The musculoskeletal system of the human body is a complex system that is comprised of bones, joints, ligaments, tendons, muscles, nerves, and skin. This system allows the body to move and maintain its homeostasis. The impairment or damage to this system may cause a great deal of pain and stress to a person and will highly limit their ability to move. The field of medicine that focuses on the diagnosis, correction, prevention, and treatment of patients with musculoskeletal problems such as disorders of the joint, bones, muscles, ligaments, tendons, skin, and nerves.
The term “orthopédie” was coined by a French physician and professor at the University of Paris named Nicholas Andry in his 1741 publication entitled Orthopedie which is translated as Orthopædia: Or the Art of Correcting and Preventing Deformities in Children. From the Greek word orthos (“correct”, “straight”) and paidion (“child”), this field of specialty was once entirely devoted to the care of children with spine and limb deformities. The physicians who specialize in this field are called orthopedist or orthopedic surgeons. Though this discipline was primarily developed with attention to children, orthopedics has developed to attend to the correction of spinal and bone deformities in all the stages of life.
EducationalRequirements
Bachelor’s Degree
Aspiring orthopedists, just like any medical professional, must first complete a pre-medical bachelor’s degree program from an accredited college or university. Majoring in sciences is not absolutely necessary, but it is highly advisable to take an undergraduate program with courses that builds a strong foundation in scientific knowledge, laboratory work and instrumentation, and basic concepts in medicine. Most aspiring doctors choose to major in scientific discipline such as biology and chemistry because these programs will most likely to contain courses that will provide theoretical and practical knowledge that is essential to continue medical school. These programs are also popular choices because they are most likely to include courses that provides the basic information necessary for passing the Medical College Admissions Test (MCAT).
Some states provide services that will help an aspiring doctor to be prepared and well-adjusted in the field that they are planning to specialize in. consulting a medical school adviser or counselor, or college adviser in general, is a recommended practice for incoming college students. This will help them have a clearer understanding on the steps that they need to take as well as the courses and knowledge that they would need to acquire in order to pursue the profession that they want. With the guidance of the counselor, the student can better plan their courses over their three to four years of undergraduate education. Partaking in volunteer activities that allows the student to acquire clinical exposure and demonstrate their passion for the medical field is also highly recommended. Having these experiences will most likely improve the chances of medical school acceptance. A good working relationship with teachers, mentors, and colleagues will also go a long way as these authority figures can serve as advisers and provide objective remarks on the student’s ability, professionalism, potential, and work ethic. These people can also provide the material for the required letter of recommendation that will be submitted to the institution that they are trying to get into.
The student’s Grade Point Average (GPA) is also an important factor considered in medical school acceptance. Majority of the well-known medical schools set a specific GPA requirement for their applicants. In order to increase likelihood of medical school acceptance, the student should be aware of the GPA cutoff of the school of their choice and make sure that their own GPA is within the range. In General, it is recommended for a student to maintain a 3.0 or higher cumulative GPA and a 3.0 or higher GPA for all their science and laboratory work courses.
Medical College Admissions Test (MCAT)
The Medical College Admissions Test or MCAT is a four-and-a-half-hour multiple choice test that is required for aspiring medical school students to take. This test is usually taken during the junior or senior year of the undergraduate degree. According to the Association of American Medical Colleges (AAMC), this test is used to evaluate the student’s knowledge and understanding on the fundamental concepts and theories of the applicable sciences that will be needed for medical school and professional practice. The specific areas that the applicants will be tested in are:
Biological and biochemical foundations of living systems
Chemical and physical foundations of biological systems
Critical analysis and reasoning skills
Psychological, social, and biological foundations of behavior
The MCAT score will be submitted along with other application requirements of the selected school. Every school has their own set of requirements that may be unique from other school that is why it is necessary that the aspiring doctors are aware of it. Most of the schools in the United States accept MCAT score from up to three years thus giving the students the option on whether he/she will enter medical school immediately or they could spend some time gaining more training and experiences.
Medical School
Medical school is generally a four-year program where aspiring doctors acquire extensive knowledge on their field of specialty and medicine in general. Applying for a medical school is usually done after graduating from a bachelor’s degree and passing the MCAT. Respective medical schools are generally competitive in nature that is why a strong academic standing as well as a high MCAT score can provide a huge advantage for applicants. Good letters of recommendation can also go a long way in ensuring a slot in medical school. In the United States, the Liaison Committee on Medical Education accredits the medical schools that has passed their standards. All prospective physicians that wish to practice in the United States are required to complete a four-year medical program from these schools.
The first two years of medical school are usually dedicated to strengthening the student’s foundation in patient care as well as their in-class coursework. This is period allows the student to expand their knowledge in the field of medicine especially in anatomy and physiology, biology, chemistry, pathology, and other necessary courses that will help them all throughout their professional career. This period is usually concluded with an examination (the first part of the USMLE) that gauges the student’s scientific knowledge and readiness to proceed to the next part where they will begin their practical work under direct supervision.
The last two years of the program is focused on strengthening the student’s patient care ability. This period also allows the students to apply the concept and skills that they have acquired during the first two years of their medical school program. The students will also be able to experience a wide variety of specialties and work environments that could help them bring out a particular set of interest or skills. Students are given an opportunity to rotate through the emergency medicine, family medicine, obstetrics, and psychiatry. It is advisable for an aspiring orthopedist to complete a rotation in orthopedic surgery in order to have a firsthand experience on the profession. This period ends with an examination (the second part of the USMLE) to evaluate their competency and to determine whether or not they will be qualified to continue to a residency program.
Residency
The residency program for orthopedists typically lasts for five years. This period is a comprehensive graduate training program that would allow aspiring orthopedists to learn about the specialty. During this period, residents develop skills in (but not limited to) general orthopedics, joint reconstruction, sports medicine, spine surgery, trauma orthopedics, and hand surgery. It is highly advisable for incoming residents to research on the residency program curriculums that fits for them before committing to a particular school because the curriculum for an orthopedics residency program varies based on the resident’s hospital placement.
USMLE
The United States Medical Licensing Examination is a three-step examination to determine the level of scientific knowledge and clinical skills that the resident has acquired. The first exam covers the scientific knowledge and clinical skills necessary to practice medicine. This exam is taken after the second year of medical school. A failure to pass this exam means that the student cannot continue on their medical education. The second part of the USMLE is completed after the fourth year of medical school. This exam determines the readiness of the student to proceed to residency. The second part of the series of the exams ensures that the medical school graduates have the necessary clinical skills to be a better caregiver and medical professional. The third and last part of the series of examinations is typically taken by residents after completing the first year of their residency. The last exam covers the biomedical knowledge and clinical skills that are necessary to practice medicine without supervision. In the United States, it is required for every physician to pass the USMLE before applying for medical license.
Board Certification and Licensing
After the USMLE, it is advisable for medical professionals who will start their orthopedic medicine practice to acquire board certification. Most employers require board certification but it is not absolutely required to practice orthopedic medicine. Graduates of accredited medical schools who have completed a minimum of five years in orthopedic residency training may take the board examinations offered by the American Board of Orthopedic Surgery. The exam for the board certification consists of a written and oral portion. The written portion has 320 multiple-choice questions while the oral exam is a set of three 35-minute sessions. The board examination will test the candidates’ skills in the following areas: data gathering and interpretation, development of treatment plans, diagnosis and applied knowledge, patient outcomes, and technical skills. Passing the examination will promote the orthopedic surgeon into a diplomat of the American Board of Orthopedic Surgery for 10 years.
Roles and Responsibilities
Injuries to the musculoskeletal system or conditions like arthritis and osteoporosis ranked as the number one reason that people visit their physicians. The use of medical, physical, and rehabilitative methods as well as surgery are learned by orthopedists in order to provide the proper treatment in all aspects of health care pertaining to the musculoskeletal system. These specialists treat a wide variety of diseases and conditions including, but not limited to:
Fractures and dislocations
Torn ligaments
Sprains and strains tendon injuries
Pulled muscles
Bursitis
Ruptured disk
Sciatica
Low back pain
Scoliosis
Knock knees
Bow legs
Bunions and hammer toes
Arthritis and Osteoporosis
Bone tumors
Muscular dystrophy and cerebral palsy
Club foot and unequal leg length
Abnormalities of the fingers and toes
Even though all orthopedists are familiar will all aspects of the musculoskeletal system, it is very common for orthopedists to further specialize in specific areas such as the foot and ankle, spine, shoulders and hands, hip, or knee. Focusing on specific fields such as trauma, sports medicine, or pediatrics is also a very common trend. The training for this field is typically 50 percent devoted to non-surgical or medical treatment of injuries and diseases while 50 percent is devoted to surgical management. If necessary, surgery may be done to restore function lost as a result of injury or disease of bones, muscles, joints, tendons, ligaments, nerves, or skin.
Orthopedists usually work closely with other healthcare professionals. A visit to an orthopedist usually start with a personal interview and physical examination. It may then be followed by diagnostic tests such as X-ray, movement tests, and/or blood tests. In order to properly treat a problem, orthopedists are required to be skilled at:
Using proper techniques to diagnose the injury and disorder
Creating treatment plans that might include medication, exercise, and surgery options
Creating rehabilitative treatment by recommending exercise or physical therapy to restore movement, strength, and function
Educating the patient about the treatment plans and options in order to prevent injury or slow the progression of diseases.
When the diagnosis is clear, the orthopedist will then discuss your diagnosis to you and help you select the best treatment plan so that the patient can live an active and functional life. Before suggesting a surgical approach, an orthopedist will first try to solve the problem by doing a less invasive approach to minimize the risk to the patient. A non-surgical treatment plan may include medication, exercise, rehabilitative therapy, physiotherapy, or targeted injections.
Most orthopedic diseases and injuries may require more than one form of treatment and when the non-surgical treatment is no longer effective in controlling the symptoms, the orthopedist may recommend a surgical approach. The most common surgical procedure that an orthopedic surgeon performs are:
Arthroscopy – the procedure where a visualizing instruments (camera) is used to assist in the diagnosis and surgical treatment of internal joint diseases. This technique is minimally invasive and allows the patient to recover from the surgery in a matter of days rather than the weeks to months required by the conventional, ‘open’ surgery.
Arthroplasty- an orthopedic surgery where the articular surface of a musculoskeletal joint is realigned, remodeled, or replaced osteotomy or some other procedure. This procedure is mainly done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.
Fusion- a surgical process by which the bones are fused together with bone grafts and internal devices, such as metal rods, to heal into a single solid bone.
Internal fixation- the use of metal plates, pins, or screws to hold the broken pieces of bone in proper position.
Osteotomy- the cutting and/ or repositioning of the bone in order to correct its deformity.
Soft tissue repair- this procedure is performed to mend soft tissue such as torn tendons or ligaments.
Other than their diagnostic and therapeutic functions, orthopedists also play an important role in conducting research in their respective field of sub-specialty. The researches aim to provide a more result-oriented remedies to the common medical conditions and to ascertain the efficacy and safety of new medicines and other treatments.
Salary
According to an April 2018 report from PayScale.com, orthopedic surgeons or orthopedists earn a median pay hovering around $362,000 a year. The final cash compensation (which include potential for bonuses and profit sharing as high as $103,000 and $127,000, respectively) to orthopedic surgeons ranges from $121,000 to approximately $570,000. These salary ranges may vary based on geographic location, type of employment, and career duration.
The PayScale report also saw a positive trend in the Pay by experience for this profession. An Orthopedist with less than 5 years of experience can expect to earn an average total compensation of $336,000 based on the individual salary report provided by 343 respondents. This includes tips, bonus, and overtime pay. An orthopedist with mid-career experience (5-10 years of experience) can expect to earn an average total compensation of $371,000 based on 203 individual salaries. An experienced orthopedist (10-20 years of experience) can expect to earn an average total compensation $373,000 based on 200 salaries while a surgeon with late career experience (20 years of experience or more) can expect to earn an average total compensation of $408,000 based on 107 individual salaries.
The geographical location of the practice also plays an important role in determining the expected salary range for orthopedists. It is found that the pay rate of orthopedic surgeons in Dallas exceeds the national average by 13 percent followed by San Jose (+11 percent) and San Francisco (+8 percent). On the other hand, orthopedists in Indianapolis earns 32 percent below the national average along with Chicago (32 percent below average) and New Haven (22 percent below average).
Compared to the previous year, compensation for orthopedists has increased by 2 percent this year and this profession ranks among the top earners this year along with plastic surgeons and cardiologists. This report is further supported by the Medscape Orthopedist Compensation Report 2018 released on April 18, 2018. The report also stated that orthopedists who are self-employed (annual average salary of $536,000) earn more than those who are employed (annual average salary of $469,000) with an average annual salary difference of $67,000. Even though self-employment recorded a higher annual salary average, orthopedists prefer employment compared to self-employment by 9 percent. This result reflects a national trend towards physician employment, as hospitals and other entities have consolidated and absorbed private practices and the new generation of physicians preferred a steadier income stream and a more regular schedule.
History of the Orthopedist
The early practice of orthopedics was focused mainly on the correction of childhood conditions such as scoliosis (curved back), paralysis as well as poliomyelitis, tuberculosis of the bone, and congenital defects such as bone deformities. In Nicolas Andry’s 1741 book, he advocated the use of exercise, manipulation, and splinting to treat deformities in children. The term orthopedics would remain in used even though the practice has broadened beyond the care of children. In 1780, the first orthopedic institute was established and is spear headed by a Swiss doctor named Jean-André Venel. The institute was considered to be the first hospital dedicated to the treatment of children’s skeletal deformities. Venel will then continue to develop various methods to treat curvature of the spine and club foot shoe for children born with foot deformities. His contributions to the development of the practical application in orthopedics earned him the title of “father of orthopedics”.
The 18th century marked an increase in the methods available for the surgical treatment of orthopedic injuries and diseases. These advances were made possible by the researches done by physicians like John Hunter’s research on tendon healing and Percival Pott’s work on spinal deformity. In 1851, a Dutch military surgeon named Antonius Mathijsen invented the plaster of Paris cast to immobilize broken bones during the Belgian Revolution. He published his findings in a Dutch medical magazine in February 1852 after testing his idea on chickens. During this time however, orthopedics was still a field of study limited to the correction of deformity in children up until the late 1890s. Another brilliant mind of the 18th century was Dr. Hugh Owen Thomas. Thomas advocated enforced rest as the best remedy for fractures and created the ‘Thomas Splint’ to stabilize a fractured femur and prevent infection. He is also responsible for the development of several medical innovations such as:
Thomas Test- a method of detecting hip deformity by having the patient lying flat in bed
Thomas’s Collar- to treat tuberculosis and cervical spine
Thomas’s Maneuver- an orthopedic investigation for fracture of the hip joint
Thomas’s Wrench- for reducing fracture
During his whole lifetime, Thomas work was not fully appreciated. His techniques came to be used and recognized for injured soldiers in the battlefield during the First World War. Sir Robert Jones, Thomas’s nephew, has also made great advances in orthopedics. In 1888, he was given the position Surgeon-Superintendent for the construction of the Manchester Ship Canal. His position has given him the opportunity to develop new techniques and improve the standard of fracture management. The popularity of his techniques increased and physicians around the world came to Jones’ clinic to learn. He and Alfred Tubby would later find the British Orthopedic Society in 1894. He also advocated the use of Thomas splint for the initial treatment of femoral fractures, reducing the mortality of compound fractures of the femur from 87 percent to less than 8 percent within the period from 1916 to 1918.
During the 1930s, a special nail was developed to hold bone fragments together thus allowing them to heal better. This innovation was then followed by the development of a metal device that can be used to replace the head of a femur, which formed part of the hip bone and often would be difficult to heal after being fractured. Nowadays a total hip joint replacement can be used and this device is still being revised and improved to allow the patient maximum range of motion and use of the leg. Gerhard Küntscher of Germany pioneered the use of intramedullary rods to treat fractures of the femur and tibia. This method made a significant difference in the speed of recovery of injured German soldiers during World War II. The popularity of the intramedullary fixation of fractures became widespread during the late 1970s when the Harborview Medical Center in Seattle group popularized the technique.
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