Help with career choice regarding surgery would be greatly appreciated

[Ihd31]

Hello,
Here's to my first post on SDN. Thanks in advance.
I am a 4th year medical student at a mid-high tier medical school. I am currently very crunched for time/stressed regarding choosing a specialty in order to be able to graduate and match on time. I started medical school under the impression of pursuing internal medicine/cardiology due to my extensive exposure to those fields through undergrad research. However, I did not enjoy my 3rd year IM rotation, felt that they are babysitting the patients while the specialists take care of the patient, slow pace, boring, long round etc. However, I did get along with my residents and attendings very well in IM and did well on the rotation. Don't get me wrong, internists are extremely knowledgable and intelligent and i would love to learn "everything about everything" as they do. After IM, I did surgery and I loved surgery, the immediate gratification, the patient population, the concept of fixing and solving problems instantly. However, I am extremely discouraged by the popular beliefs about the "bad lifestyle of surgery". I am a hard working person, and I enjoy working hard, being a leader and taking good care of my patients (did very well on surgery rotation), however I really appreciate my time off, I'm an overall happier person when I have time off to see my family and friends and relax. My long term goal is to work 50-55 hours a week, 60 max. It's becoming a dilemma of self-identity; life style vs. Pursuing something that I enjoy. Family and friends all recommend going into IM and subspecializing in a procedural fellowship such as cardiology, pulm or GI (to satisfy both lifestyle and need for procedural work) but I am afraid that not enjoying IM is a red flag. Mainly, I would like to know: HOW BAD is the surgery lifestyle during and after residency, and HOW much better is IM? Thanks very much.

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[Winged Scapula]

I'm afraid none of us can't tell you "how much better" IM is (just as you shouldn't talk to non-surgeons about what being a surgeon is like).

You can create whatever lifestyle you like once you're in practice; however, there are compromises in terms of type of employment, specialty and reimbursement.

What most non-surgeons fail to understand is that procedures aren't surgeries; the practice of a surgeon is different than that of a proceduralist.

 

[Ihd31]

Thanks a lot for your reply. As much as I love surgery, and my work, I still enjoy my life outside of Medicine more (family life, friends etc). Can you please give me an idea of the lifestyle during residency. I just want to make sure that it's something I am capable of doing. Also, is it common for people to not choose a surgical career and go into internal medicine in fear of the lifestyle.

I'm afraid none of us can't tell you "how much better" IM is (just as you shouldn't talk to non-surgeons about what being a surgeon is like).

You can create whatever lifestyle you like once you're in practice; however, there are compromises in terms of type of employment, specialty and reimbursement.

What most non-surgeons fail to understand is that procedures aren't surgeries; the practice of a surgeon is different than that of a proceduralist.

 

[Winged Scapula]

Thanks a lot for your reply. As much as I love surgery, and my work, I still enjoy my life outside of Medicine more (family life, friends etc). Can you please give me an idea of the lifestyle during residency. I just want to make sure that it's something I am capable of doing. Also, is it common for people to not choose a surgical career and go into internal medicine in fear of the lifestyle.

I'll let current residents talk about lifestyle *during* residency but it may come as a surprise to you, but IM residents generally work just as many hours as the surgical residents. Residency is not necessarily representative of your professional practice.

It may also come as a surprise to you but surgeons also enjoy their families and friends, and a life outside of the OR. There are surgical subspecialties which allow for less call/lighter schedule which may appeal to you. Internists/cardiologists/gastroenterologists don't necessarily have a great lifestyle. I think you're making a false assumption here.

As to whether its common for people to choose IM over surgery, I'm afraid I don't know the answer. Im sure there are some.

 

[ProfMD]

Lifestyle as an attending is up to you. For instance, I work in an academic practice and have partners I trust. When I am off, my partners take care of my patients. Even when I am on call, the residents field a lot of the mundane stuff and I only get called for new consults and surgeries. Weekends that I am on call, I spend 1-2 hours rounding a writing notes each day then hang out with my family unless something happens that needs my attention. I work ~60 hours a week.

Some surgeons work longer hours, some fewer. It depends on you speciality and practice type (academic vs private, solo vs group, trauma center vs not, etc).

Don't listen to non-surgeons tell you what surgery is like. If you asked me what medicine is like, I say it's all about babysitting patients, rounding, having extended conferences about minutia, and in general is torture. But, that probably is not a fair assessment.

 

[doc05]

If you really love surgery, then do it. Remember that the awfulness of residency eventually ends. Lifestyle as an attending really depends upon your subspecialty and practice setting. And most importantly remember that most IM docs (general and specialists) have long hours and awful lifestyles.

 

[Smurfette]

If you didn't like your IM rotation, choosing that as the field you are going to do 5+ days a week for the next 30+ years is a big mistake. Most surgeons will tell you that 80 hours of working in surgery a week is better (i.e. less painful) than doing 40 hours of IM a week.

Residency sucks and you need to keep in mind that the life of a resident is not the same as the life of an attending in ANY field. For example, I do not round before the sun comes up and generally see my inpatients between cases or right before/after office hours. When I'm done, I go home; there's no waiting for sign out or for the rest of the team to finish up. Surgery is very diverse depending on subspecialty and type of practice. But only you can decide if surgery is the career path for you. The choice is not limited to surgery vs. IM. Have you considered other non-IM fields like anesthesia, EM, etc.?

 

[ACSurgeon]

Lots of great advice above.

Also, when surgery residents say that training sucks, it's usually not because of the long hours or unpredictable schedule or difficulty of having a healthy work-life balance. We complain about not having enough autonomy early enough, about needing to do things the attendings way even when our way is equally valid, about all the hand holding we have to do from our attendings to consulting services to our students etc. what I'm saying is most surgery residents are totally fine working as hard as we do as long as long as we get to operate and treated with a little respected once we enter our senior years. I've heard very few residents complain about the hours or missing life events; it's something we accept as the price to pay for 5+ years to train to become a surgeon.

 

[bannie22]

Thanks a lot for your reply. As much as I love surgery, and my work, I still enjoy my life outside of Medicine more (family life, friends etc). Can you please give me an idea of the lifestyle during residency. I just want to make sure that it's something I am capable of doing. Also, is it common for people to not choose a surgical career and go into internal medicine in fear of the lifestyle.

There is no life.

Medicine residents have much shorter hours. And most other specialties too.

And dont forget their training is much shorter, 3 years and you would be a fellow with much better hours doing something you enjoy.

3 terrible years doing something you dont like versus at least 5 years without a life. You are looking at a few more years in fellowship, and significantly more as a junior faculty or partner.

Unfortunately either way you have to practice a little more delayed gratification.
If I were you and interested in cards, I know which one I would pick easy.

 

[ACSurgeon]

There is no life.

Medicine residents have much shorter hours. And most other specialties too.

And dont forget their training is much shorter, 3 years and you would be a fellow with much better hours doing something you enjoy.

3 terrible years doing something you dont like versus at least 5 years without a life. You are looking at a few more years in fellowship, and significantly more as a junior faculty or partner.

Unfortunately either way you have to practice a little more delayed gratification.
If I were you and interested in cards, I know which one I would pick easy.

Since when did cards become a lifestyle fellowship? OP is interested in procedures. Interventional cards has a crappy lifestyle as an attending also.

How do you define "no life"? As a resident I'm usually done by 6 pm, sometimes later but sometimes earlier. I get 4-5 days off per month, and usually another couple of days of just rounding and going home before noon. I am tired a lot. Some rotations are really exhausting and have a lot more call than others. I'm stil able to enjoy life.

 

[DoctwoB]

Medicine programs vary greatly in terms of lifestyle. Most are moving towards some sort of x+y model where x weeks of long hour inpatient services are followed by y weeks of clinic or consult services with better hours and weekends off. Ultimately you need to enjoy what you do, though, or you'll be miserable regardless of hours. I have many friends in 9 to 5s that make good money but don't like their jobs and aren't happy because of it, regardless of how good it looks on paper.

To me the biggest lifestyle issues come not just from hours worked, which is a bear, but from the inflexibility of those hours. The inability to go to that friends wedding, family event, be there for a friend who needs it, etc is a major source of burnout for me, more so then the number of hours worked. That is certainly not unique to surgery though. The other thing to consider is how you deal with sleep deprivation. I don't mean the lack of sleep from overnight call, which you'll get in almost any field, but the wear and tear months and years of very early wake ups takes. Once again not necessarily unique to surgery residency, but certainly a factor.

 

[ProfMD]

I would much rather spend 60 hours a week (or even 80 hours) doing something I love (surgery) than 40 hours doing something I hate (internal medicine).

This is purely a personal decision. Do what excites you most. Don't listen to the haters in either side.

Personally, you couldn't pay enough to do internal medicine.

 

[Slack3r]

There is no life.

Medicine residents have much shorter hours. And most other specialties too.

And dont forget their training is much shorter, 3 years and you would be a fellow with much better hours doing something you enjoy.

3 terrible years doing something you dont like versus at least 5 years without a life. You are looking at a few more years in fellowship, and significantly more as a junior faculty or partner.

Unfortunately either way you have to practice a little more delayed gratification.
If I were you and interested in cards, I know which one I would pick easy.

Lolwut? IM fellowships (at least GI, cards, pulm/crit) are pretty brutal with hours. Even medicine residents are hardly working a 40 hour week.