Different Specialties: Office time vs OR time

[12loser12]

I know it sounds bad, but the truth is I really like surgery but don't exactly relish the hospital rounds. Also, a plastic surgeon I was talking with told me he used to be an ENT but disliked it because he didn't spend nearly enough time in the OR.

How does Clinic to hospital rounds to OR time break down among surgery, surgical specialties, and fellowships?

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[Smurfette]

From what I've seen:

ENT and Urology seem to have more clinic than other surgical fields---but still get OR time. Kind of a blend for people who like a little of both worlds--clinic and OR

Ortho--shortest rounds, shortest notes, least amount of time spent managing inpatients (i.e. they consult others to manage everything for them)

Neurosurg---many patients, short rounds, lots of rocks, no idea about clinic volume--do these guys leave the hospital???

Plastics--varies by practice. Some do a lot of office based procedures, some do more reconstructive work and facial trauma, some do a lot of outpatient procedures with a lot of follow up visits. Patients very high maintenance.

General surgery subspecialties:
critical care--rounds galore, little to no OR or clinic depending on how practice is set up. Most also do general or trauma so still operate.

transplant--rounds galore as patients are sick. Long OR cases. Clinic heavy as well since most patients require frequent close long-term follow up

colorectal--varies by practice set up as many do general surgery as well. Probably average for surgery for clinic/OR/rounds balance....but the colorectal guys I know see a ridiculous number of patients in one clinic day and do a lot of office procedures.

MIS--slightly lower rounds time due to faster inpatient turnover rate (i.e. fewer inpatients). However, if you do bariatrics it can be high maintenance and when something goes bad, it goes really bad.

breast--more clinic heavy, less rounding, quicker procedures, high maintenance patients

trauma--many patients to round on but FAST rounds as non-ICU patients are being babysat on trauma service while awaiting neuro/ortho clearance. Minimal clinic. Little OR unless in trauma-heavy hospital

Surg Onc/HPB--longer rounds and patient interactions due to procedures/prognosis/etc. discussions and recovery.

vascular--longer rounds due to dressing changes on multiple wounds. Non-compliant patient population.

Endocrine--shorter rounds due to fewer patients, above average clinic time (lots of US, FNAs, follow up TFTs, etc.)

 

[12loser12]

Wow, extremely helpful information. Thank you, smurfette.

 

[Winged Scapula]

Thank you smurfette...that was helpful.

I would also add for breast: fair number of in office procedures. If you get the right training, you can do in office ultrasound, ultrasound guided core biopsies, placement of brachytherapy catheters, and stereotactic biopsies. I also do my own needle locs (will be transitioning to radioactive seed localization) and sentinel node injections.

But yes, the patients (and their families) are high maintenance <sigh>.

Also if you keep your GS privileges you can still do other stuff: I assisted on an open chole with a friend yesterday. 😀

 

[JackADeli]

...I assisted on an open chole with a friend yesterday. 😀

That is a cool procedure! They are not very common to begin with, saw few in GenSurgery residency.

To add to Smurfettes list, I recall from my general surgery residency:

Gen Thoracic-
about 2 days of clinic
3 days OR

Cardiac
As general surgery resident never saw their clinic but i presume they had one but we just spent time on the floor s and in OR with different attendings on different days.

Our general surgery services
usually 1 & 1/2 days of clinic
OR days about three, but their "block times" varied.

Trauma
always had several clinics a week. I think there is a requirement for trauma certification that mandates a certain amount of follow-up clinics, etc...
The OR time was dependent on time on general surgery service. So, in practice, if you want trauma, seems like you need to run at least one day of general surgery clinic and one or more days for whatever trauma clinic requirements you have.


The bottom line, it really depends on what your practice set-up is, what kind of partners you have, and what your "block times" are. The more efficient you run your clinic, the more patients you can see during the clinic, this increases the number of patients to schedule for elective blocks. A high volume, efficiently run clinic (1 or 2 days) facilitates maximum use of OR blocks. I have seen surgeons with one long clinic day and four full OR days per week. On the other hand, I have seen surgeons with 5-7 patients per clinic day, for 3 clinic days per week and 2 OR days.

 

[Buzz Me]

Also if you keep your GS privileges you can still do other stuff: I assisted on an open chole with a friend yesterday. 😀

The big question is, were you manning the Adson/Kelly/hemostat or Bovie?

 

[phantomx87]

Cardiac
As general surgery resident never saw their clinic but i presume they had one but we just spent time on the floor s and in OR with different attendings on different days.

Spent a year with CT Surgery doing research at an extremely high volume academic institution. Each attending generally only had one looooong clinic day, operated elective cases on 2 - 3 days, and otherwise floated between CTSICU / office / OR for the remainder. In-house census varied anywhere from 30 - 100 (average being around 55-60). Floor rounds were quick and dirty (less than 5 minutes with each patient on step-down and tele units). CTSICU and CCU patients took a fair bit more time ( CTSICU > CCU in general, but varied with disease and complications). As far as fellows go - I didn't have the actual schedule, but it seemed that it was a fairly consistent 2:1 OR-to-SICU coverage. This didn't include peds and VA, just the main hospital. If you were in the OR, the only time you left was to transport pt from OR to SICU (or helipad to OR). If you were in the SICU, you only left to... Well, they just didn't leave. WAAAYYYY too busy.

 

[Winged Scapula]

The big question is, were you manning the Adson/Kelly/hemostat or Bovie?

We took turns - I did the dissection on my side, and the cautery/Harmonic on his side.

 

[OtoHNS]

A few more details about ENT:

Most attendings spend 3-4 days/week in the office and 1-2 days in the OR. There are also a lot of options for office-based procedures, especially if you incorporate some facial plastics into your practice. Snoring procedures like palate pillar implants, turbinate reduction, skin excisions, ear tubes in adults, botox/fillers are all common in-office procedures. There´s also plenty of fiberoptic laryngoscopies, nasal cauterization for epistaxis, and cerumen cleaning.

The large majority of ENT surgeries are outpatient or one night observation stays, especially in private practice. The exceptions are cancer surgeries, airway recon, acoustic neuromas, etc which are almost entirely done in academic centers. Average inpatient census in private practice is 0.