How the heck do you choose?

[ExtraCrispy]

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Hi everyone,

For those who've decided in what field to specialize after residency, how did you reach your conclusion?

Here's my paradox - I love the variety of general surgery, and I love taking care of acutely sick patients. The obvious choice for me would be trauma/cc, however, I don't relish the completely unpredictable schedule of a trauma surgeon. I'm not someone for whom lifestyle is the ultimate goal, however family is important to me, and I want to ensure that I'm around while my kids are growing up.

My idea right now is to do a CC fellowship and become an intensivist, with a general surgery practice when I'm not in the ICU. This blend of ICU work (which I love) and time in the OR seems like a right fit for me, but I know it's unorthodox, and the usual response I receive from fellow residents when I describe this is a quizzical look and a furrowed brow.

Any thoughts/ ideas? How did others compromise potentially conflicting preferences when choosing a subspecialty?

Thanks in advance.

 

[surgical06]

MSIV
i was interested in trauma and got to know a bunch of trauma docs around the country. almost all of them did exactly what you said. trauma/icu care when they were on (usually 1 week out of the month or 6 24hr call days a month, and the rest of the time they spent doing gen surg practice. for the trauma docs that did the 24hr call days, they also have to round on whoever gets admitted while they are on call .

 

[Winged Scapula]

My idea right now is to do a CC fellowship and become an intensivist, with a general surgery practice when I'm not in the ICU. This blend of ICU work (which I love) and time in the OR seems like a right fit for me, but I know it's unorthodox, and the usual response I receive from fellow residents when I describe this is a quizzical look and a furrowed brow.

Any thoughts/ ideas? How did others compromise potentially conflicting preferences when choosing a subspecialty?

Thanks in advance.

Actually, as surgical06 notes, what you think is unorthodox is actually fairly common. Many trauma surgeons work a schedule akin to the following:

1 week general surgery (you aren't on call every night, but rather take all day time consults, round on patients, ER calls)
1 week trauma (just as above, you aren't on call every night, but rather take trauma consults, round on trauma patients, during the day)
1 week ICU coverage

During these weeks, trauma call would rotate based on the monthly schedule (ie, divided between the partners). Unless you are at one of the "biggies" where it might be possible to do just Trauma, most trauma surgeons also do general surgery and spend a week at a time doing intensivist work. I'm not sure why your fellows are giving you quizzical looks as this is how it works in the real world for most trauma surgeons especially in this day and age of increasingly non-op management.

 

[Tigger14]

One of our private surgeons only does general surgery (3 weeks) and Surgical Critical Care (1 week) without any trauma. He loves it.

 

[ExtraCrispy]

One of our private surgeons only does general surgery (3 weeks) and Surgical Critical Care (1 week) without any trauma. He loves it.

This is exactly what I have in mind. I think the quizzical looks arise from the fact that when I say critical care, but not necessarily trauma, people assume I don't want to operate. The question, "why didn't you go into anesthesia?" sometimes comes up. The truth is I love both the ICU and gen surg, and would rather do both.

 

[Tigger14]

We are at a level 1 trauma center, and the other critical care people are trauma when they are not covering their week in the ICU. I can't imagine that it would be difficult to do this... I think some don't because they can't really operate on their ICU week. That is what our attending does... operates 3 weeks, and schedules nothing in the week he is on ICU, but obviously covers his inpatients as well as the ICU. Good luck!

 

[NDESTRUKT]

So if you're at a point where you can't operate anymore can you just be an intensivist? Can surgeons BC in CC be intensivists in the MICU as well as the SICU?

 

[salmonella]

MICU is pulm/critical care's territory...surgeons usually stay within SICU.

 

[Pilot Doc]

So if you're at a point where you can't operate anymore can you just be an intensivist? Can surgeons BC in CC be intensivists in the MICU as well as the SICU?

That's all institution dependent. Dermatologists can be intensivists in the MICU. But as the prior poster said, it is very, very rare to find a surgeon attending in a MICU.

Getting back to the OP, your desired career path is exactly how my institution runs. Most of the attendings in our trauma division are CC boarded and when on clinical service, they rotate between weeks doing trauma days, trauma nights, ICU days and ICU nights.

 

[Dr. Dukes]

Most of the attendings in our trauma division are CC boarded and when on clinical service, they rotate between weeks doing trauma days, trauma nights, ICU days and ICU nights.

How does the compensation for this system work? Do they all get paid the same salary by the hospital (not counting extra shifts), so it doesn't matter if they spend all week in the hospital and no one hurts themselves, or do they live and die "financially" based on the activities of the knife and gun club?