Working in trauma and orthopaedics (T&O): 5 pros and 5 cons
5 Pros – why should I work in T&O?
1. Teamwork
Many elements of T&O mean working with other people: trauma calls, fracture clinics, theatre environment etc. You are surrounded members of the MDT as well as fellow surgeons; which, if you like working with other people, makes the job great fun.
2. ‘Hands on’
Lots of orthopaedic issues can be managed with interventions that you can learn to do from F1 and F2 level. On-calls commonly include fracture manipulations, applications of backslabs/casts and joint aspirations. Of course, there is also lots of operating where you can improve suturing or start to learn the basics of bone surgery. So, if you like to be hands on, it may be the speciality for you.
3. Rapid results
The above listed procedures can often make a very rapid difference to a patient. Their pain may improve in front of your eyes. Their arm goes from deformed to straight, their shoulder is back in joint. So if you like rapid results there is lots in orthopaedics to satisfy you.
4. Variety
Orthopaedic patients can range from neonates with broken clavicles to elderly patients for elective joint replacements – from intricate hand surgery to major trauma calls, large joint operations. The range of patients and procedures as well as the ‘pace of life’ is vast.
5. Fun
A lot of orthopaedics is not immediately life-threatening, meaning you have time to make decisions and ask for help if you need it. Nevertheless, you can make a huge difference to patients’ quality of life, and they will thank you for it, which makes it great fun.
5 Cons – why you may not want to work in T&O
1. Training length
Orthopaedics requires completion of ST8 and typically at least one (if not two) post-CCT fellowship. The training is intense and can involve you being moved around a large region – as most hospitals have orthopaedic departments. There are some smaller deaneries around, but you often cannot dictate exactly where you will work for very long.
2. Intensity
Surgical training requires you to meet minimum numbers in a range of procedures and case presentations along with audits, publications etc. Night shifts and weekend on-calls are the norm within rotas, and long days in theatre can be hard work. Striking a balance can be difficult at times.
3. Exams
MRCS is a requirement to get into ST3 training. FRCS Tr&Orth is a very challenging exam that is required to become a UK consultant (but it’s not usually sat until around ST7 level, so not something you have to worry about initially). However, it’s worth being aware this lies ahead as it can be difficult to juggle family life, work and preparing for a very challenging exam at that later stage in your life.
4. Competitive
Like many surgical specialities, getting into T&O demands you show interest and dedication to the job. The application process to become a speciality trainee is competitive, and may mean you have to sacrifice where you choose to live to ‘get a number’.
5. Stress
Operating, running clinics, caring for ward patients, and balancing all of these with your own life can be physically and mentally demanding. The NHS is under a lot of pressure and many patients you look after can have been waiting months or even years for their orthopaedic procedure. When you are at foundation doctor it might be hard to easily get hold of your senior if they are operating. This can take a toll on you when you feel responsible for your patient and their wellbeing. An ability to properly deal with stress and ‘turn off’ from work is vital.
Written by Miss Rosemary Wall, Registrar in Trauma and Orthopaedics (T&O)
