Doing surgery with mental illness?

[comboplayer]

I am a non-trad who was a car mechanic before deciding I wanted to become a doctor. I love working with my hands. Furthermore, I have 5 kids and a wife currently and want to make sure I can afford to give them a good future.

This has lead me to looking at surgical specialties the most. However, I have Generalized Anxiety Disorder. Its not as terrible as some, I am able to still complete all my necessary tasks and if I wouldn't tell you that I have this disorder then you likely would never know. I have still been able to do well on all my exams and interviews, etc. I would say the biggest issue I face is that I frequently get insomnia due to running anxious thoughts.

My questions are:
1) Are there any surgeons that you all know of that have an anxiety disorder? What is their experience and how do they cope?
2) If I do surgery, would plastics be the best option for me? It seems like they have a slightly less intensive residency compared to other surgical residencies and post residency has a very good work life balance, even better than primary care.

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[Goro]

Knowing that medical school is a furnace, and as I've seen it even break healthy students, you need to consider the effects of the entire pathway.

 

[RangerBob]

I'm sure there are surgeons with anxiety, but surgery and a few other areas of medicine (like EM) can facilitate anxiety in even the most relaxed of us. This differs based on the person, but surgery is going to be far more stressful than my average day on the inpatient rehab unit. So usually surgeons tend to be more relaxed (and more confident) than most. Whether they're right or not, they need to be confident in their decisions. I knew one attending surgeon who was on the more anxious side, and it was a bit tough watching him keep second guessing himself at a critical time when things were going badly for one patient on the table.

You say you have 5 kids. Understand that most surgeons I've met will tell me things like "my wife raises my kids" or "I really didn't see my kids much growing up." While it's possible to gear your attending practice towards being more family friendly, you still have to get through residency, where 80hr++ weeks are the norm for 5 or more years. And since surgical specialties are very competitive, it means putting in very long hours in medical school--maybe 50-80hrs/week in med school. That's 9+ years of long hours before you get to being an attending. Even (perhaps especially) if you do plastics, which is one of the most competitive specialties.

If you're looking for work-life balance, look no further than psychiatry. It doesn't get any better than them for ease of work-life balance/flexibility. But you would have to give up your love of working with your hands.

If working with your hands is really important but you don't feel you have to be a surgeon, consider PM&R followed by pain. Anesthesia is the more competitive way to go, but also a much tougher residency. PM&R is much more relaxed/family-friendly at all but the most competitive residency programs, and you're trained much better to be a holistic pain physician. You'll also do botox, baclofen pumps, EMGs in PM&R--all hands on, but not anywhere near the same realm as surgical procedures. Anesthesia will give you more invasive procedural experience (lines, epidurals, etc). Again, still not in the same realm as surgical procedures.

If you feel you have to be a surgeon, ENT, urology are likely better options than plastics in terms of work-life balance. Ophto can be fantastic. But they all still work like crazy in med school and residency as they are incredibly competitive specialties.

I find very few surgeons actually work "part-time" unless their forced to because of old age. Most surgeons love being in the OR more than anything. I'm not sure there's any way to make it through a surgical residency without that kind of devotion.

I very much enjoy mechanical things/working with my hands as well. The body isn't mechanical (for better or worse). I didn't find surgical/procedural specialties fulfilled my mechanical/hands-on interest, though others did. I instead chose a specialty I enjoy intellectually/inter-personally and that gives me a lot of free time with my family and good income, and then I have plenty of time left over for my mechanical/hands-on interests--using my tools at home for home remodeling/projects, working in my garden. I just picked up bike repair too.

So keep that option in mind--you might be able to get your hands-on fix elsewhere if a surgical specialty doesn't seem like the right fit. One great thing about being a physician--you make enough money to work part time and have lots of free time with family and to work on hobbies.

 

[operaman]

Agreeing wholeheartedly with my colleagues above. ENT surgeon here without any anxiety disorder and an attest that being a surgeon induces quite a bit of anxiety on its own. I’m constantly thinking about my decisions and second guessing and wondering what if. And you never know if you’re right until you see what ultimately happens to the patient. And being on call even when it’s slow is still tough - hard to sleep well when you know the phone can ring at any time and require you to rush in to the hospital.

I know one other ent who has some true anxiety issues and they barely completed training and took a lot of extra time to graduate. Chalk that up to a very understanding PD; other programs would have simply non renewed the contract. He’s in private practice now and seems to be doing well from what I’ve heard.

I would strongly urge you to consider other fields if you can. It’s definitely a pressure cooker and extremely demanding physically and mentally and I’ve seen it break people. What happens is that people with well controlled illnesses will have them exacerbated by the high stress, poor sleep, and high physical demands of surgical training. You’ll frequently have to be up and awake for 24-36 hours (“home call” often circumvents work hour restrictions legally) and you’ll have plenty of legit things to worry about when you finally do have a chance to sleep.

If you can find any other more chill field that you can tolerate, do that instead. Not many stressed out dermatologists out there! If you’re a superstar student, derm to a mohs fellowship is a nice route to low stress surgery and awesome hours.

The truth is that everything becomes routine eventually, and no attending has a practice as cool as what you will experience as a student. As a student, you bounce around to all the cool stuff but you’ll notice it’s different attendings doing them. I do some cool stuff, but then the students go hang with my partners when I go back to clinic. As you explore fields, consider both the training as well as how life will feel 5 years out from training when things are more routine.

 

[Dr G Oogle]

I am a urogynecolgist with GAD. Weirdly the one place I don’t really have anxiety is in my clinical life, especially in the OR even when I’m millimeters from the aorta. I think it’s related to repetition, I take care of the same 5 conditions and do the same 5 types of surgeries over and over and over again and there is just nothing unpredictable about my job. I don’t know how I would react or feel if I had a more generalist job and had to doing cases that come around once or twice a year and are particularly high stakes, but I also really gravitated towards the surgical fields and I think it has more to do with the fact that you (the surgeon) are the one in control. GAD and anxiety in general have to do with a a lot of what ifs, in our medical training we are trained specifically what to do in the “what if” situations.

 

[esob]

Depending on the severity and degree to which it is controlled, it could be feasible. I do agree that surgery probably trends more towards the "what if" moments, and *most* surgical specialties aren't super conducive to lifestyle (which leads to more what ifs). That said, what specialty you end up in is likely going to be more based on your board scores than on your GAD.

 

[TeddyBoomBoom]

I'm sure there are surgeons with anxiety, but surgery and a few other areas of medicine (like EM) can facilitate anxiety in even the most relaxed of us. This differs based on the person, but surgery is going to be far more stressful than my average day on the inpatient rehab unit. So usually surgeons tend to be more relaxed (and more confident) than most. Whether they're right or not, they need to be confident in their decisions. I knew one attending surgeon who was on the more anxious side, and it was a bit tough watching him keep second guessing himself at a critical time when things were going badly for one patient on the table.

You say you have 5 kids. Understand that most surgeons I've met will tell me things like "my wife raises my kids" or "I really didn't see my kids much growing up." While it's possible to gear your attending practice towards being more family friendly, you still have to get through residency, where 80hr++ weeks are the norm for 5 or more years. And since surgical specialties are very competitive, it means putting in very long hours in medical school--maybe 50-80hrs/week in med school. That's 9+ years of long hours before you get to being an attending. Even (perhaps especially) if you do plastics, which is one of the most competitive specialties.

If you're looking for work-life balance, look no further than psychiatry. It doesn't get any better than them for ease of work-life balance/flexibility. But you would have to give up your love of working with your hands.

If working with your hands is really important but you don't feel you have to be a surgeon, consider PM&R followed by pain. Anesthesia is the more competitive way to go, but also a much tougher residency. PM&R is much more relaxed/family-friendly at all but the most competitive residency programs, and you're trained much better to be a holistic pain physician. You'll also do botox, baclofen pumps, EMGs in PM&R--all hands on, but not anywhere near the same realm as surgical procedures. Anesthesia will give you more invasive procedural experience (lines, epidurals, etc). Again, still not in the same realm as surgical procedures.

If you feel you have to be a surgeon, ENT, urology are likely better options than plastics in terms of work-life balance. Ophto can be fantastic. But they all still work like crazy in med school and residency as they are incredibly competitive specialties.

I find very few surgeons actually work "part-time" unless their forced to because of old age. Most surgeons love being in the OR more than anything. I'm not sure there's any way to make it through a surgical residency without that kind of devotion.

I very much enjoy mechanical things/working with my hands as well. The body isn't mechanical (for better or worse). I didn't find surgical/procedural specialties fulfilled my mechanical/hands-on interest, though others did. I instead chose a specialty I enjoy intellectually/inter-personally and that gives me a lot of free time with my family and good income, and then I have plenty of time left over for my mechanical/hands-on interests--using my tools at home for home remodeling/projects, working in my garden. I just picked up bike repair too.

So keep that option in mind--you might be able to get your hands-on fix elsewhere if a surgical specialty doesn't seem like the right fit. One great thing about being a physician--you make enough money to work part time and have lots of free time with family and to work on hobbies.

Jesus Christ this is a good post!

 

[Bloobury]

I am a non-trad who was a car mechanic before deciding I wanted to become a doctor. I love working with my hands. Furthermore, I have 5 kids and a wife currently and want to make sure I can afford to give them a good future.

This has lead me to looking at surgical specialties the most. However, I have Generalized Anxiety Disorder. Its not as terrible as some, I am able to still complete all my necessary tasks and if I wouldn't tell you that I have this disorder then you likely would never know. I have still been able to do well on all my exams and interviews, etc. I would say the biggest issue I face is that I frequently get insomnia due to running anxious thoughts.

My questions are:
1) Are there any surgeons that you all know of that have an anxiety disorder? What is their experience and how do they cope?
2) If I do surgery, would plastics be the best option for me? It seems like they have a slightly less intensive residency compared to other surgical residencies and post residency has a very good work life balance, even better than primary care.

I am also a non-trad with a history of anxiety (well managed on low dose SSRI) with a somewhat remote history of panic attacks. I was pretty certain I would not enjoy surgery because one of my triggers for panic is feeling "trapped", and I worried that being scrubbed in, "stuck" in the OR, where I couldn't just walk away from an open patient might trigger panic. I thought that the fact that I'd even ever had a panic attack basically meant I could never be a surgeon... because ... WHAT IF?? What if I completely shut down during a critical moment of a case?? But the fact that I've had panic attacks in the past means I know what they are and how to handle them. I'm proactive about my physical and mental wellbeing so I think despite my history of "mental illness", I'm probably mentally healthier than most on any given day! Statistically, most people who haven't already been clinically diagnosed with depression or anxiety or a panic attack just... haven't experienced them yet.

Amazingly, I've actually found the OR to be very calming. I also have ADHD, and it turns out I *love* being tucked into a surgical gown and gloves, cozied up against the surgical field, with one task in front of me. It's going to come down to your triggers and what you enjoy. Being busy doesn't make me anxious, but I get overwhelmed when I have too many unfinished tasks or have to juggle too many different moving parts at once. Inpatient IM and EM clerkships were hard because I sometimes felt rushed having to bounce between patients and remember whose lab values were what and who needed what, what needed to be prioritized, and what I was going to put in my note for 3-4 different patients at a time. But if I had time to prep for surgery the night before, I found my OR days were awesome. I can handle gruff personalities, hard pimping, and critical feedback without taking things personally, so the stereotypically "hard" parts of surgery rotations haven't really bothered me. But some of my peers get anxious even *thinking about* the possibility that someone might ask them a question in front of other people and they might not know the answer. Have you done clerkships yet? Actually spending time in the different specialties will help you far more than theorizing about what you might or might like. Find out by doing, not thinking about doing!

One of my surgical mentors has spoken openly about depression and burnout in surgery, I know a depressed (very-competitive-subspeciality)surgeon who seems to do just fine, but who wouldn't admit any mental health issues to anyone other than their closest friends, and certainly not colleagues. It's not that they aren't out there, it's just that the uber-competitive, show-no-weakness mentality of surgical specialties tends to keep people hush-hush about these things. But fortunately that seems to be changing...

[Edit to add: No matter what you do, there are going to patients/cases that keep you up at night - you'll have times feeling like an imposter, you'll be anxious that you made a poor decision.. you just have to find what field offers enough good days/interesting pathophysiology/meaningful moments that fill your bucket to make up for the hard days]

 

[TragicalDrFaust]

I think the answer to your question can be found in what strengths surgeons need to have versus what limitations, if any, you have.

I've made it through 3/4 of medical school with what many consider to be a severe mental illness. Interested in psych though. Feel free to PM me for more details.

Personally I'm limited by how much work I can do in a day. I realistically can't study for the 8-10+ hours per day necessary for top marks. I got by just fine studying 3-5 hours per day.

I also have sleep issues which was a problem during pandemic med school. I'm in the "lost" class of 2024 where our first year was online. I was nocturnal for parts of first year which made 8am exams and OSCEs a challenge as that's when I would normally be going to sleep.

I did fine on surgical rotations and actually found them invigorating.

One thing I would consider is the time line since you mentioned you want to do this for your kids. A year of premed classes, a year to apply, 4 years of medical school and 5+ years of residency. That's 4-6 years where you won't be able to work and then another 5 where you'll be making probably less than you do now. By the time you're making an attending salary, your older kids might be taking pre-reqs for their own medical school journey.