General Surgery v/s Internal Medicine: Residency Conundrum

[russianalt]

Hello Colleagues,

I have a classic case of "split between which medical field to consider?". I am in the process of taking my boards and want to apply for next year (2016) residency match. I am confused about which medical field to pursue. I am an IMG (YOG=2008), completed MPH and have over 5 years of clinical research experience in the U.S. I am currently a Cardiology a research fellow, which entails heavy clinical, translational, educational expectations as well as responsibilities. Have multiple publications, conference presentations, clinical rotations, strong recommendations and extensive U.S education/employment to back up my case.

I have always had an intrinsic draw towards procedures (I am a totally hands-on person!), but had long ago excluded Surgical Residency from my aspirations due to the IMG status. As I work closely with many surgery faculty, I have scrubbed-in on many simple/complex cases. Multiple of them have suggested I should consider a Gen-Surgery Residency. These words of advice have awakened a long slumbering giant inside me. I know that Surgery is a very challenging field, but I also know that once I get involved into it, I'll do very good justice to the profession. It sounds reasonable that I want to go for a challenging specialty after carefully spending time on an informed decision. But the down side is I am not sure how my personal life will pan out during these 5+ years of GME. Its not that long working hours will be a new thing for me (I work 60-70 hrs/week anyways), but I want to balance my profession (Surgery/IM), family and other career aspirations as well. Its not that I want to spend consistently 30-40% of my time with family, but I want to be a part of life of my wife-to be, parents, kids etc. I also want to stay involved in clinical research, contribute to healthcare and apply my efforts for improvement of the medical science. I am not sure whether these things will be possible along with a career in Surgical specialties. This is more of a question for you all who are currently in the profession.

On the other hand, owing to my rich history of clinical experience, research and scholarly work, I already have a strong intellectual foundation (thinking, reasoning, didactic, etc.) necessary for Internal Medicine. Plus, I have seen many IM attendings carve out a clinical research career along with a successful clinical practice.

With so much of Cardiology clinical research experience (>2 years), I want to end up in a Cardiology practice (Medicine/Surgery).

I am confused which way to proceed and am currently gathering inputs from all sources. Whichever way I decide, I will need to do some more clinical rotations and talk to pertinent faculty and career experts. Moreover, there is the ever dominant complexity of me being an IMG, long from YOG, etc. I dont think visa will be an issue in the future.

What are you all's inputs in this? Appreciate all the help.

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[Winged Scapula]

Ignoring IMG/YOG, etc:

Do you want to be a surgeon and do surgeries or do you want to be a cardiologist and do procedures? They are very different.

This is the first step. Everything else can be sorted out.

 

[dienekes88]

Agree c above.

When you're talking about cardiology and procedures... In my experience, the interventionalists typically don't do much inpatient management and don't round. Almost all of the inpatient and outpatient management decisions are left to the general cardiologists. It's pretty fun, but there is a completely different physician-patient relationship between doing a diagnostic cors or a right heart vs. even taking out someone's gallbladder. There's also a big difference between getting radial access with a 6Fr Glide Slender then positioning a TIG4 and doing a posterolateral thoracotomy to cut out Stage II NSCLC and do a complete MLND. Think about that for a few minutes.

With respect to your research aspirations... there are many surgeon-scientists out there. You may want to ask around at your institution and find out how they do it.

 

[russianalt]

@Winged Scapula & dienekes88,
Thanks for your inputs colleagues. I think you have hit the core of my confusion "what do I want to eventually do?". Unfortunately, this has been hounding me ever since I heard about the possibility of being considered for a Surgical Residency. I am having trouble deciding it. Before this, it was simple: finish research fellowship, apply for IM, keep building CV profile, pursue application for CV Medicine fellowship and let the ship sail. Now,,,,,, its a little confusing; knowing that a surgical career is possible (one of the most hardcore fields of medical professions, where you actually provide first hand treatment intervention and see immediate aftermath of it).

I do want to do surgeries. But realistically the not so attractive side of this is that I will have to start from scratch. It will mean taking up a new challenge and exploring exciting avenues of the trade. And if you look from another perspective, if I go for Internal Medicine, I can use that time (6-8 years) in strengthening what I already have (knowledge, approach, colleagues, connections, ideas, etc.). Surgery pathway sounds as if I will have to break new ground, lay the ground work and then start the construction (getting a good grip will take at least 5-8 years). On the other hand, I have things ready in IM; all I would need to do is review foundation briefly and then start with the construction very soon (3-4 years). Moreover, one of a very reputed CT surgeons recently told me that CT surgery is not a wise decision, because it sounds glorious but the compensation (spiritual & monetary) is not adequate. He actually asked me to stick to Cardiology, saying "Cardiologists actually make more money than us (CT surgeons) compared to the amount of constant craziness that we go through".

Sorry, I don't want to sound pretentious (or to some extent obvious or negative) but my immediate concern is deciding which pathway to go; that's where I need help figuring out. Applying and getting an admission is another dragon, which I will handle once I reach that bridge (Super Mario Bros reference implied!! ). Sometimes I feel as if I am having cold feet about leaving the luxury of my known field and jumping into a new one. Or maybe I am genuinely ill informed about the realities of both the fields. Whichever the case be, I believe its best to discuss with you colleagues and get substantial inputs from people in different phases of these fields.

Is there anyone else who has/had similar situation? How did you handle that? Does anyone else have any useful technique or idea?

A more specific question for Attending/PD/Senior level members:
How do you address it if a medical student comes to you asking career advice and says "I don't want to follow the herd and just jump into some residency spot, I dont want to waste too much time, but I am also unsure which field (Surgery/General Medicine) to pursue?"
Which techniques would you suggest him/her?
What helps while setting career goals?

 

[WhateverMang]

This may not be helpful at all and may make you even more undecided and confused but I also enjoyed both medicine and surgery and chose anesthesiology because it truly is a hybrid of the two. We are considered "the internists of the OR" and we obviously participate daily in the care for surgical patients. We are directly involved in the surgeries and we do many cool procedures on a daily basis (bronch, TEE, various forms of venous and arterial access, pulmonary artery caths, regional blocks, neuraxial blocks, not to mention all the cool airway stuff ie direct, video, and fiberoptic laryngoscopy, intubations, ventilator management etc.

You said you enjoy surgery because "you actually provide first hand treatment intervention and see immediate aftermath of it." I would argue that this is one of the biggest reasons people choose anesthesiology... immediate gratification; you push a drug and see its effects immediately. Also, you could put your cardiology experience to work by persuing a cardiothoracic anesthesiology fellowship where you would, in addition to what a general anesthesiologist does, perform, interpret, and make diagnoses using live 2D and 3D TEE as well as provide medical care during surgery for patients with complex cardiac pathology.

Also you mentioned lifestyle and family as being important. Anesthesia is generally better than surgery and probably on par with interventional cardiology in terms of lifestyle after residency. The training is MUCH shorter though. You could do anesthesia then CT fellowship in 5 years (just 4 if you already did your intern year) as opposed to 6-8 for medicine and what is it, 8 or 9 years for CT surgery?? Sounds like a long, long road to me especially for someone with YOG 7 years ago.

Just something to think about.

If anesthesia does not appeal to you at all however, then disregard everything I said and decide if you want to do surgery and be in an OR taking care of surgical patients, or, be an interventionist in the cath lab and the clinic taking care of medical patients. I agree that once you decide that, you have made your decision. It sounds like your back ground would make you a shoe in for medicne/cardiology, but I do understand the allure of another intriguing specialty when someone tells you that you could do well in it when you never considered it before.

If I were you I would stick to what I know and go into cardiology. There is probably a reason you chose/ended up doing cardiology research and if you still enjoy it, why start from scratch in something else? Besides, the surgeon lifestyle is really tough. Just my 2 cents.

 

[jthedestroyr]

This may not be helpful at all and may make you even more undecided and confused but I also enjoyed both medicine and surgery and chose anesthesiology because it truly is a hybrid of the two. We are considered "the internists of the OR" and we obviously participate daily in the care for surgical patients. .

^ This. I really loved surgery too (I got awards in Ortho), but I couldn't see myself just doing any of the surgical fields since ortho specializes (boring) and GS is way more clinic than I'd ever want. Anesthesiology was the natural fit for me as well and you might as well enjoy it.

Second note, I've heard of IMGs with Step scores >250s, 260s barely getting many interviews in surgery, to only landing surgery prelim IE road to no where, as opposed to Anesthesia that would put you in very strong footing for almost anywhere except the top programs that don't fill with IMGs.