Colon and Rectal Surgery

[Green Grass]

Hello, I'm a pre-med who shadows a colon and rectal surgeon. I'm very interested in surgery, but he frequently tries to talk me out of it. I was wondering, speaking to the surgery residents and physicians, if they feel the same way. I can't tell if he is joking about it or if he just wishes he would have chosen a different specialty, but he seems to get discouraged about who he is operating on (elderly) and what his reimbursement is. Do you feel the same?

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[Winged Scapula]

You might find some of the threads here on Surgery Lifestyle, Future, etc. interesting. A search of the forum as well as reading the FAQs above should help you.

It is extremely common for practicing surgeons and residents to try and talk pre-meds and even med students out of pursuing surgery. The lifestyle is not conducive to a predictable workweek and families, friends and SOs must be able to adapt.

In addition, for those who have been practicing awhile, the reduction in income (surgeons are the only field which has seen a reduction in Medicare and Insurance reimbursements over the years) is a big blow after you've spent 9+ years training to be a surgeon and suffered through a fairly rigorous residency.

 

[pagemmapants]

Of course he's cranky. He deals with poop on a daily basis. Sheesh. 😉

 

[tussy]

I'm a colon and rectal surgeon and i like my job. Don't let one guy that's dissatisfied with life get you down.

 

[Green Grass]

thanks for the replies. I'm definitely not becoming discouraged about medicine or surgery, but it does make me wonder sometimes.

 

[Blade28]

If you feel medicine is your calling, then just work to getting into medical school, and keep an open mind as you go through your MS-III rotations.

 

[pagemmapants]

. . .

So there's this case posted on our OR schedule for tomorrow.

"Anal sphincteroplasty with artificial sphincter"

. . .

GYAAAAAAHAHAHAHAHAHAHAHAA! I wish I were mature enough that that wasn't funny.

 

[tussy]

. . .

So there's this case posted on our OR schedule for tomorrow.

"Anal sphincteroplasty with artificial sphincter"

. . .

GYAAAAAAHAHAHAHAHAHAHAHAA! I wish I were mature enough that that wasn't funny.

i don't understand the humour. This is a procedure that i commonly perform. Some of the most satisfied patients you've ever met post-op.

 

[Winged Scapula]

Its a fun procedure as well.

 

[indymed]

Would you conisder colon and rectal surgery to be an up and coming field? Is a fellowship necessary to do this or can a general surgeon still cover these procedures? Obviously a patient would probably prefer the guy with the fellowship experience. I absolutely believe that patients who have these surgeries are some of the most satisfied post op. What percentage of gen surg residents go into colon and rectal surg? Are there alot of these fellowships out there?
Can anyone touch on the variety of procedures available to the colorectal surgeon?

 

[Castro Viejo]

Would you conisder colon and rectal surgery to be an up and coming field? Is a fellowship necessary to do this or can a general surgeon still cover these procedures? Obviously a patient would probably prefer the guy with the fellowship experience. I absolutely believe that patients who have these surgeries are some of the most satisfied post op. What percentage of gen surg residents go into colon and rectal surg? Are there alot of these fellowships out there?
Can anyone touch on the variety of procedures available to the colorectal surgeon?

Some of what CRS does can be done by a General Surgeon, but then there are some of the fancier things (e.g., resecting tumors that traditionally need an APR with a butt scope), that the typical General Surgeon isn't trained to do.

There's also a CRS board, so I would assume that many institutions will be looking for this if credentialing you to do the fancier stuff.

Competitiveness? Here's some data from the NRMP.

http://www.nrmp.org/fellow/match_name/colon/stats.html

There were 45 programs with 77 positions in last year's match.

96 applicants went into the match and 80% (77) of them received an appointment.

US Grads had an 84% (53/63) match rate.

US IMGs had a 67% (6/9) match rate.

US DOs had a 100% (2/2) match rate.

Fifth Pathways had a 100% (1/1) match rate.

Non-US IMGs had a 67% (12/18) match rate.

Canadians had a 100% (3/3) match rate.

CRS' competitiveness is pretty much on par with Vascular Surgery (83% match), CTS (91% match), Trauma/SCC (88% match), MIS/Laparoscopy (79% match), and Transplant (79% match).

Good luck.

 

[Winged Scapula]

Just to add to the excellent comments by Castro above:

the vast majority of colorectal surgery in this country is still done by general surgeons. As medical students and residents, we often do not appreciate that because many of us train at facilities with fellowship trained colorectal surgeons. But our colleagues out in the community very often perform these procedures which they either learned in residency, took a course, or picked up from another surgeon.

As he (Castro) notes, some of the more advanced procedures (ie, lap colectomies, pouches, etc.) are most likely to be done in a tertiary center and typically by those with fellowship training.

What you get credentialed for depends on the market and the hospital where you are applying for credentials. As I'm going through this right now, I can comment that different hospitals want different things. For example, 1 hospital will give me Sentinel Node privileges based on the number of cases I did in fellowship. Another, in the same community, will give me conditional privileges...if I have a 95% accuracy rate in my first 20 cases there, then I will be given full privileges. This latter hospital only requires additional training for Vascular Surgery, Head and Neck, Endoscopy, Endovenous work, Conscious Sedation, Advanced Laparoscopy, Stapled Hemorrhoidectomy, use of Laser, Stereotactic biposies and Sentinel Node (under the guise of "general surgery" privileges).

So same will go for the type of cases you want to do...their board will decide what they think needs advanced training. General surgery will get you privileges for all of the basic colorectal stuff: sewn hemorrhoids, sigmoid colectomies, etc. Tertiary hospitals are most likely going to want you to be fellowship trained so they can market you (which is not an unreasonable reason to be fellowship trained) and have you compete favorably in the community.

 

[Faebinder]

You can do some cases in colorectal as a general surgeon, but there are a lot of really more colorectal intense surgeries in the field. In Colorectal Surgery, the bread is the rectum and the butter is the anal surgeries.

MMmm... off the top of my head, procedures that you would see a colorectal surgeon do that general surgeons dont like to attempt:

- Reconstructions of vaginal defects post APRs with vaginectomies.
- Lap assisted LARs with anastomosis.
- Transanal Excisions.
- Exenterations.
- Lap assisted proctocolectomies with anastomosis

You might be able to do some of these as a general surgeon, but your comfort level would not be high probably.