Read as Dr. Brian J. Cole talks about his career as an Orthopedic Surgeon.  Find him at www.cartilagedoc.org or www.myshoulderelbow.org and on the Twitter feed in the sidebar of this interview.

What do you do for a living?

I am an Orthopedic Surgeon in Chicago at Rush University Medical Center and a member of a multi-specialty partnership named Midwest Orthopedics at Rush. I am a specialist in Sports Medicine and Arthroscopy. As an overview, I am in academic and private practice that embodies clinical practice (office and surgery), research, leadership positions, team physician responsibility, and departmental administrative responsibilities.

How would you describe what you do?

As an Orthopedic Surgeon, my clinical practice emphasizes shoulder, elbow, and knee surgery. I perform most of these surgeries arthroscopically using a small camera used through minimally invasive incisions to accomplish repairs of tendons, ligaments, cartilage and bone. I have a special interest in cartilage transplantation of the shoulder and knee and am the Section Head of the Rush Cartilage Restoration Center at Rush. We perform meniscus and articular cartilage transplants using cell-based technologies and donor cartilage. We also are involved in the development of new procedures and FDA trials investigating new ways to treat young patients who have disabling cartilage problems with surgical and non operative options using biologics. Notably, most of what I do is provide non-operative care and patient education to help patients manage orthopedic injuries in an effort to avoid surgery. But, surgery and clinic each embody about 30% of my time.

One of the greatest pleasures of working in an environment within an institution is that we can perform clinical and basic science translational research. This involves identifying a problem in the clinic or operating room, developing an experiment to investigate a new or modified solution to be performed in a laboratory (biomechanics, biochemistry, anatomy, etc) and then taking the results of the study and implementing into our clinical practice. I spend about 20% of my time working in this capacity and manage a team of individuals at various levels of training to do this which includes college and medical students, residents, and fellows who have completed their residency training.

As part of being a clinician and researcher, I spend about 4 weeks a year traveling and teaching others about surgical techniques and our findings from research. In addition, with the help of our team, we write papers and text books, and make educational training videos to help others learn and improve their knowledge as an orthopedic surgeon. As a result of the hard work by the team that I interact with, I have published more than 1000 articles and book chapters, and have authored 5 textbooks used to teach our students of orthopedics.

About 10% of my time is spent doing administrative activities including being the Chairman in the Department of Surgery, a member of the managing committee of our practice, and serving on several committees and boards of organizations that help develop educational content for orthopedic surgeons .

Finally, I am the head team physician for the Chicago Bulls and a co-team physician for the Chicago White Sox. As you can imagine, this is a gratifying yet demanding aspect of my job that I am privileged to be part of.

What does your work entail?

It involves seeing patients, doing surgery, regular team meetings to discuss research, doing hands-on research in a laboratory (animal and basic science), traveling to teach at meetings and at institutions, teaching residents and fellows, running clinical trials, and covering professional basketball and baseball games. I also have many meetings to attend related to my administrative responsibilities. Lots more, but that is the main activities that embody my work as an academic clinical orthopedic surgeon.

What’s a typical work week like?

The hours of work for me are not well defined. But my basic schedule is that I see patients for a full day on Monday and Wednesday. I do surgery on Tuesday and Wednesday. Friday is used as a swing day to do research and spend time for family commitments. Weekends are off limits in the summer and reserved for my family, but involve lots of travel otherwise.

I often have early morning meetings or calls each day before clinic or surgery, and have nightly meetings after work. I exercise typically after work, before nightly family time, and if need be, have meetings after my children are settled in at night with homework or other activities.

As a team physician, I cover about 40 basketball and 10 baseball games each year in addition to doing pre-season player physicals and in season management of player injuries. This is an enormous time commitment that gets woven in between my other responsibilities, but is always a priority.

What you can hopefully see is that there is really no 9 to 5 schedule with a job like this, but you can always make it what you wish once you get there!

How did you get started?

For me, I wanted to be some type of physician since the 8th grade! While no one is a doctor in my family, I have since learned that most important decisions are made based upon positive role model experiences. As a basic rule, in today’s modern times, I would choose a career by intellectual and emotional outcome (gratification) and not necessarily by expected income.

What do you like about what you do?

I enjoy the many facets of my job. Of all the things listed, I enjoy each and every one of these responsibilities, otherwise I would simply not do them. The greatest part of my job is the joy of seeing a patient transition from a painful and inactive state to a pain-free active individual because of the care they received. That can be achieved with or without surgery. I work with lots of young patients too and seeing them return to their sport after a shoulder, elbow, or knee reconstruction is incredibly gratifying.

I also enjoy working with young people who challenge me and my thinking. It keeps me fresh, on top of my game, and always makes me strive to better myself so I can be a better resource to my patients.

What do you dislike?

The administrative aspects of insurance, emerging health care policy, limitations of patient access to appropriate care, and lawyers. All of these functions are, however, a necessary aspect of delivering care and are dramatically outweighed by the things that I enjoy as an academic orthopedic surgeon.

How do you make money/or how are you compensated?

Most of my income is derived from my day job. This includes doing surgery and seeing patients. I also earn money by developing new orthopedic devices and procedures. Finally, I work with small and large companies on new biologic and orthopedic initiatives to deliver new solutions to our patients.

How much money do Orthopedic Surgeons make?

The range in 2011 is between 300 to 500K. There are many examples, however, of surgeons who make considerably more than this. It is largely dependent upon where one practices geographically and the nature of the system that one practices in. There is a trend toward physicians being hired directly by hospitals which offers many benefits, but may be associated with less control compared to what one enjoys in a pure private practice setting.

How much money did/do you make starting out?

Today, starting salaries range between 150K and 300K.

What education, schooling, or skills are needed to do this?

4 years of college, 4 years of medical school, 1 year of business school (I received my MBA between my 3rd and 4th year of medical school), 1 year of general surgery, 1 year of basic science research, 4 years of orthopedic residency, and 1 year of sports medicine fellowship training.

The learning and skills training is an ongoing process. I still teach and attend regular courses, continuing educational initiatives, and cadaver training and skills training. In fact, for maintenance of my board certification, I need to accumulate a minimum of 120 hours every 3 years.

What is most challenging about what you do?

Balance. Balance in work, life, marriage, family, physical fitness, and learning when to say no! Managing difficult problems and complications of surgery is also particularly challenging emotionally and professionally, but fortunately, these are rare events. The biggest challenge is managing patient problems where an individual does not achieve his/her goals of pain relief and ultimate level of function. Finally, the legal challenges of being a physician cannot be ignored and these present in a variety of ways. Ultimately, one learns to take one day at a time and focus on the things he or she can control to minimize energy expenditure on those that he or she cannot control. Life is a marathon, not a sprint.

What is most rewarding?

Making someone better. Period. Being in a position where someone comes to us with a specific problem, engaging a multi-disciplinary and modality approach to treatment and achieving a positive outcome. It is really that simple. Getting there and staying there is the hard part.

What advice would you offer someone considering this career?

Find a role model, shadow someone who you think you would like to emulate, don’t burn a bridge with poor grades, test scores or choices, and maintain a balance the entire time. Those who succeed are multi-faceted and dimensional and learn to rely on the competence of others to collectively achieve and succeed. You can’t do this alone, but rather as part of a team. Be a good listener, speak slowly, but think quickly. Focus on what you can control and don’t sweat the things you cannot.

How much time off do you get/take?

When I travel for academics, I always try to take time for myself including time to exercise. I also maintain a swing day (Friday) each week to fortify the weekends. We take about 3 weeks of family vacations, but lots of 3 day weekends as I still have young children where this remains a great option.

What is a common misconception people have about what you do?

That we are surgeons. We are physicians and health care providers that address mostly non-surgical problems including the psychology of not being well. It is a system approach, not an approach to something that is broken and just needs to be fixed. People have orthopedic issues and they must be treated in the context of the system they live in, not as a specific pathologic entity.

What are your goals/dreams for the future?

To achieve finer balance in my life, to discover a predictable and cost-effective solution to treating cartilage problems in young active patients, and to develop and validate non-operative biologic solutions to treating orthopedic conditions.

What else would you like people to know about your job/career?

Find good role models, embrace a team approach with similarly like-minded individuals, recognize the accomplishments of others, foster collaboration, and maintain balance in work and life to the best of your ability.