anyone in the know about this seemingly gruesome gig....i say seemingly because from what i can see, if you can initially get over the body parts being being probed, assessed, etc, this specialty is said to offer incredible financial and lifestyle rewards....also, what path do you take to get there, and how difficult/competitive is it....thanks in advance to any who could fill me in.
colorectal surgery
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Skylizard
Well, you need to keep in mind that you will be dealing with Crohn's and UC patients....in addition to others (colo-rectal CA, etc...). There is a great deal of stoma issues too. The lifestyle can be alright but you need to remember that Crohn's & UC patients suffer a great deal and will often need your assistance during the wee hours of the night. The path requires a minimum of 5 years general surgery. Some do a fellowship after and some do not. It all depends on how comfortable and prepared you are leaving residency and where you will practice.
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Colorectal is a fairly desirable field right now. True, you may get called by your Crohn's/UC patients, but if you're just taking general surgery (non-trauma) call, life shouldn't be too bad. I know that lots of universities are working hard to get more fellowship-trained colorectal surgeons on staff. It seems to be one of the next specializations that will ultimately subtract cases from true general surgeons.
Pros:
Lots of job opportunities -- high profile colon Ca cases have made this an area that the public is more aware of.
Relatively nice lifestyle, for a general surgeon.
Patients who worship you (a happy Crohn's patient is a wonderful thing).
Cons:
Poop. Lots of poop.
Long road. Not sure if fellowship is one year or two. (I know that some attendings at my institution have double trained in colorectal and SurgOnc)
Chronically ill patients who require lots of personal attention (some Crohn's patients are just miserable and hard to help).
Great field. Lots of opportunities. Fair amount of collaboration with GI Medicine, Surg and Med Onc. Gotta love those stomas, though.
Pros:
Lots of job opportunities -- high profile colon Ca cases have made this an area that the public is more aware of.
Relatively nice lifestyle, for a general surgeon.
Patients who worship you (a happy Crohn's patient is a wonderful thing).
Cons:
Poop. Lots of poop.
Long road. Not sure if fellowship is one year or two. (I know that some attendings at my institution have double trained in colorectal and SurgOnc)
Chronically ill patients who require lots of personal attention (some Crohn's patients are just miserable and hard to help).
Great field. Lots of opportunities. Fair amount of collaboration with GI Medicine, Surg and Med Onc. Gotta love those stomas, though.
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This thread is right up my alley- I am interested in colorectal, particularly ulcerative colitis. I don't have much experience yet so am looking forward to getting my feet wet some more next year, but if I decide that it is in fact what I want to do, what institutions are the most cutting-edge when it comes to research and innovative procedures for UC? Cleveland?
I feel the prospect of what the j-pouch can offer patients who do not want a permanent ileostomy is exciting, however, the complications seem to be relatively frequent and pretty bothersome (ex: pouchitis, left over rectal stump tissue, poor continence.)
Thanks for any insight
I feel the prospect of what the j-pouch can offer patients who do not want a permanent ileostomy is exciting, however, the complications seem to be relatively frequent and pretty bothersome (ex: pouchitis, left over rectal stump tissue, poor continence.)
Thanks for any insight
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What's a "j pouch"? And how does one get "pouchitis"? Is the "J" for jejunum, or something else? Hmmm... Never heard of these things.
S
Skylizard
Didn't know if you were joking in your question, but the J-pouch is a looped together piece of bowel after colectomy. It is better understood visually by looking at a surgical atlas such as Zollingers. Pouchitis is were this pouch gets inflamed as it does serve a certain storage capacity allowing a patient without a colon to refrain from living on the toilet. It takes time for the pouch to mature and it can get inflamed resulting in some potentially bad morbidity. I wish I could explain it thoroughly in writing but the Zolliinger atlas will answer your question in one brief glance.
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Would have replied earlier but this crazy server is driving me crazy! (5 minutes to load a reply page?!) Can't wait for the new server to really kick in.
Anyway, to the question at hand. Colorectal surgery is one of the few general surgery subspecialties to have its own independent board (Thoracic and Plastics being the only other two, while vascular is making a bid now). The main society is the American Society of Colon and Rectal Surgery (ASCRS) which can be found at www.fascrs.org Click on the residency training button to see what programs are available.
Currently only 1 year of residency (note that this is technically a residency just as CT surg is technically a residency since it leads to a separate independent board certification) is required, although some programs include a 2nd year for research, the mode is definitely one.
Colorectal surgeons obviously focus on those two things. They probably stand out the most when you talk about complex pelvic and anal work (e.g. high transanal excision, continence restoration, etc.) as well as all the standard things that a cutting edge general surgeon might do (ileal pouches (J-pouch) for UC, colon cancer resections, etc.) Also, all colorectal surgeons do a fair bit of endoscopy training and incorporate it into their practice much more so than general surgeons, especially as it related to therapeutic endoscopy.
Historically, Colorectal surgery was not a specialty that was well represented in academia, however that is definitely changing, and in looking around, most academic centers now either have a board-certified colorectal surgeon or are in the process of recruiting one. Still, you will find that colorectal surgery is less well defined than the other specialties at many centers. As far as competitiveness, the days of it being uncompetitive are largely over. There are ~30 programs offering about ~50-60 spots and the number applying easily exceeds that in most years these days. The admission process is a match run by the NRMP, applications at the beginning of your chief year.
I hope this helps.
Anyway, to the question at hand. Colorectal surgery is one of the few general surgery subspecialties to have its own independent board (Thoracic and Plastics being the only other two, while vascular is making a bid now). The main society is the American Society of Colon and Rectal Surgery (ASCRS) which can be found at www.fascrs.org Click on the residency training button to see what programs are available.
Currently only 1 year of residency (note that this is technically a residency just as CT surg is technically a residency since it leads to a separate independent board certification) is required, although some programs include a 2nd year for research, the mode is definitely one.
Colorectal surgeons obviously focus on those two things. They probably stand out the most when you talk about complex pelvic and anal work (e.g. high transanal excision, continence restoration, etc.) as well as all the standard things that a cutting edge general surgeon might do (ileal pouches (J-pouch) for UC, colon cancer resections, etc.) Also, all colorectal surgeons do a fair bit of endoscopy training and incorporate it into their practice much more so than general surgeons, especially as it related to therapeutic endoscopy.
Historically, Colorectal surgery was not a specialty that was well represented in academia, however that is definitely changing, and in looking around, most academic centers now either have a board-certified colorectal surgeon or are in the process of recruiting one. Still, you will find that colorectal surgery is less well defined than the other specialties at many centers. As far as competitiveness, the days of it being uncompetitive are largely over. There are ~30 programs offering about ~50-60 spots and the number applying easily exceeds that in most years these days. The admission process is a match run by the NRMP, applications at the beginning of your chief year.
I hope this helps.
