Are GI and IR docs surgeons?

[deleted854547]

Should gastroenterologists and/or interventional radiologists be considered surgeons?

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[OrthoTraumaMD]

Should gastroenterologists and/or interventional radiologists be considered surgeons?

They are gastroenterologists and interventional radiologists.

 

[Dr G Oogle]

Not unless they perform surgery

 

[kb1900]

Only if you consider that knick IR sometimes make with the scalpel during vascular access

they are interventionalists

 

[AnatomyGrey12]

Absolutely not lol.

 

[Espressso]

Procedural-based, non-surgical subspecialists, interventionalists

 

[NickNaylor]

My EMR lists me as a surgeon when I do ECT. I definitely consider myself a surgeon.

 

[CherryRedDracul]

As someone who once gunned for IR, absolutely not.

All the IR guys I know don't consider themselves surgeons even if they had some surgical residency training before.

 

[sella.turcica]

Should gastroenterologists and/or interventional radiologists be considered surgeons?

No.

 

[ciestar]

Ive done a GI elective. They do scopes, MRCP/ERCP, EUS, PEGs...
That doesn’t count as surgery lol

 

[deleted854547]

They are gastroenterologists and interventional radiologists.

you didn’t answer my question.

 

[CherryRedDracul]

you didn’t answer my question.

She implied "no".

 

[Kuratz]

No would not consider IR or GI to be surgeons (nor Ophtho or MOHS for that matter). It is interesting, however, that when a vascular surgeon does something endovascular they consider it surgery but an IR doing the exact same thing would be a procedure. It's an ego thing. You'll come to realize that no one in the real world gives a hoot.

 

[CherryRedDracul]

No would not consider IR or GI to be surgeons (nor Ophtho or MOHS for that matter). It is interesting, however, that when a vascular surgeon does something endovascular they consider it surgery but an IR doing the exact same thing would be a procedure. It's an ego thing. You'll come to realize that no one in the real world gives a hoot.

Agreed. It's all semantics.

 

[slowthai]

No would not consider IR or GI to be surgeons (nor Ophtho or MOHS for that matter). It is interesting, however, that when a vascular surgeon does something endovascular they consider it surgery but an IR doing the exact same thing would be a procedure. It's an ego thing. You'll come to realize that no one in the real world gives a hoot.

@cubsrule4e @MOHS_01 @TypeADissection @LucidSplash

Let's get some specialty wars going. What say you?

 

[LucidSplash]

@cubsrule4e @MOHS_01 @TypeADissection @LucidSplash

Let's get some specialty wars going. What say you?

Ugh. Let’s not. Anything I can do in the cath lab without an incision, I don’t consider an “operation,” I consider it a minimally invasive procedure. But it’s all just semantics. Operations require the operating room, endo interventions can be done in a hybrid suite, cath lab, IR suite, or even a regular operating room with a c-arm in a pinch.

 

[libertyyne]

My EMR lists me as a surgeon when I do ECT. I definitely consider myself a surgeon.

I heard you just waltz in and press the button. Do you have to scrub?

 

[kb1900]

I heard you just waltz in and press the button. Do you have to scrub?

they do them in the dark curtained off corner of the PACU at my institution

 

[WinslowPringle]

GIs are surgeons in the same way I am a gastroenterologist because I’ve done hundreds of scopes and IRs are surgeons in the same way I’m a radiologist because I look at every film I order.

In other words, not.

 

[pbrocks15]

GIs are surgeons in the same way I am a gastroenterologist because I’ve done hundreds of scopes and IRs are surgeons in the same way I’m a radiologist because I look at every film I order.

In other words, not.

This was amazing. Lol

 

[hallowmann]

I heard you just waltz in and press the button. Do you have to scrub?

Hey man, don't forget reading the strip and bracing the arm. One time I even put in a bite block because the CRNA was untangling something. Let's not diminish my responsibilities on ECT.

they do them in the dark curtained off corner of the PACU at my institution

Haha, same, but it's mostly bright in the room, especially after induction. Usually very dark in recovery though.

 

[OnePunchBiopsy]

*Laughs in surgeon*

 

[TheLesPaul]

No would not consider IR or GI to be surgeons (nor Ophtho or MOHS for that matter). It is interesting, however, that when a vascular surgeon does something endovascular they consider it surgery but an IR doing the exact same thing would be a procedure. It's an ego thing. You'll come to realize that no one in the real world gives a hoot.

Why would ophtho or Mohs not be surgical? I have relationships with Mohs surgeons who do their own paramedian flaps and grafts. I do my fair share of cosmetic eyelid surgery, face lifts, facial fracture repair, and orbital/skull base work. Am I not a surgeon?

 

[Goro]

Are surgeons physicians? The full name of the medical school of Columbia University would imply not!

 

[Kuratz]

Why would ophtho or Mohs not be surgical? I have relationships with Mohs surgeons who do their own paramedian flaps and grafts. I do my fair share of cosmetic eyelid surgery, face lifts, facial fracture repair, and orbital/skull base work. Am I not a surgeon?

It's all semantics and that's the point. No one except those with egos care.

 

[slowthai]

Why would ophtho or Mohs not be surgical? I have relationships with Mohs surgeons who do their own paramedian flaps and grafts. I do my fair share of cosmetic eyelid surgery, face lifts, facial fracture repair, and orbital/skull base work. Am I not a surgeon?

It's all semantics and that's the point. No one except those with egos care.

"And it begins." *With a flourish*

 

[DeucesHigh3]

Why would ophtho or Mohs not be surgical? I have relationships with Mohs surgeons who do their own paramedian flaps and grafts. I do my fair share of cosmetic eyelid surgery, face lifts, facial fracture repair, and orbital/skull base work. Am I not a surgeon?

I think most (in medicine, and lay people) would agree that a rough definition of surgery would include any procedure where you need to break the skin with a scalpel rather than a needle (other than just to make a bigger skin hole for a bigger needle to go endovascular), that a form of anesthesia greater than local+sedation is called for, and that you are placing the patient at some modicum of systemic risk due to what you're doing. Within that rough framework of requiring 3 for 3:
Eyelid cosmetics - no.
Facelift - yes.
Skull base - yes, obviously.
Liposuction - yes.
Mohs - no.
Colonoscopy - no.
Endoscopy with aggressive clipping - still no.
Caesarian section - yes.
TIPS - no.

 

[slowthai]

I think most (in medicine, and lay people) would agree that a rough definition of surgery would include any procedure where you need to break the skin with a scalpel rather than a needle (other than just to make a bigger skin hole for a bigger needle to go endovascular), that a form of anesthesia greater than local+sedation is called for, and that you are placing the patient at some modicum of systemic risk due to what you're doing. Within that rough framework of requiring 3 for 3:
Eyelid cosmetics - no.
Facelift - yes.
Skull base - yes, obviously.
Liposuction - yes.
Mohs - no.
Colonoscopy - no.
Endoscopy with aggressive clipping - still no.
Caesarian section - yes.
TIPS - no.

Don't agree with the anesthesia requirement. There's wide awake hand surgery that's performed to ensure accurate tensioning of tendon grafts.

 

[longhaul3]

Don't agree with the anesthesia requirement. There's wide awake hand surgery that's performed to ensure accurate tensioning of tendon grafts.

Those are done under regional or spinal/epidural anesthesia, which qualifies as "greater than local+sedation." Hell, they do awake total joints and awake cranis, not to mention c-sections.

Edit: Actually I would say that at some places, awake cranis are the closest to being done under just local plus sedation. They are also starting to do awake MIS TLIFs (relatively major spine surgery) which is amazing.

 

[libertyyne]

Are surgeons physicians? The full name of the medical school of Columbia University would imply not!

No, its Surgeons and Barbers, not surgeons and physicians.

 

[libertyyne]

Those are done under regional or spinal/epidural anesthesia, which qualifies as "greater than local+sedation." Hell, they do awake total joints and awake cranis, not to mention c-sections.

Edit: Actually I would say that at some places, awake cranis are the closest to being done under just local plus sedation. They are also starting to do awake MIS TLIFs (relatively major spine surgery) which is amazing.

also some functional stuff that they do awake, or wake the patient up mid procedure.

 

[Dr G Oogle]

Lines are blurred. An appendectomy in a patient with an unruptured appendix is a relatively simple procedure yet it is a surgery while a hepatic chemoembolization is generally a complex procedure is labeled a procedure. Honestly who really cares. In the future all surgery will be done by robots and NPs.

 

[libertyyne]

Lines are blurred. An appendectomy in a patient with an unruptured appendix is a relatively simple procedure yet it is a surgery while a hepatic chemoembolization is generally a complex procedure is labeled a procedure. Honestly who really cares. In the future all surgery will be done by robots and NPs.

This is an interesting take, I agree that the future of most surgery will be more and more minimally invasive. to where it will become difficult to separate between what is a procedure and what is a surgery.

 

[deleted854547]

Why would ophtho or Mohs not be surgical? I have relationships with Mohs surgeons who do their own paramedian flaps and grafts. I do my fair share of cosmetic eyelid surgery, face lifts, facial fracture repair, and orbital/skull base work. Am I not a surgeon?

Pretty sure other surgeons hate on ophtho and Mohs because y’all triple their salary while still having work life balance.


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[dpmd]

Are surgeons physicians? The full name of the medical school of Columbia University would imply not!

I am licensed as a physician and surgeon!

 

[slowthai]

Pretty sure other surgeons hate on ophtho and Mohs because y’all triple their salary while still having work life balance.


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Mohs makes serious bank but they work for it, trust me. Ophtho does not make anywhere near as much as the other fields, on average. Lifestyle is easily the best of all, though.

 

[deleted854547]

Mohs makes serious bank but they work for it, trust me. Ophtho does not make anywhere near as much as the other fields, on average. Lifestyle is easily the best of all, though.

Retina and oculuplastics surgeons are some of the highest paid physicians. While the typical comprehensive eye doc makes $250-$300k, the ones with busy practices and a thriving optical shop can easily make 7 figures. They definitely win on lifestyle; glad we can agree on that.

 

[TheLesPaul]

I think most (in medicine, and lay people) would agree that a rough definition of surgery would include any procedure where you need to break the skin with a scalpel rather than a needle (other than just to make a bigger skin hole for a bigger needle to go endovascular), that a form of anesthesia greater than local+sedation is called for, and that you are placing the patient at some modicum of systemic risk due to what you're doing. Within that rough framework of requiring 3 for 3:
Eyelid cosmetics - no.
Facelift - yes.
Skull base - yes, obviously.
Liposuction - yes.
Mohs - no.
Colonoscopy - no.
Endoscopy with aggressive clipping - still no.
Caesarian section - yes.
TIPS - no.

Interesting argument. I do local + sedation for most cases except skull base/orbit. Surgical fields are moving towards lighter anesthesia requirements overall as well, not just smaller (or nonexistent) incisions.

I think the rule should be whether you do your work in an operating room, or a separate procedural suite -- fluoroscopy, cath lab, etc.

 

[slowthai]

Retina and oculuplastics surgeons are some of the highest paid physicians. While the typical comprehensive eye doc makes $250-$300k, the ones with busy practices and a thriving optical shop can easily make 7 figures. They definitely win on lifestyle; glad we can agree on that.

Yeah, that's why I said on average. And I have to be honest, I have never heard surgeons talk negatively about mohs and ophtho because of salary or lifestyle. Like I've said before, some don't consider them to be "real surgeons", similar to ob/gyns. Not talking about gyn oncs or urogyns, before any ob/gyners attack me.

 

[longhaul3]

To me the main defining characteristic of a surgeon is having completed a surgical residency. There's a lot more to being a surgeon than the kinds of procedures you do. Obviously GI and IR do not do surgical residencies. Derm clearly does not. I would say ophtho does. ob/gyn is a grey area for me—my understanding is that some programs are way more surgical than others—but I don't care enough to care.

Two examples:
GI and CRS both do colonoscopy. CRS are obviously surgeons and GI are obviously not.

Vascular surgeons and interventional cardiologists both do angios for PVD. Again, vascular surgeons are obviously surgeons while cardiologists are obviously not.

 

[Dr G Oogle]

Yeah, that's why I said on average. And I have to be honest, I have never heard surgeons talk negatively about mohs and ophtho because of salary or lifestyle. Like I've said before, some don't consider them to be "real surgeons", similar to ob/gyns. Not talking about gyn oncs or urogyns, before any ob/gyners attack me.

I’m a urogyn and general obgyn is a real grey area for me too

 

[Splenda88]

It's all semantics and that's the point. No one except those with egos care.

so most physicians care then... Our profession is full with individuals with egos.

 

[Splenda88]

To me the main defining characteristic of a surgeon is having completed a surgical residency. There's a lot more to being a surgeon than the kinds of procedures you do. Obviously GI and IR do not do surgical residencies. Derm clearly does not. I would say ophtho does. ob/gyn is a grey area for me—my understanding is that some programs are way more surgical than others—but I don't care enough to care.

Two examples:
GI and CRS both do colonoscopy. CRS are obviously surgeons and GI are obviously not.

Vascular surgeons and interventional cardiologists both do angios for PVD. Again, vascular surgeons are obviously surgeons while cardiologists are obviously not.

Why would obgyn be a gray area?

 

[dpmd]

Why would obgyn be a gray area?

Because a lot of what they do is non operative and the stuff they do operate on is different. Think more brute force rather than delicate finesse (yes ortho has a lot of brute force but also a lot of finesse in the approaches).

 

[ACSurgeon]

Lines are blurred. An appendectomy in a patient with an unruptured appendix is a relatively simple procedure yet it is a surgery while a hepatic chemoembolization is generally a complex procedure is labeled a procedure. Honestly who really cares. In the future all surgery will be done by robots and NPs.

just like we are blaming the surgeons’ egos for negatively impacting this debate, let’s not forget the other side. Why do non-surgeons need that title to apply to their procedures or professions? Who said being a surgeon or doing surgery was some amazing sought after thing?

 

[ACSurgeon]

I am licensed as a physician and surgeon!

so is the licensed IM resident lol

 

[Dr G Oogle]

Because a lot of what they do is non operative and the stuff they do operate on is different. Think more brute force rather than delicate finesse (yes ortho has a lot of brute force but also a lot of finesse in the approaches).

what this person said. And the fact that you have to do a fellowship to have and maintain surgical skill.

 

[longhaul3]

Why would obgyn be a gray area?

It looks like an ob/gyn chimed in already with more information than I have, but it's a grey area for me because I don't know a whole lot about it, and at my home institution the ob/gyn residents did not really operate (as in gyn surgery) a whole lot. My impression was that most of the residency program was obstetrics, clinic, and then some gyn OR on the side, and that they are not really fully trained to go out into attending hood and be surgeons within the full scope of gyn. I think the fact that the gyn subspecialties are so fellow-driven also means that the residents aren't doing a whole lot of cases by themselves—as a med student on ob/gyn I was never in a gyn case without a fellow.

 

[dpmd]

so is the licensed IM resident lol

I know, that was a joke reply to a joke post.

 

[Dr G Oogle]

It looks like an ob/gyn chimed in already with more information than I have, but it's a grey area for me because I don't know a whole lot about it, and at my home institution the ob/gyn residents did not really operate (as in gyn surgery) a whole lot. My impression was that most of the residency program was obstetrics, clinic, and then some gyn OR on the side, and that they are not really fully trained to go out into attending hood and be surgeons within the full scope of gyn. I think the fact that the gyn subspecialties are so fellow-driven also means that the residents aren't doing a whole lot of cases by themselves—as a med student on ob/gyn I was never in a gyn case without a fellow.

This about sums it up. Focus on obgyn is on OB not surgery. You only get about 12-14 months of actual surgical experience (excluding csections which many would argue focuses on skills that are not transferable to the more fine motor skills required for abdominal and pelvic surgery) and most people graduating residency are severely under prepared for surgical practice. The field is at a real cross roads and it will not at all look the same in 10-20 years.