Exploring Surgical Specialties

[bobjonesbob]

I know there are a lot of threads where attendings talk about their fields, but there isn't always a lot of background on what led them there.

How would you / did you go about exploring surgical specialties throughout medical school and deciding what you wanted to pursue? I did quite a bit of shadowing throughout undergrad, and I'm hoping to do some more during M1 and M2, but it still seems difficult to determine what direction to go in especially on a timeline that would maximize competitiveness for residency (starting research projects early, finding mentors, etc.)

What kind of emphasis would you place on enjoying pre-clinical material and gross anatomy of an organ system and choosing a specialty? i.e.: if you hate learning all the AOIs of the forearm should ortho be out of consideration? Or do you really just have to wait until 3rd year rotations and hope that clears things up?

As of right now I'm not considering lifestyle, money, or competitiveness of the field. I'm just trying to figure out what fields I could potentially enjoy.

Right now, ortho and neurosurgery are highest on my list, but I'm also intrigued by surgical oncology. However, I don't really know anything about ortho oncology or general surgical oncology.

tl;dr: How do you pick a surgical specialty as a medical student when you aren't sure what you like and won't even be somewhat competent at surgery until the middle of residency?

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[deleted547339]

I know there are a lot of threads where attendings talk about their fields, but there isn't always a lot of background on what led them there.

How would you / did you go about exploring surgical specialties throughout medical school and deciding what you wanted to pursue? I did quite a bit of shadowing throughout undergrad, and I'm hoping to do some more during M1 and M2, but it still seems difficult to determine what direction to go in especially on a timeline that would maximize competitiveness for residency (starting research projects early, finding mentors, etc.)

What kind of emphasis would you place on enjoying pre-clinical material and gross anatomy of an organ system and choosing a specialty? i.e.: if you hate learning all the AOIs of the forearm should ortho be out of consideration? Or do you really just have to wait until 3rd year rotations and hope that clears things up?

As of right now I'm not considering lifestyle, money, or competitiveness of the field. I'm just trying to figure out what fields I could potentially enjoy.

Right now, ortho and neurosurgery are highest on my list, but I'm also intrigued by surgical oncology. However, I don't really know anything about ortho oncology or general surgical oncology.

tl;dr: How do you pick a surgical specialty as a medical student when you aren't sure what you like and won't even be somewhat competent at surgery until the middle of residency?

You need to care about lifestyle and money.

 

[bobjonesbob]

You need to care about lifestyle and money.

Why do you say that? Because you think in the end it's just going to be a job regardless?

 

[Medstart108]

Why do you say that? Because you think in the end it's just going to be a job regardless?

I think you need to know what you are comfortable with. If you are the kind of person who honestly would not be bitter if you worked harder and longer hours for less pay than a colleague of yours in order to do a specific field then fine.

I think for many people, after a long day at work knowing they have something for all of that effort whether that be compensation or whatever, it can get them through the day.

So take everything into consideration and throw all the "i would do medicine for 30k a year" story you said in your medical school interview out the door. Think of your specialty like any normal sane person. It'll be a mix of everything.

 

[deleted547339]

Why do you say that? Because you think in the end it's just going to be a job regardless?

Yes. It's a job. Medicine is a great job - you get to positively affect and sometimes save people's lives; you get paid very well; you have a position of respect in the community; you get to really think; you get to have meaningful interactions with people; you interact with extremely intelligent individuals. It's a really great job. But it's just a job. It's a lot easier to get up at the crack of dawn and stay at the hospital until after dark, rinse and repeat when you love what you do, but it's still a job. Family, friends and faith are what (should) give your life meaning. If you wouldn't rather be at home with your spouse +/- children, then you're doing it wrong. I love what I do (critical care fellow) and I actually really love going to work, but I'd rather have a day at home with my family.

Further, every specialty has things about it that are terrible. I love taking care of the septic shock patient that is crumping in front of me, but I hate admitting the little old lady that had a ground level fall and has a tiny intracranial hemorrhage or the non-sick DKA where I just click on an order set. Maybe it will be a procedure you hate doing, maybe it will be crappy consults, doing dictations, dealing with admin, malingering patients, whatever. Loving the really great parts of your specialty, in addition to money and time off, make the parts you hate more tolerable. Find the job with the best ratio of good parts of the job, money and time off outweigh the crap to the amount of time you are away from your family and have to do the things you hate - how much you weigh each of those individual variables simply depends on your personal value system.

 

[bobjonesbob]

Yes. It's a job. Medicine is a great job - you get to positively affect and sometimes save people's lives; you get paid very well; you have a position of respect in the community; you get to really think; you get to have meaningful interactions with people; you interact with extremely intelligent individuals. It's a really great job. But it's just a job. It's a lot easier to get up at the crack of dawn and stay at the hospital until after dark, rinse and repeat when you love what you do, but it's still a job. Family, friends and faith are what (should) give your life meaning. If you wouldn't rather be at home with your spouse +/- children, then you're doing it wrong. I love what I do (critical care fellow) and I actually really love going to work, but I'd rather have a day at home with my family.

Further, every specialty has things about it that are terrible. I love taking care of the septic shock patient that is crumping in front of me, but I hate admitting the little old lady that had a ground level fall and has a tiny intracranial hemorrhage or the non-sick DKA where I just click on an order set. Maybe it will be a procedure you hate doing, maybe it will be crappy consults, doing dictations, dealing with admin, malingering patients, whatever. Loving the really great parts of your specialty, in addition to money and time off, make the parts you hate more tolerable. Find the job with the best ratio of good parts of the job, money and time off outweigh the crap to the amount of time you are away from your family and have to do the things you hate - how much you weigh each of those individual variables simply depends on your personal value system.

Yeah I mean I get that rational but that's not really the type of advice I was looking for. For the surgical fields that I'm interested in I'd imagine it'd be pretty easy to clear $300k as an attending (and potentially well above that from what I hear with spine). For me at least, I can't see money mattering after that point. I'd definitely give more weight to lifestyle than money but my point with neglecting that is I think I'm okay with a demanding field if it's what I'm interested in. As an M1 I'm hoping to solidly interests then consider factors like lifestyle.

 

[Medstart108]

I know there are a lot of threads where attendings talk about their fields, but there isn't always a lot of background on what led them there.

How would you / did you go about exploring surgical specialties throughout medical school and deciding what you wanted to pursue? I did quite a bit of shadowing throughout undergrad, and I'm hoping to do some more during M1 and M2, but it still seems difficult to determine what direction to go in especially on a timeline that would maximize competitiveness for residency (starting research projects early, finding mentors, etc.)

What kind of emphasis would you place on enjoying pre-clinical material and gross anatomy of an organ system and choosing a specialty? i.e.: if you hate learning all the AOIs of the forearm should ortho be out of consideration? Or do you really just have to wait until 3rd year rotations and hope that clears things up?

As of right now I'm not considering lifestyle, money, or competitiveness of the field. I'm just trying to figure out what fields I could potentially enjoy.

Right now, ortho and neurosurgery are highest on my list, but I'm also intrigued by surgical oncology. However, I don't really know anything about ortho oncology or general surgical oncology.

tl;dr: How do you pick a surgical specialty as a medical student when you aren't sure what you like and won't even be somewhat competent at surgery until the middle of residency?

To answer your question, I would shadow different surgical and non-surgical specialties. Decide if you like being in the OR and the environment in it and decide if you like the gradual progression of responsibilities in the OR. Once you've decided that, just look into the different surgical specialties by doing a day or two in them. Each specialty is different from not just the knowledge but also lifestyle, income, types of cases, crap they deal with, responsibilities on the wards, research directions, job opportunities etc. With that being said, if you hate learning about MSK you probably shouldn't be doing plastics or ortho.

So all in all look into these factors (not in order of importance):

Knowledge - Do you like learning and being an expert in this organ/organ system?
Income - Are you satisfied with the income?
Lifestyle - Are you satisfied with the lifestyle? Every surgical subspecialty has different work hours, some deal with a lot of emergencies others non at all
Vibe/Fit - Does your personality fit in with the type of individuals in the specialty? You won't really know until you interact with a number of people in the specialty. E.g. if you find potty jokes annoying or offensive and that is all you hear about in uro, it might not be for you
Case load/type - Some specialties do big cases but few of them, others do many small ones, some have variety others don't, which one do you prefer?
Job Market/Future - Which specialties have jobs in areas you want? If you want peds neurosurg you probably won't be working in a rural/remote area
Research - Do you like the research in the field?
Community vs Academic - Some surgical specialties are more academic than others

There are many more factors that I haven't covered but it is a mix of all those factors and the weighting you give to each depends on you individually as a person as well, but this is how most people decide their surgical specialty.

 

[Hemorrage]

To answer your question, I would shadow different surgical and non-surgical specialties. Decide if you like being in the OR and the environment in it and decide if you like the gradual progression of responsibilities in the OR. Once you've decided that, just look into the different surgical specialties by doing a day or two in them. Each specialty is different from not just the knowledge but also lifestyle, income, types of cases, crap they deal with, responsibilities on the wards, research directions, job opportunities etc. With that being said, if you hate learning about MSK you probably shouldn't be doing plastics or ortho.

So all in all look into these factors (not in order of importance):

Knowledge - Do you like learning and being an expert in this organ/organ system?
Income - Are you satisfied with the income?
Lifestyle - Are you satisfied with the lifestyle? Every surgical subspecialty has different work hours, some deal with a lot of emergencies others non at all
Vibe/Fit - Does your personality fit in with the type of individuals in the specialty? You won't really know until you interact with a number of people in the specialty. E.g. if you find potty jokes annoying or offensive and that is all you hear about in uro, it might not be for you
Case load/type - Some specialties do big cases but few of them, others do many small ones, some have variety others don't, which one do you prefer?
Job Market/Future - Which specialties have jobs in areas you want? If you want peds neurosurg you probably won't be working in a rural/remote area
Research - Do you like the research in the field?
Community vs Academic - Some surgical specialties are more academic than others

There are many more factors that I haven't covered but it is a mix of all those factors and the weighting you give to each depends on you individually as a person as well, but this is how most people decide their surgical specialty.

how would you rank the surgical subspecialties based on income?

 

[Medstart108]

how would you rank the surgical subspecialties based on income?

I'm Canadian so its probably not best that I answer this since it is different between Canada and the states.

 

[bannie22]

It is inexplicable but income/salary is taboo in the field of medicine. No premed, med student, or resident really knows what they are getting into.

Doximity is a good place to look up average income per specialty. I am not sure where they get their data from but they present it in a fashion that makes me believe they did some good research.