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exeunt

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..surgery was for you?

I used to think I would never do surgery but have recently started to find some of its procedures really cool. I've done some shadowing, which was also really cool, but of course, shadowing isn't really the same as the actual experience. Surgery can be a brutal field--how do you know it's worth it for you? I like surgery, and am interested in some of its subspecialties, but I don't know if I should throw away all the work I've done for other fields, or how I can decide that really..
 
i am w/ you 100%. same predicament.
 
If you can see yourself doing something other than surgery, then don't do surgery...do that other thing instead.
 
For the most part, most med students like surgery. They like getting their hands dirty, tying knots, suturing, etc.

What makes a small minority of those students actually go into Gen Surg/other surgical fields? They love surgery so much they're willing to put up with the tough lifestyle, malignant attendings, long workhours, etc.
 
I always suspected I would, which is why I shadowed a general surgeon as the first specialty I tried to shadow as a college freshman.

Secondly, I didn't think I would be happy doing anything else.
 
For the most part, most med students like surgery. They like getting their hands dirty, tying knots, suturing, etc.

What makes a small minority of those students actually go into Gen Surg/other surgical fields? They love surgery so much they're willing to put up with the tough lifestyle, malignant attendings, long workhours, etc.

I think this is very accurate. 🙂
 
For the most part, most med students like surgery. They like getting their hands dirty, tying knots, suturing, etc.

What makes a small minority of those students actually go into Gen Surg/other surgical fields? They love surgery so much they're willing to put up with the tough lifestyle, malignant attendings, long workhours, etc.

I don't know. Surgery at my school is considered the toughest rotation, I don't think most of them would say they actually liked it.
 
I don't know. Surgery at my school is considered the toughest rotation, I don't think most of them would say they actually liked it.

Same here. Very few come out the other side saying they enjoyed the surgery rotation.
 
[YOUTUBE]http://www.youtube.com/watch?v=KuNQgln6TL0[/YOUTUBE]
 
If you love the OR then do surgery. I initially thought I would be going into surgery but after 2 months in the OR in some very long cases (10 hours or more), finding pretty much every case exceedingly boring, constantly looking at the clock to see when I could go home, having to wake up at 3:30 AM, finding trauma to not be so sexy, residents who are douches for the most part, attendings who don't give a flip about students, etc I decided general surgery or any of it's branches or really any surgical subseciality was not for me.

However, TONS of people in my class loved the surgery rotation and some I never thought would be considering surgery say they want to do it. Essentially most like being in the OR, performing sometimes definitive therapies, feeling like they know a lot, not sitting around writing notes all day and rounding for long periods of time, etc. So if this is how you pretty much feel and no other rotation really sparks that same level of interest then do surgery.
 
I don't know. Surgery at my school is considered the toughest rotation, I don't think most of them would say they actually liked it.

Same here. Very few come out the other side saying they enjoyed the surgery rotation.

I'm not saying they would love the rotation...I just meant the act of "doing something" (suturing, tying, etc.) is fun. For most people, being allowed to do a nice subcuticular stitch at the end of a case is fun. But most med students don't go into surgery because it's not fun ENOUGH to put up with everything else (as a med student, this usually means the workhours, or early mornings, or occasionally the mean residents/attendings).
 
I'm not saying they would love the rotation...I just meant the act of "doing something" (suturing, tying, etc.) is fun. For most people, being allowed to do a nice subcuticular stitch at the end of a case is fun. But most med students don't go into surgery because it's not fun ENOUGH to put up with everything else (as a med student, this usually means the workhours, or early mornings, or occasionally the mean residents/attendings).
hmm, does that mean i won't really be able to tell until third year? obviously shadowing as a MS2 the attendings expect basically nothing. i know surgery will be tough, but i don't know how i can know if it will be worth it--or do you just "know"?
 
The women I've met who've dated surgeons vowed not to date them again, and the children of surgeons I've had the pleasure of talking to vowed never to do surgery. I think this says volumes.
 
The women I've met who've dated surgeons vowed not to date them again, and the children of surgeons I've had the pleasure of talking to vowed never to do surgery. I think this says volumes.
Interesting given the not-insignificant number of surgery residents I know who have a parent who is a surgeon (general/vascular). Never met a resident who is the kid of a neurosurgeon or (interestingly) ortho though.
 
Interesting given the not-insignificant number of surgery residents I know who have a parent who is a surgeon (general/vascular). Never met a resident who is the kid of a neurosurgeon or (interestingly) ortho though.

The newest neurosurg attending here is the son of one of the older neurosurgeons in the practice. Additionally, they are 2nd and 3rd generation as father of the older neurosurgeon was also in the practice. However, this does seem to be a rarity.
 
hmm, does that mean i won't really be able to tell until third year? obviously shadowing as a MS2 the attendings expect basically nothing. i know surgery will be tough, but i don't know how i can know if it will be worth it--or do you just "know"?

You won't really know for sure until you are "in the thick of it." Even then you can only do your best to be sure. With the high attrition rate in the first two years of surgery (still around 25% I believe), its obvious there are a lot of people that think they want to do it and that it will be worth it as medical students who later decide otherwise.
 
If you love the OR then do surgery.

No.

If you do surgery only because you like the OR, you'll regret it. Many people like the OR, but would be miserable in a general surgery residency. Yes, obviously enjoying the OR is a pre-requisite. However what you really need to love (or tolerate) is the other, less-sexy parts of surgery. You need to enjoy working up and managing surgical diseases, even if it means you aren't doing an operation.

And really, that advice goes for choosing any specialty. It's not the best parts that are so important, it's the most tedious, mundane, and unbearable parts. You need to be sure you can tolerate those for a chance to get the "good stuff".
 
The women I've met who've dated surgeons vowed not to date them again, and the children of surgeons I've had the pleasure of talking to vowed never to do surgery. I think this says volumes.

😕

What about the current husbands/wives of surgeons? Or the surgery residents who have one or both parents who are also surgeons?
 
The women I've met who've dated surgeons vowed not to date them again, and the children of surgeons I've had the pleasure of talking to vowed never to do surgery. I think this says volumes.

This has not been my experience AT ALL. In my program alone we have probably about 20% or more who are sons of surgeons. Almost all of us are all happily married and so are our attendings. I feel like your statement is a stereotype perpetuated by people without either the grades or the work ethic to do surgery, and it's how they convince themselves that its okay to do something else. I hear this crap from people that "wanted to do surgery but...I don't want to work those hours, so I became an anesthesiologist."

Reasons I went into a surgical specialty:
1. OR AND Clinic. It helps break up the week. I think do either 5 days a week would be incredibly tedious.
2. Definitive interventions. You identify a problem and fix it. You don't wait 3 months to find out the patient was non-compliant with their medications. You don't piddle around with chronic problems that will never be fixed (for the most part).
3. You actually know (and care) about your patients. I find it very difficult to like what I do unless I actually care about my work. Radiologists/Pathologists/ect... just grind out the day so they can get home. They rarely meet the patients or see the results of their work. Meeting someone with a problem, fixing it, and seeing them get better makes working the long hours worth it.
4. Surgery will never be done by a nurse. Surgeons don't need to worry about the DNP's encroaching on our field.
5. Surgery can not be outsourced.
6. More jobs are created by surgeons doing what they do than any other specialty I can think of. This will give them significant bargaining power in the future when most doctors become hospital employees (prediction I know).
7. Surgeons have great stories. Not as good as psych, but close.
8. Surgeons get to work with their hands. I know watching surgery as a med student SUCKS. It is MUCH more fun when you actually do it. Besides, I would much rather do 8 hours of surgery than 8 hours of rounding and writing notes. The day literally flies by during the day when you are in the OR concentrating on what you are doing. My surgery days feel much shorter than clinic days (even if they are longer). There is nothing better than losing track of time and then realizing its 5 and almost time to sign out and go home.
9. I always had a greater sense of pride in my surgical work than I ever had on any other rotation.

Things less appealing about surgery:
1. The training is much harder and rigorous than any other specialty in medicine.
2. Your complications are YOUR complications. They are a direct result of something you did (even if it wasn't your fault - because deciding to go to surgery was your decision). You can't blame it on a medication side effect, a patient sensitive to the medicine, or a natural progression of the disease. Its all on you, and you have to be ready to deal with it.
 
This has not been my experience AT ALL. In my program alone we have probably about 20% or more who are sons of surgeons. Almost all of us are all happily married and so are our attendings. I feel like your statement is a stereotype perpetuated by people without either the grades or the work ethic to do surgery, and it's how they convince themselves that its okay to do something else. I hear this crap from people that "wanted to do surgery but...I don't want to work those hours, so I became an anesthesiologist."

Reasons I went into a surgical specialty:
1. OR AND Clinic. It helps break up the week. I think do either 5 days a week would be incredibly tedious.
2. Definitive interventions. You identify a problem and fix it. You don't wait 3 months to find out the patient was non-compliant with their medications. You don't piddle around with chronic problems that will never be fixed (for the most part).
3. You actually know (and care) about your patients. I find it very difficult to like what I do unless I actually care about my work. Radiologists/Pathologists/ect... just grind out the day so they can get home. They rarely meet the patients or see the results of their work. Meeting someone with a problem, fixing it, and seeing them get better makes working the long hours worth it.
4. Surgery will never be done by a nurse. Surgeons don't need to worry about the DNP's encroaching on our field.
5. Surgery can not be outsourced.
6. More jobs are created by surgeons doing what they do than any other specialty I can think of. This will give them significant bargaining power in the future when most doctors become hospital employees (prediction I know).
7. Surgeons have great stories. Not as good as psych, but close.
8. Surgeons get to work with their hands. I know watching surgery as a med student SUCKS. It is MUCH more fun when you actually do it. Besides, I would much rather do 8 hours of surgery than 8 hours of rounding and writing notes. The day literally flies by during the day when you are in the OR concentrating on what you are doing. My surgery days feel much shorter than clinic days (even if they are longer). There is nothing better than losing track of time and then realizing its 5 and almost time to sign out and go home.
9. I always had a greater sense of pride in my surgical work than I ever had on any other rotation.

Things less appealing about surgery:
1. The training is much harder and rigorous than any other specialty in medicine.
2. Your complications are YOUR complications. They are a direct result of something you did (even if it wasn't your fault - because deciding to go to surgery was your decision). You can't blame it on a medication side effect, a patient sensitive to the medicine, or a natural progression of the disease. Its all on you, and you have to be ready to deal with it.

Dr DHT, I think this is a great response.
Thanks for taking the time to submit something insightful.
You mention some great points that I had failed to recognize on my own.

i still don't get why everyone makes such a big deal about grades for surgeons. when i look at the charting outcomes it does not seem as competitive as everyone makes it out to seem.

You won't really know for sure until you are "in the thick of it." Even then you can only do your best to be sure. With the high attrition rate in the first two years of surgery (still around 25% I believe), its obvious there are a lot of people that think they want to do it and that it will be worth it as medical students who later decide otherwise.

i had no idea the attrition rate is this high. that's actually quite frightening
 
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If you love the OR then do surgery. I initially thought I would be going into surgery but after 2 months in the OR in some very long cases (10 hours or more) at my top 20 school, finding pretty much every case exceedingly boring, constantly looking at the clock to see when I could go home, having to wake up at 3:30 AM, finding trauma to not be so sexy, residents who are douches for the most part, attendings who don't give a flip about students, etc I decided general surgery or any of it's branches or really any surgical subseciality was not for me.

However, TONS of people in my class loved the surgery rotation and some I never thought would be considering surgery say they want to do it. Essentially most like being in the OR, performing sometimes definitive therapies, feeling like they know a lot, not sitting around writing notes all day and rounding for long periods of time, etc. So if this is how you pretty much feel and no other rotation really sparks that same level of interest then do surgery.

fixed.
 
Reasons I went into a surgical specialty:
1. OR AND Clinic. It helps break up the week. I think do either 5 days a week would be incredibly tedious.
2. Definitive interventions. You identify a problem and fix it. You don't wait 3 months to find out the patient was non-compliant with their medications. You don't piddle around with chronic problems that will never be fixed (for the most part).
3. You actually know (and care) about your patients. I find it very difficult to like what I do unless I actually care about my work. Radiologists/Pathologists/ect... just grind out the day so they can get home. They rarely meet the patients or see the results of their work. Meeting someone with a problem, fixing it, and seeing them get better makes working the long hours worth it.
4. Surgery will never be done by a nurse. Surgeons don't need to worry about the DNP's encroaching on our field.
5. Surgery can not be outsourced.
6. More jobs are created by surgeons doing what they do than any other specialty I can think of. This will give them significant bargaining power in the future when most doctors become hospital employees (prediction I know).
7. Surgeons have great stories. Not as good as psych, but close.
8. Surgeons get to work with their hands. I know watching surgery as a med student SUCKS. It is MUCH more fun when you actually do it. Besides, I would much rather do 8 hours of surgery than 8 hours of rounding and writing notes. The day literally flies by during the day when you are in the OR concentrating on what you are doing. My surgery days feel much shorter than clinic days (even if they are longer). There is nothing better than losing track of time and then realizing its 5 and almost time to sign out and go home.
9. I always had a greater sense of pride in my surgical work than I ever had on any other rotation.

Things less appealing about surgery:
1. The training is much harder and rigorous than any other specialty in medicine.
2. Your complications are YOUR complications. They are a direct result of something you did (even if it wasn't your fault - because deciding to go to surgery was your decision). You can't blame it on a medication side effect, a patient sensitive to the medicine, or a natural progression of the disease. Its all on you, and you have to be ready to deal with it.

DHT, thanks so much for taking the time to write that up!
I would like to ask you and other residents here, how much internal medicine do you guys see in your clinics (approx. in %)? do you guys get to diagnose non-surgical cases and refer?
 
DHT, thanks so much for taking the time to write that up!
I would like to ask you and other residents here, how much internal medicine do you guys see in your clinics (approx. in %)? do you guys get to diagnose non-surgical cases and refer?

Well, most of our patients HAVE baseline medical issues, but as patients are typically referred TO a surgeon by their primary care provider, if you sense an underlying non-surgical issue that needs to be dealt with, you tell that patient to follow-up with their primary care provider.
 
i still don't get why everyone makes such a big deal about grades for surgeons. when i look at the charting outcomes it does not seem as competitive as everyone makes it out to seem.

Surgical subspecialities (neurosurg, ortho, ent, uro) are the hardest fields to match into. All of them. The only comparable medicine one is derm. Rad onc also up there. Then you, in my opinion, have radiology and then gen surgery.

General surgery is hard because of the number of people applying. The match rate is 80% for example. Sure the step 1 score isn't the highest but that obviously is not the only important thing when it comes to matching. Some gen surg progams have avg step 1's in the 240s. So unless you want to go to a community hospital in the middle of nowhere you need good grades.
 
..surgery was for you?

I used to think I would never do surgery but have recently started to find some of its procedures really cool. I've done some shadowing, which was also really cool, but of course, shadowing isn't really the same as the actual experience. Surgery can be a brutal field--how do you know it's worth it for you? I like surgery, and am interested in some of its subspecialties, but I don't know if I should throw away all the work I've done for other fields, or how I can decide that really..
In my case it was lack of initial information initially. I found out how tough it is by actually getting in the program. By the time I realized what I had got myself into it was hard to quit. In another one year I started enjoying it and now ten years later it is a way of life
 
No.

If you do surgery only because you like the OR, you'll regret it. Many people like the OR, but would be miserable in a general surgery residency. Yes, obviously enjoying the OR is a pre-requisite. However what you really need to love (or tolerate) is the other, less-sexy parts of surgery. You need to enjoy working up and managing surgical diseases, even if it means you aren't doing an operation.

And really, that advice goes for choosing any specialty. It's not the best parts that are so important, it's the most tedious, mundane, and unbearable parts. You need to be sure you can tolerate those for a chance to get the "good stuff".
That might actually be my favorite part. I really like the operating too, but working up a really interesting consult and then being able to take them to the OR and fixing it is what makes me think "Wow, this stuff is really cool."

Blunt trauma? Makes me hate myself.

Reasons I went into a surgical specialty:
1. OR AND Clinic. It helps break up the week. I think do either 5 days a week would be incredibly tedious.
2. Definitive interventions. You identify a problem and fix it. You don't wait 3 months to find out the patient was non-compliant with their medications. You don't piddle around with chronic problems that will never be fixed (for the most part).
3. You actually know (and care) about your patients. I find it very difficult to like what I do unless I actually care about my work. Radiologists/Pathologists/ect... just grind out the day so they can get home. They rarely meet the patients or see the results of their work. Meeting someone with a problem, fixing it, and seeing them get better makes working the long hours worth it.
4. Surgery will never be done by a nurse. Surgeons don't need to worry about the DNP's encroaching on our field.
5. Surgery can not be outsourced.
6. More jobs are created by surgeons doing what they do than any other specialty I can think of. This will give them significant bargaining power in the future when most doctors become hospital employees (prediction I know).
7. Surgeons have great stories. Not as good as psych, but close.
8. Surgeons get to work with their hands. I know watching surgery as a med student SUCKS. It is MUCH more fun when you actually do it. Besides, I would much rather do 8 hours of surgery than 8 hours of rounding and writing notes. The day literally flies by during the day when you are in the OR concentrating on what you are doing. My surgery days feel much shorter than clinic days (even if they are longer). There is nothing better than losing track of time and then realizing its 5 and almost time to sign out and go home.
9. I always had a greater sense of pride in my surgical work than I ever had on any other rotation.

Things less appealing about surgery:
1. The training is much harder and rigorous than any other specialty in medicine.
2. Your complications are YOUR complications. They are a direct result of something you did (even if it wasn't your fault - because deciding to go to surgery was your decision). You can't blame it on a medication side effect, a patient sensitive to the medicine, or a natural progression of the disease. Its all on you, and you have to be ready to deal with it.
Wow, very well said. #3 was one of the big reasons I couldn't do EM. I thought I would like it, but there was just such a huge void there for me. I felt like I wasn't accomplishing anything - I was just giving the patient to someone who would do something.
 
Surgical subspecialities (neurosurg, ortho, ent, uro) are the hardest fields to match into. All of them. The only comparable medicine one is derm. Rad onc also up there. Then you, in my opinion, have radiology and then gen surgery.

General surgery is hard because of the number of people applying. The match rate is 80% for example. Sure the step 1 score isn't the highest but that obviously is not the only important thing when it comes to matching. Some gen surg progams have avg step 1's in the 240s. So unless you want to go to a community hospital in the middle of nowhere you need good grades.

agree that surgical sub-specialties are hard to match into
but not so sure about the bolded comment above.

here are the # of applicants/spot for the specified specialty; avg step 1 scores:
plastics 1.9; 245
derm 1.7; 242

all the following have 1.5 aplicants/spot
neurosurg 239
medicine 225
gen surg 224
psych 216

the following have 1.4 applicants/spot
ent; 240
ortho; 238
radiology; 238
path; 227

it seems just as competitive as medicine and i never hear people stating medicine is a competitive specialty

thoughts???

(source: charting outcomes 2009)
 
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agree that surgical sub-specialties are hard to match into
but not so sure about the bolded comment above.

here are the # of applicants/spot for the specified specialty; avg step 1 scores:
plastics 1.9; 245
derm 1.7; 242

all the following have 1.5 aplicants/spot
neurosurg 239
medicine 225
gen surg 224
psych 216

the following have 1.4 applicants/spot
ent; 240
ortho; 238
radiology; 238
path; 227

it seems just as competitive as medicine and i never hear people stating medicine is a competitive specialty

thoughts???

(source: charting outcomes 2009)

The 2011 data is out now, so everything I say will be from that data.

In terms of applicants/spots - those numbers are taking all comers. This includes, IMG, FMG, and reapplicants that failed to match the previous year.

Gen Surg = 1.6 applicants/spots. 0.9 were US Seniors.
Medicine = 1.5 applicants/spots. 0.5 were US seniors.

Percent matched by US seniors:
Gensurg = 80%
Medicine = 95%

What this means, that even though the number of applicants/spots are similar between the two specialties, internal medicine has far more FMG,IMG, and reapplicants making up their applicant pool. So as a US senior, you are about 15% less likely to match general surgery than medicine. Only 50% of all internal medicine spots could be filled by US senior applicants, so even a marginal IM applicant would end up at a top 50% program. Compare this to general surgery where there is roughly 1 spot for 1 applicant (US Senior). A marginal Gen Surg applicant would be lucky to get a spot and have to be willing to go anywhere to get it.

Hope this sheds some light on the issue.
 
agree that surgical sub-specialties are hard to match into
but not so sure about the bolded comment above.

here are the # of applicants/spot for the specified specialty; avg step 1 scores:
plastics 1.9; 245
derm 1.7; 242

all the following have 1.5 aplicants/spot
neurosurg 239
medicine 225
gen surg 224
psych 216

the following have 1.4 applicants/spot
ent; 240
ortho; 238
radiology; 238
path; 227

it seems just as competitive as medicine and i never hear people stating medicine is a competitive specialty

thoughts???

(source: charting outcomes 2009)

The first thought that comes to mind is why are you using the 2009 charting outcomes when 2011 is out?

edit: Just saw DHT's post too late.
 
Two pieces of advice I've been given re: choosing to become a surgeon:

1. If your favorite place in the hospital is the OR, go into anesthesia. If your favorite place in the WORLD is the OR, become a surgeon.

2. If given the choice between spending time with a loved one and spending time in the OR, a surgeon should be prepared to choose the OR.

Both are a bit of hyperbole, but I think you get the point...
 
Two pieces of advice I've been given re: choosing to become a surgeon:

1. If your favorite place in the hospital is the OR, go into anesthesia. If your favorite place in the WORLD is the OR, become a surgeon.

2. If given the choice between spending time with a loved one and spending time in the OR, a surgeon should be prepared to choose the OR.

Both are a bit of hyperbole, but I think you get the point...

Those points seem pretty silly and off-base, but I agree that it's hyperbole.
 
Two pieces of advice I've been given re: choosing to become a surgeon:

1. If your favorite place in the hospital is the OR, go into anesthesia. If your favorite place in the WORLD is the OR, become a surgeon.

2. If given the choice between spending time with a loved one and spending time in the OR, a surgeon should be prepared to choose the OR.

Both are a bit of hyperbole, but I think you get the point...
Guess I picked the wrong field...
 
Two pieces of advice I've been given re: choosing to become a surgeon:

1. If your favorite place in the hospital is the OR, go into anesthesia. If your favorite place in the WORLD is the OR, become a surgeon.

2. If given the choice between spending time with a loved one and spending time in the OR, a surgeon should be prepared to choose the OR.

Both are a bit of hyperbole, but I think you get the point...
would you say this is still true for the "lifestyle" surgical specialties, i.e. ENT/urology/plastics?
 
Best time of day? Standing at the scrub sink, scrubbing in, about to do another case.
eh, hearing the little feet running toward you saying "Daddy? Daddy home?" and then hugging the wife is better.

But opening up someone's belly with a shattered spleen and getting into a blood bath is pretty sweet 😀
 
Was there ever a case or two for you current residents/attendings that when you saw as medical students, or even as residents early on, that made you either decide or confirm your decision to do surgery as a career?

In other words: what has been your favorite moment in surgery?
 
Seeing a heart/lung/liver/kidney pink up and start working after reperfusion.....that's pretty f***ing sweet...
 
Was there ever a case or two for you current residents/attendings that when you saw as medical students, or even as residents early on, that made you either decide or confirm your decision to do surgery as a career?

In other words: what has been your favorite moment in surgery?

Yep, a multi-digit replant.
 
1. If your favorite place in the hospital is the OR, go into anesthesia. If your favorite place in the WORLD is the OR, become a surgeon.

I'm an anesthesiologist and would agree with this from the other side of the drapes. I loved the OR, and liked taking care of surgical pts, but liked my time outside the hospital too.
 
I'm an anesthesiologist and would agree with this from the other side of the drapes. I loved the OR, and liked taking care of surgical pts, but liked my time outside the hospital too.

Not trying to be a smart-***** at all, but why do all the physician surveys report working similar weekly hours (around 55-60)? There is only a 2 hour difference in some of them
 
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