General Surgery - Questions

[Khaos05]

I'm currently about halfway through nursing school and I plan on getting my prereqs for med school and applying. Forever, I always said I would do general practice and work in a clinic. I just did a rotation through the OR a few days ago and now i'm thinking general surgery. I just have a few questions.

1) How does general surgery work? 4 years of med school then 5 of residency?

2) I'm afraid that the 5 years of residency will be too much with a wife (and maybe a kid by then). What is it like time/stress wise, etc.?

3) I'm also worried that if I do surgery then I will be a surgeon and not be able to do anything else (i.e. if a family member needs something then i'm not a "family doctor" so Im not sure if I can write rx's)...that I'm limited to surgery

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[jubb]

1) 4 years of medical school 5 years of residency + fellowship if you want to further specialize. Fellowships are 1 to 3 years for the most part. I guess I should say not all surgery residencies are 5 years, some have a year or two of research tacked in there. There is talk of changes to the way residency works so it's easier for people to specialize, but it's still up in the air at this point, but that may start coming into play 4 to 6 years from now.

2) I'd plan on averaging 80 hours a week during residency. Starting at the hospital on average at about 5:30am getting home at 6 or 7pm at night. Working a 30 hour shift every 3 to 4 days or having a month of working night shifts and only taking two to three 30 hour shifts a month.

3) You can write prescriptions for whatever you feel comfortable with. Most likely you won't be managing family members blood pressure or doing thing that needs appropriate follow up or regular monitoring. Most of the time family members will just hit you up for antibiotics or ask you if they should go to the ER.

 

[Winged Scapula]

Not much to add to the excellent information above except to echo the comment about caring for family members:

Do not encourage this nor think about doing it, regardless of what field of medicine you eventually choose.

Anyone with a license and an DEA can treat family members and friends for anything they want, even a surgeon. Writing prescriptions is not specialty based and as long as you have the above, you can write a script for whatever you want. However, it is not good practice to do so and you'll find a few threads here which explain why. I'd suggest doing a search.

Tell your family members now that if you ever do become a physician it does not replace their need to have their own, unbiased physician to care for their medical needs. You will not be writing them scripts except in emergencies and only for things like antibiotics or a refill on a medication you are very familiar with. You will not write them for new prescriptions nor narcotic pain medications.

 

[maxheadroom]

Agree with Kim about caring for family members. If you go into medicine, learn to say, "Hmm, that sounds like something that you should discuss with your primary doctor."

Why are you doing a nursing degree if you want to go into medicine? Nurses and doctors do very different things and have very different training. Nursing is not back-up plan for pre-med. It's totally different.

 

[Khaos05]

well, i'm doing nursing because I had planned on going the APN route. Then after a lot of thought, I realized that being an APN wasn't going to be enough. Since i'm already halfway through the nursing program, I'm just going ahead with nursing and adding on the prereqs for med school. I asked the admissions department at the med school I plan on attending and they said it sounded like an excellent plan to them since I would already have medical/clinical experience. You'd be surprised how many nurses practice for 5-6 years and then go back to med school-and do very well.

And yes, I don't plan on treating family - I don't want that on my tab. I was just saying things like questions and just a simple rx here and there (antibiotics or something). I just have it in my head (for some reason) that if I were to do cardiology (for example) then I wouldn't know how to answer a question about the renal system. If it's not a cardiology question-i wont know. I don't think that's the case, but I've got it in my head.

I'm just trying to decide between general practice in a clinic or general surgery. Residency as a general practitioner wouldn't bug me because I'm a doctor doing what I want to do. I was just asking how rough a general surgery residency would be because I have a wife and I plan on having kids near the end of med school.

 

[Winged Scapula]

well, i'm doing nursing because I had planned on going the APN route. Then after a lot of thought, I realized that being an APN wasn't going to be enough. Since i'm already halfway through the nursing program, I'm just going ahead with nursing and adding on the prereqs for med school. I asked the admissions department at the med school I plan on attending and they said it sounded like an excellent plan to them since I would already have medical/clinical experience. You'd be surprised how many nurses practice for 5-6 years and then go back to med school-and do very well.

Its actually not suprising to us because I'm sure most everyone has a classmate that was an RN before going back to school. max just wanted to point out that getting a nursing degree is fine if you plan on using it but be aware that the training is vastly different than what you'll get in medical school. That said, your nursing skills (not that you learn many in school) do come in handy at times during medical school and residency.

I'm just trying to decide between general practice in a clinic or general surgery. Residency as a general practitioner wouldn't bug me because I'm a doctor doing what I want to do. I was just asking how rough a general surgery residency would be because I have a wife and I plan on having kids near the end of med school.

Then why are you asking about surgery is its not what you want to do?

BTW, general practice no longer exists in the US. The closest you can come is a residency in Family Practice.

Many surgical residents have families. That should not preclude you from having a surgical career, as long as your spouse understands the commitment that surgery, and ANY residency takes. Frankly, you can expect to work 80 hours or more in almost any residency so I'm not sure that its vastly different especially in the intern year between surgery and other fields.

 

[maxheadroom]

I didn't have any experience with RNs who were going back to school. We had lots of people who had worked as EMTs while in college. Most of them used it as a way to make some money and get more exposure to medicine while getting through their undergrad or graduate degrees.

One of my cousins started out college wanting to do pre-med, but her parents talked her into nursing school so she would have a "fall back" in case medicine didn't work out. She's a smart girl and certainly had the abilities to be a strong pre-med. I gave both her and her parents strong advice that a BSN does not make a good pre-med degree -- it's lacking in too many upper level science credits (a trade for clinical practicums). More importantly, she would be spending her time with nursing students and not pre-meds. She missed out on lots of things that pre-meds learn about how to buff their applications because she just didn't ever really get the right exposure.

Fast forward to last May and she graduates with a BSN after doing poorly on the MCAT. She's now taking post-bac science classes and struggling because the things that she learned in "Biochemistry for Nurses" aren't helping her in "Biochemistry for Pre-Meds/Scientists". Sure, she can start an IV, take vitals, and push meds. She's already taken ACLS and PALS. That doesn't matter. If she can't learn how to do the things necessary to be a good med school applicant, it won't help her.

Now she's in a nursing job that she really doesn't like. She's realized that she really doesn't want to be in nursing at all, but she's not sure that she wants to spend another couple of years redoing undergrad so she can have a real shot at medschool.

Nurses are not junior doctors. Sure, there's the whole APN/NP thing, but that isn't a short pathway.

If you want to be an MD, follow the path of the other pre-meds. You don't have to get a Biology degree (my major was English, but I took enough upper level Bio and Biochem to match anyone with a BS in Bio or Biochem). At one time, the highest-yield degree to have when applying to medschool was Anthropology -- probably a function of having very few people with Anthropology degrees applying.

There's a pre-med track for a reason. And while it probably sucks to have a BS in Biology and not get in your first time around, you're probably better off than my cousin who has a BSN and doesn't want to be a nurse.

 

[Winged Scapula]

I didn't have any experience with RNs who were going back to school. We had lots of people who had worked as EMTs while in college. Most of them used it as a way to make some money and get more exposure to medicine while getting through their undergrad or graduate degrees.

One of my cousins started out college wanting to do pre-med, but her parents talked her into nursing school so she would have a "fall back" in case medicine didn't work out. She's a smart girl and certainly had the abilities to be a strong pre-med. I gave both her and her parents strong advice that a BSN does not make a good pre-med degree -- it's lacking in too many upper level science credits (a trade for clinical practicums). More importantly, she would be spending her time with nursing students and not pre-meds. She missed out on lots of things that pre-meds learn about how to buff their applications because she just didn't ever really get the right exposure.

Fast forward to last May and she graduates with a BSN after doing poorly on the MCAT. She's now taking post-bac science classes and struggling because the things that she learned in "Biochemistry for Nurses" aren't helping her in "Biochemistry for Pre-Meds/Scientists". Sure, she can start an IV, take vitals, and push meds. She's already taken ACLS and PALS. That doesn't matter. If she can't learn how to do the things necessary to be a good med school applicant, it won't help her.

Now she's in a nursing job that she really doesn't like. She's realized that she really doesn't want to be in nursing at all, but she's not sure that she wants to spend another couple of years redoing undergrad so she can have a real shot at medschool.

Nurses are not junior doctors. Sure, there's the whole APN/NP thing, but that isn't a short pathway.

If you want to be an MD, follow the path of the other pre-meds. You don't have to get a Biology degree (my major was English, but I took enough upper level Bio and Biochem to match anyone with a BS in Bio or Biochem). At one time, the highest-yield degree to have when applying to medschool was Anthropology -- probably a function of having very few people with Anthropology degrees applying.

There's a pre-med track for a reason. And while it probably sucks to have a BS in Biology and not get in your first time around, you're probably better off than my cousin who has a BSN and doesn't want to be a nurse.

Excellent point. I'm suprised that none of your classmates or residents were former nurses. Seems like to me there was always one in a class.

At any rate, excellent point about missing out on the pre-med community info. Its certainly possible to do without but it does make it harder to be plugged in.

 

[Khaos05]

yeah, I would love to do general surgery, I just don't know if I could handle 6:30am - 8pm 7 days a week for 5 years of residency and then do 60+ hours a week for the rest of my career. I would like to have saturdays off (I understand on call) and I would NEED sundays off because frankly that is more important to me.

I just can't see how I could have a wife and kids and work 60-80 hours a week. It doesn't seem like I could spend time with them too much. That's what is pushing me away from surgery back to my original idea of "general practice". It doesn't seem like I would have a life outside of surgery and I kind of want one.

 

[Lamborghini1315]

I'm currently about halfway through nursing school and I plan on getting my prereqs for med school and applying. Forever, I always said I would do general practice and work in a clinic. I just did a rotation through the OR a few days ago and now i'm thinking general surgery. I just have a few questions.

1) How does general surgery work? 4 years of med school then 5 of residency?

2) I'm afraid that the 5 years of residency will be too much with a wife (and maybe a kid by then). What is it like time/stress wise, etc.?

3) I'm also worried that if I do surgery then I will be a surgeon and not be able to do anything else (i.e. if a family member needs something then i'm not a "family doctor" so Im not sure if I can write rx's)...that I'm limited to surgery

Surgical residents are def not the best bet for a lasting relationship and i say this without cynicism. It can take a big toll on your spouse..i mean you need to talk this out with your wife honestly. If you value your relationship tremendously you should be prepared to accept that you might end up sacrificing a lot of time away from one or the other..so your choice surgery or wife? If you don't want to miss out valuable time away from your family..medicine should be your path. On the question of if you can be a family doc..that cracked me up. I mean family docs know just as much as you do but they practice medicine while you do surgery. May you won't remember all your antibiotics but physicians are physicians you should have a basic understanding of every system in our body for the rest of your life. So i doubt you will have a hard time dealing with simple pathology outside your field. Just don't panic about missing out on other stuff focus on what you are passionate about..also it doesn't sound like you are as vested in surgery..so take your time think it through with your family!

 

[Lamborghini1315]

yeah, I would love to do general surgery, I just don't know if I could handle 6:30am - 8pm 7 days a week for 5 years of residency and then do 60+ hours a week for the rest of my career. I would like to have saturdays off (I understand on call) and I would NEED sundays off because frankly that is more important to me.

I just can't see how I could have a wife and kids and work 60-80 hours a week. It doesn't seem like I could spend time with them too much. That's what is pushing me away from surgery back to my original idea of "general practice". It doesn't seem like I would have a life outside of surgery and I kind of want one.

Yea my dad brings that up every time i tell him about surgery..but you know what there are a lot of crazy people in this world

 

[rockdoc]

yeah, I would love to do general surgery, I just don't know if I could handle 6:30am - 8pm 7 days a week for 5 years of residency and then do 60+ hours a week for the rest of my career. I would like to have saturdays off (I understand on call) and I would NEED sundays off because frankly that is more important to me.

I just can't see how I could have a wife and kids and work 60-80 hours a week. It doesn't seem like I could spend time with them too much. That's what is pushing me away from surgery back to my original idea of "general practice". It doesn't seem like I would have a life outside of surgery and I kind of want one.

I can understand your concern about the schedule, but unfortunately, that is common across many specialties in medicine, especially during residency. Our institution's IM residents start at 5:45am to 6pm and q4 call, which is only a few hours less than the surgical residents. Of course, the schedule varies when you become an attending in any given specialty.

If you truly want to pursue medicine, then perhaps you could start taking the prerequisite classes designed for pre-meds. As others have said, the classes in nursing are not designed to prepare you for the MCATs. If you feel completely set on your decision, maybe you can enroll into a post-bac program full time and focus on doing well in the MCAT while also buffing up your CV.

It's not unheard of to have nurses go into medicine. One of my classmates was an RN, and now matched into family practice. Like you, she was previously a surgery buff, but feared that she may have problems starting a family soon. Good luck.

 

[DrDre311]

One of my co-residents is a former RN. It can be done, but you have to be willing to sacrifice in the short term to achieve your long term goals. If you go into anything but derm it's unlikely that you're ever going to have a standard 9-5 Mon-Fri job.

As far as undergrad training and the MCAT go, make sure you take a real prep course or something. I was an idiot and thought the MCAT would be like the SAT so I winged it--no prep course, no practice--probably cost myself some serious points on my score. I still got in, but looking back on it now, that was just dumb. Don't do that.

 

[MedWiz]

3) I'm also worried that if I do surgery then I will be a surgeon and not be able to do anything else (i.e. if a family member needs something then i'm not a "family doctor" so Im not sure if I can write rx's)...that I'm limited to surgery

Just to second what others have previously stated: http://forums.studentdoctor.net/showthread.php?t=319250

 

[geekgirl]

good for you - figuring out what you like is important. but it sounds like you have 4 YEARS of med school to figure out your specialty. i grant you that some of us (myself included) are planners. but that said, i thought in med school i'd be a neurologist and here i find myself a surgical resident with a love of very sick patients. you will find that intellectual curiosity and day to day jobs diverge. and converge in a weird sort of way.

so i applaud your interest and your research. i think what a "GP" or really a family med doctor does is far less glorious than in the past. i think that many medical subspecialties have very nice practices. that said, to be at the high end of the spectrum, they each work very hard. perhaps not quite at our self-flagellating pace. but hard hours nonetheless. we have renal and endocrine attendings who are there as much (or more) than any of our junior residents. and they are pleasant. and sage. and fun. all at the same time. but we all work hard.

so take stock of where you and your family are when you have to make this decision. take stock of what jobs you loved. where you did not clock watch. where you felt your skills were most applied. and then, later at that then, figure out what to pursue. for now, i applaud your career switch. as stated, that is not easy. not the least of which is the culture.

my sister is an NP and she loves her job. but she and i do very distinctly different jobs. she bristled when my parents told her to go to med school. she wanted to be a nurse. to take CARE of patients, not TREAT patients. the jobs are different, goals the same.

anyway, good luck. surgery can treat you well as an attending (i.e. endocrine, breast, etc.) but the residencies are beasts. no matter where. you will figure out as a med student what schedule and lifestyle fits you the best. no matter how easy the hours were on my electives, i always felt a little unfulfilled until surgery. it may be hard, but it matters. sadly, that was where i declared myself. but we all find our fit at different times and for different reasons.