Other Articles

Biologics for Spine: Where We Are Now
Dr. Jeffrey Wang, Chief of the UCLA Spine Service and Director of the UCLA Spine Surgery Fellowship, discusses the exciting happenings in spine biologics, including growth factors, the use of different genes, and injecting stem cells into the disc. And then there are the challenges, namely the disc environment and the funding environment.

Physician Medicare Payments: Grandma vs. Docs
The fight over Medicare physician payments in Congress has been reduced to a fight over limited public dollars between Grandma and her physician. Is this a prelude to how public health care policy will be decided in the future? Read about the tussle here.

Spine Niche! Opportunity in the Spinal Deformity Market
Given the myriad of start-up companies pursuing the same patients, product differentiation and solutions for specific target markets could be the key in the future. Using the PearlDiver Patient Records Database we estimate procedure volumes for posterior fusion as a treatment for scoliosis—followed by the results of a study identifying complications associated with instrumented posterior thoracic fusion in treating scoliosis.

AAOS Political Action Committee
Active players in the orthopedic field know the importance of the AAOS Political Action Committee (PAC). On the cusp of hot topics affecting physicians and patients, the AAOS PAC works diligently to provide data to members of Congress and improve the present and future of orthopedics.

Who ARE These Guys?
Every 60 seconds or so a surgeon tears the cover off an Integra LifeSciences package. Quietly, this company has become the seventh largest medical implant manufacturer serving orthopedic surgeons in the world. Where to now? Would you believe $1 billion in two years? How about $2 billion by 2015?

Redemption in a Mechanism of Failure: The TOPS™ Story
Impliant’s TOPS™ System had a “squeaker” in its clinical study. After a voluntary suspension of the study by the company and finding the mechanism of failure, the FDA has approved a resumption of the study. What insider lessons were learned? Class starts here.

Who is Numero Uno in the PearlDiver Database!! Are You Surprised?
The answer may surprise you. Is it sore backs, aching hips, sore knees, fingers? PearlDiver details 3.8 million spine related complaints—complete with demographic information and charging information. But that’s not #1. PearlDiver also lists 3.5 million large joint complaints. Sorry, still not #1. What could the most common orthopedic complaint possibly be? To get the surprising answer…read on.

What the Knees Need: Baby Boomers and Their Options
Knee patients often show up at the doctor’s office with recurrent mechanical symptoms. It is up to the orthopedist, says Dr. Giles R. Scuderi, Director and orthopedic surgeon with the Insall, Scott & Kelly Institute in Manhattan, to thoroughly assess the patient and then determine if nonoperative treatment will do, or if the person needs a unicompartmental or total knee procedure.

Physician: Report Thyself
The government says its healthcare anti-fraud efforts are working and it wants to encourage physicians to self-report possible fraud. How well did the government do in 2007 and what about those deferred-prosecution deals with undisclosed evidence? Read about it here.

Revising the Statistics
The word that orthopedic patients least want to hear is “revision.” Who, in the universe of large joint patients, do we expect to see on the receiving end of this news? If you guessed “the elderly” you would have been wrong. The reality of who is hearing “revision” may come as a surprise. Read what we found when probing PearlDiver’s database.

Where Is Ben Now? Trends in Venture Capital
What is being funded by VCs and why? First of all, spine is having to share the spotlight, says Gary Stevenson, Managing Partner at MB Venture Partners, LLC. Here Stevenson outlines what constitutes an attractive investment…he also highlights issues that are affecting the distribution of VC funding.

The Hounds of Wall Street
Conventional wisdom on Wall Street is that ArthroCare is in a bare-knuckle fight to the finish with short sellers. Which leaves us with the dominating question: If ArthroCare is essentially a “lame duck” growth stock, then why are sales, earnings, and the stock price contradicting the short seller’s dire predictions and even outperforming consensus analyst forecasts? We have the answer.

The Era of “Tell Me Right Now” Dawns at FDA
The FDA wants the next phase of post-market oversight to change from self reporting to proactive surveillance. How? Through the Sentinel Initiative. Read what it means to device manufacturers here.

The Day After Tomorrow: Complication Rates and Instrumentation Trends in Posterior Lumbar Fusion
Could PearlDiver be the Nostradamus of spinal instrumentation? This most commonly performed surgery on the lumbar region of the spine increases fusion rates and improves spinal stability—but what about complications? Using PearlDiver’s database we find the answers. Are you ready for some quatrains about what happens next?

You Try It. No You Try It First: New Technology Adoption
What are the forces working for and against new technology adoption? Youth versus age, risk taking versus conservatism, and the economic realities of the day, says Dr. Rick Guyer, President of the Texas Back Institute.

Cheaper, Thinner, Faster, Stronger
In this, the second of our series of three articles on innovation, we tackle the question: How do you measure medical technology innovation? While difficult, measuring innovation is NOT impossible. Why? Well to start, and in the immortal words of Supreme Court Justice Potter Stewart, “We know it when we see it.”

SAS Crosses the Rubicon in Miami Beach
The SAS 8th Annual Global Symposium in Miami Beach may have crossed the Rubicon. How? Read about the Society’s opportunities for growth and collaboration as its new President lays out a vision for the future.

Each year an intense mating dance takes place throughout the country. Rather than bright feathers or an exotic tango, however, this process involves mountains of paperwork, Zen-like patience, and your best suit (OK, display of feathers).

Match Day…the time when senior medical students learn where they will be spending the next few years of their lives. For those headed into the realm of bone, that’s five years. In 2007, future orthopedists have their eyes on March 20, 2008. That’s the day when they can exhale.

Says Matthew Popa, a fourth-year medical student at Case Western Reserve University School of Medicine in Cleveland, “The match process is one long, all-consuming crawl to the March deadline. Coordinated by the non-profit National Residency Matching Program (NRMP), the process involves a rank ordering of students’ and programs’ preferences. Ideally medical students will start preparing for this in June or July of the year preceding match day. In my case, I finally decided on orthopedics this past August after doing my first full rotation in this specialty. When I set up my fourth-year schedule I did rotations in ENT, vascular surgery, radiology, and anesthesia because I had not yet determined my future field. But once I got to try orthopedics, I fell in love with it. The variability of the patient population, from young to old or gravely ill to relatively healthy people, was a real draw. I was also lured by the fascinating technology and the physically demanding nature of the field. And then there is the immediate gratification, something you probably find more in orthopedics than in any other area.”

Continues Popa, “I dove in and applied for an away rotation in orthopedics at the University of North Carolina (UNC). Most medical students like away rotations because you get your name out there, meet new people, and see new programs. Residency programs like them because it shows you are willing to try a new region away from your school. I met with advisors at Case Western and discussed a strategy and gathered letters of recommendation. Most programs want three or four letters, which don’t all have to be from orthopedists. My plan was to do a rotation at UNC, followed by one at Case Western. My wife is pregnant with our third child, however, and is having some minor issues. Given this, I set up some initiatives here at the Cleveland Clinic and Case Western where I am working with a sports medicine doctor one-on-one, to be followed by two weeks of pediatric orthopedics. I don’t know the extent to which not having an away rotation will affect my match prospects. While it’s a bit of a concern, overall I am comfortable with my decision.”

As for Scott Tucker, in his fourth year at Tulane University School of Medicine, he is also fully engaged in the process and is content thus far. “This August I did an orthopedic rotation at Tulane, went to Boston Medical Center in September for orthopedics, and am now in New Orleans at Ochsner Hospital learning more about the field. My last stop is an orthopedic rotation at Dartmouth. The away rotations can be very helpful as you get a chance to look at their program and they get a chance to look at you. It is, after all, a mutual process.”

Adds Tucker, “I have long known that I would be headed for orthopedics, as my experience with the field predates my college years. At that time, my father underwent knee surgery at a young age and experienced complications. During my studies at Colby College in Waterville, Maine, I did a month-long internship with the orthopedist who worked on my dad. This personal experience brought the field of orthopedics alive for me.”

Unlike the mating dances that occur in nature, the match dance occurs to a great extent online. Explains Popa, “Medical students register with the Electronic Residency Application Service (ERAS), a standardized system used by nearly all residency programs. It takes one’s basic information, including some of your achievements, work experience, hobbies, and a personal statement, and sends it all to the programs where you applied. It is also where the programs can download the letters of recommendation that are written for you. I have sent out my ERAS application, but am still waiting on a few letters of recommendation.”

Adds Scott Tucker, “The ERAS basically controls a medical student’s life for six months. I knew what I wanted, so I got my application in the first week it opened in September. Because orthopedics is so competitive, those of us pursuing a residency have to be pretty strategic. On the whole, we have to apply to an enormous number of residencies as compared to other specialties. Whereas in emergency or internal medicine, people are applying for 15 or 20 programs, many people pursuing orthopedics are applying for 40 to 50. I applied to over 50 programs and am now in waiting mode.”

So what are the details of this mother-of-all job application? States Matt Popa, “The personal statement is critical and gives programs a window into your motivations, personality, and values. My statement focused on the process I went through in deciding on orthopedics. I wrote about how I find it rewarding to restore function to people who, for example, can’t walk and have lost hope. To emphasize that I can manage multiple, significant responsibilities, I discussed how I take care of my family and work in addition to attending school. I am proud that I have been able to achieve and be successful in my rotations. Also vital to the application package are the letters of recommendation. While I am very appreciative of these letters, my mentors are busy and may not look upon the letters with the same priority that I do. It can be a bit uncomfortable having to remind them, but that’s the only way to get through the process sometimes.”

Adds Tucker, “In my personal statement I focused on the fact that I am goal-oriented, like to fix things, and work quickly and efficiently. I also mentioned that I work well with a team of other doctors, physical therapists, nurses, etc. Everyone is working towards the same goal, something that is particularly unique to orthopedics. As for letters of recommendation, I have classmates that needed to gently nudge their letter-writers to complete and submit their ERAS letters. Some are still waiting, but luckily mine were done in a pretty timely fashion.”

So you’ve done the paperwork part of the “dance” and put forth the best you have to offer. Now, you’re on hold. “While getting all the required parts of the puzzle together can be stressful, the hardest part is just waiting for the phone to ring or the emails to flow to my inbox,” says Matt Popa. “I wish the programs could call me and say ‘yes’ or ‘no’ and I could move on with my life. But during the process, as you might guess, no significant communication exists between the applicant and the programs. Such a vacuum of information really gets the mind going. When not attending to the remainder of my medical school responsibilities, I have thoughts that crop up such as, ‘How good of a candidate am I? Did I do enough research? Are my board scores good enough? Do my letters of recommendation have enough weight?’ The letter issue is particularly vexing, as students are not allowed to see the letters. And it’s always in the back of my mind that there are more orthopedic applicants than there are slots available.”

Scott Tucker agrees. “I’ve been waiting to hear about interviews for a month now. Everyone encourages you to submit your application early, but then that just means that you’re sitting around and waiting—pretty stressful. I feel like I’ve submitted my life into a black hole.”

When the programs do come calling for interviews, these applicants will be ready. Says Tucker, “Although Tulane Orthopedics doesn’t do mock interviews, I feel comfortable in most interview situations, but I will refresh my memory on the things I’ve worked on to date. The challenges of scheduling the interviews are on my mind, however. I have heard from a number of people that either purposely or not, interviews at different programs may be scheduled on the same days. This sometimes happens with competing schools in the same cities. If that occurs, you are in the unfortunate position of having to choose one and drop the other.”

Continues Tucker, “I anticipate that program chairs will be asking me a lot of questions about Hurricane Katrina. Everyone at my away rotations has been very curious about the storm and how the New Orleans-based medical students made it through. Another item I would like to highlight is the fact that I helped co-found a children’s charity in Boston after college graduation. We established The Mayflower Foundation, whose efforts have now spread to other cities. At our events, we solicit donated goods and services and hold silent auctions. I hope to hold an event in New Orleans soon.”

Adds Matt Popa, “For interviews, I look at the program’s website and get as much information from that as I can. There is usually enough there to get a general idea about the program, and it gives me a good idea about things I want to look for or ask about. Other than that I’m not planning on doing much else to prepare. I don’t anticipate scheduling the interviews to be a huge problem. I had a more focused selection for programs than most people because of my family so I’m hoping for only around 10 interview offers. For those programs at which I do interview I want to stress that I’ve been able to manage a family and be a successful medical student at the same time, and that I can work hard as well as be a fun team player.”

And what are medical schools doing to help facilitate the right relationship? States Tucker, “Tulane has the process pretty streamlined, with two people in the dean’s office dedicated to helping us through the process. At the same time I wish I could have had more guidance from the medical staff. I met with the dean, but he is an internal medicine professor and thus can’t give me a full range of input on orthopedics as he hasn’t been through the same process. The only problem with someone in your own institution guiding you is that there is a natural bias to tell you to stay at his or her institution. That being said, there are nuances to the application process that I had to learn by speaking with current residents. It would have been great to have had more help readily available.”

Adds Popa, “It has been a nice surprise to have the orthopedic staff at Case offer suggestions about the match process. They can sometimes get specific with advice once I have told them where I am applying. I have a dean who acts as an advisor for the match. He and I have been meeting periodically and his input has been greatly appreciated.”

As in a social courtship ritual, people often hold their cards close to their chest. Smiles Scott Tucker, “I will say that I would be happy to remain in New Orleans. My wife has family here and we’re very happy with the city. Something unique to the match process here is an encouraging drumbeat of, ‘We would love it if you stayed here and committed to the rebuilding of New Orleans.’ Time will tell if I get to have this experience.”

And Matt Popa? “My preference would be to remain in Cleveland because our families are here. But obviously any program is better than no program, so if it comes down to it, I’ll take what I can get.”

And come March, the adrenaline will be pumping. Scott Tucker: “Everyone’s greatest fear is not matching. You can be a strong applicant, but if you don’t strategize well, you can end up without a program. Last year roughly 15 out of 150 didn’t match from Tulane. The Monday before match day everyone has his or her cell phones at the ready—that’s when you learn if you matched or not. Those who did not match then go to the dean’s office on Tuesday for ‘the scramble,’ where they have a bunch of computers and phones set up to help you search for an open program.”

Talk about speed dating.

Adds Matt Popa, “Everyone is praying they don’t get a call from the dean saying, ‘This didn’t work out and we need to do something.’ In that situation, Case Western works hard to get you into something palatable, even if it’s not your first choice. I have seen other people go through the pain of not matching. Fortunately, there is a lot of support for those people.”
Finding the right residency match is a combination of planning, life circumstances, and luck. You do your best dance, wait for the phone to ring, and listen for the tone of voice on the other end.

This article is the first in a three-part series on Matt and Scott’s match experience. Please stay tuned for more.