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When you open your Match Day envelope, you step into an orthopedic surgery field that looks nothing like it used to. John E. Klibanoff, an orthopedic surgeon, discusses his article “Navigating your orthopedic surgery residency after Match Day,” published on KevinMD. He explains why nobody will care about your physiology grade or your rotation honors once you start residency, and why the old archetype of the tall, athletic, Northeast-raised orthopedic surgeon no longer describes the field. You will hear how AI and short online snippets have collapsed a week of attending-to-attending research into thirty minutes over coffee, how impaction devices and minimally invasive tools have opened recon and spine surgery to surgeons of any stature, and why younger faculty and peer networks are replacing top-down lectures. Klibanoff also explains why mentorship and adaptability matter more than competitiveness, and why patients now arrive with hours of their own research to bring into the room. Listen to hear what actually earns you the craft of orthopedic surgery after Match Day.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome John Klibanoff. He’s an orthopedic surgeon. Today’s KevinMD article is “Navigating your orthopedic surgery residency after Match Day.” John, welcome to the show.

John Klibanoff: Thank you so much, Kevin. It’s absolutely a pleasure to be here.

Kevin Pho: All right, let’s start by briefly sharing your story and then jumping into your KevinMD article that you wrote for us today.

John Klibanoff: OK, so like many of you, I started with an aspiration to go to medical school, which was actually somewhat of a sea change for me when I found out I was not going to go to the Air Force Academy to become an astronaut because of my need for glasses. While I was in medical school, I found that playing the game of volunteering at the hospital, exploring what areas interested you, essentially the people that I really was most resonating with were orthopedic surgeons. They had similar common interests, a similar need to be tactile, and went and did my clinical rotations at a few places around the country that I thought would hold interest for me and where there were experts in aspects of orthopedics that I was most interested in.

And then like all the rest of us, ended up matching. I did my residency and then had about a 30-year clinical career that overlapped for 15 years in the military as a surgeon for the Army, activated intermittently, including both of the Gulf War conflicts. And then about a year and a half ago, made the decision after I had turned 60 to exit clinical practice in order to take a position with Zimmer Biomet as their global vice president of medical education and surgeon relations. And here I sit.

Kevin Pho: All right. Your KevinMD article is about navigating orthopedic surgery residency after Match Day. Why did you decide to write this article? And then just tell us about the article itself for those that didn’t get a chance to read it.

John Klibanoff: Well, that critical waypoint in your career when you find out that you have matched both within a field and a location. I remember quite distinctly what it was like standing in the cafeteria of our medical school with the other 99 students in my class waiting to open the envelopes. And as I look back at that, I remembered that once that envelope was opened and I had matched at the program that I had selected, what I thought about was what was I then going to be doing for the next five years? The move to Minnesota, which is where I did my residency training, how was that going to look? Who were the attendings I was going to interact with, and how was it going to impact where I ultimately landed for my career?

And when I was thinking about what’s changed, that was back in 1990. What’s changed now is so dramatic in that access to information, the way that we teach and train is so different, and that must have had or continue to have an impact on where you go and what you do.

So, as an example, when you and I trained, Kevin, and perhaps I’m being unfair in dating us, but when we trained, if you wanted to learn about something, you accessed your attendings, perhaps you went to the library, you may have done some research, you may have talked to somebody at a conference, but the ability to access the information you looked to seek was a very long time horizon. It might have taken a week, a month, three months. And now with the advent of online access of digestible snippets of information and the accessibility of faculty from around the world in an online webinar and AI format, your ability to learn has been accelerated so much.

And so the impact of what you can do as a resident has changed because one of the things that took so much time is now a very small part of your day. And I was thinking about how has that changed what the orthopedic surgeon looks like. How has that changed in what they can deliver? They are smarter, more well-trained, and more adept at interfacing with patients than we ever could have been because they have more time to dedicate to those things. So that’s what made me look back and decide to write the article.

Kevin Pho: So for the more recent classes of orthopedic surgery residents, in contrast to those, say a decade ago, you said that they have more time. Are you saying that because of things like AI and just so much access to information, they’re coming in with more knowledge and perhaps more time where they could address some of their technical skills that they need to learn as orthopedic surgeons?

John Klibanoff: Yeah, exactly. So if we look at some of the historical changes, things that made a difference when the Libby Zion case was settled, the residency hours and the understanding of how that impacted delivery of patient care had a reduction in the numbers of hours that one could apply to their technical craft, and within those hours were included all of the external learning that you needed to do or the research you needed to do. And so that was something that was perceived as, how are we going to make that up?

As online presence, as journals became electronic, as AI has entered the field, now we can expand those 80 hours to include more technical training, more ability to observe, spend more time in the clinic talking with patients, learning how to be a physician in a much more well-rounded sense, because less of that time is occupied by some of the things that would otherwise have taken so much more energy and effort.

And then similarly, our ability to compare and contrast information is better. So if I want to say, look up, what are the advantages of doing a hip replacement from an anterior approach or a posterior approach? That might have been a one- or two-week process talking with many attendings. Now, you can quickly go online, ask a decent AI, and of course you have to apply some degree of intellectual oversight, but you can also access with three- to five-minute digestible snippets of information from recorded webinars and from experts in discussion, and you can very quickly arrive at the information you need to make a clinical decision with a much higher level of confidence and no concern about, am I being presented with bias or preference even from the seat of industry. You know, we obviously have a lens that we look through, but if you can gather information from all of the major players within a short compressed period of time, maybe 30 minutes at home having coffee, and then you arrive at the OR with so much more information at your fingertips and you can make better decisions that way.

Kevin Pho: What’s the message that you want to give to newly matched orthopedic surgeons? We’re speaking in the middle of April, and of course, Match Day was about a month ago. After they match, what’s the message that you want to share with these medical students who have matched orthopedic surgery?

John Klibanoff: There’s a couple of things that I thought about and talked about this in the article for you. Number one, you have to look at this as a complete leveling of the playing field once you match. All of the things that you did before, nobody cares about. You know, what your grade was in physiology, nobody cares how you scored. Honors, high honors, satisfactory in a rotation. The goal now is to hone your craft, and so you have to put all of the baggage and stress that went into matching behind you.

You also, I think, need to be very adaptable. There’s time to learn your technical skills and there is time to have access to information. Make sure that you approach being an orthopedic surgery resident as a well-rounded physician. Find yourself mentors, people who will help you navigate not just the technical parts of being surgery, but the aspects of understanding the patient and making sure that we approach a field that traditionally was felt to be one of the top 10, and it still is in terms of competitiveness. Put all of that competitiveness aside and open yourself up to learning from everyone: the physicians you work with, the residents and the interns that you work with, and the patients.

Because patients now are so much more well-armed with the information related to their particular problem, and we have to engage them as a method of not just gaining information for us to make the analysis of what’s wrong, but also that they may come with hours and hours of research from real sources of information that may help us come to a better decision for that individual. So be adaptable and find yourself mentors.

Kevin Pho: Now, when you teach interns and residents about these newly informed patients who have access to so much more information, how do you teach that? What kind of lessons can you share when you teach these interns and residents?

John Klibanoff: Well, when we seek to engage them from an industry standpoint, one of the things we’re trying to do is use younger surgeons to help us impart the information. So we have faculty that we engage who are physicians from around the country. And you know, traditionally it’s been somewhat of a top-down approach where you have these international and nationally known KOLs at meetings and they teach and they do instructional course lectures. And that’s terrific still for information on where the field is headed. But for the dissemination of both tactical abilities and for understanding the strategic thinking around patients, having that information disseminated by people who are younger, more recently in training, who can relate, so that at the end of a seminar where we may run a bioskills for 12 or 15 senior residents and maybe a fellow or two, that at the end of that, instead of giving them a PowerPoint presentation that they can download off a zip drive, instead, what they do is they exchange emails or Instagram pages, and they establish a network where we know that it’s an iterative improvement.

They can take the things they learn, go to the OR, talk to their colleagues, and maybe they say, “Hey, you know what? I don’t remember what they said about this.” And in the past that was really challenging. I mean, how do you approach, you know, Dr. X, who’s the head of the academy, and ask a simple question about a lecture they gave versus Dr. Miller, who’s three years in practice and gave me their phone number, their Instagram page, and I just shoot them a quick text and say, “I’m about to do this with a patient. I don’t remember us talking about this. Can you give me a little advice?” So that’s one of the ways that we implement that in terms of establishing connection and mentorship.

And then also what we want to deliver is tools that are available. So that’s where that online repository becomes very, very important. Where anybody we touch, we say to them, we have, I’ll just use our company as an example, we have an online ZB Institute, which is the repository of all of our medical relevant information that physicians can access. So we give them a login, we give them their password, and then they have access to that entire ecosystem. And candidly, one of my goals is to establish that globally for our company so that a fellow in Singapore can easily access the information that we might have presented at a regional conference in Las Vegas.

Kevin Pho: What do you see as the future when it comes to orthopedic surgery training?

John Klibanoff: I think that as we implement machine learning and AI, orthopedics as a field that is, not uniquely, but one of the few that is very well made it to the adoption of technology. Many of the things that we do as orthopedic surgeons require a certain amount of physical effort in the OR that maybe is somewhat unique. And development of tools that reduce the physical stress and that allow the adoption of improved accuracy and efficacy to solve the four problems that we see as access, efficiency, safety, and outcomes. I think that orthopedics is uniquely positioned as a field to adopt that when it comes to technology, AI, and machine learning, and that is absolutely where the field is trending.

The ultimate goal, I would say, is to move from replace to restore, and the more we learn about early intervention, the more we get closer to, at least within reconstructive orthopedics, the holy grail of cartilage preservation or regrowth. Similarly, as we look at things like periprosthetic joint infection, which cost in the U.S. over $2 billion a year in care, even a small diminution in the number or percentage of joints that become actively infected is a huge savings. And from a morbidity-mortality standpoint, PJI is more lethal than five of the most common cancers over a five-year period.

So we like to see that the application of technology and AI is working towards that. And that’s something that I think the current cohort of orthopedic residents, they are so well positioned to absorb that because that’s going to be in their DNA in a way that it perhaps wasn’t in ours 30 or 40 years ago.

Kevin Pho: Now for those medical students who may be listening to you, tell us the type of traits or characteristics that would make them more amenable to a career in orthopedic surgery.

John Klibanoff: Well, wonderfully that has changed. Let’s call a spade a spade here. 40 or 50 years ago, orthopedic surgeons as a field were very homogenous in their appearance. They were almost always men. They typically came from the Northeast and a lot of them played sports. Now, obviously there are exceptions, and I’m talking about the U.S. because that’s where our match is.

If you look now at what an orthopedic surgeon looks like or brings to the table, the palette has completely changed. It is not monochromatic. It’s the entire color wheel and all the hues and tints. And that engages a vast amount of knowledge and point of view that we never had.

So, a good example: It may have been that 35 years ago someone who was five foot one and maybe had never played athletics and was very cerebral, a great musician, may have felt that orthopedics as a field was going to be too taxing on their ability mechanically or physically to engage and endure, and would create a different type of muscle memory that may hamper some of the other things they do. None of that is true. OK? You can take somebody with that stature and they can be a recon joint surgeon who no longer has to swing a five-pound mallet, seven or eight cases a day for 30 or 40 minutes, causing rotator cuff dysfunction and arthritic disease. Now we have impaction devices that weigh a few pounds and take almost all of the physical strain out of that operation.

So somebody who wants to be a recon surgeon, but may have thought it wasn’t in their wheelhouse, they can, I’ll use me as an example. I’m only five foot seven. I had some interest in doing spine, and when I trained, every spine surgeon I worked with was at least six feet tall because they, you know, they stood and looked down. Nowadays with some of the advances in spinal technology and the use of minimally invasive, I probably could have done that for a course of a career and not had to worry about always having low back pain or neck pain from looking down in the field from some of those small platforms you have had to stand on.

So we see that the engagement of many types of individuals who perhaps in the past would’ve felt excluded, and none of that’s the case anymore, and it’s wonderful.

Kevin Pho: We’re talking to John Klibanoff, an orthopedic surgeon. Today’s KevinMD article is “Navigating your orthopedic surgery residency after Match Day.” John, let’s end with some take-home messages that you want to leave with the KevinMD audience.

John Klibanoff: Yeah, a couple. Number one, if you match in orthopedic surgery, you are joining a robust field of people who share tremendously the desire, ability, and wonder that comes from restoring people to health in a way that not all of our colleagues can do, and that’s incredibly rewarding.

Number two, there are no barriers to entry within this field if you want to do musculoskeletal medicine, ranging from orthopedic oncology to knee arthroscopy, to shoulder reconstruction, to even the biology of cartilage doing research. That is such a wonderful panoply of abilities to impact care and improve the quality of lives, people around the world. We, within the field, welcome every single viewpoint and vision that you can bring because it’s from those varied viewpoints that we get the next advances.

And then third, you’re going to make mistakes and that’s totally OK. The human body has withstood our ability to poke and penetrate it for over a million years. It’s going to continue to do that. The more we apply the iterative knowledge, the more successful we are. And certainly if you enjoy the tactile and the responsiveness of engaging with somebody whose goal is to get back to the physical wellbeing that the baby boomers and beyond demand, now it’s a great field to come into.

Kevin Pho: John, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

John Klibanoff: Absolutely. Thanks, Kevin, for the opportunity and good luck to all of those of you who matched across the entire spectrum of medicine.