General Surgery Resident - AMA!

[WinslowPringle]

I haven't seen an AMA thread for a general surgery resident yet. (Or maybe my search skills are terrible; last closest one I saw was from 2012 and an integrated vascular intern...).

Current PGY4 in general surgery. Overall enjoying my life. Happy to answer any questions!

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[907914]

I haven't seen an AMA thread for a general surgery resident yet. (Or maybe my search skills are terrible; last closest one I saw was from 2012 and an integrated vascular intern...).

Current PGY4 in general surgery. Overall enjoying my life. Happy to answer any questions!

Thanks for helping us out!

I was curious, what would you say your average week is like in regards to hours worked, the work you perform etc. I know the regulation is something like "80 hours a week averaged over a 4 week period." Do you ever feel pressured to exceed that/not report all hours?

 

[WinslowPringle]

Thanks for helping us out!

I was curious, what would you say your average week is like in regards to hours worked, the work you perform etc. I know the regulation is something like "80 hours a week averaged over a 4 week period." Do you ever feel pressured to exceed that/not report all hours?

My program works very hard to make sure there is appropriate institutional support so that we are not mandated to go over the average 80hr over 4 weeks.
Average week varies depending on the rotation, case load, number of inpatients, and how efficient and/or anal-retentive you are. Lightest weeks are about 60 hours for me. Pretty consistently 70-80hours is usual. It's not so much the day to day stuff, but the weekend call that pushes me over. There is no official pressure to not report all hours. I just finished logging my hours for this month!

 

[boundlesscorpuscle]

Thanks so much for offering to answer our questions!

What drew you to general surgery? Did you always see yourself in a surgical specialty or did you discover your passion for it during medical school? Do you plan on becoming a general surgeon, or pursuing a surgical subspecialty and doing a fellowship?

 

[965978]

Alright, so what is and isn't accurate about Grey's Anatomy?

 

[WinslowPringle]

Thanks so much for offering to answer our questions!

What drew you to general surgery? Did you always see yourself in a surgical specialty or did you discover your passion for it during medical school? Do you plan on becoming a general surgeon, or pursuing a surgical subspecialty and doing a fellowship?

I enjoy fixing things and working with my hands. Knew I'd be a surgeon since I was a kid.
I like general surgery - currently interested in a subspecialty but open to remaining general. Have some long-range plans that I'd like to have the option of retaining general surgery practice rights.

 

[WinslowPringle]

Alright, so what is and isn't accurate about Grey's Anatomy?

Accurate: All surgeons are actually that good looking. ;-)
Not accurate: All of the surgery and most of the drama...

 

[965978]

Accurate: All surgeons are actually that good looking. ;-)
Not accurate: All of the surgery and most of the drama...

So there is drama!

Spill the tea!

 

[907914]

I enjoy fixing things and working with my hands. Knew I'd be a surgeon since I was a kid.
I like general surgery - currently interested in a subspecialty but open to remaining general. Have some long-range plans that I'd like to have the option of retaining general surgery practice rights.

In regards to staying general surgery, unless you are in a rural/under served area, do you actually get to do many non-abdominal cases in a large health system/major hospital? This may just be premed nativity, but aren't pretty much every other areas of the body covered by a different surgical specialty?

 

[WinslowPringle]

So there is drama!

Spill the tea!

Lol, snitches get stitches.....preferably 4-0 monocryl in a subcuticular fashion...

But of course there's drama. The world just keeps getting smaller - you go from a med school of what, 30 - 25o people to a residency cohort of 1-13/year in the larger hospital setting. But my drama won't be yours, so go make/enjoy your own!

 

[WinslowPringle]

In regards to staying general surgery, unless you are in a rural/under served area, do you actually get to do many non-abdominal cases in a large health system/major hospital? This may just be premed nativity, but aren't pretty much every other areas of the body covered by a different surgical specialty?

Depends on many factors - what do you mean by rural? Where do you train? What is the practice setting/pattern/environment of where you end up? What do you feel comfortable doing and how do you want to build your practice niche?

In general - you won't have to touch bones, you probably won't be doing endovascular, probably no neurosurgery (except taking care of the severe heads if you cover trauma), probably no parotid resections. Reasonable non-abdominal surgeries that could happen depending on lots of factors - lots of hernias, lots of lumps and bumps, melanomas, SLNBx, mastectomies/breast surgery, thyroid/parathyroid, skin grafts, lots of wound debridements, plenty of anorectal (not technically trans-abdominal but still GI), bronchs, VATs (for empyema), upper/lower endoscopy, fistula access, trauma cases, venous access.

 

[dodolol21]

Depends on many factors - what do you mean by rural? Where do you train? What is the practice setting/pattern/environment of where you end up? What do you feel comfortable doing and how do you want to build your practice niche?

In general - you won't have to touch bones, you probably won't be doing endovascular, probably no neurosurgery (except taking care of the severe heads if you cover trauma), probably no parotid resections. Reasonable non-abdominal surgeries that could happen depending on lots of factors - lots of hernias, lots of lumps and bumps, melanomas, SLNBx, mastectomies/breast surgery, thyroid/parathyroid, skin grafts, lots of wound debridements, plenty of anorectal (not technically trans-abdominal but still GI), bronchs, VATs (for empyema), upper/lower endoscopy, fistula access, trauma cases, venous access.

What are your thoughts on integrated training programs for cardiothoracic/vascular surgery? Do you think its advantegous to go down the traditional 5 year gen surg and then to a two to three year fellowship or would time be better spent at an integrated program?

 

[acslater99]

1. Do you feel as if you have a good work-life balance?

2. As you progressed through residency, do you see yourself getting more time off (i.e to enjoy with family, hang out with friends, etc) than you have during PGY1?

3. What’s a pros/cons list of general surgery?

Thanks a lot for doing this!

 

[WinslowPringle]

What are your thoughts on integrated training programs for cardiothoracic/vascular surgery? Do you think its advantegous to go down the traditional 5 year gen surg and then to a two to three year fellowship or would time be better spent at an integrated program?

Depends on the applicant's interest in the field, their competitiveness, career goals and desires for training. It's a good option for for the person who has known very early on that they want to do vascular or cardiothoracic (and probably more likely cardiac). It has also reinvigorated the fields in terms of competitiveness, too. The goal is to gain more dedicated exposure to your field and it's probably nice to be able to do what you want to focus on more and earlier. Some downsides could be that some places you could potentially be treated differently than the g-surg residents when on a general rotation; you may get less trauma/abdomen exposures; can lose the opportunity to be general surgery board certified. Overall, I would hope that both the integrated and traditional fellowships would stick around because there are advantages/disadvantages to each. There is definitely a plethora of research coming out in multiple respectable journals regarding the graduates of the integrated programs

 

[WinslowPringle]

1. Do you feel as if you have a good work-life balance?

2. As you progressed through residency, do you see yourself getting more time off (i.e to enjoy with family, hang out with friends, etc) than you have during PGY1?

3. What’s a pros/cons list of general surgery?

Thanks a lot for doing this!

1. Some days.
2. Ehh, depends on the rotation. And it depends on the person - when I was an intern, my chiefs came in after me and left before me, but I'm a workaholic and so come in before and leave after my interns often (not all the time).
3. Caveat: my list of pros/cons is going to be different from anyone else's list because it all depends on personal preference.
Pros: Operating. Short rounding. Short notes. See immediate effects of what you did. Get to be there for pretty big/important moments in people's lives (cancer, trauma, death/near-death, critical illness, etc). Operating. Broad exposure to lots of stuff. Lots of options for practice patterns or fellowships depending on what you want to do. Do what no other group of people can do. Awesome anatomy. Fix discrete problems. Probably more protected from mid-level creep (although one day there will probably be one year 'residencies' for 'operative general surgery NPs'...). Operating.
Cons: Long hours, long training. Can have lots of stress. Potential of lawsuits. You're there for scary moments in people's lives (cancer, trauma, death/near-death, critical illness, etc) and sometimes things don't go the way you and the patient/family want even though you do everything 'right'. People (including patients) take their stress out on you. You deliver a lot of bad news. Kind of the surgical dumping service - can babysit a lot of old lady falls, ortho, and neurosurgery trauma, not to mention the SBOs, pancreatitis, and vague abdominal pain you'll round on for a month but never operate on....

 

[PTPuser]

Are you in a 5 or 7 years program and why?

What sub-spec are you potentially looking into and why?

Thanks!

 

[dodolol21]

Short notes

the #1 pro I'm looking forward to /s

 

[WinslowPringle]

Are you in a 5 or 7 years program and why?

What sub-spec are you potentially looking into and why?

Thanks!

5 years, because the aging process exists and long enough training is already long enough and my debt is already high enough....
Looking into a certain sub-specialty because I like complex, technical things, big cases, big impacts of sick people that get better without drains and fistulas forever, the anatomy and physiology, team-work, innovation, and good outcomes...

 

[ciestar]

Well, as a resident, any tips for an MS3 who feels she is struggling with aspects of the surgery clerkship?

 

[WinslowPringle]

Well, as a resident, any tips for an MS3 who feels she is struggling with aspects of the surgery clerkship?

Depends on what the MS3 is struggling with.

Long hours? It's tough, keep your chin up, you'll get through it, and be thankful you aren't doing it for your lifetime.
Bad outcomes/death? Yeah, that's rough. Talk to someone you trust (religious leader/counselor/friend/fellow med student or a resident/attending)
Personality conflicts? Also tough; don't take anything personally and know it only lasts for X weeks before you can move on to a group where things mesh better. Vent with the others who have been there before.
The material? I think I used case files and one of those multiple question books to prep for the boards. Ask questions of fellow med students or residents when you can (but not in front of people higher up in the hierarchy so it doesn't seem like you are pimping up the food chain).

Feel free to PM if I can offer more specific help. You'll get through it! Try to learn what you can and try to relate what you're seeing to whatever you ultimately want to do.

 

[ciestar]

Depends on what the MS3 is struggling with.

Long hours? It's tough, keep your chin up, you'll get through it, and be thankful you aren't doing it for your lifetime.
Bad outcomes/death? Yeah, that's rough. Talk to someone you trust (religious leader/counselor/friend/fellow med student or a resident/attending)
Personality conflicts? Also tough; don't take anything personally and know it only lasts for X weeks before you can move on to a group where things mesh better. Vent with the others who have been there before.
The material? I think I used case files and one of those multiple question books to prep for the boards. Ask questions of fellow med students or residents when you can (but not in front of people higher up in the hierarchy so it doesn't seem like you are pimping up the food chain).

Feel free to PM if I can offer more specific help. You'll get through it! Try to learn what you can and try to relate what you're seeing to whatever you ultimately want to do.

Okay, maybe a better question..
What gives a student the “honors” nudge.

I keep falling on my face on the anatomy pimping. I cannot identify a lot of stuff and i freeze when asked, quite often. I get nervous tbh. My recall sucks and im not a visual learner in anyway so i really struggle. I sucked at gross anatomy too

 

[Tkc33]

Any advice for an incoming medical student who is thinking about gen surg?

 

[WinslowPringle]

Okay, maybe a better question..
What gives a student the “honors” nudge.

I keep falling on my face on the anatomy pimping. I cannot identify a lot of stuff and i freeze when asked, quite often. I get nervous tbh. My recall sucks and im not a visual learner in anyway so i really struggle. I sucked at gross anatomy too

Honors: shows up and gets work done (patients seen/notes written) by the time specified. Has reasonable plan (hint: address the diet, pain meds, bowel reg, fluids, and DVT prophylaxis). Knows what is going on with the patient. When asked: "Do you want to see a consult with me?" answers "Yes," not "I haven't eaten lunch yet....". Doesn't lie.
I personally don't care about actually getting all the right answers as long as they're somewhat ballpark and you can create a differential. I tend not to ask a lot of anatomy questions....Anatomy pimping (especially in the OR) is hard because the med student can't see anything.

For getting nervous - just state confidently the first thing that comes to mind and is the vicinity. Don't second guess yourself. Don't hedge.

Have you tried drawing things out? I drew a bunch of diagrams for arteries/veins. That stuff can be tricky. Surgical recall may be helpful. Develop some confidence in yourself - if you made it to med school, the grasp of anatomy required of a med student is not beyond you and you can do it! Before going into a surgery I would review: anatomy of the organ/area I was working on: blood flow, innervation, and relation to surrounding structures; indications for the surgery we were doing on the patient we were doing it on; basic complications; presentation of the patient and the classic presentation and differential for symptoms that this surgery would be used to address.

 

[WinslowPringle]

Any advice for an incoming medical student who is thinking about gen surg?

Back out while you can.

Seriously. Lots of debt, long hours, and stress in this field. Financially I would be far ahead at this point had I done just about anything else. It's not a sign of intelligence, machismo, or strength to say I'm going to be a doctor/surgeon or bust.

If you have very carefully evaluated yourself, your strengths and weaknesses and determined that your life goals and personality will best be served by this craziness, and you won't listen to advice to the contrary - then at least keep an open mind during med school. Do your best and realize that your best and everyone else's does not mean the same thing. Find a life outside medicine. Don't get suckered into a prestige trap. Think about what you want in your life overall and have a big-picture plan. Be able to roll with the punches and learn to deal with disappointment and failure.

 

[ciestar]

Honors: shows up and gets work done (patients seen/notes written) by the time specified. Has reasonable plan (hint: address the diet, pain meds, bowel reg, fluids, and DVT prophylaxis). Knows what is going on with the patient. When asked: "Do you want to see a consult with me?" answers "Yes," not "I haven't eaten lunch yet....". Doesn't lie.
I personally don't care about actually getting all the right answers as long as they're somewhat ballpark and you can create a differential. I tend not to ask a lot of anatomy questions....Anatomy pimping (especially in the OR) is hard because the med student can't see anything.

For getting nervous - just state confidently the first thing that comes to mind and is the vicinity. Don't second guess yourself. Don't hedge.

Have you tried drawing things out? I drew a bunch of diagrams for arteries/veins. That stuff can be tricky. Surgical recall may be helpful. Develop some confidence in yourself - if you made it to med school, the grasp of anatomy required of a med student is not beyond you and you can do it! Before going into a surgery I would review: anatomy of the organ/area I was working on: blood flow, innervation, and relation to surrounding structures; indications for the surgery we were doing on the patient we were doing it on; basic complications; presentation of the patient and the classic presentation and differential for symptoms that this surgery would be used to address.

I can’t believe people are ballsy enough to say no i havent eaten lunch yet...

Yet, two days this week I had 12 hour days without a spare second to eat. So, literally don’t eat the entire day. It sucks.

Props to you for doing surgery, though!

 

[lalalallala]

Back out while you can.

Seriously. Lots of debt, long hours, and stress in this field. Financially I would be far ahead at this point had I done just about anything else. It's not a sign of intelligence, machismo, or strength to say I'm going to be a doctor/surgeon or bust.

If you have very carefully evaluated yourself, your strengths and weaknesses and determined that your life goals and personality will best be served by this craziness, and you won't listen to advice to the contrary - then at least keep an open mind during med school. Do your best and realize that your best and everyone else's does not mean the same thing. Find a life outside medicine. Don't get suckered into a prestige trap. Think about what you want in your life overall and have a big-picture plan. Be able to roll with the punches and learn to deal with disappointment and failure.

Do you think that general surgery is different hours/lifestyle-wise from any of the integrated surgical speciality residencies like plastics or ortho?

I am also an incoming MS1 so I have a long ways to go and will obviously need to see what I like during MS3, but I really feel like operating is what I want to do. The only thing is that I definitely want to have some free time to have a relationship or exercise or something. From my shadowing I feel like the job options for attendings can be flexible on lifestyle if you find the right private practice group for example, but 5+ years of 80 hours a week is a lot. I had a surgery internship this summer where I was there with the residents 5am to 9pm Monday to Friday and 9-3 or so on Saturday and maybe 3 hours on Sunday or so and it was really tough to imagine doing that for years. I know that picking a career of 30 years based on 5 years doesn't make sense but still.

My second question is: do you think that the top residency programs for a speciality have worse hours? or is it program specific? and how do you figure out which programs have a decent culture when applying?

Thank you!

 

[drtribbiani]

How important would you say research is as a factor towards getting in to a general surgery residency? How much research is expected/ average? Thanks so much for doing this btw

 

[WinslowPringle]

Do you think that general surgery is different hours/lifestyle-wise from any of the integrated surgical speciality residencies like plastics or ortho?

I am also an incoming MS1 so I have a long ways to go and will obviously need to see what I like during MS3, but I really feel like operating is what I want to do. The only thing is that I definitely want to have some free time to have a relationship or exercise or something. From my shadowing I feel like the job options for attendings can be flexible on lifestyle if you find the right private practice group for example, but 5+ years of 80 hours a week is a lot. I had a surgery internship this summer where I was there with the residents 5am to 9pm Monday to Friday and 9-3 or so on Saturday and maybe 3 hours on Sunday or so and it was really tough to imagine doing that for years. I know that picking a career of 30 years based on 5 years doesn't make sense but still.

My second question is: do you think that the top residency programs for a speciality have worse hours? or is it program specific? and how do you figure out which programs have a decent culture when applying?

Thank you!

1. It can be. Again, a lot depends on how you set up your practice. For raw data, see the 2011 JAMA paper annual work hours across physician specialties: Annual Work Hours Across Physician Specialties. In very broad, general strokes I would say that plastics has much more of an elective lifestyle post residency than general surgery or ortho, but that's not dogmatic and there are regional and individual variations to that. As an aside, not sure what exactly is meant by integrated - typically I hear that used about integrated residencies; plastics has an integrated option or a traditional fellowship option. Last I knew, ortho was straight up ortho then fellowship.

2. You can have a relationship and exercise no matter what specialty you go into. But, yes, there are a lot of hours. And 5-7 years is still 5-7 years, it's nothing to sniff at.

3. You have to define "top". I happen to think I go to the best general surgery residency program in the US, but it's not a 'name brand place' and whenever I say the name nobody every faints or falls at my feet and says "Hail, to Thee, Resident of Man's Greatest Hospital...."

I think it's very program specific in terms of hours and expectations beyond the usual 70-80. The bigger-named places tend to be more hierarchical and may have more regimented hours, but it varies.

I looked for programs that told me I'd be operating early and often; I asked for case logs; I asked about daily routines; I asked about relationships with attendings. At the dinners, I looked to see if the residents joked around with each other, if they talked to each other, and how beaten up they looked. I looked at board pass rates. I asked what were peoples favorite operations to do or their most recent awesome case because I wanted to go somewhere where people were excited about surgery.

 

[WinslowPringle]

How important would you say research is as a factor towards getting in to a general surgery residency? How much research is expected/ average? Thanks so much for doing this btw

The NRMP publishes lots of data about matching: Main Residency Match Data and Reports - The Match, National Resident Matching Program

The Charting the Outcomes for allopathic seniors goes towards answering the research question (chart 9): https://mk0nrmpcikgb8jxyd19h.kinsta...arting-Outcomes-in-the-Match-2018-Seniors.pdf

as does the Program Director Survey: https://mk0nrmpcikgb8jxyd19h.kinsta...NRMP-2018-Program-Director-Survey-for-WWW.pdf

Overall I found it helpful but not the most important piece when applying broadly and looking at just matching somewhere. It gives you something to talk about in interviews. However, if you are wanting to go to a big-name academic research institution, it is de rigeur.

 

[OrthoTraumaMD]

When I was an intern, we had a bunch of gensurg interns (categorical not prelim) switch into IM due to malignancy/unhappiness in the program. I haven’t heard of such things happening more recently which I guess is good. Do you think such things are program specific or is it just something about general surgery that makes people quit? I don’t see it happening in the subspecialties like uro, ortho, ent.

 

[WinslowPringle]

When I was an intern, we had a bunch of gensurg interns (categorical not prelim) switch into IM due to malignancy/unhappiness in the program. I haven’t heard of such things happening more recently which I guess is good. Do you think such things are program specific or is it just something about general surgery that makes people quit? I don’t see it happening in the subspecialties like uro, ortho, ent.

I think that's a question that a lot of PDs are asking and there is some interesting research on the topic: Status of Resident Attrition From Surgical Residency in the Past, Present, and Future Outlook. - PubMed - NCBI (Shweikeh et al Status of resident attrition... J Surg Educ 2018) and Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-analysis. - PubMed - NCBI (Khoushhal et al Prevalence and causes of attrition among surgical residents, JAMA Surg 2017) are some papers I've read, and the Khoushhal piece caused some controversy I think with their sex-specific findings.

I think a lot of it is program specific, person specific, and some things endemic to general surgery.
Program wise: there are definitely malignant programs out there, where the surgery residents are used as manpower with a strict hierarchy and varying levels of operating and autonomy. Overall I think this is improved from what I have heard about 25 years ago though.

Person wise, I think that general surgery has a broader pull of applicants of varying strengths than the subspecialties have and it is probably more likely that a person may get into general surgery as a 'back up' than those going into the subspecialties. This probably increases likelihood of 'jumping ship' if things don't go as planned (although with marginal candidates could also be somewhat protective if just from the sense of just wanting to be a practicing physician and not thinking one could switch fields). There are probably broadly speaking lower entry requirements to general surgery than the subspecialties; there may be more of a sunk cost fallacy to the subspecialties. Those in the subspecialties may have a firmer grasp of their end-goal practice pattern; some people choose general surgery because they are relatively undifferentiated and just think "Hey, I like surgery" without really considering the specific patient populations and daily workload of general surgery. General surgery also tends to have fewer requirements for aways, sub-Is, etc; it may be that medical students are not getting a realistic view of the workload of general surgery (whereas from what I have seen for ortho, they work those AIs harder than interns).

General surgery wise, I also think it may not live up to expectations. There is a lot of not-operating. I mean, think of all the little old lady falls with unilateral superior pubic ramus fractures with severe pain who can't ambulate that ortho doesn't admit but trauma does because she needs her three midnights for placement...General surgery also can have a high census of patients with medical disasters which is mentally draining and resource draining. There may also be a discrepancy in desired and perceived clout/reputation/respect from the other specialties/other people .

 

[solitarius]

On the misery scale of 1/10 (10 being absolute hell), how miserable is it being a general surgery resident?

 

[WinslowPringle]

On the misery scale of 1/10 (10 being absolute hell), how miserable is it being a general surgery resident?

And 1 is what? What are the integers? Overall, it depends on the person, the program, the day, the patient census and a lot of factors.

Most days are ok to goodish. I do things I like, I fix problems and accomplish things, things go well in the OR, and people are making progress. There have been times that I would rate above a 7 (depending on your integers to this scale) for misery. There have been times that I would rate as 2. Most of the time it's probably around a 4.

 

[907914]

And 1 is what? What are the integers? Overall, it depends on the person, the program, the day, the patient census and a lot of factors.

Most days are ok to goodish. I do things I like, I fix problems and accomplish things, things go well in the OR, and people are making progress. There have been times that I would rate above a 7 (depending on your integers to this scale) for misery. There have been times that I would rate as 2. Most of the time it's probably around a 4.

How do you feel quality of life/stress of residency and work life balance would change if you had a spouse and child (assuming you don’t already)? Basically, do you think gen surgery residency would be possible with family

 

[solitarius]

GS is supposed to be the most miserable residency of them all, but many of the other surgical residencies are bad. And internal medicine is bad.

 

[907914]

GS is supposed to be the most miserable residency of them all, but many of the other surgical residencies are bad. And internal medicine is bad.

This is the very reason that I am only intent on physiatry or Pathology....

 

[RTC19]

When myself and my family members have been in the hospital, I notice people tend to round quite early in the morning.

Are those 80 hour work weeks more concentrated to the early mornings? Around what time do you normally get home from work?

 

[OrthoTraumaMD]

I think that's a question that a lot of PDs are asking and there is some interesting research on the topic: Status of Resident Attrition From Surgical Residency in the Past, Present, and Future Outlook. - PubMed - NCBI (Shweikeh et al Status of resident attrition... J Surg Educ 2018) and Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-analysis. - PubMed - NCBI (Khoushhal et al Prevalence and causes of attrition among surgical residents, JAMA Surg 2017) are some papers I've read, and the Khoushhal piece caused some controversy I think with their sex-specific findings.

I think a lot of it is program specific, person specific, and some things endemic to general surgery.
Program wise: there are definitely malignant programs out there, where the surgery residents are used as manpower with a strict hierarchy and varying levels of operating and autonomy. Overall I think this is improved from what I have heard about 25 years ago though.

Person wise, I think that general surgery has a broader pull of applicants of varying strengths than the subspecialties have and it is probably more likely that a person may get into general surgery as a 'back up' than those going into the subspecialties. This probably increases likelihood of 'jumping ship' if things don't go as planned (although with marginal candidates could also be somewhat protective if just from the sense of just wanting to be a practicing physician and not thinking one could switch fields). There are probably broadly speaking lower entry requirements to general surgery than the subspecialties; there may be more of a sunk cost fallacy to the subspecialties. Those in the subspecialties may have a firmer grasp of their end-goal practice pattern; some people choose general surgery because they are relatively undifferentiated and just think "Hey, I like surgery" without really considering the specific patient populations and daily workload of general surgery. General surgery also tends to have fewer requirements for aways, sub-Is, etc; it may be that medical students are not getting a realistic view of the workload of general surgery (whereas from what I have seen for ortho, they work those AIs harder than interns).

General surgery wise, I also think it may not live up to expectations. There is a lot of not-operating. I mean, think of all the little old lady falls with unilateral superior pubic ramus fractures with severe pain who can't ambulate that ortho doesn't admit but trauma does because she needs her three midnights for placement...General surgery also can have a high census of patients with medical disasters which is mentally draining and resource draining. There may also be a discrepancy in desired and perceived clout/reputation/respect from the other specialties/other people .

Very well formulated answer. Thank you.

 

[WinslowPringle]

How do you feel quality of life/stress of residency and work life balance would change if you had a spouse and child (assuming you don’t already)? Basically, do you think gen surgery residency would be possible with family

I happily have an SO and family. I think it's possible. Not easy, but worthwhile.

 

[WinslowPringle]

When myself and my family members have been in the hospital, I notice people tend to round quite early in the morning.

Are those 80 hour work weeks more concentrated to the early mornings? Around what time do you normally get home from work?

The expectation is that I have my patients seen, notes and orders done, people seen in pre-op, and attendings updated by OR start time (usually around 0700-0730). How early I have to start depends on how many patients I have, how sick they are, who else is on the service; usually start rounding 0530 but it varies from 0430 to 0600. I have never gotten to the hospital later than 0630. Some residencies are more regimented, so you do chief-led group rounds - intern gets there 0430-0500 to 'get the numbers', midlevel is there ~0530 to review things/pre-round, and chief is there at ~0600 and then you actually round and the chief then goes off to talk to the attendings.

I usually get home around 1800 on a 'good' rotation. Over the last two months I've been home before 1930 only once. Call is handled differently at different programs, but you get four total days off a month. So on the four weekend days I work it's a 24-hour dedicated call day, and then finishing whatever rounding/patient care didn't get done when holding the call phone.

 

[RocuROMANium]

What’s your opinion on robotics like the da Vinci? We have them at our hospital but to me it just seems wrong. It’s so strange for the surgeon to be across the room doing the operation instead of right there in the patient. But hey, if it decreases the risk for post-operative infection and you guys think it’s better for the patient then of course it’s a great device.

 

[WinslowPringle]

GS is supposed to be the most miserable residency of them all, but many of the other surgical residencies are bad. And internal medicine is bad.

"Life is pain...Anyone who says differently is selling something..."

 

[M&L]

what is the oldest surgical resident you've met? I will be 37 when i finish medical school.... I know it sounds messed up, but am i too old? (I dont know if the gender matters, but i am a female. No kids yet... No husband yet.. No life yet )) )

 

[WinslowPringle]

What’s your opinion on robotics like the da Vinci? We have them at our hospital but to me it just seems wrong. It’s so strange for the surgeon to be across the room doing the operation instead of right there in the patient. But hey, if it decreases the risk for post-operative infection and you guys think it’s better for the patient then of course it’s a great device.

What's your exposure to robotics?
I guess it is a little bit of a different paradigm. Surgery is a physical specialty and you do lose some of that physicality with the robot. It also doesn't have haptic feedback the way lap surgery does. However, I'm doing the same things robotically as I would be laparoscopically.

I'm not aware of research that robotic surgery decreases infection rate compared to laparoscopic or open surgery, what I've seen it's roughly the same. (Eg, Surgical site infection rates in robotic and laparoscopic colorectal surgery: a retrospective, case-control audit. - PubMed - NCBI, Incidence of surgical site infection associated with robotic surgery. - PubMed - NCBI - not the best designed study, though.) There is a plethora of research on outcomes with the robot, broadly speaking outcomes in general surgery fields the outcomes in hands of experienced surgeons are pretty similar.

I love using the robot, though. It really changes the operative experience and makes some tricky dissections really fun. I like it most for esophageal/mediastinal work and ultra-low anterior resections. Anecdotally people seem to have less pain (I don't have access to some of the liposomal bupivicaine and whatnot that can make some open surgeries less painful...). Also have had more than one patient go home POD1 from a robot assisted sigmoidectomy, which is pretty cool.

 

[RTC19]

The expectation is that I have my patients seen, notes and orders done, people seen in pre-op, and attendings updated by OR start time (usually around 0700-0730). How early I have to start depends on how many patients I have, how sick they are, who else is on the service; usually start rounding 0530 but it varies from 0430 to 0600. I have never gotten to the hospital later than 0630. Some residencies are more regimented, so you do chief-led group rounds - intern gets there 0430-0500 to 'get the numbers', midlevel is there ~0530 to review things/pre-round, and chief is there at ~0600 and then you actually round and the chief then goes off to talk to the attendings.

I usually get home around 1800 on a 'good' rotation. Over the last two months I've been home before 1930 only once. Call is handled differently at different programs, but you get four total days off a month. So on the four weekend days I work it's a 24-hour dedicated call day, and then finishing whatever rounding/patient care didn't get done when holding the call phone.

Thanks so much for the response!

 

[907914]

What’s your opinion on robotics like the da Vinci? We have them at our hospital but to me it just seems wrong. It’s so strange for the surgeon to be across the room doing the operation instead of right there in the patient. But hey, if it decreases the risk for post-operative infection and you guys think it’s better for the patient then of course it’s a great device.

I have sat in on 7 laparoscopic surgeries and 4 open (all prostectomies shadowing a urologist) and, at least as a naive premed observer, the Da Vinci seemed to have a lot less bleeding, the surgery was faster, and the patients seemed in less pain afterwards. I am curious to see what the opinions of other surgeons are!

Edit: I see you called laparoscopic different than the robot - what is the difference? I just thought the davinci was laparoscopic...

 

[WinslowPringle]

what is the oldest surgical resident you've met? I will be 37 when i finish medical school.... I know it sounds messed up, but am i too old? (I dont know if the gender matters, but i am a female. No kids yet... No husband yet.. No life yet )) )

One person as an intern ~40yo who quit general surgery residency.
I can't tell you if you're 'too old' or not. I can tell you it's probably not the most financially wise decision, but of course, you'd have to run those numbers for yourself. Only you can count the cost of regular shifts of 24hours without sleep. I know I would not be doing surgical residency if I were starting in my 40s.

I also think the days of only operating and nothing else and ignore all life outside the OR is gone. Every post-undergrad interview I've gone on, the attendings have asked about "What about life outside the OR?" They want to know I'm a decent human being and not an automaton. I'd recommend anyone interested in surgery develop a life and identity outside of surgery. It can help you with the difficulties of med school/residency and overall it's just a good idea; we need to be human first and doctors second. You must develop boundaries and clear separations between work and the rest of life because medicine will take everything you have to give it and then come back asking for more.

So, gently - get a life

 

[WinslowPringle]

I have sat in on 7 laparoscopic surgeries and 4 open (all prostectomies shadowing a urologist) and, at least as a naive premed observer, the Da Vinci seemed to have a lot less bleeding, the surgery was faster, and the patients seemed in less pain afterwards. I am curious to see what the opinions of other surgeons are!

Edit: I see you called laparoscopic different than the robot - what is the difference? I just thought the davinci was laparoscopic...

Yes, the DaVinci is great for navigating in narrow spaces, like the male pelvis. It has made significant changes to urologic practice for prostatectomies in my practice community - but that's coming from a relative outsider in general surgery.

Laparoscopic is used to refer to laparoscopic surgery - keyhole surgery, the one with the stick-like instruments, where you stand at bedside. Robotic surgery is when you do laparoscopic type surgery with the robot, which has a patient cart with joists that extend over the patient; the instruments have joints and allows you to move the instruments within the patient with multiple degrees of freedom while seated at a console.

This is what a laparoscopic surgery can look like.
This is what robotic surgery can look like.

 

[907914]

Yes, the DaVinci is great for navigating in narrow spaces, like the male pelvis. It has made significant changes to urologic practice for prostatectomies in my practice community - but that's coming from a relative outsider in general surgery.

Laparoscopic is used to refer to laparoscopic surgery - keyhole surgery, the one with the stick-like instruments, where you stand at bedside. Robotic surgery is when you do laparoscopic type surgery with the robot, which has a patient cart with joists that extend over the patient; the instruments have joints and allows you to move the instruments within the patient with multiple degrees of freedom while seated at a console.

This is what a laparoscopic surgery can look like.
This is what robotic surgery can look like.

Gotcha, so I have seen robotic not laparoscopic.

Thank you for the feedback!

 

[M&L]

One person as an intern ~40yo who quit general surgery residency.
I can't tell you if you're 'too old' or not. I can tell you it's probably not the most financially wise decision, but of course, you'd have to run those numbers for yourself. Only you can count the cost of regular shifts of 24hours without sleep. I know I would not be doing surgical residency if I were starting in my 40s.

I also think the days of only operating and nothing else and ignore all life outside the OR is gone. Every post-undergrad interview I've gone on, the attendings have asked about "What about life outside the OR?" They want to know I'm a decent human being and not an automaton. I'd recommend anyone interested in surgery develop a life and identity outside of surgery. It can help you with the difficulties of med school/residency and overall it's just a good idea; we need to be human first and doctors second. You must develop boundaries and clear separations between work and the rest of life because medicine will take everything you have to give it and then come back asking for more.

So, gently - get a life

Currently I work in an addiction treatment facility and I frequently pull up to 36 without sleep (overnight shifts and full time school schedule), and I am fine with that . It is weird , but my brain actually stays sharp . After 36 hours - rough . I am also very good at concentrating for hours non-stop. So I am not really worried about my body handling it per se , as I am kind of wondering if it is even normal to be a 37-42 year old resident, you know ? Like , would attendings treat me differently because I am older ? Would I not get same opportunities career wise because I am older? I know these questions might sound crazy for someone in early 20s, but I feel like you have to think about it when you start Med school later , you know ? Am I wrong ?