decisions

[PAgirl]

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Anyone seriously considering another field before deciding to do surgery? Did you make the right decision and why?

 

[njbmd]

During third year, I was going into Pathology right up until I scrubbed my first case in my surgical clerkship. At that point, I was hooked and couldn't consider anything else. Yes, I made the right decision and haven't looked back. Am I unusual? Yes, I am but I know the things that get me "out of the rack/crib in the AM and keep me going all day long". (It's not coffee and prune juice either).

 

[blue2000]

Anyone seriously considering another field before deciding to do surgery? Did you make the right decision and why?

I came into medical school pretty sure I was going to do med-onc. Did my surgery clerkship first third year and then spent the remainder of that year trying to find something else other than general surgery that I thought I could do and it would make me happy. Decided nothing was quite the same, and went for it.

I'm of two minds. I love my job, and am nearing the end of residency, which was a fabulous time in my life. I'm really excited about getting started as a general surgical attending and look forward to my career.

But? I still wonder if anesthesia could make me happy "enough." I started residency single, and after five years I'm married with a 15 month old. Part of it is the demands of chief year but I really struggle to balance my private life and my personal life and often feel like I'm coming up short in both arenas. I look to my friends in anesthesia, who seem to have it a bit easier. Because I have so much fulfillment at home, I'm not looking for quite the same fulfillment at work and wonder if I'd find anesthesia satisfying (Especially as I was leaving at 3pm...) I think in the long run, general surgery was the right choice, and I do totally love it, but those are my thoughts.

 

[filter07]

But? I still wonder if anesthesia could make me happy "enough."

Because I have so much fulfillment at home, I'm not looking for quite the same fulfillment at work.

I agree with this.

I find general surgery and a few of its subspecialties to be the most fulfilling and gratifying job I am reasonably good at doing. I'd guess this is a common view shared by most general surgery residents who haven't yet quit.

The better question in my opinion is whether it is worth the sacrifice and duty.

Perspective is very different on the other side. Premeds and medical students are very focused on proving to the world that they can achieve certain goals, and seldom focus on whether those goals are right for them.

 

[PAgirl]

I agree with this.

I find general surgery and a few of its subspecialties to be the most fulfilling and gratifying job I am reasonably good at doing. I'd guess this is a common view shared by most general surgery residents who haven't yet quit.

The better question in my opinion is whether it is worth the sacrifice and duty.

Perspective is very different on the other side. Premeds and medical students are very focused on proving to the world that they can achieve certain goals, and seldom focus on whether those goals are right for them.

This was exactly my thought behind writing this post. I had this suspicion. I have no doubt that I will enjoy residency and a career as a surgeon, but I wonder if the sacrifices I will make will be worth it, versus a career I will not enjoy as much as surgery but will afford more sleep and free time. Just something I've been thinking about recently as I approach making the commitment to surgery.

 

[BlondeDocteur]

It's something we all go through, and you're being quite smart by weighing things heavily. Personally I considered *everything* (except ob/gyn, peds, path and rads) before being absolutely sure I was meant for gen surg. All the sub-specialties, medicine, psych and neurology were on my differential, but none could offer me the special mix of interventionalism, acuity and breadth you get with general surgery.

 

[filter07]

none could offer me the special mix of interventionalism, acuity and breadth you get with general surgery.

Agreed. I hate the feeling of being limited in what I can do. That is one of the draws of GS. We are one of the most versatile and comprehensive physicians. This is one of the reasons why it is so gratifying to be training in this specialty. But when times are rough, when you are tired, or just sick of being in the hospital, it's a different story. That's when the acuity, the comprehensive nature, handling complications, telling family that your best wasn't good enough, operating late at night and then coming back to work at 5-6am... that's when a safe, limited scope, outpatient surgery type specialty... or even a boring 9-5 office job, seems very tempting.

 

[jhayes13]

The better question in my opinion is whether it is worth the sacrifice and duty.

Perspective is very different on the other side. Premeds and medical students are very focused on proving to the world that they can achieve certain goals, and seldom focus on whether those goals are right for them.

Very well said. When I went into surgery, it was after considering a lot of other things. I was closest to picking medicine and thought a lot about cardiology. I had almost convinced myself that interventional cardiology could offer the same middle of the night go save somebody sort of thrill that surgery could but with an easier lifestyle and obviously higher pay. What drew me to surgery was what I saw as being able to handle the whole care of the patient, and if taking someone to surgery was what was required, we could do that. I decided that someone had to do the tough work. I thought it would be noble.

I knew the lifestyle was bad but I had no idea what that really means. Being on a rotation for 4/8/12/whatever weeks gives you such a limited picture. Getting up in the middle of the night to go to the OR as a student is fun. Getting paged incessantly all day and night as a resident/fellow/staff is not. I went into surgery knowing that the lifestyle sucked but you really can't have an idea what that actually means until you live it. Imagine only having 4 days off all month. Did you ever have those days as a student where you came in to round on a weekend and your staff would waste all kinds of time talking to his staff buddies that he comes across in the hall while you stand in the corner twiddling your thumbs, hating having to be sitting around wasting your time being trapped there at someone else's mercy? That's what residency is like EVERY DAY! Realistically, you're going to have at least some trouble maintaining social connections, possibly even your own romantic relationship. Imagine not being able to go home for major holidays, missing important family events (graduations, baptisms, etc). Spending New Year's getting paged about someone's diet order and reordering restraints. How about missing the birth of your own child or the first time your baby smiles/laughs/says "dada", etc? High acuity is fun as a student. High acuity as a resident is a very lonely and incredibly stressful feeling. Somehow surgery programs find it safe to have one person in house (a junior resident) running an ICU at night, seeing all the consults on floors and in the ER, supervising the intern, etc. whereas medicine may have a STAFF in house just for the ICU at night to back up the (team of) residents. We don't code people as often as medicine residents do, so when someone more critical than any medicine pt (ie POD#0 liver txp, pulmonary HTN, ongoing bleeding, etc) codes in the ICU and you're the only doctor, that's a problem. Having to do complicated and risky bedside procedures that you're not experienced with in an emergent situation. One guy I know killed someone by perforating his SVC putting in a dialysis line. Imagine having that sort of thing on your conscience. The stress of being on the front line every day with less experience than almost anyone and having to operate on this level can break you psychologically. The militaristic environment and tough personalities are also hard to bear. Let's face it, in a real job managers couldn't treat employees like some staff treat residents. The organizations wouldn't stand for it. In residency nobody cares (unless of course these staff have conflicts with more senior staff). Being forced to practice non-evidence based medicine and doing so in a service orientation and not in an educational one. Do we have PAs at the university hospital? Sure we do. Do they help on the floor? No, they operate! We do the discharge summaries and the admissions. I kid you not (to be fair though this is only on 1 service).

I'm really not sure life as a staff is much better (at least in some situations). Staying up all night once a week for the next 30 years, without help (you are your own intern), carrying the weight of all your own patient's problems on your shoulders. Imagine sweating out every anastomosis, every inch (sonometer?) of raw mesentery, every tie on every blood vessel every night, along with the complications on your service currently that you are already burdening your conscience with, every night of your practicing life. As a student it was easy to tune out in M&M. Honestly, it was hard to even see the point of being there sometimes. As a staff, imagine the stress on you and your psyche when you (1) are already personally guilty feeling and stressed out by having caused unnecessary harm to someone, (2) facing the constant threat of a lawsuit for it, (3) and facing scrutiny by your hospital/payers/rate your doctor.coms for your outcomes. I work with some private guys who each take call all weekend, and they can sometimes be there literally the whole time. They don't know their children. They don't have good relationships with them. I don't think I want that much time away from my family. I don't want to be an absentee father and husband. And the reality is you're going to be working harder for less money every year. For all the time spent under adverse conditions in training and then as staff, you don't need to be worked to death seeing line and abscess consults, "come lay hands on my patient" ER stuff, and spending sleepless nights operating on indigent patients who can't/won't pay you while exposing you to the liability of doing emergency operations with their attendant outcomes.

I went into surgery to save the world but ended up bitter, stressed by the constant unending work, lack of help, and the acuity. I'm about 60% sure I'm going to resign but it's not a given. I'm over half way through so it's not a trivial decision. What I'm going to miss if I do is talking to patients and families about things that matter and doing it well. Even just taking time to explain to a family something really basic like the postop course of a lap appy can make a profound difference. So many people don't know how to talk to patients or just don't care enough not to talk over people's heads and give them the reassurance that they need. I think I'd miss talking to patients if all I do it for are less critical issues.

And this is not to say people can't thrive in surgery. People who enjoy military type hierarchies tend to do well. People who have the sort of temperament for long hours of labor who value hard work and a job well done do well. I should also say as a final note that there are "cush" community programs out there where the hospital isn't run on the backs of residents, where the focus is education (as it ostensibly is everywhere!) instead of very clearly about service, where staff share the workload and give more than lip service to resident well being, that would be worth looking into. I seriously wonder how I'd feel if I were working with 1 or 2 staff at a time, with a manageable service, supportive environment, nurses not in a teaching hospital call the resident for everything all hours of the day culture instead of in a monolithic university program.

 

[ap4uga]

I went into surgery to save the world but ended up bitter, stressed by the constant unending work, lack of help, and the acuity. I'm about 60% sure I'm going to resign but it's not a given.

Awesome....Match Day here I come!

 

[beefballs]

During third year, I was going into Pathology right up until I scrubbed my first case in my surgical clerkship. At that point, I was hooked and couldn't consider anything else. Yes, I made the right decision and haven't looked back. Am I unusual? Yes, I am but I know the things that get me "out of the rack/crib in the AM and keep me going all day long". (It's not coffee and prune juice either).

I was identical with path

 

[Biscuit799]

JHayes13 hit the nail on the head with his excellent post. Surgery is certainly a rewarding field, but the negatives he explaines are indeed frustrating and difficult to deal with. I personally chose surgery because I enjoyed the kinesthetic aspect to it, and the breadth of practice. However as my exposure to surgery increases, it's becoming less easy to blow off frustration with the "it'll get better in (X amount of) years." There is seemingly no end to the difficult workload and frustrating treatment.

He made a small point about cush community programs. I believe that these programs offer the best educational experience in the country. Even better than prestigious acadamiae. The staff cares about the residents in a way that older, more established programs simply do not. If I had it to do over again, I would focus much more on finding these type of programs.

I personally was very torn between surgery and psychiatry. In the end, I based my decision not on what I preferred, but what I preferred to not do. I.e. if you told me I could never go into the OR again, I'd be more upset than if you told me I could never interview another borderline patient again.

I think you are asking a very insightful question this early in your training. Most med students feel compelled to prove they can handle the hard work, rather than asking themselves what they want. As though switching away from surgery were some sort of personal failing. It's definitely not, and more and more students are taking this into consideration as the lifestyle specialties get more competitive every year.

 

[SLUser11]

Although I'm somewhat turned off by the "cush" label, I have to agree with Hayes and Biscuit that things don't have to be that bad.

There are university programs and community programs alike that are more resident-friendly than others. Regardless of the label, there are good and bad programs everywhere. The important thing is to do your research prior to submitting your ROL, and not get caught up in the mythical prestige factor.

Unfortunately, on SDN we can only give info on the handful of programs that we've experienced personally as residents and students. However, I personally did a lot of research prior to match day, and my experience here in Wichita has been very positive. I don't consider it cush, as I work very hard, but I have a healthy learning environment, strong academics, and an excellent case load. I'm married with a baby on the way, and I've been able to balance my work and home life well.

Do I think everyone should come to Kansas? Of course not, but I think there are similar places in multiple geographic areas that can offer a similar experience. You just have to be smart about it.

Multiple times people have judged me and condescended to me on this board without any knowledge of my scores or qualifications, immediately assuming that only weak applicants would want to be at a community program in Wichita. I've occasionally felt similar condescension from visiting professors and interviewing students. What they don't understand is that for a lot of us, this was a choice. And a very smart one, I might add......

 

[PAgirl]

Wow, these replies, along with those in the quitters thread, have made me feel so much better. I've been incredibly stressed out lately about whether or not I'm making the right decision going into surgery, but I've avoided talking about it with other students going into surgery or with surgeons for fear that my doubt would be a clue to my inherent weakness and make them think I wasn't cut out for surgery. I was also afraid that I was the only one having such doubts, and it is so good to know I'm not alone. I love surgery. Its the only field I'm truly passionate about. It gives me chills and reminds me why I went into medicine in the first place. And if it weren't for the long hours and sleep deprivation, I wouldn't think twice about going into surgery. Which is why I think I will be ok and will not regret my decision to do surgery. But it also makes me realize that lifestyle is really important to me, which is why I think I may be meant for a community program.

Thank you all for having the courage to voice your doubts and for the thoughtful advice. This forum and the people on it have been an invaluable source of both advice and support.

 

[EastCstBound]

Wow, this thread has been very informative thus far. Thanks to all those posting! After reading Jhayes13's post I started to panic! But SLUser11's post adds balance. I wonder though, how do you find more resident friendly programs? I'm coming from a university program so naturally I'm being advised to apply to other university programs, many of which have a reputation for being malignant.. Not quite sure how to find more programs and figure out what they're really like. Suggestions?

 

[Witch Doctor]

I'm really glad someone posted this! Out of my third year rotations surgery was the only thing I enjoyed (at all really), until I started peds... I know that is strange because they are so different, but they offer some of the same things to me. They both have a great deal of acuity (peds patients are rarely on long term follow up for a condition except DM which is usually taken care of by and endo), you can actually do something about their problems (unlike IM where you are just masking the issues as best you can), and the patients are usually very grateful. I have been a little panicked about this, since I have already applied to surgery sub-i's and set up my schedule to do surgery. I wonder if chosing surgery will provide instant gratification, but if peds would provide more long term satisfaction?

I really want to have children (I am a woman), and although everyone says that is possible as a surgeon I still am aware of the difficulties you would face. So I don't know, I'm doing peds sub-specialties for the last two weeks so I guess I'll see if anything comes close.

 

[njbmd]

There is no "perfect" specialty. You pick what you believe is right for you and you do it. There is no "perfect" program either. If you are not in a particular program, you are only hearing things second-hand which are colored by the experience and feelings of another person.

Community programs do not have a "lock" caring about the professional development of their residents nor are academic programs uncaring. That's too simple a generalization and the "grass always looks greener on the other side of the fence". In the end, you try to match into the program that you believe will suit your needs best and that you are competitive for.

In truth, there are many good programs that train good residents and will work for the vast majority of people. There are many specialties that will work for the vast majority of people but at some point, you have to make a decision. You can waffle and angst or you can sit down, be honest with yourself and try to find what suits you best.

The world isn't going to come to an end if you choose the wrong specialty as long as you get out before PGY-2. It happens quite often in surgery when the romance of being a surgeon outweighs the joy in actually doing it. You will be able to tell before your first year is done. If this turns out to be the case, get out and do something else.

 

[Leforte]

All fields of medicine have their pluses and minuses. You can balance work and home life well in nearly any specialty. Residency is a whole other animal and it can be brutal or not. Unfortunately, it is difficult to discern which programs are harsher than others on the interview trail, just as it is difficult for programs evaluating you to determine who will "get it" and who will not. Oftentimes those who struggle with patient management choices, perform poorly in the OR, or other resident associated problems do seek other residencies. Similar, there are occasionally good to great residents who once in the trenches decide that the career of a surgeon is not worth the trade-offs. Only you can tell what is right for you in whatever residency situation you end up in. It is important to have supportive colleagues (fellow residents), an understanding faculty and for some people, being close to family for added support is also beneficial.

Many surgeons come to surgery thinking that it is all they could do in medicine. Others, myself included, would probably have been just as happy in another field had we chosen differently, but had some positive experience which led us to our chosen specialty.

In the end, you make a decision, roll with it and see how it all pans out. If you made a mistake, talk with someone, maybe even professionally. If you are still unhappy and feel that another field is better suited for you - you can always pursue that path, with the knowledge that it would be very, very unlikely to reenter surgical training in the future should the grass not be greener.

 

[Semmelweis]

What they don't understand is that for a lot of us, this was a choice. And a very smart one, I might add......

Very true! I came out of lurking just to say that I learned very well from my research how unpleasant some of those big name university programs can be. That's why I ranked those programs that seemed to treat the residents decently above those with theoretically "better" names. Hence I happily matched last month into an academically strong, but not malignant community program in NJ.

 

[TheThird]

Although what jhayes had to say what all true, I think it's important to keep in mind that ALL residencies will tend to suck with the exception of the ROAD specialties and a few others.

During my non-OR medicine and peds clerkships, those residents would also work long hours with only 4 days off a month. Often times, the chief resident would work 14 days straight before getting just one day off because "the schedule didn't work out."

I suppose you could argue that it's an additional two sucky years for gen surg. But most sub-specialists in other fields like med-onc will take up 3+3 years... about the same if you completed a gen surg residency and did a one-two year surg onc fellowship. All in all, I think training will (and should be) rigorous for any field where you really take ownership of a complicated sick patient. Don't let 5-6 years of hard work deter you from a rewarding 40 year career if gen surg really gets you up in the morning, cause residency will be hard either way.

 

[filter07]

Surg Onc is usually 5 years GS + 2 years research + 2 years Surg Onc. 9 >> 6.

How many work 40 years after fellowship? Only the old guys in academic hospitals who show up just to collect their check...

 

[Apollyon]

Although what jhayes had to say what all true, I think it's important to keep in mind that ALL residencies will tend to suck with the exception of the ROAD specialties and a few others.

Yeah, add EM into there.

 

[Guile]

Surg Onc is usually 5 years GS + 2 years research + 2 years Surg Onc. 9 >> 6.

How many work 40 years after fellowship? Only the old guys in academic hospitals who show up just to collect their check...

And many fellowships are now 3 years... 10 years of post-grad training.

 

[jhayes13]

Wow, I can't believe I wrote that 2.5 years ago. I logged in to post something else just now (obviously this isn't my usual username for anonymity reasons) and looked at my old posts. I would like to give some followup for whoever might be reading this in the future and thinking about quitting.

I was deeply depressed in residency for the first three years and I had recently gotten out of a very unhealthy relationship when I wrote this. I was actually in lab for the past few months but still smarting from all the perceived injustices against me such as all the brutal call, unpleasantness from our PD (including the time he scrubbed out to tell me, "Don't **** with me"), compulsory call coverage during lab, etc. Junior residency was TOUGH. I thought second year was bad but then my reward for completing it was third year, which was almost identical in every respect. It was like being denied parole at the very last minute.

But then I started to decompress. The lab lifestyle was a substantial improvement. I found a psychiatrist in the university's psych department who was kind enough to see me on weekends. I met a great girl who was concerned about me and wanted me to see an internist, and to make a long story short I was found to have severe sleep apnea, with >70 events per hour. I honestly don't know how I made it through the first several years of residency. I was running on almost no real rest for over 3 years straight. I am getting much more restful sleep now with CPAP and I have been on antidepressants which made a big difference. I came off them 4th year but have had to go back on, but it still seems to be working.

What is more, my attitude about surgery changed. I grew tired of lab. It started to seem like I was stuck in neutral and was just wasting time that could be spent learning more surgery. Coming out of lab into 4th year, things were quite a bit different. A lot of the junior resident stuff I hated like dealing with pushy idiots in the ER, etc. wasn't my responsibility anymore for the most part. The year was a lot more heavily operative. By the end, I started to feel a lot more confident about my operative skills, which was something I was really wondering about all through residency. PGY5 came along and all of a sudden I'm operating more than ever, starting cases by myself, etc. and it's getting easy! It wasn't so much a transition into having a lot more confidence but more like a conceptual leap. Suddenly surgery has just started making a lot more sense.

At this point I am very excited about surgery again. I am also planning on even more training with fellowship. I've answered my own question about whether I will have the skills to do it independently (yes). I like it quite a bit, and especially now that I'm removed from the junior resident BS. I do think that I will have to have a low acuity job; trauma/CC, CV, transplant, etc, these are all things that would be WAY too stressful for me. I hope to find a nice job doing bread and butter surgery in a smaller hospital and I think that would suit me just fine. I am happily going to choose lifestyle over money if need be.

There are still some tougher and some more reasonable residencies, but overall I'm happy that I did surgery and also happy that I stuck with it. I chose to be at a university program but in retrospect I'm not sure that I would again. I guess a point I'm trying to make is that there are things you can do to make your circumstances better with getting professional help, attending to your own health, etc. If I didn't have the chance to go into lab for 2 years it's hard to say how things could have turned out because just having a chance to rest for 2 years seems like such a relief. Again, overall I'm excited about surgery and excited about a career in it. I hope that any students out there are appropriately thoughtful about going into surgery, but do keep in mind that things are hard but doable for sure.

 

[AngkorWuT]

I'm glad to hear everything is working out. It takes a strong person to realize they need help and to seek it out. I'm starting my own foray into residency and am dealing with the same BS that you older residents dealt with as a junior. I'm on a rotation that a neurosurgeon told me was when "you put your big boy pants on". Managing 45 patients (not extremely critical but still) is something I'm still struggling with but trying had to get better at. There has to be light at the end of the tunnel right?