Did you end up specializing in what you thought you would when you started med school?

[username456789]

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I came into medical school thinking I would either do Orthopedics or Urology.

Ended up loving Derm. So that's what I went into.

 

[Winged Scapula]

1) I assumed I'd do either FM or an IM subspecialty; much to my surprise I ended up doing surgery.

2) Choosing a specialty based on whether there's a specialty board is about one of the weirdest qualifications I've heard of.

As noted above, there are many specialties which don't have their own board and BC; that in no way reflects on the quality of training, your ability to be BC in your primary specialty or to be employed. Setting up a specialty board is a very long and tiresome process. The SSO (Society of Surg Onc) spent years trying to get it approved as did Vascular Surgery. To use Surg Onc as the example, you'd get BC in general surgery and then your Certificate in S.O.

3) For the user above who is interested in Oncology and Surgery, there are many choices: Surgical Oncology (you may be interested in the relatively recent Certificate for Surg Onc: http://www.absurgery.org/default.jsp?certsurgoncqe ), Orthopedics, Neurosurgery, Gyn Onc, Colorectal, ENT/Head and Neck, Urology. All of these can be tailored to an oncologic practice/focus.

 

[DubVille]

Came in thinking: neurology, forensic path, or FP

I'm doing PM&R. I didn't know it existed until 2nd year, but wasn't certain until 4th year.

The only specialties I really hated were surgery, Peds, and obgyn. I still think I would've been happy in a few different specialties.

 

[Winged Scapula]

This is why I hesitate to do Surg Onc. Many surgical specialties already train you to remove/biopsy the tumor. Path does the lab work and the Oncologist reads and assesses the findings. I could be wrong though.

Nope.

I do the biopsy.

I review the slides of all malignancies with the pathologist (although the fine details are certainly in their wheelhouse).

I discuss the results with the patient.

I discuss treatment options with the patient and we decide on the plan of action.

I refer the patient to the medical and radiation oncologists for adjuvant or neoadjuvant treatment. Surgeons are the driving force for oncologic treatment as we are typically the referral source for all solid tumors. This is why hospitals and multidisciplinary oncology groups want to hire us; we bring in the patients. By way of example, one of my partners used to work for a large nationwide oncology group. She had no quotas or requirements on number of surgeries she did because she was simply there as the referral source for the rad and med oncs. They didn't care if she saw 5 patients a day or 20. Private practice came as a big surprise for her LOL (as she now has to see a certain volume of patients to pay her overhead).

This is how it works in every institution I've trained/worked at.

It is true that your base surgical training will teach you the basics of oncologic resection and that perhaps a fellowship is not always necessary from a technical standpoint. But an oncologic fellowship tends to spend much more time on other aspects thereby enriching your knowledge of the entire treatment course rather than just surgical.

 

[Cyberdyne 101]

Nope.

I do the biopsy.

I review the slides of all malignancies with the pathologist (although the fine details are certainly in their wheelhouse).

I discuss the results with the patient.

I discuss treatment options with the patient and we decide on the plan of action.

I refer the patient to the medical and radiation oncologists for adjuvant or neoadjuvant treatment. Surgeons are the driving force for oncologic treatment as we are typically the referral source for all solid tumors. This is why hospitals and multidisciplinary oncology groups want to hire us; we bring in the patients. By way of example, one of my partners used to work for a large nationwide oncology group. She had no quotas or requirements on number of surgeries she did because she was simply there as the referral source for the rad and med oncs. They didn't care if she saw 5 patients a day or 20. Private practice came as a big surprise for her LOL (as she now has to see a certain volume of patients to pay her overhead).

This is how it works in every institution I've trained/worked at.

It is true that your base surgical training will teach you the basics of oncologic resection and that perhaps a fellowship is not always necessary from a technical standpoint. But an oncologic fellowship tends to spend much more time on other aspects thereby enriching your knowledge of the entire treatment course rather than just surgical.

More evidence that surgical oncologists are indeed real

 

[Winged Scapula]

More evidence that surgical oncologists are indeed real

(Didn't realize there was some question about our existence)

 

[Cyberdyne 101]

(Didn't realize there was some question about our existence)

I only joked about it because an earlier poster said that it's not a "real speciality (yet) because it's not BC" (or something to that effect).

Edit: Nice graphic, btw!!!

 

[Winged Scapula]

I only joked about it because an earlier poster said that it's not a "real speciality (yet) because it's not BC" (or something to that effect).

Ah yes...let's keep it a secret.

Less practitioners, more doubloons for me!

 

[RJGOP]

Nope.

I do the biopsy.

I review the slides of all malignancies with the pathologist (although the fine details are certainly in their wheelhouse).

I discuss the results with the patient.

I discuss treatment options with the patient and we decide on the plan of action.

I refer the patient to the medical and radiation oncologists for adjuvant or neoadjuvant treatment. Surgeons are the driving force for oncologic treatment as we are typically the referral source for all solid tumors. This is why hospitals and multidisciplinary oncology groups want to hire us; we bring in the patients. By way of example, one of my partners used to work for a large nationwide oncology group. She had no quotas or requirements on number of surgeries she did because she was simply there as the referral source for the rad and med oncs. They didn't care if she saw 5 patients a day or 20. Private practice came as a big surprise for her LOL (as she now has to see a certain volume of patients to pay her overhead).

This is how it works in every institution I've trained/worked at.

It is true that your base surgical training will teach you the basics of oncologic resection and that perhaps a fellowship is not always necessary from a technical standpoint. But an oncologic fellowship tends to spend much more time on other aspects thereby enriching your knowledge of the entire treatment course rather than just surgical.

What role does path play then? All they do is review results with you?

 

[lobo.solo]

None from what I heard. Usually people that want to do medicine (IM) usually end up doing that.

 

[Winged Scapula]

What role does path play then? All they do is review results with you?

Of course not.

They have a very integral role.

They process the specimens and while I review the slides with them (and can recognize a malignancy), the final diagnosis is all their work. They also provide assessment of margins and other peri operative assessment. They may suggest a second pathology opinion if they find something unusual. They present slides during tumor board and educate the group in regards to issues of importance to them.

My comment above was not to minimize the role of other specialists but to correct the user who said that the surgeons role was limited to cutting out the tumor.

 

[RJGOP]

Of course not.

They have a very integral role.

They process the specimens and while I review the slides with them (and can recognize a malignancy), the final diagnosis is all their work. They also provide assessment of margins and other peri operative assessment. They may suggest a second pathology opinion if they find something unusual. They present slides during tumor board and educate the group in regards to issues of importance to them.

My comment above was not to minimize the role of other specialists but to correct the user who said that the surgeons role was limited to cutting out the tumor.

That's what I thought. It seemed to me you were suggesting they had a minimal role. My bad, I just misunderstood.

 

[Winged Scapula]

That's what I thought. It seemed to me you were suggesting they had a minimal role. My bad, I just misunderstood.

No worries.

Patients for some reason think I can see microscopic disease or that I should rush the pathologists to hurry their results. I have to explain to them as well that a good pathologist is invaluable. I could not take care of patients without pathologists, plastic surgeons, medical oncologists, radiation oncologists, mammo/US techs, OR staff, etc. They're all very important.

 

[FutureOncologist]

Of course not.

They have a very integral role.

They process the specimens and while I review the slides with them (and can recognize a malignancy), the final diagnosis is all their work. They also provide assessment of margins and other peri operative assessment. They may suggest a second pathology opinion if they find something unusual. They present slides during tumor board and educate the group in regards to issues of importance to them.

My comment above was not to minimize the role of other specialists but to correct the user who said that the surgeons role was limited to cutting out the tumor.

That was me haha. We have an elective Hem/Onc rotation during 4th year that I am very excited to do next year (if I can survive 3rd year crap!) When I looked at the faculty, I found no Surg Oncs on the committee. I knew there were training spots in the country but I believe the American Board of Surgery recognizes it officially as "Complex General Surgical Oncology." Had no idea what that meant so I stopped my research there.

May I ask how competitive Surg Onc is? Does Step I score matter, or do they only look at Step II CK? What else do they look at as well?

 

[Winged Scapula]

May I ask how competitive Surg Onc is? Does Step I score matter, or do they only look at Step II CK? What else do they look at as well?

Surgical Oncology is a fellowship after General Surgery; thus your intraining exam (ABSITE) scores are most important. I don't recall being asked for my USMLE scores (but it's been a long time since application). It's considered one of the more competitive fellowships and highly academic. Like many surgical subspecialties it's a small world, so LORs and who you know can be helpful as is research time in the lab.

(NB: unless I misunderstood earlier posts from you about where you're in med school at, you do have a Division of Surg Onc).