Panelists Speak Frankly about How Successful Careers Require Adaptation, Reflection, and Intentionality

Orthopaedics is a wonderful career, but it is also a business. Like any business, in order to be successful, one has to be positioned to succeed.

“There is a progression to your practice, and you have to be intentional about it,” said Xavier A. Duralde, MD, FAAOS, of Peachtree Orthopedics. “Nothing happens if you are sitting around passively waiting for something to happen.”

This was just part of the career advice that Dr. Duralde imparted to attendees during the Instructional Course Lecture titled “Excellence in an Orthopaedic Career: Expert Advice from Cradle to Grave,” held at the AAOS 2024 Annual Meeting. Dr. Duralde’s presentation was a “view from the top,” looking back over a career spanning more than 30 years. The course also included experts at different stages of their careers, all with various perspectives on the best methods to succeed in leadership, research, and teaching.

Adaptive teaching
When first starting out as an orthopaedic attending, developing a successful mentoring approach is an important part of professional and personal success, according to Amiethab Aiyer, MD, FAAOS, of Johns Hopkins Medicine.

“Whether you are a medical student or an attending, there is a transfer of knowledge that occurs at every stage of your career, and that transfer is not one direction. It needs to be bidirectional,” Dr. Aiyer said.

Sometimes that transfer of knowledge can be a challenge due to generational differences or differences in attitudes or perspectives. To be an effective mentor and teacher, one must attempt to understand differences in learning styles that may exist between attendings and residents.

“Today’s trainees are now more collaborative and technologically driven,” Dr. Aiyer said. “Changes to the medical curriculum continues to occur nationally, with the introduction of clinical experience occurring way earlier in the medical school timeline.” Someone early in a career needs to learn how to manage the demands of practice, balance family or personal obligations, and figure out how to best dovetail the learner’s priorities with their own.

Unique perspectives
Although the learning styles of residents may have changed recently, one thing that has not changed is the difficulty of recruiting women to the specialty. “As a woman or an underrepresented minority, you may be in a room where you feel like you are the only one of your particular identity,” said Wakenda K. Tyler, MD, MPH, FAAOS, of Columbia University Irving Medical Center. Sometimes that can be incredibly intimidating or overwhelming, but it does not always have to be a bad thing, as members of underrepresented groups can provide diversity of perspective.

Dr. Tyler said that women in orthopaedics need to have confidence. If someone is struggling with confidence in the OR or the clinic, do not be afraid to seek help, she said. Help can be found with mentors or friends, and if that does not seem like the right pathway, professional coaching can be very beneficial.

If confronted with situations where perhaps patients, colleagues, or support staff are expecting a white male, remember: “The problem is not with you,” Dr. Tyler said. “It is with them.”

He added, “You don’t have to be confrontational or angry; it is just the reality we are in right now, but hopefully times are going to change.”

Women may also be faced with different social expectations related to family or motherhood. Dr. Tyler said to remember that each individual gets to decide which of those expectations they accept and which get thrown out the door.

“The best advice I can give people is to find your allies, which are different from mentors,” Dr. Tyler said. “Find your allies, get them in your corner, and then work to maintain those relationships. Then be an ally for as many other people as you can.”

Follow the path of joy
Course moderator Brian T. Feeley, MD, FAAOS, of University of California, San Francisco (UCSF), gave practical advice for balancing an orthopaedic practice with a love of research, something he said makes his heart happy. Research can provide additional intellectual stimulation, wider peer or mentorship groups, and the ability to innovate and create. Anyone interested in research should take the time to figure out the big-picture problem they want to solve and determine the resources available at their institution to solve it.

Dr. Feeley also spoke at length about the importance of finding a collaborator, whether that is someone in the lab or a clinical research coordinator or statistician. “For me, that is Xuhui [Liu, MD, of UCSF]. We have been together for 12 years, and I am nowhere without him,” Dr. Feeley said.

Once you have a partner, build a team. More and more studies highlight the importance of diversity in research teams. “Diversity can look a lot of different ways,” Dr. Feeley said. “Your team should complement your weaknesses.”

Reevaluating goals
With his 18 years of experience, Jonathan P. Braman, MD, FAAOS, of Henry Ford Health, has recently realized the importance of focusing his practice on what is most important. After years in a growth mindset, he said, growth became “overgrowth,” and it was time to prune.

“I wanted to turn my practice from what it had organically evolved into, to what I wanted it to be,” Dr. Braman said. To do that, he created a mission statement for his practice that helped define who he was and who he aspired to be. Then, new or existing opportunities had to achieve the goals of his mission statement.

“Your mission is your career, and your career is your mission,” Dr. Braman said. “It is important to understand how you can captain your ship to control your mission and your practice and to do that repeatedly by reexamining things you bring into your practice.”

The final speaker was William N. Levine, MD, FAAOS, of Columbia University, who focused on leadership. In a field like orthopaedics, it is especially important for leaders to keep one foot on the mountain and the other in the valley, he said. “If I was never in the operating room, it would be hard to be a successful leader,” Dr. Levine said.

People can find leadership opportunities at every stage of their careers if they look for them and put themselves out there. “You have to raise your hand,” Dr. Levine said. “And if you want these opportunities, you have to work hard.”

Leah Lawrence is a freelance medical writer for AAOS Now.