colorectal

[jayman]

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how many years is the colorectal fellowship? and how competitive is it (a vague question, but say relative to other specialties)?

 

[droliver]

one year & not very

 

[jayman]

thanks droliver.
-jayman

 

[daredevil_2010]

one year and not very competitive. If you like the work, Colorectal is a great field. No real emergencies. Great pay. Great abdominal cases. Great outpatient cases. Major OR cases generally only last 2-3 hours. Home by 5:00pm to the wife and kids.

 

[droliver]

DD,

I would not agree with that characterization. Busy colorectal surgeons work their ass off (pun intented 😉 ) Many colorectal surgeons also do signifigant amounts of general surgery in their practice, as well as being obliged to take call for general surgery ER call & consults at most hospitals. Many colorectal procedures are very long & diffucult cases as they tend to collect tertiary referals for diffucult oncologic cases as well as being the inheritors of many patients with multiple operations for IBD previously. Peri-rectal infections inevitably come into the ER @ 10 at night. This patient population can be a very sick group of people in the hospital & require a LOT of work (both physically & with the psych issues associated often with them), especially the IBD group.

The only way that you turn this kind of practice into something with bankers hours is if you are able to limit your practice to exclude all the complex patients that you recieved the specialized training for

 

[daredevil_2010]

Not too sure what kind of program you're at, but it sounds as if the colorectal surgeons are getting a lot of sh&t (no pun intended) dumped on them. In a large Academic program, most of the things you described are covered by other fields.

Colorectal surgeons deal with anal fissures, hemorrhoids, anal fistulas, etc... These are small cases that take only 1-2 hours in the OR. Their major cases are for Colon Cancers and doing ostomies or End to end anastomosis. These cases take about 2-4 hours and they work with Urology. I've talked to several Colorectal surgeons. They say they are home by 5:00 unless they stay for M&M or something. Patient popluation is very thankful for cures.

 

[maxheadroom]

All general surgeons will do hemorrhoids, anal fissures, and the like. The procedures that set a colorectal surgeon apart are all of the crazy surgeries for IBD, colon cancer, and ostomy stuff. Never saw urology come in for any cases. They were there once to repair a ureterotomy performed by OB/Gyn during TAHBSO; colorectal came to repair a big ole enterotomy that they also provided.

Gotta defer to Ollie on this one. Colorectal surgeons typically take general surgery call, maybe even trauma call (depends on the institution, but I've seen C/R be the trauma backup team quite frequently).

While their lives tend to be more tame than CT, Vascular, and Trauma, most C/R surgeons that I've worked with seem to work pretty hard.

Caveat for all readers: if the word "surgeon" appears in your job position, don't expect to work from 8-5 M-F. Even the cushier areas still require a fair amount of call, weekends, and tough patients, especially when you're building a practice. Lots of people seem to be looking for the surgical practice where they can work 50 hours per week and never take call. There's one job that allows that: Derm MOHS. They might call it surgery, but I sure don't.

 

[droliver]

Originally posted by daredevil_2010
In a large Academic program, most of the things you described are covered by other fields.

Most fellowship-trained CR surgeons do not practice in that environment. As I mentioned, general surgery procedures independent of the colon & call are routine parts of practice for a lot of these surgeons. In addition, they get paid the same way every one else does, & if they want to earn more they have to work more and in private practice that does not equal 7-5 schedules. Those 2-4 hour cases for colectomies,pouches, and the like .. are the simple ones. Reoperative abdominal cases with oncology patients can run 10-12 hours or more depending on adhesions, tumor debulking, intraoperative XRT, abdominal wall reconstruction, pelvic floor reconstruction by consulting Plastic Surgeons, etc.... Operations for the IBD group can also be very,very treacherous with aggressive dz. (fistulae everywhere).

I don't mean to suggest that their schedule is as unpredictable as most general surgeons (but again many of them are in groups where they do general surgery). It's just that I don't think you've seen how much work it takes to manage the patients that fall into the CR purvey, especially in private practice without resident or fellow coverage. Talk to your upper levels about their feelings on this and I'm sure you'll get a collective groan when they explain the joys of IBD patients

 

[Pilot Doc]

I'll second Dr. Oliver's account. With a brief exposure to a big academic center's colorectal department, the cases seen are often redo redos on IBD patients or complex cases sent from outside surgeons who have sometimes made the cases more complex by their intervention.

 

[FliteSurgn]

I echo droliver's comments. Colorectal surgeons usually take part in the general surgery call pool. Due to the nature of the surgeries performed (colon resections, ileal pouches, rectal resections, etc.) their patients also tend to stay in the hospital much longer than the average general surgery patient. That means that their inpatient census is frequently several times larger than any comparative general surgeon's. Add in the endoscopies that they do between cases and they can often be much busier the general surgeons. This is by no means a boutique surgical practice. Just my two cents.

Show me someone that thinks a total abdominal colectomy and ileal-pouch anal anastamosis is a quick case. This is a difficult operation that is the colorectal surgeon's whole purpose for existence. 🙂

 

[Foxxy Cleopatra]

I agree; though my experience is limited, colorectal surgery makes Crohn's comes to mind with many fistulas, a good amount of resected small bowel, TPN, and the like. Interesting to me but definitely a challenge.

I can see where the j-pouch would sound very appealing to a young adult faced with the decision to undergo a total colectomy (like many IBD patients.) Though CD patients are generally not candidates, it could make a world of difference in UC. However, the complications (pouchitis, remaining mucosa, frequent BM's) are significant.

On a different note, anyone know of where the major research centers for continent procedures like the j-pouch would be? Cleveland Clinic?

thanks

 

[droliver]

foxxy,

Mayo & The Cleveland Clinic are the traditional leaders in all things colo-rectal. Those are the two most prestigious fellowships as well incidentally & a huge portion of the leaders in academic CR have some pedigree from one or the other (or both)