Help Choosing Specialty (Surgery?)

[docdoc14]

Upcoming MS4 here and I wanted to ask for help in choosing a specialty. I have been thinking hard about general surgery since early on in medical school. I strongly disliked all of the other rotations during my 3rd year (Neuro, IM, FM, OB, Psych). Surgery was the only rotation I really enjoyed, however my hours were brutal (I did vascular and trauma and was easily hitting over 80+ hrs/wk). I'm concerned because although I loved what I was doing, I just don't think that that is a sustainable pace for me (and my relationship with SO) for 5 years let alone a career.

I love my wife, my family, and having hobbies outside of medicine and all the talk of "if you can do anything else and be happy do it", "surgeons live to work", or "choose surgery if your favorite place in the world is the OR" have me hesitant to pursue surgery. Operating is absolutely amazing and I admire and look up to the surgeons and surgical residents more than anyone else I have worked with, but I don't believe any job is worth sacrificing enjoying my life for.

Things about me: Step 1 score was a 228 which eliminates some of the more competitive specialties. I would definitely prefer a more procedural specialty. All suggestions or recommendations as to specialties I should look into are hugely appreciated. Thank you!

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[redfish955]

Practicing surgery and having a life. Pretty much the harder it is to replace you the more they will do to keep you.

 

[ndafife]

Off the top of my head... General Surgery and Ob-Gyn are directly procedural. Anesthesiology is procedural in a way. ER and Family Med each have some procedures.

Or you can do DR --> IR fellowship, IM --> Gastroenterology, IM --> Cards --> Interventional Cards

But it sounds like you really want surgery. And I think you know that.

 

[Moose A Moose]

Those quotes you listed are definitely accurate, and it sounds like you’ve accepted the reality of a surgeon’s hourly work week. Keep in mind, a lot of internal med is intertwined with general surgery. Managing patients, especially in the SICU, will become second nature.

It sounds like you want your life to have a better balance. If your boards were stronger, I’d say go for a subsurg specialty. Do you have any connections? If so that may bring you into the playing field.

You sound like the typical fit for emed, tbh. I think you’d be ‘blah’ with gas, and bored to tears with IM. Good luck.

 

[trobinsonmd]

Upcoming MS4 here and I wanted to ask for help in choosing a specialty. I have been thinking hard about general surgery since early on in medical school. I strongly disliked all of the other rotations during my 3rd year (Neuro, IM, FM, OB, Psych). Surgery was the only rotation I really enjoyed, however my hours were brutal (I did vascular and trauma and was easily hitting over 80+ hrs/wk). I'm concerned because although I loved what I was doing, I just don't think that that is a sustainable pace for me (and my relationship with SO) for 5 years let alone a career.

I love my wife, my family, and having hobbies outside of medicine and all the talk of "if you can do anything else and be happy do it", "surgeons live to work", or "choose surgery if your favorite place in the world is the OR" have me hesitant to pursue surgery. Operating is absolutely amazing and I admire and look up to the surgeons and surgical residents more than anyone else I have worked with, but I don't believe any job is worth sacrificing enjoying my life for.

Things about me: Step 1 score was a 228 which eliminates some of the more competitive specialties. I would definitely prefer a more procedural specialty. All suggestions or recommendations as to specialties I should look into are hugely appreciated. Thank you!

I also loved surgery, but ultimately ended up picking derm bc I have lower back issues and didn't want to be standing all day doing long procedures... I think a great option for you would be to pick DR and then do an IR fellowship. Almost unheard of to find an exclusively procedural gig in private practice, you'll definitely have a lot of DR mixed in there, so if you don't like DR or image guided procedures, anesthesiology is pretty procedural and the lifestyle is pretty good... and its a shorter residency... interventional cards is also an option, but its at least 7 years and the lifestyle is iffy

 

[mrbreakfast]

I love my wife, my family, and having hobbies outside of medicine and all the talk of "if you can do anything else and be happy do it", "surgeons live to work", or "choose surgery if your favorite place in the world is the OR" have me hesitant to pursue surgery.

Also an upcoming M4, and one who strongly considered surgery prior to M3. On my first few rotations, though, when I told the (non-surgical) residents I was thinking of a surgical subspecialty, they told me that, on average, 20-25% of surgical residents quit. They told me about multiple people in their program who had quit ortho to do IM, and that every year or two the gen surg program loses someone to radiology. I was shocked.

Then I rotated on surgery and met the surgical residents, who bragged about how many hours they worked and thought duty hour restrictions were a joke. And I met the attendings, many of whom worked 7 days a week for most of the year. As one of those guys told me, the only way to be a good surgeon is to treat every

It's your call, but I'll give you the advice my surgery R3 gave me: only do surgery if you have absolutely zero misgivings about the field/lifestyle.

Step 1 score was a 228 which eliminates some of the more competitive specialties.

Gyn surgery. You might hate half the residency, but apparently so did most OBGYN residents I met who were waiting for fellowship. Hours will be long but not quite as long. Or, one of the PMR docs at my institution spends ~10 hours in the OR/week, and I'm sure you could manage to do much more.

There's always anesthesia too.

 

[ACSurgeon]

Upcoming MS4 here and I wanted to ask for help in choosing a specialty. I have been thinking hard about general surgery since early on in medical school. I strongly disliked all of the other rotations during my 3rd year (Neuro, IM, FM, OB, Psych). Surgery was the only rotation I really enjoyed, however my hours were brutal (I did vascular and trauma and was easily hitting over 80+ hrs/wk). I'm concerned because although I loved what I was doing, I just don't think that that is a sustainable pace for me (and my relationship with SO) for 5 years let alone a career.

I love my wife, my family, and having hobbies outside of medicine and all the talk of "if you can do anything else and be happy do it", "surgeons live to work", or "choose surgery if your favorite place in the world is the OR" have me hesitant to pursue surgery. Operating is absolutely amazing and I admire and look up to the surgeons and surgical residents more than anyone else I have worked with, but I don't believe any job is worth sacrificing enjoying my life for.

Things about me: Step 1 score was a 228 which eliminates some of the more competitive specialties. I would definitely prefer a more procedural specialty. All suggestions or recommendations as to specialties I should look into are hugely appreciated. Thank you!

Not gonna sugar coat it, but also won’t try to push you away.

The hours are long and the environment can be brutal. In 2018, you’re just as likely to end up at a gossip mill with passive aggressive people as you are to end up at a frankly malignant program. For 5-9 years, you work really hard to learn to become a surgeon while trying to please too many bosses with things that don’t really matter. You’ll spend so much more time not operating than you will actually operating. It is a huge sacrifice that only you can tell if it’s worth it. And to make it better, you won’t know if it’s worth it until you’re in the thick of it.

For those who think surgeons and surgery residents enjoy not having a life: this isn’t true. While we put on a brave face, we complain amongst our selves a ton (to our classmate and close friends only). We complain about missing important life events. We complain about the abuse. We complain about being sleep deprived and being unappreciated. Nonetheless we enjoy operating, and time in the OR serves to recharge us and remind us why we decided to become surgeon (hard to tell as a student since watching isn’t the same as doing).

So, it’s 100% normal to have concerns about committing to surgery. The 20% attrition is real, and it’s there for a reason. Sure, some people had no business going into surgery and were frankly misguided. However, some people are quality residents who either burn out or decide against it after 1-3 years.

Here’s the double edged sword: if you don’t pursue surgery, you might spend your entire career regretting it. If you do pursue it, there’s a 20% chance you quit or get pushed out. Only you can decide which risk is worse for you.

Personally- I went trough the first 3 years in a happy go luck way. I started to burn out during my critical care fellowship, and my last two years were a bit of a drag. Had my first kid as a chief, and boy was that a life changing experience. Not sure how my burn out would have changed if we had kids sooner. I’m almost a year out from training, I passed my written and oral boards, and my burn out is finally subsiding. It finally feels like it was all worth it. There’s not a day that I go to work that I don’t feel like I’m making a difference in my patients lives. My job is so much better than any non-procedural job. I think anesthesia, ER, Critical Care, GI and cards could have been satisfying too, but wouldn’t trade my knowledge and skills for any of those.

TLDR: the training sucks and you have to enjoy aspects of it enough to survive. There’s a light at the end of the tunnel if you chose the right job. Totally worth it to me, but this is highly personal.

 

[ACSurgeon]

Also an upcoming M4, and one who strongly considered surgery prior to M3. On my first few rotations, though, when I told the (non-surgical) residents I was thinking of a surgical subspecialty, they told me that, on average, 20-25% of surgical residents quit. They told me about multiple people in their program who had quit ortho to do IM, and that every year or two the gen surg program loses someone to radiology. I was shocked.

Then I rotated on surgery and met the surgical residents, who bragged about how many hours they worked and thought duty hour restrictions were a joke. And I met the attendings, many of whom worked 7 days a week for most of the year. As one of those guys told me, the only way to be a good surgeon is to treat every

It's your call, but I'll give you the advice my surgery R3 gave me: only do surgery if you have absolutely zero misgivings about the field/lifestyle.



Gyn surgery. You might hate half the residency, but apparently so did most OBGYN residents I met who were waiting for fellowship. Hours will be long but not quite as long. Or, one of the PMR docs at my institution spends ~10 hours in the OR/week, and I'm sure you could manage to do much more.

There's always anesthesia too.

It’s normal to have doubt. You should however be honest with yourself and know that you can tough it out and have a great work ethic. You have to be willing to sacrifice at least in theory. For those who don’t want to work hard or make sacrifices to train, it’s clearly not for them. For the rest of us, we all had doubt, and you won’t know if it materializes until you’re in it.

Gyn isn’t the same as any other surgical training unless you do gyn-onc or uro-gyn. Only do OBGYN if you wanna deliver babies or are interested in women’s health.

 

[ACSurgeon]

Off the top of my head... General Surgery and Ob-Gyn are directly procedural. Anesthesiology is procedural in a way. ER and Family Med each have some procedures.

Or you can do DR --> IR fellowship, IM --> Gastroenterology, IM --> Cards --> Interventional Cards

But it sounds like you really want surgery. And I think you know that.

Careful about this point: procedural and surgical are not the same. For those who want to be surgeons, learning to do procedures may or may not be good enough to give you satisfaction.

 

[ndafife]

Careful about this point: procedural and surgical are not the same. For those who want to be surgeons, learning to do procedures may or may not be good enough to give you satisfaction.

Just responding to what OP wanted

Things about me: Step 1 score was a 228 which eliminates some of the more competitive specialties. I would definitely prefer a more procedural specialty. All suggestions or recommendations as to specialties I should look into are hugely appreciated. Thank you!

 

[SdoctorDR]

Ophthalmology offers some surgical aspects while still allowing a decent lifestyle. Competitive though.


Sent from my iPhone using SDN mobile

 

[docdoc14]

Practicing surgery and having a life. Pretty much the harder it is to replace you the more they will do to keep you.

Surgeon + mother of 5 +ironman triathlete. Talk about work life balance! I think rural general surgery could be really interesting. It would just be a matter of making it through the 5 years of residency to get there still though. Regardless, thanks for the link! It at least gives me hope that it can in fact be done (even if you have to be super human haha).

 

[docdoc14]

Off the top of my head... General Surgery and Ob-Gyn are directly procedural. Anesthesiology is procedural in a way. ER and Family Med each have some procedures.

Or you can do DR --> IR fellowship, IM --> Gastroenterology, IM --> Cards --> Interventional Cards

But it sounds like you really want surgery. And I think you know that.

Haha I think you are exactly right which is why this decision has been tormenting. In another life where I am single and had no other commitments I think this decision would be a no brainer. However, I do have another person that this decision will largely impact. It's easier to swallow committing myself to 5 years of misery than it is to committing my innocent SO who essentially has no choice to 5 years of misery.

I have considered DR to IR. A concern would be that IR is getting continually more and more competitive each year and the thought of being trapped (for lack of a better word) in DR sounds terrible haha. Definitely something to think about though. Thanks!

 

[docdoc14]

Also an upcoming M4, and one who strongly considered surgery prior to M3. On my first few rotations, though, when I told the (non-surgical) residents I was thinking of a surgical subspecialty, they told me that, on average, 20-25% of surgical residents quit. They told me about multiple people in their program who had quit ortho to do IM, and that every year or two the gen surg program loses someone to radiology. I was shocked.

Then I rotated on surgery and met the surgical residents, who bragged about how many hours they worked and thought duty hour restrictions were a joke. And I met the attendings, many of whom worked 7 days a week for most of the year. As one of those guys told me, the only way to be a good surgeon is to treat every

It's your call, but I'll give you the advice my surgery R3 gave me: only do surgery if you have absolutely zero misgivings about the field/lifestyle.



Gyn surgery. You might hate half the residency, but apparently so did most OBGYN residents I met who were waiting for fellowship. Hours will be long but not quite as long. Or, one of the PMR docs at my institution spends ~10 hours in the OR/week, and I'm sure you could manage to do much more.

There's always anesthesia too.

The attrition rate is crazy! My hope is not to become just another stat to add to that haha. I tried so hard to love ob/gyn. The gyn surgeries were actually really interesting, but I could not for the life of me get excited about women's healthcare. Thanks for the suggestion though!

 

[ndafife]

Haha I think you are exactly right which is why this decision has been tormenting. In another life where I am single and had no other commitments I think this decision would be a no brainer. However, I do have another person that this decision will largely impact. It's easier to swallow committing myself to 5 years of misery than it is to committing my innocent SO who essentially has no choice to 5 years of misery.

I have considered DR to IR. A concern would be that IR is getting continually more and more competitive each year and the thought of being trapped (for lack of a better word) in DR sounds terrible haha. Definitely something to think about though. Thanks!

Honestly the general surgeon attendings I have worked with have a fairly good work-life balance. If you dont mind non-academic pursuits and limiting a lot of your practice to gall bladders and appys, I feel if you can get through the residency your life can be pretty manageable

 

[docdoc14]

Here’s the double edged sword: if you don’t pursue surgery, you might spend your entire career regretting it. If you do pursue it, there’s a 20% chance you quit or get pushed out. Only you can decide which risk is worse for you.

I think this is exactly the decision point that needs to be made for myself. In talking with several of my classmates that are pursuing surgery they seem to endorse 110% general surgery is right for them without any doubts at all. It was always disconcerting talking with them in expressing my doubt because it made it seem as if having doubt alone was enough to say don't even bother applying. It's good to know that now attending level surgeons had doubts at one point or another. I really appreciate your honesty and clearly have a lot of thinking to do, thank you!

 

[redfish955]

Surgeon + mother of 5 +ironman triathlete. Talk about work life balance! I think rural general surgery could be really interesting. It would just be a matter of making it through the 5 years of residency to get there still though. Regardless, thanks for the link! It at least gives me hope that it can in fact be done (even if you have to be super human haha).

If you look around you can find small towns centered around a University or a big manufacturing company that won't seem overly rural, have decent schools, and may even have enough affluent people for a nice country club.

 

[AsianPersuasion]

I feel you, OP. Lol, I was gunning for FM and said f**k it all, up until my surgical rotation and that changed my life. Mind you, I'm about to marry the love of my life who is a trauma surgeon and he's completely against the idea of pursuing surgery because in his mind, it just isn't worth it anymore...but that's his opinion.

I hated my OR rotation during nursing school, but my rotation now as a MS is way more interesting and exhilarating. I had a HUGE exposure to Vascular and I absolutely loved it! The open style, the endo style, the hybrid style, making custom endograft, dealing with large bleeders, doing fistulas...was really awesome.

Even though I definitely hit 80 hrs like you did, too, they really didn't feel that long. But it does get to you though. I remember sneaking a nap in the library of the hospital right before heading home after call because I felt like I could barely see anything anymore. Only to find the derm residents strolling in with their suits and heels...I was low key jealous.

I worry about lifestyle too, but honestly, I haven't found a specialty that gave me the high like this.

I don't mind working hard but doing something I enjoy. I truly learn what that quote really means now after doing my surgical rotation.

I say this and I will say it again. I don't love the OR, but I love what we DO in the OR.

 

[redfish955]

Diet is a huge part of hellish hours. I have worked 400 hour months while dating a nutritionist and letting her cook everything for me and feel great. I have also dated alcoholic school teachers while working 70 hour weeks and felt horrible. From personal experience I would never go into a field that puts you at your limits unless your willing to quit drinking and eat like Tom Brady. Since you have a wife that would hopefully open a cook book you have a huge advantage on a lot of people. Imo The Goldman's Sachs idea of building power points from 9 to 1 and then pounding six shots is honestly the dumbest thing you could ever imagine. It sounds like surgery is the type of job you do if your willing to give up absolutely everything but spending 2 hours a day with your wife and kids so you can give tens of thousands of people a twenty percent longer life.

 

[IMreshopeful]

I would say - for surgery in particular I would be sure that if you want to do this kind of lifestyle when you’re in your 50s and 60s and still feel okay, then it might be a field for you. Unlike some of the medical specialties or fields like IR where there’s a noninvasive clinic or modality that you can back down to if you want to or have to (health reasons etc) back away from doing procedures, surgery is pretty much just...surgery. So make sure to factor that into your calculus.

 

[ACSurgeon]

I would say - for surgery in particular I would be sure that if you want to do this kind of lifestyle when you’re in your 50s and 60s and still feel okay, then it might be a field for you. Unlike some of the medical specialties or fields like IR where there’s a noninvasive clinic or modality that you can back down to if you want to or have to (health reasons etc) back away from doing procedures, surgery is pretty much just...surgery. So make sure to factor that into your calculus.

I would also be very careful taking any advice about going into surgery from
non-surgeons.

Depending on your practice, you can end up taking little ER call in your older years. I agree that surgeons will still have more emergencies, late nights etc than non-surgeons, but it’s not like you have to work 60 hours a week for the rest of your life.

 

[IMreshopeful]

I would also be very careful taking any advice about going into surgery from
non-surgeons.

Depending on your practice, you can end up taking little ER call in your older years. I agree that surgeons will still have more emergencies, late nights etc than non-surgeons, but it’s not like you have to work 60 hours a week for the rest of your life.

So if you develop debilitating back pain from a disc herniation later in life and can’t do surgery what is your back up?

 

[IMGASMD]

So if you develop debilitating back pain from a disc herniation later in life and can’t do surgery what is your back up?

Good disability insurance..... or be independently wealthy at that point.....

Edit: I am a non surgeon

 

[ACSurgeon]

So if you develop debilitating back pain from a disc herniation later in life and can’t do surgery what is your back up?

$$$ disability insurance

Also- I’m critical care certified so there’s always that.

For other surgeons, they can staff a wound clinic, work at a smaller hospital that’s not as busy, academic surgeons can do more teaching and limit there practice to simpler things. Honestly, we got skills that can be useful in a variety of settings

 

[Redpancreas]

Upcoming MS4 here and I wanted to ask for help in choosing a specialty. I have been thinking hard about general surgery since early on in medical school. I strongly disliked all of the other rotations during my 3rd year (Neuro, IM, FM, OB, Psych). Surgery was the only rotation I really enjoyed, however my hours were brutal (I did vascular and trauma and was easily hitting over 80+ hrs/wk). I'm concerned because although I loved what I was doing, I just don't think that that is a sustainable pace for me (and my relationship with SO) for 5 years let alone a career.

I love my wife, my family, and having hobbies outside of medicine and all the talk of "if you can do anything else and be happy do it", "surgeons live to work", or "choose surgery if your favorite place in the world is the OR" have me hesitant to pursue surgery. Operating is absolutely amazing and I admire and look up to the surgeons and surgical residents more than anyone else I have worked with, but I don't believe any job is worth sacrificing enjoying my life for.

Things about me: Step 1 score was a 228 which eliminates some of the more competitive specialties. I would definitely prefer a more procedural specialty. All suggestions or recommendations as to specialties I should look into are hugely appreciated. Thank you!

Sigh...I see too many people on here making decisions based on their love of rotations. “Operating is absolutely amazing” and “I admire surgical residents more than anyone else”. Just go with surgery though; seems like you really want to be one and that alone can be a strong factor.

 

[AsianPersuasion]

Sigh...I see too many people on here making decisions based on their love of rotations. “

But isn't that the point of 3rd year? Basically a trial run to see where you're best fit / want? If people aren't making decisions based on what they're doing, how do you suggest one picks a specialty? 3rd and 4th year is supposed to be a snap shot in the life what that specialty is like. I feel as though there's a lot of trade-off in medicine and there's really no one narrow way to doing it or practicing it. I'm sure there's people who picked surgery because of Grey's Anatomy show but then there are others like myself who are actually interested in the actual job, even if it means making some sacrifices.

Frankly, it sounds great hearing people working three 12 hrs shifts a week, having 4 days off etc who skis every other day and so forth. But for others like me, I find that hella boring and will not know what to do with myself with that 4 extra days even with some basic hobbies.

 

[docdoc14]

I feel you, OP. Lol, I was gunning for FM and said f**k it all, up until my surgical rotation and that changed my life. Mind you, I'm about to marry the love of my life who is a trauma surgeon and he's completely against the idea of pursuing surgery because in his mind, it just isn't worth it anymore...but that's his opinion.

I hated my OR rotation during nursing school, but my rotation now as a MS is way more interesting and exhilarating. I had a HUGE exposure to Vascular and I absolutely loved it! The open style, the endo style, the hybrid style, making custom endograft, dealing with large bleeders, doing fistulas...was really awesome.

Even though I definitely hit 80 hrs like you did, too, they really didn't feel that long. But it does get to you though. I remember sneaking a nap in the library of the hospital right before heading home after call because I felt like I could barely see anything anymore. Only to find the derm residents strolling in with their suits and heels...I was low key jealous.

I worry about lifestyle too, but honestly, I haven't found a specialty that gave me the high like this.

I don't mind working hard but doing something I enjoy. I truly learn what that quote really means now after doing my surgical rotation.

I say this and I will say it again. I don't love the OR, but I love what we DO in the OR.

Isn't it weird how that happens? In the OR time flies and I never feel tired at all, but as soon as I step back outside to the real world I just want to crawl into bed! hahaha freaking derm.

 

[bankaix808]

I say this and I will say it again. I don't love the OR, but I love what we DO in the OR.

This is so true. Now if I can only translate that sentiment into a personal statement, because right now, I just have "...because it feels right."

Good luck, current fourth-years.

 

[premieredoc]

Media edited out

 

[Shambere]

$$$ disability insurance

Also- I’m critical care certified so there’s always that.

For other surgeons, they can staff a wound clinic, work at a smaller hospital that’s not as busy, academic surgeons can do more teaching and limit there practice to simpler things. Honestly, we got skills that can be useful in a variety of settings

But see downgrading to any of those options (minus CC) is awful, especially for someone with high pride. That's why you encounter old timers clinging and doing a disservice to them and the community.

 

[ACSurgeon]

But see downgrading to any of those options (minus CC) is awful, especially for someone with high pride. That's why you encounter old timers clinging and doing a disservice to them and the community.

Another reason not to buy that 100k car and million dollar home straight out of residency...

If you need the money to live, you work whatever, and as a surgeon, you have plenty of knowledge and skill to earn money. Pride is secondary.

 

[Shambere]

Anothe reason not to buy that 100k car and million dollar home straight out of residency...

If you need the money to live, you work whatever, and as a surgeon, you have plenty of knowledge and skill to earn money. Pride is secondary.

But some pigeon hole themselves, you either do surgery or if you cant you cant do much else in medicine.