For those of you who like surgery, what draws you to one surgical specialty over another?

[ERDOC555]

There are so many different fields of surgery and I'd like to hear from practicing physicians, residents, and medical students interested in surgery, what specifically draws you to one type of surgery over another?

What did you like or dislike about any of the following fields?

-General Surgery
-Cardiothoracic
-ENT
-Urology
-Ortho
-Plastics
-Vascular
-Neuro

---

Members don't see this ad.

 

[WedgeDawg]

Questions that I think are important to ask yourself:

1. What type of anatomy and pathology interests you?

2. Do you prefer mostly inpatient medicine, mostly outpatient medicine (probably not the best indication for a surgical career), or a mix of inpatient and outpatient medicine?

3. How acutely ill patients do you want to see?

4. How interested in research are you, and if you're interested, what type of research?

 

[VisionaryTics]

There are so many different fields of surgery and I'd like to hear from practicing physicians, residents, and medical students interested in surgery, what specifically draws you to one type of surgery over another?

What did you like or dislike about any of the following fields?

-General Surgery
-Cardiothoracic
-ENT
-Urology
-Ortho
-Plastics
-Vascular
-Neuro

ENT resident.

I loved head and neck anatomy. The intricacy and inter-relationships, more complex than any area of the body.

Clinically, I like variety, so ENT offered a mix of quick procedures (tubes/tonsils/septums) to medium (FESS/thyroid, tympanoplasty) to marathon (head and neck cancer). In the same day a general ENT may be doing endoscopic sinus surgery, some tonsils in kids, a thyroid, and plate facial fractures. I like a more predictable lifestyle, i.e. I have no problem operating late, but I don't want to get ambushed by emergencies when I'm a grey-haired attending at 1am routinely.

#1 factor in choosing a surgical residency is loving surgery. If you aren't completely in love with it, it's easy to fall out of love when you haven't slept in 40 hours and have consults to see or clinic to staff. You have to be an OR junky, because that will be the only thing that gets you through the bad times when you're wondering what the **** you're doing with the prime of your life.

 

[Freigeist]

Another ENT resident here:

ENT: Agree with above, also the people were the happiest surgeons I'd met

Ortho: you end up picking one body part and didn't have the variety I was looking for. The surgeries seemed cool as a Med student but I could see it getting repetitive quickly

Neurosurgery: terrible lifestyle that didn't seem to get much better after residency. Not the best personality match. Wasn't in love with the spinal cases which make up a large proportion of the specialty

General: didn't like the abdominal anatomy or pathology


Sent from my iPhone using SDN mobile

 

[FootballFoot]

@ ENT folks

How many hours do ENT attendings usually end up working after residency? Do ENTs not have on-call?

 

[Taddy Mason]

Just figure out the ratio between the length of the stick up your ass to phalic size insecurity to determine where you fit on the surg subspecialty spectrum.

 

[ERDOC555]

Another ENT resident here:

ENT: Agree with above, also the people were the happiest surgeons I'd met

Ortho: you end up picking one body part and didn't have the variety I was looking for. The surgeries seemed cool as a Med student but I could see it getting repetitive quickly

Neurosurgery: terrible lifestyle that didn't seem to get much better after residency. Not the best personality match. Wasn't in love with the spinal cases which make up a large proportion of the specialty

General: didn't like the abdominal anatomy or pathology


Sent from my iPhone using SDN mobile

Thanks!

I've never met an ENT that wasn't ecstatic about his/her job so I can definitely see them being the happiest.

Do most ortho doctors do fellowships and specialize in one part of the body nowadays, or are there still general ortho that do it all?

 

[SlugMD]

Don't forget that OBGYN is also surgery!

As an incoming medical student, I have been told many times to shoot for the hardest field you could possibly want and settle if you don't end up scoring high enough on Step 1. Someone, please correct me if I am wrong but general surgery seems to be the fall back for a lot of people in who liked the surgical subspecialties but scored under 240. A surgeon I shadowed originally wanted ortho but after Step 1, he switched to GS. Following GS, he did a fellowship and told me that he makes more money than ortho and is happier than he probably would have been had he done ortho. Yes, I know there are many who wanted GS from day 1. I don't mean to offend anybody.

 

[Psai]

Don't forget that OBGYN is also surgery!

As an incoming medical student, I have been told many times to shoot for the hardest field you could possibly want and settle if you don't end up scoring high enough on Step 1. Someone, please correct me if I am wrong but general surgery seems to be the fall back for a lot of people in who liked the surgical subspecialties but scored under 240. A surgeon I shadowed originally wanted ortho but after Step 1, he switched to GS. Following GS, he did a fellowship and told me that he makes more money than ortho and is happier than he probably would have been had he done ortho. Yes, I know there are many who wanted GS from day 1. I don't mean to offend anybody.

Obgyn is surgery like the kid mowing a lawn is a landscaper

 

[mcloaf]

Urology, much like ENT, has a great mix of big and small cases with a huge variety in the field. You more or less own your organ system(s) which means you're not fighting as much competition from other fields and you can do a lot of medical management in addition to surgery. Relatively few emergencies means better lifestyle than a lot of surgical fields after residency. If you're research-inclined there's a lot of interesting things to explore. It's also a field that's been quick to incorporate technology which means fun tools (lasers and robots). Plus the people in my experience tend to be fairly laid back, sort of prerequisite considering the subject matter.

To be honest if I weren't going into urology I'd probably do IM-->GI; most of the other surgical fields have various aspects that to me are deal breakers (pathology I find boring, patients I don't like, intolerable lifestyles even after residency, or just personalities/cultures I could never fit in with).

 

[Freigeist]

It's very uncommon now for orthopedic surgeons to practice without being fellowship-trained. Same goes for general surgery. If that's the route you're interested in, your best bet would be to work in an underserved area where more generalists are needed but it's likely that sub-specialization will continue as pay-for-performance becomes the new norm. Understandably, the surgeon who only replaces hips and knees will have fewer complications than a colleague who is not fellowship-trained and has less volume


Sent from my iPhone using SDN mobile

 

[operaman]

Another ENT resident here.

If I wasn't doing ENT I think I would do Ortho. If I couldn't operate, I'd do pediatric critical care. Not sure how much sense that all makes but that's just me.

As for my field, I can think of many reasons I love it but I fully understand there are incredibly happy people in other fields, so in the end this is very personal.

1) people - at my Med school and now at my residency and even on the interview trail, every person I met was kind, interested and interesting, loved their work,worked hard, and seemed overwhelmingly happy. I felt like I fit in well with these folks and still do. We have a zero tolerance for laziness like most surgical fields, but I find our attendings to be a super approachable group who will bend over backward to help you take care of patients.

2) patients - we have the best. We have the widest breadth by far. In one call night I've personally had to take an infant tonsil bleed back to the OR and soon after a 90 year old airway emergency needing an awake trach. I've seen patients in the first hours of life and and the last hours of life all in the same day. And everything in between. Our patients are generally less sick than most; more importantly, they overwhelmingly seem to get better. We have our crazies like all fields but not too bad. The overwhelmingly majority are happy after surgery. We also see many patients longitudinally so you get some of that long term continuity as well.

3) procedures- we do the longest and the shortest in the hospital. Lots of specialized gadgets. Microscopes, endoscopes, robots, airway, drills, lasers, etc. Perhaps the most important to me is that our procedures work. They really work. This is a big part about why I'd do ortho if I did another field - I like doing things that work. They're also fun to do, at least the stuff I've gotten to do so far. We also do a lot of office based procedures as well.

4) lifestyle - I think there's a lot of misconception about this for us. We are definitely a surgical field and work a lot of hours as residents. Attendings can have it much better depending on their practice setup, but we are definitely not a lifestyle field like derm. Personally we have a great lifestyle in no small part because I really like what I'm doing at work.

Agree with above that you need to love operating if you want to do any surgical field. Maybe more than that you need to love doing things TO people rather than only FOR people. We get called to do things TO someone and we have a lot to offer them most of the time. We do a lot of thinking and medical management too.

Job market looks great from what I can tell. Lots of demand and fairly limited number of new graduates each year.

 

[VisionaryTics]

@ ENT folks

How many hours do ENT attendings usually end up working after residency? Do ENTs not have on-call?

Lifestyle varies widely. We have one FPRS guy who does 8am-5pm clinic 2.5 days a week where he sees like ~12 pts per half day, 2 days a week in OR where he is always finished by 3pm, and one half day off every week for golf. No weekends. He worked his butt off to develop a patient base to get to that point (basically cash only cosmetics). His FPRS partner does 3 days per week in clinic (30 pts per half day, plus procedures scheduled during clinic...it's awful), and then marathon operating sessions twice a week, and it's not unusual to have Saturday am cases. Plus he's a trauma junky, so if another doc picks up a trauma on call they can't fit into schedule, he'll do it at some bad hour.

So two docs, same specialty, same department, same subspecialty, completely different lifestyles.

On-call for ENT isn't as bad as gen surg or nsurg or whatever. By the time you're attending, you can probably handle most stuff over the phone, but there's occasional badness we get called for that needs a fast trip to the OR at 2am.

 

[Slack3r]

It's very uncommon now for academic orthopedic surgeons to practice without being fellowship-trained. Same goes for general surgery. If that's the route you're interested in, your best bet would be to work in an underserved area where more generalists are needed but it's likely that sub-specialization will continue as pay-for-performance becomes the new norm. Understandably, the surgeon who only replaces hips and knees will have fewer complications than a colleague who is not fellowship-trained and has less volume


Sent from my iPhone using SDN mobile

FTFY