Gen Surg vs. Family Med/Primary Care

[reverence]

I know the two are very different...
Anyone else deciding (or decided) between these two?
Would appreciate input. Please don't bother talking about $$

Surgery [+] : the hands on; the procedure is the main medicine (I would much rather learn procedures over pharmacology); I like the varied environment (OR, wards, clinic); level of gratification; constantly working with other physicians;
Surgery [-] : It seems as if you must sell your soul to surgery/career, at least during residency; I have a lot interest outside of medicine; the cold-hearted culture/stereotype (I am admittedly a bleeding heart)

Family med [+] : Strong connection to community; relationships with patients; being able to treat and manage most things, love the idea of being a generalist; easy to imagine keeping a balanced lifestyle and community involvement
Family med [-] : Must be more rural to be true FM doc; deal with a lot of BS, worried well, doing a ton of stuff an NP or PA could easily do, etc.; worry that I would get bored with clinic; having to refer all the time as you are by definition the primary physician; it's at the bottom in terms of respected specialties; with so many specialists, it seems like a dying breed...

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[Promethean]

Don't imagine that surgeons don't also have to know a ton of pharm. Not only for the meds that are used intraoperatively, both on the field and by the anesthesia team, but also they need to have a thorough understanding of how the drugs their patients take regularly affect them. Not just does it increase bleeding or not, but, for instance, what is its effect on bowel motility? How likely is it to cause or worsen a post-op complication? How will it affect wound healing? Etc. Yes, a surgeon is probably going to be less conversant with the esoterica of a given drug than someone who prescribes it all the time, but that is not ideal.

FM doesn't have to refer all the time. Primary care physician doesn't have to mean "glorified midlevel that punts everything that isn't urgent care level routine." I know that sadly some FM docs practice that way, and it turns my stomach. One of the reasons that I am in medical school because a doctor refused to do squat for my girlfriend other than refer her to specialists. "What do you do?" I asked. "Oh, I manage your specialists!" Right. So, she was a secretary, not a physician. That isn't what FM is about at all.

Unless your patient's issues really extend beyond what you can manage, you should manage them. Carting someone off to an endo because they have uncomplicated diabetes, or to a gyne for well-woman pelvic exams, or to a psychiatrist because they have anxiety or depression managed with an SSRI, etc. Those (or similar) were among the stack of referrals my girlfriend got from this doc. None of her issues were unmanageable by a competent primary care physician. The doctor in question just chose not to be one of those.

FM can also do procedures. Depending on where you want to work, that can extend up to minor surgery. FM isn't bound to a single kind of clinic experience. You can work in an emergency department, you can deliver babies, you can inject joints, etc. Don't be complacent and allow yourself to be drawn into a style of practice that doesn't suit you. The beauty of FM is its variability, that you can carve out the career you want for yourself. You can work for hire or hang your own shingle. That is ultimately what made up my mind, when I compared surgery vs FM.

I love the OR. I love it. I miss it so much. There is a clarity, a sense of order and certainty, in the OR. There is a problem. A surgeon takes a knife to it. That problem is forever different, hopefully solved, but definitely changed. There can be camaraderie like no where else in civilian life, a sense that we are going through hell together to achieve a mission, that we have to pull together to get to the other side. I cannot explain how seductive it is... and I'm sure that if you choose that, you won't be looking back wondering if you should have gone the other way.

But the team aspect has other meanings. You can't do surgery alone. It is resource intensive, and that brings in necessary evils. You will be working for hire, either as an employee or a contractor, in almost all situations. You will either have to deal with hospital administration, or else take on some administrative role yourself. There is no place in the world for a solo surgical practice. You can't do what you do without that team.

FM can be a team sport, but that isn't mandatory. If my ideal practice turns out to be going solo, FM gives me that option. That is the thing that most appeals to me about it.

There is no wrong choice here. Both of those pathways hold a lot of promise. You have to figure out what you value most. Spend some time thinking about what you want your life to look like, what you want an average day to look like, what kinds of experiences you enjoy having. Then, think about which will be most likely to do that for you. Whichever you choose, commit. Don't spend time wondering if the grass is greener the other way. Put your heart into what you do, and make it the right thing for you.

 

[bannie22]

Good piece above. However, I would also caution that there is probably little difference, that will only continue to grow narrower, in practice opportunities (solo v group v hospital) in either specialty. So I wouldnt make up my mind based on that.

I think it should be a very easy pick generally. Most FM residents would never ever imagine surgery as an option, usually extremely distressed over hours when they rotate on surgery. Whereas most surgery residents would never ever tolerate the pace of life during their dealings with FM residents.

They are two specialties with very different lifestyles and clinical emphasis and I have never seen true happiness if residents are not in their appropriate service, no matter how excellent a job they do.

 

[doc05]

I know the two are very different...
Anyone else deciding (or decided) between these two?
Would appreciate input. Please don't bother talking about $$

Surgery [+] : the hands on; the procedure is the main medicine (I would much rather learn procedures over pharmacology); I like the varied environment (OR, wards, clinic); level of gratification; constantly working with other physicians;
Surgery [-] : It seems as if you must sell your soul to surgery/career, at least during residency; I have a lot interest outside of medicine; the cold-hearted culture/stereotype (I am admittedly a bleeding heart)

Family med [+] : Strong connection to community; relationships with patients; being able to treat and manage most things, love the idea of being a generalist; easy to imagine keeping a balanced lifestyle and community involvement
Family med [-] : Must be more rural to be true FM doc; deal with a lot of BS, worried well, doing a ton of stuff an NP or PA could easily do, etc.; worry that I would get bored with clinic; having to refer all the time as you are by definition the primary physician; it's at the bottom in terms of respected specialties; with so many specialists, it seems like a dying breed...

(1) have you done clinical rotations yet? If so, it's surprising that you're still on the fence.
(2) your view of surgery is a bit uninformed. the "level of gratification" isn't very high, and you are rarely working with other physicians.
(3) you need to figure out where you want to practice, and learn about the realities of practice that most med students don't appreciate... otherwise you will make an uninformed decision. unfortunately, most graduating residents, in most specialties, become hospital-employed physicians. this is not ideal for anyone, whether surgeon or family physician...try to learn what exactly it means.
(4) family physicians don't "refer all the time"... at least they don't have to. However, as Promethean recounts, many of them do... this may be for various reasons, including lack of time, as so many PCPs are overbooked and can't spend 30-40 minutes on each patient visit (particularly given the low reimbursement for outpatient follow up visits), so referrals can be very common. (again depending upon where you practice).
(5) also keep in mind that there are many other specialties besides surgery and family medicine. In "surgery" there are about a dozen specialties, and even general surgery is becoming super-specialized these days.

 

[ProfMD]

You have to decide which you like more: clinic or surgery.

More family medicine docs would rather not spend all day in the OR. I do not know any surgeons who like clinic. Even the people I know in "clinic heavy" surgical specialties like ENT and urology do not really like clinic all that much.

The level of gratification can be high in either specialty, as long as it is the right one for you. The difference is more in the pace - surgeons like instant gratification, family practice are more contact with long-term relationships and gradual improvements.

Also, why look only at FM and general surgery? There are plenty of IM subspecialties that have long term relationships but also procedures (GI, interventional cardiology, etc). There are also surgical specialties with a fair amount of clinic (urology, ENT, ob/gyn, etc).

 

[hallowmann]

Do you like clinic? Do you love the idea of being in the OR?

The surgeons I knew that love it can spend the whole day in the OR without it phasing them. Not talking about not being physically tired, talking about it energizing their minds/spirits. The ones that don't have dropped surgery for procedure-heavy FM programs. They liked procedures and working with their hands, but hated the hours.

Agree with above that surgeons and some subspecialists really seem to hate clinic.

Ever consider another primarily procedural subspecialty? Ophtho/Derm comes to mind. If not that, Anesthesia or even PM&R followed by a Pain fellowship might be an option (although hating pharm might kill that idea). EM might even seem like a reasonable option to get variety along with procedure exposure.

 

[Psai]

Do you like clinic? Do you love the idea of being in the OR?

The surgeons I knew that love it can spend the whole day in the OR without it phasing them. Not talking about not being physically tired, talking about it energizing their minds/spirits. The ones that don't have dropped surgery for procedure-heavy FM programs. They liked procedures and working with their hands, but hated the hours.

Agree with above that surgeons and some subspecialists really seem to hate clinic.

Ever consider another primarily procedural subspecialty? Ophtho/Derm comes to mind. If not that, Anesthesia or even PM&R followed by a Pain fellowship might be an option (although hating pharm might kill that idea). EM might even seem like a reasonable option to get variety along with procedure exposure.

The good thing about clinic as a surgeon is that you can hire a few pas and teach them the indications for surgery. If they see someone who they think might need your services then they call you into the room so you can confirm. Easy way to increase surgical volume and decrease the number of clinic days. And on operating days they can assist you in the OR or see more clinic patients.

 

[dr zaius]

Can you imagine being happy doing any other specialty outside of surgery? If so, do that. If not...pick surgery.

A surgical residency (not just gen surg, but ENT, urology, etc...we all pay our dues to cut) sucks royally. You are overworked. You are tired. You constantly feel stretched thin...but when you do that case with pretty much no attending or chief assistance, and you watch that patient get better, you realize that you're making a difference. Those long hours suddenly seem worth it.

I'm not saying you can't get the same satisfaction in a non-surgical field. Maybe I'm saying you have to be a masochist. I don't know. Send help.

 

[OnePunchBiopsy]

Biggest deciding factor for me was 3rd year, and this will be the case for you as well. Deciding between FMED and SURG will be like night and day.

Even though surgery had long hours, it was the ONLY rotation that I was excited to attend every morning. When I left each day I was tired but when talking to friends/family they noticed a significant elevation in my mood compared to my IMED rotation (which left me dead inside).

My favorite day in primary care clinic was my last. Yes, there were some fun cases and cool patients, but I never left a day in clinic with the same gratification.

 

[deleted451730]

Wow, OP. I'm just going to think out loud here for a moment... I feel like you are literally me right now at this moment, with the exact same reasoning behind your FM (procedure-heavy) vs. Surg inner debate. I'm at a very difficult crossroads as well, trying to choose between those two fields (as well as EM, maybe even OB/GYN?). I love procedures/OR as well and cannot see myself in a field without at least using my hands just as much as my mind.

Having said that, I really did not like IM/subspecialties—even the ones that are procedure-heavy—as an alternative that some other posters mentioned. (Nor do I have the scores/resume for the very competitive specialty surg or IR fields.) For me, I realized I loved the intellectual aspects of IM/subs and neuro/psych (i.e. infections, critical care, cards, GI, pulm, etc.) but disliked the tedious day-to-day job of actually being an IM/sub physician (and the fact that you never/rarely deal with kids/OB nor perform the type of invasive procedures I enjoyed on surgery and EM [but not IM-subs' procedures]).

I would rather be a procedure-heavy FM physician who enjoyed maintaining a high intellectual interest in things like infectious diseases that would also apply pragmatically to a practice than pigeonhole myself into a field such as cards, GI, or infx and throw much about everything else I knew from my brain. I realized this about me the moments I became infuriatingly annoyed at the IM sub-specialists consulting who, when the pt would veer away even for a second from his/her narrow field of medicine, he/she would immediately guide the pt back to the relevant complaint or give the robotic "oh that's nice...so..." type of feedback.

 

[ProfMD]

Wow, OP. I'm just going to think out loud here for a moment... I feel like you are literally me right now at this moment, with the exact same reasoning behind your FM (procedure-heavy) vs. Surg inner debate. I'm at a very difficult crossroads as well, trying to choose between those two fields (as well as EM, maybe even OB/GYN?). I love procedures/OR as well and cannot see myself in a field without at least using my hands just as much as my mind.

Having said that, I really did not like IM/subspecialties—even the ones that are procedure-heavy—as an alternative that some other posters mentioned. (Nor do I have the scores/resume for the very competitive specialty surg or IR fields.) For me, I realized I loved the intellectual aspects of IM/subs and neuro/psych (i.e. infections, critical care, cards, GI, pulm, etc.) but disliked the tedious day-to-day job of actually being an IM/sub physician (and the fact that you never/rarely deal with kids/OB nor perform the type of invasive procedures I enjoyed on surgery and EM [but not IM-subs' procedures]).

I would rather be a procedure-heavy FM physician who enjoyed maintaining a high intellectual interest in things like infectious diseases that would also apply pragmatically to a practice than pigeonhole myself into a field such as cards, GI, or infx and throw much about everything else I knew from my brain. I realized this about me the moments I became infuriatingly annoyed at the IM sub-specialists consulting who, when the pt would veer away even for a second from his/her narrow field of medicine, he/she would immediately guide the pt back to the relevant complaint or give the robotic "oh that's nice...so..." type of feedback.

Another option to consider is surgical critical care. Of course, you would still have to go through surgery residency, but it is an option.

 

[deleted451730]

Another option to consider is surgical critical care. Of course, you would still have to go through surgery residency, but it is an option.

I've heard that at most US hospitals, if someone is hired as the designated critical care surgeon, they rarely get to perform surgeries. Whereas, if one is a cardiothoracic surgeon, then they continue to practice surgery as well as manage the SICU. Is that true?

 

[OnePunchBiopsy]

I've heard that at most US hospitals, if someone is hired as the designated critical care surgeon, they rarely get to perform surgeries. Whereas, if one is a cardiothoracic surgeon, then they continue to practice surgery as well as manage the SICU. Is that true?

I've heard that SICU surgeons do not operate nearly as much as other surgeons, because Critical Care becomes their full-time job. That being said, I have never worked with a surgeon who was exclusively in Critical Care.

Surgeons (be them cardiothoracic or general), are trained to manage patients wherever they end up, be it the ICU, Med/Surg, or just outpatient. It just so happens that more cardiothoracic surgery patients end up in the ICU (massive MI's, ruptured aortic aneurysms) that is why cardiothoracic surgeons have lots of patients there and still operate a lot.

 

[ACSurgeon]

I've heard that at most US hospitals, if someone is hired as the designated critical care surgeon, they rarely get to perform surgeries. Whereas, if one is a cardiothoracic surgeon, then they continue to practice surgery as well as manage the SICU. Is that true?

I've heard that SICU surgeons do not operate nearly as much as other surgeons, because Critical Care becomes their full-time job. That being said, I have never worked with a surgeon who was exclusively in Critical Care.

Surgeons (be them cardiothoracic or general), are trained to manage patients wherever they end up, be it the ICU, Med/Surg, or just outpatient. It just so happens that more cardiothoracic surgery patients end up in the ICU (massive MI's, ruptured aortic aneurysms) that is why cardiothoracic surgeons have lots of patients there and still operate a lot.

The VAST majority of surgeons who completed critical care training practice a combination of trauma/acute care and critical care. The reason many of them don't operate much is because 80-99% of trauma is non-operative for the general surgeon. Thus, trauma/CC staff have low operative volumes. However, in the last 5-10 years, most trauma surgeons have also become the designated acute care surgeons for the hospital. This tremendously increased their operative volumes.

Also, while CT surgeons and other surgeons think they're "essentially CC trained", I promise you, they're not. Only people who've completed CC training and spend dedicated time practicing CC and staying up to date can appreciate that.

 

[Giovanotto]

Please keep us updated, OP. I'm an incoming OMS1, but already have similar aspirations. I'm hoping clinicals will help me decide.

 

[67552931811]

Please keep us updated, OP. I'm an incoming OMS1, but already have similar aspirations. I'm hoping clinicals will help me decide.

Are you going to nursing school?

 

[Giovanotto]

Are you going to nursing school?

Didn't you know?

 

[reverence]

Wow, OP. I'm just going to think out loud here for a moment... I feel like you are literally me right now at this moment, with the exact same reasoning behind your FM (procedure-heavy) vs. Surg inner debate. I'm at a very difficult crossroads as well, trying to choose between those two fields (as well as EM, maybe even OB/GYN?). I love procedures/OR as well and cannot see myself in a field without at least using my hands just as much as my mind.

Having said that, I really did not like IM/subspecialties—even the ones that are procedure-heavy—as an alternative that some other posters mentioned. (Nor do I have the scores/resume for the very competitive specialty surg or IR fields.) For me, I realized I loved the intellectual aspects of IM/subs and neuro/psych (i.e. infections, critical care, cards, GI, pulm, etc.) but disliked the tedious day-to-day job of actually being an IM/sub physician (and the fact that you never/rarely deal with kids/OB nor perform the type of invasive procedures I enjoyed on surgery and EM [but not IM-subs' procedures]).

I would rather be a procedure-heavy FM physician who enjoyed maintaining a high intellectual interest in things like infectious diseases that would also apply pragmatically to a practice than pigeonhole myself into a field such as cards, GI, or infx and throw much about everything else I knew from my brain. I realized this about me the moments I became infuriatingly annoyed at the IM sub-specialists consulting who, when the pt would veer away even for a second from his/her narrow field of medicine, he/she would immediately guide the pt back to the relevant complaint or give the robotic "oh that's nice...so..." type of feedback.

It does indeed seem like we share a lot of similar thoughts. I too have no interest in sub-specialties, at least not right now. Any yeah, I do think OB/GYN is a perfect middle ground for the two. I loved my OB/GYN rotation. Loved it. However, I know that I want to take care of sick people (men and women).

I do love being in the OR and would much rather be in the OR all day than the clinic. However, I do have pastoral gifts and interest that push me towards specialties in which I will have continued care of my patients, providing more than just medical/surgical care.

Anyhow, please feel free to PM me as you go through the decision process

 

[reverence]

You have to decide which you like more: clinic or surgery.

More family medicine docs would rather not spend all day in the OR. I do not know any surgeons who like clinic. Even the people I know in "clinic heavy" surgical specialties like ENT and urology do not really like clinic all that much.

The level of gratification can be high in either specialty, as long as it is the right one for you. The difference is more in the pace - surgeons like instant gratification, family practice are more contact with long-term relationships and gradual improvements.

Also, why look only at FM and general surgery? There are plenty of IM subspecialties that have long term relationships but also procedures (GI, interventional cardiology, etc). There are also surgical specialties with a fair amount of clinic (urology, ENT, ob/gyn, etc).

Thank you for your input.

My answer is OR. I really enjoy the OR and lose perception of time when I am in there. Can't say that about clinic days, unless they are super busy and you just have to go-go-go. On the other hand though, I love people and have a very pastoral personality, something I worry is better used in primary care or chronic care specialties.

I realize OB/GYN would be a great fit (continued care + decent OR time), however I know with certainty that I would like to take care of ill patients (men and women). My personality and natural gifts are well suited for care of the ill.

I have lightly explored many other specialties over 3rd year. I know I don't want to specialize in an organ system. Honestly at this point the only things besides family med or gen surg that have piqued my interest are Surgical Oncology (and who knows what that field will or won't be like in 10 years...) and Palliative Medicine.

Palliative medicine is a perfect fit for my natural pastoral gifts and interests, but not for my interest in anatomy/physiology/pathology...and the "doing" of surgery.

Mind of surgeon, heart of primary care doc.

Also of note, is that I am not a "competitive" candidate for specialty residencies, hardly competitive for many gen surg residencies. Any specialty will therefore be entered by way of gen-surg, FM, or IM.

Again, thanks for the input

 

[reverence]

Biggest deciding factor for me was 3rd year, and this will be the case for you as well. Deciding between FMED and SURG will be like night and day.

Even though surgery had long hours, it was the ONLY rotation that I was excited to attend every morning. When I left each day I was tired but when talking to friends/family they noticed a significant elevation in my mood compared to my IMED rotation (which left me dead inside).

My favorite day in primary care clinic was my last. Yes, there were some fun cases and cool patients, but I never left a day in clinic with the same gratification.

I appreciate what you say. However, I have finished 3rd year is it not night and day for me. I do realize for many people, especially people who know they want to be surgeons, it is night and day.

I don't identify with that though. I did not like how boring the medicine of primary clinic was, but I enjoyed the interpersonal aspects of clinic. I've got a bleeding heart.

 

[OnePunchBiopsy]

I appreciate what you say. However, I have finished 3rd year is it not night and day for me. I do realize for many people, especially people who know they want to be surgeons, it is night and day.

I don't identify with that though. I did not like how boring the medicine of primary clinic was, but I enjoyed the interpersonal aspects of clinic. I've got a bleeding heart.

Thanks for the extra info!

In the middle of my surgery rotation, one of my preceptor's colleagues asked me what I wanted to go into. I told him general surgery. His reply was "Anything else?" After about 2-3 minutes of thinking, I realized there was nothing else, so I told him "No." He replied with "Good, most students who want to go into surgery do not want to pursue any other field."
It was only after finishing gen surg and a few other rotations that I realized he was right.

If a student is torn between gen surg and something else, it is common for those students to be told to pursue the other field.

 

[zeppelinpage4]

Thank you for your input.

My answer is OR. I really enjoy the OR and lose perception of time when I am in there. Can't say that about clinic days, unless they are super busy and you just have to go-go-go. On the other hand though, I love people and have a very pastoral personality, something I worry is better used in primary care or chronic care specialties.

I realize OB/GYN would be a great fit (continued care + decent OR time), however I know with certainty that I would like to take care of ill patients (men and women). My personality and natural gifts are well suited for care of the ill.

I have lightly explored many other specialties over 3rd year. I know I don't want to specialize in an organ system. Honestly at this point the only things besides family med or gen surg that have piqued my interest are Surgical Oncology (and who knows what that field will or won't be like in 10 years...) and Palliative Medicine.

Palliative medicine is a perfect fit for my natural pastoral gifts and interests, but not for my interest in anatomy/physiology/pathology...and the "doing" of surgery.

Mind of surgeon, heart of primary care doc.

Also of note, is that I am not a "competitive" candidate for specialty residencies, hardly competitive for many gen surg residencies. Any specialty will therefore be entered by way of gen-surg, FM, or IM.

Again, thanks for the input

I had two mentors on my surgery rotation, one was a colorectal surgeon, the other a pediatric surgeon. Both had incredible bedside manner, loved by patients and I truly think it added to their surgical careers.
I realize surgery isn't know for having the continuity of care and long term relationship building that family Ned might have. But you can bring that heart and patient skill to surgery, and it will only make you stick out among other surgeons I believe.
Building strong patient relationships is valuable in surgery. You're going to cut into that person, so being able to build a string trust and relationship with your patient is a valuable skill.

Also, I realize this is a subspecialty. But you'd be helping ill patients in Gyn/onc. That also seemed to have a good balance between OR and clinic time from what I saw. Also, these are patients who are fighting cancer and thus being kind, caring and forming a strong relationship might be really valuable with this patient population.

And if all else fails, I say, do what you love most and bring your personality to that field.

 

[ProfMD]

Thank you for your input.

My answer is OR. I really enjoy the OR and lose perception of time when I am in there. Can't say that about clinic days, unless they are super busy and you just have to go-go-go. On the other hand though, I love people and have a very pastoral personality, something I worry is better used in primary care or chronic care specialties.

I realize OB/GYN would be a great fit (continued care + decent OR time), however I know with certainty that I would like to take care of ill patients (men and women). My personality and natural gifts are well suited for care of the ill.

I have lightly explored many other specialties over 3rd year. I know I don't want to specialize in an organ system. Honestly at this point the only things besides family med or gen surg that have piqued my interest are Surgical Oncology (and who knows what that field will or won't be like in 10 years...) and Palliative Medicine.

Palliative medicine is a perfect fit for my natural pastoral gifts and interests, but not for my interest in anatomy/physiology/pathology...and the "doing" of surgery.

Mind of surgeon, heart of primary care doc.

Also of note, is that I am not a "competitive" candidate for specialty residencies, hardly competitive for many gen surg residencies. Any specialty will therefore be entered by way of gen-surg, FM, or IM.

Again, thanks for the input

I second the gyn onc opinion. From what I have seen, the manage patients long term, definitely care for sick patients, operate a lot, and manage chemotherapy in addition to the surgery. May be a good fit for you.

I also agree with the sentiment that if you can see yourself doing anything else, do that instead of surgery. Over the years, I have seen people ignore this advice and end up burning out early.

 

[ACSurgeon]

Thank you for your input.

My answer is OR. I really enjoy the OR and lose perception of time when I am in there. Can't say that about clinic days, unless they are super busy and you just have to go-go-go. On the other hand though, I love people and have a very pastoral personality, something I worry is better used in primary care or chronic care specialties.

I realize OB/GYN would be a great fit (continued care + decent OR time), however I know with certainty that I would like to take care of ill patients (men and women). My personality and natural gifts are well suited for care of the ill.

I have lightly explored many other specialties over 3rd year. I know I don't want to specialize in an organ system. Honestly at this point the only things besides family med or gen surg that have piqued my interest are Surgical Oncology (and who knows what that field will or won't be like in 10 years...) and Palliative Medicine.

Palliative medicine is a perfect fit for my natural pastoral gifts and interests, but not for my interest in anatomy/physiology/pathology...and the "doing" of surgery.

Mind of surgeon, heart of primary care doc.

Also of note, is that I am not a "competitive" candidate for specialty residencies, hardly competitive for many gen surg residencies. Any specialty will therefore be entered by way of gen-surg, FM, or IM.

Again, thanks for the input

- you can do a surgical CC fellowship after OB/GYN. Not sure what your practice would look like but it's doable. You could then be an OB/GYN who also took care of sick men and women.

- regarding your bleeding heart: surgeons have a hard job. We put on a touch exterior. You'll deal with a lot of VERY difficult personalities ranging from passive aggressive to very aggressive. You have to be able to survive that to become a surgeon. However, I'd argue that surgeons I've worked with care a TON more about their patients than the medicine and primary care folks. My attendings bend over backwards to take care of the patient. They make others (nurses, schedulers, other specialties) also go the extra mile when they otherwise wouldn't have. If that isn't a bleeding heart, I'm no sure what is. I've seen many of my attendings give their cell phone numbers to patients and family members. Our attendings will direct admit patients who really don't need to be admitted by a surgeon, and who haven't had surgery in months to years. We own our patients like no one else will.

Now yea, we aren't the most touchy feely. Surgical oncologists will do the most hand holding, get to know your family etc etc, but that's because you're dying in the next months to short years and they have to connect with the family.

Trauma/CC has a lot of difficult family meetings where having a "bleeding heart is valuable".

Palliative care is a one yeR fellowship that I'm pretty sure you can do after completing just about any residency. You can probably do it after OB/GYN or surgery.

Finally, if you are truly considering a career in surgery you need to be sure that your bleeding heart won't cloud your judgment or disable you in difficult situations. Patients will have bad outcomes. Sometimes it's directly your fault. You have to be able to accept that and move on. Similarly, you have to make sure you won't "break" under the pressure of surgical culture (seniors and attendings). It's doable, but needs a little insight.

 

[VA Hopeful Dr]

I second the gyn onc opinion. From what I have seen, the manage patients long term, definitely care for sick patients, operate a lot, and manage chemotherapy in addition to the surgery. May be a good fit for you.

I also agree with the sentiment that if you can see yourself doing anything else, do that instead of surgery. Over the years, I have seen people ignore this advice and end up burning out early.

I would also add that OB/GYN sees some very sick patients, they just define it differently. Can you honestly tell me that an eclamptic patient or one with HELLP syndrome isn't sick? And very few surgical emergencies can rival abruptions for "speed in which we have to recognize and fix this ****".

 

[reverence]

I would also add that OB/GYN sees some very sick patients, they just define it differently. Can you honestly tell me that an eclamptic patient or one with HELLP syndrome isn't sick? And very few surgical emergencies can rival abruptions for "speed in which we have to recognize and fix this ****".

I am aware OB/GYN certainly see and take care of very sick patients. We certainly did on my OB/GYN rotation. However, as my attending told me, unless you do a subspecialty within OB/GYN, ~70% of your patients are dealing with physiology more so than pathology

 

[VA Hopeful Dr]

I am aware OB/GYN certainly see and take care of very sick patients. We certainly did on my OB/GYN rotation. However, as my attending told me, unless you do a subspecialty within OB/GYN, ~70% of your patients are dealing with physiology more so than pathology

Every specialty has routine. Even trauma surgeons and intensivists get bored at work. I'd love a surgeon to back me up, but I bet more than 70% of trauma patients are nonoperative - they sure were when I was a med student.

 

[hallowmann]

You can treat the ill and have a close relationship with your patients in any field (save maybe path and DR). That's not monopolized by primary care, it just happens to be a big part of it.

If you don't like clinic primary care doesn't seem like the right choice. Others have made good suggestions, but you have a lot of conditions that may conflict, so I'd try to prioritize them. Which 1 or 2 aspects of your career could you not live without? Go from there.

 

[dadaddadaBATMAN]

I am aware OB/GYN certainly see and take care of very sick patients. We certainly did on my OB/GYN rotation. However, as my attending told me, unless you do a subspecialty within OB/GYN, ~70% of your patients are dealing with physiology more so than pathology

I'm sorry, but the whole "seeing sick patients" thing really confuses me. You aren't ok with the acuity of ob/gyn, but somehow you're ok with the acuity of FM?

I think that each day I was on OB we had some level of surgical emergency, whether it was HELLP, shoulder dystocia, abruption, post-partum hemorrhage, PE, etc.

It was on the same level of acuity as my cardiothoracic surgery rotation in terms of day to day sickness. If that isn't enough somehow, you can do high-risk pregnancy fellowship and see exclusively sick as stink pregnant people (which means two super sick people in one).

Family medicine is a super important specialty, but I honestly can't think of a single heart-pounding moment from my entire rotation. I also don't think I've seen a single FM person tell me that seeing really sick people was part of what drew them there.

If you hate OB, that's understandable, and you should just say that instead.

 

[dr zaius]

Every specialty has routine. Even trauma surgeons and intensivists get bored at work. I'd love a surgeon to back me up, but I bet more than 70% of trauma patients are nonoperative - they sure were when I was a med student.

There's a paper that I read not too long ago with the exact statistic, but I'm too lazy to look it up. It is a huge amount, though. You're probably not far off. It's only going to get worse with improvement in endovascular/IR approaches.


Every specialty has its boring/annoying cases. It's all the other cases that should make or break your decision to choose a surgical field.

 

[cbrons]

Every specialty has routine. Even trauma surgeons and intensivists get bored at work.

@jdh71 never gets bored at work, which is why I want to be him when I grow up

 

[cbrons]

The VAST majority of surgeons who completed critical care training practice a combination of trauma/acute care

Are trauma surgeons really lifeguards at the shallowest end of the gene pool?
I have heard that quote from the surgery forums. Have also heard in general that trauma surgery is one of those things that seems really cool in theory but in practice is extremely annoying and un-gratifying 90% of the time.

 

[aalamruad]

Are trauma surgeons really lifeguards at the shallowest end of the gene pool?
I have heard that quote from the surgery forums. Have also heard in general that trauma surgery is one of those things that seems really cool in theory but in practice is extremely annoying and un-gratifying 90% of the time.

That's often the case for adult trauma surgery, but I think that issue can be largely avoided if you go into peds trauma surgery. Granted, there aren't too many programs out there since it's such a specific field, but the peds trauma surgeons I've worked with over the past year seem to feel that their work is extremely gratifying (and actually now that I think about it, most of them are just trauma surgeons without the peds fellowship, but still primarily see patients in the peds ED). Same theme goes for peds EM vs adult EM, you can basically trade off the drug addicts/criminals/etc for overly-worried parents if the former group bothers you. I'm still pre-med so I don't have a tremendous amount of exposure to these fields yet, but from what I've seen, I'd much rather go into a field where I can treat a kid who was hit by a car than a field where I'd be treating a drunk driver who caused his own medical problems.

 

[aalamruad]

Um no. Peds trauma has all the same sh*tty social issues, except you now just get mad at the dipwad parents for ruining the lives of an innocent kid.

Plus you get all the fun of dealing with non-accidental trauma thrown in.

No, the social issues aren't the same. There may be more social issues in peds, and you personally might not enjoy dealing with those issues at all, but the peds trauma surgeons I worked with much preferred working on kids - even in the terrible cases of abuse/negligence - to working on drunk and high adults who did the damage to themselves, and were likely to do it again at some point in the near future. Even if you hate dealing with *****ic parents, at least your patients in peds trauma aren't at the "shallow end of the gene pool."

 

[ProfMD]

No, the social issues aren't the same. There may be more social issues in peds, and you personally might not enjoy dealing with those issues at all, but the peds trauma surgeons I worked with much preferred working on kids - even in the terrible cases of abuse/negligence - to working on drunk and high adults who did the damage to themselves, and we're likely to do it again at some point in the near future. Even if you hate dealing with *****ic parents, at least your patients in peds trauma aren't at the "shallow end of the gene pool."

You're right - they are not the same social issues, but there are still social issues that not everyone wants to deal with. Typically, people taking care of adults do not want to deal with kids and people taking care of kids don't want to deal with adults. I would be worried if the peds surgeons you worked with preferred caring for adults.

Child abuse is a major issue that not everyone handles well emotionally or wants to deal with. And all those drunk and high adults who injur themselves - they injur their kids too.

 

[DreamerCNM]

How about OB/GYN? You get lots of GYN/ primary care in a clinic setting and you can perform surgery. Win- win.


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