Choosing a kind of surgery

[12loser12]

Before med school, I thought I wanted to do surgery. Now I definitely do. My 3rd year surgery consisted of Vascular, Ortho, Urology, Colorectal, and general. But only about 2-3 weeks of each. The things I liked are OR time (!!!), office procedures, and initial patient visits. Things I didn't like as much are rounding and followup visits.

Going into med school I thought I'd want to do ortho. I was attracted by the idea of sports med and patients having been injured rather than eating and smoking their way into problems. Unfortunately my exposure thus far has been a lot of clinic time (follow-ups) and the procedures I have seen have been a lot of knee scopes which I found kinda boring The coolest part so far has been the joint replacements but it seems the majority of those patients fall into the "ate themselves into this problem" rather than getting injured. Also, it feels slightly less significant after operating to save peoples lives :/ On the plus side most orthos seemed happy and relaxed and they certainly got paid. On the negative, some seemed to not care as much about their patients.

I think my favorite rotation so far has been colorectal surgery. I think I enjoyed this largely because of the big, open surgeries and the clinical time had a lot of office procedures. However I got scared of it after being on Urology and having a urologist tell me point blank not to do general surgery as their lifestyle is crap and they don't get paid like the specialists. Most of the docs in his urology group seemed to have a very nice lifestyle and seemed very happy. Some seemed to not get a lot of OR time, but the younger urologist of the group had DaVinci training and so got most of the prostate removals from the rest of the group. (Something I may be able to do)

Part of me fears that even though I find it amazing, after 10 years of doing surgery, any variation might become somewhat routine and perhaps I'd be happier with a job with nice income/ less busy rather than the job content itself. I have a hard time asking if that is the case to surgeons grading me though.

Anyway, any insight into important things to consider when picking a branch of surgery would be extremely helpful as 2 weeks is just not enough exposure. I realize I'll get more in 4th year, but I'll have to pick my aways and set my schedule before then, so I'm on the lookout for feedback.

Thanks!

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[braluk]

Everyone will have their own spiel about why their field is better than another field (except GS's, which tends to have a gloomier outlook on their careers). Ultimately you will have to choose what you think you will enjoy doing for 30-40+ years for the rest of your life. Some careers will have some financial problems given the current climate of things (GS in particular). But, no one knows nor can predict what the heck is going to happen with a volatile healthcare system and changing reimbursements. Things seem to ebb and flow and change as time goes on (as an example, CT surgeons were the cream of the crop and didn't adopt newer "sillier" interventional methods, and are now suffering, but from my understanding, CT fellowships have begun to train with inteventional modalities). The time given as a medical student is not very comprehensive to enable you to see everything. For me, I went with broad instincts. I knew I liked surgery. I knew I liked surgery that allowed me to perform both emergency life saving and elective quality of life surgeries. My instincts were that ENT, Ortho and Uro did not provide me those goals. I also wanted a field in which I didn't have to accumulate a large number of pubs to be able to find work or be accepted to be trained by a fellowship- which led me to GS, particularly Vascular. Ultimately, a lot of my gut instincts is what I listened to, and it comes as a result of reading and asking.

 

[DrBowtie]

Everyone will have their own spiel about why their field is better than another field (except GS's, which tends to have a gloomier outlook on their careers). Ultimately you will have to choose what you think you will enjoy doing for 30-40+ years for the rest of your life. Some careers will have some financial problems given the current climate of things (GS in particular). But, no one knows nor can predict what the heck is going to happen with a volatile healthcare system and changing reimbursements. Things seem to ebb and flow and change as time goes on (as an example, CT surgeons were the cream of the crop and didn't adopt newer "sillier" interventional methods, and are now suffering, but from my understanding, CT fellowships have begun to train with inteventional modalities). The time given as a medical student is not very comprehensive to enable you to see everything. For me, I went with broad instincts. I knew I liked surgery. I knew I liked surgery that allowed me to perform both emergency life saving and elective quality of life surgeries. My instincts were that ENT, Ortho and Uro did not provide me those goals. I also wanted a field in which I didn't have to accumulate a large number of pubs to be able to find work or be accepted to be trained by a fellowship- which led me to GS, particularly Vascular. Ultimately, a lot of my gut instincts is what I listened to, and it comes as a result of reading and asking.

You want to discuss the issues you alluded to with GS? I'm considering my options as well and GS seems to be high on my list.

 

[Pir8DeacDoc]

...I knew I liked surgery. I knew I liked surgery that allowed me to perform both emergency life saving and elective quality of life surgeries. My instincts were that ENT, Ortho and Uro did not provide me those goals...

I don't want to turn this into a "my field is awesome blah blah thing" but I'd be curious to know what your exposure to ENT actually turned out to be.

We have the potential for emergency stuff (bad airways, etc) and also life saving surgery (head and neck cancer) as well as cute surgery like rhinoplasty and septoplasty. Anyway good luck with things, just want to make sure the students out there realize that one experience does not a conclusion about a field make.

 

[braluk]

Absolutely. As I said everyone has their own experiences, mine was a two week experience that were mostly elective cases. We worked mostly with plastics in head and neck cancers, which was one of the most technically involved operations I've ever seen and came away with a really strong appreciation for ENT guys. The call night we did take was uneventful so as I said, my experience was not fully encompassing. Generally speaking, it was an excellent experience but I was not interested in the surgeries. Most of my experience just came down to gut instinct and I liked the stuff I saw on my GS rotation.

Drbowtie- as for GS issues. I'm not sure what specifically about GS you would like to know. I'm not an expert on it but I think that some of the threads cover it better than I do. Mostly it came down to GS's I worked with (again disclaimer that this is my own experience) that were unhappy with how practicing as a GS is nowadays compared to the way they known it years ago. This includes diminishing reimbursements on a decreasing number of cases that are taken by the subspecialist that used to be GS procedures. That his 20-30 year old practice is constantly relocated by hospitals in place of more lucrative specialists like optho or vascular, etc.. means that within a few years he will have to join a large hospitalist group. There are a variety of other issues that some of the GS's I've worked with were very passionate about and many of them seemed to be legitimate complaints.