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Many people tell me not to go into general surgery because of the poor hours and salary (for the hours worked), ie. 65 hours/week with busy call making $250k/year, which makes me concerned about this potential choice of specialty as well, so I think that if I were to pursue general surgery, I would go for a fellowship in hopes of improving my hours and salary. My question is: Do fellowships generally improve the hours and salary?

Please correct me if I'm wrong, but I am thinking that:
- plastics, colorectal, surgical oncology, and bariatric would improve both the hours and salary, ie. 60 hours/week with little call making $350k/year
- cardiothoracic, transplant, vascular, and trauma would make the hours worse but with improve salary, ie. 70 hours/week with at least the same call schedule making $450k/year

Thanks for the insight.
 

DoctwoB

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circulus vitios

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You mean to tell me that an article published by a vascular surgeon in a vascular surgery journal found that it was beneficial to specialize in vascular surgery??

Mind = blown.
The three major differences in vascular procedures occurring after the vascular fellowship were (1) a threefold increase in the number of vascular procedures performed, (2) a shift from major open to venous and endovascular procedures, and (3) an increase in case complexity.
This is literally one of the dumbest things that I've ever read.
 

Winged Scapula

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In general, a fellowship trained physician can earn more money either due to salary negotiations or marketing. However, that is not a given and salaries and reimbursements will vary according to geography, local norms and need, insurance contracts (ie, I make more than one of my partners does because I convinced some insurance companies that because I'm fellowship trained, I am "worth" more), and your negotiation skills.

Hours will vary widely as well. In some instances, you can negotiate better hours/less call/more vacation etc and in others you cannot. There are certain specialties where call is frequent and requires a physical presence in the hospital. That will increase your hours. Being fellowship trained is likely to be independent of such things, but rather it is a function of the practice type, size, call responsibilities, case types (ie, do you have patients in the SICU or ED, or mostly outpatient).

The bottom line (IMHO) for any one contemplating a surgical career is to expect the worst and hope for the best. You may not end up practicing in an environment that resembles anything we are familiar with now.
 

fiznat

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The bottom line (IMHO) for any one contemplating a surgical career is to expect the worst and hope for the best. You may not end up practicing in an environment that resembles anything we are familiar with now.
That's pretty depressing considering the investment required. One would hope that after everything that medical school and residency takes away that there would be some sort of reward at the end of it all. Expect the worst? After all this?

I'm not saying you're wrong. Just venting, I guess.
 

Winged Scapula

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That's pretty depressing considering the investment required. One would hope that after everything that medical school and residency takes away that there would be some sort of reward at the end of it all. Expect the worst? After all this?

I'm not saying you're wrong. Just venting, I guess.
I would hope you're not saying I'm wrong – after all I've been through it and you haven't.

However, I believe you mistook my statement for something more negative than was intended. My point was that with change in medical practice environment we don't know where salaries and reimbursements are going. I do not see them heading in a positive direction. After all, the Medicare reimbursement for the codes I commonly use is lower this year than it was last year and they're bundling several procedures resulting in less payment and a potential change in my practice. Therefore you cannot simply expect that the old rules will apply. So if you plan for the worst case scenario you won't be disappointed.
 

fiznat

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I would hope you're not saying I'm wrong – after all I've been through it and you haven't.
Thanks for putting me in my place.

For the record though, my comment was not antagonistic to you in any way (it was deferential, in fact), and I would appreciate it if you would not presume to know anything about my life. I've been using SDN for almost a decade now, and I swear I've never come across such consistent and unnecessary hostility than in the surgical forums. From an admin, no less.
 
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Winged Scapula

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Thanks for putting me in my place.

For the record though, my comment was not antagonistic to you in any way (it was deferential, in fact), and I would appreciate it if you would not presume to know anything about my life. I've been using SDN for almost a decade now, and I swear I've never come across such consistent and unnecessary hostility than in the surgical forums. From an admin, no less.
You're right. I did make some presumptions.

I presumed, based on your stated status, that you were a medical student and therefore, had never completed a surgical residency in the US and were not a practicing surgeon. If that presumption was incorrect, please advise.

I also presumed that you were using the common American vernacular which, when using the phrase, "I'm not saying you're wrong..." inplies the word "but" after it and therefore, calls into question the veracity of the OP. However, I am willing to admit that some things can be lost in translation on line and that I may have made an incorrect presumption.

I am suprised that you find the surgical forums as somehow more consistently hostile than other professional forums. FWIW, it has been my observation as a staff member that the vast majority of complaints about the behavior of SDN members comes not from this forum (very few in fact come from the surgical forums), but rather a few others. The OP's question was actually answered by a senior attending with a reasonable response whereas the response in those other forums would be "GTFO newb/medical student" or something else equally as welcoming.
 
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I've gotta say I've been a member on here for quite awhile and with the exception of the occasional troll, I've been pleasantly surprised by most of the dialogue on here in the surgical forum, especially compared to some of the other forums.
 

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That's pretty depressing considering the investment required. One would hope that after everything that medical school and residency takes away that there would be some sort of reward at the end of it all. Expect the worst? After all this?

I'm not saying you're wrong. Just venting, I guess.
Um...pretty sure Winged Scapula wasn't trying to pick a fight with you. As stated above, some things may have gotten lost in translation here on an Internet forum...but your tone is pretty antagonistic for no reason at all.

Sure, it'd be great if all those long hours during residency and/or fellowship paid off in the end (i.e. great money and short hours). H0wever, this often isn't the case. Some fields are notoriously busy, despite requiring fellowship training - I'm going into cardiothoracic surgery, and while I don't expect I'll work the hours I'm currently working as a fellow (100-130 a week), I also assume I'll be in the hospital for long stretches at a time and will likely be working 60-80 hours a week. But I knew that going in - and those that are going into other surgical fields, especially the "non-lifestyle fields" (like Vascular, Trauma, Transplant, etc.) likely do as well. One way to remedy this is to join a large group practice or have "surgicalist" type hours, where you'll cover 6a-6p or 6p-6a or something like that. This works well in ACS/Trauma. Transplant can have you be on call for a week, then off for a week (or no call duties for the rest of the month), etc.
 

Coffee Machine

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But I knew that going in - and those that are going into other surgical fields, especially the "non-lifestyle fields" (like Vascular, Trauma, Transplant, etc.) likely do as well. One way to remedy this is to join a large group practice or have "surgicalist" type hours, where you'll cover 6a-6p or 6p-6a or something like that. This works well in ACS/Trauma. Transplant can have you be on call for a week, then off for a week (or no call duties for the rest of the month), etc.
Is this a viable route for CT surgery? Just curious as I've never heard of this kind of arrangement.
 

Buzz Me

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Is this a viable route for CT surgery? Just curious as I've never heard of this kind of arrangement.
No. Doesn't work in CT. Most people join group practices (whether in academics or private practice), rotate call with partners and typically operate 3-4 days a week and have clinic/academic days 1-2 days a week.
 

jc7721

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And regardless of your speciality of choice, how busy you are is also significantly impacted by where you work, how many (good) partners you have, and if you have midlevels/residents taking calls. If you practice in a smaller market then there may be fewer emergencies, less overall volume, and you may still be compensated well (there are tradeoffs of course). If you pick a hyper competitive/huge market to work in, you may have to cover 7 hospitals to stay busy/generate enough revenue. If you only have 1 other partner, then there's a lot of call (but maybe it's not bad because you choose to work in a smaller market!), or maybe you have 2 partners, but they are both senior and are gone 12 weeks a year (vacation and all the conferences you don't get to go to) and its a really busy market so you're screwed when they're gone. There are so many permutations of how busy you are vs. how much you make (see WSs comments above); pay attention to people around you--ask them/find out how many cases they do a year, how often is call, what their hours are like, see if they and their partners seem/are happy. You can be a cardiothoracic surgeon in private practice doing 150 cardiac cases a year and 20-40 thoracic cases a year (with a ridiculously generous 8 weeks of vacation, that's less than 1 case a day) in a small market and not work 80hrs a week and be compensated well, but those jobs clearly do not always equate with happiness.
 

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