General vs. Ortho

[Southpaw]

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[Castro Viejo]

1) other than the obvious, what are some of the big differences between ortho and general with regards to work hours after residency, lifestyle, payscale?

My understanding is that the lifestyle in both Ortho and General Surgery are pretty comparable, meaning both require relatively long workdays. The pay in Ortho, however, is infinitely better than in General Surgery.

2) if I were to choose general would it be impossible or just a massive pain in the butt trying to get back into ortho if I found general surgery residency to be miserable?

Almost impossible from what I've seen. Ortho spots, in general, are hard to come by and they don't tend to open up all of a sudden. General Surgery, while increasingly more difficult in recent years, isn't as competitive. And there are plenty more upper level General Surgery (R3 and R4) positions open than Ortho (probably from attrition more than anything else).

3) if I were to choose general, I'd like to go somewhere that would leave me open for fellowship opportunities in case I decide to pursue that. Right now I'm not sure what fellowship in particular, but I would like to have the option in case I so chose. These residency programs would likely be the big academic places right? (I've searched the forums for top ranked places...I assume this is important for fellowship placement?)

Generally, yes. But some stronger community programs have no problems with placing their Chiefs into academic fellowships.

4) if I switched to general, would I still be able to setup some away rotations or is it too late? Or are they even needed/suggested for general?

Yes, they're recommended if you're looking to match outside your home program to a top General Surgery residency program. As for whether or not it's too late, I don't know... That depends on the availability of slots at whatever program you're looking into.

Any other helpful advice would be much appreciated. I'll definitely hit up some faculty for help in figuring things out, but I wanted to ask you guys as well since I enjoy reading the surgery forum and have seen you all give excellent advice. Thanks guys.

I wouldn't focus too much on the lifestyle or money issues since it's difficult to predict what attending-hood for you will be like in five or more years after training. Who knows? If Obama or Clinton become President, you might be doing that Whipple or Total Joint for about $50.00 (before taxes).

Instead I'd think about what gets you out of bed in the morning and whether or not knocking away at bone all day while you're dressed up like Buzz Aldrin is your thing.

But then again... Maybe smelling poop in the middle of the night isn't your thing either (as I found out around my R2 year of residency).

Good luck.

 

[jubb]

I wouldn't focus too much on the lifestyle or money issues since it's difficult to predict what attending-hood for you will be like in five or more years after training. Who knows? If Obama or Clinton become President, you might be doing that Whipple or Total Joint for about $50.00 (before taxes).

50 bucks will be a dream come true after you fork it all back cuz your patient got a DVT, pressure ulcer, or a Urinary Tract infection.

 

[DrDre311]

50 bucks will be a dream come true after you fork it all back cuz your patient got a DVT, pressure ulcer, or a Urinary Tract infection.

Yeah I love how Medicare doesn't want to pay for pressure ulcers but they also don't want to pay for beds to prevent it. We're all going to end up working for free, which means I will have gone through 14 years of training to get a job putting in fake boobs.

 

[Pir8DeacDoc]

Yeah I love how Medicare doesn't want to pay for pressure ulcers but they also don't want to pay for beds to prevent it. We're all going to end up working for free, which means I will have gone through 14 years of training to get a job putting in fake boobs.

No shame in that brother man... Keep all us men folk happy

 

[sponch]

The big difference I see between Ortho and General is that Gen Surg structures their time to do a lot of nonoperative management; Ortho structures their time to maximize time in the OR.

That's probably because no one else will take care of your trauma patients before and after you operate on them...including you.

 

[twood]

It's not too late to get some away rotations set up (I scheduled some around this time of year for August/September).
I did 3 aways and would recommend that anyone do the same. It may have hurt me a little bit with my home program, but I was able to see programs first-hand for a month (much better exposure for you if you work hard, and you get a much more honest impression of the program and its residents).

Re: fellowships
the commonly-held idea is you can get anything but PEDS from anywhere. May not be realistic, but if you're willing to extend the 5 year training and do some research, you can match into competitive fellowships.

Finally, make sure that you can see educational value or at least tolerate the chronic E-C fistula patient. In my limited experience, the hallmark of a GS service is the chronic E-C fistula patient that cycles between the floor and the ICU.

 

[Winged Scapula]

Finally, make sure that you can see educational value or at least tolerate the chronic E-C fistula patient. In my limited experience, the hallmark of a GS service is the chronic E-C fistula patient that cycles between the floor and the ICU.

That's strange. I saw very few of those in my residency.

 

[San_Juan_Sun]

Ugh, I had a couple as a student.

Pain.

My first introduction was one call night in July when a nurses pages me with "Hey, your post op guy has brown liquid spraying from his incision like a water fountain."

 

[TxMed]

hand pus, elbow pus, knee pus=ortho
butt pus=general
labial pus=gyn

the only real question is; what kind of pus do you like best?

 

[skiz knot]

hand pus, elbow pus, knee pus=ortho
butt pus=general
labial pus=gyn

the only real question is; what kind of pus do you like best?

Off topic but I had am attending that would deliberately write "*****" instead of purulent whenever possible.

 

[Castro Viejo]

Off topic but I had am attending that would deliberately write "*****" instead of purulent whenever possible.

It's good to know that, even on the attending level, locker-room humor is the norm and not the exception in surgery.

 

[SocialistMD]

Superficial knee/elbow pus = cut it yourself

Yeah, but could you still come by and make sure it doesn't involve the joint.

That's strange. I saw very few of those (ECFs) in my residency.

Holy Lord, if I could only say that. We get them referred from all over the midwest (h/o Crohn's-> colorectal, h/o pancreatitis ->HPB, h/o gastric bypass->bariatrics, other abdominal disaster or in need of "wound care"->acute care. I've even had a couple of them at our Children's hospital. Consider yourself very, very lucky.

 

[GoodMonkey]

That's strange. I saw very few of those in my residency.

as a med student, i met an inpatient on one of my gsurg months who had no less than 5 of them at any given time. he was notoriously mean to any med student assigned to him (but was fine with every other member of his health care team) and i once saw him shoot fluid out of his E-C fistula of his own volition. seriously, he squeezed his eyes shut, made an effort like he was farting, and out it shot. *shudder*

 

[Winged Scapula]

as a med student, i met an inpatient on one of my gsurg months who had no less than 5 of them at any given time. he was notoriously mean to any med student assigned to him (but was fine with every other member of his health care team) and i once saw him shoot fluid out of his E-C fistula of his own volition. seriously, he squeezed his eyes shut, made an effort like he was farting, and out it shot. *shudder*

I do remember a few, but it seems like you guys paint this picture of seeing them right and left.

Then again, perhaps because of things like you've described, I've simply pushed it out of my mind.