breast or surgical oncology fellowships vs. general surgery

[drduck]

Do physicians who go on to do a breast or surgical oncology fellowship have a better lifestyle? I love surgery and I know it's my calling but at the same time I'm a wife and mother and I'm wondering if doing a fellowship would allow a lifestyle that is a little more conducive to raising a family. If anyone could offer some advice, that would be great!

---

Members don't see this ad.

 

[Pilot Doc]

The short answer is yes. Surg onc and breast cases are nearly all elective and produce fewer emergent post-op complications. And depending on where and how you want to practice, you could easily establish yourself as a breast surgeon without any fellowship. (The more rural and private your practice, the easier it will be.)

There are a number of other case mix and practice setting choices that will allow a reasonable lifestyle in general surgery. They are worth looking into - they do exist but are not well represented at medical schools.

best of luck,

PD

 

[drduck]

Thanks for your reply. Do you know of any websites where I could get some information on other options?

 

[womansurg]

Originally posted by Pilot Doc
Surg onc and breast cases are nearly all elective and produce fewer emergent post-op complications.

True of breast, but not at all of surg onc. Many of the cases that a surgical oncologist would see are complicated, large resections which carry high risk of attendent complications. Surg onc is a busy, complex, emotionally and technically demanding field.

 

[droliver]

Depends on what kind of Oncology you do I think. Some of the Oncologist specialize in skin CA or Melanoma which is pretty low key for most of the patients (very morbid however for the more advanced ones though). The GI & visceral malignancy and sarcoma patients require pretty large operations & can be a lot of work & very morbid care

 

[Been there]

Surg-onc.......Hmmmmm....

The problem is every general surgeons do onc. Colo-rectal surgeons do onc. Liver surgeons do onc. Pancreas surgeon do onc. Well, it seem like the only body part left for the "surg-onc" surgeons are breast, melenoma, and soft tissue tumor (even this the ortho-onc guys might want to claim it). The one good part of a surg-onc fellowship is opening the doors to research and major academic jobs and cancer center positions. In a big cancer center, they are the surgeons that get to operate of all comers.

To get back to the original question, it seem like you will be better serve as a general surgeon. You can concentrate on breast surgery even without a "fellowhip". Most fellowship of that nature are not ACGME accreditated anyway. Many program directors actually call those pseudo-fellowship. General surgeons who concentrate on breast disease are doing very well financially, and their life style is second only to dermatologist. Sometimes even better.


good luck,

 

[drduck]

Thanks for the advice. I plan to practice in a small community anyway so I'm sure I could do breasts without a fellowship. Any suggestions for a good general surgery residency program in PA?

 

[Been there]

I think Kimberli is from PA. you should ask her.


If you have a family now, you might look into programs that are pro-family life. Unfortunitely, they tend to be community base programs. I am not saying that all university programs are not pro-family. It is just that many tends to push you into a lab for 2-3 years.


My other suggestion is about practice settings after residency, a small community may need and/or requires you to take gen-surg case and calls due to a lack of coverage. In order to be a breast surgery with no calls or mid night appys and butt pus, you may have to be in a metro area. Pick one that has lots of general surgeon coverage, but they all hate doing breast surgery. Believe me, there are overwhelming amount of Gen-surg that absolutely hate breast surgery.


Good luck

 

[Winged Scapula]

Originally posted by drduck
Thanks for the advice. I plan to practice in a small community anyway so I'm sure I could do breasts without a fellowship. Any suggestions for a good general surgery residency program in PA?

I would recommend you consider my program for a few reasons:

- we have a commitment to recruiting more females; this year 3/4 of our Categorical interns are female

- our PD is a Surgical Oncologist as is our Chair (with specific interst in Breast Surgeryand is very familiar with training fellowships for Breast and would be helpful if you were so inclined in that direction)

- the environment around Hershey is conducive to having a family

I don't know much about other PA programs, but would be willing to assist in anyway I can.

 

[droliver]

Originally posted by drduck
Thanks for the advice. I plan to practice in a small community anyway so I'm sure I could do breasts without a fellowship. Any suggestions for a good general surgery residency program in PA?

It sounds like a breast fellowship would be overkill. A lot of people are still scratching their heads over legitamacy of these new breast programs & what role they'll serve. Breast cancer is a pretty simple disease & the surgeries for it don't really require additional training. The superspecialty focus of the fellowships (radiation & brachi-therapy, hormone & chemotherapy, benighn breast pathology, reconstruction, etc...) is predominately done by other providers in most real-life settings. If you're not going to run a large breast center or do focused academic work, I just can't imagine how this will benefit most surgeons

 

[Winged Scapula]

Originally posted by droliver
It sounds like a breast fellowship would be overkill. A lot of people are still scratching their heads over legitamacy of these new breast programs & what role they'll serve. Breast cancer is a pretty simple disease & the surgeries for it don't really require additional training. The superspecialty focus of the fellowships (radiation & brachi-therapy, hormone & chemotherapy, benighn breast pathology, reconstruction, etc...) is predominately done by other providers in most real-life settings. If you're not going to run a large breast center or do focused academic work, I just can't imagine how this will benefit most surgeons

You know what they say...there's only two operations to learn.

A right and a left!

P.S. I agree with droliver. A female breast fellowship trained surgeon would wield a lot of job-bargaining power. However, for someone planning on working in the community and not at a big academic center, I don't see any reason to do the fellowship.

 

[ucsfer]

I'm in a similar situation - no kids yet but planning in the future and want to be able to spend some time with them. I don't want to be a breast surgeon, maybe surg onc but can easily see myself doing critical care. How's lifestyle after a critical care fellowship?

 

[jmattwilson]

One of my mentors is a fellowship trained breast surg. He has an awesome work schedule, no gen surg call. He only comes in when his patients have complications but they rarely happen. His salary is better than most of the younger gen surgs. All of his patients think the world of him. This goes for the surg onc docs as well. The only down side appears to be repitition and a defined patient group. For someone with the concerns of the original poster this could be an excellent field.

 

[Docgeorge]

Do fellowship trained brest surgeons do reconstructions after surgey for BCA?

 

[jmattwilson]

Do fellowship trained brest surgeons do reconstructions after surgey for BCA?

Our two breast surgeons do not do reconstructions. The plastic team usually comes in and takes over when the mass/breast is removed.

 

[Winged Scapula]

Do fellowship trained brest surgeons do reconstructions after surgey for BCA?

None of our breast surgeons do the reconstruction - its done by the Plastics team and friends who have done Breast fellowships state that they were not trained in this procedure.

 

[droliver]

Do fellowship trained brest surgeons do reconstructions after surgey for BCA?

There are financial reasons why this will never catch on. Your reimbursements for subsequent procedures after the primary one is paid pennies on the dollar by insurers & the feds. It's the reason why you see for instance a surgical oncologist consult a plastic surgeon within the same multi-specialty group for something like a skin graft after a melanoma removal. The plastic surgeon can bill the skin graft as a seperate primary procedure & collect more. A peer of mine did surg-onc @ Memeorial-Sloan kettering & said from time to time the surg-onc guys there would put their own tissue expanders in because the plastic surgeons were too busy with the larger reconstructive cases to cover all of them, none of them would have attempted a TRAM or some of the other reconstructive procedures which can run many hours long.

 

[Paulista]

reconstructive breast surgery post-mastectomy is done exclusively by Plastic Surgeons because it requires training in flaps using latissiumus dorsi muscles.

Many General Surgeons actively practice Breast Surgery as part of their scope.

My question was always on how to detect breast Cancer or significant Lump in patients with prior breast implant procedures???

The other issue is Surgical Oncology is a lot more intense than Breast Surgery. Since, Surgical Oncologist in their majority are very academic oriented. The peer review in Surgical Oncology is very strict and competitive in a way.

The Surgical Oncologist's perspective of cure is sometimes 3 more months of survival for patients with very poor quality of life issues.

The biggest issue would be learning all the stages which changes time to time according to new criteria.

 

[FliteSurgn]

reconstructive breast surgery post-mastectomy is done exclusively by Plastic Surgeons because it requires training in flaps using latissiumus dorsi muscles.

Many General Surgeons actively practice Breast Surgery as part of their scope.

My question was always on how to detect breast Cancer or significant Lump in patients with prior breast implant procedures???

The other issue is Surgical Oncology is a lot more intense than Breast Surgery. Since, Surgical Oncologist in their majority are very academic oriented. The peer review in Surgical Oncology is very strict and competitive in a way.

The Surgical Oncologist's perspective of cure is sometimes 3 more months of survival for patients with very poor quality of life issues.

The biggest issue would be learning all the stages which changes time to time according to new criteria.

Huh? I have to admit that I don't understand most of this post.

Breast reconstructions are not that hard. Flaps take some experience, but first stage breast reconstructions with expanders are easy. To be honest, I did more reconstructions during my residency than I did mastectomies. The reason that general/breast/oncologic surgeons don't do them routinely is the exact reason that droliver stated. You don't get paid for them if you did the mastectomy. Why do them when you can let someone else do them so that they can actually get paid for the procedure?