Future of Gen Surg?

[SoulinNeed]

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Hello, I started med school about a month ago, and I've been exploring different surgical specialties, and seeing which ones interest me. A few really do, but I've been wondering about general surgery. Is there a demand for general surgeons? Do you have to do a fellowship, in order to make a good living on it (I really would like to avoid doing so)? I really like hernial surgeries and laparoscopic work, at least from what I've seen. I want to end up working in the midwest (IL/WI/IN), and I've seen some wide ranging starting salaries for job openings in those states (from 250K-$350K, with some claiming $400K after bonuses). I don't know how honest that is. It seems like the natural backbone of surgery, but with everything becoming so specialized, will there be anything left for gen surgeons? Thanks for the help.

 

[Taciturngosamer]

General surgeons in those markets do make the advertised salary. There is definitely a huge job market which is only going to grow as the population ages and past surgeons retire. An article came out recently about the 'coming shortage of surgeons'. Now you are right that in city markets require a fellowship in some cases. But there are plenty of mid sized cities which would salivate over a general surgeon who wanted to do hernias, laparoscopy, and scopes.

 

[Winged Scapula]

General Surgeons are still in demand and continue to be so in even larger markets. Phoenix for example, 5th largest city in the US, is a highly private/community practice market; fellowship not required although to compete, the general surgeon needs to be facile with robotics, SILS etc. here. Can't speak about the midwest but the number you quote are certainly doable here.

 

[SoulinNeed]

Yeah, I was a bit surprised when I saw "$350K-$400K" as I've always thought of that as ortho territory, but I guess the demand in the areas makes sense.

 

[Winged Scapula]

Yeah, I was a bit surprised when I saw "$350K-$400K" as I've always thought of that as ortho territory, but I guess the demand in the areas makes sense.

Not necessarily. Even lowly breast surgeons can make that. 😉

 

[SoulinNeed]

Not necessarily. Even lowly breast surgeons can make that. 😉

Doesn't that require a fellowship, though?

 

[Winged Scapula]

Doesn't that require a fellowship, though?

Only if you want to be a fellowship trained breast surgeon.

Most breast surgeons in the US are not fellowship trained; out of the 6 of us in our breast only practice, only 3 of us are fellowship trained.

 

[Danbo1957]

Yeah, I was a bit surprised when I saw "$350K-$400K" as I've always thought of that as ortho territory, but I guess the demand in the areas makes sense.

Non-fellowed GS may top out around those numbers in PP/community, but you'll work many years to get there; or you'll specialize in an area of need (oncology), work in mid-sized markets, are the "go-to-doc" for certain procedures, or go "mercenary".

Academic GS is another animal entirely from that of PP/community and does not pay as well generally starting out, and you'll have all that academic stuff to deal with. But, you'll work less insane hours, contribute to research and surgical instruction, and see some incredible pathology every so often.

Actual starting salaries at UT-Houston for most recent hires (published):

Todd Wilson Ast Pr of Surgery NTC $275,000
George Tyson III Ast Pr of Surgery NTC $250,000
Sheilendra Mehta Ast Pr of Surgery NTC $250,000
Rondel Albarado Ast Pr of Surgery NTC $250,000
Saleem Khan Ast Pr of Surgery NTC $250,000
Donald Lesslie Ast Pr of Surgery NTC $250,000
Kulvinder Bajwa Ast Pr of Surgery NTC $250,000
Brad Snyder Ast Pr of Surgery NTC $250,000
Michael Yaakovian Ast Pr of Surgery NTC $250,000
Michelle McNutt Ast Pr of Surgery NTC $250,000
Laura Moore Ast Pr of Surgery NTC $250,000

Academic GS does offer you grant monies along the way and you can earn a chair.

 

[SoulinNeed]

Non-fellowed GS may top out around those numbers in PP/community, but you'll work many years to get there; or you'll specialize in an area of need (oncology), work in mid-sized markets, are the "go-to-doc" for certain procedures, or go "mercenary".

Academic GS is another animal entirely from that of PP/community and does not pay as well generally starting out, and you'll have all that academic stuff to deal with. But, you'll work less insane hours, contribute to research and surgical instruction, and see some incredible pathology every so often.

Actual starting salaries at UT-Houston for most recent hires (published):

Todd Wilson Ast Pr of Surgery NTC $275,000
George Tyson III Ast Pr of Surgery NTC $250,000
Sheilendra Mehta Ast Pr of Surgery NTC $250,000
Rondel Albarado Ast Pr of Surgery NTC $250,000
Saleem Khan Ast Pr of Surgery NTC $250,000
Donald Lesslie Ast Pr of Surgery NTC $250,000
Kulvinder Bajwa Ast Pr of Surgery NTC $250,000
Brad Snyder Ast Pr of Surgery NTC $250,000
Michael Yaakovian Ast Pr of Surgery NTC $250,000
Michelle McNutt Ast Pr of Surgery NTC $250,000
Laura Moore Ast Pr of Surgery NTC $250,000

Academic GS does offer you grant monies along the way and you can earn a chair.

Well, the salaries that I've been finding for GS on Merritt Hawkins, for instance, for the midwest do usually start at $320-$400K, though $400K is on the high end and rarer (and with production bonuses). That's usual on there, though, but these are midsize markets. In a city like Chicago, for example, things would likely be different, but that's the case for all specialties.

 

[Danbo1957]

Good luck with that if you can get it 👍 Anyway, here's a decent general survey, with numbers that reflect what I see out there:

http://www.locumtenens.com/media/76930/2012_general_surgery_salary_survey.pdf

 

[SLUser11]

Non-fellowed GS may top out around those numbers in PP/community, but you'll work many years to get there; or you'll specialize in an area of need (oncology), work in mid-sized markets, are the "go-to-doc" for certain procedures, or go "mercenary".

Academic GS is another animal entirely from that of PP/community and does not pay as well generally starting out, and you'll have all that academic stuff to deal with. But, you'll work less insane hours, contribute to research and surgical instruction, and see some incredible pathology every so often.

Actual starting salaries at UT-Houston for most recent hires (published):

Todd Wilson Ast Pr of Surgery NTC $275,000
George Tyson III Ast Pr of Surgery NTC $250,000
Sheilendra Mehta Ast Pr of Surgery NTC $250,000
Rondel Albarado Ast Pr of Surgery NTC $250,000
Saleem Khan Ast Pr of Surgery NTC $250,000
Donald Lesslie Ast Pr of Surgery NTC $250,000
Kulvinder Bajwa Ast Pr of Surgery NTC $250,000
Brad Snyder Ast Pr of Surgery NTC $250,000
Michael Yaakovian Ast Pr of Surgery NTC $250,000
Michelle McNutt Ast Pr of Surgery NTC $250,000
Laura Moore Ast Pr of Surgery NTC $250,000

Academic GS does offer you grant monies along the way and you can earn a chair.

Some of those surgeons are getting paid for call, if I remember correctly....not sure of all the locations, but I know LBJ pays well for call, and I'm unsure about Hermann. Bonus structure is also not included....nor are benefits...so we're not getting the whole picture.

Academic reimbursement can be complicated, and the benefits tend to be a bit nicer, but certainly the overall earning potential is lower.

In academics, money is not necessarily earned with grants and chairs, although that is the end target for lifers. Honorariums, speaking engagements, medical directorships, bonuses, VA money, etc factor in a lot.

For me, I can get money from the VA (eighths, as they're called), or be a medical director, but that money just goes toward support of my salary...and hypothetically decreases my % FTE to make it easier to bonus with clinical productivity. It's sort of a backward system sometimes, and I spend hours each week doing administrative or academic activities without any specific monetary reward/reimbursement....just for the love of the game and the goodness of my heart.

For surgeons in private practice, plenty of them are making $400K and above...at least in the midwest. However, it's not just by generating RVUs. Often, they invest in surgery centers, and other similar related activities that supplement their income.

 

[Winged Scapula]

Some of those surgeons are getting paid for call, if I remember correctly....

At least one of them is. I am friends with one of those listed and he is being paid for taking Trauma Call as part of that salary.

 

[SoulinNeed]

Good luck with that if you can get it 👍 Anyway, here's a decent general survey, with numbers that reflect what I see out there:

http://www.locumtenens.com/media/76930/2012_general_surgery_salary_survey.pdf

That's average salary of $306K, which isn't too far off of what I reported. Like I said, the numbers I'm talking about are for smaller cities in IL/IN/WI, and most general surgeons are found in major cities where salaries are lower.

 

[SLUser11]

So I keep hearing about community/PP gen surgeons needing to be robot-capable.

But I can't ever quite get a handle on what procedures exactly most surgeons are tackling with the robot.

Anyone care to help me out?

From my program's obviously skewed/academic/old school perspective, the robot has been used for the following:

-Thoracic/VATs lobes and wedges. Not sure how many community GS guys are routinely doing thoracic in their practices?
-Bariatrics (roux-en-y). But my impression was that sleeves and bands far outweigh (hehe) true bypasses in the community, and I can't imagine an advantage for robotics in those procedures
-HPB (robot whipple and liver resections). Again, can't imagine too many community guys are doing these?
-Nissens/Hellers
-Pelvic (LARs/APRs)

It's not that the robot is necessary for general surgery...it's that it's marketable. If you are in PP, you are advertising your unique abilities.

Truthfully, the robot, in its current incarnation, is not too helpful for general surgery cases. I find it extremely helpful in the deep pelvis, but most general surgeons aren't going to be doing low LARs and APRs. I don't use it for abdominal cases.

 

[Smurfette]

The big thing in my area being advertised is the single incision robotic chole. Reimbursement for the surgeon's fee is the same as that for a lap chole so it is purely a PR thing to "draw patients in"; the hospitals love to be able to bill all the robot fees.

 

[filter07]

SILS had a much higher hernia rate, as I recall from a recent article. Plus it's a pain in the rear to perform. Most laparoscopy is pretty easy and the robot just slows things down in my experience.

 

[Miami_med]

The robot is an excellent way to turn a 30 minute case into a 3 hour case for no more money, no improvement in outcome, and no statistical benefit in any way shape or form. The benefit is that you can market that you can "do it robotically." I'm waiting for data which shows some benefit in doing anything away from the prostate. I've also seen a number of brand new unique complications just at my own institution alone related to that thing. I'm waiting to be convinced.

 

[medstud104]

Can we get some sympathy for the patient? 🙂

Always cautious of a performer that is more interested in money. 🙂 I avoid them at all cost's.

 

[KLPM]

I've also seen a number of brand new unique complications just at my own institution alone related to that thing.

Curious what they are. We don't have robots. I haven't seen robots either.

Skynet?

 

[Buzz Me]

Skynet?

Sigh...sadly, these days, I've met med students who weren't even born when that movie came out.

To lots of these young whippersnappers, Arnold is just an ex-governor who now dabbles in over-the-hill movies.

 

[KLPM]

Sigh...sadly, these days, I've met med students who weren't even born when that movie came out.

To lots of these young whippersnappers, Arnold is just an ex-governor who now dabbles in over-the-hill movies.

edit: Just goes to show there is a website for everything.

 

[Kahreek]

for a first year this guy is too keen on specialties incomes

 

[medstud104]

To lots of these young whippersnappers, Arnold is just an ex-governor who now dabbles in over-the-hill movies.

Have mercy. 🙂

 

[medstud104]

Hello, I started med school about a month ago, and I've been exploring different surgical specialties, and seeing which ones interest me. A few really do, but I've been wondering about general surgery. Is there a demand for general surgeons? Do you have to do a fellowship, in order to make a good living on it (I really would like to avoid doing so)? I really like hernial surgeries and laparoscopic work, at least from what I've seen. I want to end up working in the midwest (IL/WI/IN), and I've seen some wide ranging starting salaries for job openings in those states (from 250K-$350K, with some claiming $400K after bonuses). I don't know how honest that is. It seems like the natural backbone of surgery, but with everything becoming so specialized, will there be anything left for gen surgeons? Thanks for the help.

I'd suggest focusing on helping others instead of helping yourself.

 

[medstud104]

edit: Just goes to show there is a website for [URL="http://www.arnoldheight.com/about.html"]everything[/URL].[/QUOTE]


Death is such an error.

 

[PennDippody]

Non-fellowed GS may top out around those numbers in PP/community, but you'll work many years to get there; or you'll specialize in an area of need (oncology), work in mid-sized markets, are the "go-to-doc" for certain procedures, or go "mercenary".

Academic GS is another animal entirely from that of PP/community and does not pay as well generally starting out, and you'll have all that academic stuff to deal with. But, you'll work less insane hours, contribute to research and surgical instruction, and see some incredible pathology every so often.

Actual starting salaries at UT-Houston for most recent hires (published):

Todd Wilson Ast Pr of Surgery NTC $275,000
George Tyson III Ast Pr of Surgery NTC $250,000
Sheilendra Mehta Ast Pr of Surgery NTC $250,000
Rondel Albarado Ast Pr of Surgery NTC $250,000
Saleem Khan Ast Pr of Surgery NTC $250,000
Donald Lesslie Ast Pr of Surgery NTC $250,000
Kulvinder Bajwa Ast Pr of Surgery NTC $250,000
Brad Snyder Ast Pr of Surgery NTC $250,000
Michael Yaakovian Ast Pr of Surgery NTC $250,000
Michelle McNutt Ast Pr of Surgery NTC $250,000
Laura Moore Ast Pr of Surgery NTC $250,000

Academic GS does offer you grant monies along the way and you can earn a chair.

Over half of those take call most weeks and several of them (not all at the top) are boarded in surgical critical care as well.