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In his recent AAOS Now article, “Change without confrontation is unlikely”, Dr Edward J Collins stated “if one did a cost benefit analysis on what orthopaedists provide society, I believe our reimbursement [$440,000] would be quite modest compared to those benefits.” As much as I (selfishly) like that line of reasoning, the only valid argument is the converse: that if our benefits exceeded our pay, that pay should be cut.…
Sleep is an essential human function \- right up there with eating, drinking, and breathing. If you don't sleep, you die. Even after being kept awake for just 24 hours, cognitive (and emotional) changes are noted. It is for that reason, primarily, that the ACGME mandated restrictions on resident work hours. After all, who wants to be taken care of by a cognitively (and emotionally) impaired physician?…
Within a few days, we'll know if Larry Summers will be appointed to be Secretary of the Treasury (again). If he gets the post, it's because he's a brilliant economist who knows how to solve problems. If he is passed over, it's because he was an impolitic president of Harvard who put his foot in his mouth while discussing gender The issues of gender may be too hot to handle. Still,…
'Tis the season for residency applications (come to think of it, it's always the season for residency applications, except for perhaps the Thursday after the match) and pretty soon we'll be hearing from some disgruntled students.    Why are they unhappy? Because the residency selection process stinks (so they think). Without necessarily agreeing or disagreeing with the proposition,…
The Dull Hypothesis
There was another article in the New England Journal of Medicine pointing out the relative ineffectiveness of arthroscopy for arthritis of the knee. (They'll keep running them every couple of years til the word gets out.) Writing in the same issue, an esteemed colleague offered some insightful observations about the study. One of his comments, though, is hard to support: namely, "...…
Frugal Profligacy
The other day, one of the senior residents told me about his fellowship plans.  A program in New York City intrigued him, he said, but he was not going to apply- he simply did not think he could live in the Big Apple on a fellow's salary.    Of course, one's sense of what one can afford is a matter of taste; and about taste there is no argument---de gustibus something or other. But this resident was wrong.   Classical economics teaches that there is diminishing marginal utility of wealth.…
Burn out and leisure
I came across an interesting paper from The Annals of Internal Medicine on burnout among medical students. I did not quite identify with the students discussed in the article -back when I was a burnt out resident, I was probably more tempted to harm my tormentors than myself-but the story still resonated. My training was far from pleasant and it took its toll on me. I'll leave it to others to say whether I have recovered from that burn out, but to the extent that I have gotten well,…
Philadelphia Magazine just published its list of local Top Doctors, and of course I read the recent issue with great avidity. Having moved my practice from the main university hospital a few years ago, I did not expect to find myself back on the list, but of course I was fascinated to see which of my friends (and enemies) had made the cut.    That list is all good for gossip. As for actually detecting pure excellence, it's not the place to look.…
The Monty Hall Paradox
That my residents today did not know of the Monty Hall Paradox was not particularly disappointing or surprising; Game Theory is a small and quirky field. But that they never even heard of Monty Hall, thereby reminding me that I am of a previous generation, was a real downer. The Monty Hall Paradox came up in a discussion of shoulder pain and arthroscopy. I will get to that in a second. Here's the paradox (as recounted by Parade magazine): Suppose you're on a game show,…
I read the sports pages as an orthopedic surgeon - one trained in sports medicine to boot. That is, I skip the feature stories, gloss over the box scores, and go right to those little articles describing the injuries. Who broke what? Which doctor was consulted? What information is being withheld? In my crazy world, sports exist as an adjunct to sports medicine, not the other way around. When I was a kid in New York City in the 70's I was more familiar with the names Dr. James Parkes and Dr.…
I just received a notice from the AAOS asking me to once again complete my disclosure form. Of course I did so, but not without rolling my eyes. For one thing, this program simply asks if you get any money at all and ignores the magnitude of the payments one might be receiving. For the average orthopedic surgeon (whose income is by definition average, that is, about $465,000 a year) the payment of a few hundred dollars really is not material. On the other hand,…
Actually, we did not have to do much (indeed anything) to bring blogging to Orthopaedia. As you see, this is simply the NEWS section of the personal space. It would be great if our community members take to blogging. I see two obstacles, both psychological: first, users are going to have to get used to the idea that their own personal pages cannot be edited by anyone else. That is, the blog entry looks like a wiki page, but it isn't.…
That got your attention. I have no idea (yet) whether impingement will turn out to be bogus, but as of today, at least, hip impingement is a hypothesis, not a fact. And I am at a loss regarding the utility of this hypothesis. What do you do with the information--prophylactic osteotomies? I recently discovered that the "Double Crush Phenomenon",…
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