Are surgical residency hours really that much worse?

[DermViser]

I saw it. No one really believes this, and it's dumb to bring it up as "gotcha" moment in an argument, because you don't and it adds nothing. But go ahead and carry on please.

You saw it, but apparently, didn't understand it. Sorry, I happen to believe him if he says that he believes that (I have no reason to believe otherwise). Words have meaning.

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[Dwindlin]

You saw it, but apparently, didn't understand it. Sorry, I happen to believe him if he says that he believes that (I have no reason to believe otherwise). Words have meaning.

Okay fine. Let's take him at his word. He believes both to be totally hunky-dory. You calling him out on it is still pointless, it adds nothing to conversation at hand.

 

[Dwindlin]

But isn't that in itself evidence enough?

If we can improve resident quality of life without harming patients or worsening the overall quality of training, shouldn't we do so?

My issue with the duty hours is that, at least at my program, the most recent restrictions have actually made our QOL worse.

Yes, but it shouldn't be forced on everyone. If you want to stay at the hospital as long as you aren't killing people it shouldn't be a problem. Now I realize this goes both ways and there-in lies the problem. You can't make both happy, and so the default is more comfort.

 

[Dwindlin]

I sort of agree. But it has to be regulated somehow at a national level, or else it will be open to abuse at a program level. Right now I think the balance has tipped to being over-regulated; but I think going back to the days of no regulations would be worse.

100% agree, this is what I was alluding to in the part of my post you snipped (the fact that it has to be regulated some how).

 

[Bostonredsox]

No actually, you DO do it for the paycheck. The DIFFERENTIAL may be different compared to private practice, but don't tell me you do the exact same job, with it's accompanying malpractice, for just $60,000 a year. By the way great jab at the end of "higher acceptable level of self-sacrifice" that right there shows that you believe your philosophy is better.

this is essentially my point. You may be in a practice of academia where you make less money, spend more time with pts, more teaching to make better generationsof doctors, all things that make you think you are making a bigger self sacrifice then other doctors......but your still getting paid phenomenally well. and if you werent, and I dont mean 200k instead of 300k, I mean 75k instead of 300k, and you could no longer justify the massive amount of time, energy and self sacrifice medical school, residency and fellowship are, you wouldnt do it.

If you lined up 100 people and told them your signing up for 4 years of school, 3-5 years of residency, 1-4years of fellowship....your avg debt will be idk 200-250k....and your total salary will be 75k....you would have 0 takers. none. hell even with no debt at all, no loans....8+ years of training after college for 75k would yield unto itself no doctors.

You may love your patients and what you do, but your still doing it for the paycheck. and if it wasnt there to a "reasonable degree" to what it is now, you wouldnt be doing it. remember theres more to life than your job, no matter how important you think that job may be to our society. that was my point.

 

[DermViser]

this is essentially my point. You may be in a practice of academia where you make less money, spend more time with pts, more teaching to make better generationsof doctors, all things that make you think you are making a bigger self sacrifice then other doctors......but your still getting paid phenomenally well. and if you werent, and I dont mean 200k instead of 300k, I mean 75k instead of 300k, and you could no longer justify the massive amount of time, energy and self sacrifice medical school, residency and fellowship are, you wouldnt do it.

If you lined up 100 people and told them your signing up for 4 years of school, 3-5 years of residency, 1-4years of fellowship....your avg debt will be idk 200-250k....and your total salary will be 75k....you would have 0 takers. none. hell even with no debt at all, no loans....8+ years of training after college for 75k would yield unto itself no doctors.

You may love your patients and what you do, but your still doing it for the paycheck. and if it wasnt there to a "reasonable degree" to what it is now, you wouldnt be doing it. remember theres more to life than your job, no matter how important you think that job may be to our society. that was my point.

You can bet that with reimbursement cuts, these people will howl like the wind just like the rest of us. They ARE NO DIFFERENT than us, no matter how much they will try to portray otherwise. Always amazing to me the level of bravado, they have. A while back Duke's surgery program used to actually BRAG about their divorce rates of their residents, as some kind of badge of courage. That is just mentally sick.

 

[ram006]

this is essentially my point. You may be in a practice of academia where you make less money, spend more time with pts, more teaching to make better generationsof doctors, all things that make you think you are making a bigger self sacrifice then other doctors......but your still getting paid phenomenally well. and if you werent, and I dont mean 200k instead of 300k, I mean 75k instead of 300k, and you could no longer justify the massive amount of time, energy and self sacrifice medical school, residency and fellowship are, you wouldnt do it.

If you lined up 100 people and told them your signing up for 4 years of school, 3-5 years of residency, 1-4years of fellowship....your avg debt will be idk 200-250k....and your total salary will be 75k....you would have 0 takers. none. hell even with no debt at all, no loans....8+ years of training after college for 75k would yield unto itself no doctors.

You may love your patients and what you do, but your still doing it for the paycheck. and if it wasnt there to a "reasonable degree" to what it is now, you wouldnt be doing it. remember theres more to life than your job, no matter how important you think that job may be to our society. that was my point.

Well put. When I find myself whining about Obamacare and how "little" I'm going to make, I think about the fact that it took my mom 40 years in high school education to get to 75k a year... Even if you want to get in to all the arguments about student debt and inflation, etc. I'm still going to be doing well.

I honestly think the older generation of doctors might just be so far detached from reality they forget how fortunate they are. They remember the days when medical school was 500 bucks a semester, a gallon of gas was 10 cents and surgeons were getting paid 4k to take our a gallbladder. Hell, even some attendings that graduated before 2007 have no idea that interest rates doubled overnight and haven't come down since.

 

[SLUser11]

You can bet that with reimbursement cuts, these people will howl like the wind just like the rest of us. They ARE NO DIFFERENT than us, no matter how much they will try to portray otherwise. Always amazing to me the level of bravado, they have. A while back Duke's surgery program used to actually BRAG about their divorce rates of their residents, as some kind of badge of courage. That is just mentally sick.

You and I are different.

Read my second post on the issue where I point out that the situation is not cut and dry..."Nobody is claiming that personal life and family are not important. I am claiming that it cannot be your sole focus all the time...."

I am different than you for several reasons:
1. I have more experience, both as a trainee and as a practicing physician, so I know how things play out over time, and ironically (given your opinion of surgeons), I have less blind arrogance about my understanding of things.
2. While I value financial security, it is only one facet of why I practice medicine. So, surgery is much much more to me than a paycheck.
3. I am willing to place the needs of the patient and the resident ahead of my own.
4. I don't paint entire specialties with a broad, inacurrate brush stroke. Instead, I recognize that there is significant heterogeneity in priorities, practices, and philosophies. I don't deal in absolutes, e.g. "all surgeons are x." I should note, though, that it's exceedingly easy to win arguments with people who insist on such a black and white understanding of complex topics.
5. And finally, I don't share the used-out Duke 110% divorce rate story anymore....it's been weeks.

Honestly, I woudn't get your panties in such a bunch over how surgeons act. A great deal of our "bravado" is a coping mechanism to justify longer hours and more pain....it's easier to endure when you feel that you are somehow contributing more than those that sleep well and are able to see their children every day. Don't take that cross away from us.....

 

[@JackShephard]

Honestly, I woudn't get your panties in such a bunch over how surgeons act. A great deal of our "bravado" is a coping mechanism to justify longer hours and more pain....it's easier to endure when you feel that you are somehow contributing more than those that sleep well and are able to see their children every day. Don't take that cross away from us.....

The interesting thing is eventually we all face death, and when that time comes it's going to be the contributions you made in relationships that matter.

And I do think you get to do that as a surgeon if you try. I also know the unpleasant surgeons who are so brash and short with patients and residents that they miss out on the opportunity.

 

[@JackShephard]

You can bet that with reimbursement cuts, these people will howl like the wind just like the rest of us. They ARE NO DIFFERENT than us, no matter how much they will try to portray otherwise. Always amazing to me the level of bravado, they have. A while back Duke's surgery program used to actually BRAG about their divorce rates of their residents, as some kind of badge of courage. That is just mentally sick.

The competitiveness of surgical specialties closely resembles the best lifestyle/$ combinations. It's no different from other speicalties medical students chose, they just chose from only surgical specialties. I haven't looked at fellowships, but I'm sure the rule still applies.

 

[TX515]

hell even with no debt at all, no loans....8+ years of training after college for 75k would yield unto itself no doctors.

I probably would still do it, but as a pathologist working 9-5, the hourly compensation ain't that bad...and I love my job and my life outside of the hospital.

I don't think the hours one puts in equates to being a better doctor. One should always aspire for perfection no matter what the job, whether that is cleaning, removing an appendix, or diagnosing cancer.

Comparing X surgeon working 100 hours per week to Y surgeon working 40 hours per week, I'm going with the surgeon with the least peri-operative complications.

I don't understand the "surgery is more than a job". I guess pathology is more than a job too.

 

[Substance]

I probably would still do it, but as a pathologist working 9-5, the hourly compensation ain't that bad...and I love my job and my life outside of the hospital.

Would you do it with the same malpractice risk? I think you are devaluing yourself by saying you'd do that job for 75k a year. I can tell you most people wouldn't do medicine for a usual amount - I sure wouldn't. The road to get there is too long, and the risks are too great, to be compensated averagely. Plus, the public wants smart, dedicated doctors, not people who thought they'd give it a shot after undergrad much like how some decide to go into teachers college. Without the income and prestige, few people would be willing to toil through the arduous labors of residency and practice. Maybe pathology is different because it is both a lifestyle specialty and uncompetitive, but maybe it shouldn't be either of those things and that's the problem.

The interesting thing is eventually we all face death, and when that time comes it's going to be the contributions you made in relationships that matter.

This is the truth. Death comes for us all. All of the patients I've encountered who were on their final days cared only about the relationships they've fostered, and lamented the ones they ignored. Nobody cared if they worked more - most regretted it, and some were doctors.

A great deal of our "bravado" is a coping mechanism to justify longer hours and more pain....it's easier to endure when you feel that you are somehow contributing more than those that sleep well and are able to see their children every day. Don't take that cross away from us.....

I've never heard it put this way from a surgeon. That one sentence makes me respect what surgeons do all the more, even if half of the ones I encounter are, to put it nicely, unkind. The whole machismo thing is a coping strategy because living the surgery life really is a monumental sacrifice. Given the current political climate and dingus administrators that we all deal with I'm sure that being sleep deprived, literally shat on, and dealing with death weigh heavily on your heart and make it seem like nobody appreciates your work.

 

[TX515]

I can tell you most people wouldn't do medicine for a usual amount

I know this.

 

[vhawk]

But isn't that in itself evidence enough?

If we can improve resident quality of life without harming patients or worsening the overall quality of training, shouldn't we do so?

My issue with the duty hours is that, at least at my program, the most recent restrictions have actually made our QOL worse.

The studies are not designed to show whether patient outcomes were worse, because that was basically inconceivable to the proponents of the work hour restrictions. You might still expect to see a demonstrated negative effect on patient outcomes even if the studies weren't designed that way, but I think its useful to keep that in mind. It is not obvious that we have either "improved resident quality of life" OR done so "without harming patients." It is just fairly clear that we have "made some changes" and it "hasn't benefitted patients."

 

[vhawk]

this is essentially my point. You may be in a practice of academia where you make less money, spend more time with pts, more teaching to make better generationsof doctors, all things that make you think you are making a bigger self sacrifice then other doctors......but your still getting paid phenomenally well. and if you werent, and I dont mean 200k instead of 300k, I mean 75k instead of 300k, and you could no longer justify the massive amount of time, energy and self sacrifice medical school, residency and fellowship are, you wouldnt do it.

If you lined up 100 people and told them your signing up for 4 years of school, 3-5 years of residency, 1-4years of fellowship....your avg debt will be idk 200-250k....and your total salary will be 75k....you would have 0 takers. none. hell even with no debt at all, no loans....8+ years of training after college for 75k would yield unto itself no doctors.

You may love your patients and what you do, but your still doing it for the paycheck. and if it wasnt there to a "reasonable degree" to what it is now, you wouldnt be doing it. remember theres more to life than your job, no matter how important you think that job may be to our society. that was my point.

I couldn't do it if the only residency training program was located on the moon and I was all out of rocket fuel either. What exactly is the point?

 

[vhawk]

Not that it is even a remotely relevant point, and I almost feel bad appearing to validate the argument by responding to it, but if you forgave all my debt and paid me 75k/yr (only chosen because this was the number used above) I would absolutely continue to be a surgeon and it wouldn't impact my work ethic or behavior in any meaningful way.

 

[Bostonredsox]

Not that it is even a remotely relevant point, and I almost feel bad appearing to validate the argument by responding to it, but if you forgave all my debt and paid me 75k/yr (only chosen because this was the number used above) I would absolutely continue to be a surgeon and it wouldn't impact my work ethic or behavior in any meaningful way.

this was exactly the point. and if you truly feel this way then you should be proud as you are very clearly a rare breed. I sure as hell would not have gone down this path, spent this many hours away from my wife and kids and worked as hard as I do for the same amount of money you can make as nurse supervisor. Life is just too short to justify working the way we work for that little money. the satisfaction you get from the hard work and caring for your pts in the manner we do doesnt feed your kids or put them through college, the salary does. But in all seriousness, I am glad that there are some doctors out there like you who will do anything and everythign for their pts, work all hours of the day and make your pt the most important thing in your life even if you were paid a nurses salary after 12+ years of training compared with their 2 years. I cannot say that about myself.

but do me a favor, dont tell the govt you are this type of doctor, that would work the way we do for pennies on the dollar, and yes a 75k salary for what we do and how long we train is pennies on the dollar, truck drivers avg over 50k... they will start paying us nothing and keep expecting us to train for over a decade, work our asses off day in and day out, and maybe consider paying a smidge of our loans. 99% of us dont want this. so keep your stoic nature to yourself and your patients please

 

[Bostonredsox]

I agree with vhawk that I generally hate these types of ludicrous examples.

But I wouldn't do it, as I simply don't think I could meet my goals for my life with that arbitrary number. It's not that I wouldn't still enjoy the work, and I agree with others that I love my job irrespective of salary. But there are a number of things in life I'd like to accomplish. I think those would become unattainable. Examples include being able to (a) provide a secondary education debt-free to my children and (b) retire comfortably to a nice house or condo where I can spend my twilight years on the water and playing golf.

but you cant look at it retrospectivly, you have to lok at it prospectively. not as a practicing surgeon now, but as an undergrad student. If they told you THEN, you will train for another 12 years, you will work 80+ hours per week during residency, you will amass huge student loan debts, but we will only pay you X amount....how many would still do it. make it 50k, 75k, 100k. whatever. we all know if you were told that THEN, 99% of us would have chosen a different field because its just crazy to imagine working and training how we do for so little return.

We had a surgeon who died in an unfortunante accident recently. worked his tail off through school, residency, CT fellowship.. was just coming into this own as an attending and is now deceased at 38 y/o. you never know when it will be your time. He worked so hard and never even got to see the fruits of his labors. I cant imagine doing what we do and all the years and hours of studying, and rotating and residency and all of that for a low end salary you can make in 100s of other fields which dont have to invest decades of their lives training and working like a resident. there are many many fields which pay as well as ours. none, NONE, go through the training and work we go through. The money is important to everyone. I love my patients and what I do man, Im in the ICU dealign with death and family conferences and really trying to make a difference.....but I still wouldnt have walked this path for magic beans.

 

[ram006]

This is the truth. Death comes for us all. All of the patients I've encountered who were on their final days cared only about the relationships they've fostered, and lamented the ones they ignored. Nobody cared if they worked more - most regretted it, and some were doctors.
.

Case in point.

https://makelivesbetter.uthscsa.edu/davalos

I knew Karla well and was there for her last hours as a friend.

A few things that struck me were
1: how incredibly loved she was, there was literally over a hundred people in the hallways spilling in to the waiting room.
2: No one cared about anything apart from the type of person she was.
3: None of the people for whom she sacrificed her personal life while being a critical care fellow were at the bedside when she passed.

But to each their own, if someone wants to let their job or "calling" become their entire life then that's their choice. My only problem is with people who fault others for not making that same decision.

 

[Dr.LeoSpaceman]

This is the truth. Death comes for us all. All of the patients I've encountered who were on their final days cared only about the relationships they've fostered, and lamented the ones they ignored. Nobody cared if they worked more - most regretted it, and some were doctors.

Nobody cared if they worked more, but plenty cared about the job they actually did. I have a number of friends who are essentially having mid-life crises in their 30s because they hate their jobs--and I'm sure that I'm not alone. Sure, they have a lot of time to develop relationships outside of work, but they essentially view those 40 hours they spend at work as a waste. Personal relationships provide fulfillment, but so can the career that you choose. And no one is saying that you have to pick one or the other as a surgeon...but it may mean that finding the balance is a bit more challenging.

There are few careers that provide the opportunity to provide an experience so profound as to see a patient back in your office 5 years after you've resected their cancer. That patient may not show up and mourn when you die, but I'm certain they recognize the service you provided to them. Sure, life is about those lifelong relationships we foster with friends, family, and children. But the relationships with patients that may only last months, weeks, or years can be similarly as fulfilling. And like I said, it's not that you have to choose one or the other--it's possible to have both.

 

[vhawk]

but you cant look at it retrospectivly, you have to lok at it prospectively. not as a practicing surgeon now, but as an undergrad student. If they told you THEN, you will train for another 12 years, you will work 80+ hours per week during residency, you will amass huge student loan debts, but we will only pay you X amount....how many would still do it. make it 50k, 75k, 100k. whatever. we all know if you were told that THEN, 99% of us would have chosen a different field because its just crazy to imagine working and training how we do for so little return.

We had a surgeon who died in an unfortunante accident recently. worked his tail off through school, residency, CT fellowship.. was just coming into this own as an attending and is now deceased at 38 y/o. you never know when it will be your time. He worked so hard and never even got to see the fruits of his labors. I cant imagine doing what we do and all the years and hours of studying, and rotating and residency and all of that for a low end salary you can make in 100s of other fields which dont have to invest decades of their lives training and working like a resident. there are many many fields which pay as well as ours. none, NONE, go through the training and work we go through. The money is important to everyone. I love my patients and what I do man, Im in the ICU dealign with death and family conferences and really trying to make a difference.....but I still wouldnt have walked this path for magic beans.

Tough question at least for me to answer personally. I got into medicine for the wrong reasons (and no, salary was not one of them) after college mostly because I had no idea wtf I wanted to do, and just chose medicine because it seemed hard. I found out by third year that I actually hated pretty much all of it, but enjoyed surgery. Now almost done with training, I'm extremely fortunate to have basically stumbled into this profession. So, "knowing what I know now" I certainly would choose it again, even with poorer reimbursement. I dont know that there are any jobs that pay more than 75k/yr that I would enjoy more. But going back in time and imagining being a junior undergrad deciding? Dunno. If pay were that poor, then competition would probably plummet, meaning that it wouldnt seem all that "hard" to get into med school or become a doctor. I'd probably have done something else. Who knows if I'd have been fortunate enough to love that as much.

When I have rough days I imagine a scenario like yours above...what if I died next year, before "reaping the benefits" of all this hard work? And every time I realize that I'd be completely ok with that. The process of becoming a doctor and now a surgeon have been great and rewarding and completely worth it to me. I think thats a pretty good sign that you've chosen the right profession.

 

[vhawk]

This is the truth. Death comes for us all. All of the patients I've encountered who were on their final days cared only about the relationships they've fostered, and lamented the ones they ignored. Nobody cared if they worked more - most regretted it, and some were doctors.

Do you really find deathbed wisdom to be profound and helpful to you in your daily life? You need to realize that these types of regrets are EXTREMELY biased. Yes, present-you wishes that past-you had done things differently. Thats because for all intents and purposes present-you and past-you are completely separate people. Saying that you wish you had done things differently is basically just begging for a free lunch. "Man I sure wish that this guy who isnt me any more had suffered a little more and enjoyed things a little bit less so that my present-day memories and situation might be a little more enjoyable." It only sounds plausible because you are tricked into thinking that past-you and present-you are the same guy, and so it SEEMS like you are saying that you wish YOU had sacrificed more for YOUR benefit.

Your happiness in life is the sum total throughout the entire experience, not just how you feel right before you die. I'm not future-me's slave, **** that guy.

 

[ram006]

Nobody cared if they worked more, but plenty cared about the job they actually did. I have a number of friends who are essentially having mid-life crises in their 30s because they hate their jobs--and I'm sure that I'm not alone. Sure, they have a lot of time to develop relationships outside of work, but they essentially view those 40 hours they spend at work as a waste. Personal relationships provide fulfillment, but so can the career that you choose. And no one is saying that you have to pick one or the other as a surgeon...but it may mean that finding the balance is a bit more challenging.

There are few careers that provide the opportunity to provide an experience so profound as to see a patient back in your office 5 years after you've resected their cancer. That patient may not show up and mourn when you die, but I'm certain they recognize the service you provided to them. Sure, life is about those lifelong relationships we foster with friends, family, and children. But the relationships with patients that may only last months, weeks, or years can be similarly as fulfilling. And like I said, it's not that you have to choose one or the other--it's possible to have both.

Very true. I think it's important to realize that having a job that you feel fulfilled by is something not everyone is fortunate enough to have.

I do, however, emphatically disagree that a relationship I have with a patient, of any kind -short or long term, is as meaningful as my relationship with my wife.

 

[@JackShephard]

There are few careers that provide the opportunity to provide an experience so profound as to see a patient back in your office 5 years after you've resected their cancer. That patient may not show up and mourn when you die, but I'm certain they recognize the service you provided to them. Sure, life is about those lifelong relationships we foster with friends, family, and children. But the relationships with patients that may only last months, weeks, or years can be similarly as fulfilling. And like I said, it's not that you have to choose one or the other--it's possible to have both.

?

I disagree. If you think there are few careers that offer such profound experiences then you may not get out often.

There are thousands of opportunities to have profound experiences even greater than the ones you've had. And it has nothing to do with the amount of training you've had. It has everything to do with serving other people and giving 100% of yourself to them.

Do you really believe you are that unique as a human being. There weren't complicated surgeries done thousands of years ago, did humans have less profound experiences in their lives before modern day surgery existed.

We all like to think our contributions are special or unique, but in reality it's how you serve and care about the people, which can be done regardless of your level of skill, knowledge or income. Extraordinary giving can be done by any medical professional AND any person on earth. Doctors often feel special, but the profession isn't special it's the people and their attitudes that are. And that same attitude or spirit can be carried over to any profession, teaching, serving in a soup kitchen, being a carpenter. Anything.

 

[SLUser11]

I'm sorry, guys, but this argument is way too civil for my liking. It started red hot, and I thought for sure it would spin delightfully out of control....but now here we are 4 pages later, and everyone has cooled down...they're respecting eachother's opinions, and I haven't heard a single comparison to Nazi Germany! It's like Godwin's Law doesn't exist....

 

[Dr.LeoSpaceman]

I disagree. If you think there are few careers that offer such profound experiences then you may not get out often.

I mean, I guess we're going to have to agree to disagree, then. Sure, I can pick out other things that provide similar experiences, and they'd probably be similar to what you'd pick out (teaching, international aid worker, social worker, religious orders, etc.) But there are not many--you'll note that's why I chose the word "few" as opposed to "none". On the contrary, your assertion that such a feeling can be attached "anything" is something with which I'd take issue. Sure, in the abstract, I can explain why any person should take similar satisfaction in any job. But that's simply not the experience that most people have. Which is why I suspect some of the people I know struggle to figure out how what they're doing as an I-banker or consultant really "makes a difference".

Doctors often feel special, but the profession isn't special it's the people and their attitudes that are.

Again, I'd have to strongly disagree. I'm not asking anyone to throw me a ticker tape parade, or pat me on the back everyday, that's for sure. And true, I don't think I (or any other physician) is "special" in the sense that it takes some act of divine providence to be one. I do, however, believe that the service we are able to provide is quite unique.

Further, in circling back to one of the other themes of this thread, people that do find that kind of fulfillment in a career aren't just putting in 40 hours and going home. The teacher that finds fulfillment in developing their students is spending a lot more than that. And the aid worker that's living in West Africa has probably blurred the lines between personal life and career.

 

[@JackShephard]

I mean, I guess we're going to have to agree to disagree, then. Sure, I can pick out other things that provide similar experiences, and they'd probably be similar to what you'd pick out (teaching, international aid worker, social worker, religious orders, etc.) But there are not many--you'll note that's why I chose the word "few" as opposed to "none". On the contrary, your assertion that such a feeling can be attached "anything" is something with which I'd take issue. Sure, in the abstract, I can explain why any person should take similar satisfaction in any job. But that's simply not the experience that most people have. Which is why I suspect some of the people I know struggle to figure out how what they're doing as an I-banker or consultant really "makes a difference".

That's fine if most people don't have the experience. The truth is that it's possible. This special feeling one has is just wrapped around in the idea of giving 100% of yourself to a task that challenges your abilities and makes a significant impact on a person's life. The reality is that you've set up a rule for yourself, that you can feel this profound feeling when ______ happens. There are no new emotions under the sun, the experiences and emotions you feel, while you think them unique, have been felt by humans for thousands and thousands of years.

I don't think you disagree with my sentiments. As you said, while these do happen, they probably happen less frequently than in surgery. Well, that's just a decision of the human mind. Contributing something special, using all of one's talents, for a worthy ideal, and it's impacting people's lives... this can be done by a garbage man or a handicapped individual helping out in a business. It's not our innate ability that allows us to have these experiences, it's how we contribute.

Doctors and surgeons like to think themselves a special breed, but 100-200 years from now - hardly anyone will know your name or that you existed. In that respect, all that matters is how we give and relate with the people here today. Everything else vanishes.

Again, I'd have to strongly disagree. I'm not asking anyone to throw me a ticker tape parade, or pat me on the back everyday, that's for sure. And true, I don't think I (or any other physician) is "special" in the sense that it takes some act of divine providence to be one. I do, however, believe that the service we are able to provide is quite unique.

Further, in circling back to one of the other themes of this thread, people that do find that kind of fulfillment in a career aren't just putting in 40 hours and going home. The teacher that finds fulfillment in developing their students is spending a lot more than that. And the aid worker that's living in West Africa has probably blurred the lines between personal life and career.

First off on the hours, I've yet to meet the teacher upset they could only work 16 hrs a day, and that exceeding 80 hr work weeks would decline their quality of work...

Are surgeons unique? Sure, they are unique. A garbage man has a unique job. A teacher has a unique job. A person who free sex trade workers has a unique job. An investor has a unique job.

Or are you saying a surgeon has a unique job and 90% or 95% or whatever % of America doesn't? It's hard to make sense of that statement unless you can clearly define what a unique career is. Specifically, are these jobs unique or not unique: Firefighter, police officer, teacher, librarian, housekeeper, engineer, software/web designer, artist, musician, actor, etc.

 

[vhawk]

I'm sorry, guys, but this argument is way too civil for my liking. It started red hot, and I thought for sure it would spin delightfully out of control....but now here we are 4 pages later, and everyone has cooled down...they're respecting eachother's opinions, and I haven't heard a single comparison to Nazi Germany! It's like Godwin's Law doesn't exist....

Happy to oblige but I'm gonna need a better foil than DermViser.

 

[DermViser]

You and I are different.

Read my second post on the issue where I point out that the situation is not cut and dry..."Nobody is claiming that personal life and family are not important. I am claiming that it cannot be your sole focus all the time...."

I am different than you for several reasons:
1. I have more experience, both as a trainee and as a practicing physician, so I know how things play out over time, and ironically (given your opinion of surgeons), I have less blind arrogance about my understanding of things.
2. While I value financial security, it is only one facet of why I practice medicine. So, surgery is much much more to me than a paycheck.
3. I am willing to place the needs of the patient and the resident ahead of my own.
4. I don't paint entire specialties with a broad, inacurrate brush stroke. Instead, I recognize that there is significant heterogeneity in priorities, practices, and philosophies. I don't deal in absolutes, e.g. "all surgeons are x." I should note, though, that it's exceedingly easy to win arguments with people who insist on such a black and white understanding of complex topics.
5. And finally, I don't share the used-out Duke 110% divorce rate story anymore....it's been weeks.

Honestly, I woudn't get your panties in such a bunch over how surgeons act. A great deal of our "bravado" is a coping mechanism to justify longer hours and more pain....it's easier to endure when you feel that you are somehow contributing more than those that sleep well and are able to see their children every day. Don't take that cross away from us.....

I won't address most of your 1-5 as most of it is horse****. You are free to attribute certain characteristics to yourself, just bc you happen to be a surgeon. As far as your cross to bear, that is perfectly ok for you to have and I am not denying you that and don't wish to take that away from you.

What *other specialties (and now regulatory agencies, medical schools who are now emphasizing professional behavior, etc.) are generally not ok with, is you (and your specialty) using your cross as a reason for you to get your way and be treated with kid gloves, esp. when much of it is self-induced, not necessarily by the practice of the specialty, but by the colleagues in your specialty itself. Whether you wish to admit it or not, you are a cog in the wheel of healthcare just like the rest of us in other specialties. You can easily be replaced, you are not special. You are not a unique snowflake. (same applies to me too).

*Other specialties = Peds, IM, PM&R, Radiology, Radiation Oncology, Anesthesiology, Derm, Pathology, Psychiatry, etc.

Contrast the personalities on General Surgery with say the personalities in Urology, ENT, etc. on average. There is a clear and stark difference. Yet somehow the surgery establishment is shocked (just shocked!) that general surgery residents are more and more heading towards surgical subspecialties that allow for better lifestyle (i.e. Breast Oncology, etc.) and don't want to be the unhappy, demoralized General Surgeon in his/her late 60s taking call alone in a hospital.

 

[balaguru]

...
Contrast the personalities on General Surgery with say the personalities in Urology, ENT, etc. on average. There is a clear and stark difference. Yet somehow the surgery establishment is shocked (just shocked!) that general surgery residents are more and more heading towards surgical subspecialties that allow for better lifestyle (i.e. Breast Oncology, etc.) and don't want to be the unhappy, demoralized General Surgeon in his/her late 60s taking call alone in a hospital.

I'm probably going to regret feeding the troll but your generalizations about other surgical specialties is unsupported. I assume what you meant by "personalities" is really job satisfaction because picking a specialty because of your perception of the personality of it's practitioners would be silly. ENT seems to rank pretty low in career satisfaction. See http://archinte.jamanetwork.com/article.aspx?articleid=212212. Urology is strongly associated with burnout. See http://www.ncbi.nlm.nih.gov/pubmed/21946217.

If you want to pick a specialty based on "averages" then you may pick geriatric internal medicine as they seem to report pretty high career satisfaction. If on the other hand you'd like to pick a specialty based on some personal insight then you may end up picking general surgery.

 

[DermViser]

I'm probably going to regret feeding the troll but your generalizations about other surgical specialties is unsupported. I assume what you meant by "personalities" is really job satisfaction because picking a specialty because of your perception of the personality of it's practitioners would be silly. ENT seems to rank pretty low in career satisfaction. See http://archinte.jamanetwork.com/article.aspx?articleid=212212. Urology is strongly associated with burnout. See http://www.ncbi.nlm.nih.gov/pubmed/21946217.

If you want to pick a specialty based on "averages" then you may pick geriatric internal medicine as they seem to report pretty high career satisfaction. If on the other hand you'd like to pick a specialty based on some personal insight then you may end up picking general surgery.

Your evidence of "urology burnout" article is comparing surgical subspecialties in the private practice world vs. academic practice world. Try again.

It's a known fact, that most categorical general surgery trainees are doing general surgery for the sole purpose of fellowship training. Very few want the job and lifestyle of doing only general surgery (unless other factors are involved: starting a family, paying off loans now, etc.)

 

[Winged Scapula]

It's a known fact, that most categorical general surgery trainees are doing general surgery for the sole purpose of fellowship training. Very few want the job and lifestyle of doing only general surgery (unless other factors are involved: starting a family, paying off loans now, etc.)

Fellowship training for general surgery residents is not new.

As Kirby Bland (UAB) has been writing about since the early 90s, more than 70% of general surgery residents end up pursuing fellowship training. For some it may certainly be mostly for lifestyle reasons, but for many others its probably a combination of research and practice interests, lifestyle concerns, potential job market (more employers want fellowship trained surgeons: I can tell you that was one of my reasons) and of course, exposure (Bland has also noted that residents in academic programs without exposure to private practice general surgery are more likely to pursue a fellowship because they've never seen what general surgery in practice looks like).

 

[DermViser]

Fellowship training for general surgery residents is not new.

As Kirby Bland (UAB) has been writing about since the early 90s, more than 70% of general surgery residents end up pursuing fellowship training. For some it may certainly be mostly for lifestyle reasons, but for many others its probably a combination of research and practice interests, lifestyle concerns, potential job market (more employers want fellowship trained surgeons: I can tell you that was one of my reasons) and of course, exposure (Bland has also noted that residents in academic programs without exposure to private practice general surgery are more likely to pursue a fellowship because they've never seen what general surgery in practice looks like).

I agree fellowship training is not new. However, the very high proportion of those fighting for subspecialty fellowships is relatively new (vs. say the 80s/90s). The job market I think is responding to the trend that more general surgery graduates are pursuing fellowship training, thus jobs that normally wouldn't have had fellowship training as a requirement, now do so (except rural areas - in which beggars can't be choosers). It's a vicious cycle.

Not to mention, with the swallowing up of private practices of General IM doctors by hospitals due to consolidation (due to increasing government regulations), it's nowhere near a guarantee that someone who is doing General Surgery in private practice will be able to stay in private practice.

 

[Winged Scapula]

I agree fellowship training is not new. However, the very high proportion of those fighting for subspecialty fellowships is relatively new. The job market I think is responding to the trend that more general surgery graduates are pursuing fellowship training, thus jobs that normally wouldn't have had fellowship training as a requirement, now do so (except rural areas - in which beggars can't be choosers). It's a vicious cycle.

You might have a point there - employers saw that they could get someone with additional training, market is as something special and therefore made positions which formerly did not require fellowship training (i.e., breast surgeon), require that as entry level. My point about the fellowship training is that while fellowships themselves are not new, neither is the pursuit of it. In our generation (i.e., 25 years), the majority of GS residents have pursued fellowships. The percentage has not changed greatly in that period of time; its been steady in the mid 70s%. The previous generation, I agree, did not pursue GS fellowships - they weren't as prevalent, and they weren't needed to find a good job.

Not to mention, with the swallowing up of private practices of General IM doctors by hospitals due to consolidation (due to increasing government regulations), it's nowhere near a guarantee that someone who is doing General Surgery in private practice will be able to stay in private practice.

Oh don't I know it. PP is no longer appealing to a large group of residents and its rapidly becoming a thing of the past. Our group has certainly been approached by MDS groups and hospitals to "assimilate" but we've refused so far. We wield enough power here locally to make that work in our favor (e.g., groups/hospitals who talk about hiring a breast surgeon are told that we will no longer refer to them, use their facilities, etc). But for how long we can sustain that remains to be seen as changes in coding/reimbursement and regulations make it increasingly difficult.

 

[balaguru]

Your evidence of "urology burnout" article is comparing surgical subspecialties in the private practice world vs. academic practice world. Try again

That's incorrect. Read more than just the title next time.

 

[DermViser]

You might have a point there - employers saw that they could get someone with additional training, market is as something special and therefore made positions which formerly did not require fellowship training (i.e., breast surgeon), require that as entry level. My point about the fellowship training is that while fellowships themselves are not new, neither is the pursuit of it. In our generation (i.e., 25 years), the majority of GS residents have pursued fellowships. The percentage has not changed greatly in that period of time; its been steady in the mid 70s%. The previous generation, I agree, did not pursue GS fellowships - they weren't as prevalent, and they weren't needed to find a good job.

Oh don't I know it. PP is no longer appealing to a large group of residents and its rapidly becoming a thing of the past. Our group has certainly been approached by MDS groups and hospitals to "assimilate" but we've refused so far. We wield enough power here locally to make that work in our favor (e.g., groups/hospitals who talk about hiring a breast surgeon are told that we will no longer refer to them, use their facilities, etc). But for how long we can sustain that remains to be seen as changes in coding/reimbursement and regulations make it increasingly difficult.

Yes, I think if anyone is best able to hold down the fort when it comes to maintaining private practice, it would be Surgery. This wouldn't be surprising as those in Surgery and it's sub-specialties have a lifelong skill and aptitude that is not easily replaced or encroached on by midlevels.

I am, however, shocked that PP is not appealing to residents, considering that Surgeons, personality-wise tend to be a largely independent breed personality-wise, in contrast to say Internal Medicine and its largely hospital-based subspecialties.

 

[Winged Scapula]

Yes, I think if anyone is best able to hold down the fort when it comes to maintaining private practice, it would be Surgery. This wouldn't be surprising as those in Surgery and it's sub-specialties have a lifelong skill and aptitude that is not easily replaced or encroached on by midlevels.

True; I would hope that we've learned from our Anesthesia colleagues about the encroachment of midlevels and are more protective of our field.

I am, however, shocked that PP is not appealing to residents, considering that Surgeons, personality-wise tend to be a largely independent breed personality-wise, in contrast to say Internal Medicine and its largely hospital-based subspecialties.

PP isn't as appealing because most view it as "more work", "unpredictable" (in terms of income), "no residents/have to do everything myself", and they aren't (at least in academic environments) exposed and mentored by PP surgeons. I would suppose the latter might be different in a community based program but I can tell you that many academic faculty have no idea about applying for jobs outside of an employed academic model, so are unable to serve as a mentor.

 

[DermViser]

PP isn't as appealing because most view it as "more work", "unpredictable" (in terms of income), "no residents/have to do everything myself", and they aren't (at least in academic environments) exposed and mentored by PP surgeons. I would suppose the latter might be different in a community based program but I can tell you that many academic faculty have no idea about applying for jobs outside of an employed academic model, so are unable to serve as a mentor.

The huge downside of course, is being told what to do and how to handle things by hospital administrators. And if ANYONE hates "the suits", more than IM doctors, it's Surgeons.

 

[vhawk]

Who is shocked that ent is more desirable than gensurg? And you genuinely believe the explanation for this preference is that gen Surg attendings are grumpier? The level of your analysis is truly inspiring.

 

[DoctwoB]

Who is shocked that ent is more desirable than gensurg? And you genuinely beleive the explanation for this preference is that gen Surg attendings are grumpeir? The level of your analysis is truly inspiring.

ENT is more desirable then gensurg relative to the number of spots. ENT has about 1/4 the spots of gensurg (or less), but also far fewer people choose to pursue it as a career. Is it thus "more desirable?"

 

[DermViser]

Who is shocked that ent is more desirable than gensurg? And you genuinely believe the explanation for this preference is that gen Surg attendings are grumpier? The level of your analysis is truly inspiring.

The ridiculous lifestyle of a general surgeon most likely leads the person to be more grumpy. As much as surgeons may try to believe that lack of sleep, etc. doesn't affect them, in anyway, it does and medical students see that.

 

[ram006]

The ridiculous lifestyle of a general surgeon most likely leads the person to be more grumpy. As much as surgeons may try to believe that lack of sleep, etc. doesn't affect them, in anyway, it does and medical students see that.

I dunno man, I've seen some pretty happy PP general surgeons. I think the ridiculous lifestyle refers more to the old school solo practice GS who lives across the street from the hospital. Some of the larger groups that split call make a boat load of money and take call no more than q 7. They of course have us schmuck residents to answer all their pages in the middle of the night though...

 

[DermViser]

I dunno man, I've seen some pretty happy PP general surgeons. I think the ridiculous lifestyle refers more to the old school solo practice GS who lives across the street from the hospital. Some of the larger groups that split call make a boat load of money and take call no more than q 7. They of course have us schmuck residents to answer all their pages in the middle of the night though...

Yes, but we're taking about residency selection by med students who usually rotate with academic general surgeons, not private practice, which is nowhere guaranteed esp. now with greater federal govt. encroachment.

 

[ram006]

Yes, but we're taking about residency selection by med students who usually rotate with academic general surgeons, not private practice, which is nowhere guaranteed esp. now with greater federal govt. encroachment.

True, but I would contend the academic lifestyle is even better. They certainly don't get bothered in the middle of the night. Our trauma service takes all emergent consults, including really sick bounce backs, and they have two layers of residents to screen the BS. They don't make as much money, but they are salaried and have us to do all their work for them (apart from all their academic administrative stuff).

 

[thedrjojo]

So far supposedly over 100 programs preliminarily enrolled (out of ~250 surgery programs in the country) - There is a lot of overlap between NSQIP hospitals and training hospitals, unsurprisingly.

So my program is in the study, and I heard rumors which arm of the study we are in

 

[thedrjojo]

Yup randomization happened and all the PDs know. We are pretty happy.

Which means for my pgy3 and 4 year we go back to the old style, and when I'm a chief (and the idiotic hope is to be an administrative chief) I get to figure out how to go back to the old rules... Splendid.

My program has so many interns next year (8 categorical, 10 non-designated prelims, and at least 12 designated that I can recall at this time)... We better not be short staffed anywhere... (we usually do 6 non-designated, so 4 additional interns + 24hr days for interns = profit)

 

[LucidSplash]

We're control.

 

[SLUser11]

True, but I would contend the academic lifestyle is even better. They certainly don't get bothered in the middle of the night. Our trauma service takes all emergent consults, including really sick bounce backs, and they have two layers of residents to screen the BS. They don't make as much money, but they are salaried and have us to do all their work for them (apart from all their academic administrative stuff).

I also thought the lifestyle in academics would be better, but I was wrong. As a young academic surgeon 2 years into practice, I'm busier than I've ever been in the past.

I have production goals/RVU targets just like PP surgeons, but I'm expected to meet these goals in a less efficient environment with much less ancillary support. By itself, this might be fine, but this clinical production must be balanced with the many other hats the academic surgeon wears: researcher, educator, administrator, committee member, editor/reviewer, etc. I have so many meetings each week, it would blow your mind. I have things I do for my society's journal that take 4+ hours a month, then manuscript reviews I do for journals that take another 5-6 hours a month, plus giving lectures and grand rounds to students/residents/doctors in other specialties for several hours per month...along with the preparation of these talks....and of course there is no direct reimbursement for this, or any decrease in my % FTE from it....it's just done for the love of the game.

In academics, the building of a surgeon's reputation is not only important in the local hospital to secure referrals, but also on the national level to establish expertise, etc. We are always thinking about promotion and tenure.

The hardest part, though, is balancing the clinical work with educating residents. We are expected to be efficient and productive, and our outcomes are scrutinized, but we are also tasked with teaching residents, which takes a lot of time and energy, and certainly affects outcomes. They may save me from a few phone calls, but otherwise having residents around certainly makes my life much harder. Of course, I wouldn't have it any other way.

Ultimately, I think less is demanded of you in academics, so you can slide along below the radar and collect your paycheck, but if you want to be a good, productive academician, you will likely work much harder than your PP friends. Many times I've thought to myself that if all I needed to do was see patients, operate, and then go home, I would have a wonderful lifestyle, as clinical work is not usually the stuff that keeps me here in the evenings.

 

[ram006]

I also thought the lifestyle in academics would be better, but I was wrong. As a young academic surgeon 2 years into practice, I'm busier than I've ever been in the past.

I have production goals/RVU targets just like PP surgeons, but I'm expected to meet these goals in a less efficient environment with much less ancillary support. By itself, this might be fine, but this clinical production must be balanced with the many other hats the academic surgeon wears: researcher, educator, administrator, committee member, editor/reviewer, etc. I have so many meetings each week, it would blow your mind. I have things I do for my society's journal that take 4+ hours a month, then manuscript reviews I do for journals that take another 5-6 hours a month, plus giving lectures and grand rounds to students/residents/doctors in other specialties for several hours per month...along with the preparation of these talks....and of course there is no direct reimbursement for this, or any decrease in my % FTE from it....it's just done for the love of the game.

In academics, the building of a surgeon's reputation is not only important in the local hospital to secure referrals, but also on the national level to establish expertise, etc. We are always thinking about promotion and tenure.

The hardest part, though, is balancing the clinical work with educating residents. We are expected to be efficient and productive, and our outcomes are scrutinized, but we are also tasked with teaching residents, which takes a lot of time and energy, and certainly affects outcomes. They may save me from a few phone calls, but otherwise having residents around certainly makes my life much harder. Of course, I wouldn't have it any other way.

Ultimately, I think less is demanded of you in academics, so you can slide along below the radar and collect your paycheck, but if you want to be a good, productive academician, you will likely work much harder than your PP friends. Many times I've thought to myself that if all I needed to do was see patients, operate, and then go home, I would have a wonderful lifestyle, as clinical work is not usually the stuff that keeps me here in the evenings.

It's actually pretty interesting to hear what it's like from the other side. Since I'm not there yet it's tough to really wrap my head around what being an attending is like. Great info. One of my co-resident go getter types actually sat in on a meeting with some of the hospital administrators regarding OR efficiency and it seems like the issues you brought up are a problem everywhere. I could see how that gets frustrating. I don't know if it's like this at your hospital, the hospital administrators seem to be pretty clueless about how academic medicine runs (or should at least).

 

[DermViser]

It's actually pretty interesting to hear what it's like from the other side. Since I'm not there yet it's tough to really wrap my head around what being an attending is like. Great info. One of my co-resident go getter types actually sat in on a meeting with some of the hospital administrators regarding OR efficiency and it seems like the issues you brought up are a problem everywhere. I could see how that gets frustrating. I don't know if it's like this at your hospital, the hospital administrators seem to be pretty clueless about how academic medicine runs (or should at least).

The #1 requirement to being a hospital administrator is to be clueless.