Why surgery?

1) you see immediate results from your interventions (mostly good, sometimes bad)

2) the technical manual aspect is fun

god complex

One thing I've noticed is, many attendings don't like residents to sit there and overanalyze a situation. Make the best decision you can at the moment.

Taking too much time specially in trauma, in sicu, to figure what happened, will kill the patient. Surgery in general has a lot of acute situations, with limited information. And you have to make best choice. Or the patient dies, like now and not in hours.

Where as medicine, radiology, pathology you have a bit of time to sit and think. Although they have their moments of fear too.

Like when you meet your SO, it just felt right...much to my suprise.

I never realized I liked doing things with my hands until my family reminded me that as a kid, besides reading, I was the Queen of projects. That continued through my adolescence by taking woodshop and other classes in school as electives. But I am not particularly talented, its just hard work.

Perhaps even more importantly I liked the decisiveness - I could not stand the lengthy discussions about what could be wrong with the patient, including several remote possibilities, without taking action to repair the problem.

Besides, I always liked doing something that fewer women did - and I really fought the idea of doing Breast Oncology, because it seemed like something "girls did".

As noted above, at least during residency training, being too analytical and taking your time can be deadly for the patient. You have to be able to think on you feet , or at least memorize protocols because in some situations (ie, the trauma bay) you don't have time to think about the 5 or 10 different possibilities that could be causing the patient's impending death. You need to do something and now. But of course that happens in medicine and any critical care field as well.

There are more analytical surgical specialties where time is not necessarily of the essence - any of the fields with elective cases lend to more thinking time. And there is also the possibility of being a physician researcher, running a lab, with little clinical time.

xylem29 said:

Wow - I guess I'll just to wait and see if I'll like surgery, but right now, I don't think I will. Much respect to those who are able to do it.

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Keep an open mind, you never know. I KNEW I would hate surgery and would LOVE Medicine...much to my suprise, it was the opposite.

Kimberli Cox said:

Keep an open mind, you never know. I KNEW I would hate surgery and would LOVE Medicine...much to my suprise, it was the opposite.

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I'll second that. I didn't really consider surgery until my third year clerkship. I always thought I would do IM or something cerebral. (Not that surgery isn't cerebral... it can be just as intellectually stimulating as any IM field.) Then within the first few days of being exposed to it, I just knew it was right. So you never know. And now, thinking back -- I always liked working with my hands as a kid, building models and stuff like that. There's just something fun about it.

Also you feel like you are making a real difference in someone's life, an immediate impact.

Another thing- I loved the people doing surgery and the way they thought. And I loved how well-rounded they were: intelligent, decisive, good leaders, caring and technically talented. And I need to be busy and challenged to be happy.

For your app: do research between MSI and II, in anything, make it soemthing cool- all fields like that. Extra curriculars are good, pick one and really get into it, lead if you can. Surgery cares less about volunteerism but it is still good. Ace the boards, get good grades. Make people like you on clinicals, and get good people in whichever field to write your letters.

The other thing about surgery. I didn't understand why it was 5 years vs. other residencies lasting 3 to 4 years.

I understand now. You basically have to be a jack of all trades, and a master in the operative field from vascular to thoracic to colorectal.

Since, surgery is acute critical care. You must be capable of doing everything yourself when the need comes.

You have to be the radiologist: Many times you can't wait for the report. You need to be able to read all Xrays, CTs, be able to do ultrasounds in trauma.

Be the Internist: In the sicu, take care of all acute cardiac problems from arrythimias to MIs to adrenal crisis to SIADH, to acute renal failure to te infectious disease guy.

The psych guy: When your patient goes psychotic and starts pulling out every tube in the place.

Then in the SICU, GOD help you: All operative disasters come to you, from ob-gyne, interventional, to orthopedics to renal biopsies, CABGs.

I guess it use to be even worse then this before.

I kind of like this jack of trades-probably why i like surg.

Why surgery?

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a general surgeon can do everything a physician can, plus he can do something they can't: operate. he's the last complete doctor. the total package.

xylem29 said:

Are all surigical specialties crazy in terms of irregular hours?

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No. While residency is painful for most surgical specialties, some are worse than others and in practice, there are many without in-house call or emergencies.

That's another issue I have - I already have sleeping problems once in a while, and I think that I'd become a total insomniac if my sleeping pattern was screwed up due to working overnight shifts a few nights a week...

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From one insomniac to another, you'd be suprised at how sheer exhaustion cures that tendency!

I guess it's possible, if you want to - to do surgeries a few days per week, and then do research the other days? Is it possible to be like - operations only on mondays and tuesdays, the rest is research?? I guess would mean that you have to move towards academic medicine and therefore, do a lot of research in med school and residency, and then apply to become faculty??

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Sure...I don't know any surgeons who operate every day of the week. After all, you have to have office hours or clinic to see patients - pre and post op, right? It is possible to:

operate 2 days a week, have office hours 2 days a week and have 1 day as your administrative/education day

operate 3 days a week, have office hours 2 days a week

operate 3 days a week, have office hours 1.5 days a week

operate 2 days a week, in the lab 1.5 days a week and office hours 1.5 days a week, etc.

If you have an interest in doing research, and obtain a research grant to run a lab, there will likely be specifications on how much time you have to spend in the lab - ie, 75% research, 25% clinical (which would include operating, clinic, teaching, etc.). But it is possible to do both. You don't necessarily have to have an active research lab to be faculty at an academic medical center. I know plenty of surgeons who want to devote most of their time to operating and teaching and they do just that. There are others with administrative interests - they may become program directors, or department Chairs. There are many possibly job descriptions for surgeons working in academia.

Are their surgeons who have PhDs?

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Sure, lots of them, although mostly in the academic sector (as opposed to private practice). Many did combined programs in medical school, others got their PhD during residency, and some even before medical school.

xylem29 said:

Oh wow - that's amazing. I didn't know that you can be faculty w/o research - sounds like a sweet deal to me.

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Sure...hospitals wouldn't have room to house all the labs if all faculty were required to have active research labs. You simply have to have an interest in teaching, although some jobs do want people with research labs to run.

So which sub specialties are the ones with no in house or EM call?

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It may vary by hospital (as some will require all junior faculty with general surgery training to take general surgery call), but in general, the following do not:

Surgical Oncology
Colorectal
Transplant
Minimally Invasive
Endocrine
Breast Oncology (my field - good lifestyle, interest in women's health and oncology, psychological stamina to handle "sad" field, more office than OR work)


Requires in-house call:

Trauma at a Level 1 trauma center (or you must live within 5 minutes)

Requires emergency call (for your specialty):

all specialties

Requires emergency call and you are likely to come in:
general surgery
CT surgery
plastics (if in a hospital without residents)
Neurosurgery
Pediatric Surgery


Requires emergency call and unlikely to come in:
urology
ENT
the rest of the specialties

just to throw my own experience in the mix. the only thing I "knew" when i entered medical school was that i was going to hate surgery. i put my surgical clerkship at the end of third year. well much to my surprise i absolutely loved it and knew that i couldn't stand it if i didn't get to go into the OR in my future career. never having considered entering the specialty i thought long and hard about what this would mean for me, a woman with vague hopes of having a great life both at work and outside of it. when it came time to make a decision i realized that i would so much rather get up 2 hours earlier than my colleagues who hate their jobs to go to work every day and love what i do...the decision to go into gen. surg. is one i have no doubts about. when you love something it becomes crystal clear....my advice is keep an open mind and figure out what you love doing enough to leave the comfort of your bed and kiss your family goodbye to go do every day...

sml1120 said:

just to throw my own experience in the mix. the only thing I "knew" when i entered medical school was that i was going to hate surgery. i put my surgical clerkship at the end of third year. well much to my surprise i absolutely loved it and knew that i couldn't stand it if i didn't get to go into the OR in my future career. never having considered entering the specialty i thought long and hard about what this would mean for me, a woman with vague hopes of having a great life both at work and outside of it. when it came time to make a decision i realized that i would so much rather get up 2 hours earlier than my colleagues who hate their jobs to go to work every day and love what i do...the decision to go into gen. surg. is one i have no doubts about. when you love something it becomes crystal clear....my advice is keep an open mind and figure out what you love doing enough to leave the comfort of your bed and kiss your family goodbye to go do every day...

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I totally agree with this post. The only thing I knew entering my third year clerkship was that I would hate Surgery and the General Surgeons. I did my surgery clerkship first at a Community Hospital to get it over with and thought I would never look back. Fortunately, I found that I fell in love with surgery and no other clerkship ever measured up to my GS experience. And here I am - in the thick of residency and I still love it. My advice would be to find a program that strives to keep a good work/home balance - usually you'll find that in community programs over academics... but not always.

I had the same experience as jbean and sml1120. For that matter, I entered surgery thinking I would hate vascular surgery, and that is what I am going to do.

I assumed that all surgeons were evil, sadistic, inhumane people, and had the opposite experience. Plus, my mother became suddenly ill and died (ironically, of a surgical problem) in the course of the last 2 weeks of my surgery rotation, and they couldn't have been more supportive of the time I needed to spend at her hospital.

It has been said before, but bears repeating... you should pick something you not only love, but will love at 4 am, when you have had no sleep in 3 years, and the 20th admission is coming in and needing your full attention. If you can do that, you'll be ahead of the game. Hey, instead of 32 page H&P's on that 20th patient, we get to operate!

oldbearprofessor said:

You would categorize pedi surg as "unlikely to come in"? Those guys are around at night more than I am and I do 24 hour in-house call.

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No, not at all - simply forgot to list them. D'oh!

After spending 3/4 of a year doing Peds Surgery at a Level 1 trauma center with a Children's hospital during my residency, I can attest to how much of the time these guys come in.

I want to go into surgery beacause I like the idea of being able to have the knowledge about a problem, and then being able to directly implement a hands-on corrective measure. I just love working with my hands. If I wasn't going to be a doctor, I would be an engineer.