How bad are surgery hours really?

[emac]

Im considering doing surgery and was wondering how flexible the hours can be. I have heard people at my school complain about long hours even once you are out of residency. Would it be possible to be a general surgeon and work less? If surgeons make a gazilion dollars a year and work 80 hrs a week could you work 40hrs a week and make half a gazilion?

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[Chrismander]

yeah but you still gotta make it through residency. 5 years of working well over 80 hours a week and cheerfully fudging your hours each week or whatever all the while looking at your immediate superior and saying "More work sir!"
seriously, unless you *love* the OR (and even then...) find another med specialty more conducive to living, that still gives you procedures or whatever you're looking for.

 

[emac]

I'm not worried about the long hours during residency. I am more concerned with what comes after. Working 80+ hrs a week in my thirties is fine, but someday in the future I might want to see my wife/kids more and cut back hours. I was wondering if this is possible.

 

[toxic-megacolon]

yeah but you still gotta make it through residency. 5 years of working well over 80 hours a week and cheerfully fudging your hours each week or whatever all the while looking at your immediate superior and saying "More work sir!"
seriously, unless you *love* the OR (and even then...) find another med specialty more conducive to living, that still gives you procedures or whatever you're looking for.

Well stated. Agree 100%.

 

[toxic-megacolon]

This topic has been discussed in depth manytimes before. Do search.
Here's a thread to get you started.

http://forums.studentdoctor.net/showthread.php?t=270035

 

[TxMed]

i'd worry about getting into medical school and then see if surgery is a fit for you. i can guarantee you that surgeon's do not make a "gazilion" dollars. probably much closer to a nanozillion if we're talking in terms of $/hr. the bottom line is that the surgical world gets up earlier and stays up later. i do not believe this will change for quite some time.

tm

 

[Winged Scapula]

As others have noted, you need to make sure you truly enjoy the work, because a surgical career can be unpredictable, not to mention the often grueling residency (albeit less grueling than in my earlier days). So, we'll assume you LOVE LOVE LOVE surgery and would work 180 hours per week for free if you could, but your family concerns are eating at you....

- there are surgical subspecialties which work fewer hours per week and have fewer emergencies than general surgery (think Breast, Endocrine, Surgical Oncology, Urology, Colorectal (if you don't take gen surg call), Critical Care (without Trauma), etc.)

- there are smaller hospitals without a lot of trauma or emergency surgery, which would allow you to work fewer hours

- there are groups and institutions which would allow you to work less than full time (sorry, but *only* working 40 hrs per week would be considered less than full time in many surgical practices); of course, you would earn less and probably not be on a partnership track

- you must also realize that the days of earning a "gazillion" dollars as a surgeon are gone for the most part; those that do make tons of dough often work their arses off, or do highly reimbursed procedures or procedures which are cash and carry (ie, Aesthetics); if you can be happy making less than your colleagues, then who cares, work part time. But in some areas of the country, general surgeons are making less than $100K to start and that's full time, so be prepared to make substantially less in some places for less than full time (ie, 40 hrs per week).

 

[Pilot Doc]

If surgeons make a gazilion dollars a year and work 80 hrs a week could you work 40hrs a week and make half a gazilion?

NO.

Take two physicians - Dr. A works X hours, considered to be full-time, Dr. B works 0.5X hours. Dr. B will take a greater than 50% pay cut compared to Dr. A. Why? Your practice expenses as a surgeon - malpractice, office space, support staff, etc are primarily fixed. They cost almost the same every month whether you see 1 patient or 1000. Figure you start every month $10K in the hole. If Dr. A brings in $40K in revenue and Dr. B $20K, their respective salaries will be $360K/yr for Dr. A and $120K/yr for Dr. B.
This will be moderated somewhat if you can work for a large institution - HMO, government, etc.

Nonetheless, if you are willing to give up income and/or live somewhere with a relative physician shortage, you can work controlled hours as a surgeon. The best story I have heard in this regard is a plastic surgeon who operated a private practice at break even, taking no salary. The surgeon was married to another physician who was the family breadwinner. The part-time practice, while making no money, did keep the surgeon's skills up and build a patient/referal base for the time when lesser family responsibilities allowed a full-time practice.

 

[boston]

Last year at this time, one of the attendings at this community hospital where we rotate, left to move to another state -- the reason: it was no longer economically viable for him to practice medicine. He was no slouch either - he worked like a dog. He had a busy general and vascular surgery practice but confided in me that the prior year, he did enough procedures to bill for over $1 mil but could only collect on a quarter of it. After subtracting costs, his net income was negative. Sad...

 

[mcindoe]

I'm not worried about the long hours during residency. I am more concerned with what comes after. Working 80+ hrs a week in my thirties is fine, but someday in the future I might want to see my wife/kids more and cut back hours. I was wondering if this is possible.

you should be worried about the long hours. it sounds fine to say it from your vantage point, but you should think about what you're doing during those long hours. 80+ hours of surgical residency are unlike 80+ hours of anything else you'll ever experience in life. there are attendings making you feel like you're ******ed, residents more senior than you who feel less ******ed by making you feel ******ed, nurses nagging you, patients demanding your attention, scutwork that needs completing, consults needing to be seen, pagers that need to be responded to, ER calls that you have to go check out, sign-outs that have to be done, dictations that require completion, and hours in the OR with surgeons who either think you have four hands or have the skills of an attending and again make you feel ******ed that you don't.

And the depressing part about it is that once it's over and you're an attending, you're dealing with the same crap, just in a different way. You might not be saddled with tons of scut, but you're saddled with tons of responsibility---the type of responsibility that can get you sued if you make a bad decision. Attendings have described it to me and it sounds like a whole new kind of hell. And all those cases that go on in the middle of the night are staffed by attendings...and i can't tell you how depressing it can be to see men and women in their 40's and 50's working like residents and never ever getting control over their lives like other people get to by a certain age...you can pay your dues but by the time you've earned your right to call the shots you're way past your prime, cause the older you get, your skill and manual dexterity worsen, and while "old" docs in other fields get respect for their many years of experience, "old" surgeons make people nervous as they develop tremors and shaky hands and their eyesight worsens....it's not as glamourous as i thought it would be once i got in the game instead of watching from the outside.

don't mean to be Debbie Downer but take a good hard look at this if you're considering it as a career.

 

[miler]

mcindoe,
Just to play devil's advocate for a minute, (and I understand that being a surgeon is unbelievably hard..) you sound pretty down about being in surgery. Do you feel this has to do with being PGY-1? Do you think your feelings may change as you pass through the years? There seems to be quite a few surgeons who don't paint quite as bleak of a picture as you do (though, granted, all surgeons will acknowledge that it is a very hard road to go down..) You painted the bleakness very well, by the way!

 

[Winged Scapula]

Although its only grads of one residency program in Kansas, I came across an article yesterday by chance looking Gender differences in general surgery careers: results of a post-residency survey, and noted that they also collected data on the average number of hours the attending surgeons worked...

45% worked 60-80 hrs per week (more men than women)
12% worked more than 80 hrs per week (equal numbers of men and women)
32% 40-60 hrs per week (equal number of men and women)
11% < 40 hrs per week (predominately women)

So, the OP can see there is quite a bit of variability there, but the majority of surgeons, regardless of practice type, work more than 60 hrs per week. Just found it interesting...

Yutzie, JD, Shellito, MD, Helmer SD, Chang FC. Gender differences in general surgical careers: results of a post-residency survey. Am J Surg, 2005, 290: 955-959.

 

[mcindoe]

mcindoe,
Just to play devil's advocate for a minute, (and I understand that being a surgeon is unbelievably hard..) you sound pretty down about being in surgery. Do you feel this has to do with being PGY-1? Do you think your feelings may change as you pass through the years? There seems to be quite a few surgeons who don't paint quite as bleak of a picture as you do (though, granted, all surgeons will acknowledge that it is a very hard road to go down..) You painted the bleakness very well, by the way!

well let's just say my feelings about surgery have changed a lot since i got involved with it. i'm having second thoughts about my decision, and that's probably reflected quite clearly in my post. i think i may have made a mistake, and when i hear things like "i don't mind the hours" and so on, i feel like i need to step in and say something because i said the same things and had the same attitude, and i wish i took these things more seriously than i did. instead, i dismissed them like the OP did and i learned the hard way what a foolish thing that was to neglect.

my overall negativity is largely due to my belief that things are NOT likely to change as i pass through the years. i may get better at ignoring them or just accept the fact that this is the way it is and there's nothing i can do to change that---but you could use the same logic if you're a wife whose husband abuses you or cheats on you---well, that's just how things are, i love him, and i will just continue to take the abuse because i have no other choice or nowhere else to go, and i have kids to feed, etc...it's that mindset that keeps so many locked in that would otherwise say "f- this, i'm outta here!" when it comes to residency training, it's hard to just pack your bags and leave, cause where are you gonna go? what are you gonna do? yeah, you can figure that out and make a change, but it's not easy and not something that can be "fixed" quickly. that's all.

 

[solstice118]

I think (from best I can gather over the last two months) that being a PGY-1 in surgery is one of the most thankless situations one can find themselves in. you're always wrong and the bitch of it is... you never really have any power to make any decisions so you are just getting yelled at for someone else's executive decision...and mcindoe that sucks that you think that you may have made the wrong choice...maybe it's just the wrong program? I dunno...but I have to say that I have never been more tired and more frustrated. The alternative would be some medicine residency or pediatrics residency, right? Well I have been rounding with an pulmonologist/ intesivist over the past couple of days and...painful. Medicine as an alternative? no way. I think that it does get better and I really have had some awesome weeks. But we really don't know $hIT and that is the worst part. How can you expect to be the "more human than human" part of being a doctor in a critical situation without the rite of passage? I'm sure there is a way... and maybe you can rectify this with your junior residents when you are the senior. I have the fortunate ability to lean on my seniors. THat's why I made the mention of program...

To the op... 5 years+ of working over eighty hours a week is alot to ask of someone that could've been as happy working in another field working that for a year and then having a cushier 50-80 hrs for the rest of their residency, let alone life. But yeah get through med school first, and just as an aside... don't bitch/commiserate with your intern on surgery about how tired you are because " you just stood around in the OR all day."

I efin hate that.

 

[ironmaiden]

when i hear things like "i don't mind the hours" and so on, i feel like i need to step in and say something because i said the same things and had the same attitude, and i wish i took these things more seriously than i did. instead, i dismissed them like the OP did and i learned the hard way what a foolish thing that was to neglect.

my overall negativity is largely due to my belief that things are NOT likely to change as i pass through the years. i may get better at ignoring them or just accept the fact that this is the way it is and there's nothing i can do to change that.

Ok, so it sucks, but it does have the potential to get better.....

My husband is a PGY-8. No doubt, the first few years (pre 80 hour work week) were awful. But so were the next 5 years. We have always held on thinking it does get better. In our situation it will, but it has been one HELL of a ride getting here. (He's currently a q-2 fellow with INSANE hours.)

We have several friends in the same field who are just ahead of us. Attendings, finally. Their hours are better. They are financially VERY well off. And their divorce rates have fallen dramatically.

Some are in academics and are making less money, but they have an intern and a fellow buffering them from calls. Another is in a large group, so his call is nicely spread out- even as the junior in the group. To make the money and do the big cases, there are still lots of long hours. The hours just aren't as long and they are no longer for $6 an hour Plus, 6 weeks of vacation per year... they b!tch only slightly less than when they were GS residents, but their circumstances are much better, and they know it. Family life is much happier too.

However, the truth is, there will ALWAYS be a certain amount of BS to deal with. There will be missed dinners and missed little league games. Surgery is and always will be a demanding mistress, and I don't think you can go through the process without it changing you in some way. I can't think of a single marriage that did not get super stressed at some point along the way.

Also I think it is nearly impossible as a medical student to get a real sense of what the long road is like. I remember my own classmates chose GS after 2-3 surgery rotations. For my husband and I, GS was like 72 (q3-4) AIs back to back to back to back. It is so cliche, but he has just taken it one day at a time, because obsessing about the long road can be so overwhelming and self-defeating.

I feel like I have been through it, too. If you are married or in a relationship you will be dragging your SO along with you- make no mistake. Along the way we saw a lot of marriages sink.

We also have 4 friends who left GS for gas, and 2 for path and several others for various other things- and they seem so happy now.

I've also taken a few for the team just to keep some sanity in our lives. I should be a PGY4, but I'm a 1 and holding until we get settled into an attending job for my spouse. Living apart did not work for us and programs & med schools are not as kind as some might think. That has NOT been easy for me, because I am not the Holly Homemaker type. Between the hours and the Match and all the other crap, I've had to set aside the AOA ego and take care of getting our family through this. I guess a lot of us gunners wake up at some point and realize there is so much more to life than gunning. Quite honestly, I thought med school was MUCH EASIER than being married to a surgery resident!!! That said, I think a lot of the Holly Homemaker types have it harder, because they often don't understand the long hours. All but one of the divorces we know were between medical/ non-medical spouses.

Will it get easier? YES. Will it be EASY? Never. Would we do it over again.....

Surgery is so interesting when you are a med student, but IMO you should only go into it if you are absolutely hell-bent on it, and if there is nothing else in the world that would work. Otherwise, find the procedures, pay, excitement elsewhere, and you'll probably be happier.

Mcindoe, plastics can be a sweet life if you can make it through. Try to remember the happy attendings you knew when you chose this. (hopefully you knew some When my husband was chief, I learned that EVERYONE has second thoughts, especially early on. It was like constant "so-and-so is thinking about quitting" but only sometimes did it actually happen. How many interns called our house crying? Several. If you really think it's not going to get better for you, first try a week's vacation to clear your head (seriously- it sometimes helps!) If you still can't shake it, just remember you are still the awesome applicant who landed a very competitive spot. Lots of PDs in other fields would love to have you, so you still have lots of options. I wish you the very best!

 

[mcindoe]

The alternative would be some medicine residency or pediatrics residency, right? Well I have been rounding with an pulmonologist/ intesivist over the past couple of days and...painful. Medicine as an alternative? no way.

well, medicine is three years. by second year, you're running the team. imagine as a third year, you're the chief or basically top of the resident hierarchy.

second year as a surgery resident, you're still a bitch, but now you handle consults and you have people one year below you to pick on.

third year? still a bitch and still take crap from 4th and 5th year residents. and you're not even halfway done with residency until halfway through the year.

even fifth years...the chiefs....get treated like ******s by the attendings. now instead of yelling at them and making them feel stupid for not knowing this or that, they take it to a whole new level....like "you're going to be on your own next year and you don't even know how to do ___?!" or "you've been doing this for all these years and this is the best you can do?" really motivating, atta' boy culture.

my friends doing medicine get all of these "elective" months. or ambulatory. or things that have regular schedules. with surgery it's like wake up at 4-5 am every day, all year. same s**t, different service, different part of the body. but there aren't any "cush" rotations really...at least not like there are in other fields.

 

[tooshorttoolong]

Agreed -- the toughest part about surgery (besides the fact that none of my friends who are residents now work anywhere near under 80 hours a week -- think more like 100) is that there are no easy rotations and no rotations without call. Your easy rotation is mostly SICU, which for every other residency is the hardest out there. It is unending.

 

[mcindoe]

Mcindoe, plastics can be a sweet life if you can make it through. Try to remember the happy attendings you knew when you chose this. (hopefully you knew some...... If you still can't shake it, just remember you are still the awesome applicant who landed a very competitive spot. Lots of PDs in other fields would love to have you, so you still have lots of options. I wish you the very best!

thanks for the encouragement.

sadly, when i think about the attendings in plastics, in retrospect they were for the most part miserable. but i ignored it because i was like "well, it'll be different for me". no.

there's one attending who inspired me a lot to go into plastics and he's a super guy and a great surgeon, and he loves doing it. however, his marriage is essentially a joke (they're only still married i think for the sake of the kids), and he hardly ever sees his kids. maybe once over the weekends. but he doesn't come home at night, cause his office is in a big metropolis and his family lives in suburbia...again, for the sake of the kids so they can get a good education and stuff. he works like a dog. never goes on vacation. he has only one love in his life....surgery. he has no time for anything else. i thought i'd be able to make something different out of my life, but i'm realizing it just can't happen.

speaking of relationships, mine was in shambles after a few months of residency. it's tough to find a mate who can accept being #2 in your life. we never got to see each other, and we missed each other terribly. but i always had the same tired excuse....sorry, i was in the OR and the case ran late, or the attending decided to round at 9pm. we'd talk on the phone every night, and there were many times when i fell asleep in the middle of our discussion. i lost a lover because of surgery, and i can never get that back, and it is heartbreaking. devastating. it doesn't matter that it was unintentional, it is just poison to a relationship...and i couldn't promise that it would get any different in the future, which was really depressing.

i remember the time i met with the PD at my home school to ask for a letter of rec, and i asked him about if he had any regrets about going into surgery or something like that. his response: "well, it cost me my first marriage".

sorry for the rant. here's my take-home message to anyone reading who's on the fence about pursuing surgery: there is one thing i NEVER thought to consider as a med student when it came to thinking about what would make me happy in life. all i could think about was "being a plastic surgeon is all i'd need and matching would make me happy forever!" what REALLY makes for happiness is meaningful, loving relationships---companionship---someone to spend your life with, or even just close friends. surgery robs you of your CONTROL over relationships. it doesn't take away your ability to be in one, start one, or maintain them. but there will be a lot of flaking on your part, not cause you want to, but cause you HAVE to. you have no choice. and furthermore, remember that when you do actually get out of the hopsital and aren't on duty, surgery STILL robs you of your time, because you're tired and worn-out and cranky. so even if you have a day or two off, and your sweetheart is coming to visit, remember that you're not going to be your chipper self....you'll still be recovering from the day or night before. you can argue that this is the case in so many other fields, but at least nothing takes as long as surgery.

ironmaiden, with all due respect to your husband, it gave me a knot in my stomach to read "PGY-8" and "q2". yeah, so your buddies who are recently finished are financiall VERY well off, but i can't honestly say i would be happy living like that, no matter what financial incentives lie ahead. i guess it's a matter of how much you're all willing to sacrifice to do what you think will make you happy. there are a LOT of things that you can do that will allow you to be financially well off that don't involve being a pgy >6. and i hope that's not why he's doing this.

but regardless, if i decide it's not for me, i will be sad and disappointed, but i think my options will be wide open. integrated plastics is the most competitive residency spot to get, so if i can do that then i can apply for other things with a reasonably good shot of getting a good spot. thanks.

 

[supercut]

thanks for the encouragement.
here's my take-home message to anyone reading who's on the fence about pursuing surgery: there is one thing i NEVER thought to consider as a med student when it came to thinking about what would make me happy in life. all i could think about was "being a plastic surgeon is all i'd need and matching would make me happy forever!" what REALLY makes for happiness is meaningful, loving relationships---companionship---someone to spend your life with, or even just close friends. surgery robs you of your CONTROL over relationships. it doesn't take away your ability to be in one, start one, or maintain them. but there will be a lot of flaking on your part, not cause you want to, but cause you HAVE to. you have no choice. and furthermore, remember that when you do actually get out of the hopsital and aren't on duty, surgery STILL robs you of your time, because you're tired and worn-out and cranky. so even if you have a day or two off, and your sweetheart is coming to visit, remember that you're not going to be your chipper self....you'll still be recovering from the day or night before. you can argue that this is the case in so many other fields, but at least nothing takes as long as surgery.

Well said. First of all, 80 hours of surgery is probably harder than 80 hours of anything else. (even if you are in a program that is good at sticking to the 80 hour limit, as I am). Second, 55 or 60 hours of surgery as an attending is probably harder (physically, anyway) than that much time of any other field. What sucks the most about surgery is that you lose control over your life. And theres not a lot you can do, becuase so much of the reason you work such long hours is dependent on other people who work for an hourly wage. They don't care if you go home or not. They go home at 3pm regardless of how slow they move and how much they delay your cases. Doesn't matter how long it takes to turn over the room. Does't matter if they don't have all the stuff in your OR cart that you've outlined on your preference card. Doesn't matter if they have to run out of the room 5 times during the case to get suture or whatever. They don't care.

As PGY3 in surgery, I'm having serious second thoughts. No longer can I sign out to a cross covering intern and leave the hospital at a defined time. True, I don't take as much in house overnight call anymore. But now I'm often the one who must stay late and cover the add-on cases. If not, I still have to make sure I round on the entire service before I go home. Though I'm not in a relationship, what this means is that I can't make any kind of plans except for my acutal day off, as it is impossible to predict what time I will leave the hospital. And the cumulative fatigue of working 5 14 hour days in row is far more exausting than q 4 overnight in house call. I get home more exausted than I could ever imagine, too tired to eat anything decent, too tired to interact with others, too tired to prepeare for the next days's cases, too tired to do anything except fall into bed and repeat the whole thing the next day. Sometimes operating is still fun, but now it's become mostly just a job and I'm finding there are a lot of cases I just don't like to do at all.

Ever notice how often attendings fall asleep in the lounge between cases? That's a sign of sleep deprivation.

Starting salaries that I've seen for surgery range in the $200-300K range. That's hardly a gazillion, or even half a gazilloin. (granted, its' nothing to sneeze at...but it's not as good as you think!) Add to that the fact that this salary often requires you generate a minimum amount of revenue for the practice (if you don't, your salary is cut) And, then, Uncle Sam will take a hefty chunk of that, and then of course there are the student loan payments after that. Plus your AGI is high enough that the governement regards you as part of the "RICH" and therefore seeks to punish you for succeding by taking away many tax deductions (eg you can't deduct your student loan interest at that income)


I say all this is becuase I started out about as hard core as you can get, and in fact it's hard for me to believe that my attitude has changed so much. I heard all the criticizims and thought I wouldn't care. I didn't for a while. But now....it's a lot harder and a lot less rewarding than I thought it would be.

There was an article published in the Bullitin of the American College of Surgeons a couple months ago (I only just now got around to reading it). Mark Wallack, MD, FACS (chief of surgery at Metropolitan Hospital Center, NY NY) relays his experinece having angina and needing a CABG X4. His recovery gave him time to reflect, and he describes the profession of surgery as imposing "altruistic self destruction" on itself. Those words rung very true for me, because that is exactly what happens. Not only does it happen, but it's expected.

I don't think I want to engage in "alturistic self destruction" any more.

 

[mcindoe]

he describes the profession of surgery as imposing "altruistic self destruction" on itself....Not only does it happen, but it's expected.

and with residents, i would add that not only is it expected, but it's exploited.

very well said. and all true. for all the healing you do for others, how much damage do you cause to your own body? i had to start wearing pressure hose in the OR cause my lower legs were getting edematous. and i bet i am more malnourished than many of my cancer patients, with a random diet of graham crackers, peanut butter, coffee, hot pockets, and ensure.

and it's SO true about the environment in the OR being as described above, where they're working on the clock, and they have no incentive to hustle. i have my own secret language with the scrub nurses that we communicate throughout some of the long, tedious cases---consists of a lot of eye rolling, brow sweating, heavy eyelids, and then more eye rolling as we watch the chief resident keep us there another hour or two cause during our lap chole he brilliantly punctures the gall bladder, and makes a mess of the peritoneum. "oops, sorry guys". sorry indeed.....now we get to round at 9:30PM thanks to that smooth move, and i still have to be there at 5:30 to pre-round in the morning. i could go on but i'll pass.

glad others understand and are willing to speak the truth without what i'd expect from other surgical residents---that is, being put down and called weak or being made fun of for complaining. after all, that's what i'd get in the hospital.

 

[filter07]

Do others in your residency feel the same way, or are there some who seem okay with the whole thing? Do you think going into GS is a mistake? What is stopping you from quitting? Is this the first time you guys have felt this badly? Thank you in advance.

 

[supercut]

I haven't really talked about this with my fellow residents...if I did it would be all over the department in a nanosecond that I'm thinking of quitting, and that's the last thing I need. Though since I started the program in 2003 we have lost 7 categorical residents to various lifestyle specialties.

I do know that I feel like I have to pretend to be eager to do cases that are added on late (when I really just want to go home) or the big, long cases (eg...when LAR appears on the schedule, all I can think of is how long and painful will that be?) Everyone else seems eager (but maybe they are pretending too....)

For a while (first two years, to be exact) I basically liked it. THere's crap with any job....one example for surgery is the behaviour of the hourly paid OR staff that I already addressed, but overall I thought the fun outweighed the crap. I'm not sure exactly what has changed. I did take a year for research, so that was last year. And while I quickly got bored sitting in a cubicle in front of a computer (did clinical, not basic science projects), I did also get used to having a normal life.

Back in June I couldn't wait to get back into the OR (though I knew I would miss having control over my life) it didn't take long for me to start wondering why was I so eager to come back. I guess partly it's because operating isn't so novel anymore. Partly because the role and responibility of a more senior resident is much more of a burden than I imagined. And a large part is that I had forgotten what it is like to have a normal life, with control over your free time (last year helped me remember that). I acutally had time to participate in hobbies, go out, meet new people, and develop a circle of non medical friends (many of whom are now more scarce cuz they just don't get the demands on my time) Now that's all pretty much a distant memory. I really don't even mind taking call...what I hate is that even on non call days, you cannot reliably predict what time you can go home.

What keeps me from quitting today? Sometimes, not much. I feel an obligation to my program to finish the year. I do want to make sure I don't make a rash decision. To switch would cost me at least a year of extra time in residency, maybe more. The most expedient thing to do would be just hang in there and finish surgery. (I'm also trying to figure out what ways I could have a career in surgery, doing mostly operations that I like and having control over my hours...seems like it shouldn't be too much to ask for, but it might be) Also, I don't think I have enough information about being an attending in surgery (though the more I learn, the less I like). Nor do I know enough about the drawbacks of anesthesia or what it's like to be an attending in that field. Finally, I started the year with some of the crappiest rotations, and have only just started a pure general surgery rotation. Some of my discontent could be from the rotations being so bad. But more and more I'm finding myself doing cases and thinking "I really don't like doing this so much, and don't care if I never do this again" And it's not just on long, painful cases that I'm thinking that. I have heard that most people think of quitting at some point durinig residency. But I just don't know if I can take the constant pounding any more (well, I could, but doubt it's worth it). And surgery attendings get pounded more than attendings in other fields.

I think it's pathetic that surgery as a profession has a tradition of viewing it's members as weak for needing to attend to basic body functions (eat, sleep, pee...) as well as for wanting to have a personal life. I don't see that changing any time soon, despite some lip service. I used to think that I would be someone who would strive to change those aspects of the profession from the insided. But I'm not sure the cost to my own health and well being is worth it.

 

[filter07]

This is probably difficult to answer but do you think your problem has anything to do with your program? If I may ask which region of the country (West, Midwest, South, East) do you train? Thank you for sharing. I hope you find a good resolution.

 

[SLUser11]

This is probably difficult to answer but do you think your problem has anything to do with your program? If I may ask which region of the country (West, Midwest, South, East) do you train? Thank you for sharing. I hope you find a good resolution.

Supercut trains at an academic center in the Northeast....I searched her posts.

Supercut: after searching your old posts, it sounds like your residency has been a nightmare since day one. Poor treatment, poor/absent instruction, lack of autonomy, conflict with nurses and PAs. I think 40 hours/week of that would make me miserable.

Your description of your program is every negative stereotype about northeastern academic centers....and it is partly the reason why I steered away from those programs.

If you're that unhappy, I'd definitely be shopping around for transfer positions, even if it means eating a year or two, before quitting surgery altogether.

It doesn't have to be like that.

To 4th year med students: Surgery isn't inherently miserable, and the stereotype and old-school train of thought is NOT universal.....it's just more prevalent in certain environments and geographical locations. That means that you have to shop wisely, and keep your Bulls#@t meter on high when listening to residents praise their programs.

 

[naus]

Wow, I'm kind of horrified by this thread. Are other surgical subspecialties like Ortho or ENT a little bit better? They still have to do one year of GS though. Remuneration is a little bit better, but lifestyle same as GS?

 

[mcindoe]

This is probably difficult to answer but do you think your problem has anything to do with your program? If I may ask which region of the country (West, Midwest, South, East) do you train?

i can only speak for myself, but i'm at one of "america's top 20" hospitals or some list like that from us news. i don't think there's anything with my program...in fact, many of them are some of the nicest and down to earth residents i met on the interview trail.

here's the problem: the hospital (and its satellites) are BIG, and as you would expect with such a big entity, it serves a very large geographical region. being at a hospital that serves such a large area that is labeled as being a "top" medical center attracts a lot of patients, and when your hospital is the reputable one in the region, then you get a lot of the traumas, specialty cases, etc. big hospital=big patient list=big case load=busy all the time. this is important to keep in mind when you go on interviews and the residents are bragging about how high their case load is and how many whipple's they've done by their 5th year and stuff like that. to do all those cases means you're in the hospital doing them...and that takes up a lot of time. on interviews it's always a big selling point for some reason...i guess they've noticed that med students are really into the idea of doing more cases than anyone else. well, read the above posts and read between the lines. just make sure they all get exposure to a wide variety of cases and that there's no deficiencies in any areas. but don't get seduced by the chiefs who brag about doing 24 whipples in the past six months, as if that's some special gift (unless you want to be a pancreatic surgeon). this isn't a matter of "whoever does the most number of ___ wins"....you want to get enough experience and be competent, but it's kinda like studying for your boards.....you can study for 12 weeks, and that's better than 8 or 6, but it gets to a leveling point where no matter how much more you study you're not going to do any better....if anything you're just gonna get burnt out.

as for location, the northeast has its own reputation, usually not the most flattering, as do places like hopkins and mgh. but on the interview trail, it didn't seem to matter that much where you were geographically. the residents and attendings usually come from all over the place, or they've usually gone to med school or were trained for several years in different regions of the country, so you're rarely an outsider within the program.

hope this helps.

 

[whoopsie_1]

Hey, you struck a chord, supercut.

http://www.hostingphpbb.com/forum/v...=kinetic&sid=99958a103cefbad239b13ff8e022fac8

OK, and then there was this other thread I read and, in particular, this post by supercut.

You know what? It's too bad medicine has to suck so much and it doesn't have to. It's hard to put into words, but a lot of medicine boils down to "responsibility." What do I mean? supercut talks about the difference between physicians and "hourly staff"; then there's also the difference between different physicians. Being a physician, I've always felt, is made ten times more difficult because you have to work with two types of people:

1) People who are stupid and unmotivated. Usually, these people are ancillary staff. It doesn't matter if it's a secretary or a lab tech or a transporter. You know what's hilarious? You have people who go through decades of school, whose medical fund of knowledge would stagger most people, who utilize advanced technology that cost millions of dollars to develop ...and they depend on some ****** who didn't graduate high school. LOL, right? It's like you built the space shuttle and decided that the key component would be a rusty thumbtack that secured everything together.

2) People who are smart and lazy. Usually, these are people who are attendings in academic centers. They're not stupid people at all. But DAMN are they lazy mothers. The attitude is "this is what I want, now make it happen." They know that, to get it done, you will have to wage literal warfare with knives and pitchforks with the people who are stupid and unmotivated (e.g., if you want an echo done at 4 PM), but they don't care. Spare them the details. LOL, the funniest thing was when I couldn't get the test done and they went all crybaby berserk over it and then they were like, "OK, let me show you how to do it." Then they'd fail and be like, "uh, never mind, that test was irrelevant anyway." Exactly. They only ordered it because it costs them nothing in terms of work or sweat to get it -- someone else will put that in.

And a majority of people are sandwiched in between these two bastard populations in what is known as "residency training."

But to make it even more complicated, there is the third group of people. The S.O.B.s who run to specialize in Emergency Medicine or Dermatology or Anesthesiology or Orthop-LOOK AT ME USE "AE"-dicks, who only care about getting paid and getting laid. Now look, I've said it before and I'll say it again: I'm not some jerk who says "hey, everyone, let's compete to show how much we care by seeing who can go with the least sleep or go the longest before you have to take a dump so you can admit fifteen patients!" I could care less if someone doesn't want medicine to dominate their lives ...but then a) why do you think you deserve to make money and b) why are you so gay?

And nobody can answer those two questions. At best, they deflect it by just going, "HA HA LOL UR JUST JEALOUS OF ME BECAUSE IM SO GR8!" No, you're just lucky that we have people like Elysium telling primary care physicians that they "must" take care of everyone at a price that anyone can afford, which screws up the medical field and reimbursements to no end.

I think you'd eliminate maybe 60% of the problems with medicine if you made it "pay for play." You'd totally eliminate all the worthless human debris cluttering up your practice (unless you wanted them) and you'd re-normalize reimbursements so that the people who WORKED the hardest were PAID the most. And if you restructured residency so that residents weren't just "people who I keep around to make sure that the people who actually get paid do some work or else do it for them," that would get rid of another 30% of the problems.

 

[supercut]

Maybe I'm just saying what a lot of people are thinking. After all, nationwide the dropout rate from surgery is about 20%.

It is entirely possible that part of the problem is my program...it certainly is a very top heavy program in which junior residents are coddled and protected. I did look into changing programs - its almost impossible to find a categorical spot at a good program if you already have a categorical spot.

I only have about 250 cases from the first two years, so I really don't know how to operate yet, either. Now I'm in the OR most of the day, and a lot of that is still first assisting, and I find it totally exausting. Even though for the past week or so I've been doing mostly cases that I either like or don't mind, I still wonder if its worth it. Most days I am still in the OR when my juniors leave. I get home 7:30-8pm, and I'm to tired to do anything but go to bed. One day this week we had an early day, and I actually got home at 5:30. I fell asleep on the couch by 6:30 and didn't wake up til 1am. Honestly, I want more out of life than working, eating vending machine crap and sleeping. Right now I'm trying to assess whether I can tolerate an attending schedule (which I'm not sure!)

It's ironic because I was one of those hard core medical students. I was very concerned about numbers of cases when I interviewed for programs. Now I know that total numbers aren't as important as the quality of the teaching. And I've also realized that it doesn't matter if you've done, for example, 3 pancreas cases or 20 during residency. You really have no business doing pancrease cases in practice unless you've done a fellowship.there are a number of other types of operations that this statement would apply to as well. Quality and outcome demands by insurance companies and the public will expand this phenomnenon.

Part of my discontent is regarding the practice of medicine in general. The stupid rules imposed by bureaucrats and hospital administrators who have no clue about clinical medicine. (EG our "mother ship" hospital recently tried to do away with large bore -14 and 16 gauge- IV catheters, claiming that they aren't used enough to be cost effective!). I can't stand the expoentially increasing burden of paperwork. And the reimbursment rules are absolutely insane...if you tried to run any other business like medicine is run, it would fail. You'd never get a bank loan based on a business plan that is set up the business of medicine is conducted.

So here I am, sometimes liking my time in the OR but sometimes not, and most of the time feeling like I am sacrificing my health and well being...and I'm wondering why keep doing this to myself. I plan to give it a few months before I make any decisions.

 

[cchoukal]

This is a really interesting thread. I'm impressed by people's honesty and that their peers are supporting them instead of calling them wimps for not embracing the abuse. I'm a PGY2 in anesthesiology who often thinks about switching into surgery. More specifically, I interviewed in a surgical subspecialty and anesthesiology but withdrew from the match because I didn't think I loved it enough and was/am really interested in critical care. Long story short, I think a lot about whether I'd have been happier in surgery. A few people on here have mentioned switching to anesthesiology, and I just wanted share a little "grass is greener" perspective.

The hours are definitely fewer in most anesthesia programs compared to surgery, but they're not all that much more predictable. I never know if I'm leaving at 5pm or 8pm. And, frankly, it's pretty exhausting. I know it looks like we're pretty much just sitting there all day (I actually stand), but suffice it to say it's a lot more stressful than it looks. And when our cases are done, sometimes you'll take over another room (which feels a lot like being paged on the way out of the hospital to come back and take care of some patient issue). Sometimes you get done at a good time, but there's always post-ops from the day before and pre-ops for the next day. The call is definitely better and, in most programs, the weekends are free if not on call.

I don't think there's any question that surgery residents take a lot of abuse. But the neurotic attendings/making you feel ******ed I don't think is that much better in anesthesiology. Surgery people have more-senior surgery people making them feel ******ed, but we have more-senior anesthesia people AND on occasion surgery people getting in on the act. Sometimes I wonder if some anesthesiology attendings aren't so bitter because they've spent their careers on the receiving end of so much crap from surgeons, and now with residents, they finally have someone they can dish it out to.

I think one of the tougher things for me is the hierarchical relationship between us and you in the OR. I'm used to being treated like I know something, and the traditional/historical surgeon/anesthesiologist relationship feels a little boss/employee at times. It changes how you feel about yourself sometimes. And from what I can tell, this sort of thing is encouraged in private practice because you have to bend over for the surgeons in order to "keep them happy" so your group keeps their contract with the hospital. It's also a drag being made to feel like the only thing standing in the way of the surgeon getting done on time is you F-ing around.

One of the things people seem to like about anesthesiology is that it's permanently a "consult specialty" in that you aren't taking primary care of patients outside the OR (outside of ICU/pain practices, anyway). You aren't getting paged for K orders or whatever. This can be really nice, but at the same time, if you're the type of person who thrives on being the one with the answers, the one others turn to for help, I think anesthesia can be really unsatisfying, which is stressful in its own way.

Anyway, this wasn't supposed to be some entry into the "contest of whose life sucks more," but I wanted to share a little insight into what anesthesiology is like and to suggest that maybe it isn't the cush oasis that a lot of "surgery drop-outs" might think.

 

[njbmd]

Im considering doing surgery and was wondering how flexible the hours can be. I have heard people at my school complain about long hours even once you are out of residency. Would it be possible to be a general surgeon and work less? If surgeons make a gazilion dollars a year and work 80 hrs a week could you work 40hrs a week and make half a gazilion?

Surgery is one of those peculiar specialties in that you are likely going to NEED to put in a significant amount of hours at the start of your career to keep your skills honed. It is a skills-heavy specialty.

That being said, it is definitly NOT the specialty to enter because you are looking for money. Reimbursements for general surgical procedures have dropped every year and your overhead costs have risen every year. You are likely going to HAVE to put a significant amount of hours just to keep your office open.

The main reason to go into General Surgery is because you LIKE it. I have constantly said that I would have to "shoot myself" if I spent hours standing around "rounding" on patients as I have observed on many medical services. There is only "so much talking" that I can tolerate and thus the "action-oriented" specialties were more suited to my tastes.

The hours are long; the pace can be overwhelming (especially in your PGY-1 year) and some of your attending faculty can seem to have every personality disorder that you can find in your old psychiatry texts but if you are happy doing surgery, you are likely not going to be happy doing anything else.

I wish I could say that surgery is all wonderful (sometimes it is) or all bad (sometimes it is) but it has always been interesting for me. Even the drudgery stuff has an appeal and I have found nothing in surgical residency so far, that bored me. I like the variety of patients/pathology and I love the procedures. I also like the constantly changing pace and that "we handle whatever comes though the door" characteristic.

If you are questioning the hours, then think long and hard about going into surgery because I just don't see the hours getting any better for those who have yet to enter residency or practice.

 

[avgjoe]

Surgery is one of those peculiar specialties in that you are likely going to NEED to put in a significant amount of hours at the start of your career to keep your skills honed. It is a skills-heavy specialty.

That being said, it is definitly NOT the specialty to enter because you are looking for money. Reimbursements for general surgical procedures have dropped every year and your overhead costs have risen every year. You are likely going to HAVE to put a significant amount of hours just to keep your office open.

The main reason to go into General Surgery is because you LIKE it. I have constantly said that I would have to "shoot myself" if I spent hours standing around "rounding" on patients as I have observed on many medical services. There is only "so much talking" that I can tolerate and thus the "action-oriented" specialties were more suited to my tastes.

The hours are long; the pace can be overwhelming (especially in your PGY-1 year) and some of your attending faculty can seem to have every personality disorder that you can find in your old psychiatry texts but if you are happy doing surgery, you are likely not going to be happy doing anything else.

I wish I could say that surgery is all wonderful (sometimes it is) or all bad (sometimes it is) but it has always been interesting for me. Even the drudgery stuff has an appeal and I have found nothing in surgical residency so far, that bored me. I like the variety of patients/pathology and I love the procedures. I also like the constantly changing pace and that "we handle whatever comes though the door" characteristic.

If you are questioning the hours, then think long and hard about going into surgery because I just don't see the hours getting any better for those who have yet to enter residency or practice.

NJBMD, can you specify a little more? Are you really saying that people will have to work 80+ hours when they enter practice or academics after residency? That seems a little crazy.. I've always seen the statistics of people working 50-60 hrs a week which seems a lot more doable and normal. Also in terms of the 'working long huors to keep the office open', you I assume are talking specifically of a single person private practice. If one joins a university academic practice, or a large hospital/hmo type place, or even a big private practice group, is this still the case in yr experience?

 

[supercut]

Are you really saying that people will have to work 80+ hours when they enter practice or academics after residency? That seems a little crazy.. I've always seen the statistics of people working 50-60 hrs a week which seems a lot more doable and normal. Also in terms of the 'working long huors to keep the office open', you I assume are talking specifically of a single person private practice. If one joins a university academic practice, or a large hospital/hmo type place, or even a big private practice group, is this still the case in yr experience?

Yes, there are some who work that much. THe 50-60 hours a week of an attending you've seen is an average, meaning that some work less, some work more. I've known a number of attendings over the years who continue to work upwards of 100 hours a week. Granted, many of these are in private practice and either choose to (or feel obligated to...in order to keep the same income). But still, some are in academic group settings. I imagine (grain of salt here...I have no direct experinece in what I'm about to say..) that the hours you work would be in keeping with what the other members of your group, regardless of the practice setting, are doing (ie you don't want to be the "weak link" working only 50 hours a week when your partners put in 80)

I do know that often times the pay is a salary, with a bonus based on productivity. If you don't have enough billing to at least cover your salary, it is likely your salary can be reduced in subsequent years. Since medicare cuts payments every year, you can see that you will have to work increasingly more just to cover your base salary. That's part of the reason why I'm not sure that continuing in surgery is wise for me. (Still part of me is a surgeon at heart, and when I've almost decided to quit, something in me says...but this is fun, you can't quit!)

NJBMD is right...don't go into surgery for the money (don't go into the medical field at all for the money). You gotta like it, otherwise it's just an incredibly hard job. The days that I have gone into work lately and hated every minute of it have been absolutely the hardest days of my life (and I've been around the block a few times, too!)

 

[medstudent99]

dude surgery is as tough as nails, i didn't realize how tough it was going to be until after i started and i'm only a prelim, i did a few easier rotations but this vascular rotation is killing me! no joke! i'm freaking hating my life right now. if ur trying to get involved with someone and your in a prelim surgery program it is no joke, it freakin sucks!!!!!!! i am not lying, i should have probably done a medicine year. surgery sucks ass! and dnt think the other interns are nice because they're not. sugery is full of sharks, back stabbers, vendective ppl. it sucks it really does.

 

[Guile]

dude surgery is as tough as nails, i didn't realize how tough it was going to be until after i started and i'm only a prelim, i did a few easier rotations but this vascular rotation is killing me! no joke! i'm freaking hating my life right now. if ur trying to get involved with someone and your in a prelim surgery program it is no joke, it freakin sucks!!!!!!! i am not lying, i should have probably done a medicine year. surgery sucks ass! and dnt think the other interns are nice because they're not. sugery is full of sharks, back stabbers, vendective ppl. it sucks it really does.

Where are you, if you don't mind sharing? Perhaps it's your program?

 

[supercut]

dude surgery is as tough as nails, i didn't realize how tough it was going to be until after i started and i'm only a prelim, i did a few easier rotations but this vascular rotation is killing me! no joke! i'm freaking hating my life right now. if ur trying to get involved with someone and your in a prelim surgery program it is no joke, it freakin sucks!!!!!!! i am not lying, i should have probably done a medicine year. surgery sucks ass! and dnt think the other interns are nice because they're not. sugery is full of sharks, back stabbers, vendective ppl. it sucks it really does.

Please note that not all programs are like this. In my program people get along and are generally cooperative. My main beef with surgery as a career choice is the "altruistic self destruction" that I referred to in an earlier post. I eat only a couple of real meals a week. When I'm not at work, I'm falling asleep on the couch because of the amazingly bone deep fatigue that I have never experenced before. I'm not reading like I should be, simply because I'm so exausted. I can feel my physical condition decline. THere are very few pts who are so sick that they will die without my immediate attention, but still I am expected to work 15 hours a day, without eating, at the detriment of my own health. Somtimes I'm not sure that what I do during the day is even effective (eg does BID rounding on ALL pts improve outcomes, or is it expected becuase we've always done it that way? And what if we rounded at 7 and then I don't get around again until 10pm because I've been in the OR all day?) Even though I'm now on a general surgery rotation and am happier in the OR (note: happier does not equate with happy) I'm tired of having to sacrifice my health and personal life. And with reimbursement declining every year, that means we have to work harder just to stay even. Which means it will just get worse.

 

[Winged Scapula]

To echo supercut's words, surgery and surgery residency does not have to be filled with "vindictive, back-stabbing sharks." While I have known a few in my day, my residency would not have been nearly as pleasurable were it not for my fellow residents.

They covered for me when I had to take time off for emergency surgery and family issues. I never once heard a complaint, although I'm sure they existed because my time off meant that others had to take more call. And the support wasn't just from my class of residents, but from every year.

We all tried our hardest to be cooperative and get along, even when we were dead tired and cranky. Its worth it in the long run to make an effort to do so, because you will see these people much more than you will your SO, your family or your pets. And as future colleagues, it behooves us to try and work well together.

I just didn't want those not yet in the field to worry that all of the programs contained people like those mentioned by medstudent99.

 

[Llenroc]

Im considering doing surgery and was wondering how flexible the hours can be. I have heard people at my school complain about long hours even once you are out of residency. Would it be possible to be a general surgeon and work less? If surgeons make a gazilion dollars a year and work 80 hrs a week could you work 40hrs a week and make half a gazilion?

They're pretty bad. I am *so* looking forward to getting done with my Surgery clerkship in 3 weeks. I work like a dog each day from 5:30 until 6, without breakfast or lunch, and I end up being in the hospital on 3/4 of weekend days. Also, nasty, nasty people. I'd rather be dead than be a surgeon working in America.

If you want to be a surgeon because you want to drive a Ferrari and have sex with supermodels, forget about it, because I've yet to meet a surgeon whose like that. Most of these guys come into work around 5:30 and don't leave until 6 each day. They're tired and irritable, and complain about their pay. And they take a ****load of call, even in their old age.

The income for surgical specialties is higher than medical specialties, but it's not that much more. And surgery has long training (5 years minimum, and often something like 9 years for stuff like Pediatric Surgery), during which you're losing out on income. You work a lot more hours than medical doctors. And you are pretty much forced to retire early. In Allergy for example, the work is so light that these guys often maintain a practice until the age of 85 or 90. Try doing that in Surgery. You train until 35, and then have about 25 years to work your craft.

I would only go into surgery if you actually like the surgery, especially the long 5 hour ones, which make me want to kill myself after participating in them. I have friends for whom putting on a pair of scrubs, and then putting in stitches and tying suture knots is the most exhilirating thing in the world. If you're like that, do surgery. If not, then you'll be misereable, as I've met a number of surgery residents and attendings who went into the field for the wrong reasons (i.e. money, or "I had high board scores and was told to go into it", etc.) who just seem like they don't belong.

 

[Leukocyte]

Please note that not all programs are like this. In my program people get along and are generally cooperative. My main beef with surgery as a career choice is the "altruistic self destruction" that I referred to in an earlier post. I eat only a couple of real meals a week. When I'm not at work, I'm falling asleep on the couch because of the amazingly bone deep fatigue that I have never experenced before. I'm not reading like I should be, simply because I'm so exausted. I can feel my physical condition decline. THere are very few pts who are so sick that they will die without my immediate attention, but still I am expected to work 15 hours a day, without eating, at the detriment of my own health. Somtimes I'm not sure that what I do during the day is even effective (eg does BID rounding on ALL pts improve outcomes, or is it expected becuase we've always done it that way? And what if we rounded at 7 and then I don't get around again until 10pm because I've been in the OR all day?) Even though I'm now on a general surgery rotation and am happier in the OR (note: happier does not equate with happy) I'm tired of having to sacrifice my health and personal life. And with reimbursement declining every year, that means we have to work harder just to stay even. Which means it will just get worse.

Excellent post...because it is comming from a surgical resident and is very honest.

I am also very hesitant to go into surgery...I mean:

I LOVE:

-General surgery as a desipline.
-Working and helping people by doing surgery.

But I HATE:

-The life-style and hours.
-The "ARMY" mentality and culture that dominated the general surgery programs I rotated at as a medical student.
-The "need" to stick to the customs and traditions, even though some might not make a lot of sence (at least for me).

But, in the end I would rather work in Surgery, rather than work in any other field....I mean, honestly medicine, in general, is not my "dream" carreer (I wanted, and still want to -but cannot- become an airline pilot).

So as long as I am knee deep in my "Plan B" carreer (medicine), I might as well do what I like most in medicine,....Surgery.

Future Surgical Intern-2007

 

[AngelOfAbyss]

I eat only a couple of real meals a week. When I'm not at work, I'm falling asleep on the couch because of the amazingly bone deep fatigue that I have never experenced before. I'm not reading like I should be, simply because I'm so exausted. I can feel my physical condition decline. .

hey Supercut...
i think u complain a little bit too much than any of the other residents in this forum... i dont know what the reason is, whether its the program u are in or some other personal reason, but definitely its a little bit too much of whining...

yea... its true everyone complains about surgery and its lifestyle... but the things u say like "u only have a couple of real meals a week"... or "u'r physical condition is declining @ work", etc... dont u think its a little bit too much... what i dont get is if u are so busy and tired of work, how do u get the time to post such long replies in this FORUM and that even during the weekdays in evening....

anywayz... thanks for all the info... but i guess its better if u dont whine so much and discourage all the potential surgeons visiting this forum...

as for me... i am a med student... dont know much about life as a surgical resident... but i would like to thank other members (kimberli, NJBMD....others) ... even though they complain u can appreciate the fact that there is life outside hospital... and however tough the schedule is, they are happy to be surgeons at the end of the day...

 

[Pilot Doc]

Hey Angel.

I think you can't spell.

I think you haven't mastered standard written english.

I think you don't have any idea what it's like to be a surgical resident.

I think the purpose of this forum is to share useful information regardless of whether it encourages or discourages medical students.

I think you should take a break from posting.

 

[Winged Scapula]

hey Supercut...
i think u complain a little bit too much than any of the other residents in this forum... i dont know what the reason is, whether its the program u are in or some other personal reason, but definitely its a little bit too much of whining...

yea... its true everyone complains about surgery and its lifestyle... but the things u say like "u only have a couple of real meals a week"... or "u'r physical condition is declining @ work", etc... dont u think its a little bit too much... what i dont get is if u are so busy and tired of work, how do u get the time to post such long replies in this FORUM and that even during the weekdays in evening....

anywayz... thanks for all the info... but i guess its better if u dont whine so much and discourage all the potential surgeons visiting this forum...

as for me... i am a med student... dont know much about life as a surgical resident... but i would like to thank other members (kimberli, NJBMD....others) ... even though they complain u can appreciate the fact that there is life outside hospital... and however tough the schedule is, they are happy to be surgeons at the end of the day...

I appreciate all types of posts here - those which seem discouraging as well as encouraging a career in surgery. After all, no one should choose a field based on what we have to say about here in our little SDN world. I would hope that my words neither discourage or encourage someone to consider surgery as a career, but rather simply reflect my experiences.

Everyone has a different experience during residency; sometimes I too was bone-tired and had only a few "real meals" (ie, not fast food) a week. Then again, I knew that I was sacrificing somethings to stay active on SDN, to keep my new relationship afloat, etc. I'm sure I have whined on occasion and felt like it many more times than I posted about. I am not above whining and complaining about my chosen career, and have many a time had second thoughts about it. I hope users feel free to use these forums not only for information and advice but to vent as well.

Therefore, please step forward supercut and all others, and continue with the whining/venting/complaining. It will get better...and if it doesn't, you can always switch to Anesthesia. Those guys in that forum are always posting pictures of themselves without shirts on, next to their planes, and generally enjoying life...except when they are whining about CRNAs!

 

[Leukocyte]

Anesthesia. Those guys.....are always posting pictures of themselves without shirts on, next to their planes

Hmmm....Tempting, just too bad I am not gay. I liked the PLANES part (I am a pilot at heart), but posting pictures of myself half naked in a forum of mostly dudes is not me at all. However, if you have said b****** instead of "planes", then I will be more than willing to join the party.

(Sorry Kimberli, just joking)

 

[Winged Scapula]

Hmmm....Tempting, just too bad I am not gay. I liked the PLANES part (I am a pilot at heart), but posting pictures of myself half naked in a forum of mostly dudes is not me at all. However, if you have said b****** instead of "planes", then I will be more than willing to join the party.

(Sorry Kimberli, just joking)

I see more than enough boobs each day (and that doesn't count the denizens of the Anesthesia forum! Sorry...couldn't resist!) that I could do without those piccies.

 

[boston]

hey Supercut...
i think u complain a little bit too much than any of the other residents in this forum... i dont know what the reason is, whether its the program u are in or some other personal reason, but definitely its a little bit too much of whining...

yea... its true everyone complains about surgery and its lifestyle... but the things u say like "u only have a couple of real meals a week"... or "u'r physical condition is declining @ work", etc... dont u think its a little bit too much...

actually Angel, i've always found supercut's posts to be thoughtful and intelligent. along the lines of what others have said: if some anonymous internet poster can discourage you from surgery, then how strongly do you feel about it?

while supercut's experiences might not be representative of all surgical residencies, quite honestly, they are not uncommon. in terms of "working 15 hours a day without eating": i can tell you that on most days, this accurately describes my experience. i end up not eating breakfast or lunch -- just a big dinner when i get home. maybe i'm not the most efficient resident and maybe i can manage my time better. but i find i would rather sleep an extra 15 minutes than get up early to eat breakfast.

in terms of "decline in physical condition," this is true for me as well. as a medical student, i consistently worked out at the gym 5 times a week. i haven't worked out much since residency started and lost 15% body weight during intern year. this isn't to say that it's impossible to hit the gym in residency. i know plenty of residents who do (it's just a matter of your priorities). all i am saying is that supercut is not making all this up to be dramatic; there's some underlying truth.

fwiw, supercut is merely relating his reality. for each of us who chose this path, it is hard to know what we are getting into until we are fully immersed in it. as a 4th year med student, i did 3 surgical sub-i's in a row, 80-100 hours a week and it wasn't that hard to stay motivated. but as hardcore as i was, i can say that 3 years straight of general surgery residency can be draining -- physically and emotionally. you really don't have a break -- no clinic/outpatient months, overnight call every few days.

as for me... i am a med student... dont know much about life as a surgical resident... but i would like to thank other members (kimberli, NJBMD....others) ... even though they complain u can appreciate the fact that there is life outside hospital... and however tough the schedule is, they are happy to be surgeons at the end of the day...

honestly, sometimes i feel glad to have chosen surgery because i can't imagine feeling as passionate about any other field. then, there are those countless other days that i question if i made the right decision. that's just reality. i was 27 when i was applying and thought that i could work as hard as the best of them and as much as any program demanded. i am 31 now and in the back of my mind, the thought of starting a family has crept up. and i think "how on earth is this going to happen?" none of this is meant to discourage -- just to shed more light and hopefully help others be better prepared for what is coming. and if none of this ever becomes an issue for you and you can manage an efficient and balanced life in residency, then more power to you.

(btw, lots of my colleagues are having kids in the middle of residency, so it certainly is doable.)

 

[Playmakur42]

For whats it's worth, I've been reading many of the different opinions and the positive AND negative posts have provided a wealth of information based on your personal experiences that is invaluable to someone considering medical school.

It's nice to know what you may be signing up for, especially when you're afforded a candid view of the "bad" aspects of the process. Thanks for informing us so that we can formulate our own opinions based on reality, and not some ridiculous idealistic viewpoint.

Hopefully, you're frustrated "rants" serve as the outlet that you need to keep pressing on through this difficult time. At the least, they are helping others to understand what your life is really like.

 

[Celiac Plexus]

I think that surgical residents have doubts during residency for 2 main reasons: unrealistic expectations, and changing priorities.

Expectations:

With the 80 hour work week having been around for 4+ years now, there are no more students who have been exposed to the "pre-80 hour era". Students today expect to have more control over their lives during residency than I did when I chose a surgical career. Some of the interns at my program have been heard uttering things like "surgery is a job, not a lifestyle", and "it's only a job". While these comments may seem innocuous to some, the fact is that a surgical career is an all-encompassing, wholly consuming enterprise. Your family members are the sick people you take care of, plain and simple. They don't get sick during a certain 80 hours of the week. So, even though the RRC has mandated an 80 hour week, and we all must abide by this mandate, we should not allow the RRC's arbitrary number to affect how we think of our career choices. Trainees who believe that they should punch in, and punch out, and start counting their hours in the hospital are set-ups for disappointment.


Changing priorities:

When we are medical students, we only see what we want to see. If we think surgery is cool, we will be predisposed to thinking that doing a trauma ex-lap at 3am is cool. Or that retracting for 6 hours for a whipple procedure is a rush. Never mind that one's experience as a student on a surgical rotation for a few months can, and often does, have very little correlation to the reality of being a surgical resident. Students have no responsibility, and can come and go as they please. Interns/residents are accountable for major responsibilities. As a student, you might be totally gung-ho about something after only 6 weeks of exposure. Then you get wrapped up in the match, and then there it is, July 1st, and everything is markedly different.

Also, as an early 20something medical student, you might not be all that concerned with your personal life. Med school is relatively easy compared to residency, and there is a ton of free time especially in your 4th year. Once residency starts, many aspects of your life are frozen at that point in time of graduation. After some years of surgical training, after some of your friends have married, or had children, you may begin to change how you think about your own life. Surgical residency is notoriously difficult on personal relationships. It is not impossible to maintain/build friendships during residency, but it is more challenging. At some point you may think that switching fields is the way to go, and you may be right. Your happiness is important, and at the end of the day, it is your life, and your story. You have to write it the way you want to, and not the way you think others want you to. I am in my 4th year of training, and there have been a couple of people who have switched fields, and seem to be happier. Nothing is forever, and if your priorities change, be open to the possibility that you may be better suited for another field. There is no shame in wanting to be happy. But at the same time, understand that the 80 hour mandate is not an excuse to be a shift-worker.

 

[Winged Scapula]

Excellent posts both from Celiac and Boston.

Like others, I don't think supercut is exaggerating. As I've noted before, my physical being also went into decline during residency, although unlike others who lost weight, I gained it - without exercising (and going up and down stairs and being on one's feet for 24 + hrs doesn't count) and eating fatty foods in the hospital it was inevitable.

But I don't blame residency...much, but rather the fact that I gave priority to other things. Things like nourishing my new relationship, getting my laundry done, or sleep (again, I spent my first few years in the pre-80 hr workweek).

It was not hard, as others have noted, to go all day without eating, or just to have a cookie here or there that you grabbed as you passed by the nurses station. Or a piece of candy offered to you by a patient. More often than not, especially once I became more senior and spent long hours in the OR, my only meal was dinner...and sometimes I didn't even eat that.

But again, I don't blame surgical residency...much. I blame the fact that I would have rather slept a few more minutes than get up early to eat breakfast or to make a lunch to take with me to the hospital, or even to have something in my coat pocket.

The experiences of a student and of a resident are vastly different. As Celiac notes, there is a world of difference between doing something for a few weeks and doing it and knowing that it won't end for years. There are no off service rotations without call and even as a senior resident with much less in-house call, I was still back up for the service EVERY night. Its pretty hard to be rested when the interns and junior residents are calling you at all hours. Ask me about taking home call on July 1 and how "easy" that was, with new and insecure interns. Or how "easy" it was to sleep when you knew you had a sick patient in house and the intern WASN'T calling. Probably pay-back since I was a "non-caller" as an intern too.

Now as I head into my attending years, I can see that the experience as an attending is vastly different than as a resident. MY name is the name on the chart - I have the legal responsibility. Sure residents can be sued, but in the end its MY patient, not theirs. I've chose a litiginous specialty, my choice but its still makes me worry every day that I've made a patient management mistake which will result in a lawsuit, or worse, a patient being misdiagnosed, or even dying.

The bottom line for those considering a career in surgery to see is that despite all the complaining, venting, whining, etc. we are still surgeons, so there must be some reward in it. Those who cannot find it tend to change fields or burn out earlier. And like any self-report survey, you'll tend to hear the "squeaky wheel" more often than the one who is happy.

 

[Leukocyte]

Excellent posts both from Celiac and Boston.

Like others, I don't think supercut is exaggerating. As I've noted before, my physical being also went into decline during residency, although unlike others who lost weight, I gained it - without exercising (and going up and down stairs and being on one's feet for 24 + hrs doesn't count) and eating fatty foods in the hospital it was inevitable.

But I don't blame residency...much, but rather the fact that I gave priority to other things. Things like nourishing my new relationship, getting my laundry done, or sleep (again, I spent my first few years in the pre-80 hr workweek).

It was not hard, as others have noted, to go all day without eating, or just to have a cookie here or there that you grabbed as you passed by the nurses station. Or a piece of candy offered to you by a patient. More often than not, especially once I became more senior and spent long hours in the OR, my only meal was dinner...and sometimes I didn't even eat that.

But again, I don't blame surgical residency...much. I blame the fact that I would have rather slept a few more minutes than get up early to eat breakfast or to make a lunch to take with me to the hospital, or even to have something in my coat pocket.

The experiences of a student and of a resident are vastly different. As Celiac notes, there is a world of difference between doing something for a few weeks and doing it and knowing that it won't end for years. There are no off service rotations without call and even as a senior resident with much less in-house call, I was still back up for the service EVERY night. Its pretty hard to be rested when the interns and junior residents are calling you at all hours. Ask me about taking home call on July 1 and how "easy" that was, with new and insecure interns. Or how "easy" it was to sleep when you knew you had a sick patient in house and the intern WASN'T calling. Probably pay-back since I was a "non-caller" as an intern too.

Now as I head into my attending years, I can see that the experience as an attending is vastly different than as a resident. MY name is the name on the chart - I have the legal responsibility. Sure residents can be sued, but in the end its MY patient, not theirs. I've chose a litiginous specialty, my choice but its still makes me worry every day that I've made a patient management mistake which will result in a lawsuit, or worse, a patient being misdiagnosed, or even dying.

The bottom line for those considering a career in surgery to see is that despite all the complaining, venting, whining, etc. we are still surgeons, so there must be some reward in it. Those who cannot find it tend to change fields or burn out earlier. And like any self-report survey, you'll tend to hear the "squeaky wheel" more often than the one who is happy.

Dear Dr. Cox, I get the impression (and correct me if I am wrong) that you are one of the happier surgeons. If that is true (and I hope that you are happy), do you think that your current satisfaction and happiness has to do with the fact that you chose a surgical subspeciality (Breast SX) that is comparatively more life-style friendly? Would you have been as happy if you did not specialize, and remained working in GENERAL Surgery as an attending.

I am asking this because I remember reading the past posts of "WomenSurg" (a previously active SDN poster who did not do a fellowship or subspeciality training, and who started working as a General Surgeon right after residency in a group practice), and according to her, her life as a general surgery attending was tougher than her life as a surgical resident!!!

Kimberli,..feel free to kick my ass now. ...and maam, thank you maam.

 

[Winged Scapula]

Dear Dr. Cox, I get the impression (and correct me if I am wrong) that you are one of the happier surgeons. If that is true (and I hope that you are happy), do you think that your current satisfaction and happiness has to do with the fact that you chose a surgical subspeciality (Breast SX) that is comparatively more life-style friendly? Would you have been as happy if you did not specialize, and remained working in GENERAL Surgery as an attending.

I am asking this because I remember reading the past posts of "WomenSurg" (a previously active SDN poster who did not do a fellowship or subspeciality training, and who started working as a General Surgeon right after residency in a group practice), and according to her, her life as a general surgery attending was tougher than her life as a surgical resident!!!

Kimberli,..feel free to kick my ass now. ...and maam, thank you maam.

I think it would be due to a variety of factors.

Surely being in a field which is comparatively more "lifestyle-friendly" helps (ie, no in house call, no weekend rounding, days rarely start before 0700 and end before 530).

It also helps that I am now in an environment where I feel supported and valued, as opposed to my residency. This is probably the most important factor - I can be happy doing most anything as long as I like the people and feel they care for and about me. I did not always have that in my life and for one of the first times, I feel like my education, knowledge, experience and personality are held in esteem. It is very uplifting to come to work and have people tell you how wonderful you are, what a good job you did, ask if you would consider changing fields (ie, becoming a radiologist or medical oncologist, etc.). That's the trouble with residency - especially old fashioned surgical training - for those of us who need a little extra pat on the back, it often is not forthcoming.

I cannot recall whether or not womansurg was in private practice - if so, it is true that you can put in many more hours in that situation and deal with a lot more politics and stress than you would ever have to in residency, or in a hospital based practice. Its one reason I prefer to practice in a Comprehensive Cancer Center where I don't have to worry about who to hire for my bookkeeper, to clean the office, etc. Then again, the big bucks can be found in private practice.

I think I would have been as happy in General Surgery, not subspecializing, if I had liked general surgery. Trouble is, I never really cared for most of it, and it was at times a struggle to find my niche - something I enjoyed and was good at. So I'm not sure at all that "lifestyle friendly" is really important if you don't like the work - it just turned out that I did, so a big plus for me.

Besides, don't be confused by my happy demeanor - I'm a clown: laughing on the outside, crying on theinside!

 

[boston]

It also helps that I am now in an environment where I feel supported and valued, as opposed to my residency. This is probably the most important factor - I can be happy doing most anything as long as I like the people and feel they care for and about me. I did not always have that in my life and for one of the first times, I feel like my education, knowledge, experience and personality are held in esteem. It is very uplifting to come to work and have people tell you how wonderful you are, what a good job you did, ask if you would consider changing fields (ie, becoming a radiologist or medical oncologist, etc.). That's the trouble with residency - especially old fashioned surgical training - for those of us who need a little extra pat on the back, it often is not forthcoming.

So true! I find that when attendings give you the rare pat on the back, it actually motivates you to work harder because you don't want to disappoint and it gives you pride in knowing you are doing a good job. On the other hand, when other attendings constantly belittle you, you ask yourself "why try so hard? what difference does it make?"

my unrealistic romantic notions about residency training before I started was that it would be like an apprenticeship where the older, more experienced teachers would guide you and show you the way. I think knowing that you have the full support of your attendings would be the biggest difference-maker in making residency more pleasant, not lifestyle changes per se. that would go a long way toward making you feel that your efforts are worthwhile and your job fulfilling.