General Surgery...how competitive?

[mkwhitley]

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I always here people talking about ortho and neuro being among the most difficult of specialties to match into, but I never seem to here people discussing general surgery (which is what I am interested in currently). How competitive is gen surgery in general? I know that there is not definitive answer to the following question, but I'll ask it nonetheless: which programs are considered to be top notch? Thanks!
MW (three days away from finishing the first year)

 

[Winged Scapula]

General Surgery has probably never been as competitive as any of the surgical specialties (ie, Ortho, ENT, Plastics, Neuro, etc.). However, it is and remains more competitive than most of the primary care specialties (ie, Peds, IM, FP, etc.).

Like most specialties, General Surgery competitiveness runs in cycles; the 2001 NRMP was earmarked by a large number of General Surgery positions going unfilled. We've had extensive discussions herewith about the reasons, but it likely comes down to the cyclical nature of applications and the upswing in interest in "lifestyle" specialties (including, but not limited to, Anesth, Rads, EM, primary care, Derm, etc.).

The problem with ranking programs is that it usually comes down to some artifically designed and easily manipulated factor, like NIH funding. In general, the following programs are usually ranked highly - take it for what such rankings are worth:

Duke (however, widely reputed to be the most malignant as well)
UCSF
Pitt
Hopkins
Penn
Washington Univ.
UCLA
Michigan
Cornell

...number 20 (based on NIH funding): MY program! 🙂

Of course, there are many other centers that are known for surgical specialties - transplant (Pitt), peds (CHOP), hand (Kleinert in Louisville), trauma, etc.

The highest rank program is the one that's right for you - where you fit, feel happy and get good training. Bear in mind that all of the above are certainly great programs but often at big academic centers the residency is not unopposed or there are fellows with whom you may compete for more complicated cases and you may get less teaching and personal time.

I'm sure droliver (PGY3 at Louisville) will have something beneficial to add!

Hope this helps.

 

[Future Surgeon]

Hi:

Just wanted to add that as with any specialty, at the top programs it is always very competitive.

This means: AOA (including, ideally, honors in surgery, medicine and ob/gyn), two digit board scores over ~90, some good research experience (ideally with publications) with plans to do more during residency (1-2 years during residency) and obviously the other "usuals" (good recommendations from people in surgery, good interview skills, etc.).

Most people would also add the Brigham&Women's Hospital and Mass General to the list in the previous post.

Word of warning: in addition to Duke, Hopkins and Penn are also malignant programs ... but there are always those people that are into that. I am starting at Cornell this June -- it is a fantastic program with the advantage of NOT being malignant.

Hope this helps.

 

[mkwhitley]

Thank you very much for your replies. One last question... when you were interviewing, how did you gauge the "malignancy" of the program. Is it very obvious by talking with the physicians or is it somewhat common knowledge which programs are meanest to the residents. Also, did either of you intervie/know anything about Emory's program (I'm from ATL and would love to go back).
Thanks,
Matthew


-----------------------------
M. Whitley, MSI (not for long)
Yale Univ. School of Medicine
-----------------------------
😎 😎

 

[drusso]

It is my impression that those who matriculated into surgery programs from my school were not so much in the top of the class as they were the hardest workers. The people at the very top of the class did IM, EM, Ophtho, Derm, or Rads. Those who did gen surgery knew how to get along with surgeons well. They also understood and related to the "culture of surgery." It's been purported that surgeons can sniff each other out from a mile away. There may be some truth to that.

 

[droliver]

In re. to the initial query "how competative is general surgery?", the answer is it depends. Some programs are supercompetative (AOA, good letters,good school,& research papers prerequisite) & some are available to above-average students without much on their CV.

What makes a program a good fit for someone has to take into consideration what 1) their career goals are (academics vs private practice) 2) whether or not a post-graduate fellowship will be desired 3) quality of life/location issues. To go into community practice in general surgery, extensive exposure to endovascular techniques, exotic oncology & endocrine cases, and state of the art trauma care are not required and you might pick a program with less call, less trauma, & less of an academic/university bent. Now while I feel broad-based exposure in the aforementioned areas makes you a more-well rounded surgeon, they probably involve knowledge/skills that won't be relavent to the overwhelming majority of your cases you will ever see.

As Kimberli pointed out, certain places have centers of excellence for certain subspecialties. What you must be careful with in her examples cited is that with all those places Pitt, CHOP, Kleinert & Kutz (KY), etc.. is that all those fields are essentially fellow driven specialties at those centers. It is not the gen. surgery residents doing the good pediatric cases @ CHOP, the exotic transplants @ pitt, the Hand transplants @ Louisville, etc...
I'm @ Louisville & we do not even routinely rotate on the hand service during our training (only ortho & NES do as junior residents, & Kleinert & Kutz have something crazy like 28 hand fellows each year to do their work) except by special request.

I think more important benchmarks for programs are 1) a survey of where the influential publications are being produced & 2) the caselogs of the residents. Louisville was interesting to me for the very influential work here for the last 20 years here in trauma/critical care & oncology, both of which are core general surgery fields without fellows competing for the cases (here). The graduating chiefs here the last few years have finished in the 99%+ of of every case category except head & neck CA(75%) and have in fact had to literally not count as many as several hundred cases in order to not get spiked by the residency review commitee for having too many cases 😱 . You can't get too much training in my opinion during this brief 5 year period & this is a positive , not a negative to me about Louisville.
About half the programs cited in the best of list in this thread I would not have even considered due to a combination of mandatory lab years, an abundance of fellows, or poor clinical/training reputations.

 

[Winged Scapula]

Thank you droliver for your wonderfully detailed response; I knew I could count on you. 🙂

I should have perhaps clarified some elements of my earlier post. To wit:

I should have been more clear that when I was naming places known for subspecialties; it is TRUE that gen surg residents will not likely be doing those cases, hence my comment about unopposed programs or places without fellowships. I just wanted to point out that most ranking systems focus on subspecialties rather than General Surgery. If it makes you feel better droliver, even the Plastics residents at Louisville only spend 3 months on Hand at Kleinert and Kutz. The place is a mad-house, fellows swarming around everywhere, but I enjoyed spending a few days there. 🙂

The rankings I gave were based on NIH funding - a dubious distinction as I mentioned. However, using that ranking system Mass Gen and B&W do not rank in the top 10. Doesn't mean they aren't well recognized, just don't get the funding that others do.

I mentioned Duke because it was always mentioned to me as the program to avoid because of its malignancy. However, I am aware that some of the others I've listed have the same reputation. As a matter of fact, I go to Pitt for Transplant and from what I've heard from my senior residents, its not a friendly few weeks. As for judging which ones are malignant, certainly the impression of the current residents helps but also in talking to students at those programs. I was sort of out of the loop coming from Australia, but was repeatedly told about Duke, Pitt and Hopkins. Emory was never raised so I can't comment on that.

As droliver notes, there are many factors to consider when choosing a program. I wanted an academic program, so the lab years weren't an issue for me, but the ability to do what and where I wanted was. I also wanted to be at a place that wasn't necessarily top drawer - I wanted a more collegial feel, more bread and butter surgery without extensive fellowship competition. There is no BEST program that fits everyone's needs. Louisville is a great program - the Chair there is highly regarded, they produce the Amer J of Surgery there, and do lots of good research. Plus Louisville is a great town. It just wasn't the right program for me.

Your department Chair can often give you some insight into programs he thinks are good, which will fit your needs, etc. When you are doing electives or meet visiting students at your school, ask them about what programs they've been to, what their school is like, etc. Read on-line reviews of programs (http://www.scutwork.com) and pick the brains of any resident who will give you his email! 😉

And don't discount community programs - there are some great ones out there. I was particularly impressed with Wilmington DE. Think about what you want in a program - if its to be Chief of an Ivy Surgery Service, then go high powered academic program; if its to be a good community surgeon then there are many programs (both university and community) which will make you into one.

Hope this helps clarify things. 🙂

 

[Winged Scapula]

I do not know whether the Medschool.com data are based on Gen Surg residents but I suspect they are because I believe the attrition rate once you get to the subspecialty level is low.

I have had 2 friends who have left surgical programs. Both did it for family reasons - they never saw them, and wanted to spend more time with their children. They also realized that doing so was more important than being a surgeon. While malignant personalities, killer schedules, etc. certainly account for a certain number of drop-outs, I suspect that the majority do so because they find themselves unwilling to make the lifestyle sacrifices required or that surgery really wasn't what they thought it would be.

Most surgery residents I talked with thought I was pretty wild that the 4th year Surgical resident on Hopkins 24/7 would quit - granted Hopkins is known to be malignant, but to go that far into one's residency and not even pursue moving to another residency tells me that she felt other things were more important than being a surgeon.

But there are people who STAY in their general surgery residencies against all odds; at one program I interviewed with one of the residents had a GBM but she kept working despite treatment and the prognosis. I thought that a pretty amazing commitment and a good sales tool for the program (if I may be so crass as to say that).

 

[droliver]

Kimberli,

nice points as usual 🙂

1)I too find it unusual for a 4th year resident @ Hopkins to drop out. Obviously there must have been either long term personal issues or perhaps some of competence not outlined on the show.

2) as Kimberli pointed out, there are some outstanding private/ community programs around including Carolina Medical Center (charlottne,NC), Baylor-Dallas Medical center (not to be confused with the Baylor medical center & school in Houston), & Carraway Medical Center (Birmingham,AL) that I know about. The Carolina & Baylor programs are as competative as anywhere & usually require you to be AOA to be a good candidate!

3) I don't know if turnover is much higher for surgery than some of the primary care fields as a whole. The people who have left my program have been 1) older people with children who did not realize the upheaval on their family career 2) a few who have changed specialties to ortho,neurosurgery, & a plastic surgery integrated program when more attractive positions for them open up (most of these people interview for those out of medical school, but failed to match) 3) girls who suddenly wanted to start a family 4) one had a head & neck cancer that recurred & 5) people with some severe personal problems who transfered closer to home
Very few people with "normal" backgrounds & career paths have tended not to be successful (at least here)& you can pick out all the ones that left as "damaged goods" of one sort or the other.

4) places like Hopkins have their purposes & you can probably see some real bizarre pathology there like you would @ the Mayo clinic. Those places by & large are not the best places to get trained in surgery, but rather they're places to go for 1)an academic pedigree, 2) to position for fellowship training, or 3) to do outstanding fellowship training. I don't know that they are more "malignant" (whatever that means) than anywhere else. Certain programs do tend to have certain personalities however.

 

[tussy]

Please pardom my ignorance, but I've seen the term AOA used here a few times. What does it mean.

 

[Winged Scapula]

The term is *usually* used to refer to Alpha Omega Alpha: a medical school honor society to which students are elected based on grades, community service, etc. I believe it to be strictly available at US schools - about 115 of the schools have a chapter (leaving out about 40 schools).

AOA also stands for the American Osteopathic Association. Aeronautic Operators Association, and the Australian Olive Association! 😉

 

[Ponyboy]

Originally posted by Kimberli Cox:
•The term is *usually* used to refer to Alpha Omega Alpha: a medical school honor society to which students are elected based on grades, community service, etc. I believe it to be strictly available at US schools - about 115 of the schools have a chapter (leaving out about 40 schools).

AOA also stands for the American Osteopathic Association. Aeronautic Operators Association, and the Australian Olive Association! 😉•

There are some AOA societies in Canada but I don't believe that they are in all of the med schools. Because it isn't in many of the schools, most Canadian schools don't really put that much emphasis on it.

 

[tussy]

The australian olive association eh! That ought to get you into a good residency program.

thanks for the info. I was slightly puzzled.

 

[Winged Scapula]

Thanks Popoy...I had previously investigated chartering a chapter in Australia but was ggiven the impression by the organization themselves that it was only available in the good ol US of A.

Guess they didn't want to cheapen membership by letting anyone in! 😀

 

[MikeS 78]

woah hold on.....let me get this straight.....she kept working even though she has GBM....I assume you mean Glioblastoma multiforme...if so that's about the most ridiculous thing I have ever heard in my life...they're letting her perform surgery despite the fact that she has an aggresive invasive brain tumor...I think thats where we need to call in some tough love.

 

[Winged Scapula]

Originally posted by MikeS 78:
•woah hold on.....let me get this straight.....she kept working even though she has GBM....I assume you mean Glioblastoma multiforme...if so that's about the most ridiculous thing I have ever heard in my life...they're letting her perform surgery despite the fact that she has an aggresive invasive brain tumor...I think thats where we need to call in some tough love.•

That is not our decision to make and I'm sure her program had many a discussion about ite. I have no idea what her duties entailed, how large the GBM was and how it affected her.

If she is physically and psychologically able to perform her duties, it would be illegal of the residency program to prevent her from doing so. I'm sure they made provisions for the day, if and when it came, she was unable to carry out the requirements of that residency program.

 

[yigit]

Who elects new members? Upperclassman from your own school's chapter or members from chapters around the country? How do they decide? Is this just another silly frat. or something that I want to work towards? I'm starting school in the fall so I'm a little clueless....excuse my ignorance. 😀 😱 😉 😡

 

[277768]

woah hold on.....let me get this straight.....she kept working even though she has GBM....I assume you mean Glioblastoma multiforme...if so that's about the most ridiculous thing I have ever heard in my life...they're letting her perform surgery despite the fact that she has an aggresive invasive brain tumor...I think thats where we need to call in some tough love.

Amen to that.😀

 

[tfom08]

Amen to that.😀

Nice resurrection! 8+ years old, you are really digging into the archives!

 

[Pinkertinkle]

that resident with the GBM is probably long dead by now

 

[277768]

that resident with the GBM is probably long dead by now

Yeah I hear its basically a death warrent.

 

[SouthernSurgeon]

Yeah I hear its basically a death warrent.

You missed the point. Don't bump an 8 year old thread for no reason.

 

[277768]

You missed the point. Don't bump an 8 year old thread for no reason.

Wow sorry, the SDN ayatollahs are out in full force today.

 

[Twitch]

^ grave digger

 

[sendwich]

anybody know the average step1 scores of high vs. middle vs. low tier residency programs? I realize that choosing residencies has more to do with fit than scores but I'd like to get a general idea of which programs I'd be competitive for vs. high-reach programs. (ie. assuming 215 will probably not get you into MGH)