Thoughts on taking Gen Surg Boards

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Hey Everyone,

I am finishing up general surgery in the next couple months and starting my journey into plastic surgery. I am conflicted on what to do regarding my general surgery boards. How many of you took yours, are planning on taking yours, or think that you should.

My feeling is that they cost a lot of money, require a lot of stress and studying, slow down your learning in plastics for the first 6 months or so, and dont really matter in the long run. I dont think anyone recertifies down the road. What is the benefit of taking them? The only thing I can come up with is pride.....after 5 years of doing this, and getting something at the end.

Also, doesnt it hurt your Gen Surg program more if you fail it rather than just not taking it all together?

Appreciate any thoughts on the matter.
Thanks

Very few people regret going on to take your surgery boards. Some of it is a measure of pride. Your GS program does in fact get dinged when you'd don't sit for it as well.

There actually is some value to being able to advertise you're double boarded, particularly in your first few years of practice. Also, there will be some kinds of cases that you may have trouble getting privileges for without your GS certificate. My partner (an integrated residency product) for instance cannot do any hernia repairs at his main hospital unless I'm there with him and could not do a mastectomy, axillary dissection, or sentinel lymph node biopsy as these are not defined in the scope of privileges for plastic surgery.

Originally Posted by droliver

Very few people regret going on to take your surgery boards. Some of it is a measure of pride. Your GS program does in fact get dinged when you'd don't sit for it as well.

There actually is some value to being able to advertise you're double boarded, particularly in your first few years of practice. Also, there will be some kinds of cases that you may have trouble getting privileges for without your GS certificate. My partner (an integrated residency product) for instance cannot do any hernia repairs at his main hospital unless I'm there with him and could not do a mastectomy, axillary dissection, or sentinel lymph node biopsy as these are not defined in the scope of privileges for plastic surgery.

Partner cannot do hernia repairs. Is that at all reasonable or is it ONLY yellow-tape caused by legal/liability issues (i.e. he's completely able to handle it as well as a non-integrated product, but if the patient tanked, a 'good' lawyer could use his non-GS certification as an effective leverage point in a suit afterwards?)

Also, I can understand that possibly hernia repairs can help make the $ flow a bit in the beginning if you're hard-pressed in private practice... However, in 5 years (or however long to build a thriving, busy plastic and reconstructive practice, assuming it works out!) will YOU be faced with 'having' to do hernia calls for privileges while he is now happy that he can fly under that call radar b/c he's not 'certified' to do them? Does what I just asked make sense?

Thanks!

It's kind of a silly, but practical issue I was pointing out as it relates. There's a lot more overlap between surgery and plastic surgery procedures then you realize, particularly with reconstructive and oncologic procedures you might perform on a day to day basis. I fix hernias all the time on patients I do abdominoplasties, panniculectomies, and TRAM flaps on.

You will run into these credentialing issues at different hospitals. As to the hernia thing, if you do any amount of body contouring procedures, particularly on weight loss patients, you run into all kinds of incisional, umbilical, and inguinal hernias that you might fix. Also at some places you would not get privileges to do abdominal wall reconstructions (ie. component separation procedures) without your surgery boards.

Originally Posted by DrRowing81

My feeling is that they cost a lot of money, require a lot of stress and studying, slow down your learning in plastics for the first 6 months or so, and dont really matter in the long run. I dont think anyone recertifies down the road. What is the benefit of taking them? The only thing I can come up with is pride.....after 5 years of doing this, and getting something at the end.

Also, doesnt it hurt your Gen Surg program more if you fail it rather than just not taking it all together?

Appreciate any thoughts on the matter.
Thanks

It sounds like you are looking for excuses not to get board certified in general surgery. I would definitely certify for all of the reasons that were put forth in the above posts.

Being BC in general surgery can only be an asset to you, and failing to do so seems like a colossal waste of the hard work that you have already put in. The expense to become BC'ed is negligible compared to the expense and effort you have already expended to finish a full GS residency.

Originally Posted by DrRowing81

My feeling is that they cost a lot of money, require a lot of stress and studying, slow down your learning in plastics for the first 6 months or so, and dont really matter in the long run.

If you think general surgery boards are expensive, just wait until you get to the plastic surgery boards.

Originally Posted by DrRowing81

I dont think anyone recertifies down the road. What is the benefit of taking them? The only thing I can come up with is pride.....after 5 years of doing this, and getting something at the end.

Yes, a lot of us do. I don't have any numbers for you, but the folks I know that are double boarded have re-certified at least once. And yes, I am re-certifying as well in a few years.

And, compared to the plastics boards, GS are a cakewalk. I used Marc Neff's book. It's a little out of date now, but the ideas he puts forward will still apply. It's not so much what you decide to do with your patient, but how you handle the complications. If you learned anything during your GS residency, you should be able to pass without too much difficulty.

And as Droliver has said, it can cause issues.

Bottom line is that you did the work, you should get the t-shirt.

Thanks everyone for you advice.....I think I am going to get the T-shirt. Honestly, no offense to anyone in particular, and I am not trying to sound arrogant.....but after watching doing some cases with a few junior attendings these past couple weeks......I feel obligated. It bothers me that some of these people can so easily pass their boards.....when they are obviously not competent enough to be a practicing surgeon on their own.

I guess it just reassured me that maybe I know more than I think, and I just prove that by getting the tshirt. thanks

Originally Posted by DrRowing81

It bothers me that some of these people can so easily pass their boards.....when they are obviously not competent enough to be a practicing surgeon on their own.

Just a bit of avuncular advice. Be careful throwing stones. No matter how good you are, you're going to have complications, and some will be bad. I have a much kinder view now of my fellow surgeons than when I first started, even the community guys who send me stuff that went wrong.

My first 3 months in practice, I had a referral for something not very complex from a local well known private practice orthodontist who usually only treats insured patients. It did not turn out as well as I would have wanted. Since then, I have gotten much better at my craft and built a practice based on my hard work and excellent outcomes. I get referrals from physicians all over, even a couple from out of state. But NEVER have I gotten another one from him. He sends all his insured patients to an OMFS guy.

It's also much easier to backseat drive during a case.

I'm just saying be careful with judgements, and while not all surgeons are created equal, most everyone is trying to do the best they can.

--M

Something else to consider as you decide whether or not to board in general surgery...

Surgical call coverage is nearly always an issue, no matter where you go. If you are boarded in general surgery you may find that, during your negotiations, the hospitals may pressure you to take general surgery call (or you may have to give up something you want in order to get out of any general surgery call requirement). Some of the Chiefs or Attendings that follow these posts can hopefully fill in whether this was something they encountered or not. One of my younger attendings (traditional pathway) had mentioned this to me in the OR (I'm integrated so not a possibility for me, but certainly something to ask around about).

I have not been asked to cover general surgery call at any of the 4 hospitals where I have privileges. I also have been told that general surgery would not be happy if I tried to take GS call. It might be different if you're at a location where there's a paucity of coverage, but it has not been my experience.

I trained in the Integrated model and am an academic faculty member, but I've never heard of an Independent model attending who was pressured to take GS call. I have heard about CRS, Surg Onc, Endocrine, and Transplant faculty who were pressured to take GS call.