Barely five years into private medical-surgical practice, some people have asked how I am “doing” with my kind of orthopedic practice.

By orthopedic practice, I mean the working environment of an orthopedic surgeon — the type of patients and cases handled, the time, effort, and resources invested, and the returns, monetary or otherwise, gained from this professional career.

This is a simple definition, maybe even a business-oriented one, but it approximates what medical-surgical practice looks like in the real Philippine healthcare setting. The definition becomes even more complicated because of different practice styles and the way many orthopedic surgeons mix and match these approaches.

Before explaining my own practice, let me describe what I think are two ends of the spectrum: community-based general orthopedic practice and tertiary-level academic orthopedic practice.

A community orthopedic practice usually handles general orthopedic problems and extremity trauma such as fractures. It is often the first line of orthopedic care in the provinces. Patients are usually admitted to primary or secondary-level healthcare institutions within the surgeon’s community.

Academic orthopedic practice, on the other hand, is usually based in tertiary hospitals or trauma centers. It deals with more specialized and complicated orthopedic problems such as arthroplasty, spine cases, or cases requiring advanced facilities and support systems. This practice is often combined with teaching and training orthopedic residents. Some institutions also involve surgeons in administrative responsibilities.

The difference between these two types of practice is often seen in the amount of time, effort, and resources invested in each case.

Specialized academic orthopedics is generally considered more intensive in terms of learning, preparation, and complexity. It is also often perceived as more rewarding financially and professionally.

Of course, there are exceptions.

The separation between learning in urban centers and learning in the provinces is becoming less distinct because of easier access to information and technology. But for simplicity, these two models represent different ends of the spectrum.

So why differentiate between them?

Because somewhere between these two approaches is what I consider the desirable middle ground.

A balanced orthopedic practice, at least for me, involves continuous learning while maintaining a working environment focused on delivering quality orthopedic care within a community.

Many surgeons believe this balance is difficult to find or sustain.

Orthopedics naturally depends on implants, technology, specialized equipment, and hospital infrastructure. Because of this, many orthopedic surgeons continue to concentrate in urban centers and tertiary hospitals.

However, with improving information technology and better availability of orthopedic resources, community orthopedic practice is slowly becoming more feasible.

A former mentor once asked me if I was happy with this dual type of orthopedic practice.

I answered yes.

But I immediately added:

“With some necessary lifestyle and living adjustments.”

Personally, I find that these two forms of practice complement each other.

A community practice without continuous learning can become limiting.

Teaching orthopedics without actually practicing what you teach also feels incomplete.

Somewhere between these two worlds is a compromise — the balancing act.

But what about the lifestyle adjustments?

For me, I chose this balance because it fits my lifestyle.

Compared with a high-volume urban practice, I prefer the relatively quieter working environment of community practice.

At the same time, I cannot let go of the opportunities for learning that academic institutions provide.

Besides, I love teaching.

Teaching might have been my career if I had not discovered medicine. As one mentor said:

“There is no better way of learning than helping others learn.”

A community practice may rarely make you rich, but it can provide a good life. More importantly, it can provide something else — time with the people who matter.

In the end, I think it depends on what fits your lifestyle and priorities.

Mine just happens to be close to the kind of life I imagined years before I became a doctor.

So which would you prefer?