Comments from clinicians

Why did you choose this specialty and what did you most like about it ?

Orthopaedic surgeons lead busy working lives seeing and treating patients with organic problems that (in many cases) are amenable to surgical management. The specialty is attractive because it is very practical and the results are readily tangible. Colleagues in this field are generally very supportive of one another and enthusiastic members of their professional body, the New Zealand Orthopaedic Association. In general, orthopaedic surgeons are passionate about their work and go to work not only to make a living and help their patients, but also for the great enjoyment they derive from their work and from contact with their colleagues.

What particular abilities are important in this specialty?

You must be able to communicate with patients and colleagues. You will need to be energetic and capable of a moderate to heavy workload and you should possess aptitude for acquiring technical and procedural skills. Common sense and good clinical judgement are essential.

When working as a specialist in this area, what does a daily schedule look like?

A typical working day for a hospital-based consultant usually commences somewhere between 7.00am and 8.00am and finishes somewhere around (or after) 5.00pm. There is a heavy component of patient care in most orthopaedic schedules, with consultations, preoperative checks, surgery and post-operative follow-up, as well as outpatient clinics.

What are the challenges for the future of this specialty?

Orthopaedic surgery remains a rapidly expanding field. Orthopaedic knowledge and technology is expanding exponentially resulting each year in new procedures and significant new ways of helping and treating patients. The aging population and the desire to remain active into old age present particular challenges.

What advice would you give to someone thinking about this specialty?

It would probably be helpful to discuss the specialty with individual orthopaedic surgeons to find out what they perceive as being the advantages and disadvantages of a career in this field. You should be aware before entering the training programme that the clinical training schedule is arduous. If you enter this specialty you can look forward to a busy life of consulting and surgery, though there are also considerable opportunities for teaching and research.

What is your opinion about opportunities in this area?

With the increasing average age of the population and the advancement of technology there will be a significant increase in demand for the services of orthopaedic surgeons in the future. The problem will be securing funding, either from private or public sources, to finance treatment options and procedures. It is also possible for orthopaedic surgeons to develop academic careers based either on surgical or research practice. The specialty offers research opportunities in diverse areas that include molecular biology and engineering.

What are the financial rewards?

- Full time consultant, public sector: $110,000 - $230,000
- Registrar: $90,000 – $138,000
Employment opportunities exist in the private sphere where rewards are generally higher but collegial activities and opportunities to teach are fewer. It is usual for specialists to divide their time between public and private practice.

How realistic is it to take time out to travel, have children, etc.?

New Zealand needs a greater proportion of female orthopaedic surgeons. Orthopaedic surgery has provided most practising surgeons with great opportunities for travel. It is possible to spend a proportion of basic and training overseas but most surgeons in training defer travel until they have completed their fellowship examination and then generally spend between one and three years obtaining additional training overseas. Overseas conferences provide ongoing opportunities for surgeons who have returned to New Zealand and established themselves in practice and many surgeons commonly travel overseas to conferences twice a more per year.

How has your specialty impacted on your family?

It is important to have the support of spouse and family as ongoing clinical care can impact on family life. The vast majority of orthopaedic surgeons, however, manage to find a satisfactory balance between the some times conflicting needs of work, lifestyle and relationships.

Comments on training

It would be worthwhile talking to registrars who have been accepted into the programme to gain an understanding of what the selection process entails. Contributors have commented that training is arduous, but if undertaken with the right attitude it should be a highly enjoyable and rewarding period of your career.

Specialist Workforce Projections

The New Zealand Orthopaedic Association and the Royal Australasian College of Surgeons attempt to tailor workforce requirements to training numbers.
  • In 2005 there are 155 active orthopaedic surgeons in New Zealand, representing 29% of the total number of surgeons. There are 40 advanced trainees in orthopaedic surgery in 2005.
  • The recommended specialist surgeon to population ratio for orthopaedic surgery is 1:25,000. The actual ratio in New Zealand in 2005 was 1:26,400, so there is no shortfall at present, although with the aging of the population an increase in numbers of orthopaedic surgeons will be required in the future.

General

  • Training in orthopaedic surgery is conducted by the New Zealand Orthopaedic Association Education Committee under the oversight of the Royal Australasian College of Surgeons (RACS). For further information regarding advanced training in orthopaedic surgery, contact the RACS or NZOA websites (www.surgeons.org or www.nzoa.org.nz).
  • Most applicants for specialist training are enrolled in the RACS Basic Surgical Training Programme although this is not always a necessity for overseas trained doctors. Because entry to the training programme is competitive, sometimes a suitable candidate is not successful at first application. The NZOA is eager to provide opportunities for specialist training to eager and enthusiastic applicants and the additional experience gained as a result of an unsuccessful first time application may be ultimately useful and place suitable candidates in a stronger position for subsequent reapplication.
  • Interviews take place as part of the selection process and are standardised for all applications.
  • During the first year of training it is likely that you will be directed towards posts in smaller centres in New Zealand such as Whangarei, Palmerston North and Invercargill. Trainees usually spend the latter years of training in Auckland, Wellington, Hamilton or Christchurch.

Entry requirements

Entry depends on successful completion of basic surgical training or its equivalent. You also require general medical registration and must be either a New Zealand citizen or New Zealand Permanent Resident.

Length of training

Advanced training in orthopaedic surgery takes a minimum of four years to complete and consists of six-month rotations. One year of the training period may be spent in an approved surgical, medical or research post. Training in orthopaedic surgery can be undertaken on a part time basis and applications may be made to interrupt the training to undertake further years of research, for parental leave etc.

Examinations and milestones

  • A log book must be kept to document operation statistics and educational activities such as publications and attendance at conferences.
  • There are two sets of exams during training. The first, an orthopaedic principles and basic sciences exam, is sat at the commencement of the first year of advanced training. The Fellowship Examination in Orthopaedic surgery is generally sat in the fourth year of specialist training and is a requirement for exit from the programme.

Application procedures

The RACS advertises annually for applicants for its specialist training programmes and applications for orthopaedic surgery should be made directly to the NZOA. The process consists of lodging a structured application (CV) form, submitting referee reports and attending a semi-structured interview session. Your clinical performance will also be reviewed. Once successfully appointed to the training programme trainees must then apply to the recommended hospital for employment as a registrar.

Posts available

In the Auckland Area there are 12 specialist training posts in orthopaedic surgery. Nationally there are 42 orthopaedic training positions in total in New Zealand. Hospitals that offer posts include:
Whangarei, North Shore, Auckland City, Middlemore, Waikato, Tauranga, Rotorua, New Plymouth, Palmerston North, Wanganui, Wellington, Hutt Valley, Christchurch, Nelson, Dunedin and Invercargill.