Advice on Colorectal Surgery

[daact]

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I have suddenly developed an interest in colorectal surgery. Can anyone tell me about this field?

Thanks

 

[fishmonger69]

kind of a strange field to 'suddenly develop an interest in'. colorectal surgeons are basically general surgeons that charge more money and don't take call.

 

[mysophobe]

They "focus" on the rectum and colon, and there are some fellowships available from what I hear, but every general surgeon can be a colorectal surgeon if they want to be.

 

[dsmoot]

colorectal surgery is a fellowship beyond general surgery (around 30 available yearly). Most of what colorectal surgeons do, does fall under the practive parameters of General Surgery, but some of the complex reconstructions with J-pouches and extremely low resections are where the specialty shines.

 

[avgjoe]

kind of a strange field to 'suddenly develop an interest in'. colorectal surgeons are basically general surgeons that charge more money and don't take call.

So why wouldn't everyone want to be a colorectal surgeon then?
What are the other reasons to pursue this field? reasons not to?

 

[mysophobe]

Call me crazy, but some people don't particularly like rectal problems.

 

[fishmonger69]

Call me crazy, but some people don't particularly like rectal problems.

exactly. i think i'd rather take call and manage icu patients than focus on APRs and anal fissures.

 

[avgjoe]

exactly. i think i'd rather take call and manage icu patients than focus on APRs and anal fissures.

So I guess then the question is how much of a colorectal surgeons' practice (say in a big city academic center or private practice) would be strictly rectal probs like APRs etc?
And could they also be boarded in critical care and do that as part of their practice?

 

[Endzone]

As someone going into general surgery with possible aspirations for colorectal surgery, allow me to tell why I like the field.

1. Range of complexity in procedures from stapling hemorrhoids to technically demanding bowel resections and reconstructions. The latter is a fairly hot area in the realm of surgical innovation at the moment.

2. Patient population. The prevalence of colon CA is expected to increase with the aging population. Until the last decade or so, IBD patients have had little expertise support from the surgery side and there is a need for such support. These groups constitute the remainder of the common patients you see other than the routine hemorrhoids, anal fissures, etc. And while you may see many patients with more routine complaints, they tend to be very appreciative when they leave your office.

3. Opportunity to perform other procedures. With the ability to perform lower GI endoscopy, you can offer patients a wider spectrum of surgical care than what most general surgeons do (not all, I understand). Yes, you have to toe the line with GI, but at least at my institution the GIs are too busy to scope everyone anyway.

Other points about pay and work schedule may be relevant, but at this early stage when I ponder my ultimate career path, I prefer to think about what will excite me for years to come (i.e., the "Monday morning test"). I would rather work a few more hours a week and earn less income than be unhappy or bored. At least my wife would rather have me come home in a better mood after a long day than the alternative.

 

[mysophobe]

I dunno, you probably get more money with a fellowship.

 

[Winged Scapula]

colorectal surgeons are basically general surgeons that charge more money and don't take call.

Hmmm..the CR surgeons here would be suprised to hear they don't have to take call! Guess who gets called in for perforated diverticulitis, perf'd colons after colonoscopy, perirectal abscesses, toxic megacolon, general surgery problems on colorectal patient and of course, non-surgical problems on colorectal patients and recent post-op problems?

That said, the lifestyle is generally better as a colorectal surgeon especially if you don't have to take general surgery call and have residents or PAs who can admit non-complicated patients (which you see in the am). However, it is not ALL elective surgery.

 

[Winged Scapula]

And could they also be boarded in critical care and do that as part of their practice?

As long as you meet the requirements for BC in Critical Care (usually by completing a Surgical Critical Care fellowship), then yes, you can be boarded in that field. However, bear in mind that most Colorectal patients do not require extensive (or any) critical care, except in emergent situations, pre-morbid conditions or intra-op complications. The elective cases are generally pretty straight forward.

 

[mysophobe]

Guess who gets called in for perforated diverticulitis, perf'd colons after colonoscopy, perirectal abscesses, toxic megacolon, general surgery problems on colorectal patient and of course, non-surgical problems on colorectal patients and recent post-op problems?

Me, because we don't have any CR guys. 😡

 

[Winged Scapula]

Me, because we don't have any CR guys. 😡

Sorry...sounds like you need to get one (or more)!

 

[mysophobe]

Haha, I know. I'm developing an unhealthy elation at elderly prolapses.