For this blog, I had the privilege of speaking with Dr. Noelle Whyte and Dr. Neeraj Patel. Dr. Whyte is an assistant professor of orthopaedic surgery at the University of Michigan, where she oversees the pediatric orthopaedics curriculum for residents with her clinical focus centering on children with neuromuscular disorders. Dr. Patel is an associate professor of orthopaedic surgery at Ann & Robert H. Lurie Children's Hospital of Chicago, with research and clinical interests in pediatric sports medicine and health disparities. In this interview, we explore their paths to pediatric orthopaedics, what a typical day looks like, and why more aspiring orthopaedic surgeons should consider pediatrics.

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Annika: What drew you to orthopedic surgery initially when you were a medical student?

Dr. Whyte: I really liked the idea of being able to improve people's function. My undergrad degree is in kinesiology, and before I applied to medical school, I thought I wanted to be a physical therapist. Then I got injured, and I had to do physical therapy and [realized] I'm less interested in the rehab portion, and more interested in the surgeries. I went through all my rotations and was still trying to keep an open mind. Almost got drawn into OB, but I realized that things can quickly go from everything's fine to complete chaos. I landed back in ortho, and I think I landed in the right spot.

Dr. Patel: When I entered med school, I checked out different things early on in first year. I started thinking about orthopedics because I had an interest in how the musculoskeletal system works; how structure and function work together. I also, at the time, was still in the military, and people get injured. I was curious to understand more about the mechanics, anatomy, and physiology behind injury and recovery. One of my good friends in that first year of med school was extremely interested in orthopaedics and that probably rubbed off a bit. So then I just kind of started exploring stuff, cold emailing people. And I think from there, the more I learned about it, the more I enjoyed the subject matter, the people, the culture. I decided pretty quickly after that that I want to do orthopaedics, and then, ultimately, sub specializing in peds sports. But I don't have to go on and on about that right now.

Annika: Actually, that is my next question for both of you. At what point in your training did you decide on pediatrics, and why?

Dr. Whyte: I decided in my second year that I wanted to do peds. As I was going through all of my rotations, I liked a lot of different things. I really enjoyed trauma surgery, but I didn't like taking care of complex pelvic and acetabular fractures. Also, taking care of adults with fractures brings with it another set of issues that you have to deal with. I really liked foot and ankle and upper extremity but I didn’t like the anatomy in the hand. So, that got me thinking, Okay, well, what's going to allow me to work all over the body, but also have fun and do the things that I like doing? I was concerned about taking care of kids and causing irreversible disability at such an early age – something that pushes people away from pediatric surgical care. And then the other added complexity with peds is having to manage parent expectations.

When I got to my peds rotation, I had zero expectations to like it. But I had a really great attending at University of Chicago, and I enjoyed every day on service. I liked talking to the families. I liked talking to the parents. I would say I tend to gravitate towards talking to kids and engaging them a lot more so than adults. I think it was just a natural fit for me, and I enjoy seeing patients through the course of their diagnosis. Of course, I really like seeing the kids that I started with in practice now, talking to the families about how they've grown and how their diagnosis evolves over time. It’s something that I really take pride in, helping to counsel the families on what to expect and what's not to be expected for disease process.

Dr. Patel: For me, it just sort of happened by dumb luck to some degree. And I think my story really hammers home the power of good mentoring. My medical school, no shade to them, they didn't have a very busy pediatric ortho service. I didn't really know anything about pediatric orthopaedics early in med school. Between my third and fourth year, I took a gap year. I was like getting an MPH and thought it would be cool to get some additional experience doing research and learning more orthopaedics. At that time, the Children's Hospital of Philadelphia (CHOP), had one of the very few uniquely orthopaedic year-out programs for med students. It was called the Benjamin Fox Research Fellowship. I happen to get in.

I got there, and immediately I'm like, Oh, this is awesome. You have the best people in the world, at the best place in the world, doing the best things in the world. You see that every single day for a full year, and you're like, Yeah, I want to do that, right? Jack Flynn and Ted Ganley, those guys were unbelievable mentors and still are. That year at CHOP, even as a med student, cemented in my mind that it was pediatrics or bust. Later on, I enjoyed my sports rotations during residency, but I thought, Well, what are the things in sports medicine that I that I don't really like? And similar to what Noelle was saying about trauma. I don't really like rotator cuffs and degenerative knee scopes. Subtract that stuff and you have largely pediatric sports medicine. That's how I landed in peds and then peds sports.

Annika: Yes, it's always so interesting, how much mentorship and serendipity shapes things for you. Shifting gears, starting from a broader overview, what does a typical weekday at work look like for you in terms of your split between OR time, clinic time, and research time?

Dr. Whyte: I think it depends on where you are. Both Neeraj and I are at academic institutions. I'm mostly clinical, so I have one admin day, two clinic days, and one to two OR days a week. I have three kids, so I like to get them off to school and pick them up on my admin day. I try to put my research work in the morning since I find that is when I am most productive, and in the afternoon, I catch up on documentation, calling patients and other things that don't require me to be as alert. On OR days, our hospital cases start at 7:30 am, and then, depending on what types of cases, are usually finished by 6:00pm. I try to get my clinic and op notes done in between cases if I have multiple cases in a day. On my clinic days, our clinics start at 8:00 and usually go until about 4:30. Because I've got young kids, I try to rush out and get home pretty quickly, so we can have dinner together. Once I get them off to sleep, I usually will do additional documentation in the evening. Every other week I have a full OR day or a half day video visits in the morning and more admin time in the afternoon. This is a little bit of flex for me to catch up on whatever is left over from the week, do more research or additional work for resident didactics.

Dr. Patel: I think a lot of my days are probably pretty similar to Noelle’s but since I’m 50/50 clinical and research, depending on the day of the week, my days can be very different from each other. For example, today is a research day for me. I have two kids, and I was able to drop them off at school and then come back and meet with you. On days like this, I tend to have several meetings with med students who are working on projects with me, collaborators from other institutions, and others. I’m also director of our health disparities and community outreach program, so I meet frequently with community partners to move things forward. And then my research work may entail brainstorming new ideas, writing grants, running statistical analysis for a project, or reviewing manuscripts for submission.

My OR and clinic days are pretty similar to what Noelle described. Days at the main hospital usually start at 7:30 but at our ambulatory surgery center, sometimes 7:00. Between cases, you try to do what you can. I'm not great at doing deep work between cases, but will at least try to reply to some emails so they don’t build up. Clinic days start around 8:00. I try to knock out all my notes during the day so that when I get home, I don't have a dozen clinic notes to sort through. And then we take call and it just depends on what comes in the door those days. We have residents in-house, which I’m very thankful for. They're seeing the consults in the ER, fielding the pages. On the weekends, I will go in and round but, other than that, just if someone needs surgery.

Dr. Whyte: I forgot to mention the call we take. We take call on the day that we operate. I'm on call every Tuesday because that's the day that I will always operate. If something gets left over, then it usually gets added on for me. That might change how late I'm here in the hospital. It's busier in the summer. Pediatric orthopaedics is very seasonal, and you will not find that in other areas of ortho or maybe even in other areas of medicine. Appendicitis doesn't, at least to my knowledge, choose when to rear its ugly head, but fractures in the Midwest are much more common in the summer. In the winter, there's a lull and then when fall sports start, there is another blip. Our days tend to be longer in the summer, lighter in the fall and winter. You can also take advantage of that in terms of what you are doing for research and academics. And then same with me, if I'm on call on the weekend, I'll go in to round. If there are cases to do or a consult that needs another evaluation I will go in for those situations. Otherwise we rely on the residents to see the consults, staff them with us, come up with a plan together and make sure it's appropriate.

Annika: Yes, that’s really interesting. Actually, when I was on my pediatrics rotation, we work in the ED. I was there in the summer and was hopeful that we get fractures. We did not but that is very atypical.

Dr. Patel: I just wanted to touch on something that was kind of mentioned by both Noelle and I. I think the culture of pediatric orthopaedics often tends to lend itself towards a lifestyle or an approach that is a little more family friendly or holistic. I think there's just a little different value of family. Certainly in my group and many others, we help each other out and value life outside of work, family, etc. Because those things are a priority, we're often able to make accommodations or build infrastructure that, frankly, allows us to see our families, take our kids to school and be there for that kind of stuff. I do think that's one thing that is special about peds ortho.

Annika: That makes sense, especially given that you often have family centered care – that’s such a big part of what you do.

Dr. Whyte: It's hard to be upset when you go to clinic and you'll see a little baby. They just want to have fun and be happy, and so it rubs off on you a little bit. Yes, you'll have to deal with some difficult parents every once in a while, but, for the most part, it's not that bad. And you also have to remember these are their kids. They want the best for them, just like we would want the best for our kids. Sometimes that means advocating very strongly for them. That’s something to keep in mind and makes it a little bit more palatable when you do run into the situation with “overbearing” parents.

Dr. Patel: My co-residents were often like, Oh, but the parents, but the parents. I'm like, sure, but if you can get everyone on the same page and really work together, it’s double the win because the kid is happy, the family is happy, everyone is happy. I think there's added satisfaction from being successful when you're able to do all that.

Annika: Absolutely. My last question I wanted to touch on for the students who are going to be reading this, what should a medical student do if they're interested in pediatric orthopaedics?

Dr. Whyte: Number one, don't be afraid. Even when I talk to our residents, they are really nervous about hurting a kid or doing something irreversible. I think if you're going to go into peds, there is going to be that risk there, but keep remember that the overall majority of kids are going to do well. You're in this to help kids long term.

Get involved early. I would say that's super helpful because if the first time you are on peds is when you match into orthopaedics, that sometimes is a little bit late. You don't really know the extent of what's available and how fulfilling the work can be. Don't be afraid and be open to lots of different experiences and try to find a great mentor. You know, as Neeraj says, its really important to have great mentorship. I had a great mentor when I was in residency, and to this day, we talk back and forth, but I almost wish I had more mentors going through medical school because that is a really critical time in forming your opinions on what it is that you like and why it is that you like it. If you've got a mentor that's really happy with what they do, then that can really rub off on you and make a very positive impact.

Dr. Patel: I definitely echo a lot of what Noelle just said. Of course, to get to peds ortho, first you have to get to ortho. As everyone knows, it was extremely competitive this year. The playbook is still generally the same – do well in school, on your tests, be a good person, get to know people. But, to echo Noelle’s point, I think reaching out to people early and getting to know us a little bit, getting a mentor, shadowing a little bit, gaining exposure is helpful. To me, what we do is awesome, but each field has its own feel to it and culture. You go to peds ortho conferences, for example, and everyone's very approachable. They might be the biggest pediatric orthopedist in the world, but if you just go up to them, they’ll talk to you. It’s not like that everywhere. Don't be afraid to cold email as long as you approach it tactfully. I think we're all pretty approachable, and we want to help.

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I hope you all enjoyed hearing from Dr. Whyte and Dr. Patel on what a career in pediatric orthopedic surgery entails. At the end of this blog, you will find some resources linked to explore pediatric orthopaedic surgery further, including the POSNA study guide on pediatric orthopaedic conditions. Stay tuned for more MSOS x POSNA collaborations!

-POSNA Website

-POSNA Study Guides

-Peds Ortho Podcast