Orthopaedic Surgery Information and Interviews

Walter B. Greene, MD
Degree(s): B.S., M.D.
Title(s), Position(s): Professor and Chairman of Orthopaedic Surgery
University Affiliation: University of Missouri/Columbia
Hospital Affiliation: University of Missouri Hospital
Biography: undergraduate Davidson College, University of North Carolina for medical school and residency in orthopaedic surgery with internship at Parkland Hospital in Dallas. Pediatric orthopaedic fellowship at Newington Children Hospital
Special Interests: hemophilia, neuromuscular disorders, pediatric orthopaedics, adult foot and ankle

What attracted you to Orthopaedic surgery?

Initially, I interest in anatomy and my undergraduate experience working as an orderly in local hospital ER one summer. An orthopaedic surgeon frequently visited there and went out of his way to talk and explain things to me. He allowed me to scrub in with him on some cases.

Why did you choose Orthopaedic surgery? When did you start to think about this choice? (during your basic science years/clinical years/extracurricular activities)

I am interested in the musculoskeletal system and how it works and what happens with disease and injury. Initial interest note in #1 was explored by working on research project with orthopaedic department between first and second year {chromosome analysis of patients with myelomeningocele - not a very good project actually but I did a lot of reading on genetic disorders associated with orthopaedic problems and also attended some of the weekly orthopaedic conferences}. Between 2nd and 3rd year worked on another basic science study with orthopaedic department. Liked the clinical rotation the third year. Concerned that my interest in orthopaedics was influenced by my acquaintance with orthopaedic faculty at UNC and, therefore, between 3rd and 4th year, I did a two-month rotation or externship in orthopaedics at Fitzsimmons Army Hospital. This was not for medical school credit but for exposure to orthopaedics at another hospital. Another great experience. Fitzsimmons is no longer open but at that time was a training site for military and therefore worked with military residents and attendings. Two of the three attendings after finishing army career joined University Orthopaedic Departments as full time faculty.

Throughout your training, what has been the hardest thing to deal with?

This is a tough question because I always was enjoying the process when I was learning new things and part of the process to help people recover from injury or improve their function. With outside rotations during residency, there were several moves required, and this placed more stress on family, but even that was thought of more as an adventure rather than a hardship. Orthopaedics also involves late hours with trauma patients and one should understand this.

Do you have any suggestions (exposure) or advice for pre-medical and medical students considering a career in Orthopaedic surgery?

Orthopaedics is competitive. Most important factor in selecting student for interview is performance in the medical school years. The other factor is have they shown initiative to explore or develop their initial perception that orthopaedics is really what they want to do for the rest of their professional career.

Do you have any particular memories from your residency/fellowship/training that you would like to share?

See my third question. Many vignettes that added understanding of disease process, how to interact with patients that added to my growth as an orthopaedic surgeon and as an academic orthopaedic surgeon.

What would you say is the most common medical condition seen by Orthopaedic surgery today?

I guess it would be Pain NOS. The beauty of orthopaedics is the great variety of conditions. 23 years after completing my formal training I am still seeing conditions that I have not treated before.

What would you say is the most challenging problem or aspect in/of Orthopaedic surgery today?

Keeping up with the knowledge explosion.

What do you see as the three most important advances in Orthopaedic surgery over the past 10-20 years?

Elimination of poliomyelitis, development of total joint arthroplasty, refinement of arthroscopy.

What do you see as the three most important advances in Orthopaedic surgery over the next 10-20 years?

Use of molecular biology to facilitate bone and cartilage regeneration, mapping of human genome and better understanding of genetic aspect of musculoskeletal problems (see recent JAMA article on association of Type 9 collagen defects in patients with degenerative and herniated disk disorders), and larger number of patients living longer that are affected by osteoporosis.

How will Orthopaedic surgery look in 10-20 years and how will the health care system affect it?

See last question. Orthopaedic surgeon will have to have better understanding of molecular biology. Question is whether technical advances will outstrip resources and how will society pay for it. Insurance companies account for 20 to 25% of health care costs. Should eliminate this administrative burden by going to single payer system.

Throughout your career as an Orthopaedic surgeon, is there a particular case that stands out in your mind?

Lots of them for different reasons that I do not want to get into at this time.

What are some of the most rewarding aspects of Orthopaedic surgery?

Variety of conditions, variety of patient ages, working with patients to diagnose condition and improve function / reduce pain.

What are your hobbies outside of work and how do you balance your hectic work schedule and family?

Reading, cycling, being with family.

How would you summarize Orthopaedic surgery in one word, phrase, or sentence?

Variety, demanding.

What are the advantages/disadvantages of doing year-long fellowships?

I get turned off when a medical student tells me that he/she plan on doing a fellowship in ____________? Tough enough to make decision by end of third year whether one wants to become a surgeon specializing in orthopaedics.

What are some of the advantages/disadvantages of private versus academic practice?

Private practice has more income, more personal time. Academic orthopaedic surgeons, on average, work more hours per week and make less because taking care of greater proportion of uninsured patients and work involves education and research that is not reimbursed. However, people who stay in academic orthopaedics enjoy research and education component of their job.

Can you describe your normal daily/weekly/monthly work schedule to me?

14-hour days are typical Monday - Friday, usually do 6-8 hours of "work" on weekend.

If you could change anything about your Orthopaedic training, what would it be?

Better question would be how I would change the process now. I would every medical school graduate to do a year of medicine-surgery internship and then make a final decision on specialty. Decision required too early.

What do you consider the most important thing to look for in a residency program? The 2nd, 3rd, 4th?

Whether the residency program provides good all around education so that one could be very competent to practice as a general orthopaedic surgeon or could be very competitive for a fellowship program and academic position. Will the program enhance my development so that I will both want to and have the skills to keep learning? Does the program have fellowships and how do the fellows impact on the resident experience (every program will tell you that there is no negative impact. Sometime that is true and sometime it is not.

What sets one residency program apart from another?

Many good residency programs. More of deciding which program would best fit one's personality - facilitate learning. Residency is a post-graduate experience and one should not expect to be spoon-fed. In my opinion, resident physicians are adults and should be treated thusly. They must be self-disciplined and independent in doing their study.