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Aloha Kid

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I was wondering.

What is the possibility of a Gen surgeon doing only elective/outpt. cases and avoiding call. Perhaps majority of the cases could be performed at surgery centers.

They wouldn't be doing any whipples. However, bread and butter cases like cholecytectomy and inguinal hernia repair are definitely possible. If a pt. needs to be hospitalized overnight, send them to the hospital next door to the surgery center.

Gen surgeons are also qualified to do screening colonoscopies and could very well receive certification to perform upper endoscopy. The ability to steal procedures away from the GI monkeys are incredible. Not to mention, If the colon is accidently perfed, we can fix it ourselves. Let the GI monkeys handle the medicine aspect of cases like Hep C, and IBS. When it comes to removing a polyp, its surgical, let a surgeon do it. Same thought goes for ERCPs etc.

With a PA helping out with surgery, office visits, etc. a cush lifestyle definitely seems attainable. A typical week might consist of procedures M, W, F am hours. Office hours T, Th. The free time would be immense.
 

Vincristine

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I say it's completely possible, but IMHO, surgical residency is too much work to come out only doing lap choles and hernia repairs.

The two general surgeons I worked with during my surgery rotation had similar situations to the one you described. The first was 30 years into his career and had kind of gone back to general surgery after a time in the USMC and a long while as a trauma surgeon. He now had his own practice and "specialized" in breasts and hernias (although nothing I saw was overly special). He operated M,W,F afternoon (12n-3p), was in the clinic M,W,F morning (9a-1130) and T afternoon, did office proceedures T morning, and took Thursdays off. THe VAST majority of his cases were all scheduled, most were outpatient, and he didn't formally take call. However, if one of his patients needed somehting, he was the man to call, or if there was a special request for him, he would come in.

The second general surgeon I was with was about 9 months out of residency and had come to this position upon graduation. He operated M,T, and maybe Friday, was in clinic M&T morning, and Wednesday all day. Thursday he was usually on call, but had no scheduled cases or clinic. He worked at the smaller, non-level I hospital in town and very often had call days which were completely free. He was also on call one weekend a month, but all call was from home. He averaged about 2 hospitalized patients, and usually rounded on them inbetween cases in the morning. The weekends not on call, his colleuges covered his patients so he was completely off.
 
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ny skindoc

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It is certainly possible to set up virtually any a medical practice the way you want however there are considerations.If you want to get referrals from other physicians for simple cases you will have to take other consults for more complicated patients as well.Most hospitals require surgeons with staff priveleges to take call. You will need to be able to handle acute abdomens etc.Surgeons who spend most of their time doing colonoscopies and inguinal hernias will see their surgical skills atrophy over time.In many places given malpractice and other overhead costs it will not be economically viable to maintain a surgical practice based on only doing these simpler no hassel procedures.
 

Aloha Kid

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Originally posted by ny skindoc
It is certainly possible to set up virtually any a medical practice the way you want however there are considerations.If you want to get referrals from other physicians for simple cases you will have to take other consults for more complicated patients as well.Most hospitals require surgeons with staff priveleges to take call. You will need to be able to handle acute abdomens etc.Surgeons who spend most of their time doing colonoscopies and inguinal hernias will see their surgical skills atrophy over time.In many places given malpractice and other overhead costs it will not be economically viable to maintain a surgical practice based on only doing these simpler no hassel procedures.

There in lies the trade off. Better hours, better lifestlye, NO CALL. Operating out of surgery centers for outpt. cases require NO CALL. Switching to incorporate more colonoscopies in one's routine would ultimately benefit the surgeon and can also be performed at Surgery centers as well. With screening colonoscopies becoming routine, there will be more than enough to do.

Having to be on call in order to gain the attention of community PCPs and in turn have them refer to you is a misnomer. In fact, many PCPs don't even go to the hospital theses days. They wouldn't even be near the hospital to watch you bust your hump taking call. Good PR work, timely write up of consultation and procedure notes, the ability to remain open and squeeze pts in to be seen early, and a clear statement of what procedures you will and will not do, will ultimately catch the attention of PCPs.
 
N

njbmd

Hi there,
I just finished my month of Endoscopy. General Surgeons are qualified and certified to perform endoscopies, colonoscopies and other procedures. It was a nice month and one of the easiest of my second year.

I personally find the choles, appys and hernias to be interesting but I wouldn't want to do them all the time. A good pancreatic case is sweet and I love hepatobiliary. The lap gastric bypasses were pretty fun to do. Vascular is off the scale fun.

General Surgery is fun because of the variety and breadth of practice. I still maintain that eight hours of something that you hate is worse than 36 hours of something that you love.

njbmd :D
About to go off to "surgery camp" at the VA hospital.:D
 

ny skindoc

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I agree that the above plan could work to make a surgical practice with an easy lifestyle-you are on the right track.But its possible to learn endoscopy during a FP residency and learn to perform low level surgical procedures with a fraction of the effort of a surgery residency. If you took this approach and went to a physician shortage area you'd be set.Of course a board certified surgeon would be far more competent and marketable. Dont worry about being bored .. you will have plenty of free time to spend on your hobbies and family and other interests..let someone who wants to sweat over pancreatic tumors do it!
 

surg

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I have certainly seen practices like these out in the community. As another poster said, it depends on the availability of resources in the area. For example, many health plans require you to have admitting privileges in a hospital somewhere to participate in their plan. Many hospitals require all their surgeons to take some call. These two combined together may nix your idea of absolutely NO call. However, call as a private surgeon is not as bad as it sounds. In general, unless you are in a busy trauma center you don't spend the night at the hospital and only come in when there is a case to be done in the OR or someone to be evaluated in the ED. ED physicians in the community, as a rule, tend not to be as consultogenic as their teaching hospital counterparts.

Finally, even if you only did outpatient stuff, you would still need to be on call for complications. A bile injury from a lap chole could present at the hospital a few days after the operation. I would assume you would want to be called to let you know although that may be presuming too much I suppose.
 

Energon

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two words:

Hair transplantation.
best lifestyle, ample money, minimum paperwork.
 
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