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A Question for Kimberli (or other surgery residents)

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Toadkiller Dog

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Howdy--

I was chatting with a few of my classmates in our Surgery Interest Group here at my school, and we came up with some questions that we could use an unbiased answer on. Perhaps you can help me (us).

Here goes. . .

1. Are orthopedic surgery residencies "easier" (i.e less grueling, on average) than general surg? My colleagues think so, but I'm not so sure.

2. I was originally considering General Surg, but tossed the idea out because I have a family (wife + 2 kids). If I were to go into surgery, I would want to focus on rural stuff, so my question is this: are there any programs, especially community-based ones, where I could get decent training and still have a family life? I was looking, at one time, at Geisinger over there in Pennsylvania, mainly because it appears to be a rural hospital. Anyway, let me know what you think (and don't be afraid to be honest).

3. I'd be curious to know what your typical week on the surgery service looks like. When do you go to work/get home? How much useful stuff do you do vs. scut? How many days off and when? And how does this change after PGY1?

Thanks for your time. I know you are busy.
:)

TKD
 

tussy

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I'm not Kimberli, but i am a surgery PGY1, so i'll try to answer your questions as best i can:

1. Are orthopedic surgery residencies "easier" (i.e less grueling, on average) than general surg? My colleagues think so, but I'm not so sure.

I would say that it varies from program to program, but both are quite grueling.

2. I was originally considering General Surg, but tossed the idea out because I have a family (wife + 2 kids). If I were to go into surgery, I would want to focus on rural stuff, so my question is this: are there any programs, especially community-based ones, where I could get decent training and still have a family life? I was looking, at one time, at Geisinger over there in Pennsylvania, mainly because it appears to be a rural hospital. Anyway, let me know what you think (and don't be afraid to be honest).

I don't know much about specific programs, but in my opinion, in order to adequately trained as a general surgeon you need to put in a certain number of hours. - no matter what type of program you get into you still have to put in the hours.

3. I'd be curious to know what your typical week on the surgery service looks like. When do you go to work/get home? How much useful stuff do you do vs. scut? How many days off and when? And how does this change after PGY1?

my typical week:

Start each day at 6 - round on ward until 7:30 or so, then either go to the OR (if i'm lucky), or stay on the ward taking care of the scut, or go to clinic. The day ends when the scut is all done (it's the intern's job whether you're in the OR all day or not), usually around 6 or 7, sometimes as late as 8 or 9. Then call every 4th night (work all night taking care of whatever happens on the ward, and seeing consults). Also, no going home early post call. We usually have to round on the weekend (we take turns though), but get to go home once everything is taken care of - usually noonish. I don't think it really gets much easier. Once your a senior call is better, but you have much more responsibility.

I hope this answers your questions. I'm sure kimberli or droliver will have more insight to add.
 

Sheerstress

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I might add that as a Senior, you might have a slightly kinder call schedule, but you will still have your hands full with trying to fill all your case quotas (the number of cases of a given surgical procedure that you have done throughout your residency), as well as preparing for M&M each week.

The program at my institution (Michigan State University Kalamazoo Center for Medical Studies) was community-based, and relatively kind to the residents (call Q3-4, minimal scutwork, "reasonable" hours), although I think tussy is right by pointing out that in order to get adequate training, you've got to put in a given number of hours, which will mean a significant part of your life during residency will be spent in the hospital.
 

MD Dreams

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Hello there everyone. This is my first post, although I have been reading a long time. I've enjoyed all the insights I've gained. Thank you.

My question is to all aspiring surgeons or those in surgical residencies. I've pretty much got my heart set on becoming a surgeon. Through much research I've narrowed my list to the following types of surgery that I think I would enjoy: Cardiothoracic surgery, Transplant surgery, Orthopedic surgery, Neurosurgery. I would like to see what your take is on these specialties. I would appreciate any type of information you can give me. I see a lot of people mentioning General surgery (or its fellowships) and Ortho, but very few people seem to be interested in Neuro. I'm curious as to why that is. Which type of surgeon do you think can have the greatest impact on an individuals life and which one gets the greatest amount of satisfaction. Also, Dr. Cox mentioned that she would not want to be a transplant surgeon in one of her posts. I'm curious as to why that is. I appreciate everyones insight. Thank you.
 

JGDL

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What about integrated plastics? How many hours each week ? Do they have the first years the same call as gen surgery? salary?
I like cosmetic surgery but I don?t know if plastics or dermatological surgery, which would be better?
thanks
 

Winged Scapula

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I'll deal with the more recent query directed toward me first. Transplant Surgery doesn't appeal to me for a few reasons:

1) little variety in the surgeries

2) extremely poor outcome for the livers

3) extremely poor hours; organs often become available in the middle of the night, weekends, etc. and you must be available to harvest and/or transplant

4) patients tend to be a difficult lot and there are lots of complications, even with the renal txp who tend to do well (as long as they continue to take their meds, take care of themselves, etc. which many do not).

Secondly, the hours and ability to have a family life will vary widely depending on the program and the rotation. Right now I'm doing a CT rotation and am on-call tonight. I have to pre-round and write all the notes on the SICU patients before we round with the Chief at 5:30 am. This means I will start seeing patients at 3:30 am which is pretty late because we have much fewer SICU patients than usual. When doing Peds, I came in everyday at 4:30 am to pre-round and often did not go home before 8 or 9 pm post-call (because we had to wait for the Chief to come out of the OR before we could round and were responsible for responding to traumas). Then again, on Vascular we rounded at 6 am and generally were done by 6 am - nice short days.

In general, community programs tend to be more lifestyle friendly, especially for those with families. However, the hours will be difficult at best regardless of where you train, especially during the first few years.
 

droliver

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Having just finished my chief resident months on transplant, I'll agree with most of Kimberli's comments. The hours are VERY unpredictable where several slow days will alternate with not going home for several days. As a whole, it is a sick group of patients with a lot of comorbities & inherant complications due to being immunosuppresed. The surgeries themselves are OK (liver transplants are big sexy cases) but tend to be limited to just a few major kinds of cases and post-op complications (unless your transplant service does a lot of endocrine, vascular access, or liver resections for CA).

As far as hours go with orthopedics (mentioned earlier), I think by in large that they work signifigantly less hours than general or neurosurgery except when they're on the ortho trauma services @ level I trauma centers.

My hours are signifigantly different than Kimberli's now. I'm currently chief on pediatrics & I usually show up @ 6:45a & run the list with my 3 junior residents. My days are usually 10-14 hrs/day during the week with another 5-15 hrs over the weekends (70-80 hrs/week). I go in at night for signifigant traumas (very rare) or for surgeries on the NICU patients (I've been back in 3 times today for NEC perfs twice and an indomethacin perf). Most nights my beeper does not even go off.

As a junior I worked somewhat similar services to Kimberli, but I can honestly say I don't remember working some of the crazy hours she is doing right now during her internship. In fact, we have gotten rid of all our Q2 call since I was an intern, as well as working out ways to get junior residents a day off (each of my 3 will get 3 days off this month) and home early (I send the post-call intern home most days by noon).
 

tussy

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Originally posted by droliver:
•I send the post-call intern home most days by noon).•••

Gee Droliver,

I wish you were my senior! I was told by my chief resident that "real surgery residents don't leave early post-call"

However, I don't work the ridiculously early hours that Kimberli speaks of. We start rounds at 6 or 6:30 and there is no such thing as "prerounding". The junior who was on call the night before gives signover to the team, then the whole team rounds together (clerks, juniors and seniors). We finish rounding by 7:30 and the team breaks up to cover the scut/wardwork, clinics, and OR.

I just finished a community surgery rotation where i was the only resident on the service (2 staff surgeons, 1 vascular/general and 1 thoracic/general). I came in at 6 and rounded by myself on all the patients. I met up with the staff later in the day to round with them. The rest of the time i was in the OR, running up to the floor between cases to try and finish up the scut. The call was very quiet, and they let me do it from home, so i ended up doing 1 in 2 (by choice so i could get in the OR more).
 

surg

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Originally posted by Toadkiller Dog:

>I was chatting with a few of my classmates in our Surgery Interest Group here at my school, and we came up with some questions that we could use an unbiased answer on. Perhaps you can help me (us).

I'm glad to see that you have an active Surg. Int. Group. These will become more important as you try to confirm your impressions of a program that you visited. Try not to fall into the trap of competitiveness within your own group.


Here goes. . .

1. Are orthopedic surgery residencies "easier" (i.e less grueling, on average) than general surg? My colleagues think so, but I'm not so sure.

On average I would say that Ortho residencies have fewer call hours, but their call (esp. the trauma calls) are their own special corner of hell, so all in all, believe me, the hours are annoying no matter what field of surgery you go into. I will say that my ortho colleagues seem to have much more free time that I do.

>2. I was originally considering General Surg, but tossed the idea out because I have a family (wife + 2 kids). If I were to go into surgery, I would want to focus on rural stuff, so my question is this: are there any programs, especially community-based ones, where I could get decent training and still have a family life? I was looking, at one time, at Geisinger over there in Pennsylvania, mainly because it appears to be a rural hospital. Anyway, let me know what you think (and don't be afraid to be honest).

There are many relatively good community based programs out there that have more balanced lifestyles, you just have to look for them. I actually have seen programs that have q4 to q5 call on a regular basis! (or did, it's been a few years since I looked around). Check FREIDA on the AMA Website and that program's website to get a better sense of the requirements. Just don't ever tell them that you are looking for a cushy residency. I doubt it would go over well.

3. I'd be curious to know what your typical week on the surgery service looks like. When do you go to work/get home? How much useful stuff do you do vs. scut? How many days off and when? And how does this change after PGY1?

The weeks vary by year as you surmised.
PGY 1:
Typical day: arrive somewhere between 5 to 6 AM to get set up for round that typically start somewhere between 5:30AM and 6AM (depending on the number of patients on the service)

Round until patients are seen (usually about 7:15)
7:15-7:40 eat breakfast if time allows.
7:30 go to O.R. if you are scheduled for a case
if not: return to the floor and try to finish the scut that you divided up over breakfast (if you are the only intern not operating on the service, dividing it up can be pretty quick :) )
7:45-10 Finish writing orders, discharge patients, transfer patients out of the ICUs
10AM labs are usually back from morning draws, check labs, make decisions based on discussions at rounds or make first trip to OR to see your chief and discuss results.
10-12 more paperwork, see patients again (often see their families to discuss plans)
12-12:30 if scut allows: EAT
1:00 usually labs that didn't get drawn on the 7AM draw are back. Check, decide, visit chief. More discharging
4pm: relax a little, pray for evening rounds to happen. Eat again if it didn't before or looks like a long day.
sometime between 6 and 8PM: evening rounds.
A little more scut if needed, otherwise home if not on call.

Mid Level Residents
Come in between 5AM and 6AM depending on when rounds start and whether any consult patients need to be seen.
Round until 7:15. Grab a donut on way to OR. If not operating, see other consult patients that need to be seen.
OR 7:30-until done.
see consult patients in between cases. Help interns when they need help, get new consults and staff them with attendings
Evening rounds: somewhere between 6 and eternity
after rounds: see any left over consults. then go home.

Chief:
5:30-6AM start rounds
7:30-evening rounds Operate
Run lists with each attending
Help interns and mid-levels
Evening rounds: lead rounds after last case done
Night: take phone calls from interns

This varies: some days instead of OR, you have clinic. Also on the nights that your service is covering the ER, the chief goes in a lot more or may even stay in house if they are also the trauma chief.

As you can see, higher OR percentages in the upper years. Fewer in house call nights, but far more responsibility meaning your pager goes off a lot more when you are sitting at home.

>Thanks for your time. I know you are busy.
:)

No problem. Hope this helped. Post again, for more info.

TKD[/QB]••
 

Leon

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Hello, guys ...

I have a question for all of you ... actually 2 questions.

The first one might seem REALLY stupid to all of you, but still ... what is PGY ?

The second one - how old were you when you began your surgery residency ?

Thanks ! :)
 

Winged Scapula

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PGY = Post Graduate Year (ie, the number of years you are past medical school graduation. Hence, PGY-1 is usually the intern year.)

I was/am in my mid 30s starting a surgical residency.

Hope this helps.
 

tussy

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Originally posted by Leon:
•Hello, guys ...

I have a question for all of you ... actually 2 questions.

The first one might seem REALLY stupid to all of you, but still ... what is PGY ?

The second one - how old were you when you began your surgery residency ?

Thanks ! :) •••


i was 26 when i started.
 

hndrx1a

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Kimberly...is there a cut-off age for surgery programs?
 

Winged Scapula

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Originally posted by hndrx1a:
•Kimberly...is there a cut-off age for surgery programs?•••


Well that would be illegal to discriminate on the basis of age. Does that mean that programs don't do it? Not at all - I am sure that some programs would look askance at older candidates, worrying whether or not they had the stamina and commitment to the residency. Of course, this is true for all fields: just as medical schools tend not to take people much over 35, so it is the same for residencies. After all, they don't want to spend years training you for what will be a very shortened career.

Best of luck.
 

Toadkiller Dog

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Allright, I'm back (finals were a killer).

I just wanted to say "thanks" to the surgical residents who responded (surg, Kim, droliver). I am going to continue looking for a good community program that will allow me to at least spend an adequate amount of time with my kids.

Any suggestions to this effect would be appreciated. Anyone know of programs making deliberate changes to their working conditions in an effort to make their programs more appealing (i.e, to reverse some of the recent downturn in General Surgery's popularity)?
 
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