JeffLebowski

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What's the story with this? I mean, I understand the need to constantly assess whether a rigorous field like surgery, with all its demands and struggles is for you before you go into it, but it's getting a little ridiculous. If I say I want to go into surgery and the next words out of everyone's mouth is "well, make sure there's absolutely positively nothing else in the entire world that you could even remotely imagine yourself doing without killing yourself, do that" along with some diatribe about how crappy it is to be a surgeon, eventually its going to get to me. I mean I get it. I got it the first time, I especially get it after the 500th time. I mean I really like surgery, I really want to go into surgery, and even surgeons I look up to are trying to talk me out of it (and everyone else, seemingly).

Do any of you encourage students who show genuine interest and dedication to going into surgery?
 

Doctorino

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because it's hard. harder than you may realize. it's one thing to be a student writing your generic progress note every morning, retracting in the OR, where the worse thing is getting a pimp question wrong...for 8 weeks. it's a different ball game as a rez when you're q3-4 (sometimes q2) for FIVE years where what you do actually matters and you're held very much responsible. then when you're an attending and the stakes are even higher. it doesn't get easier the farther you get along despite what you may hear. there's no 80 hour rule to shield you as an attending. if need be you will be coming in to the the hospital at 3am no matter how many hours you've worked. there's a reason 20-25% of those who start GS residency never finish (a lot of them also really liked surgery as a student), and why so many attendings seem a tad bit "grumpy" shall we put it despite having reached the promised land of attendinghood.
 

filter07

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You don't get it. If you did you would thank us each time we bring it up, not complain that we are nagging you. If you aren't sure you will have second thoughts and a nagging voice in your own head constantly asking if it's worth it. Save yourself some hassle and do some real soul searching now before you commit and potentially lose several years of your life to a field that demands too much of you.
 
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homealone3

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I'm with you Lebowski. Tell these guys to take that pistol and shove it you know where until it goes, click.
 

BCLumas

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If we send a spaceship to the sun, and the last transmission we get is a garbled mess of "Holy _____! We're dying. Whatever you do, do NOT come to the sun. It's very dange....," would you take their advice? For sure.

The point of such a hyperbole is to show that we should learn from those who have come before us. If a handful of people--residents, attendings, MSIII's, MSIV's--complained about the Surgery lifestyle, I think that we could take it as opinion, given that there was some majority sentiment expressing the other side. It seems, however, that their description of their profession has a lot of merit. In fact, I would almost hazzard to say that only a "handful of people" do NOT complain about the life they have chosen.

If you take the aforementioned statistic as truth (which I do not see why we wouldn't), then there has to be some validity to what everyone is saying. Only 25% matriculation rate through the Surgery Residency? That's scary: that's the truth. I don't know about most people, but had I come to medical school with everyone telling me how easy it was, I think that I would have been in for a huge surprise. Expect the worst and be pleasantly surprised when you're wrong.

I am only an MSI trying to find my way right now. I have no idea where medical school will take me, but my heart, right now, is in surgery. I keep reading SDN when I get the time and try to understand everything that I can. Surgery takes a lot of dedication and effort and relies heavily on a huge base of support for both your personal and emotional lives. I understand where your frustration lies in having everyone tell you to get the hell away, but maybe one day you'll thank them; either that, or you'll prove them wrong and be both successful and happy. One way or another, just do what you feel is best for you. With that in mind you can never go wrong.

Good luck.
 

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Fine forget it. I apologize, this thread was a bad idea.

Too late to withdraw. The firestorm has begun!!!

Bottom line, most surgeons are happy with what they do. But that is precisely because we can't see ourselves doing anything else. Try telling a surgeon to go to anesthesia's side of the drape, it would be torture. I couldn't do EM because I would hate for my care of an interesting patient to end with the line "call the surgeon."

However all of us have encountered students and especially interns who have decided that surgery is alright because it is now a "lifestyle specialty." These people make life harder for the entire team. No one is trying to prevent interested students into choosing surgery. We all just want the right students.

Gotta run, pneumotosis intestinalis in the OR. Seriously, could my life be better?

All for now, go back to your rotissery chicken,
I am the Great Saphenous!!!!
 

ESU_MD

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I am glad you asked this question on the internet.

if you asked this to ANY resident or staff in my general surgery program you would be blacklisted for sure and doomed to become an emergency room doc. you would be asked to leave the interview session before the bogus tour of the hospital.

i do understand your question though.

the answer is.... well, it is a paradox.

most surgeons i know hate surgery in a weird way but would continue to practice surgery even if they hit the powerball.

i think if you are really destined to become a surgeon, you will find the answer without having to ask anyone.

many are called, but few are chosen.
 

SocialistMD

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If I say I want to go into surgery and the next words out of everyone's mouth is "well, make sure there's absolutely positively nothing else in the entire world that you could even remotely imagine yourself doing without killing yourself, do that"

This does note equate to this.

even surgeons I look up to are trying to talk me out of it

It is one thing to encourage self-reflection. It is another to tell you not to do it. I've never been one to discourage students away from surgery, but if they say "I like surgery and x," I will talk about all of the great things in field x, as it really is tough to stick with this when there were other things that you liked equally as well. I'm at the point now where my med school classmates are now attendings or fellows, where I have many friends in other specialties who have a much more relaxed life than I do (and I'm in lab) and I have had too many co-residents leave surgery for other fields because they liked surgery and another field as students and now see that the other field is much more amenable to a life outside of the hospital. We urge you to really consider it because (a) it really is something that you may regret 2-3 years down the road if you don't love it like anything else (b) it sucks to lose that year or two when you could have made the correct decision before and (c) you create more of a burden on us, your co-residents, if you leave the program, as that is one less body to insert into the call schedule.

If you want to be a surgeon, I'm all for it. I love it and couldn't do anything else. Just make sure you know what you are getting into.
 

dr.evil

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A medical student rotating with me last week asked me if I wished I would have done something else in medicine. I've thought about it.... a lot. I matched in Gen Surgery before I ever did a radiology rotation which I really enjoyed. So I told him, "Radiology, Likely Interventional Radiology". He asked why. I told him I hate clinic and radiologists have not clinic. I enjoy procedures and anatomy. I hate coming in at 3 am to admit the deadbeats of society. I.R. guys make easily 2x what I currently make in my neck of the woods, have more vacation time, aren't tied to a pager at home when they're "off call", and have minimal overhead.

All that being said, I would miss the operating room horribly, and the patient care that really keeps you going (the 60 yo with breast or colon cancer that you help get through). So people are right. Pick it if you don't like anything else. It's just the honest truth.

Now this is an honest OPINION from a practicing general surgeon. General Surgery, compared to all other medical specialties, just plain sucks. The hours are bad, the money is no where near what your colleagues in Ortho, ENT, Plastics, CT, Radiology, Cardiology, Derm, Anesthesiology make, the call is worse than most (especially in a trauma centered area), you pick up all the crap from the hospital (wounds, dialysis patients, central line bitch, cellulitis, vague abdominal pain of any type, GSW/Knives, blunt trauma with 98 ortho injuries and a Grade 1 liver lac is admitted to you, and you have no single "cash cow" procedure that can help make up for the $32 Medicare Level 4 office visit.

Yes, I'm bitter. But I went into this enjoying surgery and now practicing it is miserable 60% of the time. I actually had a great residency and loved it the entire time. Private practice is an entirely different ballgame. Think hard. Gen Surg, Ortho, Cardiology and Neurosurg come to hospital at 2 AM more than any other specialties. Unfortunately, Gen Surg is not rewarded like the others, financially or lifestyle-wise.
 

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Can those of you attendings who are saying how bad it is please elaborate? It's a given GS residency is tough, but I'm sort of surprised to hear it doesn't get much better once you are an attending.

And what's up with people saying you have to come in at 3 a.m. as an attending? Where I did my surgery rotation it was the residents on call who handled things after hours and if an emergency had to go to the OR then it was the on call attending who was already in-house who took the patient to the OR.
 
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I do not ever try to "talk" anyone out of any specialty that interests them. I don't have any medical students who are not adults and who are not fully capable of making the best decisions for their profession.

I love surgery and I have my reasons for loving surgery. My reasons fit quite nicely for me. I am certain that others will find the reasons that fit for them. In the end, it is you that will be living day in and day out with your decision.
 
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JeffLebowski

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If we send a spaceship to the sun, and the last transmission we get is a garbled mess of "Holy _____! We're dying. Whatever you do, do NOT come to the sun. It's very dange....," would you take their advice? For sure.

The point of such a hyperbole is to show that we should learn from those who have come before us. If a handful of people--residents, attendings, MSIII's, MSIV's--complained about the Surgery lifestyle, I think that we could take it as opinion, given that there was some majority sentiment expressing the other side. It seems, however, that their description of their profession has a lot of merit. In fact, I would almost hazzard to say that only a "handful of people" do NOT complain about the life they have chosen.

If you take the aforementioned statistic as truth (which I do not see why we wouldn't), then there has to be some validity to what everyone is saying. Only 25% matriculation rate through the Surgery Residency? That's scary: that's the truth. I don't know about most people, but had I come to medical school with everyone telling me how easy it was, I think that I would have been in for a huge surprise. Expect the worst and be pleasantly surprised when you're wrong.

I am only an MSI trying to find my way right now. I have no idea where medical school will take me, but my heart, right now, is in surgery. I keep reading SDN when I get the time and try to understand everything that I can. Surgery takes a lot of dedication and effort and relies heavily on a huge base of support for both your personal and emotional lives. I understand where your frustration lies in having everyone tell you to get the hell away, but maybe one day you'll thank them; either that, or you'll prove them wrong and be both successful and happy. One way or another, just do what you feel is best for you. With that in mind you can never go wrong.

Good luck.

No offense, but are you really giving me advice on this? I'm really not trying to be a prick, but it's a little perplexing to be hearing career advice from an M1.

Thank you to those who commented on the topic thoughtfully, I appreciate hearing people say they are happy in surgery and respect the reflections on what makes it worthwhile. I'm having a rough day.
 

smq123

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I mean, I understand the need to constantly assess whether a rigorous field like surgery, with all its demands and struggles is for you before you go into it, but it's getting a little ridiculous. If I say I want to go into surgery and the next words out of everyone's mouth is "well, make sure there's absolutely positively nothing else in the entire world that you could even remotely imagine yourself doing without killing yourself, do that" along with some diatribe about how crappy it is to be a surgeon, eventually its going to get to me. I mean I get it. I got it the first time, I especially get it after the 500th time. I mean I really like surgery, I really want to go into surgery, and even surgeons I look up to are trying to talk me out of it (and everyone else, seemingly).

:confused:

<shrug> Yeah, people will try to talk you out of it. This is a common phenomenon in pretty much every time-intensive residency (surgery, urology, OB/gyn, neurosurgery, etc.)

Are you afraid that they're "taking you out of going into surgery" because they don't think that you're good enough, smart enough, or tough enough for surgery? The chances are that they're asking you because they wish that someone had asked them when they were in your shoes. Don't read it as a reflection of their opinion of your capabilities. :)

I didn't really listen to the nay-sayers either, when I was a third year. I loved surgery, I worked insane hours on my clerkship, got little sleep, and generally worked my tail off - and I loved every second of it.

Then, something changed between third and fourth year. I met a guy that I really liked, and started having a real "life" outside of the hospital. When I returned to my fourth year to do a surgery sub-I, I was working about 120 hours a week (thanks to the most inefficient intern ever)....and it wasn't as much fun anymore. The attendings were wonderful, the chief was super-smart, a great teacher, and a good guy to work with - but....I wanted to be home. When you get home and you're too tired to talk to your significant other, you really start questioning how long you can survive this. And you start to wonder if it's truly worth it. I still love surgery as much as I did as a third year, but I now kind of understand why people would drop out of residency and do anesthesia or radiology instead.
 

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Jeff - I'm a little surprised about the responses to your question, so I'll put in my 2 cents to try and perk up the mood.

I'm an MS4 matching into general surgery this year, and I've also heard the opinion that if you can do something else and be happy, do that. I don't see it that way. I chose surgery because I want to do something absolutely incredible with my life. A surgeon is a totally unique professional, capable of bringing someone from the brink of death to being able to walk out of the hospital with the abilities of their hands and their minds. There is something incredibly special about reaching into someone and healing them. You'll occupy a role no other healthcare professional can touch in terms of the impact on the lives of your patients.

I'm going into my surgery residency full force, and I hope you do too. Don't prostitute your values for the sake of other people's priorities. If you want to be a surgeon, do it. If you think radiology is boring, that's okay. If you don't care about the difference between 200k and 400k a year, that's okay too. Be true to yourself and your interests and you won't go wrong. Good luck bro.
 

Winged Scapula

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Can those of you attendings who are saying how bad it is please elaborate? It's a given GS residency is tough, but I'm sort of surprised to hear it doesn't get much better once you are an attending.

There are some aspects of general surgery that get better as an attending when compared to residency:

1) you make more money, but as noted above, it can be FAR lower than your colleagues in other fields, often fields with less rigorous hours or workload

2) you get a *tad* more respect-from patients, colleagues and nurses. When I need something, especially if at a hospital that wants my business, they get it for me instead of shrugging their shoulders (except one facility that drives me nuts when ever I operate there).

But general surgery and general surgeons do still have the worst of the lot: BS consults, consults for stuff no one else wants to do (EC fistulas, chronic wounds, lines, ports, trauma, etc.). ALL fields have crap to deal with but general surgery, especially for the young practitioner can seem filled with such crap and without the lifestyle benefits of other fields.

And you likely underestimate the stress with having your name on the chart. I am constantly worried about being sued. Not because I think I am doing a crappy job but rather because I worry now about inadvertently missing something or being told something and not verifying it for myself (remember those Chief residents who always double checked what the intern told them? Yep...that's me...trust no one is my motto.)

And what's up with people saying you have to come in at 3 a.m. as an attending? Where I did my surgery rotation it was the residents on call who handled things after hours and if an emergency had to go to the OR then it was the on call attending who was already in-house who took the patient to the OR.

Like most SDNers you have fallen into the academic medicine, blinders on focus. The vast majority of general surgeons do not work in academic medical centers with surgical residents. So when the ED calls at 3 am, its YOU, the attending who comes in to see the patient. Community hospitals do not have general surgeons in house; someone is on call for the ED at home. When its your turn, you come in. When its your patient who shows up, you come in. No residents to work them up and call you.

Even academic medicine doesn't always work the way you have experienced. My residency program did not have general surgeon attendings in house. Sure the residents *tended* to get the first call (although sometimes the ED or floor would call the attending first) and see the patient, but whomever was on call got the call at home and came in if needed. EVERY service I worked on had someone on call - ie, you did not call the acute care surgeon on call for the colorectal or vascular patient. Those calls went to CR or Vascular attending on call.

I miss having residents, especially in the sense of having some eyes and ears for what is going on in house. Trust me, I will scream if I go into round tomorrow and find that half of my orders have been ignored or that the patient is in pain and I was not called or the patient was told, "there is nothing else written for you, sorry charlie."

Lean out your window and turn your ear west because I can guarantee you that there will be something wrong. It will undoubtedly be something like SCDs off because they were "too noisy" or patient not being walked because they "needed their rest". Maybe it will be something like the 82 yo with SBP in the 70s that nursing just figured needed her Lisinopril held and to continue her fluids and that didn't warrant a call to me. Yeah thanks...when she has an MI, DVT or her PE and dies, guess who's fault it is? Not nursing staff.

<off my soap box>

At any rate, as others have noted, pick surgery if you cannot envision doing anything else. I'll complain and it chaps my hide that general surgeons are so underpaid, but I still love what I do. I would never discourage someone from going into surgery unless I really thought they weren't cut out for it but I also want to make sure they have fully considered what they are getting themselves into. General surgery residents are pretty miserable, but there are several surveys which also note that general surgery attendings are pretty unhappy as well.
 

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Precisely the reason I skipped out on your field. How can you be unhappy when you're operating? It was amazing to see.

I dunno...let's see what made me unhappy today.

- the 8 am call from Nuc Med demanding that I call them back immediately to clarify my order for sentinel node injection or they were cancelling my case. My 1230 case, not the 9 am case. Demanding. THEY would cancel the case. Because they couldn't understand the order "sentinel lymph node 5 mCu, left breast, INJECTION ONLY." Never mind that I never want lymphoscintigraphy.

- the OR staff who set up my room for a lumpectomy rather than a mastectomy, despite the fact that the patient, my assistant and the Vitagel rep all knew we were doing a mastectomy

- the circulator who kept claiming that tube stockinette was what I used to dress my wounds with, despite me repeatedly stating that tube stockinette is not the same as the tube tops which have been specially ordered for my patients

The best part of the day? Listening to the new AC/DC album, my record time in doing a modified radical and a new circulator whom had never worked with me before ACTUALLY READ my preference card. She knew what I wanted MUCH better than the usual circulators who act like each case is the first time they've ever been in my room.

These things can happen even in Ortho, Tired.;)
 

BCLumas

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No offense, but are you really giving me advice on this? I'm really not trying to be a prick, but it's a little perplexing to be hearing career advice from an M1.

Thank you to those who commented on the topic thoughtfully, I appreciate hearing people say they are happy in surgery and respect the reflections on what makes it worthwhile. I'm having a rough day.

Oh. Well, then I guess I will just keep my opinions to myself, let you pout about how this thread did not go your way, and duck back into the shadows.

Good luck with life.
 

opr8n

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ahh, i have heard many true things in this thread
a couple of points:

1. Most attendings do not have residents to do their dirty work at 2am in the morn

2. Pay for GS is much less than it used to be and muckless than other surgical subspecuialities

3. GS requires alot of hard work, ALOT! And lets be honest, how many people do you go to/or have gone to medical school with who are total slackers? P=MD for them?? Well it cant be that way in surgery, the stakes are too high. You have to be anal, meticulous, trust no one attitude. You have to be confiddent that you can take care of that dying patient in the ICU whose BP is 60/palp HR 130 and an acute abdomen, and resp distress. You are ther last line of defense. its not like medicine where you can call surgery to save you azz, in surgery, you are the person that can take care of very sick people. As a resdident i cant stand people that are compleet slackers, residents or med students, and i discourage thema all from going into surgery, but if i have a good ms3 who is very interested, it try to let them do alot in the or and on the floor, and they learn alot and hence it further encourages then to go into gensurg

4. Yes we deal with aloot fo crap, but as other have said, taking care of patients and feeling like you have made a positive difference in their lives is what keeps me going

5. I love to operate, would not like medicine as much if i couldnt cut :(
 

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I am a fourth year doing the whole match thing in general surgery right now.

The only people who tried to talk me out of doing surgery were...
a.) anyone doing anything other than surgery (i.e. Medicine, Peds)
b.) my friends who hated surgery
c.) my friends who secretly loved surgery but would never do it

Other than those, attendings and residents are trying to talk people into it.
 
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One thing about going into surgery that is undeniable is that you become a SURGEON!
 

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The only medical students I try to talk out of going into surgery are the ones that suck.
 

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In general, I think residents are miserable, particularly at the junior level. On every rotation except psychiatry and neurology, my residents said "do *anything* except [their specialty]!!"

Of course, when I said I was interested in general surgery everyone told me I was nuts. I think it's because they cling to their wispy shreds of hope because when they're feeling especially beat down, they say with the utmost schadenfreude "at least I'm not a surgery resident."

I feel I'm cut out for surgery residency, as well as anyone can be. I realized that outside of hanging out with my fiance, I don't really do much outside of the hospital. Call it pathetic, but my interests are things that can absolutely be done at any time (reading, making music, writing arcane history articles) rather than catching concerts, going to bars/clubs and the like. I'm very happy to work long hours, not because of any crazy workaholic/gunner proclivity but rather because I'm a pretty contented person who's happy being at work or being at home. I know after a couple of weeks of scrutiny my residents on my surgery rotation agreed that I was well-suited. I was never talked out of it by surgery people, only by everyone else.

Of course, now I've decided to go for plastics, but I think the point holds.
 

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I'm young, naive, and impressionable, but right now I feel very strongly that surgery is right for me. I'm open to that changing... at least I say that I am. I'm obviously still questioning the lifestyle and whether or not other priorities will come into play. Right now the plan is surgery and medical missions until I croak.
 

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I think it's because they cling to their wispy shreds of hope because when they're feeling especially beat down, they say with the utmost schadenfreude "at least I'm not a surgery resident."

Well, that's the second time I've seen you use schadenfreude in a sentence.

I believe you've managed to fit Gedankenexperiment into a previous post as well.......


Hold on, I'm getting out my German Philosophy Calculator (GPC 5.0...you can buy it on Amazon):

Beep-boop-boop.....

Beep-boop-boop.....


Okay, here it is.....

Your next obscure German philosophical reference will be: Weltanschauung.


Use it wisely......
 

BlondeDocteur

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Ah, but I have the 6.0 (available in Japan only, hits US market in March 2009), and it's telling me that the STURM UND DRANG of the medical student's quest for approval and acceptance-- their feelings manifest examples of the EMPFINDSAMKEIT-esquespirit of the times-- will privilege sentiment over any silly cold-hearted cosmology, or "weltanshauung," anyday.

Probably cause I'm a chick.
 
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I've noticed a lot of times the "oh, don't go into surgery" rhetoric comes from the first and second year residents and tapers considerably as you get into senior residents and attendings. The attendings were actually the most positive telling quite a few students they should really consider surgery for a career etc.

I think this is for a couple reasons. First, the life of the surgical intern is brutal and they're the most likely to be the most discouraging. Second, surgery has always had (and likely always will) have a general sense of "We only want those who really want us". Once a fourth year medical student crosses over to residency, he feels he's part of the in crowd and now he maybe overuses the old "make sure you really want to be a surgeon" blah blah blah because it makes it feel like he fits in better.
 

FliteSurgn

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There are certainly less demanding specialties, but none that give the same sense of accomplishment IMHO. The variables associated with life after surgery residency can make huge differences in practice opportunities. The reimbursement/compensation issue also has WIDE ranges.

I really think there is significant light at the end of the tunnel for all those so inclined to pursue general surgery as a way of life. Using myself as an example, I work in a large midwestern city in private practice. We have no residents, but do have a PA for assistance. Call can be busy at times, but on average I only have to get up and go to the hospital 20% of the nights that I am on call. Yes, central line consults suck but fortunately the referring doctors know that and really try to minimize their requests. We work 4 days per week, take one night call per week and one weekend in 5. On weeks that I am not the weekend call doc, I work 40 hours per week or less. I average between 50 and 70 cases per month and make a VERY good living. After overhead, but before taxes we all make more than $400k (some significantly more than that).
 
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Well, that's the second time I've seen you use schadenfreude in a sentence.

I believe you've managed to fit Gedankenexperiment into a previous post as well.......


Hold on, I'm getting out my German Philosophy Calculator (GPC 5.0...you can buy it on Amazon):

Beep-boop-boop.....

Beep-boop-boop.....


Okay, here it is.....

Your next obscure German philosophical reference will be: Weltanschauung.


Use it wisely......

I nominate this as THE best post of 2008. A late entry, and it surges to the front.
 

NPR

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Is this common in the surgical subspecialties as well? (plastics. neurosurg, ortho, ENT, uro)

Or are we referring more to general surgery?
 

BlondeDocteur

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I think the predominant vibe for the subspecialties is skepticism re: the student's ability to get in. The attitude is more "talk to me when you've matched." They're seen as having better lifestyles than general surgery, with the exception of neurosurgery (which is really more of a cult than a specialty).
 

dr.evil

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There are certainly less demanding specialties, but none that give the same sense of accomplishment IMHO. The variables associated with life after surgery residency can make huge differences in practice opportunities. The reimbursement/compensation issue also has WIDE ranges.

I really think there is significant light at the end of the tunnel for all those so inclined to pursue general surgery as a way of life. Using myself as an example, I work in a large midwestern city in private practice. We have no residents, but do have a PA for assistance. Call can be busy at times, but on average I only have to get up and go to the hospital 20% of the nights that I am on call. Yes, central line consults suck but fortunately the referring doctors know that and really try to minimize their requests. We work 4 days per week, take one night call per week and one weekend in 5. On weeks that I am not the weekend call doc, I work 40 hours per week or less. I average between 50 and 70 cases per month and make a VERY good living. After overhead, but before taxes we all make more than $400k (some significantly more than that).

Things are different everywhere, that's for sure. If I had FlightSurgeon's life, I would not be quite as bitter. So, general surgery can be good and it depends on your set-up. I go in 95% of the time when I'm on call so that adds to misery.

I don't mean to be bitter because I love to operate and I really enjoy taking care of my patients as they are very grateful for your efforts when you try to do a good job. When you look for a job after residency, try to get a feel for your life. Call is huge. Not necessarily how much call but how brutal your call is. Payor mix is another thing. No pay patients are everywhere but the number of them can make or break you.

How much your hospital (and referring docs) need you and appreciate you is another thing that we never ask about. That makes a huge difference especially your referring docs not asking for a central lines on every Tom, Dick and Harry that comes in the hospital (I swear at my hospital that an IV is a foreign entity to our nurses). It also will make you immediately busy and be able to do 50-70 cases/month.

Efficiency of your O.R. is also huge as you don't want to be sitting around in between cases for 4 hours twiddling you thumbs.

So, I really don't think its general surgery that sucks. It's the environment in which you practice general surgery that has a huge impact.
 

dienekes88

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Ah, but I have the 6.0 (available in Japan only, hits US market in March 2009), and it's telling me that the STURM UND DRANG of the medical student's quest for approval and acceptance-- their feelings manifest examples of the EMPFINDSAMKEIT-esquespirit of the times-- will privilege sentiment over any silly cold-hearted cosmology, or "weltanshauung," anyday.

Probably cause I'm a chick.

:laugh:

Well played.
 
4

45408

Things are different everywhere, that's for sure. If I had FlightSurgeon's life, I would not be quite as bitter. So, general surgery can be good and it depends on your set-up. I go in 95% of the time when I'm on call so that adds to misery.

I don't mean to be bitter because I love to operate and I really enjoy taking care of my patients as they are very grateful for your efforts when you try to do a good job. When you look for a job after residency, try to get a feel for your life. Call is huge. Not necessarily how much call but how brutal your call is. Payor mix is another thing. No pay patients are everywhere but the number of them can make or break you.

How much your hospital (and referring docs) need you and appreciate you is another thing that we never ask about. That makes a huge difference especially your referring docs not asking for a central lines on every Tom, Dick and Harry that comes in the hospital (I swear at my hospital that an IV is a foreign entity to our nurses). It also will make you immediately busy and be able to do 50-70 cases/month.

Efficiency of your O.R. is also huge as you don't want to be sitting around in between cases for 4 hours twiddling you thumbs.

So, I really don't think its general surgery that sucks. It's the environment in which you practice general surgery that has a huge impact.
What's limiting your ability to change your employer? Just curious. I wouldn't go into general surgery with the sole expectation of taking out 35-year old women's gall bladders from 9-3, M-F, but I'd also prefer to avoid a job that was one catastrophic operation after the next.
 

biophysicianai

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I really think there is significant light at the end of the tunnel for all those so inclined to pursue general surgery as a way of life. Using myself as an example, I work in a large midwestern city in private practice. We have no residents, but do have a PA for assistance. Call can be busy at times, but on average I only have to get up and go to the hospital 20% of the nights that I am on call. Yes, central line consults suck but fortunately the referring doctors know that and really try to minimize their requests. We work 4 days per week, take one night call per week and one weekend in 5. On weeks that I am not the weekend call doc, I work 40 hours per week or less. I average between 50 and 70 cases per month and make a VERY good living. After overhead, but before taxes we all make more than $400k (some significantly more than that).

It seems to me that you're the exception rather than the rule. How did you pull this off?
 

dr.evil

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What's limiting your ability to change your employer? Just curious. I wouldn't go into general surgery with the sole expectation of taking out 35-year old women's gall bladders from 9-3, M-F, but I'd also prefer to avoid a job that was one catastrophic operation after the next.

Most guarantees/contracts are for 3 years (or at least that was the most common I found). Therefore, you tend to get stuck somewhere for 3 years unless you want to come up with big cash to get out of the contract. Getting out is entirely doable but sometimes it's easier to suffer an extra year just not to hurt yourself anymore financially. Quarter million in student loans is enough.

I agree that one catastrophic operation after the next is completely draining. I really got sucked into that my first year out. I would get the absolutely bombs dropped on me and it was absolutely emotionally and physically exhausting.

Outpatient operations are where it's at. The more of those you can do, the better your life will be. The problem when you get out is that you want to do big operations (at least I do). What you don't want is to ONLY do big operations. You won't get paid as well overall and the patients are much sicker and in the hospital longer. 2 or 3 lap choles reimburses as well as a Whipple with MUCH less pain. So a balance is ideal.

And TRAUMA SUCKS. it sucks the life out of you, it doesn't pay worth a crap, and the patients are demanding & sue happy.
 

Chubs OMalley

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Now fellas this here topic reminds me how I had to sort out my crew of med students recently. As yall know you got your gunner students, your sucking-up students, and of course your hide-in-the-library students. Just some of the hoodlums assigned to the team. Heck gents, team is too strong of a word here. More like a loose collection of individuals.

Now I had a near mutiny on my hands hombres and it came to head one day few weeks back. Went a little something like this.

"You there, go update the census. You, we need some blood draws. You, digital disimpaction in the ER. And you, coffee no sugar before I head on over to the OR. Page the prelim if anything comes up.

Then the guy assigned to the disimpaction spoke up.

"Hey Chubs, we've been meaning to talk to you. We don't like how you pass off all the floor work to us so you can spend all day in the OR. We have rights as students and it doesn't include doing all your scut."

I had insubordination on my hands and had to put down the rebellion stat.

"Oh you have rights. And lefts, ups, and downs. So what? You don't get to decide anything around here. This is not Family Medicine, not Emergency Medicine, nor Anesthesiology. This is the sovereign state of Surgery...WIPE THAT SMIRK OFF YOUR FACE! I will be in the OR. And you will do the disimpaction whether the hell you like it or not!

Just as I was getting started to really let them have it, a heavy player walked in.

"Everything alright here?"

"Everything's fine, sir. Just dividing up the day's work for the team..."

Another lightweight piped up.

"Actually, everything's not fine as Chubs may have you believe. Everyday he assigns us all the floor work so he can spend the day operating."

A brooding expression panned over the heavy.

"Is this true, Chubs?"

"Well, sir, uhhh, it's just that..."

"Chubs, I realize you're new here. But there's more to being a surgeon than operating."

Smug looks of satisfaction were plastered over my insubordinates.

"Like what, sir?"

"Like making sure you show up to court when they're dividing up your assets to give to the golddigger of an ex-wife sucking you dry."

"Ha, ha! That's a good one, sir. You had me going there for a bit."

"I'll see you in the OR."

"Yes, sir. I'll be right there."

As soon as the heavy was out of earshot I turned my attention back to the team.

"Nice try, amigos . Get to work."
 
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JeffLebowski

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Now fellas this here topic reminds me how I had to sort out my crew of med students recently. As yall know you got your gunner students, your sucking-up students, and of course your hide-in-the-library students. Just some of the hoodlums assigned to the team. Heck gents, team is too strong of a word here. More like a loose collection of individuals.

Now I had a near mutiny on my hands hombres and it came to head one day few weeks back. Went a little something like this.

"You there, go update the census. You, we need some blood draws. You, digital disimpaction in the ER. And you, coffee no sugar before I head on over to the OR. Page the prelim if anything comes up.

Then the guy assigned to the disimpaction spoke up.

"Hey Chubs, we've been meaning to talk to you. We don't like how you pass off all the floor work to us so you can spend all day in the OR. We have rights as students and it doesn't include doing all your scut."

I had insubordination on my hands and had to put down the rebellion stat.

"Oh you have rights. And lefts, ups, and downs. So what? You don't get to decide anything around here. This is not Family Medicine, not Emergency Medicine, nor Anesthesiology. This is the sovereign state of Surgery...WIPE THAT SMIRK OFF YOUR FACE! I will be in the OR. And you will do the disimpaction whether the hell you like it or not!

Just as I was getting started to really let them have it, a heavy player walked in.

"Everything alright here?"

"Everything's fine, sir. Just dividing up the day's work for the team..."

Another lightweight piped up.

"Actually, everything's not fine as Chubs may have you believe. Everyday he assigns us all the floor work so he can spend the day operating."

A brooding expression panned over the heavy.

"Is this true, Chubs?"

"Well, sir, uhhh, it's just that..."

"Chubs, I realize you're new here. But there's more to being a surgeon than operating."

Smug looks of satisfaction were plastered over my insubordinates.

"Like what, sir?"

"Like making sure you show up to court when they're dividing up your assets to give to the golddigger of an ex-wife sucking you dry."

"Ha, ha! That's a good one, sir. You had me going there for a bit."

"I'll see you in the OR."

"Yes, sir. I'll be right there."

As soon as the heavy was out of earshot I turned my attention back to the team.

"Nice try, amigos . Get to work."

:laugh:
 
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