General surgery question

[remo]

I'm an MS3 thinking about surgery. I just want to do a 5 year gen surg residency and then go into private practice. No research, probably no fellowship. I would like enough trauma experience in residency so that I could do it without doing a fellowship.

Would I want to go through a community program rather than a university one? It seems from reading the forum that you tend to get more OR time in a community program. I'm concerned about being ready to operate on my own when I get out considering that there are fewer operative cases available these days. Also, can someone list good community programs in the west and midwest. Thank you!

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[Winged Scapula]

I'm an MS3 thinking about surgery. I just want to do a 5 year gen surg residency and then go into private practice. No research, probably no fellowship. I would like enough trauma experience in residency so that I could do it without doing a fellowship.

No one NEEDs to do a Trauma fellowship unless you're looking at doing Trauma as a specialty (and even then most surgical residencies should prepare you adequately). Believe me, at most programs you'll get more than enough Trauma experience (and learn to hate it like most of us do).

Would I want to go through a community program rather than a university one? It seems from reading the forum that you tend to get more OR time in a community program. I'm concerned about being ready to operate on my own when I get out considering that there are fewer operative cases available these days. Also, can someone list good community programs in the west and midwest. Thank you!

I think these are artificial lines. It is true that at many community programs you operate more and sooner than in many academic university based ones. The opposite is true as well...this is program dependent, not type dependent.

Obviously you'll want to rule out programs requiring research and focus on those that send people into private practice (thereby implying that the training is adequate for people to feel comfortable doing so). But there are university programs that do this just as well.

On the west coast, the big name community programs are Swedish and Santa Barbara Cottage; whether they are right for you is another matter entirely. But I'm fairly sure we have a list around here somewhere.

 

[NJA61479]

I agree w/ WS. Although all MS-3's are enamored by trauma, there is very little trauma that actually goes to the OR. If you want to do private practice / community practice then you will very rarely see operative trauma. Likely anything that is severe will head to a Level-1 or Level-2 trauma center (which is not where you will be working most likely). If you want to be a priv practice surgeon that is fine but do not waste your time applying to academic med centers. You obviously have no interest in research so just stick to community programs and even hybrid programs that have some rotations at larger med centers. As far as good programs for you in SoCal. I can recommend Cottage in Santa Barbara, Huntington in Pasadena, Kaiser in Los Angeles. They will all give you the broad exposure that you will need to function in private practice as well as allowing you to rotate at a bigger hospital for a trauma experience (that they all hate because most went to community programs as they are a bit cushier and trauma at a level-1 is busy... especially in LA)

 

[Biscuit799]

While I'm personally a fan of community programs, you by no means are limited. There are very many good university programs from which surgeons come out and practice. The trick is to find the ones that a) don't explicitly require research and b) don't pressure you into academic careers/research. This is a pretty easy thing to find out. Ask the residents explicitly on the interview. Also, if you haven't heard of it, it's probably not research heavy. Don't interview at Hopkins or Univ Chicago and say "how do you feel about not doing research and going straight into practice." Most community programs are great about this, however the trick (as mentioned above) is to find the ones that aren't crap. Some community programs (mostly in NY/NJ area from my experience) just match sub par residents and work them to death, offering no education.

Good community/community-style programs in the west/midwest? The University of Iowa is a great program. The previously mentioned Cali programs are good. Avoid Chicago and St. Louis if at all possible. UI-Peoria and UI-Springfield are good. Both programs in Nebraska are really good. All the community programs in Phoenix are amazing and definitely deserve consideration! UNLV is pretty good, but hard to get into. Virginia Mason in Seattle is a very good program and definitely worth checking into! Most university programs that are in more rural towns give great experiences without being research heavy (i.e. Univ Arkansas, ETSU, Univ Oregon).

Best of luck!

 

[minchy]

I have also heard good things about Cedars-Sinai? But I suppose you would get less trauma there. From what I've heard in So Cal, any program where you get to work at LA County gives you plenty of trauma experience- so USC, UCLA-Harbor too. I have also heard good things about Virginia Mason and Santa Barbara Cottage.

 

[SLUser11]

Good community/community-style programs in the west/midwest? The University of Iowa is a great program. The previously mentioned Cali programs are good. Avoid Chicago and St. Louis if at all possible. UI-Peoria and UI-Springfield are good. Both programs in Nebraska are really good. All the community programs in Phoenix are amazing and definitely deserve consideration! UNLV is pretty good, but hard to get into. Virginia Mason in Seattle is a very good program and definitely worth checking into! Most university programs that are in more rural towns give great experiences without being research heavy (i.e. Univ Arkansas, ETSU, Univ Oregon).

Best of luck!

I have to disagree with a lot of this....especially since you only mentioned a few actual community programs, then referenced a bunch of midwest university programs. I don't want to trash any programs in particular, but being a native of the area, and having experienced some of these programs personally, I can say you are being generous with your praise.


Here's a list of actual community programs in the midwest that are worth a look. Some of them are university-affiliated, and some are straight up community.

Baylor-Dallas
Iowa-Methodist
Mich State-Grand Rapids
Good Sam/Trihealth Cincinnati
Scott and White (I've heard, never experienced)
KU-Wichita (obviously)
St. Joseph's -Denver

On the West Coast, I have no experience, but had a friend at Virginia Mason and he seemed happy.

 

[Biscuit799]

Fair enough. However my list of programs was support for my initial comment that the OP need not restrict himself to community programs. Also, as there are plenty of responses giving lists of community programs, so I decided to throw out some good "community style" university programs that maybe don't emphasize research or acadamiae as much as a lot of other university programs do. My last sentence explicitly addresses this idea. I did mention several community programs in my statement as well.

As far as my "generous praise," well to each their own I suppose. All I know is, like everyone else, what I hear. I've heard good things about each individual program I listed. My opinion on this forum, like every other opinion on this forum, is worth exactly what you pay for it.

 

[Pir8DeacDoc]

University of Iowa is a huge academic center, especially for surgery. No way should they be mentioned as a place to go for a non-academic career.


PS: Scott and White by my exposure was a great place. If you can handle warm weather and living in a fairly non-descript place it's awesome. Cost of living is great and it's close enough to Austin to make an easy day trip or weekend trip for stuff to do.

 

[catgut]

not sure if this is a hijack or not but...

is it possible to have the broad, general practice in academics? if i could design my dream job (today) it would be in an academic center, with protected research time. the practice would include be: 40% hpb (including lap livers) and the rest a mix of: bariatrics, trauma, hernia, sbo, endocrine, inflam bowel stuff, etc, etc.

is this job out there or mythical and i should quit dreaming?

if it is.... do i have to do a fellowship? if so, is there a fellowship to get me there?
ie, 1yr hpb?, acute care surgery (or will i be stuck with only trauma, chole, appy)?

advice? insights?

 

[JackADeli]

...is it possible to have the broad, general practice in academics? if i could design my dream job (today) it would be in an academic center, with protected research time. the practice would include be: 40% hpb (including lap livers) and the rest a mix of: bariatrics, trauma, hernia, sbo, endocrine, inflam bowel stuff, etc, etc.

is this job out there or mythical and i should quit dreaming?...

1. If you want HPB in academics, you will either have to do a HPB fellowship or liver transplant fellowship. Some surge-onc fellowships may also be the way.
2. Most HPB surgeons I have known in academics do a variety of general surgical cases.... lap choles, lap appies, +/- inguinal hernias, bowel resections, gastric resections. They usually take general surgery call.
3. At most academic centers, you can get on the trauma call very, very fast. It is far more difficult to get off the trauma call.
4. At an academic center, you are likely to not be the bariatric person after you do your HPB/Liver training fellowship of some sort.
5. At an academic center, you are likely to not be the endocrine person after you do your HPB/Liver training fellowship of some sort. Thyroids will go to ENT and/or the senior endocrine general surgeon. Adrenals will go to the endocrine/MIS surgeons. They are nice cases, but will be the domain of those individuals.

 

[thedrjojo]

our liver guys (all transplant trained) don't do anything but livers (both xplants and hepatectomies) and the occasional whipple...

the surg onc attending does liver cases, 95% of the pancreatic cases in the hospital and takes general call

trauma is only done by trauma attendings, but the trauma attendings also take general call so gets some appy's/chole's/sbo

HPB is a 2 year fellowship I believe. Transplant is 2 years, Surg onc is 2 years. MIS is 1-2 years.

Endocrine can be chopped up many ways. Here ENT does the thyroid/para, Surg Onc gets the adrenal cases and pancreatic cases. Where I did my away, Surg Onc had the thyroid/para, and gen surg was still doing adrenal/pancreatic cases along with surg onc. A community hospital i did a month at, a vascular attending did 3 thyroids during my month there, as well as a LAR...

I think you can achieve most of what your dream is, but will have to make some sacrifices, and will have to work your way into it...

 

[SocialistMD]

HPB is a 2 year fellowship I believe.

One year.

 

[catgut]

One year.

are people doing multiple fellowships....
ie mis and hpb?

perhaps a good way to do whipples, lap livers and bariatrics?

 

[JackADeli]

are people doing multiple fellowships....
ie mis and hpb?

perhaps a good way to do whipples, lap livers and bariatrics?

Some might... but I doubt it.

Looking at surgical fields from the outside you may love immense diversity in procedures. The reality of these dieverse procedures is far less appealing. Folks develop interests that usually diverge. The population of patients requiring bariatrics is different the the patients dying from hpb and pancreatic cancers. The post-op care is also different. There is also the strike while the iron is hot phenom. When you leave your chief year, you are on top of your game in very broad areas. If you haven't been doing complex liver/panc/vasc anastamosis surgery for a year cause you have been doing bariatrics, I suspect to a hpb PD you are no longer hot?

Finally, one of the reasons often cited for the decline in interest in some specialties is the prolonged length of training. A good deal of the folks doing hpb or surge onc fellowships have taken additional time for research. I do not see folks continuing to put off starting their career for another year of training to do lap-fat loss surgery...

It can happen. I am certain people are ready to recall the buddy they once knew that did three fellowships and is now doing lap-fem-carotid bypass. But, all of that is likely the exception and I suspect quite uncommon.

 

[thedrjojo]

One year.

https://hpb.fellowshipcouncil.org/directory/browse2.php

There are both 1 and 2 year fellowships (5 are 2 years, 4 are 1 year, and 3 are either 1 or 2 years)