthopaedic Society Board of Directors, leadership, can be good training for the Board of Councilors. 
      • If you want to start a fellowship, put in place partners, research facilities and staff, and work on future funding. Consider applying for leadership seminars
        • Eg AAMC Mid Career Women Faculty Leadership Development Seminar
        • If interested, consider asking colleague to sponsor you for membership in the American Orthopaedic Association (AOA) 
      • Networking
        • Helps for others to know your interests
        • Other career opportunities may come along
        • Seek advice from mentors
        • Mentor others
      • Family
        • Obtain kids’ extracurricular schedules early to make/adjust schedule and call to ensure attendance at events/games/plays/graduations/etc
        • Share a calendar with spouse, kids, and key relatives so that you are prompted to ask for help when you need it.
      • Financial
        • Set aside for Retirement & other family needs
          • Be prepared for caring of your parents/family
            • It's amazing how much consideration is given to starting a family (eg having kids) versus how much planning is involved for caring for your parents and older relatives at the end of their lives and dealing with their estates.  This is most likely going to hit most of us in those "mid-career" years and can really affect your life and practice.  Have those uncomfortable talks early and put plans in place because you never know what is going to happen.  Unfair as it may be, it is usually the female adult children, even if (or perhaps because) they are a doctor, who takes the lion share of the burden of caring for a terminally ill parent.  FMLA is not always an option.  Partners are not always understanding.  You don't have much control over the timing and won't necessarily be able to give people nine month’s notice.  Be prepared.
          • Asset protection, estate planning, financial goals
          • This is the most important time.  In the early years, you're likely playing catchup with school debt and new family expenses, and as you get closer to retirement, there is not as much time for the interest and your nest egg to grow
          • Money will grow with compounded interest.  Put the plan in place and make major strides during these working years. 
        • Explore non-clinical opportunities which can provide supplemental income and be continued into the pre-retirement years.
      • Consult for an Ortho company, develop products/tools to advance the field
        • You might be able to set up a SEP (individual retirement account) with consulting earnings. Ask your accountant or financial adviser. 
  • Late Career (20-30 years+)
    • Practice
      • Taper work
        • Continue pursuing your favorite professional activities (clinical, research, leading committees, administrative)
        • Taper down on less important, less enjoyable tasks
        • Make more time for Family
      • Enter a different type of career
        • politics/advocacy
        • medical consultation
        • non-op ortho clinic (in your favorite vacation destination perhaps?)
    • Academic
      • Consider teaching at the local Medical School/Residency
        • Share your expertise with others
    • Research
      • Continue, taper, or expand depending on preference and enjoyment level
    • Advocacy
      • Continue efforts
      • Instill the “Advocacy Bug” into other, younger partners/people in the field
    • Leadership
      • Run the Show (if you want to)
        • Chair a program
        • Be President of a Society, Committee, AAOS or other organization
    • Networking
      • Mentor
        • Leave a legacy that can continue your efforts of furthering the field/department
      • Keep up with colleagues and Mentors
    • Family
      • Plan fun hobbies, etc to allow a smoother, less shocking transition into Retirement
    • Financial
      • Work with financial advisor to determine when retirement would be best