How Fun Are The Surgeries?

[webbjj]

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How fun are the surgeries to perform? Any particularly interesting ones? How long are the surgeries? What do you like best about opthamology surgeries?

webbjj

 

[JR]

I don't think anyone can tell you how fun surgeries are. It would be best to do a tag-along and see it for youself. In my experience, some people are absolutely fascinated by it (like me); Others, on the other hand, are completely horrified and disgusted with cutting the eyeball.

 

[GlaucomaMD]

Ophthalmic surgeries are thousand times more interesting to DO than to watch!

 

[Retinamark]

Ophthalmic surgery is infinitely fun. It is so precise & technical, with so many intricacies. No matter how good you get, there are always things to improve & challenges to conquer. I could never get sick of it.

 

[Andrew_Doan]

Ophthalmic surgeries are challenging, exciting, and rewarding. It was particularly rewarding last month when I operated on a 22 diopter myope who was 20/25 without correction one week after his cataract extraction. It was the first time he could see without corrective lenses. He preferred his operated eye so much that he walked out of my clinic with a patch over the non-operated eye until his next surgery.

Last week, the wife of a different patient gave me a hug. These are the moments that make being an ophthalmic surgeon fun. I love it! 😍

I must admit, however, each surgery consists of unique challenges. Each case is never the same because there are so many factors that will make the case harder.

 

[mdkurt]

Very, very fun. Cataract surgery is the mainstay and provides nearly instant gratification for the patient and the surgeon, but glaucoma, plastics, and strabismus surgery all give the general ophthalmologist reasons to get up in the morning. Surgeries can take 10 minutes for an experienced cataract surgeon or 2-3 hours for complicated combined cases (rare).

 

[JJMD]

learning cataract surgery is very difficult and stressful--it takes almost 100 cases before it is "fun"

The amount of stress one feels during surgery is related to the visual potential of the eye. If you are cutting on a potentially 20/20 eye, there is more pressure than repairing a ruptured globe.

 

[Toadkiller Dog]

One thing I've noticed is that most ophthos have 1-3 surgeries that they will do over and over and over. One that I worked with last week had a schedule that looked like this:

1. (Name); Phaco IOL OD
2. (Different name); Phaco IOL OS
3. (Different name); Phaco IOL OS
4. (Different name); Phaco IOL OD
5. (Different name); Phaco IOL OS
And so on up to 15, scheduled every 20 minutes or so.

He gets a few Lasiks every week, and occasionally does something different on call (corneal lacs, etc). That's about it. Most surgeons have a surgery or two that they do most frequently, but doing the same one over and over is not for everyone. Retina subspecialists seem to have a bit more variety than others.

 

[Andrew_Doan]

Repetition is a familiar theme for most of medicine. As we transition from generalists into increased sub-specialization, physicians will find themselves doing a few procedures or surgeries again and again. For instance, GI physicians do tons of colonoscopies. If you don't like scoping the colon, then don't pursue GI.

Similarly, if individuals don't like cataract surgery, then don't go into general ophthalmology. Mastering a few surgeries is great for me. I'd rather be in the OR doing cataracts than looking at dry eyes all day long. 👍

 

[aphistis]

Andrew, something I've wondered about you as a surgeon MD/PhD: my understanding has been that mudphuds are traditionally expected to spend their careers on biomedical research, which seems like something much better suited for the more medicinal specialties. As a surgeon, I assume you'll spend your time between the two aspects of your job? Also, are surgeon MD/PhD's less common, or are you found in surgery as often as in other specialties? Thanks.

 

[Andrew_Doan]

Andrew, something I've wondered about you as a surgeon MD/PhD: my understanding has been that mudphuds are traditionally expected to spend their careers on biomedical research, which seems like something much better suited for the more medicinal specialties. As a surgeon, I assume you'll spend your time between the two aspects of your job? Also, are surgeon MD/PhD's less common, or are you found in surgery as often as in other specialties? Thanks.

Good question. There are plenty of MD/PhD surgeons; however, I plan to spend my time in academia as an ocular pathologist too. One of the main reasons I picked ophthalmology is that the surgeries are short, and I can dedicate one-half to one day per week to surgery. This leaves the rest of the week for research, teaching, and clinic. Ophthalmology, consisting of mainly outpatient surgery and routine clinic hours, is one of the few surgical specialties that allow MD-PhD surgeons to "do it all".

As an ocular pathologist, I'll have "dedicated time" in the laboratory to read my slides. It'll give me the time needed to do research. You're correct that MD-PhDs will have to choose to do mainly surgery/clinic vs research. Many will do both, but one entity will eventually be the main emphasis. As an ocular pathologist, I'll have the best of both worlds. I can spend the afternoons in the lab, and be in the clinic/surgery in the mornings. The ocular pathologist for the Navy in Bethesda enjoys surgery and clinic more than research so he spends one day a week reading out specimens and the rest of the time doing refractive surgery, general ophthalmology, and surgeries.

The MD-PhD degree is highly flexible. There is the main goal of training biomedical researchers, but there is also a goal of producing future academics in medicine. If one is sick of both, then there is always private practice. I've seen it happen.

 

[JR]

Even though there is some truth to what you are saying, I can not completely agree with you. I think knowing the basics of internal medicine have just as much importance for a future a ophthalmologist as do basics in general surgery, if not more. Remember, many systemic conditions manifest themselves in the eye (DM, HTN, hypertyroidism, etc.,etc.). I personally think I'd much rather know systemic disease than how to manage critically ill patients; we have intensivists for that as well as anesthesiologists. Another point: I just recently spoke with a graduating ophtho resident from a local program who was considering CT surgery before he decided on ophtho; he told me that his prelim surgery year wasn't of any benefit for his microsurgical skills. There is just too much difference between macro- and microsurgery; if you can ligate or suture a bleeding vessel during an appy, one wrong move during cataract surgery can cost pt that eye.

Those who want to do oculoplastics are another story. If you know early on you are into it, that prelim surgery year is probably better for you. As for the rest of us, I think most would better benefit from doing medicine or transitional.

 

[Andrew_Doan]

I agree with JR. Hand tying silk sutures is of little benefit to those who have to work with 10-O nylon under a microscope. Also, a strong preliminary year in internal medicine provides a good foundation to build on.