General Surgery advice

[angeleyez]

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I am a currently nearing the end of my third year and I am very torn in picking a speciality. Based on all my rotations so far I know I have to pick something that had OR surgical time ( not anesthesia). I got very bored on internal medicine with endless rounding, did not like peds, or psych. family med was awesome for the hours but I see myself getting bored with the routine & mundane complaints. I really enjoyed surgery however, I am very concerned like most people contemplating a general surgery route about personal time and burnout especially because I am female . I have no big interest in academic surgery and will probably specialize if I make it through a general surgery residency. I know residency is hard universally but more so for surgery, does it improve after residency? A couple of people have told me to consider urology but I have not really had exposure to it plus its uber competitive not sure if am competitive enough or should waste my time pursuing it. OB/GYN was my other option although i did not like it as much as surgery it was ok. I have a few sub-i's scheduled in both surg and obg/gyn to see if they might help make my choice easier. I have also heard that if at any point you question your interest in surgery it is not for you is this true? I don't mind working hard but I value my personal time with friends and family as do most people, am really torn.

I am hoping current residents or attendings can give me some advice on how bad or manageable the lifestyle is transitioning from medical student to surgical resident to attending

 

[Winged Scapula]

I have no big interest in academic surgery and will probably specialize if I make it through a general surgery residency. I know residency is hard universally but more so for surgery, does it improve after residency?

It can, depending on your choice of specialty and work environment. There are surgical jobs which are shift work, and there are those in which the hours are very long with frequent call. Currently private practice is an option as is being a hospital or HMO employee. Some subspecialties have a good lifestyle and others do not.

I have also heard that if at any point you question your interest in surgery it is not for you is this true? I don't mind working hard but I value my personal time with friends and family as do most people, am really torn.

I believe you misheard or misunderstood. The quote is, "if you can see yourself doing something else besides surgery, you should do so." Many people question their commitment. That is normal.

Moving to Allopathic forum.

 

[evilbooyaa]

You could ask WS about the life of a breast surgeon. Based on what I've seen, there aren't an awful lot of breast surgical emergencies, meaning call is likely less of an issue than general (gallbladders and appendectomies) or trauma/critical care (trauma, old people falling)

It's hard to recommend something based on a short internet post. However, the number of female surgeons is on the up and up, and what you decide to do after your residency (in terms of lifestyle) is generally up to you, as long as you are willing to sacrifice some bucks.

However, Ob/Gyn can also be a surgical field, especially something like GynOnc. Or just C-sections/delivering babies.

I know none of this is a good answer, and a surgery residency is definitely a major time sink for 5+ years, but you get to choose the hours a little better once you're an attending.

 

[ArcGurren]

I am a currently nearing the end of my third year and I am very torn in picking a speciality. Based on all my rotations so far I know I have to pick something that had OR surgical time ( not anesthesia). I got very bored on internal medicine with endless rounding, did not like peds, or psych. family med was awesome for the hours but I see myself getting bored with the routine & mundane complaints. I really enjoyed surgery however, I am very concerned like most people contemplating a general surgery route about personal time and burnout especially because I am female . I have no big interest in academic surgery and will probably specialize if I make it through a general surgery residency. I know residency is hard universally but more so for surgery, does it improve after residency? A couple of people have told me to consider urology but I have not really had exposure to it plus its uber competitive not sure if am competitive enough or should waste my time pursuing it. OB/GYN was my other option although i did not like it as much as surgery it was ok. I have a few sub-i's scheduled in both surg and obg/gyn to see if they might help make my choice easier. I have also heard that if at any point you question your interest in surgery it is not for you is this true? I don't mind working hard but I value my personal time with friends and family as do most people, am really torn.

I am hoping current residents or attendings can give me some advice on how bad or manageable the lifestyle is transitioning from medical student to surgical resident to attending

I get a little tired of the constant complaint about the rounding on medicine. Private practice/hospitalist medicine does not involve rounding in the manner that you see on your rotations - for the most part, you go and see your patients, admit them, write orders for treatment, do any procedures needed if you have to, etc and follow them throughout the day on your shift - then sign out to the person who's on the next shift. On top of that medicine has a wealth of different subspecialties with their own special focus, many of which are highly procedural (cardiology, GI, pulmonary/critical care, etc).

Much as medicine involves many of the same chief complaints on a regular basis, so does every other specialty. In most surgical specialties you end up doing the same few procedures every day on end for years and years (vascular surgeons largely do CEAs, AAA repairs, endovascular surgeries, etc; general surgeons do primarily choles, appys, and hernias, etc). If you are okay with doing that with the rest of your life, by all means go into surgery; similarly for OB/Gyn, if you want to do D&Cs, TAH/BSOs, etc every day with clinic/deliveries in between, go into OB.

Pick specialties based on what you would rather do for the rest of your life as opposed to worrying about the perception of it being "difficult" or the way it's practiced in academics.

 

[ArcGurren]

You could ask WS about the life of a breast surgeon. Based on what I've seen, there aren't an awful lot of breast surgical emergencies, meaning call is likely less of an issue than general (gallbladders and appendectomies) or trauma/critical care (trauma, old people falling)

Breast surgery was actually one of my favorite surgical subspecialties - had I been more interested in general surgery, I would likely have tried to do that as a subspecialty.

However, most of the breast surgeons I know do take call as general surgeons because they have the training to do simpler operations like appendectomies, cholecystectomies, hernias, etc - consequence of being parts of the groups they join. I don't know if this is the norm though; WS can shed more light on that.

 

[xrevision]

Breast surgery was actually one of my favorite surgical subspecialties - had I been more interested in general surgery, I would likely have tried to do that as a subspecialty.

However, most of the breast surgeons I know do take call as general surgeons because they have the training to do simpler operations like appendectomies, cholecystectomies, hernias, etc - consequence of being parts of the groups they join. I don't know if this is the norm though; WS can shed more light on that.

QFT. The breast surgeons at my institution take general call and come in for emergencies still, not just breast emergencies.

 

[Winged Scapula]

You could ask WS about the life of a breast surgeon. Based on what I've seen, there aren't an awful lot of breast surgical emergencies, meaning call is likely less of an issue than general (gallbladders and appendectomies) or trauma/critical care (trauma, old people falling)

It is true that there are few breast emergencies; however, there are some issues with a breast surgery practice that aren't often thought of:

1) any oncologic heavy practice means that you can have long hours at times; when a referring physician calls and asks me to see a patient of his with a new diagnosis of breast cancer, I can't very well give her my next available slot in 2 weeks. That means I'm adding her on to my schedule at 0700 or 1800, to fit her in.

2) breast patients are high maintenance; as one of my general surgeon friends likes to say, "I'd rather have 1000 male hernia patients than 1 breast patient". They will call for things that most other patients would simply leave until their next appointment; the anxiety is high and many of them need a lot of handholding, which is why the field is unattractive to many general surgeons. So I may not go into the hospital after hours very often, the calls can be a nuisance sometimes.

It's hard to recommend something based on a short internet post. However, the number of female surgeons is on the up and up, and what you decide to do after your residency (in terms of lifestyle) is generally up to you, as long as you are willing to sacrifice some bucks.

That depends on what you deem as "lifestyle"; you don't always have to sacrifice money (unless you are working part time). I enjoy a much nicer lifestyle than a general surgeon but I make more than the average general surgeon in the US.

Breast surgery was actually one of my favorite surgical subspecialties - had I been more interested in general surgery, I would likely have tried to do that as a subspecialty.

However, most of the breast surgeons I know do take call as general surgeons because they have the training to do simpler operations like appendectomies, cholecystectomies, hernias, etc - consequence of being parts of the groups they join. I don't know if this is the norm though; WS can shed more light on that.

That is pretty uncommon, at least for fellowship trained breast surgeons.

If by "breast surgeons" you know, you are referring to general surgeons without fellowship training who call themselves breast surgeons because they do a fair bit of breast, then yes - they do tend to do general surgery because they cannot demand a 100% breast surgery position. It can also be more common in academic practices where they might take GS call, or Surg Onc (I had to take the latter while in fellowship).

I am unaware of more than a very small percentage of fellowship trained breast surgeons who do general surgery. I am personally only acquainted with 2 - one, a male, who still wanted to do some general surgery, and another, female, who was limited in her job search because of her husband's employment, and so had to take the only job available to her in their community. As the former liaison for the American Society of Breast Surgeons, and a member of the SSO Education Committee, I can state that we support our member's desire to forge whatever career path they desire, but data from ASBS members show that the majority do only breast, with the second highest number claiming their practice is 75% breast.

 

[evilbooyaa]

It is true that there are few breast emergencies; however, there are some issues with a breast surgery practice that are often thought of:

1) any oncologic heavy practice means that you can have long hours at times; when a referring physician calls and asks me to see a patient of his with a new diagnosis of breast cancer, I can't very well give her my next available slot in 2 weeks. That means I'm adding her on to my schedule at 0700 or 1800, to fit her in.

2) breast patients are high maintenance; as one of my general surgeon friends likes to say, "I'd rather have 1000 male hernia patients than 1 breast patient". They will call for things that most other patients would simply leave until their next appointment; the anxiety is high and many of them need a lot of handholding, which is why the field is unattractive to many general surgeons. So I may not go into the hospital after hours very often, the calls can be a nuisance sometimes.

Fair points. It is understandable, as the difference between getting a hernia fixed (and knowing that generally the worst that can happen is that it comes back) vs getting a breast tumor removed (and knowing that the worst that can happen is finding mets years down the line anyways). I'm interested in treating cancer from the non-surgical side, and can appreciate that there will be an awful lot of reassurance in my job description. As for the point about long hours at times, makes sense. It's still not call in the general sense however. Everything is still scheduled so you don't have to a surgery at 2AM.

That depends on what you deem as "lifestyle"; you don't always have to sacrifice money (unless you are working part time). I enjoy a much nicer lifestyle than a general surgeon but I make more than the average general surgeon in the US.

I meant more within a field (as in comparing general surgeons to each other) not between general surgery and something that requires a fellowship.


As for the bit about breast surgeons taking call; none of the ones at the hospital I'm rotating at take general call.

 

[Law2Doc]

I get a little tired of the constant complaint about the rounding on medicine. Private practice/hospitalist medicine does not involve rounding in the manner that you see on your rotations - for the most part, you go and see your patients, admit them, write orders for treatment, do any procedures needed if you have to, etc and follow them throughout the day on your shift - then sign out to the person who's on the next shift. On top of that medicine has a wealth of different subspecialties with their own special focus, many of which are highly procedural (cardiology, GI, pulmonary/critical care, etc).

Much as medicine involves many of the same chief complaints on a regular basis, so does every other specialty. In most surgical specialties you end up doing the same few procedures every day on end for years and years (vascular surgeons largely do CEAs, AAA repairs, endovascular surgeries, etc; general surgeons do primarily choles, appys, and hernias, etc). If you are okay with doing that with the rest of your life, by all means go into surgery; similarly for OB/Gyn, if you want to do D&Cs, TAH/BSOs, etc every day with clinic/deliveries in between, go into OB.

Pick specialties based on what you would rather do for the rest of your life as opposed to worrying about the perception of it being "difficult" or the way it's practiced in academics.

I actually think deciding you "dislike rounding" is pretty telling, not because rounding is the same drawn out process everywhere that you see in some academic centers, (although it certainly can be) but because it tells you where the focus is. In internal medicine, for instance the rounding is the focus -- you see the patient, come up with a plan, and the rest is drawn from that point. In surgery being in the OR is the focus, and the rounding, post-op care, etc are the parts that are more algorithmic and in routine cases you will rush through. So I think deciding you hate rounding is really a proxy for saying where you want the focus of your day to be, and less about the format of rounding itself.

 

[ophthope]

I am a currently nearing the end of my third year and I am very torn in picking a speciality. Based on all my rotations so far I know I have to pick something that had OR surgical time ( not anesthesia). I got very bored on internal medicine with endless rounding, did not like peds, or psych. family med was awesome for the hours but I see myself getting bored with the routine & mundane complaints. I really enjoyed surgery however, I am very concerned like most people contemplating a general surgery route about personal time and burnout especially because I am female . I have no big interest in academic surgery and will probably specialize if I make it through a general surgery residency. I know residency is hard universally but more so for surgery, does it improve after residency? A couple of people have told me to consider urology but I have not really had exposure to it plus its uber competitive not sure if am competitive enough or should waste my time pursuing it. OB/GYN was my other option although i did not like it as much as surgery it was ok. I have a few sub-i's scheduled in both surg and obg/gyn to see if they might help make my choice easier. I have also heard that if at any point you question your interest in surgery it is not for you is this true? I don't mind working hard but I value my personal time with friends and family as do most people, am really torn.

I am hoping current residents or attendings can give me some advice on how bad or manageable the lifestyle is transitioning from medical student to surgical resident to attending

Since nobody else has mentioned this - you mention urology but are worried about competitiveness so have you considered any other surgical subspecialties that do not involve a general surgery residency? You might be a fine Urology candidate, or ENT comes to mind, or Ophthalmology if you'd be satisfied with a day per week in the OR, or Ortho, or Plastics. Although some of those may be just as busy in residency as general surgery. You've got time to decide, so I'd recommend searching for time to get experience in other surgical fields ASAP and doing some varied rotations early in fourth year to continue that trend - but they might have to double as letter-accrual experiences too since you'll be preparing for the match too.

 

[kavorca]

I think most of the surgical sub specialists are happier than the general surgeons. I am only basing this on my own experience. Even outside of surgery almost everyone I talk to thinks the grass is greener in other specialties. They all day dream about hopping residencies, except the OMFS guys. Those guys seem pretty happy.

 

[ArcGurren]

I actually think deciding you "dislike rounding" is pretty telling, not because rounding is the same drawn out process everywhere that you see in some academic centers, (although it certainly can be) but because it tells you where the focus is. In internal medicine, for instance the rounding is the focus -- you see the patient, come up with a plan, and the rest is drawn from that point. In surgery being in the OR is the focus, and the rounding, post-op care, etc are the parts that are more algorithmic and in routine cases you will rush through. So I think deciding you hate rounding is really a proxy for saying where you want the focus of your day to be, and less about the format of rounding itself.

That is not the reason that I hear from 90% of people I know. In fact I know people who said that they like IM, but can't deal with the "endless rounding".

 

[gravitywave]

That is not the reason that I hear from 90% of people I know. In fact I know people who said that they like IM, but can't deal with the "endless rounding".

That's too bad. "Endless rounding" is not a good reason to rule out an IM career.

 

[hewmanoid]

That's too bad. "Endless rounding" is not a good reason to rule out an IM career.

It CAN be a valid reason for not pursuing IM. While on my IM rotation, I loved the diversity of patient cases I encountered and also many intellectual discussions on different pathologies and what-not. Also people were generally great to work with. However, I just could not stand rounding on patients for 3-4 hours everyday, and in fact I often had to literally stab myself with a pen to keep me awake. Definitely not a good sign if I were to go into IM. You may not have to round if you become a hospitalist or own your practice, but "endless rounding" is certainly an inherent part of IM in most cases. That's why I chose to pursue a surgical field instead. Love spending time in the OR and a good way to keep my daily routines varied.

To the OP: If you have competitive stats, I would definitely consider going for either ENT or urology depending on the anatomy of interest. General surgery is also another option: the residency is tough, but you can always subspecialize afterwards.

 

[ophthope]

To the OP: If you have competitive stats, I would definitely consider going for either ENT or urology depending on the anatomy of interest. General surgery is also another option: the residency is tough, but you can always subspecialize afterwards.

Or Ophthalmology. It's so awesome that almost nobody ever leaves.

 

[gravitywave]

The experience of rounding as a medical student isn't how it is as a resident or an attending. As a student there's a lot you don't understand about what's going on, and the team spends a lot of time talking about patients whose problems and condition you aren't familiar with. Plus: dispo is huge on the floor, people spend a lot of time dealing with it, and as a medical student it's got almost nothing to do with you. Contrast this to the chiefs, who are always engaged because they're responsible for everyone on the team and all the patients on the service.

Plus, IM rounds from the med student perspective isn't what the residents do for three years straight, only during the months they spend on the floor. Which I think at a lot of places is six months for interns and progressively less time than that as you go forward. And have you seen how the subspecialists round? All I was trying to say was that ruling out IM because of "endless rounding" seems short-sighted to me.

It CAN be a valid reason for not pursuing IM. While on my IM rotation, I loved the diversity of patient cases I encountered and also many intellectual discussions on different pathologies and what-not. Also people were generally great to work with. However, I just could not stand rounding on patients for 3-4 hours everyday, and in fact I often had to literally stab myself with a pen to keep me awake. Definitely not a good sign if I were to go into IM. You may not have to round if you become a hospitalist or own your practice, but "endless rounding" is certainly an inherent part of IM in most cases. That's why I chose to pursue a surgical field instead. Love spending time in the OR and a good way to keep my daily routines varied.

To the OP: If you have competitive stats, I would definitely consider going for either ENT or urology depending on the anatomy of interest. General surgery is also another option: the residency is tough, but you can always subspecialize afterwards.

 

[kavorca]

Rounding is more boring for the med students than the rest of the team. You will never be as invested in the team cause your responsibility is less, as well it should be. There's a thousand things to do to get a patient out the door and students are shielded from 90 percent of that because it is a huge time sink and a waste for more than one person to be burdened with it.

 

[KnuxNole]

The problem I had with rounding is the obsession with electrolytes and talking about endless possibilities that seem to go on and on. Instead of rounding to get work done. Not to mention residents(or worse, a student) asking questions which brings another 30 min topic. Rounds as an attending post-residency sounds better though, the focus is on getting work done, which is what I prefer.

 

[hewmanoid]

The problem I had with rounding is the obsession with electrolytes and talking about endless possibilities that seem to go on and on. Instead of rounding to get work done. Not to mention residents(or worse, a student) asking questions which brings another 30 min topic. Rounds as an attending post-residency sounds better though, the focus is on getting work done, which is what I prefer.

Exactly my point. 👍

 

[ijn]

I am unaware of more than a very small percentage of fellowship trained breast surgeons who do general surgery. I am personally only acquainted with 2 - one, a male, who still wanted to do some general surgery, and another, female, who was limited in her job search because of her husband's employment, and so had to take the only job available to her in their community. As the former liaison for the American Society of Breast Surgeons, and a member of the SSO Education Committee, I can state that we support our member's desire to forge whatever career path they desire, but data from ASBS members show that the majority do only breast, with the second highest number claiming their practice is 75% breast.

Maybe it's more common in smaller centers? I live in a city of 100k and the one female general surgeon w/ a breast fellowship down here does a heck of a lot of GS. She's also fresh out of training and new to the practice.

 

[username456789]

Rounding is more boring for the med students than the rest of the team. You will never be as invested in the team cause your responsibility is less, as well it should be. There's a thousand things to do to get a patient out the door and students are shielded from 90 percent of that because it is a huge time sink and a waste for more than one person to be burdened with it.

Sucks when you're a resident, too.

 

[Winged Scapula]

Maybe it's more common in smaller centers? I live in a city of 100k and the one female general surgeon w/ a breast fellowship down here does a heck of a lot of GS. She's also fresh out of training and new to the practice.

She probably falls into one of three categories:

1) she *wants* to do GS; this is least likely (because it makes no sense then to do the fellowship)

2) she was geographically restricted and didn't have a lot of job options

3) she is just out of fellowship, naive and didn't realize that there are a myriad of good paying 100% breast only positions across the country which don't require GS and that she can demand such a job because of her training and the supply.

 

[ArcGurren]

It CAN be a valid reason for not pursuing IM. While on my IM rotation, I loved the diversity of patient cases I encountered and also many intellectual discussions on different pathologies and what-not. Also people were generally great to work with. However, I just could not stand rounding on patients for 3-4 hours everyday, and in fact I often had to literally stab myself with a pen to keep me awake. Definitely not a good sign if I were to go into IM. You may not have to round if you become a hospitalist or own your practice, but "endless rounding" is certainly an inherent part of IM in most cases. That's why I chose to pursue a surgical field instead. Love spending time in the OR and a good way to keep my daily routines varied.

To the OP: If you have competitive stats, I would definitely consider going for either ENT or urology depending on the anatomy of interest. General surgery is also another option: the residency is tough, but you can always subspecialize afterwards.

You directly contradicted yourself there - the majority of people entering IM who do primary care careers end up taking up private practice/hospitalist types of jobs and most people who go into subspecialty do private practice - how in the hell does that make "endless rounding" an inherent part of IM?

 

[ArcGurren]

The experience of rounding as a medical student isn't how it is as a resident or an attending. As a student there's a lot you don't understand about what's going on, and the team spends a lot of time talking about patients whose problems and condition you aren't familiar with. Plus: dispo is huge on the floor, people spend a lot of time dealing with it, and as a medical student it's got almost nothing to do with you. Contrast this to the chiefs, who are always engaged because they're responsible for everyone on the team and all the patients on the service.

Plus, IM rounds from the med student perspective isn't what the residents do for three years straight, only during the months they spend on the floor. Which I think at a lot of places is six months for interns and progressively less time than that as you go forward. And have you seen how the subspecialists round? All I was trying to say was that ruling out IM because of "endless rounding" seems short-sighted to me.

👍👍 Generally agreed with this. The more responsibility you have, the more important it is to know all about the patients on your service b/c you make direct patient care decisions.

I think on our GI service there isn't even formal rounds.

 

[hewmanoid]

Sorry, but even 3 years of "endless rounding" during an IM residency is already a huge deterrent for me. Also, I have been on IM subspecialties such as endo and renal, and even they easily round for 2+ hrs in the am. Of course, this may depend on the census and institutions, but regardless rounding certainly is the core of IM training/practice, and this fact ruled IM out as my career path early on.

 

[ArcGurren]

Sorry, but even 3 years of "endless rounding" during an IM residency is already a huge deterrent for me. Also, I have been on IM subspecialties such as endo and renal, and even they easily round for 2+ hrs in the am. Of course, this may depend on the census and institutions, but regardless rounding certainly is the core of IM training/practice, and this fact ruled IM out as my career path early on.

Dude, I'm not trying to convince you to go into IM. If it's not in your interest, then certainly don't feel forced to do it of course. But don't completely misrepresent the specialty by using aspects of the residency training (that too, only the inpatient aspects, which only comprise a part of it) to represent what it's like in the "real world".

Again, you are equating academic/teaching service practice to that of the entirety of IM. I don't understand why you don't get this. FWIW I had just as much rounding on my trauma service as I did in medicine (if not even longer sometimes) because of the census size and because of how sick the patients were.

 

[evilbooyaa]

Dude, I'm not trying to convince you to go into IM. If it's not in your interest, then certainly don't feel forced to do it of course. But don't completely misrepresent the specialty by using aspects of the residency training (that too, only the inpatient aspects, which only comprise a part of it) to represent what it's like in the "real world".

Again, you are equating academic/teaching service practice to that of the entirety of IM. I don't understand why you don't get this. FWIW I had just as much rounding on my trauma service as I did in medicine (if not even longer sometimes) because of the census size and because of how sick the patients were.

Agree with the part of trauma ICU taking forever to round sometimes. Some of the attendings would have us go from 8:30 to 2:30 straight, 5 days a week. Wanted to stab myself b/c the attendings were just being indecisive about what they wanted to do. The other ones would finish the entire TICU in < 2 hours.

 

[gravitywave]

Dude, I'm not trying to convince you to go into IM. If it's not in your interest, then certainly don't feel forced to do it of course. But don't completely misrepresent the specialty by using aspects of the residency training (that too, only the inpatient aspects, which only comprise a part of it) to represent what it's like in the "real world".

Again, you are equating academic/teaching service practice to that of the entirety of IM. I don't understand why you don't get this. FWIW I had just as much rounding on my trauma service as I did in medicine (if not even longer sometimes) because of the census size and because of how sick the patients were.

Precisely my point as well. Many areas in medicine can have rounds that seem to go on forever, and beauty is in the eye of the beholder. I wouldn't characterize hours of rounding as the reason to rule out any specialty.... Hours of rounding on topics you can't get excited about is closer to the mark.

I only replied to this person's initial post because it was bending over backwards to suggest that the only reason they found IM intolerable was the length of rounds.