PLEASE HELP - IM vs Surgery decision

[want2beadoc1]

Sorry to bother everyone, but I really need to decide whether to go into IM or surgery. Here are my lists of pros and cons.

IM pros:
Only 3 years commitment
Can get very interesting
More thinking, thought process, diagnosing
Plenty of fellowships options, some being more procedural (though I'm not guaranteed to get it)
Ability to get into better residency program, more residency options (since there are more IM spots and it's less competitive), hence happier residency
You may get called afterhours but usually don't have to come in

IM cons:
Follow lots of patients instead of focusing on a few
More paper/busy work
PA and NP are slowly taking over
Less money
Less prestigious (just from what I see, not trying to offend anyone)

Surgery pros:
Work with my hands
Getting things done
High advancement/progress
More prestigious
Higher salary
Lifestyle is becoming better with increase group practice and hospital hiring surgeons
PA and NP are getting more privileges and therefore able to do more of your scutwork

Surgery cons:
Min 5 year residency commitment
Surgery days can be draining (high stress) and exhausting (standing for a long time doing laborious work)
Some surgeons tell me they get stressed outside of work thinking about the cases they just did and how they maybe should've done something different – that really decreases your quality of life if always stressed out
I know lots of surgeons who have chronic neck pain and hands arthritis (they're physically deteriorating over the years)
Less thought process, more monkey work
Lots of downtime and waiting in between surgeries (frustrating because that's time away from your family)
When called in you usually have to come in

I know I should choose based on what I love, but it's hard to tell being a medical student because I'm not assuming the role of the physician. All I can do is predict what will make me the most happy. That's why I use my pros/cons list to influence my decision.

I WOULD GREATLY APPRECIATE ANY HELP AT ALL, whether it's your pros and cons or let me know if my pros/cons list is accurate and rational. If you had this dilemma please let me know what made you decide one over the other.

Thank you,

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[da8s0859q]

I used to hear people say that you should only go to medical school if it's the only thing you can see yourself doing. There's some truth to that, but it's hardly a perfect rule.

These days, I hear people say "you should only be a surgeon if it's the only specialty you can see yourself entering." THAT is something I agree with. The training, lifestyle, and nature of the work make it something that you better want to do to the exclusion of everything else in medicine.

I won't be applying to surgery programs. But if I were considering it, the only way I'd go that route is if I couldn't see myself being happy in any other field.

 

[want2beadoc1]

I keep hearing that you should do surgery only if you can't see yourself happy in anything else. Correct me if I'm wrong but I believe this saying is about to change. With the 80 hrs residency rule (I hear they're now trying to make it 60), surgery residencies are becoming more similar to medicine in terms of workload. In practice, group physicians and hospital employed surgeons are becoming increasingly common. I know many surgeons who work 4 days week with the help of PA, NP and partners. Many surgeons tell me the working condition after residency is what you make of it. Can anyone else comment on that?

 

[dapple]

You should check out Interventional Radiology. I remember being in a similar conudrum not too long ago. Personally, I think it is a perfect balance between the "thinking" of medicine and the "doing" of surgery. This is only my opinion, however, so take it with a grain of salt. Good luck!

 

[willbemd1day]

I have been having the same dilemma, I always thought I would do IM/cardiology. (I did my PhD in cardiovascular disease) but I did my IM rotation at a VA and it was underwhelming. I didn't feel like I was accomplishing anything.

I just started my surgery core rotation in transplant surgery and I love it!

I just spent 30 hours on the donor run and didn't even notice. Over the last few days I have been reading about surgical training as it is something I had never considered until now.

I have heard the same things mentioned above. A surgeon lives for being the OR. A surgeon likes being in the OR more than sleep, more than food and more than sex. I never thought I would fit into that category, but I have to say its over halfway through my 3rd year and Surgery has been my happiest rotation.

As far as the time difference in training, i don't think about that too much. I feel certain that I would not be content as a general hospitalist, so I would definitely specialize if I went that route, thus the IM+specialty and general surgery training are similar in length.

I think our problem is to decide if we really like the OR that much. I'm trying to get as much OR experience as possible now and see if I do.

I agree with you that this is a tougher decision than at first glance. A previous post on this topic compared medicine and surgery to apples and toasters. The truth is that both fields have positive attributes that can appeal to the same person.

Good luck with your decision.

 

[officedepot]

.

 

[SnakeOil]

I noticed you listed "more money" and "more prestige" under the pros for surgery. If those two things were taken out of the equation, how much easier would it be to make your decision? Money and prestige won't make life any easier if you find out you can't stand the job. They might be a nice added benefit to something you already enjoy doing but you shouldn't use those things to make a decision.

 

[MossPoh]

I'm still baffled by this IM thinks/Surgery does thought process. I really haven't done any more or less thinking on IM than surgery so far...just different thinking. Really, the vast majority of what I'm encountering just feels like I'm following the same algorithms over and over again.

 

[Buzz Me]

With the 80 hrs residency rule (I hear they're now trying to make it 60), surgery residencies are becoming more similar to medicine in terms of workload.

Incorrect.

Don't go into surgery thinking you'll experience 60 hour workweeks (that would only happen if all residencies were lengthened by one year) or have the same workload as others in medicine. Your "census" can get huge - 20-40 patients, and ridiculously so when you're cross-cover or night float. And all months are "ward months," i.e. there are no easier elective/clinic months.

 

[ArcGurren]

Sorry to bother everyone, but I really need to decide whether to go into IM or surgery. Here are my lists of pros and cons.

IM pros:
Only 3 years commitment
Can get very interesting
More thinking, thought process, diagnosing
Plenty of fellowships options, some being more procedural (though I'm not guaranteed to get it)
Ability to get into better residency program, more residency options (since there are more IM spots and it's less competitive), hence happier residency
You may get called afterhours but usually don't have to come in

IM cons:
Follow lots of patients instead of focusing on a few
More paper/busy work
PA and NP are slowly taking over
Less money
Less prestigious (just from what I see, not trying to offend anyone)

Surgery pros:
Work with my hands
Getting things done
High advancement/progress
More prestigious
Higher salary
Lifestyle is becoming better with increase group practice and hospital hiring surgeons
PA and NP are getting more privileges and therefore able to do more of your scutwork

Surgery cons:
Min 5 year residency commitment
Surgery days can be draining (high stress) and exhausting (standing for a long time doing laborious work)
Some surgeons tell me they get stressed outside of work thinking about the cases they just did and how they maybe should've done something different – that really decreases your quality of life if always stressed out
I know lots of surgeons who have chronic neck pain and hands arthritis (they're physically deteriorating over the years)
Less thought process, more monkey work
Lots of downtime and waiting in between surgeries (frustrating because that's time away from your family)
When called in you usually have to come in

I know I should choose based on what I love, but it's hard to tell being a medical student because I'm not assuming the role of the physician. All I can do is predict what will make me the most happy. That's why I use my pros/cons list to influence my decision.

I WOULD GREATLY APPRECIATE ANY HELP AT ALL, whether it's your pros and cons or let me know if my pros/cons list is accurate and rational. If you had this dilemma please let me know what made you decide one over the other.

Thank you,

The two things I bolded aren't necessarily true. I think the idea of surgery having more "prestige" comes mostly from the surgeons themselves (that too the older crowd), but I don't think the cardiologist or the oncologist has any less prestige than a surgeon. Also, you can make 200-300k as an IM doctor or a surgeon, but as everything in medicine, it depends on how long and how hard you work. You can also make much less as a surgeon and much less as an IM doc.

You sound more like an IM person to me. I agree that IM is in some ways a lot more cerebral (though it's not true that gen surg isn't) but many of the fellowships (cardio, CCU/ICU/pulm, GI, heme/onc) do allow you to work with your hands.

 

[Sheldor]

The two things I bolded aren't necessarily true. I think the idea of surgery having more "prestige" comes mostly from the surgeons themselves (that too the older crowd), but I don't think the cardiologist or the oncologist has any less prestige than a surgeon. Also, you can make 200-300k as an IM doctor or a surgeon, but as everything in medicine, it depends on how long and how hard you work. You can also make much less as a surgeon and much less as an IM doc.

You sound more like an IM person to me. I agree that IM is in some ways a lot more cerebral (though it's not true that gen surg isn't) but many of the fellowships (cardio, CCU/ICU/pulm, GI, heme/onc) do allow you to work with your hands.

I completely agree with Arc, you definitely sound like an IM person. As I was reading your post, the whole time, I just felt like you should do IM.

I also laughed out loud when I read the thing about surgeons being more "prestigious." I'm not sure where you got that impression, but I'm guessing it was from a surgeon

In all seriousness, I really don't think there is a difference in prestige between general IM and general surgery. If prestige is important to you, there are some fields of IM that the public tends to think are more prestigious, like those mentioned by Arc.

Anyway, I'd vote IM.

 

[C5toC9]

Your Pros list is longer for IM.

Your Cons list is longer for Surgery.


I think you made your decision.

 

[reventon2]

i'd pick IM over surgery anyday but that's just me. Like people said above you should only do surgery if you're unhappy in most other rotations. Also, when we're young and in the midst oftype A med students/residents/faculty it's cool to think about prestige, but over your lifetime it really doesn't matter what you do. Also, think about your 30 year career span and how you might change and how family/kids become more important than you might think now. Again, if you don't LOVE surgery its tough to endure not just the work hours but really the intensity and the stress that comes with it.

 

[MossPoh]

Pick the one that has the least amount of things that drive you absolutely crazy. Annoying things don't matter, but the least amount of BS is important.

I personally like surgery more and think I would drive a nail through my eye with rounding, check labs, writing, rounding, check labs, writing x rest of my life. We are all different people though. I wouldn't assume that going in surgery means no life and family and medicine does. There are surgeons that work a little and internists that work a lot.

Really, if it is that hard of a decision for you, then it probably won't make much of a difference because you are just as likely to have regrets on either side of the fence. There are plenty of bitter internists that hate being a dumping ground and type A is not exactly limited to surgeons.

 

[BigRedBeta]

It's simple: do you need to be in the OR in order to be happy.

That's it. If you don't find the OR anything more than a nice "bonus", then do IM. If the thought of not being in the OR nearly every day of your working life sounds barely tolerable, then do surgery.

There are many fields as others have mentioned (IR/GI/Interventional Cards or Pulm/Critical Care/ER) that give you the opportunities to use your hands if that's really what draws you to surgery. Likewise in Critical Care, there's very much the "I do something, and the patient's condition changes" scenario which can be a draw for surgery to. But in the end, you have to NEED the OR in order for surgery to be the right fit.

 

[drizzt3117]

You should check out Interventional Radiology. I remember being in a similar conudrum not too long ago. Personally, I think it is a perfect balance between the "thinking" of medicine and the "doing" of surgery. This is only my opinion, however, so take it with a grain of salt. Good luck!

This is quite possibly the worst post of 2012 so far.

 

[ArcGurren]

This is quite possibly the worst post of 2012 so far.

I agree; if anything, IR is more or less like a minimally invasive surgical field. I remember one of the IR docs at my institution saying it's even worth doing a surgical prelim for it (which I don't know how good of an idea that would be...)

 

[drizzt3117]

I agree; if anything, IR is more or less like a minimally invasive surgical field. I remember one of the IR docs at my institution saying it's even worth doing a surgical prelim for it (which I don't know how good of an idea that would be...)

I thought about it, I think it would be helpful, but in the end I decided to go with TY programs and will hopefully match at one I do have surgical prelims as backup though.

 

[unsung]

So I don't have the exact same problem... but I'm also one of those few who are waffling between surgery & something completely unrelated (in my case, neurology or anesthesiology).

Whereas most everyone I've met IN surgery are always like "I've always wanted to be a surgeon" or even if they weren't sure of surgical sub-specialty, they're like "I knew I wanted to do something surgical".

This makes me wary of whether surgery is the right field for me. 'Cuz I haven't met any people with a story similar to mine of being indecisive, then choosing surgery.

The thing is... I always thought I'd love internal medicine.. then I did a rotation & for a variety of reasons HATED it. The politics. The passive-aggressive behavior (at all levels, attending on down). The endless rounding. The slow pace. I couldn't stomach it AT ALL.

Then I did surgery. And while I didn't exactly love it (no intrinsic love for anatomy)... I really had a TON of fun when I got to do stuff. It was exciting to realize that I sutured that incision site. The feeling is remarkable. I also got a kick out of actually doing something for the team... things like getting supplies or prepping in the OR. I also found it easier to get along with the personalities in surgery than a specialty like family med or peds... where sometimes I felt like I had to fake a warm fuzziness by cooing at kids or whatnot.

So the reasons I liked surgery:

- I actually understood how to "do well" on the rotation; physical skills & work ethic more rewarded than presentations or social crap
- fast-paced
- MINIMAL ROUNDING
- personalities of people- edgier, I like it; greater comraderie
- doing things with my hands
- feeling of teamwork in the OR
- not going to lie, the "prestige" feels good... being a surgeon is badass

Here's the problem:
I can't figure out whether I simply liked surgery as a ROTATION... or whether I really would like surgery more as a career.

A big part of why I liked surgery rotation is because I felt like I was good at it. I understood how to succeed on the rotation, plus I felt like I had some natural manual dexterity, so it was fun. We all like things we happen to be good at, right?

Conversely, I felt like I sucked as a medical student on rotations such as IM. Not actually because I'm bad at IM, per say. I like forming the DDx & all that. I sucked 'cuz I was never the type of student to "advertise" my knowledge by saying "btw, I read on [journal] last night, that such-and-such". Basically I didn't play the "IM game" right & schmooze in the right way. Whereas I understood the "surgery game" a lot better & was much better at it.

But the "3rd yr game" isn't representative of the reality of a career in that specialty, right? As a med student in IM whose work doesn't count, it's easy for people to evaluate you purely based on how much they like chatting with you or how good you make them feel. 'Cuz my "good work" with patients doesn't save them any work or make their day any shorter. It might even make'em jealous if I'm too independent or don't flatter them enough.

Whereas in a real work environment (residency), people actually care about how good you are at your job... 'cuz if you're good at taking care of the patient, it means less work for them. If you suck, it makes life more difficult for them. Hence, evals are based much more on merit. If they like chatting with you, it's a bonus. But just being a pleasant, dependable co-worker is good enough... people don't have to be BFFs with their co-workers. Whereas a student who just keeps their head down & does their work well is going to get worse marks than the student that talks out their ***** all the time & does no work once the attending leaves the room.

Does that make sense?

I can see myself enjoying an IM residency despite hating IM rotation, because of that reason. So it's really hard to know what specialty to choose based on how I felt during rotation... 3rd yr is a game, whereas residency & beyond is not a game- it's real patient care.

I could suck at the game, but I might be really good at & really enjoy IM as a career. Say, as a IM attending at a non-teaching hospital- round by myself, less politics, focus is between me & my patient.

Thoughts ?

 

[officedepot]

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[Buzz Me]

I agree; if anything, IR is more or less like a minimally invasive surgical field. I remember one of the IR docs at my institution saying it's even worth doing a surgical prelim for it (which I don't know how good of an idea that would be...)

A Prelim year will at least teach you good sterile technique - important for IR.

 

[45408]

I keep hearing that you should do surgery only if you can't see yourself happy in anything else. Correct me if I'm wrong but I believe this saying is about to change. With the 80 hrs residency rule (I hear they're now trying to make it 60), surgery residencies are becoming more similar to medicine in terms of workload. In practice, group physicians and hospital employed surgeons are becoming increasingly common. I know many surgeons who work 4 days week with the help of PA, NP and partners. Many surgeons tell me the working condition after residency is what you make of it. Can anyone else comment on that?

Surgery is not going to go to 60 hours/week, and remember that most/all of your surgery rotations as a resident are going to be on the higher end of your work hours. The medicine residents at my program get elective rotations where they don't take call, they work 8-5, and they have every weekend off. In surgery, not so much. Plus, 5 years (plus fellowship) is a pretty long time.

Your work life will vary WILDLY depending on which surgical specialty you pick, and your working life is what your situation dictates. You'll be playing the cards you're dealt, not dealing the cards, for quite a while until your career is well under way.

 

[ArcGurren]

A Prelim year will at least teach you good sterile technique - important for IR.

Eh, I think any medical student could technically learn that on their surgery rotation. I have that drilled into my head, even though I'm not going into surgery.

 

[ArcGurren]

Surgery is not going to go to 60 hours/week, and remember that most/all of your surgery rotations as a resident are going to be on the higher end of your work hours. The medicine residents at my program get elective rotations where they don't take call, they work 8-5, and they have every weekend off. In surgery, not so much. Plus, 5 years (plus fellowship) is a pretty long time.

Your work life will vary WILDLY depending on which surgical specialty you pick, and your working life is what your situation dictates. You'll be playing the cards you're dealt, not dealing the cards, for quite a while until your career is well under way.

Yeah, I can't imagine doing transplant surgery as a career. They have the worst hours and lifestyle of any surgical specialty/subspecialty I've ever seen.

In general, my experience - nicer lifestyle: Peds surgery (sort of), Urology, Ophtho

Okay-ish lifestyle: Ortho (again, depending on how you practice it), ENT (depends since each surgery pays you quite well), General surgery (maybe)

Awful lifestyle: Vascular, Transplant, Colorectal, Neurosurgery (long surgeries, long hours, and every surgeon I've seen in these services is either twice divorced or talks about how bad his home life is).