Best Surgical Fields

[emlopez2]

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So I know when it comes right down to it, this question is probably more of a personal opinion, but can anybody give me a little more insight on what surgical fields are great and which ones to probably stay away from.

 

[LGMD]

Great post. What about vascular?

 

[dynx]

CT, anybody who tells you otherwise is a sissy.

 

[Castro Viejo]

Vascular Surgery hands down the best.

 

[emlopez2]

Thanks for the responses and all but can anybody give me a few reasons why they think their field is better than the next?
Work hours, pay, residency time, lifestyle, job satisfaction, any explanation would be great.

 

[dilated]

Something I'm curious about is how much emphasis people put on the actual cases you do (versus patient population, reimbursement, lifestyle, etc etc). Is it commonly the case that you found a lot of other surgical areas kind of boring but then found one where you just loved the cases or is it more like "I like GS and uro cases about the same but I like the day to day of uro more"?

 

[Blake]

Having rotated through/been exposed to ortho, neurosurgery, CT, ENT, GS and urology, I'd say neurosurgery wins it hands-down for ''just plain awesome'' field. Why ? To me, nothing got close to aneurysm surgeries (open or endovascular), AVM resection (like an attending said, it's like disarming a bomb. Cut the wrong wire/vein and it's game over), epilepsy surgery and complex spine instrumentation+fusion. Besides, it was fun examining neuro patients, reading their CT/MRI/angios as best as I could, and reading the basics of neurosurgical approaches and learning about the pathologies. I had a great time during my neurosurgery rotations. Besides, I just NEED to work with operating microscopes and cool high-tech toys for a living... That's just me though.

I thought CABGs were pretty cool too in CT, but not as bad-ass. Besides, the field isn't in the greatest position right now for reasons mentioned ad nauseum. GS didn't really wow me too (granted, most of the stuff I saw was appendectomies and cholecystectomies). I also didn't really dig the ''relative'' lack of extreme precision required in GS (sometimes, it felt like whether the attending cut an extra 5 inches of colon or not, it wouldn't really change anything.) This is somewhat of a naive med student perspective, but I'm telling it like it was for me. Great thing about GS though : those guys are quite complete docs.

Ortho had the coolest residents/staff, although 5+ hours of outpatient clinic every single day was enough for me to say no to the field, at least at my program. Bones and muscles bored the hell out of me too, and you couldn't pay me enough to go through a grueling residency learning stuff I'm not passionate about. Good prognosis for most cases though, and you can really see the ''before surgery'' and ''after surgery'' progress/improvement. And while I'm not a fan of internal medicine, I wouldn't mind checking on more than just hemoglobin level when completing notes (granted, IM was involved with those patients, but still).

I won't name the not-so-great field for fear of internet retaliation by hordes of angry SDNers, haha.

My worthless 2 cents (not a resident yet).

 

[Dr JPH]

So I know when it comes right down to it, this question is probably more of a personal opinion, but can anybody give me a little more insight on what surgical fields are great and which ones to probably stay away from.

I think this is incredibly hard to answer. You need to find the field that best fits you, your desired lifestyle and one that will offer challenges.

For some its gen surg, others ortho and still others want the uber-crazy pediatric neurosurgery.

For me vascular doesnt excite me. For others its all they want to do.

So for me...which are great? Any specialty where you dont have to get out of bed before 5am and weekends are for rowdiness, not rounding. 👍

 

[NDESTRUKT]

I think this is incredibly hard to answer. You need to find the field that best fits you, your desired lifestyle and one that will offer challenges.

For some its gen surg, others ortho and still others want the uber-crazy pediatric neurosurgery.

For me vascular doesnt excite me. For others its all they want to do.

So for me...which are great? Any specialty where you dont have to get out of bed before 5am and weekends are for rowdiness, not rounding. 👍

and....which surgical specialty would that be =)?

 

[BlackSails]

and....which surgical specialty would that be =)?

Dental Surgery

 

[Castro Viejo]

and....which surgical specialty would that be =)?

"Dermatological Surgery."

 

[NDESTRUKT]

Oh you mean fake surgery?

 

[kaos]

Trauma surgery of course. 😎

 

[Dr JPH]

and....which surgical specialty would that be =)?

I havent invented it yet.

 

[Winged Scapula]

As you can see, there are as many opinions as there are *&*^^.

While I hated Neurosurg, others love it. When my Vascular attending told me at my Chief's dinner that should I change my mind, I should go into Vascular, I replied that I'd rather poke my eyes out with hot sticks ("but thank you for the compliment, Sir!" 😉 )

Of course, many would feel the same about my field of choice - but for me, its the right one.

 

[TheThroat]

I think this is incredibly hard to answer. You need to find the field that best fits you, your desired lifestyle and one that will offer challenges.

For some its gen surg, others ortho and still others want the uber-crazy pediatric neurosurgery.

For me vascular doesnt excite me. For others its all they want to do.

So for me...which are great? Any specialty where you dont have to get out of bed before 5am and weekends are for rowdiness, not rounding. 👍

So true, so true. How 'bout Oto:

Plusses:
-pretty good lifestyle. At the OR at 6:45 to 7 am two days a week, otherwise at the office by around 7:30. Leaving for home around 5 to 5:30 most days (traffic blows, though). Round on the weekends maybe once a month. Get called into the hospital about two to three times a month (I take call q 7 for my ER).
-real surgeries. Don't let "real" surgeons tell you that oto doesn't do real surgery. As a general oto, routinely do thyroidectomies, parotidectomies, neck dissections, and occasionally do more crazy stuff like a total laryngectomy, maxillectomy, or glossectomy. Of course, I also do "fake surgery" like endonasal sinus surgery, tubes, tonsils, and micro-laryngeal and ear surgeries, even though it make be "real" to me (3 to 4 hours to do a good mastoidectomy).
-Pretty good pay, but not any better/worse than most other surgical subspecialties.

Minuses:
-Clinic: I only operate about a 1 and half days a week. That means that I am in clinic more than most general surgeons. If you hate clinic, don't do oto. That said, most H&N cancer surgeons have more OR and less clinic than I do, as well.
-Snot/ear wax/trach butter: if you hate these things, but love poo/butt puss/diabetic feet/the penis/the woman nethers, go into g-surg/vascular/uro/ob.

 

[adismo]

and....which surgical specialty would that be =)?

Acting!!

 

[MWK]

Sterile fields are best.

 

[NDESTRUKT]

If I could only be as cool as Turk.

 

[surgwannabe]

MIS in premature infants: long-lasting instant gratification (although long and complicated procedures)

 

[BurnOnMyYeeeow]

I asked my research PI when I was in the lab.

He said, if you want lifestyle, nothing beats having an empty waiting room to give you all the time to do other things you could ever want.

Someday they'll find a way to melt away every cancer with some kind of shot. Look what H2 blockers did to gastric surgery.

Things that aren't going away anytime soon:

1) People are always gonna get hit by cars, get shot, fall off ladders.
2) People are always gonna want an even more minimal surgery. In my day, it was laparoscopic. Now they're working on natural orifice surgery.
3) People are always going to have hemorrhoids.

🙂

 

[Guile]

As you can see, there are as many opinions as there are *&*^^.

While I hated Neurosurg, others love it. When my Vascular attending told me at my Chief's dinner that should I change my mind, I should go into Vascular, I replied that I'd rather poke my eyes out with hot sticks ("but thank you for the compliment, Sir!" 😉 )

Of course, many would feel the same about my field of choice - but for me, its the right one.

People either love (njbmd) or hate (yourself, for example) vascular surgery? Why is that? What about it parts the waters so decisively?

 

[Pilot Doc]

People either love (njbmd) or hate (yourself, for example) vascular surgery? Why is that? What about it parts the waters so decisively?

The defect in vascular surgeons in believed to reside in the short arm of chromosome 12, but further work is needed to fully describe the phenomenon. Unfortunately, there is no known treatment for the syndrome. Both liver transplant and ECT, though promising, have failed in clinical trials.

 

[Winged Scapula]

People either love (njbmd) or hate (yourself, for example) vascular surgery? Why is that? What about it parts the waters so decisively?

Something about the fem-pop, fem-flop, fem-chop algorithm perhaps!

Don't get me wrong...I like doing vascular anastomoses, BUT...

- the patients are often very ill - pre and post op; I prefer generally healthy patients
- the work can be tedious and time-consuming; I'd much rather do 8 1 hr cases in a day than 1 8 hr case
- the work sometimes fails and has to be redone, or simply chopped off; I rarely have to go back to the OR and then its for positive margins and the case is quick
- the call can be miserable; its gotten better with IR's help, but cold legs in the middle of the night ain't my idea of fun. I have little to no emergencies which require my coming in in the middle of the night
- some people object to operating on patients who are, at least, partially responsible for their disease through smoking and bad eating habits; my patients are either the product of a gene mutation or bad luck.

As for why some like it, I think Pilot Doc is on to something...obviously its some sort of gene misarray!

 

[Guile]

Something about the fem-pop, fem-flop, fem-chop algorithm perhaps!

Don't get me wrong...I like doing vascular anastomoses, BUT...

- the patients are often very ill - pre and post op; I prefer generally healthy patients
- the work can be tedious and time-consuming; I'd much rather do 8 1 hr cases in a day than 1 8 hr case
- the work sometimes fails and has to be redone, or simply chopped off; I rarely have to go back to the OR and then its for positive margins and the case is quick
- the call can be miserable; its gotten better with IR's help, but cold legs in the middle of the night ain't my idea of fun. I have little to no emergencies which require my coming in in the middle of the night
- some people object to operating on patients who are, at least, partially responsible for their disease through smoking and bad eating habits; my patients are either the product of a gene mutation or bad luck.

As for why some like it, I think Pilot Doc is on to something...obviously its some sort of gene misarray!

I can definitely see those points. So then why do some people love vascular surgery, other than those who like sicker patients?

 

[Winged Scapula]

I can definitely see those points. So then why do some people love vascular surgery, other than those who like sicker patients?

Because they like taking care of critically ill patients.

Because they don't find the work tedious and aren't bothered by the long cases or not uncommon need to go back to the OR.

Because while they don't love call, they aren't as bothered by it as the rest of us.

Because they are lunatics.😉

Who knows why people like certain fields and others don't? Its like asking why one person prefers blondes and the other brunettes, or chocolate over vanilla or surgery over pediatrics. I have several friends who wouldn't even consider doing what I'll be doing and I wouldn't trade places with them. Given your screen name, I might assume you like Anesthesiology - why? I'll bet you we'll come up with reasons why we don't like it.

 

[Guile]

Given your screen name, I might assume you like Anesthesiology - why? I'll bet you we'll come up with reasons why we don't like it.

Actually not. No gas for me. I actually really want to do CT surgery, despite the naysayers. I just thought it was a cool screenname. 🙂

There are always reasons why people like certain fields. Thanks for fleshing out why people like vascular surgery. (I just don't have any experience in it except seeing some TAAA repairs and endarterectomies which were done by CT surgeons.) I like CT surgery because I like sicker, older patients. It's got a good mix of fine suturing (CABG) and work on a larger scale (lobectomies, valve replacements where you don't need the 4.5x loupes, etc.) You operate A LOT. (I'm shooting for as high an OR to clinic ratio as possible.) And finally, there's nothing like cracking a chest. 😀

But who knows--I'm so early in the game now that anything is possible...except medicine. 😉

 

[Winged Scapula]

And finally, there's nothing like cracking a chest. 😀

Want real chest crackin' action? Go into Trauma...makes those CTS with their saws look like wimps!

 

[Guile]

Want real chest crackin' action? Go into Trauma...makes those CTS with their saws look like wimps!

A trauma surgeon once told me, upon hearing that I wanted to do CT surgery, that if I wanted to REALLY sew hearts, I should go into trauma--they sew them while they're beating. I suppose that doesn't apply to off-pump CABGs though. 😉

 

[Tigger14]

I am starting a vascular surgery fellowship in July.

1. A lot of people don't like vascular because they are sick patients. I love critical care, but doing a critical care fellowship and ICU coverage usually means a severely diminished operating schedule. Vascular is a great combination of sick patients who need surgery... from you.

2. Also, most of them do very well. There are jokes around about repeat operations and ultimate amputation, but that is not the rule. In all specialties there are frequent fliers; vascular is no exception.

3. It is delicate surgery, so your skills will have to be really good... vascular anastomoses do not tolerate rough handedness.

Having said that, I love endo and open surgery.

Because they like taking care of critically ill patients.

Because they don't find the work tedious and aren't bothered by the long cases or not uncommon need to go back to the OR.

Because while they don't love call, they aren't as bothered by it as the rest of us.

All true...

Because they are lunatics.

Very funny...🙄

 

[Skylizard]

A trauma surgeon once told me, upon hearing that I wanted to do CT surgery, that if I wanted to REALLY sew hearts, I should go into trauma--they sew them while they're beating...

Not to insult trauma surgeons.... I have great respect for their very broad scope of practice. Some of my best mentors have and are trauma surgeons....

But, trauma surgeons are not experts in heart surgery and their scope is not predominantly hearts. There are numerous level I trauma centers. However, among level I centers there are a smaller number that actually have any real volume of thoracotomies and chest cases. You also need to consider the success rate with traumatic chest cases.

Long winded, bottom line, go to trauma for the broad scope and and be sure you know the "bread & butter" of that specialty or any other specialty you choose. Also, you need to be sure about where you want to live because the procedures you want in a specialty may dictate where you have to practice to see those cases. If you want a trauma practice with high volume penetrating chest wounds, you will need to be working (and living) in specific communities.

 

[Guile]

Not to insult trauma surgeons.... I have great respect for their very broad scope of practice. Some of my best mentors have and are trauma surgeons....

But, trauma surgeons are not experts in heart surgery and their scope is not predominantly hearts. There are numerous level I trauma centers. However, among level I centers there are a smaller number that actually have any real volume of thoracotomies and chest cases. You also need to consider the success rate with traumatic chest cases.

Long winded, bottom line, go to trauma for the broad scope and and be sure you know the "bread & butter" of that specialty or any other specialty you choose. Also, you need to be sure about where you want to live because the procedures you want in a specialty may dictate where you have to practice to see those cases. If you want a trauma practice with high volume penetrating chest wounds, you will need to be working (and living) in specific communities.

LS

He said it with a smile. He was just joking.

Also, we were at a level I trauma center with a really high percentage of penetrating trauma. I think I saw three ER thoracotomies that summer. (All died...I think the mortality is about 90-95%.)

 

[Skylizard]

He said it with a smile. He was just joking...I think I saw three ER thoracotomies that summer. (All died...I think the mortality is about 90-95%.)

I was pretty confident it was in jest. I just posted my comments because... I have learned these forums are often read, misread, and occassionally misunderstood by young med students trying to choose a future career.

I always encourage students to not get sucked into any single field based on the exciting "ZEBRA" they saw during their rotation. look at the true bread and butter of any field. I like surgery.

 

[Guile]

You offer very good advice. Fortunately I was there long enough to get a good feel of the bread and butter (which felt like ab washouts and trach/PEGs), so I wasn't misled to think that if I did trauma, I would cross-clamp aortas and sew beating hearts on a daily basis. But I do like the bread and butter of CT surgery--CABGs and valves, plus a fair amount of thoracic surgery that I didn't get to see as much of: lobectomies, etc.

 

[Skylizard]

...I do like the bread and butter of CT surgery--CABGs and valves, plus a fair amount of thoracic surgery... lobectomies, etc.

Me too😀

 

[PreMedDocMD]

Which specialty has the most variaty of cases?

 

[chael]

plastic surgery has the most variety (hand, craniofacial, cosmetic, microsurgery, breast recon, etc), requires the most skill (microsurgery), and offers a lot of leeway in terms of what kind of practice you want. the surgeries are cool as hell, and the field is constantly and rapidly evolving.

 

[Winged Scapula]

Very funny...🙄

Thanks. I'm here all week! 😀

 

[Tigger14]

Thanks. I'm here all week! 😀

It's alright. I did research in breast surgery, and when our breast surgeon asked why I was not doing a breast fellowship, I told her I do not like blob surgery. She laughed, and still pokes fun at me when we do a breast case together! 🙂

 

[NDESTRUKT]

How hard is it to get a fellowship in breast? I mean do you have to do a lot of research during residency to get into a breast fellowship?

 

[Winged Scapula]

How hard is it to get a fellowship in breast? I mean do you have to do a lot of research during residency to get into a breast fellowship?

It hasn't reached the point of being research required except for perhaps at some of the real big name, academic programs which are geared towards training academic surgeons (MD Anderson, Sloan Kettering, Farber). If you are planning a career outside of big league academics, you don't want to do to those places anyway (as you currently will not be trained in many of the core procedures needed for practice).

The last two years have had more applicants than positions - 16 I believe went unmatched last year and there is a two year moratorium on new fellowships opening by the SSO.

I don't know most of the applicants who didn't match and obviously different programs are looking for different things but I would imagine the following to be true:

1) if you are using the fellowship as a step toward getting into plastics, it will be frowned upon. Most want to train people who want to do full time breast surgical oncology (so either be a good actor or change the subject if it comes up)

2) you must show evidence that you can communicate well with others; it is a practice which spends a lot of time in the office. If you come across as abrasive, uncommunicative or insensitive, it will likely be held against you

3) you must be able to delineate why you are interested in breast surgery; it is more than the surgery of "blobs" but it is much more limited in scope than many general surgical practices. You must be able to answer why you are interested in the field.

4) you need to present a polished facade; for some reason, many of the programs include physical appearance as part of the scoring system. You can be ugly but please wear a nice suit and shower beforehand! 😉 The factor is based on the large office component and ability to present oneself well.

5) if you have relevant research, all the better, especially now that its getting more competitive

6) have a sense of what you want to do in the field - academics vs community practice vs opening a breast center, etc.

 

[Winged Scapula]

It's alright. I did research in breast surgery, and when our breast surgeon asked why I was not doing a breast fellowship, I told her I do not like to do blob surgery She laughed, and still pokes fun at me when we do a breast case together! 🙂

The blob surgery is the least fun part of it for me...I like sentinel nodes the best, followed by axillary dissection and then modified radicals. But the excisonal biopsies and other blob surgeries are the major portion of your OR cases.😀

 

[TheMightyAngus]

Do most people go into general surgery already with a good sense of what kind of fellowship they plan to pursue?

I just started my gen surg rotation. Many of the residents have their eyes set on plastics. A few of them didn't get into integrated programs, so will be applying independently. Others are interested in vascular, colorectal, etc. I haven't met anyone yet who is undecided. All seem sure about what they want, even the interns. Typical?

 

[Winged Scapula]

Do most people go into general surgery already with a good sense of what kind of fellowship they plan to pursue?

Probably not.

I just started my gen surg rotation. Many of the residents have their eyes set on plastics. A few of them didn't get into integrated programs, so will be applying independently. Others are interested in vascular, colorectal, etc. I haven't met anyone yet who is undecided. All seem sure about what they want, even the interns. Typical?

Probably. But like medical students many may change their minds. I know very few of my co-residents who did not change their minds during residency about which fellowship to pursue:

my ex went from Plastics to Trauma
another friend went from Peds to Transplant
another from Peds to Colorectal
yet another from Colorectal to Surg Onc
one from Trauma to Surg Onc

and so on...

Some may know and end up doing that specialty, but I'll bet there are several others than find reasons not to pursue what they started out doing.

 

[rox]

What's trauma surgery like? Do they see outpatients? Do they operate outside the abdomen and chest, like on bone , head & spine, urogential tract injuries?

Is it the worst lifestyle among general surgery fellowships in terms of night calls and so on?

Thanks!

 

[Castro Viejo]

What's trauma surgery like? Do they see outpatients? Do they operate outside the abdomen and chest, like on bone , head & spine, urogential tract injuries?

Is it the worst lifestyle among general surgery fellowships in terms of night calls and so on?

Yes, there's an outpatient practice to Trauma.

Trauma is evolving nowadays. It's not only partly trauma coverage, but also surgical critical care, presently. In the future it's probably going to add on the responsibilities of "acute care surgery," which is any urgent case that needs to go in the overnight period where the general surgery guys would rather sleep (an increasingly common phenomenon, especially in the community).

Trauma surgeons today almost invariably have a General Surgery practice on the side as well, as many of them want to keep up with their operative skills (though many are poor due to the lack of operative experience as an attending).

While trauma and general surgeons are trained somewhat for simple head things, like burr holes and the like, and can probably fix most common GU injuries, I don't think many would be willing to do it in the modern era of malpractice-minded practices. Generally trauma will occur to the chest and belly, but can involve the extremities and head/neck. Anything urgent the trauma surgeon can and will try to fix. They might even perform an vascular anastomosis every now and then (they're not pretty, but they work).

As for fellowship calls, it's not any worse than general surgery resident call so most don't complain about it. It tends to be in-house overnight kind of call rather than home call for most types of fellowships (except for CTS residency). One of my former Chiefs is doing a trauma fellowship where he does 1 in 3 call in-house overnight with attending privileges in trauma and in general surgery. As a result he has his own general surgery "practice" that runs out of the main faculty practice, bills for the faculty practice, and does most things on his own. It's actually quite neat. Too bad he gets shafted with the salary, but such is the life of the training doctor.

 

[Dr.Millisevert]

How about Maxillofacial surgery? There are a growing number of programs in the US and overseas that are taking medical school graduates and offering them a combined (Dental degree and Maxillofacial surgery training) program. US programs that consider medical graduates that come to mind are (Mich, Kentucky, Virg, Baylor, Columbia, UAB, and others).

If you find yourself interested in plastics, but are only interested in the craniofacial cases.. and also have an interest in ENT. Then I would suggest you at least do a short attachment with a Maxfacs surgeon and see what it is like. (PM me if you are interested and I can refer you to good programs). 👍

 

[dilated]

How about Maxillofacial surgery? There are a growing number of programs in the US and overseas that are taking medical school graduates and offering them a combined (Dental degree and Maxillofacial surgery training) program. US programs that consider medical graduates that come to mind are (Mich, Kentucky, Virg, Baylor, Columbia, UAB, and others).

How long are they? Are you actually qualified to practice dentistry afterward too, or just OFMS (and would you ever want to)?

 

[toofache32]

How long are they? Are you actually qualified to practice dentistry afterward too, or just OFMS (and would you ever want to)?

4 or 6 years for dental grads, 6-7 years for MD grads. You will be practicing dentistry because OMFS is a dental specialty accredited by dental governing bodies and you get mainly dental referrals in private practice. The MD is optional...less than half of the programs offer it.

 

[Castro Viejo]

4 or 6 years for dental grads, 6-7 years for MD grads. You will be practicing dentistry because OMFS is a dental specialty accredited by dental governing bodies and you get mainly dental referrals in private practice. The MD is optional...less than half of the programs offer it.

I think the question was for the MDs interested in the OMFS programs that may or may not offer a DDS/DMD.

Six to seven years to practice OMFS? It ain't brain surgery, is it? 🙂