I am a surgical intern. Take what I have to say with a grain of salt given that my response is likely imbued with naivety and inexperience.
I applied to medical school wanting to be a surgeon. I went through medical school wanting to be a surgeon. I am at the point in my career where by rights I could probably refer to myself as a surgeon and have that be technically correct. However I am not a surgeon. Not yet.
In the mere few weeks I've been a resident, several things have been impressed upon me about the fundamental tenets of building a surgeon. Surgery and all of its subspecialties are fields where you are expected to be able to do everything perfectly* every time. If you cannot, people will get hurt or may even die, and both of these things can happen quickly. Don't have the ability to do that C-section? Patient dies. Can't get that EVD in properly? Patient dies. Can't find and control the bleeding large vessel? Patient dies. These are things you will be expected to do by yourself at the end of your training. The buck stops with you.
Becoming a surgeon is about developing judgment and skill through experience. Knowledge is obviously requisite and informs decision making, but experience is really what builds your ability to perform and mature. But you don't get that experience without putting in the work. And putting in the work means giving your best effort. I attempted a relatively simple bedside procedure today and was unable to complete it to satisfaction. The situation was more difficult than others I had faced and I did not have the experience to navigate these particular circumstances. That is okay because I am an intern and I have my seniors backing me up. But eventually I'll be at the point where I am the backup, and if I am not able to do it, then there isn't anyone else. That level of skill and responsibility is the intended end result of this work and the experience that comes with it. I will attempt and execute this procedure many more times over the course of my residency because when I leave, I need to be able to do it as close to perfectly as possible every time.
And it's not all about procedures. Perhaps more important than technical skills are judgment and the ability to adapt to new or evolving situations. Learning how to navigate these again requires experience. Lots and lots of experience to the point where you have the tools necessary to handle any situation within your scope of practice. Handle does not necessarily mean definitively solve. It just means handle.
My life as a surgical trainee is actually pretty good right now. I work 6 days a week, I haven't broken 90 hours/week yet, and I usually have an hour or two at the end of my day to myself to do whatever I want. Other than eating, I can use that time to read, go to the gym, talk to friends and family, watch TV, or pursue another hobby (apparently right now it means posting on SDN). My primary focus right now and for the next X years is learning to be a good resident so that one day I can refer to myself as a surgeon without feeling abashed or unsure because I will have the experience to handle the responsibility that such a descriptor implies. That does not mean I don't have time for other things, it just means when I need to make choices and prioritize, I unquestionably prioritize my training above everything else because to do anything else would be irresponsible to myself, to my team, and most importantly to my patients.
So to summarize, surgery requires judgment and skill acquired through experience gleaned through hard work and appropriate prioritization. You can describe that however you wish, but if you want to be able to call yourself a surgeon, that is what is required of you.
