General Surgery - WHY SO LONG?!?!

[europeman]

So, I'm applying into general surgery residency. I'm not sure if I will do academics or private, but whatever; I want to go to a good academic residency. Most places require 2 years of research.

CAN SOMEONE PLEASE EXPLAIN TO ME THE HISTORY of how this came to be? I mean, I'm looking a the CV's of all the chairman, and crazy academic attendings who are cardiothoracic, and vascular, and onc... and they all did like 7, MAX 8 years total post medical school training. BUT NOW, if you want to do anything competitive through general, it's like 9-10 years. That's ridiculous. How did this come about?

I know there are a few fast track programs, thank god, but they are few and far between.

It seems to me that too many people are doing 2 years of research simply to be "more competitive' in order to broaden their ability when it comes to fellowship application time; obviously all of them are not going into research careers.

Any good surgery programs that don't force you to do research?

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[Anka]

There's a number of them. Emory comes to mind.

Anka

 

[europeman]

Thanks. I was sorta asking rhetorically if there are any top programs w/o forced research. Instead, i'm interested in ideas and thoughts about how this came to be.

I mean, I know there is more to learn than there was 15 years ago. Still, it just seems like way too much. In Neurosurgery, residency is 7 years, whereby 1 of those years incorporates a year of research AND another year typically gives residents some elective time to actually complete part of their fellowship requirements; hence, most neurosurgery fellowships are only an additional year.

Not that neurosurgery is more difficult, or entails a lot more stuff to learn; it's like comparing apples to oranges. However, it's certainly not a field that has a lot LESS material than general surgery. Hence, it just seems weird that after 7 years of general surgery training (i.e. w/2 years of research) you are qualified to be a general surgeon, which, now-a-days limits you to a handful of bread and butter stuff. Whereas after 7-8 years of neurosugery, you are a subspecialist and capable of doing a lot.

weird.

Think about it. Med school is more competitive than ever now. A good number of kids go into medical school with an additional year after college of research. Then lots of medical schools even encourage an extra year of research. I just think it's nuts.

I should have done those 6 year high school to BS/MD accelerated programs, and then done neurosurgery! I'd be an attending at the young age of 31. Oh wait, that's not even THAT young!

Instead, it'll be like i'll be done w/fellowship thru general surgery at age 37. Ridiculous.

 

[gasnewby]

another piece of the puzzle is that some residencies put you in the lab so there are more bodies available for call...in order to keep the clinical residents in compliance with the 80 hour week.

 

[europeman]

sure, perhaps, but that's hardly a good reason to force 2 years of research! Plus, the 80 hour work week is something every speciality needs to deal with - not just general surgery.

 

[gasnewby]

sure, perhaps, but that's hardly a good reason to force 2 years of research! Plus, the 80 hour work week is something every speciality needs to deal with - not just general surgery.

i agree, it's bad to force your residents into research!

i don't know about other specialties, but i think getting enough surgery bodies for in-house call (especially at busy trauma centers) and keeping everyone under 80 hours is pretty difficult. there are at least six surgical residents in house on call at our main hospital. this does NOT include the cicu and sicu, which are also staffed by surg residents (along with other specialites). so ~30-100% of the time, there are 8 surgical residents in house at night. the 80 hour rule will lengthen residency. it sucks.

 

[Pilot Doc]

Not sure of the history of surgical research - but it's a well established practice and I would disagree that this is some new phenomenon. e.g. The classic Duke "Decade with Dave" referred to the required 2 years of research to be considered for the then very competitive CT fellowship. There's an article somewhere (I'll find the citation if you want) surveying SUS and ASA members - a large number (? majority) did research in residency.

As for using research residents for call coverage, a number of programs do that, but it hasn't changed much post 80-hours and that's a pretty inefficient way to fill the call schedule, anyway. No serious research program has it's residents carry more than a trivial call load. You can cover 3 calls a month way cheaper than keeping a lab resident around at an annual cost of $60K.

 

[Winged Scapula]

I would also take issue with the comment that as a general surgeon you are "limited to bread and butter". That may be, but its generally not a function of your training but rather the environment in which fellowship trained surgeons take a piece of the pie.

There are plenty of communities in which general surgery trained people do much more than "bread and butter".

 

[Faebinder]

Everything is getting harder. More people are graduating and more IMGs/FMGs are applying and the number of residencies are the same (Thank you misses clinton for being a dumb ass) and so programs have their pick and they choose whomever will shut up and do the work. You really can't do anything about it at this point unless they lift the caps or find another way to supply money for residents. For now, you have to play along.

Research btw is not a requirement for community centers. It's a requirement for many university centers cause they want to produce academic surgeons. Academic surgeons must be able to do research and MUST do research while in academia otherwise they dont advance up the ranks of the department. Research is required by all Universities (not just the medical college) to advance a professor from assistant to associate to full (your salary goes up as well). Plus the research brings in money to the department.

It sounds like you would rather go into private practice. Do you really need to pick a university based residency? What benefit will you get from the 2 years research if you dont want to go into academic medicine?

 

[gasnewby]

Everything is getting harder. More people are graduating and more IMGs/FMGs are applying and the number of residencies are the same (Thank you misses clinton for being a dumb ass)

Yes, clearly it's all hiliary's fault.

 

[njbmd]

Let's keep on topic folks. If you have a comment a specific post or something aimed at one poster, then send a PM (Private Message) to the poster. If you have a comment or an answer to the OP's question, then post so that all may benefit. Thanks!

To the OP: Look carefully at what academic physicians do in their practice. For many folks, myself included, my practice includes a significant amount teaching and research duties in addition to clinical work. The research time was golden. The other advantage of doing a couple of research years was that you are more competitive for fellowship by virtue of having plenty of time to read and study. This leads itself to making one stronger in the senior years of residency and lends itself to stronger ABSITE scores.

The "fast-track" programs are great for folks who are very sure of what they want to do in practice. Unfortunately, many folks need a couple of years to make this type of decision because you don't get a ton of operative experience during PGY-1 and PGY-2.

Many of my fellow residents (especially women) welcomed the research years as a time to start families and gear up for the senior years. Those research years may be time well spent for most folks. If not, then there are plenty of people who elect no to enter programs that require research.

 

[gasnewby]

Let's keep on topic folks. If you have a comment a specific post or something aimed at one poster, then send a PM (Private Message) to the poster. If you have a comment or an answer to the OP's question, then post so that all may benefit. Thanks!

like your post last week?

That which does not burn on the way down does not make thee stronger! Seriously, Jamaican Rum is flammable but an ounce or two in your pineapple juice can make you feel much better if you are ailing.

sure, no problem boss

 

[gasnewby]

As for using research residents for call coverage, a number of programs do that, but it hasn't changed much post 80-hours and that's a pretty inefficient way to fill the call schedule, anyway. No serious research program has it's residents carry more than a trivial call load. You can cover 3 calls a month way cheaper than keeping a lab resident around at an annual cost of $60K.

- our research residents take more than 3 calls a month. they are often plugged into the schedule for maternity leave, vacations, etc.
- the hospital/program pays $0 in salary, as these positions are funded by grants (although they do pay for health insurance/book money)
- i don't know of any residency that pays 60K/year. More like mid-high 30s, low 40s for the chiefs.

 

[Pilot Doc]

- our research residents take more than 3 calls a month. they are often plugged into the schedule for maternity leave, vacations, etc.

Ours don't. I'm sure it varies by program. A substantial number have no clinical duties at all.

- the hospital/program pays $0 in salary, as these positions are funded by grants (although they do pay for health insurance/book money)

Those NIH grants are not easy to come by and most departments significantly subsidize research resident salaries.

- i don't know of any residency that pays 60K/year. More like mid-high 30s, low 40s for the chiefs.

The number I quoted was cost to the department including salary, FICA and benefits. Source available if you want it.

 

[Winged Scapula]

Ours don't. I'm sure it varies by program. A substantial number have no clinical duties at all.

Ours had no official clinical duties, although they did get pulled on rare occasions (ie, emergencies) or at the end of the year when the Chiefs have left.

The number I quoted was cost to the department including salary, FICA and benefits. Source available if you want it.

And salaries for Chiefs can easily approach or exceed 50K in many places; so 60K including benes is not unreasonable at all.

 

[europeman]

Let me clarify I guess...

I'm applying into general surgery now. What I'm noticing as I look at the CVs of the GREAT MAJORITY of attendings is that they did *NOT* do 2 years of research during residency. Hence, this *MUST* be a relatively new phenomenon. I mean, I know the "decade with dan" at duke or whatever... i know that's been like that for a while. But, that seems to be the exception. Look at all the program directors, and professors, and they did not do 7 years of residency and 2-3 years of fellowship. Yes I know, chairs tend to be an exception; but are we only training future chairs?




...
sorry for the bread and butter comment.

Chiefs where I'm at make 60. It's starting 48 for interns, and about 2k every year you go up. Then the administrative chief get an extra 5-6 grand. That's over 64K! 🙂

 

[Winged Scapula]

No need to apologize for the bread and butter comment...I just wanted to clarify for those who might read this and think that Gen Surg ONLY did B&B stuff.

But I understand where you are coming from...yes, we have always had people who spent time in the lab, but it does seem like its much more common. Perhaps its a function of fellowships becoming more commonplace, and therefore more competitive, so residents feel they have to do research to get into those programs?

 

[Blade28]

Let me clarify I guess...

I'm applying into general surgery now. What I'm noticing as I look at the CVs of the GREAT MAJORITY of attendings is that they did *NOT* do 2 years of research during residency. Hence, this *MUST* be a relatively new phenomenon. I mean, I know the "decade with dan" at duke or whatever... i know that's been like that for a while.

That's the "decade with Dave," after Sabiston. 🙂

Research seems to only be the norm for those residents seeking competitive fellowships such as Peds Surg, Plastics, Surg Onc and the like. It's much more varied among those seeking other fellowships.

I can't recall the exact number, but there actually aren't THAT many programs that require 1-2 years of research. And it's limited to the academic programs.

 

[Pilot Doc]

Hence, this *MUST* be a relatively new phenomenon.

I disagree.

At present, about 1/3 of surgical residents spend time in the lab. Roughly 1/2 for 1 year, half for two.

10 years ago, at least 20% of residents were spending time in the lab, at about the same 1 yr/2yr proportions. See Souba WW, Tanabe KK, Gadd MA, et al. Attitudes and opinions toward surgical research: a survey of surgical residents and their chairpersons. Ann Surg. 1996;223:377–383

And as mentioned above, there really are very few places that _require_ research. Not to mention that it makes a nice break from clinical practice. Find somewhere that has good moonlighting opportunities and you can make good $$ as well.

 

[Pir8DeacDoc]

Off the top of my head the only two places I can think of that require two years are Duke and UTHSCSA (UT-San Antonio).

 

[Blade28]

The Brigham also requires 2 years.

 

[DrDawg]

Think about it. Med school is more competitive than ever now. A good number of kids go into medical school with an additional year after college of research. Then lots of medical schools even encourage an extra year of research. I just think it's nuts.



Medical school is actually significantly less competitive now than ever. In the US last a checked there was less than 3 applicants per spot, and this number was trending down. What has changed is that there are a number of SAT/MCAT ect test prep companies and we have become better at testing.

Further I don't think that residency is getting any longer. Actually I think its the opposite. Many places are developing dedicated programs like those for vascular, CT, and plastics. Categorical residents are more or less assured that they will graduate in 5-7 years. I've also heard stories that in Neurosurgery you could go into the lab and not come out for years... Many fellowships don't require a research background, and not doing any in residency wont hurt you

 

[filter07]

I agree that the length of training in general surgery is absurd. While I think a majority of Chairmen in General Surgery have done research, most did not do fellowships. I question whether even these "great men" of surgery would have taken 2 years of their lives willingly, knowing that they would have to do bogus fellowships in colorectal, surgical oncology, laparoscopy, endocrine, trauma/cc that could extend their residency to 8-10 years.

Why is it that dedicated research years are not required in Internal Medicine, Radiation Oncology, Radiology, or basically any other more "cerebral" field of medicine? Why take a bunch of blood and guts cowboys and send them into the lab to tickle mice and play with test tubes? I wonder why it's General Surgery specifically that requires two whole years of research in order to be qualified for academics, whereas other fields, including that of surgical subspecialties (ENT, Urology, Ortho) don't? What's so special about General Surgery?

My suspicion is that the required research time in General Surgery has nothing to do with benefitting future academicians, but has everything to do with the spineless residents who have been conditioned from day one to tolerate misery and swallow endless amounts of bullsh*t from their superiors. No one treats residents like **** better than General Surgery, and therefore it is the only field that can get away with sending their residents to exile in research Siberia and still be considered a "top program."

 

[radslooking]

My suspicion is that the required research time in General Surgery has nothing to do with benefitting future academicians, but has everything to do with the spineless residents who have been conditioned from day one to tolerate misery and swallow endless amounts of bullsh*t from their superiors. No one treats residents like **** better than General Surgery, and therefore it is the only field that can get away with sending their residents to exile in research Siberia and still be considered a "top program."

lol. standing ovation.

 

[H_Caulfield]

It's really just about milking the residents for all they're worth. People going into general surgery have demonstrated their capacity for abuse merely by choosing that field, and so program directors know they can be used.

Furthermore, I think that many residents look forward to those research years, or dive willingly into them (even if not required) to sleep more, moonlight and pay for baby food. Perhaps in the past it was worth it to slave through all those years, since surgeons were paid well and there weren't so many lifestyle avenues elsewhere. Now, I think there are just some poor souls who have yet to realize how miserable an option it is.

 

[medsurg2010]

Op,

strangely, I have the opposite feeling about surgical programs. I'm undecided about my specialty and I am considering surgery-- my problem is that I'm not sure I would be ready to be an attending in only 5-6 years. I have seen some patients with significant morbidity/mortality in the hands of the most experienced surgical attendings.

I understand that it seems our lives are stuck in the stagnant decade of med school/residency, but personally I just want to come out prepared for anything. I came to this conclusion after doing a trauma/surgical intensive care unit rotation, taking care of the sickest patients in the hospital. Maybe if you find a residency with significant research in a field you're interested in, it would be less painful. You could ask program directors for lists of grants and start there. Just a suggestion...