T&O tends to be split into elective (e.g. foot/ankle, hands, sports knees, etc) and trauma rotations. The elective jobs are often 9-5 with a tendency towards doing non-resident on calls. They probably account for 3/4 of rotations and most people enjoy them, although I'm not as enthusiastic about spending years doing knee/shoulder arthroscopies and spine clinics.(Original post by Anna1988)
How are you finding life as a T&O SpR? both in terms of what you do and the hours and rotas.
Trauma jobs are - I think, although I am amongst a minority of T&O trainees - more interesting but much more intense. There is a good case mix, e.g. children/adults, acute fractures of all different types in all different places in all different people, operating across a range of anatomical sites, complications (infections, non-unions), critically ill polytrauma patients, and the frail elderly with co-morbidities and deranged physiology. It's a very multidisciplinary specialty that necessarily works closely with physios, hand therapists, OTs, plaster technicians, radiographers, A&E docs, orthogeriatricians, etc. My last trauma job meant working 5/7 per week (3 of those days being 13-14 hour shifts) with 1:4 resident nights and 1:4 weekends. Nights/weekends were also 13-14 hour shifts. Unlike EM, a lot of this time is not scheduled - you are just expected to work because it is (a) part of your training, (b) everyone else does it, and (c) you will not progress if you aren't a "team player".
The downsides (for me) of T&O are:
1. It is very hierarchical. It takes a long time to learn to do what your consultant can do and this means that SpRs feel (and are often treated) like children unless they are very good or very senior. As so little is actually evidence based anyway, all trainee decisions are open to criticism. In EM, trainees have a lot more autonomy at an earlier stage and their consultants are available for the more serious/complex cases.
2. The training is long - after FY1/FY2/CT1/CT2 a lot of people take a year or two ("CT3") before getting a training SpR job. The training itself then runs until ST8 but everyone is expected to go on fellowship afterwards and many now do two fellowships. That's 12 years in total without taking any CT3 time, maternity leave, OOPR (MD/PhD), or being held back a year (what my Training Programme Director calls "the gift of extra high quality training...!!), etc. I am doing a PhD now and will return to ST3 in two years. Contemporaries of mine from medical school are already fully qualified GPs and those in the year ahead are consultants in EM and radiology.
3. Even trauma is much narrower than the broad spectrum of patients seen in EM. Orthopods are almost actively discouraged from being involved in peri-operative care - other specialties, nurses, and SHOs simply assume that you can't assess a sick patient, read an ECG, or do an ABG, etc. It doesn't take long before this assumption becomes correct...
... and the ones that won't