GS PGY3 burning out. Is decent work/life balance possible once BE/BC Attending?

[gringo8419]

Currently a categorical PGY3 in GS at an academic center. Have done reasonably well in residency, >p90 in absite PGY1 and PGY2, love and feel I understand surgical pathology, surgical patients and love operating and the OR. However the hours and lack of time to see family, wife/children are getting to me. I have a young child that barely recognizes me. This has struck a cord with me that now has me doubting my career path. I have financial obligations that I must meet, and hope to someday make better income once I am an attending surgeon. However I am now questioning my choices and wondering if this will all be worth it. Will I be obliged to work similar hours as I work as a GS resident once an attending to be able to make ±200.000? Realistically, is it possible to survive as a General Surgeon, or say do one of the 1 year fellowships like MIS/bariatrics or CRS, make >200.000 and work less than 80 hours, say 50-60 hours or God forbid, even 40 hours a week and be able to spend time with family and make up for the lost years, without going broke? I am feeling burnt out and questioning myself whether this is all worth it. Again, I love operating, but I don't love the long hours and enormous workload.
I am seriously considering quitting GS and applying to anesthesia, not because I don't love operating but because I love my family even more than operating and am thinking more and more how there is only 1 shot at life , and time gone is never gained again. I am hesitant however as I know once I attempt to jump ship there will be no turning back. I do love the OR (hence thinking of anesthesia, which is a job I know I could do well and having had 3 PGY years of GS I would hope should facilitate becoming an outstanding anesthesiologist). From what I understand their residency is less hours than ours and that their hours once attendings are better than GS or say MIS or CRS.
I know they this would mean giving up forever the privilege of operating which would suck, but it may be worth it for a better work schedule and more time off for family. I have not yet approached my PD to discuss this. I know in GS we are famous for working hard and putting our patients above our own families and being willing to endure the misery of residency due to the sheer joy we get in the OR. I know it "gets better" once a BE/BE GS or fellowship trained surgeon, however I understand the hours will be similar to residency and the compensation from what I gather from google or medscape seems to be ±200.000? Anesthesia seems to do substantially better for less hours work from what I gather, but what I don't know is if it is possible to work 40 hours as GS or MIS/bariatrics or CRS and survive.
I would appreciate any input from anyone that has emerged from the tunnel of GS residency and found the light at the end, is it possible to have a good life, see one's family, still be able to operate and sure, not make the big bucks but still be able to survive, pay rent and loans and work less hours than I know most general surgeons seem to work?
Thank you very much for taking the time to read this, very much appreciate any input.

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[bannie22]

Anesthesia works half of GS and makes double.

You have watched your attendings. The younger ones will have to work just as much as residents regardless of their financial wellbeing whereas the older ones have more leeway given their seniority and especially if they are not as interested in the money.

I hope you are able to somehow find time to spend with your kids if you believe them to be more important than GS.

 

[ACSurgeon]

Currently a categorical PGY3 in GS at an academic center. Have done reasonably well in residency, >p90 in absite PGY1 and PGY2, love and feel I understand surgical pathology, surgical patients and love operating and the OR. However the hours and lack of time to see family, wife/children are getting to me. I have a young child that barely recognizes me. This has struck a cord with me that now has me doubting my career path. I have financial obligations that I must meet, and hope to someday make better income once I am an attending surgeon. However I am now questioning my choices and wondering if this will all be worth it. Will I be obliged to work similar hours as I work as a GS resident once an attending to be able to make ±200.000? Realistically, is it possible to survive as a General Surgeon, or say do one of the 1 year fellowships like MIS/bariatrics or CRS, make >200.000 and work less than 80 hours, say 50-60 hours or God forbid, even 40 hours a week and be able to spend time with family and make up for the lost years, without going broke? I am feeling burnt out and questioning myself whether this is all worth it. Again, I love operating, but I don't love the long hours and enormous workload.
I am seriously considering quitting GS and applying to anesthesia, not because I don't love operating but because I love my family even more than operating and am thinking more and more how there is only 1 shot at life , and time gone is never gained again. I am hesitant however as I know once I attempt to jump ship there will be no turning back. I do love the OR (hence thinking of anesthesia, which is a job I know I could do well and having had 3 PGY years of GS I would hope should facilitate becoming an outstanding anesthesiologist). From what I understand their residency is less hours than ours and that their hours once attendings are better than GS or say MIS or CRS.
I know they this would mean giving up forever the privilege of operating which would suck, but it may be worth it for a better work schedule and more time off for family. I have not yet approached my PD to discuss this. I know in GS we are famous for working hard and putting our patients above our own families and being willing to endure the misery of residency due to the sheer joy we get in the OR. I know it "gets better" once a BE/BE GS or fellowship trained surgeon, however I understand the hours will be similar to residency and the compensation from what I gather from google or medscape seems to be ±200.000? Anesthesia seems to do substantially better for less hours work from what I gather, but what I don't know is if it is possible to work 40 hours as GS or MIS/bariatrics or CRS and survive.
I would appreciate any input from anyone that has emerged from the tunnel of GS residency and found the light at the end, is it possible to have a good life, see one's family, still be able to operate and sure, not make the big bucks but still be able to survive, pay rent and loans and work less hours than I know most general surgeons seem to work?
Thank you very much for taking the time to read this, very much appreciate any input.

You can get a job working an AVERAGE of 40-60 hours/week, but it would be difficult to get a job where you ONLY work 40-50 hours/week every week. Breast/MIS may or not be an exception, and @Winged Scapula can comment more about breast surgery lifestyle.

On average, a general surgeon can except to make 300-400 outside of academia. Fellowship training helps with income potential sometimes, but mostly allows you to become an expert in an area, and maybe take less general surgery call.

If you're ok to "work hard/play hard", you might want to look into acute care surgery (without a fellowship) where you can work 24 weeks/year (or less) and be off the rest of the time. Your weeks of work can vary from 12hr days to 24/7 home call coverage. Not exactly lifestyle friendly if you consider lifestyle to be free nights and weeks year-round.

The problem with wanting a 40 hr/week job is you have to take call, and even on non-call days, OR can run behind, cases can take longer than expected, you might have a complication that requires take back to surgery and/or many hours at the hospital trying to figure it out etc etc. Also, your first 5-10 years as an attending you have to be in the OR on a regular basis to maintain and master your skills. This is probably the biggest barrier to being able to work half as much and ear half as much.

 

[ACSurgeon]

Anesthesia works half of GS and makes double.

You have watched your attendings. The younger ones will have to work just as much as residents regardless of their financial wellbeing whereas the older ones have more leeway given their seniority and especially if they are not as interested in the money.

I hope you are able to somehow find time to spend with your kids if you believe them to be more important than GS.

The averages in pay are similar, with anesthesia having better hours, but FAR from "half the hours."

Actually, I'm getting offers to work in acute care surgery for better pay and less work (overall) than our anesthesia chiefs. In the same city.

 

[Donald Juan]

Anesthesia works half of GS and makes double.

You have watched your attendings. The younger ones will have to work just as much as residents regardless of their financial wellbeing whereas the older ones have more leeway given their seniority and especially if they are not as interested in the money.

I hope you are able to somehow find time to spend with your kids if you believe them to be more important than GS.

This is highly inaccurate, you can't just look at your attendings in academics and think you have to do what they do. In private practice (or just nonacademic hospital employment) you can tailor your practice to whatever lifestyle you want. How much you make will depend on how much you want to work and where you are willing to live.

 

[SLUser11]

Currently a categorical PGY3 in GS at an academic center. Have done reasonably well in residency, >p90 in absite PGY1 and PGY2, love and feel I understand surgical pathology, surgical patients and love operating and the OR. However the hours and lack of time to see family, wife/children are getting to me. I have a young child that barely recognizes me. This has struck a cord with me that now has me doubting my career path. I have financial obligations that I must meet, and hope to someday make better income once I am an attending surgeon. However I am now questioning my choices and wondering if this will all be worth it. Will I be obliged to work similar hours as I work as a GS resident once an attending to be able to make ±200.000? Realistically, is it possible to survive as a General Surgeon, or say do one of the 1 year fellowships like MIS/bariatrics or CRS, make >200.000 and work less than 80 hours, say 50-60 hours or God forbid, even 40 hours a week and be able to spend time with family and make up for the lost years, without going broke? I am feeling burnt out and questioning myself whether this is all worth it. Again, I love operating, but I don't love the long hours and enormous workload.
I am seriously considering quitting GS and applying to anesthesia, not because I don't love operating but because I love my family even more than operating and am thinking more and more how there is only 1 shot at life , and time gone is never gained again. I am hesitant however as I know once I attempt to jump ship there will be no turning back. I do love the OR (hence thinking of anesthesia, which is a job I know I could do well and having had 3 PGY years of GS I would hope should facilitate becoming an outstanding anesthesiologist). From what I understand their residency is less hours than ours and that their hours once attendings are better than GS or say MIS or CRS.
I know they this would mean giving up forever the privilege of operating which would suck, but it may be worth it for a better work schedule and more time off for family. I have not yet approached my PD to discuss this. I know in GS we are famous for working hard and putting our patients above our own families and being willing to endure the misery of residency due to the sheer joy we get in the OR. I know it "gets better" once a BE/BE GS or fellowship trained surgeon, however I understand the hours will be similar to residency and the compensation from what I gather from google or medscape seems to be ±200.000? Anesthesia seems to do substantially better for less hours work from what I gather, but what I don't know is if it is possible to work 40 hours as GS or MIS/bariatrics or CRS and survive.
I would appreciate any input from anyone that has emerged from the tunnel of GS residency and found the light at the end, is it possible to have a good life, see one's family, still be able to operate and sure, not make the big bucks but still be able to survive, pay rent and loans and work less hours than I know most general surgeons seem to work?
Thank you very much for taking the time to read this, very much appreciate any input.

Your feelings are completely normal, and are experienced by many PGY3s, especially when you have a young family at home.

If you enjoy anesthesia more than surgery, then you should certainly switch. They are very different specialties, both relatively well reimbursed. In academics, I make substantially more than my anesthesia colleagues, but I also work a lot more.

When you become an attending, you have more control over how much you work, so it is realistic to aim for 50-60 hours/week. However, many of us work harder as attendings than we did as residents. This is for many reasons, including the 1) inability to say "no" for some, 2) new administrative and academic obligations that need to be completed once the clinical work is done, and 3) the process of building a practice.

I think the main point I'd like to make is that you can be a surgeon and have a reasonable lifestyle. In doing so, you will likely sacrifice prestige and money, but plenty of people do it and are very happy. There are some subspecialties that have few emergencies and don't require much ER call, and those are the ones you should be looking at. However, these subspecialties occur in a variety of environments that could impact this. For example, some communities have CRS doing all the diverticulitis and all the butt pus, along with other small issues that find their way to the ER (fecal impaction, rectal prolapse, thrombosed hemorrhoids, etc). If that was the case where I practice (which it's not), and I didn't have a strong line of defense (residents), I'd find myself in the ER relatively often.

Good luck, and feel free to PM with any specific questions. Once again, your feelings are normal, and it would be weird if you didn't second-guess your decisions now that you see the impact it has on your young family.

 

[ACSurgeon]

Your feelings are completely normal, and are experienced by many PGY3s, especially when you have a young family at home.

If you enjoy anesthesia more than surgery, then you should certainly switch. They are very different specialties, both relatively well reimbursed. In academics, I make substantially more than my anesthesia colleagues, but I also work a lot more.

When you become an attending, you have more control over how much you work, so it is realistic to aim for 50-60 hours/week. However, many of us work harder as attendings than we did as residents. This is for many reasons, including the 1) inability to say "no" for some, 2) new administrative and academic obligations that need to be completed once the clinical work is done, and 3) the process of building a practice.

I think the main point I'd like to make is that you can be a surgeon and have a reasonable lifestyle. In doing so, you will likely sacrifice prestige and money, but plenty of people do it and are very happy. There are some subspecialties that have few emergencies and don't require much ER call, and those are the ones you should be looking at. However, these subspecialties occur in a variety of environments that could impact this. For example, some communities have CRS doing all the diverticulitis and all the butt pus, along with other small issues that find their way to the ER (fecal impaction, rectal prolapse, thrombosed hemorrhoids, etc). If that was the case where I practice (which it's not), and I didn't have a strong line of defense (residents), I'd find myself in the ER relatively often.

Good luck, and feel free to PM with any specific questions. Once again, your feelings are normal, and it would be weird if you didn't second-guess your decisions now that you see the impact it has on your young family.

The bolded statement is magnified at programs where you don't really operate until your fourth year. Being a junior for 3 years is not fun.

 

[SouthernSurgeon]

I would strongly agree with @SLUser11 that what you are going through is normal.

The first two years are tough, and you start to feel the cumulative weight of all that time in the hospital dragging you down. I was pretty salty as a PGY3 and I think in retrospect I was definitely dealing with some emotional exhaustion.

My main advice is don't rush any decision. Take time to think about your options.

As has been said above, there are definitely fields and options for more lifestyle control after residency/fellowship. It may also be worth noting that if you find a particular field you are passionate about, you may get more "bang for your buck" so to speak out of it. I've definitely found now that I've settled on a fellowship choice that I much more enjoy my time at work when I'm on those rotations or doing those cases.

The good news, at most programs, is that PGY3 is very different from PGY2. You get to operate more, you get out of the intern call pool. While the hours are still long you hopefully can get toward seeing the light at the end of the tunnel a little bit.

I would recommend trying to explore some of the different fellowship/specialization options you mentioned this year. Try to talk to some people outside of the grind of residency. Do you have any mentors at your program you can talk to about this?

If you're truly not happy and want to change fields, I think everyone respects that. Just make sure you're doing your due diligence about it and not making a choice that will lead to less happiness in the long run.

 

[gringo8419]

Thank you all very much for taking the time to reply. It is very much appreciated. I am still debating about giving up forever something I love (operating) for more time for something I love more (my family).

 

[bannie22]

Thank you all very much for taking the time to reply. It is very much appreciated. I am still debating about giving up forever something I love (operating) for more time for something I love more (my family).

It is a difficult decision that in reality is very simple. Do not be suckered into the militaristic expectations in GS.
All the best doing what is it that you love most.

 

[Pir8DeacDoc]

Do you have any way of knowing you'll like anesthesia beyond your brief interactions with them now? I considered anesthesia during med school and was utterly and hopelessly bored during the rotation. A surgeon in the OR just sitting on a chair watching someone else operate - not my idea of fulfilment. 30 years is a long time to do something you aren't somewhat passionate about. Surely you can find a GS subspeciality to fit your personal life

 

[ThoracicGuy]

Thank you all very much for taking the time to reply. It is very much appreciated. I am still debating about giving up forever something I love (operating) for more time for something I love more (my family).

Find a job in the community, particularly with a large group to share call and you could have a real chance at a good lifestyle even with general surgery.

There are fellowships out there that have nice lifestyles as well. How many colorectal emergencies are there at night?

If surgery is truly the field that you love, I'd say stick with it. Making the sacrifice now will allow you to find the kind of job you want at the end. Don't base the expectations of your attending job on what you see as a resident. Even those attendings at your training program probably have a better lifestyle than you think. When you are on a service and have 15-20 pts to round on, you are usually seeing 3-5 attending's worth of patients. When it's just you, then you just have your patients. It's really a big change.

Good luck.

 

[ThoracicGuy]

It is a difficult decision that in reality is very simple. Do not be suckered into the militaristic expectations in GS.
All the best doing what is it that you love most.

Do you really have any insight on this, seeing as you claim to be 'pre-podiatry'?

 

[LucidSplash]

I think you've received some good advice above. The only thing I have to add is that one of my attendings says that 3rd year is often the toughest year: there's no light at the end of the tunnel yet but you are so far into the tunnel that you can't see back the way you came so you are just walking in the dark, step-by-step, trying to trust that there'll be light again someday soon. All that is to say that you are not alone and others have felt this way and made it out on the other side. Best wishes and hang in there.

 

[ram006]

Anesthesia works half of GS and makes double.

You have watched your attendings. The younger ones will have to work just as much as residents regardless of their financial wellbeing whereas the older ones have more leeway given their seniority and especially if they are not as interested in the money.

I hope you are able to somehow find time to spend with your kids if you believe them to be more important than GS.

False.

 

[balaguru]

As suggested earlier, acute care surgery might satisfy your salary and lifestyle objectives if you can find fulfillment in only doing about 100 cases of the on call variety per year. The group that I provide some acute care services for has something like 100 surgeons throughout the US and seems to always be hiring. I am pretty sure that by the time you finish training the demand will still be there.

 

[VPDcurt]

I was in your shoes a few years back. Was going to quit GS - but didn't have it in me to go into a different specialty - for me, in medicine, it was surgery or nothing. I was actually looking into law school for a minute or two there. I recently completed an MIS/Bariatric fellowship and I'm finally an attending. I work at an institution that has 24/7 trauma/ACS call (don't have to cover that at all), 24/7 CRS call, and 24/7 resident coverage and we have an MIS fellow. When I'm on call...which is about 1 in 7 weekends only covering private patients if they are in-house or present to the ED...I am the 3rd in line to be bothered (behind the residents and the fellow). I recently came home from work on a Friday afternoon, sat down on my couch, put my feet up, and turned on my new 65 inch TV...and for the first time in 10 years, I realized that "this was all worth it." FWIW, I actually enjoy being a surgeon now - I was a fairly bitter resident.

 

[drranjit]

What are some of the more lifestyle/family-friendly fellowship from Gen Surg? From reading this thread, seems like Colorectal and MIS are good options. Anything else? Thanks

 

[ThoracicGuy]

What are some of the more lifestyle/family-friendly fellowship from Gen Surg? From reading this thread, seems like Colorectal and MIS are good options. Anything else? Thanks

Breast?

 

[doc05]

What are some of the more lifestyle/family-friendly fellowship from Gen Surg? From reading this thread, seems like Colorectal and MIS are good options. Anything else? Thanks

they can all be "family friendly". really depends upon the practice setting.

 

[Winged Scapula]

You can get a job working an AVERAGE of 40-60 hours/week, but it would be difficult to get a job where you ONLY work 40-50 hours/week every week. Breast/MIS may or not be an exception, and @Winged Scapula can comment more about breast surgery lifestyle.

On average, a general surgeon can except to make 300-400 outside of academia. Fellowship training helps with income potential sometimes, but mostly allows you to become an expert in an area, and maybe take less general surgery call.

If you're ok to "work hard/play hard", you might want to look into acute care surgery (without a fellowship) where you can work 24 weeks/year (or less) and be off the rest of the time. Your weeks of work can vary from 12hr days to 24/7 home call coverage. Not exactly lifestyle friendly if you consider lifestyle to be free nights and weeks year-round.

The problem with wanting a 40 hr/week job is you have to take call, and even on non-call days, OR can run behind, cases can take longer than expected, you might have a complication that requires take back to surgery and/or many hours at the hospital trying to figure it out etc etc. Also, your first 5-10 years as an attending you have to be in the OR on a regular basis to maintain and master your skills. This is probably the biggest barrier to being able to work half as much and ear half as much.

Breast is commonly offered as a solution for men and women seeking a more family friendly lifestyle.

However, breast surgery, like any other surgical career, can be unpredictable. As noted above, patients show up late, are caught eating in the pre-op waiting room, cases take longer than scheduled/anticipated, you have an unanticipated complication or you are following someone which pushes your cases later. Some of these are out of your control and suddenly your lifestyle speciality becomes less so.

It is possible to work 40-50 hours per week as a breast surgeon; however, the only ones I know working that little are in employed positions. Because of fixed expenses in a practice, most are not interested in hiring someone who works less than full time. The pros/cons of employed positions vs pure PP have been discussed at length before but in general you have much less flexibility and income in employed positions. Also bear in mind that most positions that are advertised as "only X hours" don't include the hours spent doing charts, reviewing images, etc. So while you may only spend 40 hrs/week in the OR and office, you will have other duties (regardless of specialty) which add to the total hours.

Lastly, as noted above, it is certainly possible to earn more than $200K doing general surgery, including a breast only practice.

 

[Winged Scapula]

What are some of the more lifestyle/family-friendly fellowship from Gen Surg? From reading this thread, seems like Colorectal and MIS are good options. Anything else? Thanks

Breast
Endocrine
Plastics and Reconstructive (excluding trauma/hand/face call)

but as noted above, any can be provided the right employment situation.

 

[gringo8419]

Thanks again to all (but specially @SouthernSurgeon and @SLUser11 )for taking the time to reply. Ultimately, I spoke with some mentors at my program and decided to stay in GS, finish residency (everyone insists it gets much better at/after PGY4), and attempt to match a 1 year fellowship. Will most likely attempt CRS (really enjoyed the cases and also very much enjoyed scoping). Something that resonated strongly with me was a comment on this thread of picturing a surgeon (as a PGY3 I guess I'm halfway there) sitting on a stool for 30+ years watching someone else operate, I realized I love operating and probably would not be fulfilled in life were I to give it up forever. Based on conversations with mentors and the replies on this forum, I do believe it will be possible to achieve some balance in life once an attending, and yet still do what one loves.
Having seriously entertained the idea of quitting GS and finally deciding to stick it out, I have re-discovered my passion for GS, and am now quite happy at the job again.
Once again, to all you attending's and senior/chief residents who took the time to read this thread and reply, THANKS!

 

[Trauma Surgeon]

Thanks again to all (but specially @SouthernSurgeon and @SLUser11 )for taking the time to reply. Ultimately, I spoke with some mentors at my program and decided to stay in GS, finish residency (everyone insists it gets much better at/after PGY4), and attempt to match a 1 year fellowship. Will most likely attempt CRS (really enjoyed the cases and also very much enjoyed scoping). Something that resonated strongly with me was a comment on this thread of picturing a surgeon (as a PGY3 I guess I'm halfway there) sitting on a stool for 30+ years watching someone else operate, I realized I love operating and probably would not be fulfilled in life were I to give it up forever. Based on conversations with mentors and the replies on this forum, I do believe it will be possible to achieve some balance in life once an attending, and yet still do what one loves.
Having seriously entertained the idea of quitting GS and finally deciding to stick it out, I have re-discovered my passion for GS, and am now quite happy at the job again.
Once again, to all you attending's and senior/chief residents who took the time to read this thread and reply, THANKS!

The best thing you could do is when you are done with residency + fellowship and maybe 1 or two years in practice that you find this post and give us an update. I guess many SDNers would appreciate and have much help in their future decision in regards to applying/staying in surgery, if you took the time and posted the aftermath of your decision.

Personally I have never worked as much as I do now as an attending, but to calm those that think my experience is the "the one to set standards by", I can assure it is self inflicted pain and I could go down to 50-60 hours if I wanted.

All the best!

 

[mw18]

Do you really have any insight on this, seeing as you claim to be 'pre-podiatry'?

He is likely a resident, judging by the very detailed MDapps from 2009. I saw the pre-podiatry and thought the same thing.

 

[Winged Scapula]

He is likely a resident, judging by the very detailed MDapps from 2009. I saw the pre-podiatry and thought the same thing.

Perhaps...but he frequently posts inaccurate information which makes us question his status.

 

[Consigliere]

Anesthesia seems to do substantially better for less hours work from what I gather, but what I don't know is if it is possible to work 40 hours as GS or MIS/bariatrics or CRS and survive.
.

Strongly consider anesthesiology if you want a better work/life balance. You are already seeing what a time vampire surgery is. I have been an anesthesiologist for almost 20 years and have NEVER made less than $350k/yr and fluctuate between $450-500k most of the time. Average hours worked are right around 50 hours a week. I have also had 10-12 weeks vacation my entire career. Think about that - salary, time spent in the hospital, and working 9-9.5 months a year. Your family will love you for it and your life will be much better. Trust me, mine is.

 

[Consigliere]

Anesthesia works half of GS and makes double.

You have watched your attendings. The younger ones will have to work just as much as residents regardless of their financial wellbeing whereas the older ones have more leeway given their seniority and especially if they are not as interested in the money.

I hope you are able to somehow find time to spend with your kids if you believe them to be more important than GS.

Very true. This is unfortunate and you CAN find a better work/like balance but generally speaking, this statement is spot on.

 

[ram006]

Very true. This is unfortunate and you CAN find a better work/like balance but generally speaking, this statement is spot on.

Not according to any objective source like Medscape, MGMA or Doximity, but please, continue with your anecdotal data.

 

[Consigliere]

Not according to any objective source like Medscape, MGMA or Doximity, but please, continue with your anecdotal data.

It's not anecdotal in my case. Though I do agree the statement is a gross generalization.

 

[ram006]

It's not anecdotal in my case. Though I do agree the statement is a gross generalization.

According to your numbers, you believe that a surgeon works 100/hr per week for for between 175-225k per year? Lol. Seriously?

 

[SLUser11]

http://www.ncbi.nlm.nih.gov/pubmed/27238875

A relevant JACS study on resident burnout.

One should "strongly consider anesthesiology" if he/she likes the specialty of anesthesiology. Like I said before, it's very different than surgery in almost all aspects. If it's just lifestyle, surgery residents could consider a switch to several other specialties.

If you love surgery and you want to be a surgeon, you can certainly find a work/life balance, but as I've said before, something has to give....money, prestige, geography, scope of practice, etc....

 

[Consigliere]

According to your numbers, you believe that a surgeon works 100/hr per week for for between 175-225k per year? Lol. Seriously?

Not at all. As stated above, I do believe the statement is a gross generalization. Do anesthesiologists make more than surgeons and work less? Indisputably.

 

[SLUser11]

Not at all. As stated above, I do believe the statement is a gross generalization. Do anesthesiologists make more than surgeons and work less? Indisputably.

2/10

Can't denounce gross generalizations then immediately make one. Anybody who deals in black and white/absolutes is easy to battle...too many holes in the armor.

Still, I agree with you that people can be happy in anesthesia. I just want to make it clear that they are not somehow parallel paths that have overlapping systems of risk/reward, etc. Anesthesiology is a service line profession, and a great anesthesiologist, much like a great emergency physician, is worth his/her weight in gold, but that is not how administrators see it, and service line providers have stressors that are not experienced by surgeons.

My best friends in the hospital are anesthesiologists, and we share jokes in the lunchroom every day, and we have similar interests outside of work...but neither of us would trade jobs with each other, as our goals and priorities are quite different.

Last week I had 3 very difficult laparoscopic cases that tested my patience, my resilience, and my confidence, but ultimately ended well. That same week I was privileged to tell 3 cancer patients that their pathology was favorable and their prognoses are excellent. I love the ups, and I am strong enough to handle the downs. The weight of my patients' complications, liability, unpredictability, and sadness is heavy, but I am willing to carry it because I know that's the price of being in the big leagues....high cost, high reward. I want the responsibility, I want the glory, I want it all. It takes sacrifices on all levels, but the patients come to my hospital to see me because they've been told that I'm the best.....which is debatable, but still....and I value that trust.

I made that paragraph self-aggrandizing on purpose, BTW. I think surgeons develop gargantuan egos because it's a necessary defense mechanism. How else can we justify the sacrifice? More importantly, how else can we stomach the complications? The only way I can sleep at night after a leak...or a stroke...or a death....is if I truly believe that I was the best man for the job. So the patients come to the hospital for me, and they meet you in preop and give you little regard, and that is not fair because your contribution, like that of many other faceless physicians, is priceless....but I want to be the face of their cancer journey.

OP: that was my motivation. Others want something to do between 8 and 5, and they are happy with their choices. My motivations are trite and perhaps still a bit naïve, but they are mine. You should find your own, and use them to make a very tough decision. Your feelings are normal, and it's acceptable to switch specialties. It's also acceptable to grind it out, and ultimately take a less grandiose approach to your own surgical career. Good luck, and feel free to PM me if I can help in any way.

 

[Consigliere]

2/10

So the patients come to the hospital for me, and they meet you in preop and give you little regard, and that is not fair because your contribution, like that of many other faceless physicians, is priceless....

No problem whatsoever. There is currently no means to detect how little I care about what degree of regard patient's give me. I know I am responsible for their life and that's all I need. To me, priceless is being able to retire when I am 55 with a fully funded, multimillion dollar retirement account. I'll be able to enjoy my kids getting older and hanging out at our beach house. Hell, with the continuing decline in the public's perception of physicians in general, I really don't care what they think. We're all just "providers" nowadays - I'm grateful that I'm a very well off "provider."

 

[ram006]

No problem whatsoever. There is currently no means to detect how little I care about what degree of regard patient's give me. I know I am responsible for their life and that's all I need. To me, priceless is being able to retire when I am 55 with a fully funded, multimillion dollar retirement account. I'll be able to enjoy my kids getting older and hanging out at our beach house. Hell, with the continuing decline in the public's perception of physicians in general, I really don't care what they think. We're all just "providers" nowadays - I'm grateful that I'm a very well off "provider."

Are you under the impression surgeons can't retire at 55 if they're smart with their money? The salaries are not so different that anesthesiologists are privy to things a surgeon can't be.

I think people keep arguing with you because you seem to be under the impression that anesthesiologists are in another league in terms of earnings and work *much less for much more.* There is basically no objective source/data to support your claim.

Also, the numbers you throw out there don't make much sense. For example, you have never made less than 350k/yr and you work an average of 50 hrs/week. You then go on to say you've cleared as much as 550k. Are you implying you worked less hours to nearly double your salary? Not likely, you probably worked more for a period of time (or reimbursement cuts really hit your practice hard which I suppose is possible). Working 60hrs (which is not that far off from your self reported average of 50) per week puts you in the average range for a surgeon, so you're not really working all that much less for your income that may, or may not, be more.

I can also tell you from my own anecdotal experience, the job offers (especially if you're willing to move to a place in need) are well over 350k/year.

 

[Consigliere]

Are you under the impression surgeons can't retire at 55 if they're smart with their money? The salaries are not so different that anesthesiologists are privy to things a surgeon can't be.

I think people keep arguing with you because you seem to be under the impression that anesthesiologists are in another league in terms of earnings and work *much less for much more.* There is basically no objective source/data to support your claim.

Also, the numbers you throw out there don't make much sense. For example, you have never made less than 350k/yr and you work an average of 50 hrs/week. You then go on to say you've cleared as much as 550k. Are you implying you worked less hours to nearly double your salary? Not likely, you probably worked more for a period of time (or reimbursement cuts really hit your practice hard which I suppose is possible). Working 60hrs (which is not that far off from your self reported average of 50) per week puts you in the average range for a surgeon, so you're not really working all that much less for your income that may, or may not, be more.

I can also tell you from my own anecdotal experience, the job offers (especially if you're willing to move to a place in need) are well over 350k/year.

Nope. Never said that.

The numbers make perfect sense. As our group acquired additional contracts at additional hospitals, our salaries increased. My work hours, averaged out through my career, are around 50 hours a week.

 

[ram006]

No problem whatsoever. There is currently no means to detect how little I care about what degree of regard patient's give me. I know I am responsible for their life and that's all I need. To me, priceless is being able to retire when I am 55 with a fully funded, multimillion dollar retirement account. I'll be able to enjoy my kids getting older and hanging out at our beach house. Hell, with the continuing decline in the public's perception of physicians in general, I really don't care what they think. We're all just "providers" nowadays - I'm grateful that I'm a very well off "provider."

Also, are you a CRNA or an anesthesiologist. Your profile says "Acute Care Nurse Practitioner Intensivist"

 

[Consigliere]

Also, are you a CRNA or an anesthesiologist. Your profile says "Acute Care Nurse Practitioner Intensivist"

Anesthesiologist. It's a tagline I created years ago and it's meant to be ironic.

 

[nymedstudent874]

Excuse me if these are naive questions but I've been following this thread since it was posted and as an MS3 deciding what to go into I have several questions.

1) why does anesthesia make so much? I don't get it. Are there highly reimbursed procedures or something?
2) aren't there a large number of practicing anesthesiologists? One of the residents on my rotation currently told me that anesthesia has a larger workforce than most fields. How does this not depress the salary
3) will such anesthesia jobs be available to the current generations of residents and med students? Or is this type of salary coming to an end as medicine changes?
4) how much can a fellowship certified surgeon (post GS residency) expect to make? Or does this vary drastically based on the specialization?


Sent from my iPhone using SDN mobile

 

[SLUser11]

No problem whatsoever. There is currently no means to detect how little I care about what degree of regard patient's give me.

That's my point. There's nothing wrong with your approach (or mine), but they are different, and our career goals are different as well. Comparing surgery to anesthesia is apples to oranges. I've always been surprised by the number of people who are tortured trying to decide between the two.

As for the money discussions, there's great money to be made in plenty of specialties. In general, the earning potential is higher in surgical subspecialties than it is in anesthesia, but there are plenty of PP anesthesiologists doing very well, especially if they have other income sources beyond clinical production.

Excuse me if these are naive questions but I've been following this thread since it was posted and as an MS3 deciding what to go into I have several questions.

1) why does anesthesia make so much? I don't get it. Are there highly reimbursed procedures or something?
2) aren't there a large number of practicing anesthesiologists? One of the residents on my rotation currently told me that anesthesia has a larger workforce than most fields. How does this not depress the salary
3) will such anesthesia jobs be available to the current generations of residents and med students? Or is this type of salary coming to an end as medicine changes?
4) how much can a fellowship certified surgeon (post GS residency) expect to make? Or does this vary drastically based on the specialization?

Those sound like great questions for the anesthesiology forum.

You answered your own fourth question.

 

[dpmd]

Late to the party but I will throw in my experience. I started out as an attending at a county hospital with a general surgery residency program. I had to take call a pretty reasonable amount (especially considering that I seldom had to come in because I was protected by the residents) and the amount of patients/cases I ended up with between that and shared clinic responsibilities meant that I was working under 40 hours a week (though I probably should have been doing some research or other activities instead of just hanging out and relaxing when I was done for the day). I had a pretty nice guarantee for the first year but was going to probably take a 100k pay cut once it switched to production, but that still would have put me in the >200 for 40hrs a week average that the OP was looking at. But instead I went into private practice in the same community (but now working at private hospitals) with a pretty sweet set up. I contract my overhead for a percentage of my collections and the same guy runs the call schedule for the hospitals I have privileges at. So I take call 6-10 times a month for a certain amount of money (the 10 was before a couple of people joined the call pool so that isn't likely to happen anymore) and now that I am more known in the community I am getting more elective referrals. I bill for whatever work I do on call or whatever other work I do, and in the leaner months (calls not so busy plus or minus me skipping a clinic or 2 for vacation) my overhead is less so I don't have to kill myself to pay to keep the lights on and the staff happy. I have been taking a week or two off 3-4 times a year since I started 3 yrs ago (plus various long weekends) and my work hours probably average out to under 40 hrs (and therefore I pay half as much for malpractice insurance) but I am still making >200k. Granted call can create issues with family life due to unpredictability, but I can indicate in advance which days I don't want to be on call or post call if I know something important is coming up. It may not be a common set up, but I am glad I happened upon it. But there are tradeoffs as SLUser indicates. In my case I am never going to be well known in the field of surgery, and while I get a decent variety of stuff on call I know my limitations and am not afraid to refer when appropriate. Plus the money was a lot more when I took more call, but I am perfectly content to earn less and work less (though am not afraid of working hard when the patient needs it).

 

[Hemorrage]

Late to the party but I will throw in my experience. I started out as an attending at a county hospital with a general surgery residency program. I had to take call a pretty reasonable amount (especially considering that I seldom had to come in because I was protected by the residents) and the amount of patients/cases I ended up with between that and shared clinic responsibilities meant that I was working under 40 hours a week (though I probably should have been doing some research or other activities instead of just hanging out and relaxing when I was done for the day). I had a pretty nice guarantee for the first year but was going to probably take a 100k pay cut once it switched to production, but that still would have put me in the >200 for 40hrs a week average that the OP was looking at. But instead I went into private practice in the same community (but now working at private hospitals) with a pretty sweet set up. I contract my overhead for a percentage of my collections and the same guy runs the call schedule for the hospitals I have privileges at. So I take call 6-10 times a month for a certain amount of money (the 10 was before a couple of people joined the call pool so that isn't likely to happen anymore) and now that I am more known in the community I am getting more elective referrals. I bill for whatever work I do on call or whatever other work I do, and in the leaner months (calls not so busy plus or minus me skipping a clinic or 2 for vacation) my overhead is less so I don't have to kill myself to pay to keep the lights on and the staff happy. I have been taking a week or two off 3-4 times a year since I started 3 yrs ago (plus various long weekends) and my work hours probably average out to under 40 hrs (and therefore I pay half as much for malpractice insurance) but I am still making >200k. Granted call can create issues with family life due to unpredictability, but I can indicate in advance which days I don't want to be on call or post call if I know something important is coming up. It may not be a common set up, but I am glad I happened upon it. But there are tradeoffs as SLUser indicates. In my case I am never going to be well known in the field of surgery, and while I get a decent variety of stuff on call I know my limitations and am not afraid to refer when appropriate. Plus the money was a lot more when I took more call, but I am perfectly content to earn less and work less (though am not afraid of working hard when the patient needs it).

Do you work in a metropolitan area? IMO it seems like 200k or 250k is a bit low for what surgeons handle considering the average FM salary is 230k. Any idea what most general surgeons make? AAMC CIM quotes the average as 380k but i dont know how reliable their data is.

 

[dpmd]

Do you work in a metropolitan area? IMO it seems like 200k or 250k is a bit low for what surgeons handle considering the average FM salary is 230k. Any idea what most general surgeons make? AAMC CIM quotes the average as 380k but i dont know how reliable their data is.

I am in a big small town (375k pop) where coat of living is low enough that a big house in a gated community is still under 500k. Your opinion is that 200k is too low for what works out to be part time work but to me it would have still been more than twice what I need to live in the nice house i bought in residency and fund my retirement while still going on some decent trips so i would accept it. However, I never know what number to use when discussing this because i don't have a salary, i have gross collections/business income/adjusted gross income/taxable income, but they were all more than 200k so i didn't dial it down. I never said how much above 200k my numbers go.

 

[Psai]

Do you work in a metropolitan area? IMO it seems like 200k or 250k is a bit low for what surgeons handle considering the average FM salary is 230k. Any idea what most general surgeons make? AAMC CIM quotes the average as 380k but i dont know how reliable their data is.

How is fm income relevant to surgeon income? And why do you say salary?

 

[balaguru]

It's not anecdotal in my case. Though I do agree the statement is a gross generalization.

Uh. You might want to look up the definition of anecdotal.

Sounds like SLUser11 and I went into general surgery for similar reasons. If seeing the wave of relieve wash over somebody whom you just told was margin and node negative or seeing a trauma patient in clinic looking like a normal human being that you snatched from the jaws of death and nursed in the ICU for weeks if not months doesn't stir your soul then you will never understand why somebody would do this sort of thing.

PS. My mom was and still is an anesthesiologist. I never heard her brag about how great it was working so little for so much. I have heard her complain about how the current generation of young anesthesiologists go on and on about lifestyle.

PPS. While we are being anecdotal. Prior to medicine I was a programmer earning 200k a year, 2 years out from school. This was with only an undergrad degree, no debt, weekends off, no fear of litigation, no guilt over complications, etc. If you chose medicine as a path to getting your bank account to X so you can retire quickly, I would argue you chose poorly.

 

[Consigliere]

PS. My mom was and still is an anesthesiologist. I never heard her brag about how great it was working so little for so much. I have heard her complain about how the current generation of young anesthesiologists go on and on about lifestyle.

PPS. While we are being anecdotal. Prior to medicine I was a programmer earning 200k a year, 2 years out from school. This was with only an undergrad degree, no debt, weekends off, no fear of litigation, no guilt over complications, etc. If you chose medicine as a path to getting your bank account to X so you can retire quickly, I would argue you chose poorly.

What's wrong with wanting a great lifestyle and income? If you choose to slavishly devote yourself to a career in medicine, that's on you pal; it just ain't my bag.

And I would argue that I chose wisely. While my experience may not be typical, I will retire at the age of 55 with a multimillion dollar retirement fund.

Don't hate.

 

[balaguru]

What's wrong with wanting a great lifestyle and income? If you choose to slavishly devote yourself to a career in medicine, that's on you pal; it just ain't my bag.

And I would argue that I chose wisely. While my experience may not be typical, I will retire at the age of 55 with a multimillion dollar retirement fund.

Don't hate.

There's nothing wrong about wanting to make a quick and easy buck. I had a day trading phase. There's nothing particularly inspiring about it either.

Saving 60k/yr starting at age 30 with an average yearly return of 7% should leave you with 4.1mil at age 55. Your experience should be typical of any physician.

Not hating. Just disagreeing.

 

[Pir8DeacDoc]

Any advice on where I can get a 7% return on my money? Not really going that way for me

 

[dpmd]

Any advice on where I can get a 7% return on my money? Not really going that way for me

Average over time, past performance is not indicative of future value, etc. But that is a reason why i said the decision gets really complicated based on time horizon you are looking at and whether you are talking about retirement accounts or those are already maxed and you are looking at taxable investing versus paying loans. Also individual comfort with risk.