Choosing a specialty: Mix of medicine and surgery

[Ineedhopenow]

What are some medical fields with a good mix of medicine and surgery? I'm also interested in caring for patients of all ages, and don't want to be heavily reliant on technology (e.g. radiation oncology).

Ideally, I'd like to become a physician that is also able to go on mission trips in underserved areas which is why I don't want to go into a field that's too reliant on technology.

Any thoughts? Thank you!!!

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[FSU2013]

Critical care, EM, GI, Cards, OB/gyn, Family Med (in a rural area) all have elements of medicine and procedures. IR does a lot of procedures but is by definition tech-dependent.

 

[evilbooyaa]

Anesthesia to add to what FSU said.

 

[Stellar Clouds]

ENT. Fix cleft lips/palates on mission trips. Great mix of medicine and surgery, and you can work with patients of all ages.

 

[Non Pizza Lunch]

ENT. Fix cleft lips/palates on mission trips. Great mix of medicine and surgery, and you can work with patients of all ages.

+1 ENT, it sounds perfect for what you are looking for. You can work on all ages, and you basically do a mixture of both surgery and medicine. Can work from the simple cold to some pretty hardcore surgeries.

 

[Daodejing]

ENT, ophtho, uro, ob/gyn, etc.

disclaimer: some of the above are increasingly integrating technology, so do your research and assess your goals.

 

[Dral]

Derm has a good mix, pts of all ages, lots of mission opps...tropical Derm is basically a whole different field it seems.

ENT is a great mix too. Fam is what I think of for good mission opps.

 

[Test2Go]

disclaimer: some of the above are increasingly integrating technology, so do your research and assess your goals.

care to elaborate?

 

[Daodejing]

care to elaborate?

on what exactly? It's no secret that robotics and other automated modes of minimally invasive surgery have been utilized since the 90s. This trend isn't looking to stop anytime soon. Initially, abdominal and urogenital surgeries took advantage. Later, other fields, such as CV surg, jumped on the wagon. In my eyes, ENT kind of took the last stand against robotics, since entrance via the mouth and movement in the upper airway tract was cumbersome and risky, but even that has now more or less fallen by the wayside. Of course, robotics is only one part of the overwhelming shift towards integrating more technology in practice. These days, powered burs and blades and intraop nerve-monitoring systems are commonplace. Technology is, whether we like it or not, becoming more of a player in anatomical region-specific fields as I mentioned previously.

 

[jerseytrash]

Urology is a mix of medicine and surgery?? Since when? My urology rotation was largely outpatient planned surgeries with an occasional diagnostic procedure.

Ophtho, ENT, yes. GI and Cards for sure.

 

[Daodejing]

Urology is a mix of medicine and surgery?? Since when? My urology rotation was largely outpatient planned surgeries with an occasional diagnostic procedure.

Ophtho, ENT, yes. GI and Cards for sure.

That's the thing. Med school gives a very narrow-minded and individual view of what a specific specialty's actual SOP is, which is why shadowing on your own time becomes paramount.

http://www.ncbi.nlm.nih.gov/pubmed/16217365 ("Positive determinants cited by urology applicants included the mix of medicine/surgery, the diversity of urological procedures, and clinical exposure to the field")

 

[da8s0859q]

What are some medical fields with a good mix of medicine and surgery? I'm also interested in caring for patients of all ages, and don't want to be heavily reliant on technology (e.g. radiation oncology).

Ideally, I'd like to become a physician that is also able to go on mission trips in underserved areas which is why I don't want to go into a field that's too reliant on technology.

Any thoughts? Thank you!!!

I matched into it and am biased, but EM would fit.

 

[Kaustikos]

Urology is a mix of medicine and surgery?? Since when? My urology rotation was largely outpatient planned surgeries with an occasional diagnostic procedure.

Ophtho, ENT, yes. GI and Cards for sure.

Who do you think fixes testicular torsions and cryptochidism? There's lots you can do with Urology. Except you deal with the urinary tract...which I'm not a fan of.

 

[VisionaryTics]

Urology is a mix of medicine and surgery?? Since when? My urology rotation was largely outpatient planned surgeries with an occasional diagnostic procedure.

Ophtho, ENT, yes. GI and Cards for sure.

My urology rotation was lots of medical management of kidney stones, renal and adrenal masses, BPH, erectile dysfunction, incontinence, etc with a couple of days per week in the OR.

 

[globalferver]

General surgery sounds like something to think about. I shadowed a general surgeon that's spent almost an equal amount of time in the OR, the hospital wards, and the clinic. Doings in the OR are obvious - a palate of small procedures to large abdominal surgeries . Clinic was either small wound care issues, surgery consultation or surgery followup. Time on the wards is also spent either with surgery followup, small procedures or surgery consultation.

This is also a great field to be in for missions.

***Blessings ***

 

[Pons Asinorum]

General surgery sounds like something to think about. I shadowed a general surgeon that's spent almost an equal amount of time in the OR, the hospital wards, and the clinic. Doings in the OR are obvious - a palate of small procedures to large abdominal surgeries . Clinic was either small wound care issues, surgery consultation or surgery followup. Time on the wards is also spent either with surgery followup, small procedures or surgery consultation.

This is also a great field to be in for missions.

***Blessings ***

All those things might not be surgery, if by surgery you mean time in the OR. But they are not medicine. General surgery in no way provides a "good" mix of surgery and medicine, unless you and I have a different definition for "good."

 

[11MD2B]

ObGyn

Ob is mostly medicine.
Def get all ages except pre adolescent peds typically (15 y/o with the clap, 25 y/o pregnant, 40 year old w/ fibroids, 66 y/o with breast ca, uterine ca etc, prolapse etc)
Gyn is outpatient/procedural in the clinic and OR of course.

international health = women's health in much of the world. anything from fistula repair to general obstetrics.

 

[survivordo]

As you shape your practice to your liking any of the above fields would be a legit choice. I would throw my hat in for Uro or ENT. Certain vascular surgeons have created a niche doing outpatient procedures as well but I think any of the general fields may be a bit too heavily weighted on surgery for you.

Survivor DO

 

[rocketbooster]

General surgery sounds like something to think about. I shadowed a general surgeon that's spent almost an equal amount of time in the OR, the hospital wards, and the clinic. Doings in the OR are obvious - a palate of small procedures to large abdominal surgeries . Clinic was either small wound care issues, surgery consultation or surgery followup. Time on the wards is also spent either with surgery followup, small procedures or surgery consultation.

This is also a great field to be in for missions.

***Blessings ***

Yea no. As I read your post and wondered how any med student could possibly think what you typed, I looked over and read "pre-med" next to your name. Go to your forum. You're giving incorrect advice here about things you know nothing about.

General surgery is literally one of the fields with the LEAST amount of medicine. Clinic does not equal medicine. Gen surg clinic is a bunch of pre and post-op checks. That's not "medicine" in the way everyone refers to it.

The fields with a great mix of medicine and surgery are the ones already mentioned: ophtho, ENT, urology, GI, cards

 

[JP2740]

Am I missing something? How is EM, Derm, family med, etc a good mix of surgery and medicine if it has no surgery? Or maybe I need to broaden my definition of surgery?

 

[ACSurgeon]

What are some medical fields with a good mix of medicine and surgery? I'm also interested in caring for patients of all ages, and don't want to be heavily reliant on technology (e.g. radiation oncology).

Ideally, I'd like to become a physician that is also able to go on mission trips in underserved areas which is why I don't want to go into a field that's too reliant on technology.

Any thoughts? Thank you!!!

General surgery with a critical care fellowship. After 6 years, you'll have a broad knowledge and skill base, and you can tailor your practice to be more medical or surgical.

Surgical subspecialties tend to be more surgical and a lot less medical (in the general medical sense, not just having a non-operative component).

Other medical specialties might be "procedural" but don't kid yourself, that's not the same.

 

[neusu]

I'll throw the neurosurgery hat in the ring.

We run our own intensive care units and manage our patients in the hospital from A to Z. Unlike general surgery, you do not need a fellowship to admit patients under yourself to an ICU. It's a 7-year residency and, depending on the program, a fair amount of that time is managing critically ill patients. We do consult other services when necessary, but take pride in management of most issues on our own.

We also get to operate.

 

[ACSurgeon]

All those things might not be surgery, if by surgery you mean time in the OR. But they are not medicine. General surgery in no way provides a "good" mix of surgery and medicine, unless you and I have a different definition for "good."

I beg to differ. General surgeons are trained to take care of many/most general medical things (general surgery residents spend 4-12 months rotating in critical care where you manage everything yourself). In practice, most general surgeons do NOT have a medical mix, by choice. However, if you want the training that will truly enable you to operate while giving you the knowledge to care for your average medicine patient, general surgery is the only field that offers that.

Many people seem to be confused about what a good mix of medicine and surgery means. Some equate this to procedural and non-procedural, which is how EM becomes a good "mix". Even ENT/Urology, while these are surgical subspecialties with a good mix of operative and non-operative components, I'd venture to bet that most ENT/urologists are not as comfortable taking care of general medical problems in the way a general surgeon would be. Certainly not as well as a critical care trained general surgeon.

At the end, it depends what your goals are. What skills are you trying to learn. What patient population are you trying to care for. That is a much better criteria to chose a specialty than the vague "a good mix of blah and blah."

 

[ACSurgeon]

I'll throw the neurosurgery hat in the ring.

We run our own intensive care units and manage our patients in the hospital from A to Z. Unlike general surgery, you do not need a fellowship to admit patients under yourself to an ICU. It's a 7-year residency and, depending on the program, a fair amount of that time is managing critically ill patients. We do consult other services when necessary, but take pride in management of most issues on our own.

We also get to operate.

General surgeons don't need a fellowship to manage critically ill patients. Many surgeons in rural areas become the intensivist for the their little hospital, without a critical care fellowship. Many urban hospitals still have open ICU concepts where general surgeons admit and manage their patients in the ICU, and only consult ICU staff if needed.

 

[Pons Asinorum]

I beg to differ. General surgeons are trained to take care of many/most general medical things (general surgery residents spend 4-12 months rotating in critical care where you manage everything yourself). In practice, most general surgeons do NOT have a medical mix, by choice. However, if you want the training that will truly enable you to operate while giving you the knowledge to care for your average medicine patient, general surgery is the only field that offers that.

Many people seem to be confused about what a good mix of medicine and surgery means. Some equate this to procedural and non-procedural, which is how EM becomes a good "mix". Even ENT/Urology, while these are surgical subspecialties with a good mix of operative and non-operative components, I'd venture to bet that most ENT/urologists are not as comfortable taking care of general medical problems in the way a general surgeon would be. Certainly not as well as a critical care trained general surgeon.

At the end, it depends what your goals are. What skills are you trying to learn. What patient population are you trying to care for. That is a much better criteria to chose a specialty than the vague "a good mix of blah and blah."

I respect the gaping experience differential here, but I guess I'll have to agree to disagree. The OP is looking for a specialty that is a mix a medicine and surgery. General surgery is not that field, regardless of your feeling that you *could* manage the average medicine patient. I'm assuming that the OP meant specialties that have a balanced mix of surgical management of disease and medical management of disease. General surgeons, except for your rare GS/SICU fellow or surgical intensivist or whatever they are going to end up calling critical care/trauma folks, is not the place for a blend of therapeutic management. I'm not going to be convinced otherwise. GS seems like it would nearly define the far "surgical" side of the spectrum. You last paragraph, could not agree more. I appreciate your thoughts on all though.

 

[neusu]

I beg to differ. General surgeons are trained to take care of many/most general medical things (general surgery residents spend 4-12 months rotating in critical care where you manage everything yourself). In practice, most general surgeons do NOT have a medical mix, by choice. However, if you want the training that will truly enable you to operate while giving you the knowledge to care for your average medicine patient, general surgery is the only field that offers that.

Many people seem to be confused about what a good mix of medicine and surgery means. Some equate this to procedural and non-procedural, which is how EM becomes a good "mix". Even ENT/Urology, while these are surgical subspecialties with a good mix of operative and non-operative components, I'd venture to bet that most ENT/urologists are not as comfortable taking care of general medical problems in the way a general surgeon would be. Certainly not as well as a critical care trained general surgeon.

At the end, it depends what your goals are. What skills are you trying to learn. What patient population are you trying to care for. That is a much better criteria to chose a specialty than the vague "a good mix of blah and blah."

Perhaps the reason the ACS has a fellowship in Surgical Critical care is they feel surgery residents are undertrained in critical care. That to be an intensivist, further training is warranted, and there just isn't enough time in residency to do so. Certainly, there are hospitals where there are surgery intensivists without fellowship, just as there are pulmonary and anesthesia trained doctors without fellowships. Most academic institutions, where the patients who are the most sick end up, have fellowship trained intensivists. While many of these fellowships are trauma/critical care, the critical care side procedures typically do not amount to much more than trach/peg/bronch/line.

 

[Slack3r]

I'm assuming that the OP meant specialties that have a balanced mix of surgical management of disease and medical management of disease.

Ya, that was my thinking as well. Which means, as stated earlier: ENT, urology, GI, cards, ophtho, ob/gyn, and maybe derm.

 

[Pons Asinorum]

Ya, that was my thinking as well. Which means, as stated earlier: ENT, urology, GI, cards, ophtho, ob/gyn, and maybe derm.

+1 on that list.

 

[rocketbooster]

I beg to differ. General surgeons are trained to take care of many/most general medical things (general surgery residents spend 4-12 months rotating in critical care where you manage everything yourself). In practice, most general surgeons do NOT have a medical mix, by choice. However, if you want the training that will truly enable you to operate while giving you the knowledge to care for your average medicine patient, general surgery is the only field that offers that.

Many people seem to be confused about what a good mix of medicine and surgery means. Some equate this to procedural and non-procedural, which is how EM becomes a good "mix". Even ENT/Urology, while these are surgical subspecialties with a good mix of operative and non-operative components, I'd venture to bet that most ENT/urologists are not as comfortable taking care of general medical problems in the way a general surgeon would be. Certainly not as well as a critical care trained general surgeon.

At the end, it depends what your goals are. What skills are you trying to learn. What patient population are you trying to care for. That is a much better criteria to chose a specialty than the vague "a good mix of blah and blah."

No, just no. The only one confused is you. Thanks for your input though.

I respect the gaping experience differential here, but I guess I'll have to agree to disagree. The OP is looking for a specialty that is a mix a medicine and surgery. General surgery is not that field, regardless of your feeling that you *could* manage the average medicine patient. I'm assuming that the OP meant specialties that have a balanced mix of surgical management of disease and medical management of disease. General surgeons, except for your rare GS/SICU fellow or surgical intensivist or whatever they are going to end up calling critical care/trauma folks, is not the place for a blend of therapeutic management. I'm not going to be convinced otherwise. GS seems like it would nearly define the far "surgical" side of the spectrum. You last paragraph, could not agree more. I appreciate your thoughts on all though.

Yes.

Ya, that was my thinking as well. Which means, as stated earlier: ENT, urology, GI, cards, ophtho, ob/gyn, and maybe derm.

Yes.

 

[45408]

Yea no. As I read your post and wondered how any med student could possibly think what you typed, I looked over and read "pre-med" next to your name. Go to your forum. You're giving incorrect advice here about things you know nothing about.

General surgery is literally one of the fields with the LEAST amount of medicine. Clinic does not equal medicine. Gen surg clinic is a bunch of pre and post-op checks. That's not "medicine" in the way everyone refers to it.

The fields with a great mix of medicine and surgery are the ones already mentioned: ophtho, ENT, urology, GI, cards

That's not at all accurate. Most other surgical specialties/subspecialties will do significantly less medical management of their surgical patients than general surgery.

I wouldn't solicit it as a "good mix of medicine and surgery," but I rarely get medicine involved with my patients, as opposed to a specialty like ortho which won't dream of touching the blood sugar on their patients here.

 

[secants]

Finishing my Gsurg rotation and I have to agree that it still had a decent amount of medicine but it was moreso narrowed to pre/post op complications. There's heavy renal/electrolyte medicine with some GI mixed in.They're definitely more comfortable handling things than the surgical subspecialties; at least in my hospital.

 

[FSU2013]

That's not at all accurate. Most other surgical specialties/subspecialties will do significantly less medical management of their surgical patients than general surgery.

I wouldn't solicit it as a "good mix of medicine and surgery," but I rarely get medicine involved with my patients, as opposed to a specialty like ortho which won't dream of touching the blood sugar on their patients here.

Orthopods are aware that patients have sugar in their blood? News to me, lol.

 

[mimelim]

I'll throw the neurosurgery hat in the ring.

We run our own intensive care units and manage our patients in the hospital from A to Z. Unlike general surgery, you do not need a fellowship to admit patients under yourself to an ICU. It's a 7-year residency and, depending on the program, a fair amount of that time is managing critically ill patients. We do consult other services when necessary, but take pride in management of most issues on our own.

We also get to operate.

This is not true at 2 out of the 3 Neurosurgery programs in the city I work in. They aren't as bad as ortho, but a lot of NSGY is very very anti-basic medicine management and defer left and right to hospitalists.

Also, we admit people to our ICUs all the time under general surgery and vascular surgery attendings.

 

[evilbooyaa]

This is not true at 2 out of the 3 Neurosurgery programs in the city I work in. They aren't as bad as ortho, but a lot of NSGY is very very anti-basic medicine management and defer left and right to hospitalists.

Also, we admit people to our ICUs all the time under general surgery and vascular surgery attendings.

The neurosurgery program at my institution pretty much runs the neuro ICU with a staff of PAs. It's not an auto medicine consult like every patient from ortho is.

Vascular and gen surg also have their own patients, and I never saw a hospitailst consult from either of them in 6 weeks. Renal/Cards/EP/GI etc. etc. sure, but never a general medicine/hospitalist service consult.

 

[jerseytrash]

My urology rotation was lots of medical management of kidney stones, renal and adrenal masses, BPH, erectile dysfunction, incontinence, etc with a couple of days per week in the OR.

I also had clinic in my uro rotation too and we took care of those things. By medical management I was taking it to mean that you build a patient base that you follow for many years in a primary care-esque manner and contribute to their "overall" health.

Don't get me wrong. I wasn't a big surgery fan but I REALLY enjoyed urology and I liked the cystscopic/minimally invasive stuff they did (hence why I'm aiming for a cardiology fellowship). I just thought it was primarily surgical and the medicine stuff is kind of "in the realm" of surgical problems.

 

[jerseytrash]

That's not at all accurate. Most other surgical specialties/subspecialties will do significantly less medical management of their surgical patients than general surgery.

I wouldn't solicit it as a "good mix of medicine and surgery," but I rarely get medicine involved with my patients, as opposed to a specialty like ortho which won't dream of touching the blood sugar on their patients here.

I think it's also institution dependent - our gen surg service consults out a lot more than yours seems to (which always annoyed me). Our ortho is pretty much the same though - they don't admit anyone to their service who's on the elderly side b/c they don't know how to manage anything even remotely medical.

NSG is pretty good about some medical issues but not everything

 

[rocketbooster]

I also had clinic in my uro rotation too and we took care of those things. By medical management I was taking it to mean that you build a patient base that you follow for many years in a primary care-esque manner and contribute to their "overall" health.

Don't get me wrong. I wasn't a big surgery fan but I REALLY enjoyed urology and I liked the cystscopic/minimally invasive stuff they did (hence why I'm aiming for a cardiology fellowship). I just thought it was primarily surgical and the medicine stuff is kind of "in the realm" of surgical problems.

This is what ppl assume when they add the "medicine" tag to a field. Ophtho doesn't manage chronic pt problems outside the eye but everyone says its a great mix of med and surgery. I think "medicine" means having a patient base that you follow over years, spend a lot of time in clinic, regularly diagnosis and regularly using medical treatment rather than just surgery everytime. Gen surg clinic is not very often, you rarely see pts again, and it's usually just pre and post op visits. The diagnosis is usually already done by the PCP and you rarely send the pt out with just med management. The main reason the pt is referred to you is bc med management has failed or is not an option.

So that's what most ppl refer to as a mix of medicine and surgery. Ophtho, ENT, urology, cards, GI, obgyn and maybe derm.

 

[jerseytrash]

This is what ppl assume when they add the "medicine" tag to a field. Ophtho doesn't manage chronic pt problems outside the eye but everyone says its a great mix of med and surgery. I think "medicine" means having a patient base that you follow over years, spend a lot of time in clinic, regularly diagnosis and regularly using medical treatment rather than just surgery everytime. Gen surg clinic is not very often, you rarely see pts again, and it's usually just pre and post op visits. The diagnosis is usually already done by the PCP and you rarely send the pt out with just med management. The main reason the pt is referred to you is bc med management has failed or is not an option.

So that's what most ppl refer to as a mix of medicine and surgery. Ophtho, ENT, urology, cards, GI, obgyn and maybe derm.

It's actually not true that Ophtho doesn't manage chronic eye problems - I know at least in our school's ophtho clinic there are people who have been going there for years for management of their macular degeneration. A lot of ophtho requires management with drugs/medications and not necessarily with surgery, as is the case with ENT for sure. I suppose depending on the practice urology can have a large bulk of it as medical management as well.

 

[VisionaryTics]

I also had clinic in my uro rotation too and we took care of those things. By medical management I was taking it to mean that you build a patient base that you follow for many years in a primary care-esque manner and contribute to their "overall" health.

Don't get me wrong. I wasn't a big surgery fan but I REALLY enjoyed urology and I liked the cystscopic/minimally invasive stuff they did (hence why I'm aiming for a cardiology fellowship). I just thought it was primarily surgical and the medicine stuff is kind of "in the realm" of surgical problems.

So medicine = primary care to you.

 

[rocketbooster]

This is what ppl assume when they add the "medicine" tag to a field. Ophtho doesn't manage chronic pt problems outside the eye but everyone says its a great mix of med and surgery. I think "medicine" means having a patient base that you follow over years, spend a lot of time in clinic, regularly diagnosis and regularly using medical treatment rather than just surgery everytime. Gen surg clinic is not very often, you rarely see pts again, and it's usually just pre and post op visits. The diagnosis is usually already done by the PCP and you rarely send the pt out with just med management. The main reason the pt is referred to you is bc med management has failed or is not an option.

So that's what most ppl refer to as a mix of medicine and surgery. Ophtho, ENT, urology, cards, GI, obgyn and maybe derm.

See the bold above.

It's actually not true that Ophtho doesn't manage chronic eye problems - I know at least in our school's ophtho clinic there are people who have been going there for years for management of their macular degeneration. A lot of ophtho requires management with drugs/medications and not necessarily with surgery, as is the case with ENT for sure. I suppose depending on the practice urology can have a large bulk of it as medical management as well.

Yes, that's what I said lol. I said they don't manage chronic problems outside the eye. Yes I know they manage many things of the eye without surgical management...at least I hope I do since I'm applying to ophtho in a few months.

My point was I think most ppl refer to having "medicine" in these fields as having to diagnosis and manage chronic problems using medical management. They also have to use surgical management at times, which is where the "surgery" element comes from.

 

[Winged Scapula]

I'll throw the neurosurgery hat in the ring.

We run our own intensive care units and manage our patients in the hospital from A to Z. Unlike general surgery, you do not need a fellowship to admit patients under yourself to an ICU. It's a 7-year residency and, depending on the program, a fair amount of that time is managing critically ill patients. We do consult other services when necessary, but take pride in management of most issues on our own.

We also get to operate.

Perhaps the reason the ACS has a fellowship in Surgical Critical care is they feel surgery residents are undertrained in critical care. That to be an intensivist, further training is warranted, and there just isn't enough time in residency to do so. Certainly, there are hospitals where there are surgery intensivists without fellowship, just as there are pulmonary and anesthesia trained doctors without fellowships. Most academic institutions, where the patients who are the most sick end up, have fellowship trained intensivists. While many of these fellowships are trauma/critical care, the critical care side procedures typically do not amount to much more than trach/peg/bronch/line.

As stated above, GS does not "need" a fellowship to admit patients to an ICU.

The reason ACS has a fellowship in SCC has absolutely nothing to do with any perceived weaknesses in their residency training programs (God forbid that the ACS or surgeons for that matter admit weakness). For the same reason that AANS has fellowships in Spine, Cerebrovascular NSgy, etc.

1) to help people focus their interests in one area and gain more in-depth exposure, not to rectify any perceived weakness;

2) marketing; I see this all the time in private practice: fellowship trained surgeons advertising themselves as "Double Board Certified" or "Specialist in X". The public doesn't know that many people who do fellowships are "double board certified" or that you can be "specialist X" without a fellowship

3) hospital requirements (see above, as it often has to do with marketing). Hospitals want specialists so they can market themselves as attracting only the most highly trained. I recently asked one hospital board member why only fellowship trained Vascular surgeons could get vascular privileges and he actually admitted that it had to do with marketing but mostly because the hospital feels that with "riskier" surgeries, they are less likely to get sued if they limit the practice to fellowship trained surgeons. Interesting.

At any rate, General Surgery is *not* a good choice for someone looking for a good mix of surgery and medicine. Neither is Neurosurgery.

EM/FM etc are not either; as all surgeons will tell you doing procedures is not the same as doing procedures. If the OP wants to operate, then these will not satisfy.

I put my hat in for Uro and ENT.

 

[45408]

Gen surg clinic is not very often, you rarely see pts again, and it's usually just pre and post op visits. The diagnosis is usually already done by the PCP and you rarely send the pt out with just med management. The main reason the pt is referred to you is bc med management has failed or is not an option.

No. Seriously, just stop posting about general surgery.

Many of the cancer patients come for long-term follow-up on a serial basis. If you do any vascular work, you might see some of those patients many, many times. There are a number of issues that you can end up seeing for a fairly prolonged basis, depending on what the patient had done. Unless it's an inguinal hernia or gallstones, it's going to require more than a consult and one post-op visit. Go to a breast clinic some time, or see some Crohn's patients.

The diagnosis that the PCP sends may be completely wrong or just quite limited. If they didn't have some working diagnosis, it would be asinine to make the referral, yes, but you give the PCPs way too much credit. Many are just mid-levels anyway.

 

[Sheldor]

Just wanted to throw out Rad Onc as an option, as I chose it because of its good mix as well.

On the medicine side, rad onc is a clinic based specialty where one spends a majority of the time seeing consults to determine if their cancer treatment would benefit from radiation treatment.

On the surgery side, brachytherapy allows you to get to the OR a day or two a week to either place tandem and ovoids for gyn brachy, or place seeds for prostate brachy. For some practices this can be more or less, some do it a couple times a month, and others do it a few times a week.

All of the planning done in rad onc is also a mix of med and surgery, as the approach to treatment is more targeted like surgery, ie, Best way for the radiation to enter? How to avoid critical structures? Etc. However, there is a medicine undertone with regard to preexisting medical conditions and radiation sensitivity.

Anyway, something to consider, as it also has the coolest technology 🙂

Good luck!

 

[smq123]

Just wanted to throw out Rad Onc as an option, as I chose it because of its good mix as well.

On the medicine side, rad onc is a clinic based specialty where one spends a majority of the time seeing consults to determine if their cancer treatment would benefit from radiation treatment.

On the surgery side, brachytherapy allows you to get to the OR a day or two a week to either place tandem and ovoids for gyn brachy, or place seeds for prostate brachy. For some practices this can be more or less, some do it a couple times a month, and others do it a few times a week.

All of the planning done in rad onc is also a mix of med and surgery, as the approach to treatment is more targeted like surgery, ie, Best way for the radiation to enter? How to avoid critical structures? Etc. However, there is a medicine undertone with regard to preexisting medical conditions and radiation sensitivity.

Anyway, something to consider, as it also has the coolest technology 🙂Good luck!

It appears that he's already thought about it, and that the tech aspect doesn't appeal to him at all.

What are some medical fields with a good mix of medicine and surgery? I'm also interested in caring for patients of all ages, and don't want to be heavily reliant on technology (e.g. radiation oncology).

 

[Sheldor]

It appears that he's already thought about it, and that the tech aspect doesn't appeal to him at all.

Touche 🙂 Thats what I get for reading it a few days ago and not rereading it before posting. Carry on...

 

[rocketbooster]

No. Seriously, just stop posting about general surgery.

Many of the cancer patients come for long-term follow-up on a serial basis. If you do any vascular work, you might see some of those patients many, many times. There are a number of issues that you can end up seeing for a fairly prolonged basis, depending on what the patient had done. Unless it's an inguinal hernia or gallstones, it's going to require more than a consult and one post-op visit. Go to a breast clinic some time, or see some Crohn's patients.

The diagnosis that the PCP sends may be completely wrong or just quite limited. If they didn't have some working diagnosis, it would be asinine to make the referral, yes, but you give the PCPs way too much credit. Many are just mid-levels anyway.

I said gen surg, not surgonc, vascular or any of the fellowships you can do after gen surg. I agree gensurg has some cool fellowships. But gensurg itself is usually hernias, gall bladder, appendix, cysts/lipomas, and poop (any bowel resection). IBD pts only see the gen surg for the surgery. They see a GI doc or minimally invasive GI surgeon (a fellowship) for chronic management.

You're grouping gen surg specialties under gen surg. No, just no.

 

[mvenus929]

Am I missing something? How is EM, Derm, family med, etc a good mix of surgery and medicine if it has no surgery? Or maybe I need to broaden my definition of surgery?

Depending on where you train, there are some FM people who do basic surgical procedures, including appendectomies and cholecystectomies. These are often the people practicing in really rural areas where the closest surgeon is too far away to make a referral. They can also do basic procedures in the office, such as removal of cysts/warts/skin tags/etc.

Derm does have surgery... Mohs surgery is often done by the dermatologist. Not to mention just basic removal of SCC or BCC.

And EM you do some basic procedures, including I&D, suturing up lacs, casting, chest tubes, etc. You could even do a crich or emergency thoracotomy, which are things done by surgery at my school. Depends on where you train and where you work. These are good skills to have if you're doing a medical mission trip, though, and are focusing more on the medicine side of things (there are trips that are virtually entirely surgical in nature).

 

[FSU2013]

Depending on where you train, there are some FM people who do basic surgical procedures, including appendectomies and cholecystectomies. These are often the people practicing in really rural areas where the closest surgeon is too far away to make a referral. They can also do basic procedures in the office, such as removal of cysts/warts/skin tags/etc.

Derm does have surgery... Mohs surgery is often done by the dermatologist. Not to mention just basic removal of SCC or BCC.

And EM you do some basic procedures, including I&D, suturing up lacs, casting, chest tubes, etc. You could even do a crich or emergency thoracotomy, which are things done by surgery at my school. Depends on where you train and where you work. These are good skills to have if you're doing a medical mission trip, though, and are focusing more on the medicine side of things (there are trips that are virtually entirely surgical in nature).

Uhhhh, what?

 

[rocketbooster]

Uhhhh, what?

Yes I have heard these too buy they're really only the old school rural family docs and it's happening less and less due to risks of being sued for complications and whatnot.

 

[lomia]

"Yea no. As I read your post and wondered how any med student could possibly think what you typed, I looked over and read "pre-med" next to your name. Go to your forum. You're giving incorrect advice here about things you know nothing about.

General surgery is literally one of the fields with the LEAST amount of medicine. Clinic does not equal medicine. Gen surg clinic is a bunch of pre and post-op checks. That's not "medicine" in the way everyone refers to it."


That's some elitist BS if I've ever seen it. Are you the king of the forums? I think not. Blasting someone for a reasonably stated opinion only underscores your arrogance and ignorance. Also, your subsequent definitions of "medicine" pretty squarely rule out hospitalists who are board certified in what? Oh yeah, medicine.

As a third year, you've done a bunch of rotations, but what makes you an expert, and how can you speak with such authority?

I recently did an outpatient eyeball rotation just for kicks. One day when, as I was walking in the door, there was a frantic woman exiting the elevator screaming "call a code". I walked over and started assessing the patient and asking what had happened. "She's non-responsive, has no pulse and isn't breathing. We've got to start chest compressions!" the lady yelled.

Turns out the patient did have good peripheral pulses and was breathing just fine, but by the time I got her wheeled over by the receptionist who was hanging up the phone with the dispatcher, the ambulance was already on the way. He had also called the code team from the OR; both ambulance and code team were called at this lady's behest.

By the time anesthesia got there, she was much better. A little D5 and she was right as rain.

After the appropriate hand off, I walked into clinic. Guess who my attending was? The screaming lady.

Last time I checked, in most places "medicine" folk run codes. This particular eyeball doc couldn't even recognize that this was not a code. As a MSIV going in to GS, I could. I'm not saying that to blackball her or the specialty. Honestly, if she couldn't get a pulse, couldn't see/hear breathing, she did the right thing by calling a code.

She's highly specialized and only sees certain types of patients, but even in general ophtho clinic, I can't tell you how many times I heard "you'll have to see someone else for that problem".

Granted that's anecdotal, and n=1 does not evidence make. Saying, though, that the eyeballers have more "medicine" than GS may be a stretch.

Just saying.