Inside The Shoulder

Bart-Jan Veen was in Byron Bay when the interview for his next post came through. It was the middle of the night in Australia and the middle of the working day in the Netherlands. He sat down in board shorts and a tie while drunk surfers walked past shouting at the screen.

He got the job.

The Dutch shoulder surgeon talks about the fellowship year that reset his career. He arrived in Brisbane in 2020, days before the country locked down, with his wife and two young sons and no support network at all. His eldest had to start school in a language he did not speak.

Bart-Jan is unusually direct about what the year taught him that had nothing to do with technique. That a surgical practice is a business and you have to be willing to build a name, which he says is close to taboo in Dutch medicine. That committing to a single joint rather than hedging across hips, knees and trauma is what actually accelerates a career. That the operating room rewards the surgeon who stays calm and finishes the case over the one who panics.

They also discuss the arthroscopic releases that changed how he treats patients who never regain movement, where 3D virtual surgical planning has taken shoulder replacement, and why he still posts difficult cases to a WhatsApp group of Australian fellows when he wants a second opinion.

"Surgery is not about the incision. It's about the decision."

To become a specialist in Mexico you sit a national examination. Ninety per cent of candidates do not make the cut.

Roberto Pareyón did.

Now a shoulder surgeon in Mexico and a former Brisbane fellow, Roberto talks about the road there, including a stretch working as a civilian inside the military, saluting officers while learning the culture from the inside.

He describes the Mexican pathway in detail: internship, a compulsory year of social service, then the examination that decides everything. And he explains what the fellowship changed. He says plainly that everything he does now, he learned in Brisbane.

He and Ken discuss the boom in shoulder surgery they both lived through, and the relief of finally being told by a supportive group that you will be the shoulder person and will not have to do knees or hips.

There is a substantial section on the Australian joint registry, which Roberto says is very highly regarded internationally, and on computer navigation and patient specific planning in shoulder replacement.

He also talks about the Latin American shoulder society he helped build with a Colombian colleague. A junior committee giving younger surgeons across Mexico, Colombia and Argentina exposure at meetings, access to research grants and, most importantly, people in their own region facing the same problems.

His advice for anyone wanting this career is one word. Obsessed.

Rohit Sane is the fifth consecutive surgeon in his family. His father is a urosurgeon. His grandfather was a general surgeon. So was his great grandfather, in a small town in Maharashtra, before the family moved to Mumbai.

Rohit is the first orthopaedic surgeon among them.

He describes a path into medicine that is difficult to comprehend from Australia. Roughly 1.5 million people apply for medical school in India each year. Then, after five and a half years of medical school, the postgraduate entrance exam. Three and a half hours, around 200 multiple choice questions, sat by 240,000 doctors in a single sitting. Your entire career depends on it, and as Rohit puts it, you can miss one question and find ten thousand people separated from you by a single mark.

He is candid about what passing it took. Waking up and studying until you sleep, every subject weighted and strategised, revision on revision, then sitting the exam and hoping.

There is also a detour worth hearing about. Young and, by his own account, naive enough to listen to other people, he did an MD in pharmacology and interned at a Fortune 500 pharmaceutical company. Two months in he understood that his calling was surgical, sat the entrance exam again, and got into orthopaedics.

He talks about what drew him to bones, the instant feedback of a fixed tibia, and why shoulder surgery in particular. It is still developing in India, which he sees as an opportunity rather than a limitation.

Recorded near the end of his fellowship year in Brisbane, with his wife back in Mumbai expecting their first child, and 25 publications and a residents' arthroscopy handbook already behind him.

His advice for surgeons applying from India is blunt, and comes from the other side of the inbox. Decide what you actually want to specialise in before you email anybody.

Five days into the job, the experienced reps who were meant to fly down and support him missed their flight.

So Danial Grevsmuhl stood in theatre alone for a posterior cruciate ligament reconstruction, one of the most complex procedures there is on the knee, done close to vessels and nerves where the consequences of getting it wrong are severe. He describes himself as absolutely terrified.

That was the moment he fell in love with the industry.

Danial is now a regional sales manager for a major medical device company, running a team across Queensland. He explains a role most patients have no idea exists: the person in theatre making sure the right instrument reaches the surgeon's hand at the right moment, and briefing nursing staff so a procedure runs smoothly.

He grew up in a small North Queensland town and moved to Townsville the day he turned eighteen. His mother has multiple sclerosis and could not work for large parts of his childhood, and the household ran on everyone chipping in.

He talks candidly about the period when his company lost a major account, and about what managing people has taught him. Chiefly that treating everyone the same is the fastest way to get it wrong.

His advice is the most direct in the series. If you wait for the right time, you will be waiting forever. And if it all falls over, you can always go home.

An introduction to the series.

Inside The Shoulder is a long form interview podcast about how people find their way into medicine, hosted by Associate Professor Kenneth Cutbush, a specialist orthopaedic surgeon practising exclusively in shoulder surgery in Brisbane, Australia.

Every episode is an unhurried conversation with someone working in healthcare. Surgeons, physiotherapists, researchers, biomedical engineers, theatre staff and trainees. The subject is the path that brought them here. Why they chose medicine, what the training asked of them, and what they would tell someone standing where they once stood.

No script. No clock. A proper conversation about a career most people only ever see from the outside.

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