Help with Gen Surg decision

[medsurfer]

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Hello Folks,

I've been struggling a bit with the decision to pursue Gen Surg - perhaps some of you can help. I am an MS3 and at this point I know for sure that I want a surgical career. I completed my Surgery Clerkship and also spent a month on Peds Surg and loved it. My pediatrics rotation was another amazing experience. I've heard that Pediatric Surgery is an extremely competitive field to go into. Some browsing revealed the following stats for Peds Surg in '10:
http://www.nrmp.org/fellow/match_name/ped_surgery/stats.html
86 applicants for 44 spots.

Given my desire to go into Peds Surg along with this competitiveness, is it risky going into Gen Surg knowing that there is this one field you want to end up in? Yes, I know Vascular, Surg-Onc, Colorectal are all great fields to go into but I really felt a very strong connection with Peds Surg. It is this uncertainty that bothers me about a match that'll happen 7 years from now. If I decide on Day 1 that this is what I want - will it negatively impact my Gen Surg training?

Any thoughts, suggestions? Any pediatric surgeons lurking that would care to comment?

Thanks.

 

[Smurfette]

You need to have a back up plan if you are hoping for ped surg. Aside from peds research (2 yrs), many people interested in peds surg have bolster their resumes with peds CC years (another year), having good connections, stellar LORs, ABSITE scores, etc. The 86 applicants are almost all extremely high caliber applicants and many go unmatched....sometimes multiple times before they give up trying.

Many peds surg spots are only open every 2-3 years....on average I thought there are only 25-30 spots per year. Maybe they have increased the number of positions funded in the last 2 yrs (?), or 2010 had a higher number of programs in the cycle that year (?) but my classmates who applied for peds surg applied to every program in the country totalling somewhere in the 30 range from what I recall. If there's consistently now 44 programs in the match every year, that will help your likelihood of matching considerably compared to ~27 slots.

If you want peds surg and DON'T match, what will you do? Would you wish you did a peds subspecialty instead of surgery? Or would you be ok with doing something surgical if it's not peds surg? Wanting to do peds surg will not negatively affect your ability to do general surgery....but if you absolutely do not want to do anything other than peds surgery, you may want to reconsider now before finding out in 7 yrs that you didn't match.

 

[medsurfer]

Thanks a lot for the response. Those are great points to think about.

Thinking about peds subspecialty versus surgery, I'm fairly certain I would prefer surgery but peds appeals to me in a way that I never thought about in my first two years of med school. I was always focused on gen surg but the peds surgery and peds rotations shed light on a field that I think I would be very passionate about.

I think my best option would be to go with gen surg and hope that this works out in the end. Is there anything else I should be thinking about at this stage when applying for Gen Surg?

Are there are predictions as to whether peds surgery spots will increase over the coming years?

 

[HitGirl]

Thanks a lot for the response. Those are great points to think about.

Thinking about peds subspecialty versus surgery, I'm fairly certain I would prefer surgery but peds appeals to me in a way that I never thought about in my first two years of med school. I was always focused on gen surg but the peds surgery and peds rotations shed light on a field that I think I would be very passionate about.

I think my best option would be to go with gen surg and hope that this works out in the end. Is there anything else I should be thinking about at this stage when applying for Gen Surg?

Are there are predictions as to whether peds surgery spots will increase over the coming years?

This may be a "duh" no brainer but if I were in your shoes I'd make sure to go to a gen surg program that has a strong peds surg fellowship. It ensures that you have the right resources for research during your professional development years and you'll get to know the peds surgeons really well, which will help your chances of matching at your home institution or another good institution if you have great letters from respected peds surgeons.

Since the only way to go into peds surgery is through gen surg, I don't see how having a passionate interest in peds surg would hurt your application at all. If I were you, that would be the focus of my app and I'd get letters from the chair of gen surg as well as some peds surg folks... General surgeons have seen people change their minds all the time, and it might happen to you, but I get the sense that they at least like applicants who have thought seriously about what they want to do, even if they change their minds later.

 

[ACSurgeon]

This may be a "duh" no brainer but if I were in your shoes I'd make sure to go to a gen surg program that has a strong peds surg fellowship. It ensures that you have the right resources for research during your professional development years and you'll get to know the peds surgeons really well, which will help your chances of matching at your home institution or another good institution if you have great letters from respected peds surgeons.

Since the only way to go into peds surgery is through gen surg, I don't see how having a passionate interest in peds surg would hurt your application at all. If I were you, that would be the focus of my app and I'd get letters from the chair of gen surg as well as some peds surg folks... General surgeons have seen people change their minds all the time, and it might happen to you, but I get the sense that they at least like applicants who have thought seriously about what they want to do, even if they change their minds later.

This has been a topic of debate on SDN (and elsewhere). Having a fellowship program is a double-edged sword. I think the more important factor is going somewhere with strong peds-surgeons (well known in the field, doing great research that you can get involved with, etc).

My home program matched two people into peds-surg this year. We don't have a fellowship.

 

[Buzz Me]

Ah...the age-old question of whether to apply for a given residency if you're only interested in a super-competitive fellowship.

It's a tough decision - IIRC there were only 34 open fellowship spots every year (as of a couple years ago), but there may be more now. You have to ask yourself if you'd be satisfied with pursuing an alternative surgical career (Gen Surg, or some specialty) if worst came to worst and you didn't match into Peds Surg. Or would you be better off in a procedure-based field like Peds Cards, etc.?

 

[Encephalectomy]

OP, are you interested specifically in pediatric general surgery or do you want a career with surgery + pediatric patients? One thing to think about is that peds fellowships are among the least competitive in most of the surgical subspecialties.

 

[dpmd]

Are you really interested in working with kids, and also like the idea of doing surgery. Or do you really want to do surgery but are interested in working with kids. That is really the decision you need to make. The common advice is not to do general surgery if there is anything else you would be happy doing. Hard to know if it will be any easier to get into peds surg later, but only you can decide if you would be satisfied with something else (perhaps general surg in a town where you do pedi hernias, pyloromyotomies, and other kiddo stuff)

 

[Pir8DeacDoc]

OP, are you interested specifically in pediatric general surgery or do you want a career with surgery + pediatric patients? One thing to think about is that peds fellowships are among the least competitive in most of the surgical subspecialties.

Excellent point. I was planning to add this myself. Pedi ENT isn't super competitive. I suspect Uro/Ortho/NSurg are similar.

I find it hard to imagine you could sustain your enthusiasm for general surgery residency if you are only truly interested in one very small component of it. At least in ENT a good percentage of our patients every day are pediatric. In practice you can see a ton of kids, even if you don't do a pedi fellowship

Good luck.

 

[cautiousvampire]

Excellent point. I was planning to add this myself. Pedi ENT isn't super competitive. I suspect Uro/Ortho/NSurg are similar.

I find it hard to imagine you could sustain your enthusiasm for general surgery residency if you are only truly interested in one very small component of it. At least in ENT a good percentage of our patients every day are pediatric. In practice you can see a ton of kids, even if you don't do a pedi fellowship

Good luck.

I have never fully understood this. Why is it that peds is so ultra competitive out of general surgery, but but can't even fill all the spots when coming out of surgical sub-specialties. Any thoughts would be appreciated.

 

[Winged Scapula]

I have never fully understood this. Why is it that peds is so ultra competitive out of general surgery, but but can't even fill all the spots when coming out of surgical sub-specialties. Any thoughts would be appreciated.

You've clearly never done Peds ENT...😴

 

[filter07]

GS and ped surg overlap a lot. If you find yourself thinking things like "I love ped surg but can't stand GS" then consider that a red flag.

Second, as mentioned already, only like 30-40 people get into ped surg, out of 1000 GS residents. If you want to be among those people, look at your CV (not just your hopes and dreams, but what you've actually done and proved interest in), and see if you have research, if you have high grades and high USMLE. That will give you an estimate of how you might do in residency. If you are average, chances are, you will be average in residency. If you have no research, chances are you will not do much research in residency. So if you don't have either of those things in your CV, that is another red flag.

Then also consider the excellent advice of our subspecialists above.

Personally I can't figure out why anyone would willingly do pediatric surgery, aside from just liking kids. It is just like GS except everyone is uptight about research, your job options are limited, and you have to train extra years.

 

[Pir8DeacDoc]

You've clearly never done Peds ENT...😴

Awhh come on, be nice! 🙂 I agree that tonsillectomy and ear tubes aren't terribly exciting. But..


There are a lot of good things about pedi ENT. Pedi ENT's are masters of the airway- airway reconstruction and trach management on neonates is complicated stuff and the kids are usually rather unhealthy. Not to mention cochlear implants, etc. Can be fun stuff!

 

[Winged Scapula]

Awhh come on, be nice! 🙂 I agree that tonsillectomy and ear tubes aren't terribly exciting. But..


There are a lot of good things about pedi ENT. Pedi ENT's are masters of the airway- airway reconstruction and trach management on neonates is complicated stuff and the kids are usually rather unhealthy. Not to mention cochlear implants, etc. Can be fun stuff!

LOL, ok.

I loved ENT when I rotated on it as a 3rd year Gen Surg resident but the Peds stuff bored me. To each his own, I guess. 😀

 

[medsurfer]

Hi Everyone,

Thanks for all your input and advice.

To clarify, I was originally interested in Gen Surg for the longest time. I decided that I would make the decision on subspecialties sometime during my gen surg residency - whether it be Colorectal, Surg-Onc, MIS etc. or even Vascular, CT, Plastics etc.

Then came my Peds Surg rotation and I was certain that I like this stuff way more than anything else so far. Add to that my Peds rotation and I realized just how much I enjoyed the excitement and fun of dealing with pediatric patients. This is not to suggest that I don't like dealing with adult Gen Surg patients - that was after all my primary interest - but I really feel like I've found something to be passionate about - which is an awesome feeling to have in medicine.

To some it might seem like a no-brainer that I should probably do Gen Surg - but the fact of going through seven years and not doing something that I've finally found a true passion for is a little scary. Would I mind treating just adult patients? Definitely not. Would I prefer treating kids? Absolutely. But again, all this is true for me in the realm of Gen Surg. To suddenly start thinking about ENT or pediatric cardiology (I cannot endure 3 years of peds medicine - need to be in the OR more) would be quite jarring to me - again, these are great specialties, but my love for GI, thoracic and some extremity anatomy fits better with Gen Surg.

The other peds surgical specialty that I think could be on the radar would be peds cardiac surgery (not cardiology) - these have been some of the most technically challenging surgeries I've seen (lets avoid that debate here please). I got to talk to some of the peds cardiac fellows at my hospital and their view was that apart from the issue of the length of training, if you want to do it, its not difficult finding a spot. So a second option could be an integrated cards program followed by peds cards - should take 8 yrs total (provided an integrated program thinks I'm good enough for them).

Also, a reply to one of the postings, from the data I saw, there were 86 applicants for 44 spots for peds surg. I don't know if there was some other data that showed 1000s of applicants.
http://www.nrmp.org/fellow/match_name/ped_surgery/stats.html

And finally, I think I have a fairly competitive application. Overall a Step 1 more than 265+ with some honors and high passes with publications on random topics related to the basic sciences. So judging from this, I should hopefully be competitive come time for Peds Surg applications but it is only human to have that uncertainty drive you crazy when you realize there is something you've finally found to do and then its oh, wait, please wait 7 years before you find out.

Sorry for that ridiculously long post. It helps me clarify my own mind too.

Thanks again for your thoughts.

 

[stapleit]

From what I understand, the 44 spots that you see on the match results alternate every other year (explained by some fellowship programs taking 1 fellow at a time). The prior ped surg match had 30-something spots available (I think there were ~60-70 applicants...I can't find the link) so the number fluctuates from year to year.

It's great that you have a passion for ped surg but I also think that it's fair to go into general surgery with the possibility of not matching and considering other specialties within gensurg. I've met a few cheifs (and their attendings) who were pretty sure they were going to match but ended up otherwise. Of course nothing's ever really "sure" until the Real Deal. If I were you, I would make sure to rule out peds in other subspecialties before committing to gensurg.

 

[filter07]

Seems like you should go for it. You like GS, you have a passion for ped surg. You are competitive and if you keep it up you will probably be competitive 5 years from now. The 1000 is the number of GS residents per year... not all will be applying to peds obviously. There is probably some self-selection involved, just like when it comes to applying for medical school.

I was similar to you in that I wanted to do a subspecialty during medical school. I liked GS also, so it wasn't a super tough decision, but you're right, having one goal in mind and knowing that you won't really be able to do it for several years is tough. You'll get through it though, just like you were able to get through all those rotations in med school. If not, you have a competitive CV and will have the opportunity to transfer to a different residency if it doesn't work out for you during internship.

 

[ACSurgeon]

Hi Everyone,

Thanks for all your input and advice.

To clarify, I was originally interested in Gen Surg for the longest time. I decided that I would make the decision on subspecialties sometime during my gen surg residency - whether it be Colorectal, Surg-Onc, MIS etc. or even Vascular, CT, Plastics etc.

Then came my Peds Surg rotation and I was certain that I like this stuff way more than anything else so far. Add to that my Peds rotation and I realized just how much I enjoyed the excitement and fun of dealing with pediatric patients. This is not to suggest that I don't like dealing with adult Gen Surg patients - that was after all my primary interest - but I really feel like I've found something to be passionate about - which is an awesome feeling to have in medicine.

To some it might seem like a no-brainer that I should probably do Gen Surg - but the fact of going through seven years and not doing something that I've finally found a true passion for is a little scary. Would I mind treating just adult patients? Definitely not. Would I prefer treating kids? Absolutely. But again, all this is true for me in the realm of Gen Surg. To suddenly start thinking about ENT or pediatric cardiology (I cannot endure 3 years of peds medicine - need to be in the OR more) would be quite jarring to me - again, these are great specialties, but my love for GI, thoracic and some extremity anatomy fits better with Gen Surg.

The other peds surgical specialty that I think could be on the radar would be peds cardiac surgery (not cardiology) - these have been some of the most technically challenging surgeries I've seen (lets avoid that debate here please). I got to talk to some of the peds cardiac fellows at my hospital and their view was that apart from the issue of the length of training, if you want to do it, its not difficult finding a spot. So a second option could be an integrated cards program followed by peds cards - should take 8 yrs total (provided an integrated program thinks I'm good enough for them).

Also, a reply to one of the postings, from the data I saw, there were 86 applicants for 44 spots for peds surg. I don't know if there was some other data that showed 1000s of applicants.
http://www.nrmp.org/fellow/match_name/ped_surgery/stats.html

And finally, I think I have a fairly competitive application. Overall a Step 1 more than 265+ with some honors and high passes with publications on random topics related to the basic sciences. So judging from this, I should hopefully be competitive come time for Peds Surg applications but it is only human to have that uncertainty drive you crazy when you realize there is something you've finally found to do and then its oh, wait, please wait 7 years before you find out.

Sorry for that ridiculously long post. It helps me clarify my own mind too.

Thanks again for your thoughts.

You certainly sound competitve for integerated CT programs, and I guess if you go down the peds-cardiac surgery route, all uncertainty goes away once you match CT next year.

Two problems: 1) what if you don't... you should have a back up plan, likely gen surg) and 2) this eliminates the possibility of general peds surg for good. I guess a third issue is the ****ty life style that peds cardiac surgeons lead (you might be the only surgeon for a hospital or more)...

My suggestion: go to a great gen surg program with an excellent track record of matching people into peds surg. If you don't match, you can always go the cardiac--> peds cardiac route. This route will add more years (if you go the cards route), but at least it doesn't rule out what you state as your passion (unless peds cards is equally as good to you).