Career Advice - General Surgery or Surgical Subspecialties?

[undecided2008]

I am 3rd year medical student interested in a career in surgery. Although this is naive, I think my dream job would be minimally invasive surgery or plastic surgery. I understand to to get to this endpoint, I have to go through general surgery. I know there are integrated plastic programs but I really don't think I'm a qualified applicant for it. The problem I am having is everyone and their mothers tell me not to do general surgery. I hear comments like general surgery is dead' or 'go into ortho' or 'general surgery is not what it used to be.' I am good student and I would make a competitive candidate for things like ortho, ent. nsurg, etc. So I am tempted to consider those things for their demand, financial lucrativity, and good lifestyle. I eliminated a lot of these fields for the following reasons I will discuss. I am wondering if my reasons are stupid and I should just suck it up and enter these lucrative/lifestyle professions and sacrifice the cool endpoints of a demanding and supposedly demoralizing general surgery residency. I really don't mind working a lot and money isn't that important to me. I think any man/family can live very very comfortably with a $180,000 a year -- any more just leads to spoiled children and mo' problems. So please tell me if my reasons for eliminating these popular fields are valid and not just psychological and stupid:

1) Anesthesia - I had a rotation in this and the whole time I was looking over the shield at the surgery instead. There's no way I can do this obviously.
2) Cardiology - I liked learning about heart pathophys the most. Interventional is very appealing but I don't want to go through internal medicine training. I also consider interventionalist a dream job but the pathway to get there is too long and boring. In internal medicine, every patient is a damn anion gap and labs, etc. Cardiology may be interesting but I really don't want to manage patients -- I want to cure them. This immediate satisfaction is what attracts me to surgery and precludes medicine. Interventionalists 'cure' but the entire pathway is management and that would bore the hell out of me.
3) Derm -- Skin is dead boring. Don't you think??
4) GI -- Diseases are boring. There is no cure or etiology for 1/3 of all patients. Its all diagnosis and management -- very little curing going on.
5) Neonatology-- The idea of playing God with very young babies is a rush but who wants to go through pediatrics to get there?
6) Optho - Don't want to specialize in eyes and forget the rest of the body. Honestly I see this as a feminine field for some reason. But that photocoagulation surgery is pretty amazing.
7) Ortho - procedures seem cool but i'm not really that 'mechanical.' I couldn't build a bookself if you asked me to. It seems to be all nuts and bolts and screws and I don't have that type of dexterity at all. Ortho is the most popular field amongst top students in my school so I am really tempted to check it out. But bone disease are so damn boring and like i said, i don't want to be a car mechanic working with nuts and bolts for the rest of my life. I am interested your opinions on this field more than others.
8) ENT -- procedures are amazing but I absolutely don't understand the anatomy above the clavicle. Neuroscience/anatomy was also my weakest subject.
9) Radiology - who wants to look at pictures their whole livss? I don't like the lack of patient responsibilty and interaction. I also had a ton of trouble in anatomy with the x-rays and ct scans. IVRads is nice but the 5 year training looking at pictures has nothing to do with fixing an aneurysm in the brain.
10) Urology - lucrative and 'special' but erectile dysfunction, BPH, prostate cancer...boring!
11) Neurosurgery -- I don't understand the CNS at all. No way.

So these are my reasons. I am worried I am thinking too much about how these subjects are from a basic science point of view and disregarding the importance of how they are in a clinical day-to-day aspect. For example, for ENT, is a fear of anatomy or the boringness of the diseases good enough reasons or am I just being immature? Does anyone have any idea what I mean??

Thanks.

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[automaton]

i agree with a lot of things you mentioned on the list but honestly is general surgery that much better? if you want to make 180,000 a year then you can go into family practice, join a small group and work maybe 4.5 days a week. or you can have a nice private practice in psych and make a similar amount with similar lifestyle. you can do pm&r and possibly make more for probably less work.

just saying that you shouldn't discount those other specialties too much. it's easy to rationalize when you have one goal in mind. however if you do general surgery you can definitely have an easier lifestyle by working at the VA or for an HMO and make similar to the 180k range. if you do MIS lifestyle will be good and you'll make a ton, especially if you are part of an outpatient surgery practice.

i would also consider ortho more. you can scope the knee and replace hips over and over and over and rake in all the cash. it can be dope.

 

[sscooterguy]

First of all, its ok to be undecided. Go into every specialty with an open mind. My opinion changed dramatically based on hands on experience, not preconcieved notitions.

You mentioned that you don't think you are a candidate for straight plastics, but would be competative for ortho and neurosurg? Yes the 5 year plastics programs are incredibly competative, but so are ortho and ns, if you truely as you say are in reach of these two, with most of your 3rd year ahead of you, you can do research and try for plastics.

By the way, the ways to get into board certified plastics that I know of are (and they are all very competative to get into):
Get into a 5/6 year plastics program
3 years of gen surg and then enter into 2-3 year plastics fellowship
Complete Ortho or ENT training and do plastics fellowship

No matter what specialty you go into, there will be patient managment with fewer cures, except in certain fields like maybe sports ortho and ophtho. Even in those specialties, a lot of the surgery is palliative, performed to moderately improve symptoms/function, to slow down disease - not all of it is outright cure.

What do you want to do with minimally invasive surgery? There is gonna be minimally invasive techniques for most surgical specialties (from knee scopes, boob jobs, certain spine surgery, Roux en y, etc). I think the fellowships available at my institution for minimally invasive are exclusively for GI though.

I guess my advice is to go talk to as many people as you can during your 3rd year to get their view of their own specialty, especially specialists and fellows. Your preconcieved opinions may be wrong. Good luck.

sscooterguy

 

[undecided2008]

thanks for these interesting advices. i admit i am stuck in preconceived notions -- its almost like a mind block.

its just that before med school, i never really even heard of ortho or ENT. i think i always just wanted to be a big bad surgeon working on the core of the body, not with bones and sinuses and tympanic membranes! that's just not what anyone dreams of as a kid.

like i said, i'm open to your criticisms and advices. anything that can help me think objectively. medicine is changing so quickly and surgery is an unstable as it gets. i don't want to make the mistake of going into an already unstable field of medicine and enter the least brightest field of 'general surgery' when its clear a lot of these other subspecialties have some amazing innovations and really seem to be going forward.

i guess the core of my question really is why do people choose general surgery if they are bright students that can also compete for surgical subspecialties? what makes you love 'general surgery' or its endpoints over ortho or ENT? just hearing how some of you gen surg residents rationalize this can really lessen the confusion for me.

thanks.

 

[Knight_MD]

I guess I'm exactly where u r considering many of the things u said.

I like the immediate satisfaction of curative surgery, and that's what's throwing me in this direction. I've also heard MILLIONS of times... "Don't go into General Surgery"... "GS is not what it used to be"... "No more patients..." etc..

And what I see is, Gen Surgeons are getting so empty handed, they've started taking Nephrolithotomies from Urosurgeons, Hysterectomies from Obs&Gyna, and Liposuctions from Plastics... while I agree the latter is debatable, it still isn't a good indicator to how well things are going for General Surgery.

Laparoscopy is the only thing that's strongly pushing me towards GS, but at the end of the day, everything is directing me to Urology, including Laparoscopy.

If only they didn't have the male genital disorders in their scope.

Cruise around in all specialities till u find "ur place", where u feel most comfortable. Don't forget that this is what ur most probably gonna be spending the rest of ur life doing, so keep money out of ur calls, specially if all lie -more or less- within the same pay scope.

 

[Plastikos]

Couldnt read your book, but if you think you like surgery your going to have to learn to make it succint.
EOM

 

[wexy]

what about fellowships after gen surg? Cardiothoracic, Transplant, Peds, Vascular, Breast- all incredible fields, just a very long road.

 

[Catalyst]

Couldnt read your book, but if you think you like surgery your going to have to learn to make it succint.
EOM

HAHAHAHA

 

[undecided2008]

being succint is good advice, but i am trying to get an important point across..

honestly, it really seems to me people go into gen surg just b/c they can't get into ortho. my school's match last year and current trends favoring surgical subspecialties supportthis thought. it really does seem like general surgery is dead and the only reason someone would dare choose it is to try for plastics later -- and this only b/c he wasn't a good enough candidate to do integrated plastics out of med school.. i hope you understand what i'm trying to say and why i decided to write a book on this.

if there's any GS residents out there, please, i am terribly curious what you guys have to say about this issue. it is sad but it is true: general surgery is considered second rate to ortho/ent. the discrepancy of the candidates is immense. if you were a good candidate for ortho/ent, how did YOU ratioanlize going into GS? the lack of responses just goes to show that good candidates don't even bother going into GS in the first place.

 

[undecided2008]

If only they didn't have the male genital disorders in their scope.

I appreciate your candor on this issue. I know when you were a kid, you never thought in a million years you would be resecting prostates for a living -- i bet you didn't even know what a prostate was -- i know i didn't. but i like how you rationalize this with your interest in laporoscopy and the undeniable fact that urology has the hihgest career satisfaction rates.

i just wish these GS residents would clarify their interests as well

 

[Knight_MD]

I actually don't mind the Prostates at all Easy, extremely common, many different appraoches, and a lifestyle changer all in one.

I don't mind the scrotum either..

It's the penile disorders and male sexual dysfunction that I find highly irrelevant to Urology as a whole... but it comes with the package.

 

[Blade28]

honestly, it really seems to me people go into gen surg just b/c they can't get into ortho.

What?

There's a huge difference between ortho and many of the surgical subspecialties - plastics, peds surg, vascular, surg onc, transplant, breast, laparoscopic, etc. Lots of residents are in G Surg to pursue one of these fellowships.

 

[sscooterguy]

being succint is good advice, but i am trying to get an important point across..

honestly, it really seems to me people go into gen surg just b/c they can't get into ortho. my school's match last year and current trends favoring surgical subspecialties supportthis thought. it really does seem like general surgery is dead and the only reason someone would dare choose it is to try for plastics later -- and this only b/c he wasn't a good enough candidate to do integrated plastics out of med school.. i hope you understand what i'm trying to say and why i decided to write a book on this.

if there's any GS residents out there, please, i am terribly curious what you guys have to say about this issue. it is sad but it is true: general surgery is considered second rate to ortho/ent. the discrepancy of the candidates is immense. if you were a good candidate for ortho/ent, how did YOU ratioanlize going into GS? the lack of responses just goes to show that good candidates don't even bother going into GS in the first place.

You'll hear all sorts of crap about every specialty, "gen surg is dead, CT surg is dead, etc". I haven't seen this at all, and I'm at a major academic institution and also rotate at community hospitals.

Gen surg does primarily GI as well as trauma. If you like GI, then its for you. If you don't, but still like surgery, then there are the host of subspecialty fellowships that have been mentioned. Talk to more GS people, and you'll find people going into GS because they like it, not because they couldn't get into ortho.

Many of last year's senior class at my school went into GS although they were top candidates. The student who was suma cum laude went into gen surg with no aspirations for plastics. My best friend in that senior class chose gen surg with an eye on minimally invasive fellowship because he loves GI. GS is not dead, neither is CT. Are they changing? Hell yes, but all of medicine and all specialties are constantly changing.

You'll hear CT is dead and all they do is pulmonary resections for COPD. However, there are 3 major heart hospitals in my area, and I see them do cardiac transplants, CABG (which is still NOT dead as there are still plenty of people presenting with triple vessel disease), AICD/Single and double ventricular pacers, LVAD/BIVADs, as well as pulm stuff.

In any case, if more GS people don't chime in, then continue to go talk to your GS residents, fellows, and attendings. There's a reason why there are over 7000 active residents (I believe each year consists of 1000 to 1500 incoming categorical GS residents) and only ONE spot went unmatched in the entire NATION last year (Ortho can't even claim that), and its because GS is very alive indeed.

sscooterguy

 

[undecided2008]

awesome reply and i thank you for your input. your points are just what i'm looking for. i admit i am subconsciously looking for people to tell me why GS is so great so i can feel better about deciding to pursue it. i know its wrong and i'll just use this 3rd year to see where i fit best as someone else mentioned earlier -- even if that means using my vacation time to observe the different subspecialties.

but forgive me if i was and still am worried about doing a GS residency. you have to start questioning things when only 5% of your AOA class goes into general surgery. let me put this in another way. if there are a 100 top kids, 95 of them are doing something besides general surgery. that's shady no matter how you look at it.

also, if you don't mind, i'd rather ask my questions here anonymously than confront attendings and residents in person and have them think of me as an overanalyzing jackass, which i know i am.

 

[automaton]

i can see where you are coming from but you gotta grow up a little. the pissing contest has to stop sometime. at some point you gotta sack up and be your own man. know what's important for you, what you want in a career, and which specialty will get you there. things about how many AOA or whatever isn't going to make you happy. you can be the guy who does plastics or derm just because it's the hardest to get into or you could be the guy who does family medicine and loves what you do. and yes there are plenty of the latter group, and no, not all of them go into it because they couldn't match into anything else.

i know we all want to maximize every pro and minimize every con. we want to land the best residency we are competitive for. go to the top med school. go to the top residency. make the most money for the least hours. etc... honestly this is a trap. do general surgery if you want, not because smart people are doing it or dumb people are doing it, or whatever else. hell do psych if that's what you want. i personally know very many smart, well accomplished, well respected people who are doing family medicine, psychiatry, anesthesia... you name it. i can assure you i don't think they are doing it because they aren't qualified for anything else. where i go to school all of the general surgery residents have scores good enough for ortho/ent/uro/ophthy/etc.

 

[Smurfette]

awesome reply and i thank you for your input. your points are just what i'm looking for. i admit i am subconsciously looking for people to tell me why GS is so great so i can feel better about deciding to pursue it. i know its wrong and i'll just use this 3rd year to see where i fit best as someone else mentioned earlier -- even if that means using my vacation time to observe the different subspecialties.

but forgive me if i was and still am worried about doing a GS residency. you have to start questioning things when only 5% of your AOA class goes into general surgery. let me put this in another way. if there are a 100 top kids, 95 of them are doing something besides general surgery. that's shady no matter how you look at it.

also, if you don't mind, i'd rather ask my questions here anonymously than confront attendings and residents in person and have them think of me as an overanalyzing jackass, which i know i am.

Given how many specialties there are to choose from, 5% doing gen surg is not necessarily shady. In my med school class, we had AOA people go into just about every specialty (psych, FP, OB, Peds included---just b/c someone is AOA does not mean they want to do something super-competitive). We had AOA people go unmatched in gen surg.

Keep in mind when you graduate you can try for IM, FP, Gen Surg, Ortho, Ophtho, ENT, Plastics, Rads, Rad-Onc, OB-Gyn, Peds, Urology, PMR, Med-Peds, Psych, Neurology, Neurosurg, Anesthesia, Derm, as well as other more uncommon ones (IM-Psych, etc.). For 5% to do GS out of all the choices is not all that shabby or shady.

 

[undecided2008]

ok thanks -- you are right about everything you said. it was shortsighted of me to ask such sensitive questions about people's motivations b/c everyone is different. even now, i'll never understand for the life of me why someone would go into rheumatology for example. but that's ok -- i guess its not me going into it and i shouldn't care.

i'm not here to judge anyone but i also would not like to be judged myself in the future if i am about to make a poor career decision. i've had a retired surgery chairman of a private community hospital, a respected plastic surgeon, and a relative who is a general surgeon telling me not to go into general surgery. this is why i'm so anxious and worried about this problem. but its clear i shouldn't share these fears with other people b/c its just too sensitive and personal of an issue. i'll just have to make my own opinions as i float through third year, just like everybody else. its just a little harder for me b/c i'm idealistic to a fault and i've wanted to be a that beastly surgeon even when i was in my mother's womb.

if the moderator would like to delete this now useless thread, please feel free to.

 

[Doc Ivy]

Lots of residents are in G Surg to pursue one of these fellowships.

Exactly. You need to get rid of the idea that people going into Gen Surg weren't "good'' enough to get into one of the subspecialities. That's like saying that people going into Medicine are doing so because they couldn't do derm--- it's a ridiculous notion. You couldn't pay me to do ortho or optho or ENT, and don't get me started on urology. As others have said-- If you want any of the many surgical subspecialities that you can't match in right out of medical school then GS is for you, if you love GI/Endocrine, then GS is for you.

Dont worry about what others are doing-- just cuz you score 240+ on the boards doesn't mean you should live a life of popping zits and giving botox if that's not what floats your boat just to prove that you are at the top of your class-- that's what I call stupid.

Besides, I've heard from more than one source that after a general surgery residency you are one of the most competent and capable physicians in the entire hospital because you can manage medical and surgical issues.

Now go be a bada$$

 

[madtowngirl]

I'm headed into GS. I was wavering b/w ortho and GS during 3rd year, but love the medicine aspect of surgery too much to forget it all (the ortho tri-point ) And the variety of cases is great.

And there's nothing like an ex-lap. I think of it like a present, you never know what you're gonna get. When I realized that, I knew it was GS all the way.

And the beauty of a GS residency; you can still specialize. I can put off my final career decision another 5-7 years. tee hee hee

You just have to ignore salary a little bit, and do what you enjoy. You'll make plenty doing anything surgical. But you'll work a lot, and you might as well be doing what you'd most like to be doing, you know?

 

[Dr JPH]

honestly, it really seems to me people go into gen surg just b/c they can't get into ortho.

Sorry friend, but this is untrue.

Ortho and Gen Surg are totally different beasts.

Consider a rotating internship or transitional year to familiarize yourself with more areas of medicine. I think your lack of experience is clouding your perceptions.

I just dont see how a 3rd year medical student in his 2nd or 3rd month of clinical rotations can claim know so much about so many areas of medicine.

I wish you the best of luck in your future decisions.


[Note: (As a future surgeon) Notice how my response is short and spaced out so that it can be read quickly and easily.]

 

[San_Juan_Sun]

Sorry friend, but this is untrue.

Ortho and Gen Surg are totally different beasts.

Consider a rotating internship or transitional year to familiarize yourself with more areas of medicine. I think your lack of experience is clouding your perceptions.

I just dont see how a 3rd year medical student in his 2nd or 3rd month of clinical rotations can claim know so much about so many areas of medicine.

I wish you the best of luck in your future decisions.


[Note: (As a future surgeon) Notice how my response is short and spaced out so that it can be read quickly and easily.]

Note read, agree with above.

(When you're an attending, things can get even shorter. )

 

[cptnplanetdc]

I can't decide b/w ortho and gen surg though I actually have opposite feelings on the issue than the original poster b/c I feel like choosing ortho is the easy way out and that gen surg residents are the ones who work harder and are the more complete doctors. i like ortho cases but i'm just not sure if i want to forever write notes with "af, vss, nvi, a/p: d/c today". but then i wonder if i'll actually love the better hours and less sick patients 5/10 years from now when i'm able to have an outside life and be an ortho doc at the same time. any advice on how to choose ... i'm running out of decision time.

 

[undecided2008]

i'm really sorry if i offended anyone by saying it seems like gen surg. residents are those who couldn't get into ortho. that was a terrible generalization and is no way accurate. my very limited experiences tempted me to suggest what is only superficially obvious.

planet DC -- i think we have similar feelings. i am also questioning whether or not to sell out to the lifestyle of surgical subspecialties. i'll do my best to keep an open mind in 3rd year, but i have a feeling i'll end up in your exact position. the original intent of my post is to foster discussion from eligible students who could have done both but decided to go the difficult route. its a simple question with a complex answer that people are reluctant to address b/c everyone is different.

 

[Blade28]

Note read, agree with above.

(When you're an attending, things can get even shorter. )

 

[cardsurgguy]

2) Cardiology - I liked learning about heart pathophys the most. Interventional is very appealing but I don't want to go through internal medicine training. I also consider interventionalist a dream job but the pathway to get there is too long and boring. In internal medicine, every patient is a damn anion gap and labs, etc. Cardiology may be interesting but I really don't want to manage patients -- I want to cure them. This immediate satisfaction is what attracts me to surgery and precludes medicine. Interventionalists 'cure' but the entire pathway is management and that would bore the hell out of me.

If you like heart pathophys the most and want to cure people, what about CT surg?

Other people have mentioned it and you haven't really responded either way.
I was just curious if this was something you would think of.

It seems to satisfy your requirement for curing, as well as for the subject matter (ie specific organ system) that you like.



In adult CT, there are a lot of people who your dealing with who will be "cured" for some extra years considering they already were in bad shape most likely from smoking or being overweight and who knows will probably have their bypass and AVR and go on their merry way smoking for the next few years until they are back for their heart transplant.

If you really want a truly cure field, then I'd give a look into congenital heart surgery. Kids who are born who lost in the genetic lottery who you can really cure them and give them a normal life.

You want immediate satisfaction? A kid goes into surgery with O2 sats in the high 70's and comes out of the OR with sats in the low-mid 90's. Seems pretty immediate to me.

In many cases, like a VSD, you're doing a final cure that will last the person their life as compared to a certain death if nothing was done.


In any pediatric surgical subspecialty, you'll inevitably deal with congenital malformations that I would imagine (I have absolutely no clue about any other field than cardiac) would give the opportunity for a cure.

Just a thought...

 

[drbruce]

I haven't been following the whole thread and I apologise if I have gone over past ground but I don't have much time on the computer and do want to get in my 2 cence worth.

General surgery is growing in popularity again, some hospitals, according to one of the moderators here, are offering starting salaries of up to $300,000 for freshly certified general surgeons. It is also the only route into trauma surgery, a fast, dynamic, exciting field.

But you are judging this field on lifestyle and financial criteria alone. You shouldn't do this. General surgery opens up an enormous number of possibilities that you probably haven't even considered yet.

How can tell at this early stage in your medical career that plastic surgery would be better for you than vascular, colo rectal or trauma? The media often glamourises plastics or neuro at the expense of all the other surgical subspecialities so medical students tend to know exactly what they want to do from day one. Many, however, change their minds, many opt for the less glamourous specialties because they find in the field something that appeals to them. Recently I read that a female surgeon chose trauma because she liked the unpredictability of the field, the scope it provides, and the fact that patients and their relatives were on the whole very appreciative of her efforts, etc.

Keep your eyes peeled, do what interests you, but don't think too hard about your future career yet, medical students change their minds all the time.

 

[mcindoe]

i think your reasoning shows a lot of immaturity...as in you're using a bunch of tired stereotypes about all these fields as the basis for dismissing them as career possibilities and you contradict yourself at times. some examples:

3) Derm -- Skin is dead boring. Don't you think??

then you might as well cross plastics off your list, cause you deal with a lot of skin. a lot of infected, foul-smelling skin and wounds.

4) GI -- Diseases are boring. There is no cure or etiology for 1/3 of all patients. Its all diagnosis and management -- very little curing going on.

um, why did you apply to med school? do you really want to be a doctor? and the line about "very little curing going on"... please tell me, in which field is there a ton of "curing" going on that doesn't exist in other fields? (besides oncology, of course). but you think you're going to be doing a whole lot of "curing" with all of your patients with pancreatic cancer? when i was on surg onc and stuck my hand in the belly of a woman with metastatic ovarian cancer, you think the thought of a cure ever crossed our minds? the whole point of that operation was hardly curative...it was an exploratory laparotomy, and you do a lot of them, and why are they performed? mostly for the purpose of diagnosing those "boring" diseases with "no cure", getting a biopsy, to--guess what-- guide the patient's post-op managment.

and how can you cure something if you don't diagnose it?

5) Neonatology-- The idea of playing God with very young babies is a rush

i don't know if i'm creeped out by this statement because you think you'd be "playing God" or that you describe it as a "rush", or if i'm turned off by the arrogance.

6) Optho - Don't want to specialize in eyes and forget the rest of the body. Honestly I see this as a feminine field for some reason.

what reason is that? what state ....and decade...are you living in? of all the reasons i've heard for not going into optho, this takes the cake as most ridiculous, offensive, and ignorant.

8) ENT -- procedures are amazing but I absolutely don't understand the anatomy above the clavicle.

well, then forget plastics too. if you don't understand the anatomy above the clavicle, then you might as well forget about surgery. considering that the thryoid is above the clavicle, you're probably not cut out for endocrine surgery as well. and that would be part of gen surg residency.

9) Radiology - who wants to look at pictures their whole livss?

radiologists. and they make a hell of a lot of money looking at "pictures" and work a lot less than most other specialties. they're laughing at you all the way to the bank.

hope when you do decide what you want to do, your reasoning is a lot better than what you posted.

 

[factoid]

awesome reply and i thank you for your input. your points are just what i'm looking for. i admit i am subconsciously looking for people to tell me why GS is so great so i can feel better about deciding to pursue it. i know its wrong and i'll just use this 3rd year to see where i fit best as someone else mentioned earlier -- even if that means using my vacation time to observe the different subspecialties.

but forgive me if i was and still am worried about doing a GS residency. you have to start questioning things when only 5% of your AOA class goes into general surgery. let me put this in another way. if there are a 100 top kids, 95 of them are doing something besides general surgery. that's shady no matter how you look at it.

also, if you don't mind, i'd rather ask my questions here anonymously than confront attendings and residents in person and have them think of me as an overanalyzing jackass, which i know i am.

dude, you need psychiatric help. this is such an ego issue for you. you're just worried about the fact that GS doesn't have the same prestige that the other subspecialties do (which is not correct by the way) because none of the gunners in your class want to do GS. the medical profession is filled with all kinds of weirdos and unfortunately most of us have ego probs on top of everything else. if you like GS, do GS; dont' do it or not do it because of how it is perceived. man, you're ridiculous. what the hell is shady about going into freaking GS?? give me a break. and i'm not even doing surgery!

 

[drbruce]

Ego is a major pitfall in medicine, too many smart and image conscious students enroll into medical school because they want the prestige, money and power that comes with entering a responsible and well paid profession. How many times has the question about salary appeared in this forum, usually beginning with the words, "Out of curiosity.."

I once suggested to a medical school colleague of mine that she consider working as a part time nursing assistant to pay her way through university instead of her current job at Burgerking and her response was that "she didn't want to wipe bums". The job was beneath her abilities. I use to do nursing and the experience at the mental health hospital where I worked taught me so much about relating to and managing patients. Some of the people here are quite happy with the idea of charging a fortune to treat patients with life threatening illnesses. Why not make money out of the terminally ill. This is unscrupulous! Obivously this doesn't apply to every young medical student or junior doctor, thank God, many are decent, kind, hardworking and full of intergrity but it is a concern of mine having listened to many of the stories that our professor of surgery likes to tell about students who has known in the past; this is another man who wants our egos captured and contained.

Anyway, I think you are coming from this at the wrong angle. I read a little more of this 2 page thread today, like the book War & Peace, I have to break it down into smaller, more manageable, bitesize pieces. Your interest and knowledge of surgery will develop at a later stage. Or it may not, you might decide that surgery is not for you after all, and choose a "less interesting" career such as cardiology or GI, with all those incurable, boring diseases to tackle on a daily basis. Oh the nightmare! Let your experiences be your guide, you can ask for no better, and open your mind to all the other possibilities. Opthm, for instance, is a great career; it combines surgery and medicine, while giving somebody their sight back is a fantastic gift. Retina surgeons do well financially so that should please you.

GI is an exciting and dynamic field - the lifestyle is good, the hours are much better than IV cardiology and its very procedural base. I could go on all day....

 

[Mr. McDuck]

The above post is very good, except for one thing. Less than a page and a half worth of posts is too much to read at once? How did you get through med school?

 

[avgjoe]

being succint is good advice, but i am trying to get an important point across..

honestly, it really seems to me people go into gen surg just b/c they can't get into ortho. my school's match last year and current trends favoring surgical subspecialties supportthis thought. it really does seem like general surgery is dead and the only reason someone would dare choose it is to try for plastics later -- and this only b/c he wasn't a good enough candidate to do integrated plastics out of med school.. i hope you understand what i'm trying to say and why i decided to write a book on this.

if there's any GS residents out there, please, i am terribly curious what you guys have to say about this issue. it is sad but it is true: general surgery is considered second rate to ortho/ent. the discrepancy of the candidates is immense. if you were a good candidate for ortho/ent, how did YOU ratioanlize going into GS? the lack of responses just goes to show that good candidates don't even bother going into GS in the first place.

I'm a latecomer to this thread, but just had to respond ot this.
ARE you &*!#$% kidding me?!?! There is no WAY I would have gone into ortho or really any of the surgical subspecialties. I just don't care a hoot about the bones, etc. The facial anatomy is interesting but way too many people operate there for my liking. Also, I raelly don't like microscopic surgery - i like to look directly at what i'm doing, feel the bowel, etc. and you just can't do that when doing a cataract op or sticking a tube through someone's nose or someone's urethra.
Also, gen surg is so complete - i truly believe they're the most complete docs in the hospital as they cover everything neck down (besides urology and gyn), and need to know both the surgical and medical tx's for all. you just don't get that anywhere else.
So I don't know what your school and the match fromlast year showed, but please do understand that there are definitely plenty of people who are in gsurg because we love it and can't imagine doing anything else (especially other subspecialties).
good luck with yr decision process.

 

[avgjoe]

awesome reply and i thank you for your input. your points are just what i'm looking for. i admit i am subconsciously looking for people to tell me why GS is so great so i can feel better about deciding to pursue it. i know its wrong and i'll just use this 3rd year to see where i fit best as someone else mentioned earlier -- even if that means using my vacation time to observe the different subspecialties.

but forgive me if i was and still am worried about doing a GS residency. you have to start questioning things when only 5% of your AOA class goes into general surgery. let me put this in another way. if there are a 100 top kids, 95 of them are doing something besides general surgery. that's shady no matter how you look at it.

also, if you don't mind, i'd rather ask my questions here anonymously than confront attendings and residents in person and have them think of me as an overanalyzing jackass, which i know i am.

Okay again .. not sure wehere you are coming from.
First of all, you already said that GI bores you. I find it extremely interesting and exciting and therefore I went into Gsurg. Why are you thinking about Gsurg if you feel completely bored by GI (what makes up definitely the bread and butter of gsurg)? It doesn't sound like you have a fellowship after gsurg in mind either which is where it may make sense.
When you're talking about who goes into what - First of all, let me ask you how it really matters. Are you really going to go into something else just becuase many of the AOA kids went into that?!?!
Secondly, you are talking about a sample size of 1 - one school, yours. do you know what mine was like? What you do know across the board is that there was only one categorical spot open as people have already mentioned. That speaks right there to the competitiveness and interest in gsurg.

 

[geekgirl]

there are those guided by the external. and those guided by the internal.

there are a myriad of reasons each person chooses their given path.

just because you CAN compete for a given slot - be that job, residency position, place in life - is not equivalent to if you SHOULD (i.e. will that slot make you happy, better, more developed as a human).

i COULD have pursued many different avenues out of medical school. i CHOSE general surgery for the aforementioned reasons. completeness. beauty. challenge. big picture.

but i could have chosen another path, had i been a different person.

so do what FITS you. not what you think that the world perceives as better. because trying to please an external audience is an empty cause.

instead, please yourself. and find what fits.

goodness - these debates do make me verbose. i'm way too tired for this sort of thing most of the time...... AND you forced me to use caps, which is way way out of my normal e-league.... whew.....

 

[tito8512]

u people that r sayin that the lil smarties dont go to gsurgery r pretty stupid.and u get me pist,im an img and im hopin and prayin that i can get a general surgery residency,cuz i just love it.i cant believe u people.4real.its gonna be pretty hard for me,but thats wat i want.but i just cant stand when people act like gsurgery is babysittin or somethin,its freakin surgery,come on its a pretty big thing!!!!

 

[TxMed]

there are alot of angry posts here. i'll go with the vibe that geekgirl is putting out. everybody breathe. ahh.


tm

 

[Debridement]

...there's nothing like an ex-lap. I think of it like a present, you never know what you're gonna get.

I hope Santa visits your house this year and takes out your colon...

 

[Debridement]

i truly believe they're the most complete docs in the hospital as they cover everything neck down (besides urology and gyn),

Or any of the four extremities...

 

[Debridement]

u people that r sayin that the lil smarties dont go to gsurgery r pretty stupid.and u get me pist,im an img and im hopin and prayin that i can get a general surgery residency,cuz i just love it.i cant believe u people.4real.its gonna be pretty hard for me,but thats wat i want.but i just cant stand when people act like gsurgery is babysittin or somethin,its freakin surgery,come on its a pretty big thing!!!!

Aren't you the guy that was posting in the ortho forum last week asking about gettin into ortho? There they told you that you don't have a chance? Now you want to do GeneralSurg? Hmmm....

The proof is in the pudding....

 

[Debridement]

Dude. Stop. Listen.

1) You are competitive for ortho.

2) If you want to cure, stop doing Whipples and do a total joint. That or nail a tibia.

3) If you can throw a figure-of-eight or sew an anastamosis you can rod a femur. Laparospopy=arthroscopy=Nintendo=$buck$=prestigous career=being a doctor. Are we gonna split hairs here, Donny?

4) People dont have to die in ortho.

5) No one is telling you NOT to go into ortho.

I think it's a slam-dunk, but I'm just a roid-raged, weight lifting, dunb jock former college athlete that's relocates hips.

In acuallity, I'm a regular guy--you wouldn't even think that I can reduce a diatal radius (also a cure).

Learn more. Choose ortho.

Best of luck.

 

[Winged Scapula]

Or any of the four extremities...

That would be a suprise to the general surgeons who do vascular or general surgeons who cover trauma and do fasciotomies or the surgical oncologists who manage lesions and any other number of procedures (including 4 quarter amputations) on the "four extremities".

Lets all just get along and encourage people to do whatever they want, without relying on absurd stereotypes (or ridiculous beliefs a la, "they went into specialty X because they couldn't get into Y").

 

[tito8512]

yea im the guy that put a post in ortho,and no im not interested in g surgery now cuz that one guy told me that i cant.i always like surgery,i like all kinds of surgery.ur assumin that i like gsurgery cuz they said that 2 me.dont assume!!!!

 

[ElliotAR]

Why am I doing GS?

1) I love taking care of patients who are critically ill.
2) I want to be the best doctor that I can be- I want to know as much about every field possible and do other peoples' jobs (internists, radiologists, etc.) as well as they can or better.
3) While I like GS, I LOVE trauma and CC. There is nothing like reversing a physiological death grip. Surgical CC does it all day long.
4) I know what I do best, and that is work. I have never done anything less than 110% in my life, and I don't plan on starting now. I have very good board scores and more publications that most people finishing residency and LOR's to beat the band and can't think of anything I would rather do than a GS rsidency. General surgeons don't bit*h. They get the job done. Taking care of the patient RIGHT NOW is all that matters.

You obviously want to operate, so you can remove any IM fellowship fields from the differential. You aren't going to do it, so stop thinking about it. As for surgical subs, think of the people in your class that are doind them and think about what kind of doctor you envision them being in 15 years. I am not saying they are good or bad, but are they the kind of people that will be up at the bedside at 3 am worring over a patient at the bedside? I know that I would be there, but I don't know that I have every seen an ortho/ENT attending fretting over a patient like that.

. When I went to med school, I knew I wanted to be a great doctor, someone my patients could count on. Period. That is what you will be if you are a general surgeon. If that kind of dedication to your craft is not within you, then please don't apply to GS.

My wife is also an MS4 and while she is nervous of the lifestyle I plan on maintaining, she has encouraged me to continue my course because she knows that I who I am. You have to figure out who you are and plot your own course.

 

[CycloneDub]

Maybe you haven't dealt/seen too many acute airways or bad facial trauma. All times, day or night. Last week, we brought a 10 mo with a foreign body occluding the right mainstem at 3am; Also, brought a 89 yo F with multiple mid-face fractures in the middle of another night. And that was just the OR. These are smaller areas to work on, but not less acute. So, don't think that ENT doesn't do emergent/urgent procedures -- not as much as GS, but we have our things.

Residency for all the surgical specialities (GS or not) is a long road. Go through this year, try out some other specialities. Spend a couple of real days there. If you think it is a possible career, do a sub-I. All of the question answering here isn't going to help your decision. Just make sure you can enjoy the most boring/repetitive aspect of that field, b/c if you pick for the wrong reasons, that is what will make you miserable in the end.

CD

 

[redzz]

u people that r sayin that the lil smarties dont go to gsurgery r pretty stupid.and u get me pist,im an img and im hopin and prayin that i can get a general surgery residency,cuz i just love it.i cant believe u people.4real.its gonna be pretty hard for me,but thats wat i want.but i just cant stand when people act like gsurgery is babysittin or somethin,its freakin surgery,come on its a pretty big thing!!!!

Booyakasha! U's betta lissen to muh main man tito! He's be the top surgeralist in da house. West side.

 

[toofache32]

It's the penile disorders and male sexual dysfunction that I find highly irrelevant to Urology as a whole... but it comes with the package.

Pun intended, right?

 

[toofache32]

.....honestly, it really seems to me people go into gen surg just b/c they can't get into ortho...

Funny, I used to think this. Then I did a year of general surgery and now I know it's true. The bitterness is unbelievable with these people.

And to the person who said general surgeons don't b!tch, they do nothing but b!tch where I work. But I would too if most of my time was spent doing non-surgical care.

All the specialty-surgery residents at my institution are pretty cool and definately more laid back, while the general surgeons here are a bunch of silverback gorillas. When there's a problem, they jump up and down and bonk you over the head and think that deals with the problem. I've never seen so much yelling, bitterness, and disrespect in all my life.

The real kicker is the attitude that general surgeons "can do everything that other medical/surgical specialties can do" as if it were an all-encompassing specialty. I hear things like "general surgeons are medicine doctors who can operate." Give me a break.

Of course, this is only based on my experience with general surgery at my institution (UT Southwestern).

 

[toofache32]

...Also, gen surg is so complete - i truly believe they're the most complete docs in the hospital as they cover everything neck down (besides urology and gyn), and need to know both the surgical and medical tx's for all. you just don't get that anywhere else....

Hmmmm.... Then why do they consult Ortho, ENT, Neurosurg, cardiology, etc?

 

[2easy]

General surgeons are prime example of doctors who have been devalued by society. You may say now that money is not that importatn, but when you look at the reimbursement for your procedures and couldn't pay your overhead expenses, you'll be seeing a different tune.

You can do a ten minute knee arthroscopy, get unbelievably good results, and get paid waaaaaay more than a 3 hour complex bowel case. Then the patient dies anyway.

I am glad we have general surgeons though. They deserve what they get paid. I couldn't do what they do.

 

[Winged Scapula]

Funny, I used to think this. Then I did a year of general surgery and now I know it's true. The bitterness is unbelievable with these people.

Bitter and unhappy we may be but its NOT because we didn't match into Ortho.

BTW, the Ortho residents in my program were pretty bitter and unhappy as well, at least the junior ones who spent all their time in the ED with trauma were.

 

[Debridement]

All junior ortho residents are bitter b/c all we do is put casts on in the ED.