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Getting cold feet?

Discussion in 'Surgery and Surgical Subspecialties' started by SurgONC, Jul 26, 2006.

  1. SurgONC

    SurgONC Member
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    Anyone else getting cold feet about committing oneself to a career in gensurg? I've been so focused on getting into a surgery residency for the past few years, and now I find myself as a 4th year reconsidering everything. I'm starting to think a lot about....please don't flame me....lifestyle. I was thinking of switching to rads or gas. Unfortunately, I don't really like ENT, ortho, neurosurg, or uro. Anyone else find themselves in a similar situation?

    I know this has been disussed ad nauseum on these forums, and I have read most of the posts about lifestyle issues. Does anyone have anything to add about the lifestyle as a general surgery attending? Or attending with fellowship training?
     
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  3. Lebesgue

    Lebesgue Senior Member
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    I'm suprised to see neurosurgery on your list, seems this would be at least as busy as general surgery...

    Do you have a different opinion?
     
  4. SurgONC

    SurgONC Member
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    Same opinion. NS is equally as busy but that's not why I dislike it. I just hate neuro in general. :)
     
  5. Winged Scapula

    Winged Scapula Cougariffic!
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    There are surgical specialties outside of those you mentioned which can be lifestyle friendly...Breast is an obvious choice, but consider that Surg Onc, Colorectal, Minimally Invasive - all of these tend to be elective, planned cases and if you can find a hospital which doesn't require you to take general surgery call, then you might find your hours are just as good as a Radiologists or Anesthesiologists. Same for Plastics - if you don't take Trauma call, the lifestyle isn't bad.
     
  6. sscooterguy

    sscooterguy Senior Member
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    I think lifestyle is important. We all either have or hope to have families during and after training. Don't down play that. However, I'll be the first to say that any residency is gonna be hard. After that, being a junior attending will be hard. It just keeps getting difficult in different ways. Personally, I think its really how well you cope with a busy lifestyle of any medical specialty.

    You mentioned Rads and Gas. Those two specialties can be a lot harder and busier than you realize. Really, I think it depends what you want to do with your career more than the specific field (outside of certain specialties such as OB and Trauma surg of course). If you want to do surgery in a smaller town or suburb, life can be pretty nice. These decisions have just as much impact as what specialty you enter.

    sscooteguy
     
  7. footcramp

    footcramp Senior Member
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    lifestyle is a combination of money and free time. compensation for rads and gas i think are headed downwards, which means you will either have less money, or less free time because you'll work more to make the same as before, or the nightmare scenario where you work harder and make less than before... which is kind of where general surgery is now. i guess this is my way of saying general surgery probably won't change much but rads and gas won't be the sweet deal it is now. if that matters a whole lot. usually those who are crazy/stupid enough to go into general surgery are concerned about things other than lifestyle.
     
  8. jihu

    jihu New Member
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    Glad someone else mentioned it. I'm finishing up my sub-i this month, and I find myself wavering, too. I finished out MS3 last year with some ridiculously light rotations, and man, life was good. I miss it a lot.
     
  9. Dr JPH

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    I think being nervous about committing to a specialty is perfectly normal, regardless of what that specialty is. There are doubts surrounding every specialty...lifestyle, money, practice options, job outlook, etc.

    Specifically with surgery I am nervous as well...maybe for a different reason as you (I am overwhelmed by the options AFTER gen surg. Will I be able to choose something all over again after 4-5 years?).
     
  10. ghost_its

    ghost_its Junior Member
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    had a "crisis of faith" yesterday evening, so it's funny that I ran across this post today... for me it comes down to what's important at the end. I wanna do something that matters, where after I'm done with my work, I can say yes I made a small change somewhere for the better. I realize that most patients we see nowadays in the hospitals come in with multiple morbidities and are too busy killing themselves without our help, so in many cases the differences we make are not necessarily that big or will matter. But once in a while, you get that case, where you work your ass off, you do the right thing, and you walk out after a 36 hour call and you know that you made a change for the better and you feel good about what you do and don't wanna go home and wanna do it again right then and there. The only place where I've found that in medicine was on the surgical services. So at the end it's that simple for me. I worry that the amount of time I'll spend in training in residency/fellowship and afterwards will somehow hurt me in my family life, etc., but then I stop and I realize that I knew that all along and I'm willing to risk the loss right now.

    By the way, an open question to the forum, what does it mean LIFESTYLE? Is that having the biggest house, the Ferrari, the condo at Vail, or is it coming home to a comfortable house with a loving partner, 2.3 kiddies, 2.4 cars, and a dog. 'Cause I know that my parents worked like dogs when I was young, but I still think that I had one of the best childhoods ever and I miss it. Maybe it's not necessarily about quantity, but the quality. I think it would be interesting to hear on this issue from current attendings/senior residents/fellows?? Thoughts, comments??
     
  11. Blake

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    That was an excellent post, ghost_its :thumbup:
     
  12. I don't understand - you love everything about general surgery, EXCEPT the lifestyle? I don't see how radiology and anesthesia could provide you with the same excitement.
     
  13. shreebee

    shreebee Senior Member
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    i've been experiencing cold feet as well. i keep thinking about how much i love my free time. i'm a single chick and i worry that it's going to be really hard to make time for fun, much less finding "the one". i worry about matching to a malignant program or worse off, not matching at all given the competiveness of last year. however, the only other specialty that i liked was GI, but unfortuntely i didn't love internal medicine. i could totally see myself doing GI, but being that a fellowship isn't guaranteed and i'd have to get through 3 years of medicine, i didn't think it was a realistic option. but, when comparing it to the lifestyle of surgery, it's not looking so bad now. was anyone else in a similar situation and applied to 2 specialties? i'm seriously considering that i might need the extra time to think things through and do more sub Is/electives and hopefully come rank time, ill know which one i can be happy with.
     
  14. sharkbait

    sharkbait Junior Member
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    I share your concern as well. I, too, like my free time. But then again, who doesn't?? I think it's a given that you're just not going to have a lot of time to kick it once you choose to hold a knife. People think that because of the 80 hour work week that the lifestyle during residency is better... well, it's not that much better. The reason is that there's an equal amount of work to be done, but less people there to do it. As a result you'll likely have little time during the day doing other things like reading and preparing for conferences / lectures. Well, guess what, you'll just gonna have to do it at home when you're "off". Besides, people still go over the 80 hour anyway, even though it's emphasized these days to report any violations of the rule. After residency, things are not going to be that much better in the beginning either, when you're trying to establish yourself as a real surgeon. Life will be VERY busy for a while. It's feasible to have some sort of a life, but you have to be very efficient with your time.
    So in short, if you're wavering committing yourself to 5 years of gen surg residency, then it's probably not a good idea for you. This what my resident told me when I was a med student, and it's true: if you have any doubt about lifestyle, unless you're just absolutely crazy about gen surg, then it's not for you. Clear as mud?
     
  15. SurgONC

    SurgONC Member
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    See that's just my problem, Blade. I don't really love everything about general surgery. I don't like rounding on patients. I don't like following them on the wards. I don't like being in clinic. I don't like the length of training (esp. if I choose to do a fellowship). In fact, I don't like most of what gensurg has to offer. The problem is this: I LOVE being in the OR. I love anatomy, and I love operating (i've got to open the chest and the abdomen a few times).

    The thing with radiology is that I don't love it but perhaps I will learn to. I certainly like it but I have had limited exposure to it (including a 4-week elective). I just need more time to decide. I'm starting my sub-I soon in general surgery, so I'm sure that will shed some light on the situation. Hopefully, I will be able to make a decision soon.

    I've always heard that if one can see themselves happy doing anything other than general surgery, then one should pursue that other field. I'm starting to think that maybe surgery just isn't for me.

    What do people think of applying for rads but doing a prelim surgery? That way, if I love surgery I can just drop out of rads. Is this even possible?

    This whole situation is just incredibly stressful. I've been agonizing for weeks over surgery or radiology. At this point, I think I'm leaning towards radiology but only by a hair!! I've wanted to do surgery for as long as I've wanted to be a doctor, and it's hard coming to the realization that maybe it's just not for me. How many people end up doing surgery but then drop out during their residency to go into things like rads or gas?

    Sorry to just lay it all out here but my girlfriend is sick of hearing me talk about it, and my advisors are pretty useless.
     
  16. SurgONC

    SurgONC Member
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    Yeah, I was thinking about applying to 2 specialties as well. The problem with this is that if I end up applying to radiology, then I need to apply for my PGY1 year (transitional, prelim med, or prelim surg). That would make for an awful interview season, and I probably would just hurt myself by not doing enough interviews in either surgery or radiology. Thus, I might not match to either. BAD!!!
     
  17. footcramp

    footcramp Senior Member
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    love of the OR is not a good enough reason to do surgery. you seem to hate everything else about it. seems like an easy decision to me. just admit it to yourself and do something else. that would be my advice.
     
  18. Faebinder

    Faebinder Slow Wave Smurf
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    You can go radiology then internventional radiology... they operate (drain, needle sampling etc, which is as close to operating as you can get). Probably more control over your lifestyle than surgery. You really don't want to pick up a career that you can potentially hate 10 years down the road.
     
  19. ghost_its

    ghost_its Junior Member
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    I agree with Faebinder. Sounds like IR might be your ticket - NO rounding, NO clinic, procedures, pretty cool anatomy stuff (endovascular repairs for instance)... I would check into that.
     
  20. Winged Scapula

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    Interventional Radiology might be a good option, but you still have to get through a 5 year radiology residency.

    If you don't already love Rads, it might be a tough residency to complete. The pace of life can be totally different. Frankly, I'm on a Mammo rotation right now and all the down time between patients (ie, getting them in, on the machine, setting up for procedures), is killing me. So the lifestyle may be better (ie, 8 - 1130; 1-4) but I'm bored stiff most of the time. 5 years is a long time to be miserable if you have to do the Rads residency first.

    If you don't like rounding on patients, don't like clinic, don't like anything but operating, a surgery residency will be difficult as well, given that you will have to do most of those things for 5 + years, but you can tailor your practice - but most outpatient type procedures/practices will have lots of clinic hours.
     
  21. factoid

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    that whole "no rounding, no clinic" thing is changing fast in IR secondary to multiple other fields wanting a piece of the pie. it's busy and challenging, so hope no one's thinking it's a cakewalk. same thing goes for diagnostic radiology. it's a pretty hard residency for one thing --yes, we don't have to deal with the pain of rouding but the sheer level of knowledge required in radiology is quite overwhelming. there's quite a bit of patient contact in radiology as well. but the $$ sure is good right now :)

    bottom line: every specialty in medicine is painful to some degree. do what gets you to wake up in the morning without cursing your alarm clock.
     
  22. Hate to say it, but sounds like general surgery may not be the right fit for you. Many med students love being in the OR - but the many other aspects of G Surg don't appeal to them.

    I usually hear complaints about some combination of the following:

    *Tough lifestyle - long hours, lack of sleep, lots of call
    *Large services - lots of prerounding and rounding
    *Frustrating clinics
    *Tough, "malignant" personality attendings and senior residents
     
  23. supercut

    supercut Senior Member
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    Love the OR but hate clinics, rounding etc....sounds like Anesthesia might fit the bill! Have you given that any thought?

    Nationwide the dropout rate for surgery is about 20%. Most commonly those dropouts go to rads or gas. In fact, many anesthesia programs save a slot or two each year for surgery refugees.

    Ask yourself this...do you think you'd be happy never going to the OR again (or going but only watching the surgery?)
     
  24. MS3er

    MS3er New Member
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    thought i'd add in my two cents. I'm one of the MS4's going into general surgery and I've thought alot about those same questions and had alot of those same doubts. I'm one of those people that thinks it's one of the most important things in the world to have a good family life (as I had when I was a kid). I gave considerable thought to that idea in particular and how or if I would be able to balance that if I went into surgery.

    The conclusion I came to is that you'll make time for the things in life that are important to you. To me, having a happy family life is not a contraindication to becoming a surgeon. Will you have to make more interesting arrangements then say, someone who went into family practice? Sure. But I believe its doable. If your that guy that likes to go out drinking with his buddies instead of being home with your family after work, they'll be neglected sure because you dont have time to do both. But you will be able to prioritize.

    Like someone else mentioned, my parents worked their butts off when i was younger. Many days my dad would drop me off to school at 7:30 in the morning and I wouldnt see him again till 8:30 at night when he came home from work. But I never at all felt like "he wasnt there" for me if I had a problem or that I was 'neglected'. Just the opposite, I've had one of the most fortunate childhoods. I remember speaking to my father about that one issue when I was deciding to go into surgery, how to balance family life with work. He said that there are some people out there that only work 30 hours a work who neglect their family. Its the QUALITY of time you spend that is more important than the quantity.

    What do I like about surgery? Love being in the OR. Like the quicker rounds but patient interaction still. Like the no BS attitude. Love procedures. Like dealing with surgical issues. There is an absolute immediatecy that I found in surgery that I did not feel in other rotations. What you do at that exact moment on that exact day WITH YOUR OWN HANDS is what makes a difference. At this exact moment id rather spend the next 4 hours practicint knots or reading up on some OR procedure then studying the top 50 causes of anemia or whatever. But yeah dont get me wrong, there are parts of surgery that suck. Long hours. Less pay than others for what your working. Not so friendly attendings/residents at times. But this good VS bad thing is in any profession I think. Rarely does one particular work or speciality just say "yes" at ever level. Like that 8 to 5 no call no weekend work schedule that radiologists have? Ok great - but you have to sit in a dark room all day etc.

    Lastly (as if this wasnt long enough already) there are alot of people that like surgery alot but go into anesthesia for 'lifestyle' essentially (not because they like anesthesia so much per se). My thoughts on it are this..if i even remotely liked like anesthesia id sure as hell do it, better lifestyle, better pay etc. But dont think the next 5 years of hard work..think 20 years from now. If you did something different, are you the type of people that will say "great I got to make 50 K more a year and got to work 5 or 10 hours less a week cause I went into anesthesia" or will you say "you know what, I could have just put in a little more hard work and been "THAT GUY' doing the surgery into that guy watching". Thats what ultimately did it for me. I wouldnt want to look back later in life and think to myself 'you know, what that guy is doing is so [email protected]#$$ cool and I could have been doing that today if I had just put in some more of my time".

    Hopefully this perspective pans out :)
     
  25. toxic-megacolon

    toxic-megacolon Toxic Member
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    You realize by going into gas, you will be forced to watch SOMEONE ELSE operate on a daily basis for the next 4 years, and probably for the rest of your life. Ouch. I feel like if you like surgery, but want to have a life during residency, don't pick a field that reminds you of that decision on a daily basis. I'd rather go into somethign where I can put the decsion behind me and enjoy my newly chosen field.
     
  26. bigtimesmally

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    As a PGY-1 general surgery track intern, i'll give my view point. I actually considered anesthesiology enough to do rotations, get letters and be ready to move into it this year if things did not work out in surgery. However, my perspective has changed and these are the reasons

    First, Imagine yourself 10-15-20 years from now. what do you see yourself doing at that age? If you would look back then and reflect, would you regret not going into surgery and be a practicing surgeon. Could you be a 50 year old radiologist or anesthesiologist and be happy and content?

    Second, lifestyles are not concrete. I've not met a practicing surgeon who works hard because he/she has to. It was always a choice. Many surgeons have pretty decent lifestyles. I don't understand where all the negativity comes from. It might stem from the grueling residency experience of the old days where residents were worked to death. That's not really the case anymore in many places, especially where i am. So, that should not deter you. You will dictate what your lifestyle will be after residency. Remember, you can always find a way to make yourself happy and still practice.

    Third, although, the starting salary for GS is pretty dismall these days, most practicing surgeons with a few years under their belt are doing very well. Also, I have a feeling that things will change for the better.

    Fourth, most people are doing fellowships these days anyway, so there are lots of directions you can take you career into. Just make sure that surgery is what you want and follow your interest as time progresses.

    Fifth, there's always the opportunity to change into anesthesiology or radiology if you don't like surgery. Many do that during their residency. It might be what you have to do. At least, you would know for sure that surgery is not for you and would head the other direction, confident of your decision.
     
  27. ghost_its

    ghost_its Junior Member
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    I absolutely agree with everything that has been said. BTW, just started one of my 4th year surgery electives... Lap. esophagomyotomy and total colectomy today, AWESOME... NOW, I remember why I don't mind getting up at 4AM every morning... The cases reinforced my opinions. I love the work. Is it hard?? Yes. Will I be tired and wanna quit sometimes?? Probably. Would I be happy in 20 years, if I looked back and saw myself give this up?? H*** NO. I don't mind the fatigue, the drain, because I leave the hospital happy, satisfied, like I did something and contributed and that's the key for me.

    To each his own, go where you're happy. As many an attending told me - "If you see yourself doing ANYTHING else other than surgery, DO IT!"
     

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