Does anyone wonder...?

[SocialistMD]

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Many of the recent threads in this subheading have been about the lifestyle friendly subspecialties and how hard the surgical residency is. I'm not trying to judge, but does anyone wonder what will happen to the more time-consuming/less desirable general surgery specialties (trauma/acute care surgery, transplant, peds) in the coming years? Are most of the "hard-core" people too busy practicing their knot tying and how to properly hold a needle driver that they can't be bothered to post on the surgical forum?

 

[Castro Viejo]

Many of the recent threads in this subheading have been about the lifestyle friendly subspecialties and how hard the surgical residency is. I'm not trying to judge, but does anyone wonder what will happen to the more time-consuming/less desirable general surgery specialties (trauma/acute care surgery, transplant, peds) in the coming years? Are most of the "hard-core" people too busy practicing their knot tying and how to properly hold a needle driver that they can't be bothered to post on the surgical forum?

Well, there's already a crisis in surgical trauma and ED coverage so the demand will be uber high for trauma grads, but the work is a lot less glamorous than most young 'uns make it out to be. It continues to be one of the least popular fellowship choices of General Surgery grads, with only a little over 30% of programs filling their spots. But I think the big demand and the relatively low supply will afford the few guys who do go through with this command of bigger-than-average salaries and the ability to work anywhere they want on their terms. Perhaps not quite that liberal, but you catch my drift.

Transplant is probably about as popular as trauma, though I have no data on how many positions are being filled. It definitely counts in along with trauma and CTS as among the least desired post-residency training avenues to pursue at the moment. I remember speaking to one of the Transplant fellows who told me that the job market was terrible, and that a lot of these guys end up doing fellowships one after the other until they've pretty much done a fellowship for every transplantable organ. Crazy stuff.

I think that generally the future is bleak for CTS and Transplant grads, but relatively bright for Trauma if you're into that sort of thing. The truth is I like trauma for trauma laps, but not the MVAs and blunt traumas that end up being exercises in patience, baby-sitting, and social work. Or taking care of someone's mess because the weekend's coming and that guy wants you to take care of his crap... Or taking care of emergency general surgery cases in the middle of the night because the primary surgeon is too lazy to drag himself in at 3AM to do a Hartman's...

I don't think Vascular Surgery is a lifestyle fellowship necessarily, and all indications are that it's getting more popular with General Surgery grads. I mean, it ain't no PRS, but the number of applicants from this past cycle over the cycle just before that rose by quite a large percentage I believe (I can't remember the numbers from NRMP off the top of my head and I'm too lazy to look it up).

 

[doc02]

People don't hate trauma because of the lifestyle, they hate trauma because it's non-operative 90% of the time. And of the remaining 10% of the time, it's like a 50-50 shot that your patient is going to die on the table and you're performing a futile operation which is a waste of time just to say you did something.

A lot of these other fields are less desireable because you deal with a lot of medical management. Transplant is a lot of dealing with immunosuppressants and people with life-long problems owing to them. Also, for example, doing kidney transplants is about the most boring operation you could ever do. I'd rather do a hernia operation than a kidney transplant.

Finally, CTS is not dying, it's changing. There are still lots of cardiac surgeries that need to be performed. The problem is that CT guys got used to their '80s lifestyle where they had huge volumes and were rich. Now, in order to maintain those volumes, people have carved out territories and they guard them jealously. You can't break into the field, except as an exclusively-thoracic surgeon. You need to join a pre-existing practice, and that would only happen if one of their guys dropped dead. But if you got in, you'd be basically set for life.

 

[doc02]

Oh, yeah, and when you're doing Trauma, there's an 85% chance that the person you're working hard to save is some jack-ass who was high or drunk or trying to do something to get high or drunk. I don't have the time to waste on ******s like that. Someone else can take care of that.

 

[Winged Scapula]

People don't hate trauma because of the lifestyle, they hate trauma because it's non-operative 90% of the time.

I hate trauma because of the lifestyle AND the non-operative work.

 

[Blade28]

You need to join a pre-existing practice, and that would only happen if one of their guys dropped dead. But if you got in, you'd be basically set for life.

I'm counting on this!

 

[johnny_blaze]

I think lifestyle is very important. I feel sorry for some of the surgeons I work with who seem to prefer working extra hours rather than being with their families. I work with two paediatric surgeons at the moment who seem to always be in the hospital when they're not on-call... even on days that would be improtant to their wives (i.e. birthdays!) I enjoy cardiac surgery very much, however, I am realistic. I know that if and when I get married, my wife will be the most important thing in my life. This is why I am very determined to keep a strong thoracic interest in case I decided to give up cardiac to make a bit more time for my family. I think that I’m quite lucky in being in the U.K as CT surgery here is practiced exclusively in large academic centres… therefore there is plenty of cover and more time for a personal life.

Just my view on things.

 

[johnny_blaze]

Also, I forgot to add that if you’re good at time management then there’s no reason why you cant have a busy job and a personal life. I’m a junior resident and (I don’t mean to brag) I also have a kick ass social life (comprised mainly of beer and chicks)

 

[doc02]

That's because you're in the UK, where socialized medicine reigns and people routinely drop dead waiting for health care. One attending I worked with trained in Australia and he said it was extremely relaxing, too, since hospitals basically shut down at 4 PM. You literally couldn't get admitted after 4 PM. And you could only do a few cases a day. If you tried to do more, people would quietly explain to you that you were making them work harder than was required and that would be that. Naturally, the physicians also made zero dollars, but they loved it because they were always relaxing, even the surgeons. P.S. That's why your health care system needed to get all of its physicians from the Middle East. The End.

 

[Blade28]

Also, I forgot to add that if you're good at time management then there's no reason why you cant have a busy job and a personal life. I'm a junior resident and (I don't mean to brag) I also have a kick ass social life (comprised mainly of beer and chicks)

...but how many hours a week do you work? I know there's a big difference between residency programs in the UK vs. here.

 

[doc02]

Let's just say that his name refers to how quickly he moves at 3 o'clock. KA-PWINGGGGG!!!

 

[johnny_blaze]

That's because you're in the UK, where socialized medicine reigns and people routinely drop dead waiting for health care.

You mean like the poor and the lower middle class do in the U.S?

One attending I worked with trained in Australia and he said it was extremely relaxing, too, since hospitals basically shut down at 4 PM. You literally couldn't get admitted after 4 PM. And you could only do a few cases a day. If you tried to do more, people would quietly explain to you that you were making them work harder than was required and that would be that. Naturally, the physicians also made zero dollars, but they loved it because they were always relaxing, even the surgeons.

I work in the u.k not australia. I have worked for surgical teams in both north america and the u.k. i can make a comparison... u are just talking out of your ass because you "know a guy". do i really need to point out the stupidity of this argument?

P.S. That's why your health care system needed to get all of its physicians from the Middle East. The End.

Most of our foreign doctors are here to train and if they're good enough they can practice. Now the U.K doesn’t allow doctors to stay unless they are U.K/EU passport holders. Foreign doctors still come here because we have some of the best medical and surgical training in the world. The royal collage of surgeons of England/Glasgow/Edinburgh set the standards for what the RCSC, ACS, and RACS are based on.

Now it’s the end son.

P.S: This isn't a UK is better than the US rant because i don't think that. this is just a reply to someone who obviously didn't get what i was trying to get at.

 

[johnny_blaze]

...but how many hours a week do you work? I know there's a big difference between residency programs in the UK vs. here.

I do around 65-80h work week depending on my on-call status. It'll probably take me two years longer to become a CT surgeon then if i was training in the U.S but i'll get there comfortably. i'd rather take my time and enjoy life then be stressed and overworked. this makes sense to me because it's an option i have (hence one of the reasons why i'm not returning to north america).

 

[johnny_blaze]

Let's just say that his name refers to how quickly he moves at 3 o'clock. KA-PWINGGGGG!!!

finding someway to justify the workload to yourself just seems like a defensive mechanism to me... i.e. "i will force myself to see the benifit of not having a social life, being underpaid, and overworked so i dont feel like i've chosen the wrong path in life. "

i have money (pounds sterling!, US dollars aren't even better than canadian dollars anymore) and the free time to spend it. my god.. my life sucks!

Think about that while you're working all night
KA-PWINGGGG!

 

[gasnewby]

I do around 65-80h work week depending on my on-call status.

really? i looked into training/practicing in the UK as I hold dual citizenship. i thought you had a 56 hour limit. which will be decreased to 48 in a year or two. maybe things have changed.

 

[Blade28]

I do around 65-80h work week depending on my on-call status. It'll probably take me two years longer to become a CT surgeon then if i was training in the U.S but i'll get there comfortably. i'd rather take my time and enjoy life then be stressed and overworked.

Ah, OK, I stand corrected.

Looking forward to eventually seeing you at the CT Surg conferences/meetings when we're attendings. 👍

 

[Winged Scapula]

really? i looked into training/practicing in the UK as I hold dual citizenship. i thought you had a 56 hour limit. which will be decreased to 48 in a year or two. maybe things have changed.

These are just "suggestions" like in the US...registrars do work over the limits (as you can see from JB's response).

 

[gasnewby]

i hear you. but 56 hours vs 80, or 48 vs 80...pretty big discrepancy. of course, we complete residency more quickly.

 

[Winged Scapula]

i hear you. but 56 hours vs 80, or 48 vs 80...pretty big discrepancy. of course, we complete residency more quickly.

True...but the point wasn't how few hours they worked, but rather in response to your question about "limits".

No one is arguing that there isn't a big difference between 56/48 and 80 hrs per week. As I recall a few years back when we polled people, hardly anyone here in the US would be willing to spend a few extra years in training to work the Euro hours.

 

[misery]

As I recall a few years back when we polled people, hardly anyone here in the US would be willing to spend a few extra years in training to work the Euro hours.

I wonder if that would hold true if we moved to a european model of lower education, ie medicine bound from high school. arent their programs like 6 yrs strait from highschool?

 

[Winged Scapula]

I wonder if that would hold true if we moved to a european model of lower education, ie medicine bound from high school. arent their programs like 6 yrs strait from highschool?

Yes, traditional schools are for "high school leavers" and 6 years in length, very similar to the combined programs here in the US. I'm sure a lot of people would do it, mistakenly so, IMHO.

 

[Castro Viejo]

Yes, traditional schools are for "high school leavers" and 6 years in length, very similar to the combined programs here in the US. I'm sure a lot of people would do it, mistakenly so, IMHO.

Yeah... How on Earth someone coming out of high school would know FOR SURE that being a physician is, as the kids said in my day, "rad" is well beyond me.

I almost regret having gone straight through from college to med school! Where did my youth go? 🙁

 

[Blade28]

Yeah, it's unreasonable to expect 17- and 18-year-old kids to know what they want to do for the rest of their lives.

I mean, there's a reason "Undeclared" is the most common major among freshman undergrads!

 

[Winged Scapula]

Yeah, it's unreasonable to expect 17- and 18-year-old kids to know what they want to do for the rest of their lives.

Hell, I"m still not sure!

I mean, there's a reason "Undeclared" is the most common major among freshman undergrads!

Let's see...I was a Physical Therapy, Social Work, Biology, Psychology and Math major at least once!

 

[Blade28]

Let's see...I was a Physical Therapy, Social Work, Biology, Psychology and Math major at least once!

I was a Bioengineering major...and by midway through college, was still a Bioengineering major...then...well I guess I graduated with a Bioengineering major as well.

OK, bad example.

 

[doc02]

finding someway to justify the workload to yourself just seems like a defensive mechanism to me...

Wow, really? This piece of psychoanalysis from the guy who:

- started out by bragging about how he has so much time on his hands

- then was like, "oh, uh, actually I work up to 80 hours/wk, too, although in the UK that means I have to assume a second identity in order to get around the work laws, but I'm that dedicated!"

- and then is like, "...well, it doesn't matter anyways because I'm rich! I can buy anything they sell in Europe!! Like, if you want a car that is three feet long, I can get two of those!

 

[doc02]

Let's see...I was a Physical Therapy, Social Work, Biology, Psychology and Math major at least once!

And they say women can't make up their minds. You gals are so cute when you run around in circles haphazardly!

 

[Blade28]

And they say women can't make up their minds. You gals are so cute when you run around in circles haphazardly!

But man, those physical therapists and their fitted scrub bottoms and tight T-shirts... 👍

 

[Pir8DeacDoc]

But man, those physical therapists and their fitted scrub bottoms and tight T-shirts... 👍

Must be a standard uniform worn by all PT's across the country. NICE

 

[Blade28]

Must be a standard uniform worn by all PT's across the country. NICE

Yeah, I agree. Just where do they get those outfits? Man! 👍

 

[doc02]

Our PTs aren't that hot. Some of the social workers are, however. Still, seriously, I can't see myself being interested in someone whose job is to call companies to arrange home nursing.

 

[johnny_blaze]

Wow, really? This piece of psychoanalysis from the guy who:

- started out by bragging about how he has so much time on his hands

- then was like, "oh, uh, actually I work up to 80 hours/wk, too, although in the UK that means I have to assume a second identity in order to get around the work laws, but I'm that dedicated!"

- and then is like, "...well, it doesn't matter anyways because I'm rich! I can buy anything they sell in Europe!! Like, if you want a car that is three feet long, I can get two of those!

Fist of all, I apologise if I've given you the impression that U.K surgeons are in any way better than US surgeons. I'm not ignorant and this was not the point of my argument.

Yes, in the U.K we do work long hours as well but (I've noticed) we also have a lot of support. For example, our on-call rotas aren't as heavy as yours and we have a lot more staff to support us. If you refer to a thread before when Dr. Cox and myself were discussing the difference between CTS in the U.K and in the U.S we discovered that in the U.K this specialty is much more relaxed, as there are about 8-12 consultants per institution rather than just 4. There aren't as much CT institutions but those who work within the ones that exist are essentially working a 1:12 rota rather than a 1:4. ALSO, the U.K is very small in size… therefore surgeons may cover calls for different cities that are close by, thus reducing the on-call commitment even further. However, I do see the benefit of being in the U.S. You guys learn a great deal in a very short period of time. I preferred to spread out my learning, even if it takes my two extra years to become a CT surgeon. I'll only be 32 when I finish my training, so obviously the extra years don't mean much to me. I'd rather take my time and enjoy my progress through residency.

NOW, this doesn't mean that the U.K produces superior surgeons to the US in anyway! Both countries are very well respected for their medical practice. I was simply stating that what was offered to me in the U.K (including the salary) seemed like a better option than what was offered in the US… but that's just my point of view. There are some in the U.K who would argue this, these include
1. Post-graduates (those who started medical school after the age of 24, which I did not) who do not want to undertake such a long training scheme.
2. Consultants in specialties with little or no private practice (i.e. transplant surgery) who feel that they would be much better paid in the U.S at consultant level. They are probably correct in assuming this.

 

[johnny_blaze]

Looking forward to eventually seeing you at the CT Surg conferences/meetings when we're attendings. 👍

haha yeah... i'll be the guy presenting the work on surgery for the thoracic aorta. actually.... i might be attending one soon (probably in the U.K). Anything going on in the U.S soon that i could submit my work to?

 

[Winged Scapula]

haha yeah... i'll be the guy presenting the work on surgery for the thoracic aorta. actually.... i might be attending one soon (probably in the U.K). Anything going on in the U.S soon that i could submit my work to?

Too bad you missed the deadline for Society of Thoracic Surgeons - its in January in Fort Lauderdale, Florida!😎

Amer Associ of Thoracic Surgeons is in San Diego in May 2008 (but you've missed their deadline too).