Orthopedic surgeon job description: fourteen duties, the decision to operate and a template

Ask most people what an orthopaedic surgeon does and they will describe an operation. Ask a department manager and they will describe a clinic list, a trauma rota, a multidisciplinary meeting and a backlog of dictated letters.

This article sets out an orthopedic surgeon job description: fourteen duties across clinic, theatre, ward and service, the decision about whether to operate at all, the registration position in the UK, what the document must state that a generic one does not, and a template. It describes the role rather than the medicine, and is general information rather than clinical or legal advice.

A surgical consultant is assessed by a clinical director, an appraiser and a service lead at once. See how New Dynamics multi-manager reviews gather input from every manager involved in a person's work.

The spelling, and the title

"Orthopedic" is the US spelling; British practice writes "orthopaedic". In the UK the specialty is trauma and orthopaedic surgery, usually shortened to T&O, and the substantive job titles are consultant orthopaedic surgeon or consultant trauma and orthopaedic surgeon. In the US the equivalent occupational title is orthopedic surgeon. The clinical scope is the same in both: the musculoskeletal system, which means bones, joints, ligaments, tendons, muscles and the nerves that serve them.

Fourteen duties

The US occupational database O*NET lists fifteen tasks for Orthopedic Surgeons, Except Pediatric. Grouped, they make a workable job description.

In clinic

1. Assess the patient. Examine the patient "to obtain information on medical condition and surgical risk", and diagnose "bodily disorders and orthopedic conditions".
2. Investigate. Order and interpret "the results of laboratory tests and diagnostic imaging procedures".
3. Treat without operating. Diagnose or treat "disorders of the musculoskeletal system" and provide treatments "such as medicines and surgeries, in clinics, hospital wards, or operating rooms". A large part of an orthopaedic clinic ends in an injection, a brace, physiotherapy or a plan to wait.
4. Refer. Refer a patient "to medical specialist or other practitioners when necessary", rheumatology, pain services, oncology, rehabilitation.

Deciding to operate

5. Verify necessity. Analyse the patient's "medical history, medication allergies, physical condition, and examination results to verify operation's necessity and to determine best procedure". This is the duty that defines the job, and it is covered in its own section below.
6. Consent and plan. Prescribe "preoperative and postoperative treatments and procedures, such as sedatives, diets, antibiotics, or preparation and treatment of the patient's operative area".

In theatre

7. Operate. Operate "on patient's musculoskeletal system to correct deformities, repair injuries, prevent and treat diseases, or improve or restore patient's functions".
8. Follow technique. Follow "established surgical techniques during the operation".
9. Check the environment. Examine "instruments, equipment, and operating room to ensure sterility".
10. Assist and advise colleagues. Provide "consultation and surgical assistance to other physicians and surgeons".

Team and service

11. Direct the team. Direct and coordinate "activities of nurses, assistants, specialists, residents, and other medical staff".
12. Run the service. Manage "surgery services, including planning, scheduling and coordination, determination of procedures, or procurement of supplies and equipment".
13. Record. Prepare "case histories", in the UK, the clinic letters, operation notes and discharge summaries that everyone downstream depends on.
14. Contribute to the evidence. Conduct research "to develop and test surgical techniques that can improve operating procedures and outcomes related to musculoskeletal injuries and diseases", alongside teaching and supervision.

Duties 11 to 14 are the ones a job description usually under-writes, and they are where a consultant's week actually goes when theatre is not running.

The decision to operate

Deciding against an operation is as much a part of the role as performing one, and in elective orthopaedics it is the decision under the most scrutiny.

NICE's guideline on osteoarthritis, NG226, sets out when referral for joint replacement should be considered: where the person's "joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life", and "non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable".

Three further points in that guidance shape the clinic:

• Clinical assessment rather than scores. NICE says to "use clinical assessment when deciding to refer someone for joint replacement, instead of systems that numerically score severity of disease".
• No blanket exclusions. People should not be excluded from referral for joint replacement because of "age", "sex or gender", "smoking", "comorbidities" or "overweight or obesity, based on measurements such as body mass index (BMI)". Where those factors change the risk, the guidance is to explain that to the person rather than to exclude them.
• Some procedures are not offered. NICE is direct: "do not offer arthroscopic lavage or debridement to people with osteoarthritis."

A job description for an elective post should say which pathways the surgeon works within and who else sits in the decision, physiotherapy, pain management, the multidisciplinary meeting.

The trauma half

Trauma is the other half of the specialty and the half that dictates the working pattern. It arrives unplanned, competes with the elective list for theatre time, and comes with a rota: on-call frequency, cover arrangements, whether the surgeon is resident, and what happens to the following day's clinic after a night operating.

A job description that omits the rota is not describing the job. State the frequency, the cross-cover arrangement, the compensatory rest and the escalation route.

Who the surgeon directs

The duty to direct and coordinate "nurses, assistants, specialists, residents, and other medical staff" is the closest thing to line management in the role, and it is usually informal. In practice the surgeon works with theatre nurses and practitioners, anaesthetists, physiotherapists and occupational therapists, radiographers, resident doctors and physician associates, plastics and vascular colleagues for complex trauma, and a service manager for lists and capacity. Our registered nurse job description and med surg nurse posts cover two of those roles from the other side.

Appraisal usually comes from a clinical or medical director, while day-to-day priorities come from a service lead, which is why the job description should name both.

Registration, and what a UK post requires

In the UK, a substantive consultant post depends on registration rather than on the job title. Section 34D of the Medical Act 1983 requires the General Medical Council to keep "a register of specialist medical practitioners (known as 'the Specialist Register')". That register contains registered medical practitioners "who hold a CCT in a recognised specialty", those "eligible to be admitted to that register in accordance with the scheme" the Council publishes, and any other categories specified by the Privy Council. Inclusion follows an application to the Registrar and payment of any fee specified in regulations.

For an employer writing the document, that produces four essential requirements to state plainly:

1. Full registration with a licence to practise.
2. Entry on the Specialist Register in trauma and orthopaedic surgery, or eligibility within a stated period.
3. Fitness to practise history and the references the appointment process requires.
4. Participation in appraisal and revalidation.

Everything else (subspecialty interest, research, teaching) belongs in the desirable criteria. Our recruitment and selection guide covers keeping essential criteria genuinely essential.

Subspecialties

Orthopaedics is one specialty and a dozen working lives. A job description should name the subspecialty interest and the proportion of the job plan it occupies: hip and knee arthroplasty, foot and ankle, hand and wrist, shoulder and elbow, spinal surgery, sports injuries and soft tissue knee, paediatric orthopaedics, orthopaedic oncology, and trauma itself. A post advertised without a named interest attracts applicants who will leave when the list turns out to be someone else's.

What the job description must state

• The job plan. Clinics, operating lists, trauma sessions, and the split between direct clinical care and supporting professional activities.
• The on-call rota. Frequency, cover, resident or non-resident, and what happens to the next day.
• The subspecialty interest and what proportion of the work it accounts for.
• The theatre and clinic infrastructure actually available: sessions, beds, imaging access, day-case capacity, and the teams the surgeon works with.

Add who appraises the post holder, who sets weekly priorities, and what the surgeon is expected to contribute to teaching, governance and audit.

How the role is measured

• Outcomes, reviewed with case mix, not in isolation. A surgeon taking complex revisions will not look like one doing primary day cases.
• Clinic and list utilisation, treated as a service measure rather than a personal one, since cancellations are usually organisational.
• Timeliness of records. Operation notes and clinic letters completed promptly, because the whole pathway waits on them.
• Participation in audit and governance, including morbidity and mortality meetings.
• Supervision and teaching of residents and other staff, which is a duty rather than a favour.
• Appraisal and revalidation completed on schedule.

An orthopedic surgeon job description template

Job title: Consultant trauma and orthopaedic surgeon [subspecialty interest]

Accountable to: [clinical director]. Day-to-day priorities set by: [service lead]

Job plan: [n] clinic sessions, [n] operating lists, [n] trauma sessions, [n] supporting professional activities per week

On call: [frequency], [resident or non-resident], [cross-cover arrangement]

Purpose: Assess, diagnose and treat patients with musculoskeletal disorders and injuries, operating where surgery is the right treatment, and lead the surgical care of those patients throughout their pathway.

Responsibilities

• Assess patients in clinic, including medical condition and surgical risk.
• Order and interpret imaging and laboratory investigations.
• Provide non-surgical treatment and refer to other specialists where appropriate.
• Verify the necessity of an operation and determine the best procedure.
• Obtain consent and prescribe preoperative and postoperative treatment.
• Operate on the musculoskeletal system to repair injury, correct deformity and restore function.
• Maintain established surgical technique and confirm the theatre environment is safe and sterile.
• Direct and coordinate nurses, assistants, resident doctors and other staff.
• Contribute to planning, scheduling and the running of the surgical service.
• Complete operation notes, clinic letters and discharge summaries promptly.
• Participate in audit, governance, morbidity and mortality review, teaching and supervision.
• Take part in the trauma rota as set out above.

Essential: full registration with a licence to practise; entry on the Specialist Register in trauma and orthopaedic surgery, or eligibility within [period]; satisfactory fitness to practise history; commitment to appraisal and revalidation.

Desirable: [subspecialty fellowship], research output, teaching qualification, service development experience.

Frequently asked questions

What does an orthopedic surgeon do?

Diagnoses and treats disorders and injuries of the musculoskeletal system: bones, joints, ligaments, tendons, muscles and nerves. The work includes clinic assessment, ordering and interpreting imaging and tests, non-surgical treatment, deciding whether an operation is necessary, operating, prescribing preoperative and postoperative treatment, directing the theatre and ward team, running the surgical service and keeping the records.

What are the main duties in an orthopedic surgeon job description?

Assessment and diagnosis in clinic; investigations; non-surgical treatment and referral; verifying an operation's necessity and choosing the procedure; consent and perioperative prescribing; operating; maintaining surgical technique and a sterile environment; assisting and advising colleagues; directing nurses, assistants and resident doctors; managing surgery services including scheduling and supplies; preparing case histories; and contributing to research, audit and teaching.

Is trauma and orthopaedic surgery the same as orthopedic surgery?

Yes, with a difference in name and emphasis. Trauma and orthopaedic surgery is the UK specialty title, and it makes the unplanned half of the work explicit. "Orthopedic surgeon" is the usual US title for the same clinical scope: the musculoskeletal system.

What qualifications does an orthopaedic surgeon need in the UK?

A consultant post requires full registration with a licence to practise and entry on the Specialist Register. Under the Medical Act 1983 the General Medical Council keeps that register of specialist medical practitioners, which includes practitioners holding a CCT in a recognised specialty and those eligible under the Council's published scheme. This is general information rather than advice on any individual application.

When is a patient referred for a joint replacement?

NICE's osteoarthritis guideline says to consider referral where joint symptoms such as pain, stiffness, reduced function or progressive deformity are substantially affecting quality of life and non-surgical management is ineffective or unsuitable. It also says to use clinical assessment rather than numerical severity scores, and not to exclude people on the basis of age, sex or gender, smoking, comorbidities or BMI.

What should an orthopaedic surgeon job description include that a generic one does not?

The job plan in sessions, the on-call rota and its cross-cover, the named subspecialty interest and how much of the work it accounts for, the theatre and clinic capacity actually available, who appraises the post holder and who sets weekly priorities.

Your next step: write the job plan, not the list of operations

1. Set out the job plan in sessions, including supporting professional activities.
2. State the trauma rota, its frequency and what happens to the next working day.
3. Name the subspecialty interest and the proportion of the work.
4. Keep the essential criteria to registration, licence and fitness to practise, and put everything else in desirable.

For keeping those criteria defensible and the selection process consistent, read and download our recruitment and selection guide. The guide is free to read, and the PDF uses our short download form.

Want appraisal input from a clinical director and a service lead in one record rather than two conversations? Book a New Dynamics demo and bring your current job plan template. You can also email contact@new-dynamics.com.