First, a little about hours. . . . .
surgery residency is like a band of brothers (and sisters). Everyone needs to work together. Sometimes the system is going to hurt you. you will feel overwhelmed sometimes; but it is the kind of person who can drink a cup of coffee, take a deep breath, and push on through that is successful. I've done the 100 hour work week and I've worked a few trauma and SICU months that had me at the 80-90 hour average for the month. Does it suck? hell yes. did your body, and maybe your relationships suffer a little? maybe. is it getting better? most definitely. Those kinds of hours are fading fast with shift work systems and night float, but occasionally you will have a week that is really that busy. what any surgical residency wants is for a resident to show-up and perform competent and efficient work without complaining. when you transition care to someone else you should do your best to make sure there is as little left not completed as possible. The icing on that cake, is if you can find a way to help one of your comrades (stay late to do the case that is about to start, finish up the consult that came in before signout, etc.) . Hopefully they will return the favor for you one day. If you do all of that stuff and you are hanging out with the residents in the lounge then you have more than earned the right to bitch a little about the ****ty consults you got from the ER or IM the night before and the fact that you haven't eaten in 13 hours.
I'm near the end of my residency, but here are two quick facts from my intern year.
I lost 15lbs in the first 2 months because I never had time to sit down when I was at work. when I had time to eat it was usually the highest calorie thing I could find (hamburger, french fries, a medium pizza folded in half and eaten in a stairwell).
I fell asleep standing up while rounding on patients and even in the OR quite a few times.
would I change any of my experiences for a little more rest and time to eat? absolutely not. I have learned and done so much, and I am excited to be nearing the end so I can get started living my life. Also, a little suffering lets you know what your limits truly are. I can proudly say that I have not yet reached the point of saying I can't push through.
Now, onto the main even!
You like kids and you want to do surgery. Have you ever thought about ENT or plastics
ENT - 5 year residency with 1 year peds fellowship. myringotomy tubes, tonsillectomies, sinus surgery all day, appointments for allergy workups and nasal obstruction are your bread and butter.
upside: can function in private practice with a loose hospital affiliation, great salary and reimbursement, can treat adults and kids, can still do general ENT if you want (head and neck cancer, etc), high volume of cases in a day with the bread and butter, few true emergencies that will get you out of bed. On call as an attending it will depend on the arrangement you have with the ER. In my hospital ENT does not cover facial trauma, all turfed to plastics. Can do some cleft palates, but most of that goes to plastics unless you are in an underserved area.
downside: can get a little pigeon holed with the bread and butter cases. peds ENT's I have worked with have the same 3 cases 90% of the time.
Residency: highly competitive subspecialty surgery. high board scores, research, etc.
intern year can be tough as you rotate on other services. Run the floor on the inpatients. ENT 2-5th year get a lot better. Hours are pretty reasonable, more in the 60-70 range.
Plastics: 6 year residency followed by 1 year fellowship in peds craniofacial surgery. This allows you to work on cleft palates/lips, and a huge list of other facial abnormalities.
upside: work with kids every day, a lot of continuity, you could start today on some of the kids and by the time you retire you would have just finished their last revision rhinoplasty, few true emergencies on call at night (for peds).
downside: pretty much can only exist in association with a large university medical center. can't really run a mixed practice (cosmetic, peds, hand, general plastics etc.), re-imbursement (you will be paid well in comparison to others but if making maximum $$$ is your game, this is not for you). If you cover ER call you may get a fair amount of peds facial/adult facial trauma at night depending on how that is done in your institution.
Residency: highly competitive subspecialty surgery. Average applicant has a USMLE step 1- 240-250, plastics research, away rotations, and good letters. if you were thinking of doing PRS, taking a year off to do research for an applicant who decided in their 3rd year is not unheard of.
1.5-2 years on general surgery or non plastics rotations during the first 3 years . General surgery call year 2 and 3 can suck depending on the program, but the rotation schedule usually does not kill you with the worst that GS can offer (not a lot of transplant, Hepatobilliary, etc at most places). Plastics call is mostly home call but you may be driving in from home a lot depending on the ER with no post-call day afterwards. total work hours as a plastics 3.5-6 highly variable but generally 60-90/week.
Good luck
Thanks for doing your research on my predicament... Ok, here's the story of exactly what happened, since I really do appreciate the fact that you're all taking the time to help me out. Read on if you're so inclined, I'll keep it short:
I did surgery as my first rotation ever of third year, and needless to say, I had no idea wtf I was doing or what to look for in a specialty. All I knew is that the hours were very intense but the job was *pretty* fun. The interns were new so they wanted to do everything, and I kind of just stood around holding retractors and trying to stay awake. In retrospect, I doubt that was a very accurate example of surgery. Then I got to IM /ambulatory and realized that rounding and clinic just ain't my style (your "check the creatinine tomorrow" example is spot on).
So here I am, months away from deciding my career, and I'm in a bit of an identity crisis since I haven't really found anything (except that I like working with kids).
Fast forward to just this month, a research mentor invited me to do a bone marrow harvest, which is in the operating room under general anesthesia, and he let me practically run the case... Hands down the coolest thing I've ever done, I'm talking in my entire life. Problem is, I'm not sure if it was being back in the operating room with plenty of responsibility in a "surgery", or if it was the idea of treating a patient's cancer that really pumped me up about it. Whatever it was that caused the feeling, that's what I want to do for my career.
I understand that I'm the only one who can really answer these questions, but I do appreciate the input so far. Here are a couple ideas that I invite you all to shoot down:
- Be a general surgeon at a community hospital and kind of be like a "family med" type surgeon, taking all cases, kids and adults, and likely getting a bit of continuity since I'd have to do follow-up appointments too. The con is the lack of complexity of the cases, and minimal teaching opportunities.
- Do peds IR; I know this exists, but I haven't found much practical info like job markets or where I can practice, since it is really subspecialized. This option is currently the biggest mystery to me.
- Sack up and do peds heme/onc with a bone marrow transplant fellowship and hope that I get by with the very occasional procedure. I can make the argument that the rest of the job makes up for the lack of hands-on work. Peds cards/peds GI also kind of fall into this category.
- Be a total savage and do 9-10 years of peds surg residency. I'll be graduating when I'm 29 years old and I can't help but feel... old. On top of that, it's 10 really tough years, and even though most other things I'm considering are 6-7ish, those years are spent with an easier schedule than surgery. This feels like the least feasible option for whatever reason.
- PICU is kind of out because even though I like the acuity, I'm not a fan of the looooooong rounds.
- Anything else I'm missing?
Thanks again, amigos.