Gen Surgery or IR?

[Cheyf]

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Hey all,

I'm coming to the end of my 3rd year of med school at a mid tier school in the south. I'm looking to match in the Midwest with my wife who is interested in optho.

My main problem right now is not being sure whether or not I want to pursue gen surg or DR/IR. I really like being in the OR, having a little bit of clinic, and seeing patients in the hospital. The thing is that I really like having a life outside of work and I really want to have a family. I really want to see my wife and kids most days, take them to do fun things, teach them life lessons, make sure they don't grow up to be terrible people. I want to be home for some holidays, take vacations with them, have dinner with my family most days.

Any advice? I'm open to hearing everything. Maybe I won't even go into either of these fields and do something else. Thanks all 🙂

 

[Pinkertinkle]

Hmm maybe you should do ophtho too, jk. Anyway I think once you're an attending you have a lot of choices regarding lifestyle and don't necessarily have to live the general surgery resident lifestyle forever. Couples matching two competitive specialties can be very difficult.

 

[doc05]

do not do general surgery

 

[kenjixshadow]

How competitive are you and your wife? I don't want to be a downer, but you or your wife should read this thread http://forums.studentdoctor.net/threads/didnt-match-im-horrified.1116127/
Couple matching for either gen surgery/optho or IR/optho are tough. Btw, I think that you're leaning toward IR more from your post.

 

[Derv]

Are you ok with going through 3 years of radiology to get to your IR years? Either way, these are both pretty demanding fields. General Surg will definitely be the more demanding residency, but DR/IR will be longer, and for the last 2 years you will be taking a lot of call. Once you get out, you really could find a job in either field (or many others) that would fit your lifestyle interests. You might need to sacrifice money and prestige, but its possible to live a good life doing anything if thats your priority.

 

[Cheyf]

How competitive are you and your wife? I don't want to be a downer, but you or your wife should read this thread http://forums.studentdoctor.net/threads/didnt-match-im-horrified.1116127/
Couple matching for either gen surgery/optho or IR/optho are tough. Btw, I think that you're leaning toward IR more from your post.

I am around average for rads and gen surg and she is around average (241 on step) for optho. Yeah, I love most everything about gen surg but I hate the hours.

 

[ACSurgeon]

I am around average for rads and gen surg and she is around average (241 on step) for optho. Yeah, I love most everything about gen surg but I hate the hours.

General surgery is not a lifestyle specialty. However, it doesn't have to preclude you from having a nice family life. If you end up at an academic hospital, your call could be very light. If you join a group of 6 surgeons, you're on call one in seven (days/weekends/ holidays). You'll certainly have plenty of time for your family but not as much as a radiologist. You'll be a lot cooler though.

 

[hello lady!]

You can't couples match with someone in ophthalmology - ophtho does their own match (sfmatch). She will match before you even submit a rank list.

Have you done rotations in both specialties yet? Surgery is done during third year, but have you had a chance to do some IR? Or are you thinking about it just because it's procedural based?

 

[dienekes88]

General surgery is fun. There are a lot of lifestyle friendly options afterwards (endocrine, MIS, general surgery, breast, etc.). I don't know what the fuss is all about. I enjoyed whacking out gallbladders. Also, hernias are one of the few operations (outside of vascular and cardiac) in which there is any sewing involved.

IR is ok. After a couple hundred times, getting access is just not that exciting. The good endovascular stuff is TEVAR, EVAR, structural heart, transcatheter valves... Just remember, as an interventional radiologist you'll also have to do a lot of abscess drains, lymphangiograms, etc.

 

[Ischemia1032]

I am going to say quickly, radiology while you can certainly make it a lifestyle, is not as much of a lifestyle as it used to be in it's golden era. I know some radiologists who work 9-5, I also know radiologists who work 6-8 every day of the week, and at least 6 hours on the weekends. Radiology is weird, because workload actually increases a ton as an attending, it gets more difficult because there is less leeway to make a mistake obviously, also private practice works more than academics, also private practice, even as a general radiologist, you can be responsible for NR, MSK and such even if you are not fellowship trained, radiology also has some of the most diverse knowledge and most studying in my experience. General surgery is also very difficult of course like any surgical specialty, however I figured I would share my side.

 

[GadRads]

Radiology is not easy.

 

[gwooooooooooooooooooood]

Trying to answer this question as someone going into radiology, the best way to answer may be to do rotations in gen surg and IR. Both have difficult lifestyles (not that diagnostic rads is a cakewalk anymore either) but they both have very different surgeries they do.

Also, meet with someone in both departments, and see what they think. Attendings can tell you what their lifestyles are like (and don't be fooled by diagnostic radiology residents, they actually have great lifestyles compared to practicing radiologists).

 

[badasshairday]

Well IR is not really a lifestyle field at all. Even diagnostic radiology is middle of the road in terms of lifestyle.

Is the lifestyle better in DR than CT surgery, neurosurgery, vascular surgery, and cardiology? Yes.

Is the lifestyle better in DR than rad/onc, PM and R, optho, endocrine, ER, nephro, rheum, pain, and psychiatry? No.

DR lifestyle these days is not what it use to be. Practices are taking back the night, in the past night hawks were in place. These still exist, but with changing payment structures many groups are taking there own in house call. So you can imagine being a 40 year old attending with a wife and kids doing overnight call from 10 PM to 7AM? Also radiology call is non-stop, you will not sleep. If you are at a group with a night-hawk you still will likely be covering weekends and holidays since radiology is a 24/7 department. Also general day time work hours are longer and volumes are increasing.

Interventional Radiology lifestyle is more similar to general surgery in terms of hours, and in many cases worse. You will carry a pager and be woken up at 2 AM to embolize a GI bleed or do an angiogram on that cold foot that vascular surgery and cardiology don't want to touch. Days can be long with lots of add on cases, especially dumped on at the end of the day or Friday late afternoon, ie. urgent percutaneous nephrostomy by the urology folks, or G-tube by GI guys who want to get out of town at 5 pm on Friday. IR lifestyle is still better than neurosurgery, CT surg, vascular surgery, and interventional cardiology in general.

 

[badasshairday]

(and don't be fooled by diagnostic radiology residents, they actually have great lifestyles compared to practicing radiologists).

Quoted for truth.

 

[GadRads]

Days can be long with lots of add on cases, especially dumped on at the end of the day or Friday late afternoon, ie. urgent percutaneous nephrostomy by the urology folks, or G-tube by GI guys who want to get out of town at 5 pm on Friday. IR lifestyle is still better than neurosurgery, CT surg, vascular surgery, and interventional cardiology in general.

This made me lol a bit.

 

[gwooooooooooooooooooood]

Well IR is not really a lifestyle field at all. Even diagnostic radiology is middle of the road in terms of lifestyle.

Is the lifestyle better in DR than CT surgery, neurosurgery, vascular surgery, and cardiology? Yes.

Is the lifestyle better in DR than Derm, PM and R, optho, endocrine, ER, nephro, rheum, pain, and psychiatry? No.

DR lifestyle these days is not what it use to be. Practices are taking back the night, in the past night hawks were in place. These still exist, but with changing payment structures many groups are taking there own in house call. So you can imagine being a 40 year old attending with a wife and kids doing overnight call from 10 PM to 7AM? Also radiology call is non-stop, you will not sleep. If you are at a group with a night-hawk you still will likely be covering weekends and holidays since radiology is a 24/7 department. Also general day time work hours are longer and volumes are increasing.

Interventional Radiology lifestyle is more similar to general surgery in terms of hours, and in many cases worse. You will carry a pager and be woken up at 2 AM to embolize a GI bleed or do an angiogram on that cold foot that vascular surgery and cardiology don't want to touch. Days can be long with lots of add on cases, especially dumped on at the end of the day or Friday late afternoon, ie. urgent percutaneous nephrostomy by the urology folks, or G-tube by GI guys who want to get out of town at 5 pm on Friday. IR lifestyle is still better than neurosurgery, CT surg, vascular surgery, and interventional cardiology in general.

The other question that has really yet to be answered is IR lifestyle in private practice moving forward. Right now, IR is purely IR if you work at an academic program, but in private practice, IR attendings are still expected to do DR reading. But with the new residency and changes in the field (IR has so many new specialized procedures), it remains to be seen how that lifestyle changes. IR attendings now switch toward more DR as they age, but that may not be an option moving forward.

 

[badasshairday]

The other question that has really yet to be answered is IR lifestyle in private practice moving forward. Right now, IR is purely IR if you work at an academic program, but in private practice, IR attendings are still expected to do DR reading. But with the new residency and changes in the field (IR has so many new specialized procedures), it remains to be seen how that lifestyle changes. IR attendings now switch toward more DR as they age, but that may not be an option moving forward.

Definitely. Future is uncertain with the new IR residency stuff. I feel that being about to switch back into diagnostic radiology is one of the best advantages interventional rads has over other procedural/surgical fields. In many other fields there is not much to fall back on if you get out of doing procedures. IR can be a taxing career depending on your practice setting and burn out is not uncommon, hence the relatively better job market of IR compared with the rest of radiology.... there is more turn over.

 

[gwooooooooooooooooooood]

Definitely. Future is uncertain with the new IR residency stuff. I feel that being about to switch back into diagnostic radiology is one of the best advantages interventional rads has over other procedural/surgical fields. In many other fields there is not much to fall back on if you get out of doing procedures. IR can be a taxing career depending on your practice setting and burn out is not uncommon, hence the relatively better job market of IR compared with the rest of radiology.... there is more turn over.

Exactly. To me the benefit of a DR residency is the option to do IR via ESIR or a 2yr fellowship. Whereas with the new IR residency, I'm not sure if you can switch back to a DR path via fellowship or within the program.