For all the surgery residents- is it worth it? And should I do it?

[PAgirl]

I am an MS3 a month into my surgery rotation. I was seriously considering going into surgery before I started, but now I'm not so sure. For one thing, the hours the residents work are sooooo long, and I don't know if I could give up my entire life outside the hospital for five years (or more with fellowship), even if I really liked surgery itself. Also, there is a third year resident who hates her life and is trying to convince me not to do surgery and do anesthesiology or something more cushy.

The other thing is that I get really bored watching procedures if I am standing there doing absolutely nothing, especially during procedures I've seen before, to the point that I cannot wait for it to be over. On the flip side, however, if I am given any task whatsoever, be it retracting, suctioning, literally anything, I'm so into it and I absolutely love it. Time goes by so fast and I thoroughly enjoy myself.

So basically every other day, sometimes three times a day, I go back and forth about whether I want to do surgery. What I want to know is: is my boredom and dread of long hours a sign that I should not do surgery? And for everyone who went into surgery, did the long hours during residency crush your soul or did you manage to have a good time and get through it ok?

As far as whether or not I should choose surgery, keep in mind I have nothing to compare surgery to as it's my first rotation, so I'm also thinking it may be hard to make that determination until I've seen everything. It just seems like everyone I know who goes into surgery absolutely loved their surgery rotation and never had any doubts about choosing the profession.

---

Members don't see this ad.

 

[ESU_MD]

you will be giving up more than 5 years- you will be giving up your entire life.

in fact- you probably should seek another field: if you have to ask yourself if you can handle the surgery lifestyle.

If you are supposed to be a surgeon, one will ask themselves: can I handle my lifestyle if I DONT do surgery?

 

[JackADeli]

...in fact- you probably should seek another field...
If you are supposed to be a surgeon, one will ask themselves: can I handle my lifestyle if I DONT do surgery?

I must agree. Based on your question and background you provided, I suggest you accept you are meant for something else. Figure out what you are truly excited about and do that. Understand that you must identify the "bread & butter" day in and day out of whatever specialty and determine if that is what you like and can be satisfied doing for 20+ years? Do you find womens health, pap smear, birth control, pregancy, etc exciting... OB/Gyn; How about children, vaccines, growth charts, health maintenance, school performance counseling, etc... pediatrics; limited patient involvement, dark rooms, technology, fine image analysis.... radiology; etc, etc, ....

Whatever you are looking at, you should be examining fields and making that determination on each of your clinical rotations.....

JAD

 

[Winged Scapula]

PAgirl,

bear in mind that almost all medical students like surgery when they get to do something, even those who absolutely know they will be doing another specialty, and almost everyone finds it boring to just watch.

Operating is fun, but if you cannot handle the long hours (and yes, they continue AFTER residency), the unpredictability of those hours (even in my so-called lifestyle specialty, I do not always know when I'll be home), and the day to day activities OUTSIDE of the OR, then don't go into surgery.

We've all met residents and attendings who are unhappy and will try to talk you out of it. I'd say that if this is your first rotation it is way to early to be deciding. Almost every medical student likes their first M-3 rotation, regardless of what it is - its so much fun to be in the hospital and out of the library.

Remember surgery is not just operating; if you cannot handle the long hours outside of the operating room, surgery is probably not for you. Note I did not say ENJOY the long hours because for many of us (and I'd venture ALL of us at some point in time), residency is not/was not fun.

 

[PAgirl]

Thanks for all the great replies. I guess I'm just conflicted because I always thought I would love 100% everything about surgery, and my boredom during surgeries I've seen before and have no participation in, combined with a resident who hates her life and is telling me to do something else, is making me seriously consider whether or not surgery is right for me. On the other hand, I love doing anything to help, I love the people, and I love seeing new procedures, especially when the attending describes what is going on. The days go by quickly and I miss it over the weekends when I'm not there.

I just hate not being certain. I don't know if I'm being prudent in not taking the decision to go into surgery lightly, or if my uncertainty is a sign I shouldn't go into it as a career. It seems like people who choose it know without a doubt that it is right for them. Is that usually the case? Basically, how do I know that I'll be happy as a surgeon?

How did you all know?

 

[Winged Scapula]

NEWSFLASH:

You will NOT like EVERYTHING about any specialty you choose.

Whether or not you can tolerate the crappy stuff, is the measure of whether or not a field is right for you. If you can tolerate butts and guts, then GS might be right. If you can tolerate decubitus ulcers, PRS might be right...and so on.

If you weren't uncertain, I'd say you don;t know what you're getting yourself into. It IS prudent to worry, to want to be sure. It is also prudent to let yourself experience other specialties and see if they interest you as well.

 

[filter07]

I wasn't certain. Still not certain now. You may never know. Sometimes you just get far enough along that it's more of a hassle to start over than to continue with the training.

What you are experiencing now is the novelty. Things are new, you are doing something instead of reading about it, etc. A lot of people feel that. Most eventually get over it and choose to do something else. Also, feeling like the day goes by fast and having more energy etc is temporary. It is much different to do something very rigorous for 2 months than to do it for 20 years. Things that can be "overcome" during 2 months become painful and burdensome when you have to do it your entire career.

There is no need to decide now. You might enjoy other rotations this year. You will have 4th year rotations to help you later once you get more perspective. It will just take time and experience to know whether the sacrifices and hard work still appeal to you. There's no way to really know that now and we don't have a crystal ball or psychoanalytic method to determine whether surgery will be personally worth it for you.

 

[JackADeli]

...Figure out what you are truly excited about and do that. Understand that you must identify the "bread & butter" day in and day out of whatever specialty and determine if that is what you like and can be satisfied doing for 20+ years?

...Whatever you are looking at, you should be examining fields and making that determination on each of your clinical rotations.....

...Operating is fun, but if you cannot handle the long hours... , the unpredictability of those hours... , and the day to day activities OUTSIDE of the OR, then don't go into surgery.

...if this is your first rotation it is way to early to be deciding...

Remember surgery is not just operating; if you cannot handle the long hours outside of the operating room, surgery is probably not for you...

...Whether or not you can tolerate the crappy stuff, is the measure of whether or not a field is right for you...

...It IS prudent to worry, to want to be sure. It is also prudent to let yourself experience other specialties and see if they interest you as well.

...What you are experiencing now is the novelty... A lot of people feel that. Most eventually get over it and choose to do something else...

There is no need to decide now. You might enjoy other rotations this year...

I think the above pretty much sums it up.....

 

[Sarcophageal]

Also, try not to base a decision on a specialty (any specialty) because your resident you are working with is unhappy. If you do that, you knock off a lot of specialties. Realize you will be the one doing it. Just because Steve or Suzie is always pissed off/tired or even go getter/excited, does not mean that you will be.

 

[Pir8DeacDoc]

Consider some of the "lifestyle" fields in surgery too like ENT and Urology. The same active participation in patient care is there but residency and the "real" world tend to be better. You need to want to do them, but it can lend to a better life than general, ortho, NSurg.

But please note I say tend to be better. We (ENT) put in a lot more hours than people think with our big cancer wacks. The interns from GS that rotate on our service are always surprised at the hours we keep. They assume we leave the hospital at 5 for our evening tennis. 🙂

 

[Winged Scapula]

I thought it was evening golf! 😉

 

[njbmd]

I haven't seen too many of the surgical subspecialties working less hours that I work. My days average 12-16 hours with the office work, operating and clinic. Granted, I am in a surgical subspecialty but the hours don't get less post residency/fellowship. They are pretty much the same but the pay is much nicer.

 

[LovelyRita]

I'm a resident and life's pretty good right now. It's a long 5 years filled with good times and bad.

Yes, it's worth it.

I was telling a student last night that I think people who go into medicine wanting or expecting 8 hours a day with no other obligations have unrealistic expectations. In my eyes there are only a few specialties that might be like this. Otherwise, you still see patients and are consumed by paperwork (for the most part) no matter what you choose.

Anyway, it's 3rd year for you, the OP, and you should keep an open mind and be like a tourist thru the specialties. Whatever one makes you feel excited at the end of the day and you want to go home and read about might be something to look into!

 

[Winged Scapula]

I was telling a student last night that I think people who go into medicine wanting or expecting 8 hours a day with no other obligations have unrealistic expectations. In my eyes there are only a few specialties that might be like this. Otherwise, you still see patients and are consumed by paperwork (for the most part) no matter what you choose.

Truer words never spoken.

Perhaps its because I'm older and have worked full time before medical school but you sometimes wonder if these students think that a full time job is 30 hours per week (there was a Hills episode where one of the characters was quoted as, "You mean I have to come to work EVERY day?").

At any rate, I'm in a lifestyle specialty. I work less hours than I did in residency, but not much different than fellowship. However, despite the appearance of an 8-5 existence, many forget that just because I see patients from 8-5 doesn't mean that I don't have any paperwork. I have a 2 inch stack of paperwork from patients today that I haven't finished, plus am packing for my trip to Chicago tomorrow for the SDN Board of Admin meeting.

Sometimes the paperwork and the phone calls is a killer and can easily add 20 hrs on to my week.

 

[filter07]

Something I read the other day:

http://www.journalacs.org/article/PIIS1072751509003767/abstract

A total of 895 surgeons responded. Surgeons worked 64 hours per week; ideally, they would prefer to work 50 hours per week (median). Fifteen percent were dissatisfied with their careers. Forty percent would not recommend a surgical career to their own children. 33.5% did not achieve work-life balance.

 

[funshi baba]

stealing away from the original topic a bit here:

And i have decided its surgery, no other specialty. I am a 4th yr on a vascular surgery ai, then trauma, surg onc, gen surg etc. Only 1wk into my first ai and i feel like am struggling.

People am working with seem like good people. my concern is that i am not getting much feedback on what they expect from me. I feel like they already expect me to know. I am trying to keep up with the pack and i intend on learning to do as much as i can to help the team but sometimes just can't help the "fly on the wall" feeling.

Any advice for my rambling is welcomed.

 

[Pir8DeacDoc]

The fly on the wall feeling is part of being a medical student.

 

[funshi baba]

i guess so. Am determined to make sure everyone know my name by the end of this rotation. lol!

 

[Miami_med]

So here's the thing. As a medical student, you don't really know enough to be useful. If I have you perform a task, I have to double check the task anyway. You cannot sign orders. In some facilities, you can't even write a note. It's a rough position to be in, especially since we all know that effective participation was much greater in years past. Practically however, you have to start somewhere, and you can't start automatically knowing what to do.

That being said, there is an element of this in EVERY level of medicine. I can handle the majority (certainly not all) of the day to day management of my floor patients now, but I can only imagine how frustrating it was for the first few surgeons who let me do the case this last month as an intern. I probably doubled the length of the surgery, and it only wasn't worse because they did the parts themselves that it was too painful to watch me do. It does get better. As you move along, you will notice that there is more and more that you are doing without any oversight, and you will occasionally have a day (one like I had yesterday in fact) where the pace that you keep up leads you to realize that your once completely ignored work is becoming reasonably indespensible.

If you choose to go into a surgical field, there are certain things that you should pay attention to, and they are not obvious. It doesn't matter whether you watch 100 whipples, because you will never learn how to do a whipple before sometime between your chief year as a resident and never. You SHOULD pay attention to the techniques employed in doing the procedure. In this case, being a fly on the wall is incredibly useful. Observe how instruments are held. When you are retracting, what are you retracting and why? There are unique differences between how you handle the scalpel and the bovie. Which layers are you closing and with what? That will translate into having an easier time mastering basic operative skills, and the rules are the same regardless of which procedure you are involved with.

 

[funshi baba]

thanks for insight. 👍

 

[Gentle]

Miami_med

Thanks for the advice; it's quite a helpful piece for any 4th year med student thinking of surgery. I'm currently on an away rotation (vasc surgery) and I understand what the OP is talking about. As Miami_med said, sometimes it's not that we are being ignored it's just b/c there're things that we just can't do without having residents check over our work. But this's how teaching is done. So I think a good teaching resident will make you do stuff, even if they'll have to recheck. I understand that they only have a limited amt of time to do alot so I really do appreciate that single task that he/she assigns to me and supervises/teaches.

Gentle

 

[funshi baba]

i happen to have an intern that lets me do stuff and go over it. also gives me good pointers abt how to shine with attendings and res. so i think i will jyst stick to that.

thanks for the input

 

[surgicalskills]

I had the same thoughts as the OP 4th year med school. I was drawn to surgery but was apprehensive about the lifestyle and the difficulty of residency. I considered anesthesia then and also in my intern year and applied. And you know what. I'm absolutely sure that I made the right decision to continue in surgery. At the end of the day, I feel "satisfied." The road is difficult. First 2 years were hell at times. But, it gets better and I'm a better man both in my professional life and personal life. As a senior resident, things are easier, make more sense, less scut, more OR time, feel comfortable in the OR, get respect from attendings, OR nurses, PD and chair, see the light at the end of tunnel, get leadership role in running a surgical service and the satisfaction and pride that comes with that, guaranteed future employment without the threat of midlevels. When I see the patients that I operated on postop days knowing that I was able to change their anatomy without getting arrested, well, how can you put a price on that.

Majority of attendings really don't work that hard. Compared to the resident's life, general surgery attendings have it pretty good. It gets better.

 

[mosfet]

I had the same thoughts as the OP 4th year med school. I was drawn to surgery but was apprehensive about the lifestyle and the difficulty of residency. I considered anesthesia then and also in my intern year and applied. And you know what. I'm absolutely sure that I made the right decision to continue in surgery. At the end of the day, I feel "satisfied." The road is difficult. First 2 years were hell at times. But, it gets better and I'm a better man both in my professional life and personal life. As a senior resident, things are easier, make more sense, less scut, more OR time, feel comfortable in the OR, get respect from attendings, OR nurses, PD and chair, see the light at the end of tunnel, get leadership role in running a surgical service and the satisfaction and pride that comes with that, guaranteed future employment without the threat of midlevels. When I see the patients that I operated on postop days knowing that I was able to change their anatomy without getting arrested, well, how can you put a price on that.

Majority of attendings really don't work that hard. Compared to the resident's life, general surgery attendings have it pretty good. It gets better.

I absolutely agree with the OP. Life is already MUCH better for me as a PGY-2 than it was as a PGY-1. I am in the OR much more with not as much scutwork to do. And I can tell you that my attendings' lifestyles are pretty good compared to us residents. A lot of times, my general surgery attendings let us residents run the show without actually putting in a considerable amount of time into direct patient care postoperatively. I am OK with this since it gives me and my team quite a bit of autonomy to make decisions and at the same time it is nice to see that when we become attendings we won't have to work as hard as we did when we were residents. The bottom line is, don't give up, surgery is an amazing field and you will reap the rewards after everything is said and done.

 

[PAgirl]

Thanks for the words of encouragement. It's nice to know that you can be happy, or at least not miserable, as a surgery resident. I'm thinking more and more that surgery is right for me. I know I have all my other rotations, but I can't imagine liking anything else so much. I love the people, the autonomy, the procedures, joking around in the OR, and the idea of actually doing something physically to heal people. Plus, I scrubbed in on a ruptured AAA the other day and held the clamp on the proximal aorta, all the while the attending telling me that I have the patient's life in my hands and he will die if I let go, and the experience pretty much changed my life. It was amazing, to say the least.

And I am working with an amazing vascular fellow right now who gives me a lot of encouragement. He has said that as a medical student, or even a resident, just watching a surgery is completely different than actually doing it. He says he has known residents who have fallen asleep on their feet while retracting. But if you're actually doing it, it's really fun and exciting. And picturing doing what he's doing, I think I will really enjoy it. And I don't even mind hanging out with the interns and following them around while they do scutwork, so I think I will be able to survive the first few years of residency, which are supposedly the worst.

Thanks again for the replies. If you have any other words of encouragment or advice about choosing surgery, I would appreciate it.

 

[surgicalskills]

I absolutely agree with the OP. Life is already MUCH better for me as a PGY-2 than it was as a PGY-1. I am in the OR much more with not as much scutwork to do. And I can tell you that my attendings' lifestyles are pretty good compared to us residents. A lot of times, my general surgery attendings let us residents run the show without actually putting in a considerable amount of time into direct patient care postoperatively. I am OK with this since it gives me and my team quite a bit of autonomy to make decisions and at the same time it is nice to see that when we become attendings we won't have to work as hard as we did when we were residents. The bottom line is, don't give up, surgery is an amazing field and you will reap the rewards after everything is said and done.

It gets even better as PGY-4. 😀Good work and hang in there.

 

[surgicalskills]

Thanks for the words of encouragement. It's nice to know that you can be happy, or at least not miserable, as a surgery resident. I'm thinking more and more that surgery is right for me. I know I have all my other rotations, but I can't imagine liking anything else so much. I love the people, the autonomy, the procedures, joking around in the OR, and the idea of actually doing something physically to heal people. Plus, I scrubbed in on a ruptured AAA the other day and held the clamp on the proximal aorta, all the while the attending telling me that I have the patient's life in my hands and he will die if I let go, and the experience pretty much changed my life. It was amazing, to say the least.

And I am working with an amazing vascular fellow right now who gives me a lot of encouragement. He has said that as a medical student, or even a resident, just watching a surgery is completely different than actually doing it. He says he has known residents who have fallen asleep on their feet while retracting. But if you're actually doing it, it's really fun and exciting. And picturing doing what he's doing, I think I will really enjoy it. And I don't even mind hanging out with the interns and following them around while they do scutwork, so I think I will be able to survive the first few years of residency, which are supposedly the worst.

Thanks again for the replies. If you have any other words of encouragment or advice about choosing surgery, I would appreciate it.

Just make sure you're going into it knowing that it's more difficult than other fields. But, if you are this excited, I would definitely give a go. And yes very true in that doing the procedures is night and day different than watching/retracting. there have been times when I was so tired, then, I was given the case, and viola, wide awake with adrenaline. You must know that at times you will be miserable, tired, cranky, hate the world, and kicking yourself for going into surgery. But, that's part of the game.

 

[funshi baba]

well, i really hope all that has been said (esp. the positives) hold very true for surgery. I too dont really see myself doing anything besides surgery eventhough i keep hearing these horrible stories abt how my life is going to be over once i match surgery.
Attending def got it good but they earned it. As a 4th yr med student at my current prog, i actually have never been more excited to actually retract, suction or cut. I will take that any day over standing there and watching an endovasc repair of infrarenal AAA with embolizatoin of hypogastric artery aneurysm. Sounds cool, but its a b!tch if u just standing there watching.

I guess as a 4th yr, there isn't much u can do but its definitely a new learning curve for me especially at big instituition. Gonna present my first pt tommo on morning rounds vasc. surg svc, so nervous its like have never presented before. Mostly because my chief; though nice at heart, but face cold as ice. look like she's ready to give a beat down.

just venting, hoping and praying to GOD to be able to do enough to squeeze out a LOR too. Anyhow, vasc surg is fun, just need to get over my nerves and get use to d system. another AAA repair in am, feel like am doing some serious ****.

Thank God for this forum.

 

[Winged Scapula]

well, i really hope all that has been said (esp. the positives) hold very true for surgery. I too dont really see myself doing anything besides surgery eventhough i keep hearing these horrible stories abt how my life is going to be over once i match surgery.

[/QUOTE]

That's a pretty common theme from non-surgeons and others who really don't understand.

Its true that many things will change, that you will work long and hard hours. But as far as your life being over? That is the refrain from those specialties in which working 40 hrs per week is a lot.

 

[45408]

i guess so. Am determined to make sure everyone know my name by the end of this rotation. lol!

So my school started a new initiative for M4 students on their acting internships, and that's to work closely with one faculty member for the whole rotation. I set up that arrangement by meeting with a surgeon that another surgeon had recommended as a good teacher. I went to his clinics, scrubbed on his cases, followed his patients in the hospital, and when he was gone, I worked with his partner. It worked out really well, and there's no doubt that he "knows my name." If you try to follow too many faculty, there's a good chance you'll get lost in the shuffle. See if you can scrub primarily with 1-2 attendings on a routine basis.

It also made a MUCH better continuity of care. I saw people pre-op in clinic, scrubbed on their case, and then followed them in the hospital, and saw some of them post-op in clinic. Good times.

And it's reassuring to see that citation that the average general surgeon works 64 hours a week. I can work with that.

 

[VincentAdultman]

Well...

1. When you're just building your practice and trying to get people to refer you cases, that will certainly not be the average.

2. I wonder if people are under-representing their hours because they are "taking their work home with them" so to speak.

 

[45408]

Yeah, I'm aware of both. Bombs away.

 

[funshi baba]

So my school started a new initiative for M4 students on their acting internships, and that's to work closely with one faculty member for the whole rotation. I set up that arrangement by meeting with a surgeon that another surgeon had recommended as a good teacher. I went to his clinics, scrubbed on his cases, followed his patients in the hospital, and when he was gone, I worked with his partner. It worked out really well, and there's no doubt that he "knows my name." If you try to follow too many faculty, there's a good chance you'll get lost in the shuffle. See if you can scrub primarily with 1-2 attendings on a routine basis.

It also made a MUCH better continuity of care. I saw people pre-op in clinic, scrubbed on their case, and then followed them in the hospital, and saw some of them post-op in clinic. Good times.

And it's reassuring to see that citation that the average general surgeon works 64 hours a week. I can work with that.

That's a good point. I scrub on the regular with one of the attending, and also see his clinic pts, so he knows my name. Its def a new expeirnece doing my ai in a large instituition, so much to learn in such a short period of time. This should prep me for my next trauma surg ai.