Other Articles

Multicenter Clinical Trials: Do They Get the Respect They Deserve?
They’re not fast or sexy, but they are critical…large trials, that is. With multiple sites and principal investigators who donate their time, large trials are more complex—and normally yield more actionable data—than smaller, quicker studies. But large trials don’t always get the respect they deserve. And, says at least one physician-researcher, this could affect the future of the field.

Patent Wars: Medtronic Attacks NuVasive
MSD’s lawsuit came amid a period of declining spinal implant market share – from a peak of 60% in late 1998 (just prior to being acquired by Medtronic) to, we estimate, 36% currently – and a growing sense that MSD’s reign as the king of spine was coming to a close. What’s really behind Medtronic’s attack on its former senior exec? Read on.

Spine Gainsharing Through the Looking Glass
The feds have issued their first opinion allowing a spine gainsharing proposal. In Alice in Wonderland style, Through-the-Looking-Glass logic, they said the proposal was improper but would not impose sanctions. Who is the author of such a plan and what’s her secret? Read here.

PearlDiver Data Raises New Questions About Synovial Injections
Synovial injections for painful knees have been approved for use since 1997. If the goal is to improve the quality of life for the patient, is that being accomplished? The latest numbers from the PearlDiver Patient Records Database cast doubt.

Plantar Fascia: The Annual 3 Million Patient Market
“Plantar Fascial Fibromatosis (ICD-9-D-728.71) is right up there in frequency with pain in the shoulder joint, degeneration of lumbar intervertebral discs, pain in the lower leg joint, and carpal tunnel syndrome. As usual, PearlDiver has this market mapped out.

Orthopedic Incubators: Where Little Ideas Grow Up
Business incubation, also known as acceleration, can be a wild ride. Thus it’s best to approach it armed with the solid advice of experienced professionals. Who should take this ride? What can venture financiers bring to the table? These questions and more are answered by two seasoned VC professionals.

Just Say No to CMS Potential Coverage Decision List
Unless you want to be on the receiving end of a non-coverage letter, just say no to CMS’ proposed list of potential National Coverage Decisions. You’ve got until September 28 to make your case. Read what a leading industry consultant and analyst have to say.

Staking a BIG Claim
Alphatec, the company whose IPO collapse served as an object lesson for all medical device companies, has nearly completed its turnaround. The key? New management and new technology. Exhibit A: OsseoFix™—with it Alphatec stakes a claim to the next big spinal implant market.

The Pennsylvania Orthopaedic Society
The Pennsylvania Orthopaedic Society, 1,000 members strong, tackles a variety of challenges on behalf of patients and surgeons alike. According to AAOS, they were the top state professional society in 2007. Fifty-two years in the making, here is how they did it.

Percutaneous Spine Procedures: Just Setting the Stage for Fusion?
Selective nerve root blocks, laminectomies, and percutaneous discectomies. How many times do these procedures lead to a full blown spine fusion? Using PearlDiver’s Patient Records Database, we longitudinally tracked patients to find out. All we can say is that after surveying the 3.9 million spine patients in the PearlDiver database, the answer may be different from what you’d expect!

Physicians Targeted by Whistleblowers
The whistleblowers that targeted Medtronic in 2006 are now aiming their guns on 136 physicians and distributors as we move into the next era of the “Great Disruption.” Read about their qui tam lawsuit in Boston and what it means for industry and surgeons.

Zimmer’s Bet on Compliance
Is Zimmer’s Enhanced Compliance Program going to cost it market share? Analysts demanded answers from CEO Dave Dvorak during the quarterly conference call on July 23 that also included the announcement of the Durom® cup suspension. Dig in here.

Faculty Compensation in Academic Medicine
Dr. Sanford Emery, Chair of Orthopaedics at West Virginia University, has put his M.B.A. to good use. Delving into the issue of compensation in academic medicine, Dr. Emery and his colleagues surveyed 31 orthopedic programs and conducted in-depth interviews with leaders of eight programs. Their findings include information on the compensation structure and point systems.

Engineering an Unfair Advantage
After $1.2 billion in equity capital, what did the tissue engineering pioneers accomplish between 1990 and 2000? For one thing, LifeCell, Integra and Osiris. For another, a generation of wiser, tougher managers who are targeting the big orthopedic markets. Now all they ask for is an unfair advantage. Are the big guys ready?

The Pain of Fashion! 4 Million Patients Every Year and Growing
Eighty-eight percent of all women wear shoes that are too small. Fifty-five percent developed bunions. Despite costs that can reach as high as $20,000 per procedure, four million patients every year seek surgical relief. Want to know the footprint of this market? Read on.

Oxiplex® – “Not Approvable”
The FDA’s Orthopaedic and Rehabilitation Devices Advisory Panel said FzioMed’s Oxiplex gel was safe but not proven to be effective, and therefore, not approvable. Did statistics get in the way of something that’s needed, works for some and is safe? Decide for yourself.

Tiger’s Knee and the Cruel Twist to the Sport of Golf
At the U.S. Open in June, Tiger Woods played through intense knee pain to stay on the leader board. His next appointment is with an orthopedic surgeon. Last year there were 103,000 golfing related orthopedic injuries reported. That’s $2.4 billion in medical care. For more on this important and growing market segment read on.

When we last left our future orthopedists, Scott Tucker and Matt Popa, they had finished their Electronic Residency Application Service (ERAS) registrations and were collecting the remaining letters of recommendation. Tucker, a fourth-year medical student at Tulane University School of Medicine in New Orleans, had applied to over 50 residency programs, while Popa, a fourth-year medical student at Case Western Reserve University School of Medicine in Cleveland, had applied to 25 programs and was taking a decidedly focused approach.

With five interviews under his belt, Tucker is feeling comfortable and confident as he moves through the process. “I finished an orthopedic rotation in New Orleans and then from late October to Thanksgiving I rotated at Dartmouth-Hitchcock Medical Center. While there I began to hear from programs and get invitations for interviews. To date I have heard from half of the programs to which I applied and received 11 interview invitations. From what I gather, if one hasn’t heard from a program it means you are being waitlisted.”

As Tucker had predicted, scheduling the interviews can be dicey at times. “You may get an offer for an interview and they want you there in three to four days. Some program coordinators are better than others, however, and will work to make things easier on you. I had a situation where two interviews, one in the South and one in the Midwest, were on the same day. The program coordinator at one of the schools was very accommodating and switched me to another day. In another situation, an East Coast school offered me the same interview date as a Southern school, so I went on www.orthogate.com and saw that one of the schools had other interview dates available. Armed with that information, I phoned the residency coordinator and got one of my dates changed. As for the letters, some begin their ‘sales’ pitch right then, a la, ‘We have a great program because…’ and some are very matter of fact, i.e., you rotated with us so you automatically get an interview. Some are blunt and basically say, ‘If you can’t come on this date, too bad.’ This sort of attitude reflects on the program and makes me wonder if I want to go there. We students are looking at five years of working with people at a given residency, so it’s nice to know how flexible they are going to be.”

As everyone knows, interviews are a bit like dates. You want that best foot forward, as opposed to in your mouth. Says Tucker, “I was a little nervous because it had been four years since I last had an interview. I was pleasantly surprised at the tone of my first interview, however, and quickly settled into an interesting discussion. I had asked the program coordinator to schedule the interview early because I had to fly out that day to be ready for another interview the next morning.”

Continues Tucker, “I have learned from residents to be prepared for a lot of down-time during the interview day as there are only so many interviewers. This extra time was usually spent with residents, who were encouraging and said things like, ‘Look, the hardest part was medical school. You’re going to be a doctor…this will get easier.’ As for the process, it has been similar at all five institutions. I arrive at around 7 a.m., get a nametag and welcome packet, and hear an introductory talk from the department Chair. There are several stations (rooms), each with a varying number of people. If someone is in a significant position of responsibility, like the Chair, he or she may be there alone. In another room you may have two younger staff, such as a total joints surgeon and a sports medicine specialist. At yet another station you might find four Chief Residents. There is usually a program coordinator in the hall with a timer who knocks on the doors to let you know it’s time to move to the next room.”

So what are the students being asked? Scott Tucker: “Some interviewers will come out and say that they don’t look at applications. It seems that they primarily want to chat about a variety of topics with the goal of finding out if you’re relatively normal. Although I have encountered no formal personality assessments, a handful of programs asked me to fill out strength and weakness forms. Some have also asked those people who wrote letters of recommendation for me to complete a questionnaire on my strengths and weaknesses. The questions usually go something like, ‘Would you want to work with so-and-so in the future?’ As for how I’ve handled the strengths/weaknesses issue, I am up front and tell them that I’ve never been good at standardized tests, but that I am good with my hands and with people and in fact excelled in clinical rotations. While one interviewer inquired about some occupational medicine research that I did a few years ago, no one has asked me if I intend on incorporating research into my career. They have, however, shown interest in my trauma study and the children’s charity I founded. Some of my interviews have been all about Katrina. People have asked, ‘What needs to be fixed at your program? How have medical schools responded to the situation? Where did you evacuate to?, etc.’”

Nowadays, in the residency interview process it seems that brash is out and congeniality is in. And yet, some people still need to be educated as to what questions are off limits. Says Tucker, “The process has been quite laid back. I’ve been pleased to find that I’ve encountered no truly difficult people as of yet. That’s great because it can be a real turn-off when someone’s giving you a hard time in an interview. I have had a couple of interviewers who asked me a probing and uncomfortable question, namely, ‘Do you and your wife plan to have kids?’ While I felt irritated, I tried to handle it smoothly and said, ‘We’re considering it’ and then tried to move on. I talked to another applicant, a female, who said that an interviewer actually asked her, ‘Are you going to get pregnant in the next five years?’ My take on it is that there are some men in the field who think that this is no place for women…and that they have a right to ask these types of things.”

As for how the programs sell themselves, Tucker says nothing in particular has stood out. “Most programs have a structured, professional presentation for students. There was one, however, where the spelling was bad and the Chair wandered in late and was still in scrubs. It’s helpful that the residents have been straightforward with what they like and don’t like about their programs.”

“I feel pretty good about the process thus far,” says Tucker. “It was recommended to me that as soon as I’m done with an interview, I make a pros and cons list. That has been helpful as there are so many details to each program that it’s easy to forget some things. The only major trying thing has been the cost. Flying around the country, renting hotel rooms and cars, has been a financial burden. And because these are all in the winter, if you’re flying north there’s a good chance you will encounter a storm. For those people living on the East Coast, say New York, they are fortunate to be able to drive to many interviews.”

At this point, there is little left to be done in between the interviews. For Tucker, there is only his ranking list. “I am ranking every place I interviewed, something that is relatively easy to do when you’re talking about your first or second preferences. It gets more difficult when you have to rank your fifth or seventh ones, however. For me, it’s going to come down to location as my wife and I would prefer to stay here in New Orleans. When I’m done I will put the list on the National Residency Matching Program website, and they will do the matching algorithm. The deadline to have that up is late February.”

Turning to Matt Popa, we learn that since October he has completed his applications and ensured that all his letters of recommendation were collected. “Thus far I have done seven interviews. The first was the easiest because it was at Case Western and was informal in nature. The next ones took place at the University of Chicago and the University of Illinois at Chicago and were a lot more relaxed than I thought they would be. In general, they want to see if you would be a good fit for their program. I have also come to the conclusion that if a program elects to interview you, that means they are relatively confident that academically speaking, you can make it. That takes some of the pressure off and contributes to a more congenial atmosphere."

Like Scott Tucker, Matt Popa has found a fairly standard process across multiple programs. “There is a welcome speech by the Chair, a review of their research programs, information on rotations, followed by the interview sessions. Although I have had multiple interviewers at once, I like one-on-one better as it is easier to engage one person at a time. Even the multi-person interviews have contained nothing too provocative, however. The programs have done a great job of presenting their pedigrees and discussing their plans for the future. If it is a larger, more academic institution, they talk about their research and research funding. Some go into detail on the conferences they’re prepared to send you to. In the evening the schools usually plan a social function for us to mix with residents and see how fun the town can be.”

In anticipation of the strengths/weaknesses question, Matt Popa had a familiar resource at the ready. “My wife was only too happy to supply the answers to those questions,” laughs Popa. “She said I’m genuine, intelligent, and dedicated. On the flip side, she told me that I am sometimes too self-confident and that this may come off as arrogant. She also said that I can have a quick temper at times. I believe in being up front and honest in the interviews. I don’t want to sugar coat things and say, ‘Oh, I work too hard’ or something so contrived. If a program has a false sense of who I am and I end up matching there, it’s not going to be a good fit.”

While Popa has been asked no inappropriate questions, for a minute it seemed as if he were applying for seminary instead of a residency. Explains Popa, “The most interesting question I’ve gotten has been, ‘How do you reconcile evil in this world with a loving God?’ This is a far cry from, ‘Tell me why the vertebral disc is more than a shock absorber,’ so I had to take a minute to mull over that one. The interviewer was a philosopher at heart and the question came in the context of a discussion about my faith. Although in retrospect I would tweak my answer a bit, overall I was pleased with it.”

The congenial atmosphere found in the orthopedics field has shone through in Popa’s interview experiences. “The people I have encountered in interviews have for the most part been laid back and seem to enjoy their lives. They are excited about their programs and proud to show the work they’ve been doing. I really expected to be more nervous during this process, but people are making it obvious that they just want to get to know you (as opposed to a lot of grilling). And there has been only one interview where they had me apply any medical knowledge. I had thought they would all be like that. The interviews have largely been focused on understanding my personality and discussing my family or the time I spent working as a teacher and coach. Some residency programs are interested in my teaching and coaching experience because they would like residents to be able to teach the newer residents as they progress in the program. As for the one or two people I did find to be difficult, they were individuals who didn’t seem to be following my responses. In essence, they didn’t appear interested enough to engage me further.”

Matt Popa has several more interviews scheduled. He says, “I probably will cancel some of these as I am homing in on my favorites already. Re-visiting my top three choices and bringing my wife along should help me make up my mind.”

Asked how things would be different if they were in charge of a given program’s interview day, the students had the following to say. Scott Tucker: “Most applicants don’t want to do the tour because they say a hospital is a hospital. That’s something that could be left out.”

Matt Popa agrees. “The tour should be optional as it takes a lot of time. Also, some programs have you attend their daily conference, usually a 1.5-hour didactic affair. These usually begin around 7 a.m., so you have to get up extra early and add on to what is already a long day that may involve plane travel. Like the hospital tour, there’s usually little difference in conferences between various programs, so I think most applicants would not mind missing them.”

But the hassles will likely be forgotten come March 20, match day. Stay tuned to find out where Matt and Scott will spend the next five years.