Thirty Years of Ortho: What I’d Tell the Next Generation I’ve been an orthopedic surgeon for three decades. Long enough to see techniques come and go, implants rise and fall, and the pendulum of “standard practice” swing back and forth more times than I can count. What hasn’t changed are the pressures that come with the job… and the quiet lessons you don’t fully understand until you’ve liv,ed them. If I were talking to the next generation—residents, fellows, the young attendings just getting their legs under them… this is what I’d tell them. You can’t build a meaningful career on RVUs. You can meet every target and still feel empty. A career that lasts is built on trust, judgment, and relationships. You don’t measure that in productivity metrics. A good surgeon listens more than they talk. People think surgery is a technical field, but the real work is in understanding what someone is actually asking of you. Most patients are just scared. They don’t need your scalpel, no matter what the MRI shows. Half the mistakes in this profession start with bad listening. Master the anatomy. Master the craft. But learn the limits too. Early in your career, you’re focused on what you can do. With experience, you start to appreciate what you shouldn’t do. Judgment is a superpower. Protect your time, or the system will take every minute you allow it to. Learn to say no!!! There’s no shortage of demands. Notes. Inboxes. Meetings. Every one of them feels urgent. Some of you might actually feel important when you go to meetings... But... None of them is worth sacrificing your sanity or the people waiting for you at home. Seek colleagues, not titles. Promotions and committee seats feel important for a season, but it’s just fluff, and nothing gets accomplished in those meetings anyway. Your strength matters more than you realize. Not your technical strength—your physical and emotional strength. You can’t take care of people if your own health fades. Move, lift, sleep, and protect your energy. A worn-out surgeon becomes brittle. Be the doctor you’d want for your family. You need a life outside the operating room if you want a long life inside it. The surgeons who last aren’t the ones who work the most—they’re the ones who stay grounded. They have people they care about, interests that pull them away from medicine, and enough perspective to know that identity and work are not the same thing. Thirty years in, the operations are only part of the story. What keeps you going is the purpose behind the work—helping people move, reassuring them when they’re scared, giving them back pieces of their life. That’s the part that never gets old.