Would You Stay In Surgery if You Couldn't do a Fellowship and had to work like an Oldschool Surgeon

[RecumbentChair]

I am coming very close to the process of deciding on my career. I want surgery, but i cant see myself being a general surgeon, alas my scores limit me to GS and indicate a big probability of ending up as one in the long run.
Should i risk it and choose surgery to get into a fellowship, with the possibility of being stuck in regular gen surgery?

Help appreciated

---

Members don't see this ad.

 

[LucidSplash]

I am coming very close to the process of deciding on my career. I want surgery, but i cant see myself being a general surgeon, alas my scores limit me to GS and indicate a big probability of ending up as one in the long run.
Should i risk it and choose surgery to get into a fellowship, with the possibility of being stuck in regular gen surgery?

Help appreciated

What subspecialty would you be interested in?

Why do you think your current scores limit you in terms of fellowship choice? ABSITE scores are what matter from a score standpoint for fellowship, not USMLE.

And to answer your question, yes I would have done Gen Surg. I was well-trained in general Surgery by a program that wanted you to graduate capable of being a general surgeon but also supported you in whatever your career goals were. About 50% of our grads went to Gen Surg and 50% to fellowship. Personally I didn’t dislike Gen Surg, I just liked vascular more.

 

[vhawk]

I am coming very close to the process of deciding on my career. I want surgery, but i cant see myself being a general surgeon, alas my scores limit me to GS and indicate a big probability of ending up as one in the long run.
Should i risk it and choose surgery to get into a fellowship, with the possibility of being stuck in regular gen surgery?

Help appreciated

There is no reasonable scenario in the near future where you will be forced, due to scores or circumstances, to be "just" a general surgeon. For approximately half, perhaps more, general surgery fellowships there are more spots than applicants, and if you know from day 1 what you want to do and are motivated by a crippling fear of being a general surgepn, you should easily be able to match into any fellowship you want. Even the worst gen surg applicant is capable, with 3-5 dedicated years of work and accomplishment, of getting into even peds or surg onc or whatever.

But your attitude kind of sounds like it sucks and my aneceotal experience with incoming residents who feel the way you do is that they are more likely to work towards getting themselves fired than to work towards getting themselves into a competitive fellowship

 

[Pir8DeacDoc]

How do you anticipate managing to do residency in a field that you don't seem to like at all? It's a long road. You need dedication. Good luck

 

[Blackdogue]

There is no reasonable scenario in the near future where you will be forced, due to scores or circumstances, to be "just" a general surgeon. For approximately half, perhaps more, general surgery fellowships there are more spots than applicants, and if you know from day 1 what you want to do and are motivated by a crippling fear of being a general surgepn, you should easily be able to match into any fellowship you want. Even the worst gen surg applicant is capable, with 3-5 dedicated years of work and accomplishment, of getting into even peds or surg onc or whatever.

But your attitude kind of sounds like it sucks and my aneceotal experience with incoming residents who feel the way you do is that they are more likely to work towards getting themselves fired than to work towards getting themselves into a competitive fellowship

Wow. It really takes very little for someone on sdn to call you unfit to be a doctor.

 

[vhawk]

Wow. It really takes very little for someone on sdn to call you unfit to be a doctor.

Not sure if serious...

 

[Blackdogue]

Not sure if serious...

Totally serious. Does vascular surgery or cardiothoracic surgery have much overlap with general surgery in terms of procedures? Is it not possible to like one but dislike the other completely? I just felt you judged OPs atittude too quickly.

 

[AsianPersuasion]

Absolutely! I would take a community position and dip into all the aspects I'm comfortable with and depending on hospital privileges. But my goal is to be really good at something and I want to be known in the community has the surgeon to go to for that surgery. My mentor is an amazing breast surgeon and she's the "IT" girl for all your breast care. I want to be like that!!!

 

[vhawk]

Totally serious. Does vascular surgery or cardiothoracic surgery have much overlap with general surgery in terms of procedures? Is it not possible to like one but dislike the other completely? I just felt you judged OPs atittude too quickly.

Point taken I guess, I didnt have his MBTI to check up on and was limited to the post in which, in 8 lines he seemed to be dripping contempt for the job that he is asking if he should do for 5-7 years. And I certainly didnt say anything like "you are unfit to be a doctor." I gave him a specific response to his question, that there is very little chance that he would end up being stuck doing general surgery, and then I gave him the even more useful advice that people who go into general surgery residencies with the attitude he seemed to be conveying, in my limited, anecdotal experience (I used the word anecdotal even!) dont tend to be the ones that get glowing recommendations, publish a ton of articles, beef up their resumes and get into competitive fellowships.

Its a red flag to me, thats all. I'm sure he can be a doctor, I'm not passing some sort of moral judgment on him, I'm sharing my experience that going into it with the conveyed attitude is a recipe for disaster, not success. If I'm misreading him and he is in fact super stoked, fine. If he is simply better at faking it than expressed in OP, that may even be enough, though I would caution anyone who thinks they can fake it for 80 hr/week for 5 years.

 

[Blackdogue]

Point taken I guess, I didnt have his MBTI to check up on and was limited to the post in which, in 8 lines he seemed to be dripping contempt for the job that he is asking if he should do for 5-7 years. And I certainly didnt say anything like "you are unfit to be a doctor." I gave him a specific response to his question, that there is very little chance that he would end up being stuck doing general surgery, and then I gave him the even more useful advice that people who go into general surgery residencies with the attitude he seemed to be conveying, in my limited, anecdotal experience (I used the word anecdotal even!) dont tend to be the ones that get glowing recommendations, publish a ton of articles, beef up their resumes and get into competitive fellowships.

Its a red flag to me, thats all. I'm sure he can be a doctor, I'm not passing some sort of moral judgment on him, I'm sharing my experience that going into it with the conveyed attitude is a recipe for disaster, not success. If I'm misreading him and he is in fact super stoked, fine. If he is simply better at faking it than expressed in OP, that may even be enough, though I would caution anyone who thinks they can fake it for 80 hr/week for 5 years.

I see. I guess I might have been quick to judge your answer as well, after I've noticed this phenomenon occur in different threads. Young guy expresses concern about one aspect of medicine. Older guy immediately schools him by saying that these kinds of attitudes wouldn't fly in his residency and he should change professions. Glad to see you're not one of them and I really appreciate your advice. Cheers.

 

[RecumbentChair]

Point taken I guess, I didnt have his MBTI to check up on and was limited to the post in which, in 8 lines he seemed to be dripping contempt for the job that he is asking if he should do for 5-7 years. And I certainly didnt say anything like "you are unfit to be a doctor." I gave him a specific response to his question, that there is very little chance that he would end up being stuck doing general surgery, and then I gave him the even more useful advice that people who go into general surgery residencies with the attitude he seemed to be conveying, in my limited, anecdotal experience (I used the word anecdotal even!) dont tend to be the ones that get glowing recommendations, publish a ton of articles, beef up their resumes and get into competitive fellowships.

Its a red flag to me, thats all. I'm sure he can be a doctor, I'm not passing some sort of moral judgment on him, I'm sharing my experience that going into it with the conveyed attitude is a recipe for disaster, not success. If I'm misreading him and he is in fact super stoked, fine. If he is simply better at faking it than expressed in OP, that may even be enough, though I would caution anyone who thinks they can fake it for 80 hr/week for 5 years.

I am sorry but you started the contempt.

 

[HighwayVagabond]

I am sorry but you started the contempt.

In fairness to vhawk, your words 'Should i risk the possibility of being stuck in regular gen surgery' are quite contemptuous toward the field of general surgery. Regardless, I am planning on subspecializing, but I also absolutely love general surgery and would be very happy working as a general surgeon, though happier in my specialty of choice. I can't imagine going through 5 years of residency if I didn't enjoy general surgery, and I imagine anyone doing so struggles. Vhawk is simply trying to advise you that if you go through 5 years in 'survival mode' it will be difficult to flourish, and furthermore difficult to impress those you need to impress to successfully match into certain fellowships. Not to mention that you will probably be so burnt out and over the whole training process you won't be able to imagine going through another 2-3 years of it by the time fellowship applications are due.

BUT, if you enjoy general surgery at baseline, there are many fellowships of various levels of competitiveness that you will have opportunities to specialize in, and your step scores will be unlikely to limit you much. If you log onto FREIDA (Residency & Fellowship Vacancies | AMA) you can check specific programs for specific fellowships and some do have step 1 and 2 cut offs to consider your application, so I highly suggest you check that website out and see what limitations you may (or may not) be facing. (Search the specialty of interest, see results, select a program, go to the 'program' tab (if available) and scroll down to the USMLE minimum chart. I hope that's helpful.

 

[RecumbentChair]

In fairness to vhawk, your words 'Should i risk the possibility of being stuck in regular gen surgery' are quite contemptuous toward the field of general surgery. Regardless, I am planning on subspecializing, but I also absolutely love general surgery and would be very happy working as a general surgeon, though happier in my specialty of choice. I can't imagine going through 5 years of residency if I didn't enjoy general surgery, and I imagine anyone doing so struggles. Vhawk is simply trying to advise you that if you go through 5 years in 'survival mode' it will be difficult to flourish, and furthermore difficult to impress those you need to impress to successfully match into certain fellowships. Not to mention that you will probably be so burnt out and over the whole training process you won't be able to imagine going through another 2-3 years of it by the time fellowship applications are due.

BUT, if you enjoy general surgery at baseline, there are many fellowships of various levels of competitiveness that you will have opportunities to specialize in, and your step scores will be unlikely to limit you much. If you log onto FREIDA you can check specific programs for specific fellowships and some do have step 1 and 2 cut offs to consider your application, so I highly suggest you check that website out and see what limitations you may (or may not) be facing. (Search the specialty of interest, see results, select a program, go to the 'program' tab (if available) and scroll down to the USMLE minimum chart. I hope that's helpful.

Let's say i want to do thoracic, what is the point of learning to do a hemicolectomy.

 

[swoopyswoop]

Let's say i want to do thoracic, what is the point of learning to do a hemicolectomy.

The esophagus is the colon of the chest.

 

[Dr.LeoSpaceman]

Let's say i want to do thoracic, what is the point of learning to do a hemicolectomy.

Well, if they ever develop an operation where you could "interpose" the colon as an esophageal conduit, it could be helpful to know abdominal surgical techniques...

I'm with @vhawk here. If you're attitude is "why do I need to know this", then you're the resident rotating on my service with whom I get concerned about their ability to be part of the team. The fundamentals of surgery (tissue handling, dissection, suturing, laparoscopic techniques, anastomoses, etc.) are similar whether you're operating in the chest or in the belly. If you can't see how general surgery is at least somewhat helpful in thoracic training, then you haven't thought hard enough.

I'm also biased, but I think there is the existential issue of general surgery residency making "good doctors". My experience has been that people doing traditional routes through GS then fellowship demonstrate the intangibles of how to run a service and his to manage complex medical issues in surgical patients in a more polished fashion than those in integrated programs.

 

[RecumbentChair]

Well, if they ever develop an operation where you could "interpose" the colon as an esophageal conduit, it could be helpful to know abdominal surgical techniques...

I'm with @vhawk here. If you're attitude is "why do I need to know this", then you're the resident rotating on my service with whom I get concerned about their ability to be part of the team. The fundamentals of surgery (tissue handling, dissection, suturing, laparoscopic techniques, anastomoses, etc.) are similar whether you're operating in the chest or in the belly. If you can't see how general surgery is at least somewhat helpful in thoracic training, then you haven't thought hard enough.

I'm also biased, but I think there is the existential issue of general surgery residency making "good doctors". My experience has been that people doing traditional routes through GS then fellowship demonstrate the intangibles of how to run a service and his to manage complex medical issues in surgical patients in a more polished fashion than those in integrated programs.

I disagree for every well adjusted integrated resident i met a fellowshipper run-out with sour attitude. Run them to the ground and build'em up, am I right? Only if the pay off was better attendings in comparison, but often that is not the result.

 

[Pir8DeacDoc]

I disagree for every well adjusted integrated resident i met a fellowshipper run-out with sour attitude. Run them to the ground and build'em up, am I right? Only if the pay off was better attendings in comparison, but often that is not the result.

Are you a med student? I'm curious how you've decided so many things definitively enough to argue with people that have been through the process. I suggest when you start your training that you argue with everyone and tell them none of it is useful except the things you deem necessary. Oh well. Good luck.

 

[RecumbentChair]

Are you a med student? I'm curious how you've decided so many things definitively enough to argue with people that have been through the process. I suggest when you start your training that you argue with everyone and tell them none of it is useful except the things you deem necessary. Oh well. Good luck.

Your post reads: "How dare you to make an observation about something if you hierarchy is lower than mine?"
I am merely suggesting that maybe gs+fellowship is overkill.

 

[Apollyon]

Your post reads: "How dare you to make an observation about something if you hierarchy is lower than mine?"
I am merely suggesting that maybe gs+fellowship is overkill.

But that is the question: on what do you base this? Abstract conjecture, or anecdote, or something else?

 

[RecumbentChair]

But that is the question: on what do you base this? Abstract conjecture, or anecdote, or something else?

Based on life experience. Dozens of residents and attendings that i've talked to.

 

[Apollyon]

"Dozens"? Really?

 

[LucidSplash]

Your question started with a concern that you wouldn’t be a candidate for integrated anything and you’d be “limited” to Gen Surg. I overlooked your wording and didn’t take offense because I understood as a Med student you might not appreciate how that might sound.

But now you’re suggesting that GS + fellowship is “overkill.” From my personal experience I do not agree with that idea. And then there’s the fact that, by your own words, it’s your only surgical option. Pretty ballsy to call something that is YOUR ONLY OPTION overkill. Not sure why someone who doesn’t think they are a candidate for an integrated residency is debating the relative merits of the different pathways.

People here are trying to teach you how to succeed in GS. Since that’s your only option, probably best to focus on whether you want to do THAT and not worry about how the other half lives.

 

[VA Hopeful Dr]

Let's say i want to do thoracic, what is the point of learning to do a hemicolectomy.

Maybe we should ask our local thoracic surgeon about that... @ThoracicGuy

 

[ThoracicGuy]

Let's say i want to do thoracic, what is the point of learning to do a hemicolectomy.

Your post reads: "How dare you to make an observation about something if you hierarchy is lower than mine?"
I am merely suggesting that maybe gs+fellowship is overkill.

While you may never need to do any surgeries in the belly if you go into thoracic surgery, if you do esophagectomy, the experience will be very helpful. Even just doing cardiac surgery, you can pick up skills that will serve you in any surgery you do.

I went the GS + fellowship route. I went in thinking about doing pediatric surgery and came out doing thoracic surgery. What if you change your mind?

But, you seem to know better than the people doing it, so do as you wish. Don't be surprised when you fail.

 

[vhawk]

The esophagus is the colon of the chest.

Just as the mouth is the anus of the face

 

[vhawk]

I am sorry but you started the contempt.

If you say so

 

[RecumbentChair]

While you may never need to do any surgeries in the belly if you go into thoracic surgery, if you do esophagectomy, the experience will be very helpful. Even just doing cardiac surgery, you can pick up skills that will serve you in any surgery you do.

I went the GS + fellowship route. I went in thinking about doing pediatric surgery and came out doing thoracic surgery. What if you change your mind?

But, you seem to know better than the people doing it, so do as you wish. Don't be surprised when you fail.

Why would i change my mind? That can be applied to any speciality regardless of sub-specialization. Integrated path is better, in my opinion, I will look into that, definitely.
When i fail?

 

[ThoracicGuy]

Why would i change my mind? That can be applied to any speciality regardless of sub-specialization. Integrated path is better, in my opinion, I will look into that, definitely.
When i fail?

How do you know absolutely that you want to do one specialization vs another in the realm of general surgery? Do you have exposure to everything you'll get in general surgery? I doubt it.

As I stated, I changed my mind going into it on what to do. That is not uncommon. As your experiences grow, your interests can change.

And your attitude is what will make you more likely to fail... Good luck.

 

[HighwayVagabond]

Why would i change my mind? That can be applied to any speciality regardless of sub-specialization. Integrated path is better, in my opinion, I will look into that, definitely.
When i fail?

This is exhausting. If you fail to match integrated, you have one option, and you know what it is. If you are asking whether or not you should pursue the traditional route, we really can't answer that for you. We can simply give you objective information to determine whether you have any limiting factors to matching into fellowship, as we have already done.

For what it's worth, I've known that I wanted to go into a subspecialty with an integrated route since third year of medical school, and I still went the traditional route, and I wouldn't change a thing.

 

[RecumbentChair]

How do you know absolutely that you want to do one specialization vs another in the realm of general surgery? Do you have exposure to everything you'll get in general surgery? I doubt it.

As I stated, I changed my mind going into it on what to do. That is not uncommon. As your experiences grow, your interests can change.

And your attitude is what will make you more likely to fail... Good luck.

You dont know me, you cant say that. That is very presumptuous of you.

 

[ThoracicGuy]

You dont know me, you cant say that. That is very presumptuous of you.

All I know is what you present yourself as on here. And as you said in your first post in the thread, your numbers are not such that you would be a viable candidate for an integrated pathway. Doing the traditional pathway is likely your only option if thoracic or vascular are your goals.

Don't downplay general surgery training. You still get valuable skills that will help you be a better surgeon. You'll particularly see this in vascular as many places are seeing less and less open aorta surgery and more endovascular procedures. Having that abdomen experience from general surgery can be very helpful.

I'm not sure why you think what you do as a medical student would have any bearing on a fellowship choice. Your ABSITE scores and LOR will be what gets you the fellowship spot. No one cares what your step scores are for fellowship.

 

[HighPriest]

All I know is what you present yourself as on here. And as you said in your first post in the thread, your numbers are not such that you would be a viable candidate for an integrated pathway. Doing the traditional pathway is likely your only option if thoracic or vascular are your goals.

Don't downplay general surgery training. You still get valuable skills that will help you be a better surgeon. You'll particularly see this in vascular as many places are seeing less and less open aorta surgery and more endovascular procedures. Having that abdomen experience from general surgery can be very helpful.

I'm not sure why you think what you do as a medical student would have any bearing on a fellowship choice. Your ABSITE scores and LOR will be what gets you the fellowship spot. No one cares what your step scores are for fellowship.

You don't know all of the fellowship directors. That's very presumptuous of you.

 

[Apollyon]

You don't know all of the fellowship directors. That's very presumptuous of you.

Maybe he has spoken to dozens of them, though.

Oh, wait...

 

[ThoracicGuy]

You don't know all of the fellowship directors. That's very presumptuous of you.

I'm the fellowship directors director!

 

[HighPriest]

I'm the fellowship directors director!

 

[swoopyswoop]

You dont know me, you cant say that. That is very presumptuous of you.

On the contrary, it is very presumptuous of you to claim that your limited experience as a medical student is more durable than the opinions of the many surgeons who have replied to your question.

 

[Pir8DeacDoc]

I've decided this is just trolling. No way in hell this cat is remotely serious

 

[ItsSurgicallyComplicated]

Make no mistake, you don't go directly from college to residency for a reason.
I am a plastic fellow. I would rather do a career change than go back to having general surgery call, but general surgery is a very important formative stage.

 

[Apollyon]

Make no mistake, you don't go directly from college to residency for a reason.
I am a plastic fellow. I would rather do a career change than go back to having general surgery call, but general surgery is a very important formative stage.

Just like on the medical side, as has been said elsewhere, the worst thing about GI or cards is 3 years of IM.

 

[Medstart108]

Let's say i want to do thoracic, what is the point of learning to do a hemicolectomy.

This is the wrong attitude for surgery.

 

[ItsSurgicallyComplicated]

This is the wrong attitude for surgery.

Absolutely right.
I go as far as advising the medical student who started this topic that he/she shall never apply to general surgery, for his/her own good.
Apply to ENT, categorical Plastics or whatever you fancy, when you dont get a spot, go find something else.

 

[Pir8DeacDoc]

We don't need this type person in ent...hard pass