General Surgery cases

[MileHighEast]

I am wondering if some current or former military surgeons can speak to the volume and diversity of military cases? I'm currently finishing 2nd year of General Surgery residency and have a strong interest in Navy FAP. I was interested in pursuing the Navy HPSP in medical school, but deferred consideration due to the GMO program. I have searched some prior threads and their seems to be conflicting reports. I would say the majority of young surgeons here complain about the lack of cases, however there have been a few with positive remarks. There have been two ex-military attendings (one ex-Navy, the other ex-Army) in my program and an ancillary site, who have developed solid surgical skills bore largely from their strong trauma experience. However, I wonder if this was a wartime anomaly due to their service from roughly 2003-2007. They each seem to have developed profound efficiency and confidence, which I cannot say has been shared by the majority of junior civilian attendings.

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[bobbyseal]

2014 = end of Afghanistan and thus the number of deployments will drop alongside that. However, there's always the next war for us to go to. Most military general surgery residents in 2000 weren't anticipating the future.

Otherwise, your experience will largely be dependent upon who you are caring for. Most military folks are age 18-50. Lots of hernias, pilonidal cysts, hemorrhoids, and breast biopsies. I tend to doubt you would be doing much more than a colectomy from an oncology standpoint. If you are Navy and end up on a carrier or with a MEU, you could spend 6 months doing nothing.

I anticipate the ex military confidences may be from some war trauma experience. But, a lot of it is probably personality dependent. Some surgeons have it with residency, others get it with fellowship, some never do.

 

[MileHighEast]

Thanks for the perspective. I guess predicting the likelihood for future conflicts is near impossible. Haven't quite figured out my future. Started with an interest in Vascular, now more interested in Colorectal (prefer working in the abdomen). Sounds like bread and butter general surgery with rare onc. What are the consulting services like? Specifically, do you do your own EGD/Colonoscopies? Are ERCP's common or are lap CBD explorations common? The latter would be more annoying, but perhaps more beneficial in the long term.

 

[Ziehl-Neelsen]

I am not a surgeon, but I probably have a better idea of the volume and complexity of surgical cases at my institution than anybody outside of the anesthesiologists.

Every one of your questions is depedent on so many variables as to essentially be unaswerable. Volume at the major medical centers is more than adequate with significant complexity keeping surgeons pretty busy and training highly competent residents. Volume at the quasi medical centers is barely adequate and most surgeons I know stationed in these hospitals moonlight to retain their skills. Volumes at the community hospitals are totally inadequate and the complexity is limited to only the most basic procedures due to limited support (no anesthesiologists, no pathology, no ICU, etc.). As for deployments, I know surgeons deployed to CSHs and FSTs during the surge or around Korengal who spoke of operating for 36 straight hours, but during my wife's last deployment to Iraq after the ROE change she watched an FST at her base sit on their butts for 6 months without a single surgical case.

I think the military produces some excellent surgeons, but there are many who leave the military after their commitment has been repaid who have been stuck at small hospitals taking tons of call and doing tons of consults but operating very little and watching their skills erode. Since one has little control over what type of hospital they'll practice in and how much they will operate during a deployment, it's a crap shoot as to whether you'll end up like the former or the latter.

 

[chemist157]

Unless I'm missing something, ERCPs are the domain of gastroenterologists.

 

[MileHighEast]

I was alluding to smaller hospitals or deployments, when a gastroenterologist may be unavailable. From what has been posted, there seems to be quite a diversity of services depending on your site.

At Ziehl-Nielsom: By community hospitals, you mean Pensacola, Camp Pendleton, etc?

 

[chemist157]

I didn't realize surgeons could do ERCP. It's a very technical procedure that requires a lot of training and practice to maintain. The surgeons at my institution don't perform ERCP and wouldn't attempt it, according to them.

 

[Ziehl-Neelsen]

I'm not a squid, but I did my residency in a combined program with them. These are my impressions, but Navy physicians are a better resource than me.

Medical Centers: Balboa, Walter Reed, NMCP.

Quasi-Medical Centers: Lejeune, Jax, Yokosuka, maybe Pendleton (it has never been adequately explained to me how their surgery department works being so close to Balboa).

Community Hospitals: P-cola, Charleston (it may not even be a hospital anymore), Bremerton, Guam, Oki, 29 stumps, Great Lakes, Rota, Sig.

 

[jabreal00]

I didn't realize surgeons could do ERCP. It's a very technical procedure that requires a lot of training and practice to maintain. The surgeons at my institution don't perform ERCP and wouldn't attempt it, according to them.

It's rare for a surgeon to be credentialed in ERCP. However some hepatobiliary surgeons get that training. There are no ERCPs done at any small MTF in the military. It's limited to Medcens and the larger MTFs due to the anesthesia and Fluoroscopy.

In the military gastroenterologist are the ones who do ERCPs. General surgeons are competent enough to do EGDs/Colos.