Surgery mix of Clinic and OR...

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I was curious if those familiar with the field could comment on the mix of clinic vs. OR time each week for the various surgical specialties.

In particular, if you could comment on:

-General Surgery
-Acute/Critical care
-Trauma (same?)
-Colorectal
-Endocrine
-Vascular
-Cardiothoracic
-Urology

Will this differ between Community or Academic/larger city practices?

Originally Posted by JackShephard MD

I was curious if those familiar with the field could comment on the mix of clinic vs. OR time each week for the various surgical specialties.

In particular, if you could comment on:

-General Surgery
-Acute/Critical care
-Trauma (same?)
-Colorectal
-Endocrine
-Vascular
-Cardiothoracic
-Urology

Will this differ between Community or Academic/larger city practices?

The general average I've seen for my attendings (in academic practice) is somewhere between 1-2 clinic days a week with 1.5 seeming to be the most common. How they are split up is highly variable, though. I haven't seen anyone do two full clinic days, but they may do 1 full day and 2 half days with the other half days for OR time or academic/administrative time.

I have observed that in specialties where there is opportunity for office procedures, you're more likely to do more clinic because it's a good opportunity to increase revenue. Colorectal has that opportunity, as does endocrine and breast if you learn to do your own ultrasound/biopsies.

Originally Posted by FaytlND

I have observed that in specialties where there is opportunity for office procedures, you're more likely to do more clinic because it's a good opportunity to increase revenue. Colorectal has that opportunity, as does endocrine and breast if you learn to do your own ultrasound/biopsies.

Agreed, although it's not necessarily for the sake of increasing revenue. I can see how you would make more money, because it's a lot faster when you're not waiting for OR turnover and such. I know that for vascular surgery, a few vein procedures can be way more lucrative than a big open case that takes all day and stresses you out far more than some phlebectomies.

Urology does a lot of clinic procedures - prostate biopsies, cystoscopies, vasectomies, and if you've got fluoro, you can stent ureters and do pyelograms. They used to do ESWL in the office here, but the cost/benefit ratio eventually favored getting rid of it.

Trauma clinic is boring and infrequent.

Originally Posted by TheProwler

Agreed, although it's not necessarily for the sake of increasing revenue. I can see how you would make more money, because it's a lot faster when you're not waiting for OR turnover and such. I know that for vascular surgery, a few vein procedures can be way more lucrative than a big open case that takes all day and stresses you out far more than some phlebectomies.

Urology does a lot of clinic procedures - prostate biopsies, cystoscopies, vasectomies, and if you've got fluoro, you can stent ureters and do pyelograms. They used to do ESWL in the office here, but the cost/benefit ratio eventually favored getting rid of it.

Trauma clinic is boring and infrequent.

Good to know. Thanks.

I enjoy the mix so I guess I should cross trauma off my list.

Originally Posted by JackShephard MD

Good to know. Thanks.

I enjoy the mix so I guess I should cross trauma off my list.

Not saying you should or shouldn't, but doing so based on one person's perception is probably a little drastic.

We don't have a trauma-specific clinic at my current institution; the attendings see trauma patients in follow-up on their usual clinic days when they also see their acute care and general surgery patients. Like FaytIND, they typically do 1.5-2 days of clinic time/week (not all full days).

In medical school, each trauma team had a dedicated day of clinic each week. It was painful because as a pure trauma clinic, there was a high rate of no-shows, non-compliance, and general idiocy.

So basically, remember that individual experiences on SDN are good anecdotal information but do not necessarily reflect the full spectrum of available options once out in practice.

In cardiac, I can operate 4 days a week. 1 day for clinic ( but im always hoping for an emergency so the NP can do postop clinic!)

In residency, the i saw the academic guys do the opposite- they had 1 OR day and saw pts and did research the other 4.

Originally Posted by JackShephard MD

Good to know. Thanks.

I enjoy the mix so I guess I should cross trauma off my list.

Clinic is quite variable, and many things factor in.

If you are in private practice, the number of hospitals and locations may affect your clinic. If you are academic, you may have separate VA and university clinics, and you may have to sponsor the resident clinic. If you are early on in your career, you may have to do more clinic so you're more available and can generate an elective caseload (e.g. Friday afternoon clinic...a horrible thing that is often delegated to the junior partner to clean up messes before the weekend).

And, of course, the speed of individual surgeons can affect clinic. If you see patients fast, and you're in a specialty that doesn't have a lot of lengthy discussions, you may be able to survive on 2 half-days a week. However, if you're slower, and/or you're in a specialty with lengthy discussions (e.g. cancer surgery, bariatrics, plastics, etc) you may need 5 half-days a week. If your specialty has a lot of unpredictable emergencies that can require you to cancel clinic, e.g. OBGYN/Transplant/Trauma, the number can vary even more.

Also, when you are early on in your career, you'll have more no-shows and late arrivals....patients don't know you from Adam, so they don't bend over backwards to make your clinic. Once you're more established, clinic is more on your terms...patients will have to wait longer periods of time for an appointment, and you can scale down the number of clinics....the result is a much lower no-show rate and more timely patients.

For colorectal surgery, you need a minimum of 3 half days per week. Clinic will be necessary to see new consults (cancer, diverticulitis, anal pain, rectal bleeding, and many many more), do office procedures (proctos, anoscopy, banding, IRC, lumps/bumps, I and Ds, TEH excision, etc), follow ups, and elective screening colonoscopies (although this doesn't really pay anymore).

Some CR surgeons do 6 half-days per week. I know one female CR surgeon who does 8 half-days a week, in 3 hour increments, spread out over 2 locations.


We all loathe clinic as residents, and do everything in our power to avoid it. However, in hindsight, I think that clinic is essential to a balanced surgical education, and we should probably have more mandatory hours in the clinic. It will contribute much more to our skills as a practicing surgeon than countless hours on the hospital wards.

Originally Posted by SLUser11

We all loathe clinic as residents, and do everything in our power to avoid it. However, in hindsight, I think that clinic is essential to a balanced surgical education, and we should probably have more mandatory hours in the clinic. It will contribute much more to our skills as a practicing surgeon than countless hours on the hospital wards.

It also makes me keenly aware of how many of the patient's questions I'm unable to answer about certain procedures.

Originally Posted by SLUser11

Clinic is quite variable, and many things factor in.

If you are in private practice, the number of hospitals and locations may affect your clinic. If you are academic, you may have separate VA and university clinics, and you may have to sponsor the resident clinic. If you are early on in your career, you may have to do more clinic so you're more available and can generate an elective caseload (e.g. Friday afternoon clinic...a horrible thing that is often delegated to the junior partner to clean up messes before the weekend).

And, of course, the speed of individual surgeons can affect clinic. If you see patients fast, and you're in a specialty that doesn't have a lot of lengthy discussions, you may be able to survive on 2 half-days a week. However, if you're slower, and/or you're in a specialty with lengthy discussions (e.g. cancer surgery, bariatrics, plastics, etc) you may need 5 half-days a week. If your specialty has a lot of unpredictable emergencies that can require you to cancel clinic, e.g. OBGYN/Transplant/Trauma, the number can vary even more.

Also, when you are early on in your career, you'll have more no-shows and late arrivals....patients don't know you from Adam, so they don't bend over backwards to make your clinic. Once you're more established, clinic is more on your terms...patients will have to wait longer periods of time for an appointment, and you can scale down the number of clinics....the result is a much lower no-show rate and more timely patients.

For colorectal surgery, you need a minimum of 3 half days per week. Clinic will be necessary to see new consults (cancer, diverticulitis, anal pain, rectal bleeding, and many many more), do office procedures (proctos, anoscopy, banding, IRC, lumps/bumps, I and Ds, TEH excision, etc), follow ups, and elective screening colonoscopies (although this doesn't really pay anymore).

Some CR surgeons do 6 half-days per week. I know one female CR surgeon who does 8 half-days a week, in 3 hour increments, spread out over 2 locations.


We all loathe clinic as residents, and do everything in our power to avoid it. However, in hindsight, I think that clinic is essential to a balanced surgical education, and we should probably have more mandatory hours in the clinic. It will contribute much more to our skills as a practicing surgeon than countless hours on the hospital wards.

Thanks everyone for the informative posts.

Originally Posted by ESU_MD

In cardiac, I can operate 4 days a week. 1 day for clinic ( but im always hoping for an emergency so the NP can do postop clinic!)

In residency, the i saw the academic guys do the opposite- they had 1 OR day and saw pts and did research the other 4.

Are you doing strictly cardiac and endovascular at the moment? or do you do a good amount of thoracic cases also?

I know this model is almost unheard of in academia, but I know at least a hand full private practice CT surgeons who do both thoracic and cardiac in (non-small town) medium size cities and do so quite successfully.

I do thoracic cases too, as do my partners. It is mostly out of necessity though to fill the needs of our patient base. frankly, it is revenue too. It is tough to keep up on the latest in both fields since they are polar opposites.