Gen Surgery vs Peds + ER fellowship

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Pookie9000

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Sorry for the long post, there's so many factors! I'm a 3rd year medical student getting ready to submit applications for interview rotations in peds and/or surgery. So far here is what I have:

1)Peds+ Fellowship in ER/NICU/Cardiology

They are a group patients that intrinsically need help and what you do can directly can help their future. I find myself truly invested in their well being. Also I love working in the hospital. What concerns me is that ER/NICU/Cardiology won't be procedural enough to get me through. Peds ER has the very occasional lac that needs stitches, that's sad. Attendings have told me I have a great personality and work ethic for ER, but for some reason when I tell people I want to do peds they just say oh. I'm energized by kids and they respond great to me but outside of that I am focused and motivated to finish the work that needs to be done, so maybe I come off too serious in the work setting?

2) General surgery (So I can still have the occasional teenager).

Because I am so drawn to the pediatric population, I find that at times I lose sympathy for adults, especially in instances where they have directly caused the outcomes for which they need the surgical procedure. Smoker -> lung cancer, you get the idea. However, when they are draped and it becomes anatomy and procedurally driven, that's what excites me. Surgery with a pediatric fellowship would be the dream however realistically I know that as a DO candidate I would be climbing an even steeper cliff. Also does an intermittent lack of sympathy make a bad candidate for general surgical residency? Through conversations, attendings from several different rotations have told me that I have the mind set of pursuing a surgical residency and more than once suggested I look into general surgery. They also commented on my ability in the OR, I guess 15 years of playing the violin gave me great dexterity.

I'm a female that went into medical school right after college, so I'm willing to dedicate 5 years to an intense residency so that's not a factor. I'm trying to decide if fact that I may almost never work exclusively with kids again, is the ultimate deal breaker. Or if never being in an OR again is the ultimate deal breaker. As with all the millennials of my generation, I'm also interested in having an ok lifestyle as an attending. Peds+ER, great hours. I know that certain general surgery jobs in a bigger group to share call, and maybe day surgery can have a predictable Mon-Friday lifestyle. Also I think there's enough Peds EDs in Massachusetts and general surgery job openings that it wouldn't been too difficult finding a position either way am I correct?

I feel the same level of passion doing procures as I do working with kids. Any advice? Have I missed other factors to consider? Thanks in advance! :)

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It's 4am. You've been up for 23 hours and you ate a bag of popcorn for dinner in the OR lounge. An 88 year old lady with colon cancer comes to the emergency room with a belly the size of a watermelon and a colon about to burst from obstruction. You know she needs to go to the OR, and that it could be a multiple hour operation that will keep you awake well past when the night shift residents of other specialties have gone home.

Are you excited?

The OR and "doing procedures" are two very different ballgames, and I worry that medical students don't get enough exposure to figure that out until they've already matched. Surgery is not a process that can be done with in 15 minutes - surgery requires so much more pre-operative planning, wait time, fixing mistakes and post-op followup than fixing a laceration.

I suggest you do some elective rotations in non-pediatric surgery, and see if you're still just as interested. And try some non-surgical pediatric rotations to see if they float your boat. NICU/PICU, for example - procedure opportunities, but again, they are not the OR.
 
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I agree I wish we had more time to make a decision (we were only allowed one elective third year, which I used to rotate through anesthesia), I will have to squeeze in electives at the beginning of 4th year before residency applications are due. Thank you!
 
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It's 4am. You've been up for 23 hours and you ate a bag of popcorn for dinner in the OR lounge. An 88 year old lady with colon cancer comes to the emergency room with a belly the size of a watermelon and a colon about to burst from obstruction. You know she needs to go to the OR, and that it could be a multiple hour operation that will keep you awake well past when the night shift residents of other specialties have gone home.

Are you excited?

Meh. I've had that scenario multiple times and I would definitely not say I'm "excited" when it comes in.

More pertinent to the OP's questions...imagine this scenario: life as a general surgeon, working with adults. For the rest of your career.

Because the odds are overwhelming that that's what you'll be doing if you enter a general surgery residency.

There are less than 50 pediatric surgery fellowship slots in the country, with rumors that those numbers may drop even further down in the upcoming years due to concern for saturation in the field.

The match rate is <50% (44 slots/97 applicants last year http://www.nrmp.org/wp-content/uploads/2016/12/2016-Pediatric-Surgery-Match-Results-Statistics.pdf).

You're looking at a seven year residency, not a five, because you will need research time.

You're a DO. The odds are even worse in your case. Only two DOs applied last year; only one certified a list (i.e. got interviews). That one went unmatched. Those 44 matched applicants are heavily skewed towards residents from the top academic programs and community program or lower-tier residents often fail to match despite spending two plus years doing research with leaders in the field.
 
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Ok ok, this is the mindset of a PGY2 who still gets excited when an open case walks in and I get to take it!

Also pertinent is the fact that I'm not just taking her to the OR. I'm rounding on her daily until her ostomy starts working and she can ambulate again. I'm tweaking her pain regimen and receiving calls about her blood pressure and urine output. I'm seeing her in the office weeks and months down the line. I'm admitting her again from the ED when she comes back with a small bowel obstruction. This is a very different mentality from that of an ED physician, pediatric or otherwise. Surgery doesn't stop after they leave the OR.
 
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I admire the aspect of owning your own work and following through. Planning pre op, executing, and following through post op on the work that you will do/have done with the patient.
Also I've accepted that DOs in ped surg is about impossible so I'm ok with that fact.
 
Do surgery.


If you felt a sense of pride and excitement, then there's your answer.

If you had other emotions... correlate clinically
 
Do EM -> Pedi EM fellowship. You save a year vs. the other way round, and you'll have 3 years to intubate, suture, reduce, and centrally access adults til you get bored of that and then you get to play with cute kids for the rest of your career and occasionally resus a sicko and put in lots of nursemaids which are a blast.
 
1)Peds+ Fellowship in ER/NICU/Cardiology

They are a group patients that intrinsically need help and what you do can directly can help their future. I find myself truly invested in their well being.

You need to go into pediatrics. Doubtful you will satisfied dealing with the adult/ elderly population for your career. The excitement of the OR gets old very quickly, you will need something more. Best of luck.
 
You need to go into pediatrics. Doubtful you will satisfied dealing with the adult/ elderly population for your career. The excitement of the OR gets old very quickly, you will need something more. Best of luck.
You need to go into surgery. Doubtful you will satisfied dealing with the pediatric/parents population for your career. The excitement of pediatrics gets old very quickly, you will need something more. Best of luck.

In all seriousness, I agree with doc05... and myself - just depends on what you are really passionate about. I lost my passion and forgot why I loved surgery during my intern year, only to re-discover my love of the field as a PGY2 when I was in the OR or doing consults. Intern year was a window into how I'd likely enjoy a career in a non-procedural specialty (although being a hospitalist obviously isn't as bad as being a surgery intern).

In med school, I loved my peds rotation and learned a lot but I didn't find myself itching to get back to treating kids when on other services. In retrospect, I was incredibly bored/antasy/unhappy when on my family medicine and psych rotations and wound up getting heavily involved in surgery research to "scratch the itch."

So ask yourself: when you are on your Geriatric Psychiatry rotation and bored to tears what do you find yourself wishing you were doing?
 
Meh. I've had that scenario multiple times and I would definitely not say I'm "excited" when it comes in.

More pertinent to the OP's questions...imagine this scenario: life as a general surgeon, working with adults. For the rest of your career.

Because the odds are overwhelming that that's what you'll be doing if you enter a general surgery residency.

There are less than 50 pediatric surgery fellowship slots in the country, with rumors that those numbers may drop even further down in the upcoming years due to concern for saturation in the field.

The match rate is <50% (44 slots/97 applicants last year http://www.nrmp.org/wp-content/uploads/2016/12/2016-Pediatric-Surgery-Match-Results-Statistics.pdf).

You're looking at a seven year residency, not a five, because you will need research time.

You're a DO. The odds are even worse in your case. Only two DOs applied last year; only one certified a list (i.e. got interviews). That one went unmatched. Those 44 matched applicants are heavily skewed towards residents from the top academic programs and community program or lower-tier residents often fail to match despite spending two plus years doing research with leaders in the field.

Plenty of good programs are five years still. This removes surg Onc and Peds and maybe colorectal out of the mix, but research is far from mandatory to be a surgeon
 
Ok ok, this is the mindset of a PGY2 who still gets excited when an open case walks in and I get to take it!

Also pertinent is the fact that I'm not just taking her to the OR. I'm rounding on her daily until her ostomy starts working and she can ambulate again. I'm tweaking her pain regimen and receiving calls about her blood pressure and urine output. I'm seeing her in the office weeks and months down the line. I'm admitting her again from the ED when she comes back with a small bowel obstruction. This is a very different mentality from that of an ED physician, pediatric or otherwise. Surgery doesn't stop after they leave the OR.

Be real, bae. She's going to the SICU on pressors after that Hartmann's. They'll take care of it for you :D
 
Of course. I meant in the context of the OPs desire for peds surg

A
Meh. I've had that scenario multiple times and I would definitely not say I'm "excited" when it comes in.

More pertinent to the OP's questions...imagine this scenario: life as a general surgeon, working with adults. For the rest of your career.

Because the odds are overwhelming that that's what you'll be doing if you enter a general surgery residency.

There are less than 50 pediatric surgery fellowship slots in the country, with rumors that those numbers may drop even further down in the upcoming years due to concern for saturation in the field.

The match rate is <50% (44 slots/97 applicants last year http://www.nrmp.org/wp-content/uploads/2016/12/2016-Pediatric-Surgery-Match-Results-Statistics.pdf).

You're looking at a seven year residency, not a five, because you will need research time.

You're a DO. The odds are even worse in your case. Only two DOs applied last year; only one certified a list (i.e. got interviews). That one went unmatched. Those 44 matched applicants are heavily skewed towards residents from the top academic programs and community program or lower-tier residents often fail to match despite spending two plus years doing research with leaders in the field.

I've never really understood the desire to do peds surgery. Honestly, I've helped close clefts, reconstruct missing thumbs, patch up spine hardware wounds, close myelomeningoceoles, do strip craniectomies and vault remodelling and all sorts of craziness that happens to kids as a jr plastics resident. Why train for 10 years to do single port appies and heller myotomies.. seems so boring.
 
A


I've never really understood the desire to do peds surgery. Honestly, I've helped close clefts, reconstruct missing thumbs, patch up spine hardware wounds, close myelomeningoceoles, do strip craniectomies and vault remodelling and all sorts of craziness that happens to kids as a jr plastics resident. Why train for 10 years to do single port appies and heller myotomies.. seems so boring.

I've seen them do vats tef repairs, hepatoblastoma excisions with removal of mets, colonic resections from nec in my month with them. They're still a "general" surgeon. Not bad imo.
 
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I've seen them do vats tef repairs, hepatoblastoma excisions with removal of mets, colonic resections from nec in my month with them. They're still a "general" surgeon. Not bad imo.

Aye, except for the tefs and cloaca/butthole atresias, and nec, it's mostly once a year for these oddities. I also don't understand why they treat those kids like they'll fall apart upon being touched. I'm watching chief residents watch fellows watch attendings watch other attendings close skin... idiotic.
 
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I've seen them do vats tef repairs, hepatoblastoma excisions with removal of mets, colonic resections from nec in my month with them. They're still a "general" surgeon. Not bad imo.

Absolutely. Also the CDH kids, pectus and a growing body of evidence supporting early initiation of ECMO for respiratory failure - all done by our peds surg team, who is (save for one guy) an awesome group to work with.
 
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Aye, except for the tefs and cloaca/butthole atresias, and nec, it's mostly once a year for these oddities. I also don't understand why they treat those kids like they'll fall apart upon being touched. I'm watching chief residents watch fellows watch attendings watch other attendings close skin... idiotic.


this
 
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You are definitely a pediatrician.

I have a ped cardiologist and a pediatrician in my family. I'm an urologist.

You hold joy of working with children. This will bring you a better life in ped vs gen surgery. Considering you are talented in emergency, an EM-ped seems suitable. GS will bring you to a hierarchy that will make you miserable. Oncologic surgery which comprises a significant case load in GS will also make you question the outcomes of your efforts. Patients who had ignored the early treatment oportunity and come back to hospital in complicated positions will also burn your desire in GS. A very strong thing that you love children, not adults.

For procedure, much thing said before on the thread are very correct and clear. Elective surgery is different than EM procedures.

For ped surgery, @caffeinemia had a good point. It gets a unreasonably long and tiring way to stand on your feet. I don't know the situation in the US, but in my country Ped Surg attendings (who could find a place in tertiary centers) are dreaming to undertake a fundoplication before the chief comes. For rural, it's circumcision and app.

Take Ped, or EM-Ped. Every woman who love to work with children and get into ped (or subs) are happy and very helpful to her patients.
 
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