Having trouble deciding Gen Surg vs Ortho

[RADjet]

Hi guys,

I've narrowed down my residency decision to either general surgery or orthopedic surgery. However Im having a tough time deciding between the two. I've listed some pros and cons of each specialty below. But I would apreciate more insight and input on the matter if possible.

Pros for general surgery:

I like that there is still a lot of medicine involved.

Life saving surgeries.

More interesting pathology in my opinion.

More fellowship options.


Cons:

Poor compensation.

As far as I know fewer available jobs

Often times very sick, difficult and unhappy patients


Pros for Orthopedic Surgery:

. Better patient outcomes

Better compensation

. More job oppurtunities

Better future job outlook (I've heard)


Cons:

Less interesting pathology

Very little medicine involved

Not lifesaving surgeries (mostly)

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[RustBeltOnc]

RADjet --

It is hard to see the ortho gravey train chugging along forever. I have pts currently who struggle with co pays, deductibles etc that will put their (elective) ortho procedures out of reach. Also, ortho is saturated in a lot of places.

Don't let $ figure into this.

 

[synecdoche]

Are you competitive for ortho? Are you picky about geography?

 

[frosted_flake]

Maybe not life saving, but my orthopedic surgeon changed my quality of life for the better after my surgery. I will be forever thankful for her!

 

[----------12c]

Hi guys,

I've narrowed down my residency decision to either general surgery or orthopedic surgery. However Im having a tough time deciding between the two. I've listed some pros and cons of each specialty below. But I would apreciate more insight and input on the matter if possible.

Pros for general surgery:

I like that there is still a lot of medicine involved.

Life saving surgeries.

More interesting pathology in my opinion.

More fellowship options.


Cons:

Poor compensation.

As far as I know fewer available jobs

Often times very sick, difficult and unhappy patients


Pros for Orthopedic Surgery:

. Better patient outcomes

Better compensation

. More job oppurtunities

Better future job outlook (I've heard)


Cons:

Less interesting pathology

Very little medicine involved

Not lifesaving surgeries (mostly)

According to my father. General surgery is fun in the beginning because of the toys but it becomes a miserable existence. So I would say ortho!

 

[Winged Scapula]

I'd hardly say that the reimbursement for general surgery is "poor".

Its not the same as Ortho Spine, but then what is? If making several hundred thousand a year isn't enough for you (and yes, lets leave out the hours worked), then a lot of things are going to make you unhappy. GS has a lot of fellowships which can bring the average reimbursement up to that of Ortho and can allow you to tailor a nice lifestyle.

And I'm not sure where you heard that there aren't jobs available in GS but this is inaccurate. Everyone wants a good general surgeon especially one willing to do vascular and/or trauma. Not all of those jobs are in the middle of nowhere either.

Pick the specialty that has the most colleagues and cases you enjoy.

 

[RADjet]

I'd hardly say that the reimbursement for general surgery is "poor".

Its not the same as Ortho Spine, but then what is? If making several hundred thousand a year isn't enough for you (and yes, lets leave out the hours worked), then a lot of things are going to make you unhappy. GS has a lot of fellowships which can bring the average reimbursement up to that of Ortho and can allow you to tailor a nice lifestyle.

And I'm not sure where you heard that there aren't jobs available in GS but this is inaccurate. Everyone wants a good general surgeon especially one willing to do vascular and/or trauma. Not all of those jobs are in the middle of nowhere either.

Pick the specialty that has the most colleagues and cases you enjoy.

Hmm. I appreciate your input. I guess I had some misunderstandings. And just to clarify, compensation really isn't that big of a deal to me. It's just a bonus I guess. My problem is I enjoy both of them equally. I'm just trying to compare them

 

[RADjet]

Are you competitive for ortho? Are you picky about geography?

Yes and I don't have much geological preference. I'd rather live somewhere warm(er) but it's not a must. Certainly not for residency at least.

 

[ConfusedChemist]

Hi guys,



Cons:

Poor compensation.

As far as I know fewer available jobs

I'm sorry....but how is making hundreds of thousands a year poor....

 

[fastlane]

I'm sorry....but how is making hundreds of thousands a year poor....

Get off your high horse, saintly Pre-medical student. The ortho average income is ~500 and the general surg average is ~300.
The free market dictates that working 10 years as an orthopedic surgeon is worth the same as a general surgeon working for 16.7 years. That is a huge difference, plus the fact that living on 300K/year + putting 200K/year in the bank is a massive difference in lifestyle than a general surgeon.

If money doesn't mean anything to you, hike over to family medicine and go be content there. Unfortunately for most people, especially those with loans, the average starting salary can be and should be a serious factor to keep in mind when choosing a specialty to practice for the next 20-30 years.

 

[Screwtape]

Get off your high horse, saintly Pre-medical student. The ortho average income is ~500 and the general surg average is ~300.
The free market dictates that working 10 years as an orthopedic surgeon is worth the same as a general surgeon working for 16.7 years. That is a huge difference, plus the fact that living on 300K/year + putting 200K/year in the bank is a massive difference in lifestyle than a general surgeon.

If money doesn't mean anything to you, hike over to family medicine and go be content there. Unfortunately for most people, especially those with loans, the average starting salary can be and should be a serious factor to keep in mind when choosing a specialty to practice for the next 20-30 years.

Health care in America is anything but a free market...

 

[ConfusedChemist]

Get off your high horse, saintly Pre-medical student. The ortho average income is ~500 and the general surg average is ~300.
The free market dictates that working 10 years as an orthopedic surgeon is worth the same as a general surgeon working for 16.7 years. That is a huge difference, plus the fact that living on 300K/year + putting 200K/year in the bank is a massive difference in lifestyle than a general surgeon.

If money doesn't mean anything to you, hike over to family medicine and go be content there. Unfortunately for most people, especially those with loans, the average starting salary can be and should be a serious factor to keep in mind when choosing a specialty to practice for the next 20-30 years.

okey then. Sorry to offend you. Having grown up in a household with a 25k income I actually find even 100k to myself unfathomable and I can't say I've ever been concerned with the lifestyle difference between 300k and 500k.
Lucky for you, saintly pre-meds such as myself will leave more of those 500k jobs open to those such as yourself.

 

[Winged Scapula]

All the practicing general surgeons in this thread please standup.

I thought so.

$300,000 would be at the low-end for a general surgeon. I don't know anyone making that little except perhaps as a starting employee who signed up that contract.

Most of us make significantly more than that, even without fellowship, and some of us even make more than those numbers quoted above for orthopedic surgery.

#dontbelievesalarysurveys

 

[operaman]

When I was on my rural family med rotation, I pulled the Form 990 (tax return) of the local hospital and there were multiple general surgeons making in the 500-800 range. None of the ortho guys were hospital-employed though so their salaries weren't listed, but I'm sure they were as high/higher. Point is that there is opportunity for great incomes in both fields.

 

[doc05]

you're all being ridiculous. there's no difference in quality of life between 300k and 500k. pick the field you like.

 

[Winged Scapula]

you're all being ridiculous. there's no difference in quality of life between 300k and 500k. pick the field you like.

This is the most salient point. While the extra money is nice it's not like it's going to take you from driving a Honda to flying a G6.

 

[Stagg737]

you're all being ridiculous. there's no difference in quality of life between 300k and 500k. pick the field you like.

Maybe not, but if you work 30 years and make an extra 200k, that's an extra 6 million in the bank. More if you invest it right. Depending on your lifestyle you could easily retire 5-10 years earlier making that extra 200k/year. Acting like 200k isn't a significant amount of money, especially when taken annually, is just foolish.

 

[Bancrofti]

Go in to gen surg and make my match life easier I feel like everyone is either Ortho or EM for c/o 2017.

 

[RustBeltOnc]

RADjet,

I don't want to "beat a dead horse," but much of the appeal of ortho is financial; even in medschool it's pretty obvious that much of the bonhomie of the field ("how much do you bench, bruh?",etc) finds its fount in the expectation of a good lifestyle and compensation. The problem is, though the lifestyle might remain good, the compensation will likely get worse - the payers are going to clamp down with a vengeance.

You yourself state in the OP the material doesn't inspire you. Will you be able to engage in "hand conference" with the requisite vigor? I am skeptical.

 

[Winged Scapula]

Maybe not, but if you work 30 years and make an extra 200k, that's an extra 6 million in the bank. More if you invest it right. Depending on your lifestyle you could easily retire 5-10 years earlier making that extra 200k/year. Acting like 200k isn't a significant amount of money, especially when taken annually, is just foolish.

I think we've established that the salary difference between general ortho and general surgery is not that great.

 

[Winged Scapula]

RADjet,

I don't want to "beat a dead horse," but much of the appeal of ortho is financial; even in medschool it's pretty obvious that much of the bonhomie of the field ("how much do you bench, bruh?",etc) finds its fount in the expectation of a good lifestyle and compensation. The problem is, though the lifestyle might remain good, the compensation will likely get worse - the payers are going to clamp down with a vengeance.

You yourself state in the OP the material doesn't inspire you. Will you be able to engage in "hand conference" with the requisite vigor? I am skeptical.

This is my concern. Given what the OP has posted (and admittedly it may not be complete or accurate), his interest in the GS material seems to be greater. That has better implications for a longer lasting satisfying career, IMHO (and one of the reasons I decided against Ortho).

 

[Slack3r]

All the practicing general surgeons in this thread please standup.

I thought so.

$300,000 would be at the low-end for a general surgeon. I don't know anyone making that little except perhaps as a starting employee who signed up that contract.

Most of us make significantly more than that, even without fellowship, and some of us even make more than those numbers quoted above for orthopedic surgery.

#dontbelievesalarysurveys

For now...

 

[Psai]

okey then. Sorry to offend you. Having grown up in a household with a 25k income I actually find even 100k to myself unfathomable and I can't say I've ever been concerned with the lifestyle difference between 300k and 500k.
Lucky for you, saintly pre-meds such as myself will leave more of those 500k jobs open to those such as yourself.

Who invited the premed? Its amazing how they will try to make themselves out to be the next mother teresa for accepting a lower hypothetical salary over a higher one. The only people who benefit from your faux generosity are administrators. None of us are impressed

 

[repititionition]

Get off your high horse, saintly Pre-medical student. The ortho average income is ~500 and the general surg average is ~300.
The free market dictates that working 10 years as an orthopedic surgeon is worth the same as a general surgeon working for 16.7 years. That is a huge difference, plus the fact that living on 300K/year + putting 200K/year in the bank is a massive difference in lifestyle than a general surgeon.

If money doesn't mean anything to you, hike over to family medicine and go be content there. Unfortunately for most people, especially those with loans, the average starting salary can be and should be a serious factor to keep in mind when choosing a specialty to practice for the next 20-30 years.

FM $ is WAY up. Not hard to do $300K working 9-5 in many markets now.

 

[Kaustikos]

Maybe not, but if you work 30 years and make an extra 200k, that's an extra 6 million in the bank. More if you invest it right. Depending on your lifestyle you could easily retire 5-10 years earlier making that extra 200k/year. Acting like 200k isn't a significant amount of money, especially when taken annually, is just foolish.

Wow... You're arguing salary differences in which both make salaries beyond comfortable in terms of living.
It's not foolish. 6 million dollars difference is negligible in this case. Especially when you consider job satisfaction.
But, yes, that 6 million could buy you a helluva lot more hookers than a general surgeon. Or a Ferrari. Or a mansion.
But, I'm, unless you live in Manhattan or in a million dollar condo, then you won't see any detriment to a general surgeons salary.

 

[Stagg737]

I think we've established that the salary difference between general ortho and general surgery is not that great.

Wow... You're arguing salary differences in which both make salaries beyond comfortable in terms of living.
It's not foolish. 6 million dollars difference is negligible in this case. Especially when you consider job satisfaction.
But, yes, that 6 million could buy you a helluva lot more hookers than a general surgeon. Or a Ferrari. Or a mansion.
But, I'm, unless you live in Manhattan or in a million dollar condo, then you won't see any detriment to a general surgeons salary.

I wasn't addressing the salary difference between fields, I was addressing the difference that 200k/year in general would make. Like I said before, will it make an immediate difference? Probably not unless you're buying the stuff you mentioned. But there is a VERY big difference between potentially retiring when you're 60 vs. retiring at 70. I also never said I'd have a problem making a surgeon's salary. I'll be happy just making 6 figures. That doesn't change the fact that an extra 200k is a significant difference.

 

[Stagg737]

FM $ is WAY up. Not hard to do $300K working 9-5 in many markets now.

I've heard of some making that much, but definitely didn't think it was that common. Are certain subspecialties making that much or is it more dependent on where one lives/the business model he or she uses?

 

[bc65]

I am going to offer up my personal opinion here for OP, for what it's worth.

I was initially going to go into ortho, but decided on general surgery instead because it involved more physiology, more life-and-death situations, and more excitement. I didn't care about the lifestyle or the money. I wish I had stayed with ortho. Here's why: The excitement faded quickly. Dealing with incredibly sick ICU patients was challenging at first. Imagine being an intern, being on call alone at night in the SICU at the county hospital, taking care of multiple trauma patients, septic, sometimes with head trauma and with SIADH and high intracranial pressure. It's all very exciting at first, but it became routine very quickly. The same with the gunshots and the MVAs.

Here's the truth about excitement: The first time you do something, it's scary. The second time, it's exciting. The third time, it's routine, and after that, it's boring. If your surgery is always exciting, you're doing it wrong.

So what you're left with is the day to day, bread and butter cases. So, which would you rather do, hernias and hemorrhoids, breast biopsies and gall bladders, or would you prefer reducing fractures and scoping knees? Some will prefer one, some the other, but I think that's the real decision for you to make.

The money shouldn't be the deciding factor, but more money is always better, all else being equal. So, if you can't decide, you can go with the better lifestyle, or more money. In that case, ortho wins on both counts. Although, lifestyle is somewhat dependent on the kind of practice you have. In my hospital, ortho is probably just as busy at night as general surgery, although I would rather be dealing with a hip fracture in the middle of the night rather than a 90 year old with dead bowel, but that's just me.

Also, ortho is a very intellectual field, and will be just as challenging as general surgery in terms of basic science and your fund of knowledge.

 

[karayaa]

FM $ is WAY up. Not hard to do $300K working 9-5 in many markets now.

Is this normal, PC FM with 15min appointments for a range of insurance types, or is this a practice that does a lot of cosmetic dermatology etc to increase the $$?

 

[Merely]

FM $ is WAY up. Not hard to do $300K working 9-5 in many markets now.

What's that you ask? The sound of students starting to become passionate about primary care.

 

[jw3600]

The ortho average income is ~500

...the fact that living on 300K/year + putting 200K/year in the bank...

It doesn't really change your point but ummm taxes?

 

[W19]

Is this normal, PC FM with 15min appointments for a range of insurance types, or is this a practice that does a lot of cosmetic dermatology etc to increase the $$?

My cousin in IM makes more than that in 2011, but I think he work ~60 hrs/wk. He owns his practice.

 

[karayaa]

My cousin in IM makes more than that in 2011, but I think he work ~60 hrs/wk. He owns his practice.

Wow. 60 is low hours. Does he do normal primary care? I assume most of his patients have medicare, but that doesn't pay much. Where does all his money come from?

and is his salary gross or net? If he owns the practice, does he also has to pay staff, benefits, rent, malpractice, etc?

 

[W19]

Wow. 60 is low hours. Does he do normal primary care? I assume most of his patients have medicare, but that doesn't pay much. Where does all his money come from?

and is his salary gross or net? If he owns the practice, does he also has to pay staff, benefits, rent, malpractice, etc?

He does normal primary care 9-5pm and he is also the medical director of a nursing home...

 

[Winged Scapula]

Wow. 60 is low hours.

Not really. The hours worked as an attending private practice internist are generally a fair bit less than that worked as a resident. 60 is what I would have guessed as well (to include paperwork and not all patient care).

Does he do normal primary care? I assume most of his patients have medicare, but that doesn't pay much.

Most internal medicine practices have a certain percentage of Medicare patients but also a lot of privately insured; not all patients are over 65, there are many younger ones with either chronic medical problems, acute ones or just there for health maintenance who have private insurance.

Where does all his money come from?

Patient volume and the nursing home gig.

and is his salary gross or net? If he owns the practice, does he also has to pay staff, benefits, rent, malpractice, etc?

If he is an owner/partner in private practice of course he is responsible for his overhead which would include staff, rent, malpractice etc.

 

[Stagg737]

What's that you ask? The sound of students starting to become passionate about primary care.

You could pay me $1,000,000 per year and FM would still be a back-up at this point. Extra money is nice, but not as nice as actually enjoying what I do.

 

[RustBeltOnc]

You could pay me $1,000,000 per year and FM would still be a back-up at this point. Extra money is nice, but not as nice as actually enjoying what I do.

I have a similar feeling. However, if it was hem onc and they made me do FM one day a week or a hospitalist shift twice a month, believe me I would become the USPSTF master.

 

[repititionition]

I've heard of some making that much, but definitely didn't think it was that common. Are certain subspecialties making that much or is it more dependent on where one lives/the business model he or she uses?

FM doesn't have many folks who "subspecialize" (sports medicine is really the only one that gets many applicants).

Everything is dependent on "the business model" (sorry for two quotes in this post, doesn't indicate sarcarsm)... If you work at a urban safety-net clinic, you're not going to make much money. But the median of the FM market is MUCH higher than most people recognize, and is higher in more markets than people would expect.

Why: primary care reimbursement is up (RUC), hospitals recognized that owning docs meant owning a referral stream and are paying well in the employed model as a result, the Direct Primary Care movement (this is where the real primary care money is, btw), and finally just a good old fashioned shortage. People follow money (shocking, I know), and supply is a trailing indicator.

My guess is that we're 5-10 years from peak primary care compensation, at which point supply will have caught up with demand, and then things will level. But for the next decade or so, the primary care financial trajectory (IM & FM, though peds is a different story) is rising sharply.

 

[repititionition]

Not really. The hours worked as an attending private practice internist are generally a fair bit less than that worked as a resident. 60 is what I would have guessed as well (to include paperwork and not all patient care).

Efficient hospitalists in PP are working way less than 60 hours a week. I know many that are clocking half that and making nearly $300K/yr.

Without the endless drama of academic rounding, a hospitalist who is on his **** can work 8a-1p.

Shhhh... some intensivists in PP work (on-site) even less than this and take home call.

 

[DokterMom]

you're all being ridiculous. there's no difference in quality of life between 300k and 500k. pick the field you like.

There's truth in this -- Happiness research pegs the point of diminishing returns at around $70K/year where more money doesn't really buy more happiness.

As to certain fields being 'out of balance' lucrative, there's still enough 'free market' in healthcare that things will even themselves out somewhat over the coming year. So yeah, don't decide based on the money.

 

[Stagg737]

FM doesn't have many folks who "subspecialize" (sports medicine is really the only one that gets many applicants).

Everything is dependent on "the business model" (sorry for two quotes in this post, doesn't indicate sarcarsm)... If you work at a urban safety-net clinic, you're not going to make much money. But the median of the FM market is MUCH higher than most people recognize, and is higher in more markets than people would expect.

Why: primary care reimbursement is up (RUC), hospitals recognized that owning docs meant owning a referral stream and are paying well in the employed model as a result, the Direct Primary Care movement (this is where the real primary care money is, btw), and finally just a good old fashioned shortage. People follow money (shocking, I know), and supply is a trailing indicator.

My guess is that we're 5-10 years from peak primary care compensation, at which point supply will have caught up with demand, and then things will level. But for the next decade or so, the primary care financial trajectory (IM & FM, though peds is a different story) is rising sharply.

Since you mentioned sports med...

Would these trends also include SM subspecialists? I honestly don't know many sports med guys that don't work in private practice. Since you're saying the employed model is what is driving up salaries, if there are a lot of sports med FMs that are employed or if that particularly sub-specialty will see a slower rise in salaries.

 

[SplenoMegastar]

There's truth in this -- Happiness research pegs the point of diminishing returns at around $70K/year where more money doesn't really buy more happiness.

No. That's my combined family income and I can guarantee you I'd be happier in the house Winged Scapula has in my imagination than in my place with all the broken doorknobs. I also grew up a lot poorer than I am now and despite how much I loved jumping around open fire hydrants (#hoodsummer) I'd rather my kids have pool parties. I don't need 500k to make that happen but I also don't need a crystal ball to know I'll be less stressed with a little more money.

 

[DokterMom]

No. That's my combined family income and I can guarantee you I'd be happier in the house Winged Scapula has in my imagination than in my place with all the broken doorknobs. I also grew up a lot poorer than I am now and despite how much I loved jumping around open fire hydrants (#hoodsummer) I'd rather my kids have pool parties. I don't need 500k to make that happen but I also don't need a crystal ball to know I'll be less stressed with a little more money.

Here are the articles I referenced. So on average, even a FM doc should be able to be reasonably happy

http://time.com/money/2802147/does-money-buy-happiness/

http://www.huffingtonpost.com/2014/07/17/map-happiness-benchmark_n_5592194.html

http://content.time.com/time/magazine/article/0,9171,2019628,00.html

 

[SplenoMegastar]

Here are the articles I referenced. So on average, even a FM doc should be able to be reasonably happy

http://time.com/money/2802147/does-money-buy-happiness/

http://www.huffingtonpost.com/2014/07/17/map-happiness-benchmark_n_5592194.html

http://content.time.com/time/magazine/article/0,9171,2019628,00.html

Don't have energy to spell out all the reasons this is not an apt comparison.
1) these are not studies that are going to hold weight in a community of thousands of people trained in science (sdn as an example) - esp the one by an investment advisor or whatever the middle one was
2) you can't compare a physician to the average American in terms of what will make them happy

I apologize to the OP for my role in this thread derailment.

 

[doc05]

No. That's my combined family income and I can guarantee you I'd be happier in the house Winged Scapula has in my imagination than in my place with all the broken doorknobs. I also grew up a lot poorer than I am now and despite how much I loved jumping around open fire hydrants (#hoodsummer) I'd rather my kids have pool parties. I don't need 500k to make that happen but I also don't need a crystal ball to know I'll be less stressed with a little more money.

sorry - you're wrong. A wise man once said "Mo money, mo problems"

 

[doc05]

I wasn't addressing the salary difference between fields, I was addressing the difference that 200k/year in general would make. Like I said before, will it make an immediate difference? Probably not unless you're buying the stuff you mentioned. But there is a VERY big difference between potentially retiring when you're 60 vs. retiring at 70. I also never said I'd have a problem making a surgeon's salary. I'll be happy just making 6 figures. That doesn't change the fact that an extra 200k is a significant difference.

first off, it's an extra 100k. you forgot about taxes.
more importantly, you should be able to plan a very comfortable retirement on a 300k salary, or even less. the extra $$ doesn't make a substantive difference.

 

[Stagg737]

first off, it's an extra 100k. you forgot about taxes.
more importantly, you should be able to plan a very comfortable retirement on a 300k salary, or even less. the extra $$ doesn't make a substantive difference.

If you want to add taxes then it would be a take home of around 200k vs. 330k, so a 130k difference. Take that out 30 years and it's still 3.9 million. One could also be capable of retiring comfortably on 75k/year. The difference is how many years of retirement you can get out of it and what you want to do during retirement. An extra 4 mil will make a substantive difference unless one is living an exuberant lifestyle. I'm really pretty surprised by the number of people here who seem to think having an extra couple million dollars wouldn't make a difference...

Anyway, to contribute to the original question: I would only let money be a factor if I really thought I'd be happy doing either job. This is taking into account the sage advice given by @bc65 , but still, money shouldn't be the primary concern here.

 

[W19]

first off, it's an extra 100k. you forgot about taxes.
more importantly, you should be able to plan a very comfortable retirement on a 300k salary, or even less. the extra $$ doesn't make a substantive difference.

I think someone @Stagg737 already pointed that out. It does not make that much difference in term of lifestyle, but it makes a huge difference in term of purchasing power i.e the ability to invest, which can substantially lower one's retirement age... Anyway, we are discussing 300k vs. 500k when the average household income in the country is 53-54k/year.... Even if we factor in loan/taxes, these incomes are 4-6 times more of what the average family make... I know, I know! we are special since we go thru 11-15 years of rigorous training and our job is a lot more demanding . People will definitely have some sympathy for us .

 

[W19]

'When in doubt about specialty, go with the money.' That's what a wise doctor told me...

 

[SplenoMegastar]

sorry - you're wrong. A wise man once said "Mo money, mo problems"

Maybe, but I think the average family of four would be happier on 150k than 70k. I agree that I probably wouldn't notice the difference between 300k and 500k much but we also don't need to be ridiculous.