Colorectal vs HPB vs Surg Onc vs... Gyn Onc?!?

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DoctorCthulhu

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Hi all, long time lurker. And here's my dilemma.

I love Surgery. I love ObGyn too (or rather, I loved Gyn and tolerated Ob).

I've been in love with oncology since pre-med, and I have a (modest) research background involving molecular biology and cancer dating back to undergrad.

I am in awe of big abdominal and pelvic cases. I also like taking care of very sick people.

I would like, however, the opportunity to do something smaller and "lighter" interspersed with the big, impressive cases.

Colorectal affords the chance to do both anorectal surgery and endoscopy
between colectomies and APRs. Lifestyle seems decent outside of GS call, and fellowships seem moderately competitive.

Surg Onc has big abdominal resections galore, but not a lot of "small" stuff - it seems like breast surgery is getting increasingly done by breast surgeons, instead of traditional surgical oncologists. And that leaves what, catheter insertion? Meh. I wouldn't mind doing some melanoma/sarcoma, though those seem uncommon. Lifestyle looks a bit worse than Colorectal, but not bad overall. Fellowships sound like a bitch to get in, though.

Gyn Onc... I've seen a bit of this in my core rotation and loved it. Those guys mess around with bowels and bladder on a regular basis, and perform some beautiful operations - I scrubbed for a TAH-BSO with iliac lymph node dissection, and it was awesome! And if I could intersperse some benign gynecology (and avoid obstetrics entirely after residency) that would be a major plus. Not sure about those guys' and gals' lifestyles, or how hard is it to get a fellowship.

So... if anyone could volunteer any more information... should I be applying to GS or ObGyn next year?

Any information is appreciated. ;)

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Gyn Onc... I've seen a bit of this in my core rotation and loved it. Those guys mess around with bowels and bladder on a regular basis, and perform some beautiful operations - I scrubbed for a TAH-BSO with iliac lymph node dissection, and it was awesome! And if I could intersperse some benign gynecology (and avoid obstetrics entirely after residency) that would be a major plus. Not sure about those guys' and gals' lifestyles, or how hard is it to get a fellowship.

VERY.

It is really hard to get a gyn onc fellowship - it is very, very competitive.

The advice that I was given when I had a similar dilemma was that if you could not see yourself being happy doing general OB/gyn, then you should not pursue an OB/gyn residency just for the possibility of doing gyn onc. Because there is a very real possibility that you will not get a gyn onc fellowship, and will be "stuck" doing general OB/gyn.

You never mentioned anything about HPB. How much experience do you have with HPB stuff? They do the big whacks that you seem to love....a lot of it is very oncologically-oriented....and those are some sick patients. They don't do a lot of "small" stuff, that's true....but a lot of what they do is still pretty interesting....
 
I've heard the same advice re: don't go into Ob-Gyn unless you can tolerate doing general ob-gyn because it's quite possible you won't get one of the highly competitive gyn-onc spots. I've also been told that if you like ob-gyn for the "surgery" of it, rather than the mix of surgery, primary care, reproductive health, etc, you should go for gen surgery or some other surgical subspecialty, as general ob-gyns are at best "part time surgeons," as in only part of their practice is surgical. Also, it seems that most general surgeons have a lot of contempt for the surgical skills of general ob-gyns...this is in part because the general surgeons I worked with were a-holes, but it acutally seems to be a fairly widely held sentiment.

It sounds like your heart is in doing surgery of some sort, so if I were you, I'd go the gen surg route. You'd get to do a fair amount of cancer management, particularly if you decided to do a fellowship, but even if you didn't, I bet you would still get to. In fact, at the hospital I did my rotation at, which I know is not representative of everywhere, all the surgeons does general plus cancer stuff....so my non-fellowship trained attendings managed breast cases, colon cancer, hernias, gall bladders, etc, and the fellowship trainied HPB/colorectal/surg onc surgeons took some general cases as well. The only people who never did general cases or ER call was the breast group (not sure how they pulled that one off...). So, even if you do do surgical onc or HPB or whatever, it's possible for you to take some "little stuff" too, if you want (although from the sound of it, the surgeons at my school hate that they have to do those sorts of cases and take ER/trauma call). To me, it doesn't seem worth the risk of NOT getting a gyn onc fellowship and ending up as a general ob-gyn not having as much OR experience as you might like.
 
Good advice all around.

Gyn Onc is terribly competitive and if that is your only interest in the field, you may be disappointed if you don't match and end up having to do general Ob-Gyn.

Gen Surg on the other hand, opens up a lot of opportunities for you in the way of oncologic surgery. The environment in which you practice has a lot to do with what you can and will do. In many medical centers, the smaller surg onc cases are not necessarily all done by breast fellowship trained surgeons and I'm not sure where you're at, but melanoma hasn't been that uncommon, IMHO. Then again, I would necessarily categorize melanoma as a "small case" either as I've seen some pretty big whacks coming from it.

The truth is that you may very well change your mind about what you wish to do by the time you get to fellowship applications. If you enjoy surgery more than you enjoy office stuff, you want to find a practice where you can maximize that.
 
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