Orthopaedic Surgery Information and Interviews

Mary Lloyd Ireland, MD
Title(s), Position(s): Private Practice Physician at Kentucky Sports Medicine, Eastern Kentucky University, Team Physician, Georgetown College, Team Consultant, 1998 to Present Women's United Soccer Association (WUSA), Medical Director
Hospital Affiliation: Consultant in Orthopaedic Surgery, Shriner's Hospital, Lexington, KY Biography: Undergraduate 1974, Memphis State University, Memphis, TN; Medical School at University of Tennessee, Memphis, Center for Health Sciences; University of California, Irvine: Pediatrics Postgraduate Level 1, University of California, Irvine: General Surgery Postgraduate Level 2, University of California, Irvine: Orthopaedic Surgery Postgraduate Levels 3-6; Fellow Pediatric Orthopaedic Surgery/Sports Medicine, Boston Children's Hospital, Harvard University, Boston, MA; Fellow Orthopaedic Surgery/Sports Medicine, Hughston Orthopaedic Clinic, Columbus, GA
Special Interests: Sports Medicine

What attracted you to Orthopaedic surgery?

I participated in many sports during my adolescence and had injuries to my shoulder and a back problem with spondylolisthesis which required spinal fusion when I was 15. I was a good student and enjoyed science. As I continued to perform well in school, I decided on medicine and remembered the physicians that took care of me who were orthopaedists. My parents who were not physicians were friends of these orthopaedic surgeons. I liked their lifestyle and the type of patients that they took of-like me-who were very motivated to get well and return to a high level of activity. When I graduated from the University of Tennessee Center for the Health Sciences in 1978, I was discouraged from going into orthopaedic surgery by my advisors. They felt that the residency would be a long commitment of time and energy and suggested I look into other specialties which attracted me. I said I like children and I applied for rotating in pediatric internships. I matched at the University of California Irvine for a year of pediatrics. After two days in pediatrics, I was convinced that orthopaedic surgery was what I wanted to do.

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

Partly answered in #1. The years and commitment in residency, doing research, and clinical activities never discouraged me. If I am interested and stimulated by a task, the number of years that it takes to reach the goal was never an issue. The choice of orthopaedic surgery always was in my mind from my injuries competing in numerous sports, including field hockey, basketball, track, and mostly swimming. I also had an injury to my shoulder for which I had surgery in 1977. The choice of orthopaedic surgery was always in the back of my mind but confirmed when I was unable to find a specialty in pediatrics which I felt I could pursue as a lifelong work.

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

Training was certainly challenging, but since I had been out of training now for 15 years, I don't remember a particularly terribly difficult thing. The time commitment involved in the in-hospital call was the most difficult.

How would you classify the competitiveness of obtaining one of the Orthopaedic surgery residency positions?

In the 1980s, orthopaedic surgery was competitive, however, it is even more competitive today. I had two opportunities to enter orthopaedic surgery after doing a general surgery second year. I therefore was not straight through the match. If you decide later you want to do orthopaedic surgery, it is still possible to be placed in programs. Just because you didn't match medical school should not discourage you from doing orthopaedics if you are impassioned by this goal.

How would you classify the competitiveness of obtaining one of the Orthopaedic surgery fellowship positions?

As stated, I did not enter directly after medical school. The competitiveness, however, was very high.

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

I would suggest rotations at other institutions in orthopaedic surgery where you might want to do your residency. Research projects and working with the orthopaedists, basic science physicians at your institutions with the goal of published papers is also invaluable.

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

Our residency had four per year, and I really felt as if I had 15 brothers. I carried my own weight, never asked for any favors, was never challenged on strength issues, since I was the only female in the program. The faculty members were great and gender was never an issue.

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

I have a special interest in sports medicine and therefore the most common condition that I see is knee injuries. From a surgical standpoint, 80% of the surgeries that I do are on knee or shoulders. The most common injury in sports medicine is a sprained ankle but this sometimes does not get to the orthopaedic surgeon's office.

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

I enjoy the work and stimulation of doing research projects and presenting at local, national, and international meetings. I also enjoy teaching and have a fellowship program. The most challenging problem for me in private practice is funding these endeavors because of reduction in reimbursements. Reduction in fees generated over the past five years has been about 30%. I am not complaining about my bottom line income but about the inability to continue with these programs. At this point, I am able to continue. In the future, academic institutions and private institutions who are doing research may be in trouble because of inability to fund of these very important programs. Outside dollars for research from pharmaceutical companies, equipment companies and private interest groups must be considered.

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

The most important advances in orthopaedic surgery over the last 10 to 20 years are arthroscopy, including methods and equipment, far and away #1 as it affects my practice. Total joint design and material, poly research for hip and knee arthroplasties, and instrumentation for back instability have also come a long way.

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

The three most advances over the next 10 to 20 years would include genetic engineering, i.e., biopsying a muscle cell and turning it into a ligament cell and growing one's own ligament, for example. Creation of cells which can be placed with the scaffolding in the knee for articular cartilage and meniscal replacements, and preventative medicine, including earlier diagnosis for arthritis and medical treatment including newer PO medications and intra-articular medications.

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

The health care system continues to affect orthopaedic surgery. Fortunately, we have a very active Academy of orthopaedic surgeons who work at a national level with Congress and represent us well in the private sector. Defending and promoting our positions on issues to keep individuals mobile will be maintained at the highest level. Support of the associations which take our message to those who listen and call the shots for health care system is very important.

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

As a junior resident, a knee fusion with individually designed prosthesis was used in individual with giant cell tumor. The result was not good of compartment syndrome and later amputation.

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

Most rewarding aspects is having the ability to restore the patient to previous level of activity. In case of an athlete, it is most rewarding to see them out on the field again doing well. Patient satisfaction is my greatest reward. Teaching of fellows and others is right behind that.

How long is the training process and is research an integral part of your training?

I ended up with six years post medical school and did two sports medicine fellowships. So training was eight years. Research was suggested during my training but not mandatory for completion.

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

Hobbies are golf and incorporating the places I travel to give talks as vacation. Priorities must be set to maintain balance of work and family. In sports medicine, there are certain times of the year, such as football in the fall, where the coverage schedule makes for an imbalance with less time for research and at home. However, you adapt.

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

Orthopaedic surgery is challenging but rewarding, in that the patient has musculoskeletal problem (as which are usually improvable, if not fixable).

How competitive are various fellowships in Orthopaedic surgery?

The fellowships vary greatly in level of competition by what specialty and place that you want to do the specialty. There are some fellowship programs which are much more popular than others and would therefore be more difficult to get into. Specific information can be obtained through ACGME or the particular fellowship society.

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

The sports medicine fellowship is a year long. Working with several different physicians during that year is advantageous. I feel the year is the right length to allow for time to really see patients and results, and in particularly, complete research projects. I have been in private practice for the last 15 years. I do have a fellowship program and do research, which is basically research in association with the university.

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

The advantage of private practice is that I am responsible for my own decisions.

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

The weekly schedule is seeing patients in the office for half-day clinic sessions for a total of two days and operating two days. We usually take an afternoon for research two times a week.

What sets Orthopaedic surgery apart from other surgery specialties?

As orthopaedic surgeons, we see patients recover very quickly after surgery. If we make the correct diagnosis and steer the patient in the right direction with rehabilitation program and the right timing in returning to full activities and sport, they do quite well. Certainly, not all musculoskeletal injuries require surgery. The real key is knowing who to operate on.

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

I really wouldn't change anything. The call issue as far as hours are now being addressed by mandatory limits on hours per week per call. If you are not available and around to conditions, you won't see enough during residency, as those go quickly.

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

There are pamphlets which can give you specific questions to have of residency programs. Talking with the residents who are presently in the program is a good suggestion. Even talking to graduates of the program would be good advice. You should look for where you will be most comfortable from several views-the faculty, geographic location, and make sure you can have the enthusiasm to perform well throughout your residency.

What sets one residency program apart from another?

Residencies can be very different. Looking at the stability of the residency program as far as basically giving you accreditation, how old is the program, how many residents are in the program-some like smaller, some like bigger. Some programs are more academic than others or academic with research or even research year, than others. Residency programs can be very different. By doing a month rotational program, one can get a better sense of what the program is really like.

Is there anything that you can add to my list here?

There have been some specific questions to ask, more from the gender issue from the Ruth Jackson Orthopaedic Society, http://www.rjos.org/, which was developed to support and mentor women who are going into Orthopaedics.