Hi I have a question for people who may have a better insight at this than me. I know both these residencies work very very hard but which is more intense in terms of call, hours worked and what is expected of you, IM or surgery? I'm not asking this because I will somehow base my future decisions on this but because I want some other opinions.
While some surgical residencies break the 80 hour work week rules, some try not to, I think this has lead to an increased popularity of general surgery among medical students who might not have considered a surgical residency in the past and resulted in it being more competitive.
I think that the nature of the work and pace is different in medicine and surgery. In surgery often times there are significant mortality/morbidity rates associated with various procedures and surgical attendings/surgical senior residents can be *very* harsh with interns and junior residents, so you have to have a somewhat of a thick skin.
You have to know internal medicine very well as you must make decisions about who goes to surgery and managing complicated post-op patients, almost anyone can learn the surgical technique involved, but some residents can't seem to put it all together or aren't hardworking enough and get creamed by attendings on a regular basis, or so at least it apearred to me as a student.
The work is different as it helps to be good at multi-tasking and the patient population can be sicker. In any residency, especially internship, you will be working hard when you are in the hospital.
In internal medicine many patients after admission and initial workup are pretty stable and you can wait until morning to discuss further management with the attending while some patients during the night are found to be less stable and need more observation/care and shift you into a higher level of alertness. So I think internal medicine can be stressful as you don't know when you have to start really worrying about one of your patients.
In surgery there is less time to catch your breath as all surgical patients could go south as any moment and you are basically in emergency mode from when you start to when you end you day, so think while a surgery residency may have marginally more hours (at least in the future with 80 hour work week, and at least less than in the past), the pace is much different in surgery. There is a lot of worry concerning a good percentage of patients on a genera surgery service, with good reason due to what I think are higher rates of mortality/morbidity. The good thing is that you will always have to be "on your toes". Internal medicine requires that you pick up a seriously underlying situation in a patient in the ER after eating a leisurely half hour dinner with fellow residents and having only 5 patients on service.
When things are slow on a IM service residents basically knock on wood that everything stays that way. However, on surgery the work just keeps on coming, at least in my limited experience. I think that if you like procedures and are very goal oriented in terms of patient care then a surgical residency might actually be preferable to an internal medicine residency.
Some surgical attendings, especially in academics, have reasonable lifestyles, and vascular surgeons basically do very similar work day in and day out, and are pretty comfortable with what they are doing. What is more stressful, being an internal medicine attending and seeing 30 patients on multiple teams in one day or being a vascular surgeon and doing 5 or less procedures a day and being on call for your patients?? I think that life as an internal medicine attending is harder than an internal medicine resident (more patients and responsibilities), while I get the impression that life *can* be much be better for surgical attendings than surgical residents, especially surgeons that specialize after general surgery residency.
I think if you can see yourself as an internist and like diagnostic problems and managing treatment then internal medicine might be a good fit, whereas if you loved your surgery rotation and don't mind getting patients that are more or less worked up and diagnosed, but love multitasking and being in the OR then toughing it out through a surgical residency might be worth it.
I am not a surgeon, so somebody should asked Winged Scapulae if she thought her surgical residency training was "worth it" in terms of doing work she likes now . . .