Can I be a CT surgeon and still have a life?

[KBO]

Today, I just finished a sub-I in CT surgery at my medical school in Southern California. It was my favorite rotation so far in medical school. Even with all of the stress and chaos involved, I found myself excited to wake up every morning and scrub into a CABG or valve replacement or an aortic dissection.

I felt extremely connected to the various residents, fellows, and attendings I worked with. Some of them even told me I would have a really good chance at getting accepted to my med school’s integrated CT residency. However, I know that CT surgery is not an easy life.

I have had a hard time deciding on a specialty in medical school, mostly because I’m only 25 and I’m single. However, I truly love CT surgery. I don’t mind working 70ish hours a week or 24-hour call. But, I want to be able to enjoy my youth and have at least some time to travel or go to bars with friends and have a dating life.

What do you all think? Is a career in CT surgery incompatible with a life outside of the hospital?

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[operaman]

You can definitely be a CT surgeon and have a great life. Most of your lifestyle will ultimately depend on your practice setup and your surgical skills.

Residency will be tough, no doubt about it. Long hours, hard work, unpredictable. That's the gig. But it passes and eventually you graduate. I don't think it's any different lifestyle-wise than any other surgical field with many high acuity patients.

The biggest question will be your surgical skill. If it takes you substantially longer to do something, your lifestyle will be worse. In med school we had a surgeon who would typically operate to 10 or 11pm. In residency, we did those same cases and were out by 1:30pm in time to catch lunch. Guess who had a better lifestyle? This is probably the least talked about aspect of surgical lifestyle - your skills are everything. If you're efficient in clinic and efficient in the OR, you can have a great life. If you are bad at either, you're going to suffer. If you make bad decisions and have poor skills, you will have more complications and be called more often. If your patients do well, you won't. Hard to predict this one, but you can hedge your bet by getting the best training you can. The whole schtick about everyone gets well trained is baloney - find the good programs and try to train there.

The other thing that decides lifestyle is your practice setup. You will have to make some sacrifices in this way if QOL is important. I could open a saturday clinic/OR and make an extra 100-200k /year if I wanted and my hospital would love me for it, but I value that time more than the extra money. If you want to be the youngest chair of CT surgery ever and run a big lab with major NIH and industry funding, you're doing to be working a LOT. If you want a busy work schedule but plenty of down time to enjoy your life, you may have to forego some aspects of those other career and monetary goals. Find a good group with a favorable call schedule where the other docs really work well together and cover for each other and you can have a good life. Not dermatology good, but surgical good.

No surgical field is a lifestyle specialty, that's for sure. But it makes up for it by being a lot of fun, varied work week, and time passes quickly.

 

[KBO]

You can definitely be a CT surgeon and have a great life. Most of your lifestyle will ultimately depend on your practice setup and your surgical skills.

Residency will be tough, no doubt about it. Long hours, hard work, unpredictable. That's the gig. But it passes and eventually you graduate. I don't think it's any different lifestyle-wise than any other surgical field with many high acuity patients.

The biggest question will be your surgical skill. If it takes you substantially longer to do something, your lifestyle will be worse. In med school we had a surgeon who would typically operate to 10 or 11pm. In residency, we did those same cases and were out by 1:30pm in time to catch lunch. Guess who had a better lifestyle? This is probably the least talked about aspect of surgical lifestyle - your skills are everything. If you're efficient in clinic and efficient in the OR, you can have a great life. If you are bad at either, you're going to suffer. If you make bad decisions and have poor skills, you will have more complications and be called more often. If your patients do well, you won't. Hard to predict this one, but you can hedge your bet by getting the best training you can. The whole schtick about everyone gets well trained is baloney - find the good programs and try to train there.

The other thing that decides lifestyle is your practice setup. You will have to make some sacrifices in this way if QOL is important. I could open a saturday clinic/OR and make an extra 100-200k /year if I wanted and my hospital would love me for it, but I value that time more than the extra money. If you want to be the youngest chair of CT surgery ever and run a big lab with major NIH and industry funding, you're doing to be working a LOT. If you want a busy work schedule but plenty of down time to enjoy your life, you may have to forego some aspects of those other career and monetary goals. Find a good group with a favorable call schedule where the other docs really work well together and cover for each other and you can have a good life. Not dermatology good, but surgical good.

No surgical field is a lifestyle specialty, that's for sure. But it makes up for it by being a lot of fun, varied work week, and time passes quickly.

Thanks for your reply!

One of the fellows (who completed gen surg + CT) painted a really grim picture of cardiac surgery when I was operating with him. He told me that he operates until midnight multiple times a week and still has to show up for work the next day. He also mentioned that he's over 400K in debt and he just generally seems miserable. Other residents and fellows don't seem as burnt out as he is, but they all seem really tired. An attending I was operating with told me to pick plastic surgery or derm, instead. I don't want either derm or plastics, but if an attending is telling me this, maybe I should listen?

On the other hand, I would also over hear them talking about having partners/spouses, and participating in at least some fun activities whenever they had free time.

I really do love this field, but I am really afraid I'll regret choosing this path. It's just a very hard decision to make because I'm an M4 and residency applications open around September.

 

[LucidSplash]

You need to talk to some attendings. Residency and fellowship can be hard, but they don’t last forever and don’t reflect what your life will be like when you’re done with training.

 

[Anakinmemer]

If you're having doubts I honestly wouldn't do it. That residency is egregious at least at the hospital I'm familiar with.

 

[operaman]

Thanks for your reply!

One of the fellows (who completed gen surg + CT) painted a really grim picture of cardiac surgery when I was operating with him. He told me that he operates until midnight multiple times a week and still has to show up for work the next day. He also mentioned that he's over 400K in debt and he just generally seems miserable. Other residents and fellows don't seem as burnt out as he is, but they all seem really tired. An attending I was operating with told me to pick plastic surgery or derm, instead. I don't want either derm or plastics, but if an attending is telling me this, maybe I should listen?

On the other hand, I would also over hear them talking about having partners/spouses, and participating in at least some fun activities whenever they had free time.

I really do love this field, but I am really afraid I'll regret choosing this path. It's just a very hard decision to make because I'm an M4 and residency applications open around September.

The fellow is not wrong and it sounds like that may be a great training program. Better training typically means longer hours and more operating, and you want to get everything out of it you can so that you can have a great quality of life in practice.

Once you’re done, you can avoid operating til midnight by not booking cases that late. Maybe you still go late when you’re on call, but you can usually adjust your schedule to absorb the call volume.

Plastic surgery is definitely worth a solid look. You can do some really big cases and recon is pretty cool. Pay is great and usually acuity is lower than CT so better hours even on call. Most things that need recon can wait til morning unless you have a flap going down or something like that. Again, the better your skills, the less this happens. Plastics also has other practice models and less physically demanding things that can be nice as you get older.

Overall probably best to pick something you really like since youll spend so much time doing it. All the surgical fields will be tough in training. If you can stomach derm and have the stats to match then that’s a nice option, but if you know you want surgery you might as well aim for the kind of surgery you find most interesting.

 

[ChordaEpiphany]

I've been working with academic CT surgeons for many years now, and an important qualifier to all of this is that CT surgeons definitely work faster, longer, and more efficiently than other medical specialties out of necessity. If you could apply that same level of intensity and efficiency to another field, you'd likely rise to the top. Surgery (especially CT) is to medicine what medicine is to the rest of the workforce.

I'm making this analogy because I think everyone here can relate to it. To an outsider (or a premed) medicine looks amazing. Compensation in the $300-400K range. 45-60 hours/week as an attending. Rewarding work. High level of respect in most circles. That's all true, but we've also experienced the sacrifices that come along with that. For a similar level of talent and effort, you'd have higher initial pay, higher ceiling pay, and a much more flexible lifestyle with lower day-to-day stress in other high paying fields (e.g., tech, finance, consulting, business management, sales, etc...). Any doctor with perspective on industry will come away from training saying, "I could have saved myself a ton of debt, a decade of living like a student, and a decade of pushing off saving for retirement if I had put a similar level of effort into another traditionally high paying field."

CT surg is the medical equivalent. After training you'll realize you could have made similar money under less stressful conditions in another specialty. During residency, match the hours of CT surg residency with moonlighting, pull in $100K+ the entire time, and bank the extra. During the extra years as an attending (shorter training vs. 6-10 years for CT surg) set up investments (e.g., real estate) that bring in extra, tax-advantaged cashflow, which could put you on par with the extra $200K gross ($120K net) you'd make as a CT surgeon vs. other specialists. Like @operaman alluded to, as an attending you can also work as much as you want and put effort into working efficiently. Most non-surgical specialists work ~10 hours/week less than CT surgeons (on average, I know many exceptions exist), and there's a lot of room for workflow optimization. Use this higher productivity ceiling to either: a) make extra money (i.e., increase RVUs, locums, admin work), or b) spend time with family/friends, whichever provides more value for you and your life. In a different specialty you have the choice to turn up the intensity. In CT surg it's turned up for you.

The doctors who are happy being doctors chose medicine because they loved the actual work, everyone else wishes they were a VP at a Fortune 500. I think similarly, the (seemingly) happy CT surgeons all just love the OR and the specific cases they do, but they all understand that it's a sacrifice. The others wish they had been ENTs or ophthalmologists.

 

[Tenk]

CT surgery lifestyle sucks compared to other specialties. I’m sure some surgeon is gonna come on here and say it’s what you make it but almost no CT surgery full time gig has 15-20 days off a month and no call. I appreciate CT surgeons for what they do, but anyone saying they have a good lifestyle is delusional.

 

[Anakinmemer]

CT surgery lifestyle sucks compared to other specialties. I’m sure some surgeon is gonna come on here and say it’s what you make it but almost no CT surgery full time gig has 15-20 days off a month and no call. I appreciate CT surgeons for what they do, but anyone saying they have a good lifestyle is delusional.

It's a common theme i've noticed in specialties that have an ass lifestyle. You always have to ask what their actual schedule is when they say "I have plenty of free time to do things I enjoy" because most of the time that means a couple free days a month. To them it's a lot, to most it is not.

 

[Babble Heap]

Any technical surgical sub-specialty you choose is going to require you to sacrifice more than you should to do a job that has the potential to be both incredible and devastating. Disconnect from the narrative that high level surgery is equal to status and consider what is valuable to you in your life. When I did that, I realized that my entire life has been defined by a desire to spend 100 hours per week learning how to be better at something. The decision to pursue one of those specialties became really easy to make: if I'm going to spend that much time doing something anyway, I might as well make it my job and use it to help people.

Have you considered reconstructive Plastic Surgery? If you're concerned about lifestyle for CT, imagine having to wait until they're all done with the root or elephant trunk to come in and start raising flaps. It's the best.

 

[RangerBob]

You can definitely have a life in CT surgery.

As long as CT surgery is your life…

Most surgeons don't have much of "a life" because they are type-A "workaholic" types. I don't mean that in a bad way--some people really, really like to work. There is nothing wrong with people loving work so much that they spend most their time doing it. No one is forced into surgical specialties with poor work-life balances.

It wouldn't be my choice. But I can also say the unhappiest period of my life was the six months I spent on unemployment after one of my pre-med jobs was "eliminated." So I get that sense of needing to feel useful/have a purpose.

 

[KBO]

CT surgery lifestyle sucks compared to other specialties. I’m sure some surgeon is gonna come on here and say it’s what you make it but almost no CT surgery full time gig has 15-20 days off a month and no call. I appreciate CT surgeons for what they do, but anyone saying they have a good lifestyle is delusional.

15-20 days off and no call for a whole month is way more free time than I would need, personally. Does this mean that a CT surgeon can have a good enough lifestyle, according to my metrics?

 

[DOVinciRobot]

We do a lot of CT at my GS program because they’re aren’t any fellows.

Even amongst surgical fields CT surgery is brutal. In general surgery you can mix in a bunch of elective hernias and gallbags to break up the big whacks on sick patients. In CT there aren’t really any chip shot cases, and the patients are consistently very sick. You can do a perfect CABG or valve and the patient can crump that night without a great explanation. IC has largely stolen all of the “easy” patients and CT surgeons are left with the re-dos, the multi-vessel disasters with extensive comorbidities, or all of the above.

Unless you want to be one of the select few who just does pure thoracics with a lot of robot lobes, thymectomies, etc, then I would never choose CT if your goal is lifestyle. Even when you’re at home your mind is at work.

And forget about 70 hour work weeks in residency. You’ll be pushing 100. Our youngest CT faculty says he sat down one time and added it up, and he averaged 120 hours a week during fellowship. said he saw his wife and kids maybe once a week.

 

[Tenk]

15-20 days off and no call for a whole month is way more free time than I would need, personally. Does this mean that a CT surgeon can have a good enough lifestyle, according to my metrics?

Probably not.

 

[dienekes88]

Today, I just finished a sub-I in CT surgery at my medical school in Southern California. It was my favorite rotation so far in medical school. Even with all of the stress and chaos involved, I found myself excited to wake up every morning and scrub into a CABG or valve replacement or an aortic dissection.

I felt extremely connected to the various residents, fellows, and attendings I worked with. Some of them even told me I would have a really good chance at getting accepted to my med school’s integrated CT residency. However, I know that CT surgery is not an easy life.

I have had a hard time deciding on a specialty in medical school, mostly because I’m only 25 and I’m single. However, I truly love CT surgery. I don’t mind working 70ish hours a week or 24-hour call. But, I want to be able to enjoy my youth and have at least some time to travel or go to bars with friends and have a dating life.

What do you all think? Is a career in CT surgery incompatible with a life outside of the hospital?

Can you have a life? Life is how you define it.

Also, don't discount the value of work fulfillment. As an example, it seems like emergency medicine has a ton of time out of the hospital but also reports a lot of burnout. I have to suspect that it's because people go into EM because they want time outside the hospital and don't necessarily enjoy EM for the sake of itself. Would love to hear the perspective of some EM folks.

Not all work is the same. I enjoy operating and have no problem operating through the night. It's not a chore. Fortunately I don't do it very often now that I'm done with fellowship.

You also have to separate your enjoyment of the specialty from the positive experience you had with the specific residents and fellows. Sometimes this is hard.

Finally, you have to think a bit about how your goals may change over time. What is interesting or important to you now is going to be different from 10 years from now.

Good luck with your decision.

 

[LucidSplash]

I know someone that does locums CT and works 2 weeks a month. She seems to have a pretty good life by anyone’s standards.

Look if you don’t want to operate a lot then don’t go into surgery. Most of us that do surgery do it because we don’t think we’d be happy in any other specialty. I’m not CT, but I think we can agree that vascular is not really considered a “lifestyle specialty.” Yes I work a lot. But I have friends and I take trips and I go to shows. I don’t have kids by personal choice but I spoil the crap out of my nieces and nephews and friends kids. Auntie life is amazing, 10/10 highly recommend. But I also have friends who are vascular and are amazing parents.

If you’re looking for a specialty where you don’t spend a lot of time at work, don’t choose CT or vascular. But those surgeons I know that work ALL the time and never see their kids or spouse? Straight up that is a choice to prioritize work to the detriment of your family. Any surgeon will work relatively more than the Average Joe with a 9-5. But you don’t HAVE to be a stranger to your family as an attending unless that’s what you’ve chosen.

 

[deleted1056062]

As the daughter of a CT surgeon at an elite teaching hospital, I can tell you that until you become an attending at your institution for 5+ years, the answer is no.

 

[LucidSplash]

As the daughter of a CT surgeon at an elite teaching hospital, I can tell you that until you become an attending at your institution for 5+ years, the answer is no.

Thankfully there are other ways to practice medicine than at the elite academic places. But yes many people find that the first few years in practice you work harder and longer hours, whether you’re in PP or academics. Some of that is because you are not yet as efficient a surgeon as you will ultimately be. Some of that is because you don’t automatically get handed block time and your cases may not be scheduled at optimal times. Some of that is because while building a practice, you might source more of your referrals from the ED and urgent/emergent cases are a different ball of wax than elective scheduled cases.

At the hospital-employed practice where I used to work, our CT surgeon took call pretty much 24/7 except when he was out of town on vacation, because he was the only one there. But he also left by 3pm most days. Some days he was there until late. But yeah he’d been in practice for 20 years and I suspect his early career didn’t look like that. My point is just that some of this stuff will depend on you and your chosen practice type and environment.