How to make the right decision?

[thebadger]

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I have basically wilted down my residency choices to internal med and general surgery. I'm having a very difficult time figuring out what to do. To make a long story short, I find IM interesting/okay; but much prefer general surgery (love the OR, the anatomy, technical skills, pace etc - the other surgery specialties don't interest me except maybe CT...). The gen surg residency will probably be brutal and I won't have a life; but I'm cool with that. What scares me is the life after residency.

In the end I feel like I'm choosing based on lifestyle and it's a crummy feeling. I'm not looking for a cushy 40hours/week job or anything; but I do want to have a stable, happy life outside the hospital after residency. I know what I just described is possible, but is it common? Can anyone give me a little guidance on how to approach this? Thanks.

 

[twinmommd]

Imagine that you couldn't ever do each one again. Then realize which makes you sadder if you couldn't do it ever again. Then do that specialty. I went through that a year ago, got a huge lump in my throat thinking about never doing surgery again, and I haven't looked back. It also doesn't hurt that the only honors I could ever pull off was on surgery rotations.

 

[Tired Pigeon]

There are many areas within general surgery where you can have a manageable lifestyle, if this is a priority for you. Colorectal and breast surgery are two areas I've had friends go into citing lifestyle and family concerns as factors in their decisions. Another option is to look at a shift-based surgical specialty such as trauma or critical care -- basically you can work your ass off while you're on, but then you hand off to another surgeon once you're off, freeing up time to pursue whatever it is that interests you in your personal time. There are, of course, colorectal, breast, trauma, etc. people who work 100+ hours a week - I'm not suggesting that these are cushy specialties, only that they may offer you some ability to tailor your post-residency practice to address the concerns you're expressing.

 

[dr.evil]

You're thinking ahead and that's a good sign. Would you specialize in IM? If so, what would you do? If you are just IM, the two fields couldn't be more different.

After residency, the tough parts of surgery are that people have complications and die directly from something that you do. The stress level when this happens is off the charts miserable. Sure, it's not often but once every 6 months will consume a month of your life...believe me. Especially when it's something elective. Internal medicine docs don't have this except for specialists such as cards or GI.

Hours can be worse but you can usually work these to your life as long as you are willing to make less money. I'm rarely not finished by 5pm and make my kid's t-ball game. Call is painful at times but call is painful in all specialties. Get rid of call, and medicine would be a dream (except for the people dying part).

Wise students look to the end. I looked to the residency instead of the end.

 

[kirurg]

Imagine that you couldn't ever do each one again. Then realize which makes you sadder if you couldn't do it ever again. Then do that specialty. I went through that a year ago, got a huge lump in my throat thinking about never doing surgery again, and I haven't looked back. It also doesn't hurt that the only honors I could ever pull off was on surgery rotations.

I wouldn't agree 100%. If the OP loves surgery, but possibly couldn't see him/herself working weekends or taking call (ever), then surgery would be a bad choice. It's important to consider all aspects of your life when choosing a specialty.

There are all kinds of jobs in every specialty. I know general surgeons/CRS who work for the VA/city hospitals, and work less than 8 hrs per day and take 1:8 call. When they go home, their on-call partner fields all phone calls and takes care of all complications. They probably make less than someone in PP working 80 hrs/week, but it's good for them.

With socialized medicine on the horizon, who knows what to expect?!!

 

[Dr.LeoSpaceman]

I have basically wilted down my residency choices to internal med and general surgery. I'm having a very difficult time figuring out what to do. To make a long story short, I find IM interesting/okay; but much prefer general surgery (love the OR, the anatomy, technical skills, pace etc - the other surgery specialties don't interest me except maybe CT...). The gen surg residency will probably be brutal and I won't have a life; but I'm cool with that. What scares me is the life after residency.

In the end I feel like I'm choosing based on lifestyle and it's a crummy feeling. I'm not looking for a cushy 40hours/week job or anything; but I do want to have a stable, happy life outside the hospital after residency. I know what I just described is possible, but is it common? Can anyone give me a little guidance on how to approach this? Thanks.

You shouldn't feel crummy because you are letting lifestyle concerns factor in your decision. In fact, I'd actually say you're making a mistake if you aren't factoring them in. If you hate your life, it doesn't matter how much you love surgery (or anything else) because there's a good chance you'll be miserable.

But, as others say, there's certainly flexibility in determining what you're lifestyle will be like in every specialty. You simply must be willing to make the tradeoffs that kind of lifestyle requires.

 

[twinmommd]

I wouldn't agree 100%. If the OP loves surgery, but possibly couldn't see him/herself working weekends or taking call (ever), then surgery would be a bad choice. It's important to consider all aspects of your life when choosing a specialty.

This is true. I always forget to consider lifestyle issues, since I left a lifestyle-friendly career to go to med school. It's probably not a smart thing from my perspective, but this end-of-M4, pre-residency time is killing me.

 

[thebadger]

Thanks for the advice everyone.

 

[45408]

One specialty I don't see mentioned often is hand surgery. You can do a hand fellowship after a general surgery residency, and after that, you can have a pretty good lifestyle. I've worked with our hand surgeons, and they seem to have a pretty active life outside of work. Except for traumas, all of their cases are outpatient and elective, and it's going to be pretty unlikely for your patients to die after something you did. For the traumas, the really bad traumas are probably going to be on someone else's service and someone else's problem.

So, my point is that you can have a much more controlled lifestyle in surgery than a general surgeon who is covering anything/everything. I don't think it's wrong at all to consider lifestyle in your specialty choice. I think I'll be aiming for something in the middle...

 

[SLUser11]

One specialty I don't see mentioned often is hand surgery. You can do a hand fellowship after a general surgery residency, and after that, you can have a pretty good lifestyle.

Yes, but why would you ever spend five years in general surgery then do something unrelated like hand, which most general surgery residents have little to no experience in?

Also, my understanding from talking with the ortho guys is that their residents hate hand rotations the same way most general surgery residents hate vascular....

 

[45408]

Yes, but why would you ever spend five years in general surgery then do something unrelated like hand, which most general surgery residents have little to no experience in?

Because it's got a great lifestyle? What I don't understand is why it only takes one year to become a hand surgeon, coming from a GS background OR an ortho background. Sure seems like it would be hard to keep up your GS board certification when you never, ever do GS after residency.

Also, my understanding from talking with the ortho guys is that their residents hate hand rotations the same way most general surgery residents hate vascular....

I think it's extremely location dependent, as a big inner-city place will have a much more complex cases with worse patients than an elective practice with secretaries with carpal tunnel.

 

[maxheadroom]

Because it's got a great lifestyle?

I'm a Hand surgeon. I love upper extremity anatomy and pathology. But I'd challenge you on the whole "lifestyle" thing in Hand. There are lots of places where Hand call can be pretty brutal (depends upon the ED physicians' comfort level in taking care of some injuries), which is why Ortho and Plastics residents tend to have a strong dislike for the Hand trauma call that they take.

If you can do carpal tunnels all day in an ASC and not take Hand call, you can have a pretty nice life. Problem is, that kind of practice is not easy to build. And compensation is not great. And you do a lot of Workman's Comp stuff, which means lots and lots of paperwork (and WC payments are decreasing, meaning you're doing extra paperwork for less and less money).

Most of the General Surgeons who go into Hand are either trying to get a Plastics spot OR they hate General Surgery and want anything to never see the inside of an abdomen again (in my experience).

 

[45408]

I'm a Hand surgeon. I love upper extremity anatomy and pathology. But I'd challenge you on the whole "lifestyle" thing in Hand. There are lots of places where Hand call can be pretty brutal (depends upon the ED physicians' comfort level in taking care of some injuries), which is why Ortho and Plastics residents tend to have a strong dislike for the Hand trauma call that they take.

If you can do carpal tunnels all day in an ASC and not take Hand call, you can have a pretty nice life.

Which is what my experience is limited to. I really don't know what it's like elsewhere. When I rotated through the ER, I sewed up a few fairly serious hand lacs, so I guess if you were getting called for all of those, it could really suck. Our hand guys also share the call with quite a few other people (inside and outside the dept), so Q7 call isn't bad...

 

[maxheadroom]

Q7 call isn't bad if you're mostly fielding phone calls to arrange follow up. If you're getting hit with major extremity trauma/mutilated hands/replants/revascs on a regular basis, you'll find it to be fairly painful. There's a reason for the crisis of Hand call coverage in many major areas.

 

[DHT]

Because it's got a great lifestyle? What I don't understand is why it only takes one year to become a hand surgeon, coming from a GS background OR an ortho background. Sure seems like it would be hard to keep up your GS board certification when you never, ever do GS after residency.


I think it's extremely location dependent, as a big inner-city place will have a much more complex cases with worse patients than an elective practice with secretaries with carpal tunnel.

I agree that I have NO CLUE how a general surgeon can become well trained in hand with a 1 year fellowship. Ortho on the other hand has a significant portion of their training devoted to hand, not just our dedicated hand rotations. Remember that we take hand call throughout our training (at my institution we are hand call every night we take call), and our other rotations like trauma, sports, and peds will overlap with hand as well (sports does shoulder and elbow, trauma will have upper extremity trauma down to the distal radius, and peds will do a lot of congenital hand/upper extremity cases).

Also my experience is that hand is quite popular among ortho residents where I have rotated as a med student and at my own program.