Is Gen Surg as bad as people make it out to be?

[CatDad26]

People really put down gen surg online, especially mentioning the residency being unbearable. My goal right now is ENT, would I be better off doing anesthesia over gen surg if plan A doesn't work out?

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[Angus Avagadro]

Let's ask @operaman . In my experience the 1 st yr Gen surgery residents work very hard, but they do it because they can't see themselves doing anything else but surgery.

 

[Starbuxian]

Also if @DOVinciRobot can cast some pearls of wisdom our way... that would be very much appreciated.

 

[DOVinciRobot]

It depends on what your definition of “bad” is. Most weeks I work 70-80 hours, some I work 100+ and others I’ll work 50.

In my biased opinion no it is not the hell on earth people online make it out to be, although it’s definitely more of a grind than something like FM/peds. But I love surgery, and would quit medicine before I did a different specialty.

General surgery is very different from ENT though. A lot more poop and DRE’s in general surgery. We also do a lot of critical care as part of training, quite a bit more than pretty much any other surgical field.

Happy to answer any specific questions you might have

 

[DarkBluMage]

It depends on what your definition of “bad” is. Most weeks I work 70-80 hours, some I work 100+ and others I’ll work 50.

In my biased opinion no it is not the hell on earth people online make it out to be, although it’s definitely more of a grind than something like FM/peds. But I love surgery, and would quit medicine before I did a different specialty.

General surgery is very different from ENT though. A lot more poop and DRE’s in general surgery. We also do a lot of critical care as part of training, quite a bit more than pretty much any other surgical field.

Happy to answer any specific questions you might have

100hr weeks? Isn’t the cap 80hrs?

 

[scoopdaboop]

100hr weeks? Isn’t the cap 80hrs?

 

[Mad Jack]

100hr weeks? Isn’t the cap 80hrs?

Averaged over 4 weeks. You can do 110, 50, 110, 50 and it's still fine

 

[DarkBluMage]

Averaged over 4 weeks. You can do 120, 60, 120, 60 and it's still fine

Sounds like death

 

[ACSurgeon]

Sounds like death

Much easier than having a couple of little kids….

 

[DarkBluMage]

Much easier than having a couple of little kids….

Yea cause everyone aspires to be a workaholic with no time for anything else besides sleep. What human needs a family/social life? Might as well sell your home/break your apt lease and live in the on-call room at the hospital…

 

[ACSurgeon]

Yea cause everyone aspires to be a workaholic with no time for anything else besides sleep. Might as well sell your home/break your apt lease and live in the on-call room at the hospital…

Residency is a short phase. Kids are forever

 

[Mad Jack]

Much easier than having a couple of little kids….

Yes. That truly sounds like death

 

[DarkBluMage]

Residency is a short phase. Kids are forever

7 years isn’t short but ok lmbo
especially add in 4 soul sucking years of med school plus whatever research year for some and gap or undergrad years and 7 years seem like a long time to still not have a life and be worked into the ground.

 

[srirachamayonnaise]

Averaged over 4 weeks. You can do 120, 60, 120, 60 and it's still fine

That's no life..

 

[Wordead]

7 years isn’t short but ok lmbo
especially add in 4 soul sucking years of med school plus whatever research year for some and gap or undergrad years and 7 years seem like a long time to still not have a life and be worked into the ground.

I mean then don't do surgery it's pretty simple. I don't think anyone in gen surg is trying to trick people into thinking it's an easy life.

 

[DOVinciRobot]

100hr weeks? Isn’t the cap 80hrs?

Lol. You will break duty hours on some weeks in pretty much any specialty. I know FM residents that will break 80 hrs a week on some rotations.

And it’s a rolling average over 4 weeks, as others have mentioned.

Much easier than having a couple of little kids….

Somehow I manage both. I have a very dedicated spouse who I clearly don’t deserve.

Yea cause everyone aspires to be a workaholic with no time for anything else besides sleep. What human needs a family/social life? Might as well sell your home/break your apt lease and live in the on-call room at the hospital…

I have a family. Residency is hard, sure, but I still have time to be a parent and spouse. I have never once regretted choosing surgery.

 

[Mad Jack]

7 years isn’t short but ok lmbo
especially add in 4 soul sucking years of med school plus whatever research year for some and gap or undergrad years and 7 years seem like a long time to still not have a life and be worked into the ground.

Shorter than 18 years. But yeah, residency is hard and it sucks and surgery is up there in the suck department. I've never met a surgery resident I would describe as "thriving"

 

[DarkBluMage]

I mean then don't do surgery it's pretty simple. I don't think anyone in gen surg is trying to trick people into thinking it's an easy life.

Or I can choose it and still think the training needs to change and lobby to make that happen. Did I say they were trying to trick people into thinking it’s easy? Why are people on sdn so threatened by people saying they want any kind of work/life balance after dedicating most of their life to education? We’re not robots. We’re human beings. It’s asinine to pretend that 100+ hr work weeks are something someone shouldnt be repulsed by if they want any kind of life besides basically living in the hospital, which is something I constantly see on responses about residencies.

 

[DarkBluMage]

Lol. You will break duty hours on some weeks in pretty much any specialty. I know FM residents that will break 80 hrs a week on some rotations.

And it’s a rolling average over 4 weeks, as others have mentioned.

Somehow I manage both. I have a very dedicated spouse who I clearly don’t deserve.

I have a family. Residency is hard, sure, but I still have time to be a parent and spouse. I have never once regretted choosing surgery.

Around how much time on an average day are you able to spend with your family? I made a thread asking about that because it’s something im concerned about. I don’t want to basically be an absent parent in the home if I try to start a family in residency. Doing some quick math, working 120hrs a week only leaves like 6hrs in a day on average and one would assume that’s spent sleeping before going back to work. I’m not seeing how it’s possible to be a present wife/mother (talking about myself) working those hours for 7 years.

 

[DarkBluMage]

Shorter than 18 years. But yeah, residency is hard and it sucks and surgery is up there in the suck department. I've never met a surgery resident I would describe as "thriving"

Not everyone is repulsed by parenthood. Some of us look forward to building a family. You’ll have to excuse me if I look more negatively on work keeping me so busy that I barely have time to build a life outside of it after dedicating most of my life to education thus far.

 

[DOVinciRobot]

Or I can choose it and still think the training needs to change and lobby to make that happen. Did I say they were trying to trick people into thinking it’s easy? Why are people on sdn so threatened by people saying they want any kind of work/life balance after dedicating most of their life to education? We’re not robots. We’re human beings. It’s asinine to pretend that 100+ hr work weeks are something someone shouldnt be repulsed by if they want any kind of life besides basically living in the hospital, which is something I constantly see on responses about residencies.

Do not choose surgery if you think you will change the training paradigm. Simply put, in order for the weekly workload to get better, you’d have to extend the training length. No one wants that.

I also want a work life balance. That’s why I’m going to pick fellowship with that in mind. As much as I love surgery it’s just my job. Having said that I also can tell you that you can’t learn surgery the way you need to without working a lot in residency. It just is what it is.

Around how much time on an average day are you able to spend with your family? I made a thread asking about that because it’s something im concerned about. I don’t want to basically be an absent parent in the home if I try to start a family in residency. Doing some quick math, working 120hrs a week only leaves like 6hrs in a day on average and one would assume that’s spent sleeping before going back to work. I’m not seeing how it’s possible to be a present wife/mother (talking about myself) working those hours for 7 years.

It is completely rotation dependent. On the super busy ones maybe 30 minutes. On average 1-2 hours. On colorectal or the VA I’m home by 3 typically.

For the record, my average weekly hours worked is about 72. 120 is a really bad week and I’ve only had a few of those

Being a mom and a surgery resident is difficult, but I know people that are doing it. One of our ortho residents is a mom. Some programs are much better at being accommodating than others, it kinda just depends on how stretched thin the residents are.

 

[ACSurgeon]

Lol. You will break duty hours on some weeks in pretty much any specialty. I know FM residents that will break 80 hrs a week on some rotations.

And it’s a rolling average over 4 weeks, as others have mentioned.

Somehow I manage both. I have a very dedicated spouse who I clearly don’t deserve.

I have a family. Residency is hard, sure, but I still have time to be a parent and spouse. I have never once regretted choosing surgery.

I never understood how people (esp women) managed kids and surgery residency, but our program had at least 10 parents. Mostly women. I didn’t appreciate how difficult this was until
I had kids later. Woof.

 

[ACSurgeon]

Shorter than 18 years. But yeah, residency is hard and it sucks and surgery is up there in the suck department. I've never met a surgery resident I would describe as "thriving"

Yea but if you have a couple kids a couple years apart that quickly stretches to many more years. That, and often people don’t stop being parents as soon as the kid turns 18. Talk about a real life sentence.

But it’s great etc. highly recommend it.

 

[DarkBluMage]

Do not choose surgery if you think you will change the training paradigm. Simply put, in order for the weekly workload to get better, you’d have to extend the training length. No one wants that.

I also want a work life balance. That’s why I’m going to pick fellowship with that in mind. As much as I love surgery it’s just my job. Having said that I also can tell you that you can’t learn surgery the way you need to without working a lot in residency. It just is what it is.

It is completely rotation dependent. On the super busy ones maybe 30 minutes. On average 1-2 hours. On colorectal or the VA I’m home by 3 typically.

For the record, my average weekly hours worked is about 72. 120 is a really bad week and I’ve only had a few of those

Being a mom and a surgery resident is difficult, but I know people that are doing it. One of our ortho residents is a mom. Some programs are much better at being accommodating than others, it kinda just depends on how stretched thin the residents are.

I didn’t say I was going to change the training paradigm but changes do need to be made. It’s like when people complained about an 80hr cap being put. Residency training isn’t perfect, medical school isn’t perfect. People complain with how medical students basically shadow these days compared to previous years. I do think things can be made better for both hospitals/residents. Either way, the opinion of people on sdn isn’t going to make me feel bad about actually wanting a life. I see why so many doctors are divorced, why the suicide rate is so high if it’s considered normal to work yourself to death while essentially having no life or time to have a family outside of work. Im sorry but I’ll go to my grave in disagreement with medical training continuing to normalize treating human beings as robots in medicine.
I really appreciate the feedback about your time you have available to dedicate to your family. I know that was a really personal thing for me to ask.

 

[ACSurgeon]

Not everyone is repulsed by parenthood. Some of us look forward to building a family. You’ll have to excuse me if I look more negatively on work keeping me so busy that I barely have time to build a life outside of it after dedicating most of my life to education thus far.

Different strokes for different folks.

Building a family is so much more precious than anything you can accomplish in a career. But not everyone can or should try to be an astronaut.

We live in an era where many people want it all. The old sayings that “doing two things at once is like doing neither” is still very true.

There’s no shame is focusing on building a family. There’s no shame in focusing on a building a spectacular career. Different paths. Few people can truly do both. Often one suffers at the expense of the other.

 

[DarkBluMage]

Different strokes for different folks.

Building a family is so much more precious than anything you can accomplish in a career. But not everyone can or should try to be an astronaut.

We live in an era where many people want it all. The old sayings that “doing two things at once is like doing neither” is still very true.

There’s no shame is focusing on building a family. There’s no shame in focusing on a building a spectacular career. Different paths. Few people can truly do both. Often one suffers at the expense of the other.

This is honestly what I’m afraid of most. I’m passionate about being a pediatric surgeon. At this stage I couldn’t imagine doing anything else, however I still have rotations to experience so there is a chance of it changing though I doubt it. My fear is not being present for my family and it’s sounding more like that’s what’s gona happen if I start one in residency. Guess I’ll be waiting till 40 to start one lmbo. Super depressing to think about but I guess it is what it is.

 

[Mad Jack]

Not everyone is repulsed by parenthood. Some of us look forward to building a family. You’ll have to excuse me if I look more negatively on work keeping me so busy that I barely have time to build a life outside of it after dedicating most of my life to education thus far.

I'm not repulsed by it, just very realistic about the endless work it requires

 

[Mad Jack]

Yea but if you have a couple kids a couple years apart that quickly stretches to many more years. That, and often people don’t stop being parents as soon as the kid turns 18. Talk about a real life sentence.

But it’s great etc. highly recommend it.

It's a wonderful choice for anyone with a parental bone in their body. I have zero such bones and just know it's best for any potential child that I not have them. Kids are great, but not for me, personally, due to both my personality and unrelated complicating factors

 

[DOVinciRobot]

I didn’t say I was going to change the training paradigm but changes do need to be made. It’s like when people complained about an 80hr cap being put. Residency training isn’t perfect, medical school isn’t perfect. People complain with how medical students basically shadow these days compared to previous years. I do think things can be made better for both hospitals/residents. Either way, the opinion of people on sdn isn’t going to make me feel bad about actually wanting a life. I see why so many doctors are divorced, why the suicide rate is so high if it’s considered normal to work yourself to death while essentially having no life or time to have a family outside of work. Im sorry but I’ll go to my grave in disagreement with medical training continuing to normalize treating human beings as robots in medicine.
I really appreciate the feedback about your time you have available to dedicate to your family. I know that was a really personal thing for me to ask.

Oh don't get me wrong, the systemic abuse of medical residents is appalling and absolutely should change, but the actual work hours aren't the problem. The implementation of the 80 hour work week did nothing to improve resident wellness, multiple studies and data points have shown that.

 

[operaman]

I think it all depends on what your definition of "bad" is. And whatever it is, it varies between programs. And once residency is over, being an attending surgeon is no cakewalk either whether thats in ENT or gen surg.

On the attending side, I think the hardest part is the unpredictability. If someone rolls into my clinic with a surgical emergency, guess who's not getting home on time? If one of my post-ops has a complication, guess who comes in to fix it? That's the flip side of getting to do some really fun cases and have what is generally a great life with high pay.

The real secret to having a good life in gen surg or anything else is this: you have to be good. I don't know why this never gets talked about, but your surgical skill is largely what will determine your quality of life (in addition to a few other things). If it takes you until 8pm to do cases that I can finish by 4pm, guess who has a better life? We had a free flap surgeon in residency who could finish cases by 1pm that faculty in my med school would take until 10pm, and she would pick her kids up from school every day. She was also really good so rarely had late night takebacks. Others had more complications and their lives sucked a lot more. IF you can get good training and develop excellent skills in clinic and the OR, you can definitely have a good QOL in any surgical field. One of my free flap surgeon partners is stupidly awesome and he does 5-7 flaps a week and usually works from 9-2 and no call other than his own patients and maybe does one late night takeback a year if that. That's what skills can buy you.

So how do you do this? This is where working hard in training comes in, and take all this with a grain of salt because I'm not a general surgeon, but I've certainly worked with them and went through training with a lot of them. But surgical residency does require a certain investment of time so you can develop the skills you will rely on for your career. This comes in the form of long hours, long cases, busy calls, etc., so you can learn how to do surgery and care for perioperative patients and manage your complications. As a junior GS resident this means a lot of busy weeks, weekend rounds, etc. Many gen surg programs will have senior and chief residents taking frequent backup call as well. At my program, the GS chiefs were on call 24/7 for their service while in ENT we had senior level call rotate q10-12. So for GS they have brutally long hours as juniors and then more frequent call as seniors, and call as seniors is usually with interns/2s so they get called quite a bit. Things are always service specific, so some rotations have fewer late night issues/calls, but some may have the chief coming in to operate quite a bit and those tend to be services that have longer more complex cases during the day as well.

The other flip side to the hours is the amount of reading you'll need to do if you want to get good, and getting good is what gives you a good life later.

So yes GS and other surgical fields can be brutal. Some programs are cushier than others, but no program is going to turn a surgical field into a Derm residency lifestyle. You do surgery because you want to be a surgeon. If that's what makes you happy, then go for it. Develop your skills and you'll be able to have a decent QOL.

 

[Wordead]

Or I can choose it and still think the training needs to change and lobby to make that happen. Did I say they were trying to trick people into thinking it’s easy? Why are people on sdn so threatened by people saying they want any kind of work/life balance after dedicating most of their life to education? We’re not robots. We’re human beings. It’s asinine to pretend that 100+ hr work weeks are something someone shouldnt be repulsed by if they want any kind of life besides basically living in the hospital, which is something I constantly see on responses about residencies.

I didn’t say I was going to change the training paradigm but changes do need to be made. It’s like when people complained about an 80hr cap being put. Residency training isn’t perfect, medical school isn’t perfect. People complain with how medical students basically shadow these days compared to previous years. I do think things can be made better for both hospitals/residents. Either way, the opinion of people on sdn isn’t going to make me feel bad about actually wanting a life. I see why so many doctors are divorced, why the suicide rate is so high if it’s considered normal to work yourself to death while essentially having no life or time to have a family outside of work. Im sorry but I’ll go to my grave in disagreement with medical training continuing to normalize treating human beings as robots in medicine.
I really appreciate the feedback about your time you have available to dedicate to your family. I know that was a really personal thing for me to ask.

I mean you can protest reality all you want but I don't think reality really cares what you think it "should" be. If you want to do peds surg, probably the most competitive subspecialty, but have a great work life balance during gen surg residency.....well, good luck.

 

[Future_Bone_Docta]

Do not choose surgery if you think you will change the training paradigm. Simply put, in order for the weekly workload to get better, you’d have to extend the training length. No one wants that.

I also want a work life balance. That’s why I’m going to pick fellowship with that in mind. As much as I love surgery it’s just my job. Having said that I also can tell you that you can’t learn surgery the way you need to without working a lot in residency. It just is what it is.

It is completely rotation dependent. On the super busy ones maybe 30 minutes. On average 1-2 hours. On colorectal or the VA I’m home by 3 typically.

For the record, my average weekly hours worked is about 72. 120 is a really bad week and I’ve only had a few of those

Being a mom and a surgery resident is difficult, but I know people that are doing it. One of our ortho residents is a mom. Some programs are much better at being accommodating than others, it kinda just depends on how stretched thin the residents are.

Do you think the total duration is necessary from a residents perspective? 5-7 years gen surg to then have to do 2-3 years fellowship... when these surgical subs get to be done by 6.

 

[DarkBluMage]

I mean you can protest reality all you want but I don't think reality really cares what you think it "should" be. If you want to do peds surg, probably the most competitive subspecialty, but have a great work life balance during gen surg residency.....well, good luck.

If “reality” didn’t care what anyone thinks then residency programs would never have made changes over the years and residency unions wouldn’t be a thing but obviously they have made changes and residency unions exist… makes one wonder why so many get upset at people airing displeasure over ridiculous work hrs. I’m not for the cog in the wheel mentality.

 

[DarkBluMage]

Oh don't get me wrong, the systemic abuse of medical residents is appalling and absolutely should change, but the actual work hours aren't the problem. The implementation of the 80 hour work week did nothing to improve resident wellness, multiple studies and data points have shown that.

Of course it didn’t improve resident wellness overall. There’s more than one factor that affects that. I doubt any resident before the cap was complaining about a cap being instituted rather than being grateful for it considering the amount of abuse and mental health damage present before it though. It’s not as if 80hrs isn’t still a lot at the end of the day and as you said people are still pulling 100+hrs at times which I’m sure skews the results since it’s not a hard cap of 80hrs. If it had been hard capped at 50hrs I’m sure wellness would have been more effected though I doubt it would wholly solve the problem because it’s multifaceted.

 

[Wordead]

If “reality” didn’t care what anyone thinks then residency programs would never have made changes over the years and residency unions wouldn’t be a thing but obviously they have made changes and residency unions exist… makes one wonder why so many get upset at people airing displeasure over ridiculous work hrs. I’m not for the cog in the wheel mentality.

I dont know why you think I'm upset. I don't have a dog in the race I'm not gen surg. I don't really care. You care because you want an easy path to being a pediatric surgeon that doesn't require the sacrifice and pain it currently requires.

Whether the pain is necessary is the underlying question. I don't know - how many hours or years of training would you want to cut out for the surgeon cutting into your kid?

 

[DarkBluMage]

I dont know why you think I'm upset. I don't have a dog in the race I'm not gen surg. I don't really care. You care because you want an easy path to being a pediatric surgeon that doesn't require the sacrifice and pain it currently requires.

Whether the pain is necessary is the underlying question. I don't know - how many hours or years of training would you want to cut out for the surgeon cutting into your kid?

It’s seems clear you are to me. If I wanted an easy path I never would have chosen medicine. Someone wanting improvements doesn’t equal wanting an easy path. Not wanting to work insane hours after already sinking so much time, effort, pain (sacrificing everything outside of education) into this path already isn’t the same as wanting an easy path. That’s such an odd conclusion to come to. I’m pushing 30 and I haven’t even graduated med school yet. I’m not some young adult that has forever to build a family. The age of the average matriculant is getting higher as more and more gap years are necessary to be competitive for med school. You seem out of check with reality. The average suicide rate of med students is 3x higher than the population. The average suicide rate of physicians is 2x higher, in fact last I read it’s the highest of any profession. Y’all really think medical training has nothing to do with that? Harsh medical school demands and then hop into residency which is arguably worse. Spending 10+ years in which you’re unable to dedicate any time to a personal life essentially? Low pay in residency for long hrs? Barely being able to afford a place of your own as a grown ass adult with a MD? Barely having time to finally start building a life outside of medicine despite the pain and sacrifice already given? This is something y’all have an issue with people complaining about? Nothing needs to change? It’s so odd to see so many medical professionals promoting an unhealthy life balance for such an extended period of time that we would never promote to anyone else for their own sanity/mental health.

 

[Neopolymath]

Or I can choose it and still think the training needs to change and lobby to make that happen. Did I say they were trying to trick people into thinking it’s easy? Why are people on sdn so threatened by people saying they want any kind of work/life balance after dedicating most of their life to education? We’re not robots. We’re human beings. It’s asinine to pretend that 100+ hr work weeks are something someone shouldnt be repulsed by if they want any kind of life besides basically living in the hospital, which is something I constantly see on responses about residencies.

I feel like you don't understand why surgical residency is the way that it is. If you did you wouldn't be saying these things.

 

[DarkBluMage]

I feel like you don't understand why surgical residency is the way that it is. If you did you wouldn't be saying these things.

I understand why, but recognize it could be better and it’s possible for it to be that way. However it would require a massive change in the way we go about graduate medical education in the US. Thinking that residency training is perfect the way it is and couldn’t possibly be tweaked is laughable.

 

[DOVinciRobot]

I think it all depends on what your definition of "bad" is. And whatever it is, it varies between programs. And once residency is over, being an attending surgeon is no cakewalk either whether thats in ENT or gen surg.

On the attending side, I think the hardest part is the unpredictability. If someone rolls into my clinic with a surgical emergency, guess who's not getting home on time? If one of my post-ops has a complication, guess who comes in to fix it? That's the flip side of getting to do some really fun cases and have what is generally a great life with high pay.

The real secret to having a good life in gen surg or anything else is this: you have to be good. I don't know why this never gets talked about, but your surgical skill is largely what will determine your quality of life (in addition to a few other things). If it takes you until 8pm to do cases that I can finish by 4pm, guess who has a better life? We had a free flap surgeon in residency who could finish cases by 1pm that faculty in my med school would take until 10pm, and she would pick her kids up from school every day. She was also really good so rarely had late night takebacks. Others had more complications and their lives sucked a lot more. IF you can get good training and develop excellent skills in clinic and the OR, you can definitely have a good QOL in any surgical field. One of my free flap surgeon partners is stupidly awesome and he does 5-7 flaps a week and usually works from 9-2 and no call other than his own patients and maybe does one late night takeback a year if that. That's what skills can buy you.

So how do you do this? This is where working hard in training comes in, and take all this with a grain of salt because I'm not a general surgeon, but I've certainly worked with them and went through training with a lot of them. But surgical residency does require a certain investment of time so you can develop the skills you will rely on for your career. This comes in the form of long hours, long cases, busy calls, etc., so you can learn how to do surgery and care for perioperative patients and manage your complications. As a junior GS resident this means a lot of busy weeks, weekend rounds, etc. Many gen surg programs will have senior and chief residents taking frequent backup call as well. At my program, the GS chiefs were on call 24/7 for their service while in ENT we had senior level call rotate q10-12. So for GS they have brutally long hours as juniors and then more frequent call as seniors, and call as seniors is usually with interns/2s so they get called quite a bit. Things are always service specific, so some rotations have fewer late night issues/calls, but some may have the chief coming in to operate quite a bit and those tend to be services that have longer more complex cases during the day as well.

The other flip side to the hours is the amount of reading you'll need to do if you want to get good, and getting good is what gives you a good life later.

So yes GS and other surgical fields can be brutal. Some programs are cushier than others, but no program is going to turn a surgical field into a Derm residency lifestyle. You do surgery because you want to be a surgeon. If that's what makes you happy, then go for it. Develop your skills and you'll be able to have a decent QOL.

This. Just because you finish a surgery residency doesn’t mean you’ll be a good surgeon. Being good takes a lot of time and effort.

Do you think the total duration is necessary from a residents perspective? 5-7 years gen surg to then have to do 2-3 years fellowship... when these surgical subs get to be done by 6.

Yes, absolutely. Anyone who says surgery residency could be shortened doesn’t understand surgery training. The 7 years are really just for those wanting to do research. I don’t suggest a 7 year program to anyone unless they know they want an academic career or are dead set on peds/Surg onc. But none of the 5 years could be removed without serious detriment to training and patients.

I doubt any resident before the cap was complaining about a cap being instituted rather than being grateful for it considering the amount of abuse and mental health damage present before it though.

Actually a lot of the residents that were in residency at the time complained about it a lot. It completely changed their training paradigm in unforeseen ways, many of them not good. Talk to more mid career surgeons who were in training when it was instituted, it will open your eyes a bit.

I understand why, but recognize it could be better and it’s possible for it to be that way. However it would require a massive change in the way we go about graduate medical education in the US. Thinking that residency training is perfect the way it is and couldn’t possibly be tweaked is laughable.

No one thinks it’s perfect. But it’s straight up delusional to think you can work 50 hours a week and be competent at the end of 5 years. That’s a LOT of cases and patient management you’re missing in those 30+ hours that are being cut out. As things stand right now new grads are about 2 years behind the learning curve compared to where they were 20 years ago based on what I’ve seen, been told by my likely future partners, and what the data shows.

 

[Angus Avagadro]

I think it all depends on what your definition of "bad" is. And whatever it is, it varies between programs. And once residency is over, being an attending surgeon is no cakewalk either whether thats in ENT or gen surg.

On the attending side, I think the hardest part is the unpredictability. If someone rolls into my clinic with a surgical emergency, guess who's not getting home on time? If one of my post-ops has a complication, guess who comes in to fix it? That's the flip side of getting to do some really fun cases and have what is generally a great life with high pay.

The real secret to having a good life in gen surg or anything else is this: you have to be good. I don't know why this never gets talked about, but your surgical skill is largely what will determine your quality of life (in addition to a few other things). If it takes you until 8pm to do cases that I can finish by 4pm, guess who has a better life? We had a free flap surgeon in residency who could finish cases by 1pm that faculty in my med school would take until 10pm, and she would pick her kids up from school every day. She was also really good so rarely had late night takebacks. Others had more complications and their lives sucked a lot more. IF you can get good training and develop excellent skills in clinic and the OR, you can definitely have a good QOL in any surgical field. One of my free flap surgeon partners is stupidly awesome and he does 5-7 flaps a week and usually works from 9-2 and no call other than his own patients and maybe does one late night takeback a year if that. That's what skills can buy you.

So how do you do this? This is where working hard in training comes in, and take all this with a grain of salt because I'm not a general surgeon, but I've certainly worked with them and went through training with a lot of them. But surgical residency does require a certain investment of time so you can develop the skills you will rely on for your career. This comes in the form of long hours, long cases, busy calls, etc., so you can learn how to do surgery and care for perioperative patients and manage your complications. As a junior GS resident this means a lot of busy weeks, weekend rounds, etc. Many gen surg programs will have senior and chief residents taking frequent backup call as well. At my program, the GS chiefs were on call 24/7 for their service while in ENT we had senior level call rotate q10-12. So for GS they have brutally long hours as juniors and then more frequent call as seniors, and call as seniors is usually with interns/2s so they get called quite a bit. Things are always service specific, so some rotations have fewer late night issues/calls, but some may have the chief coming in to operate quite a bit and those tend to be services that have longer more complex cases during the day as well.

The other flip side to the hours is the amount of reading you'll need to do if you want to get good, and getting good is what gives you a good life later.

So yes GS and other surgical fields can be brutal. Some programs are cushier than others, but no program is going to turn a surgical field into a Derm residency lifestyle. You do surgery because you want to be a surgeon. If that's what makes you happy, then go for it. Develop your skills and you'll be able to have a decent QOL.

^^^^This should be a sticky. If unsure, ask anyone in the anesthesia dept who is a skillful surgeon. They get paid to watch surgeons operate. They can tell you who they would choose to operate on family. They know who is skillful and efficient. A skillful surgeon can make the operation seem so smooth and easy that anyone watching might think they could do it too. To develop skill takes time and repetition. Hence the long hours of training.

 

[nofliesonme]

7 years isn’t short but ok lmbo
especially add in 4 soul sucking years of med school plus whatever research year for some and gap or undergrad years and 7 years seem like a long time to still not have a life and be worked into the ground.

Dear budding pediatric surgeon......Concert pianists practice 15 years at 5 hours a day (no pay, in fact they pay their teachers) before they are ready, violinists work 10,000+ hours (no pay)before they call themselves professionals, world class tennis players begin age 5 turn pro age 18 (no pay, significant expenses)
what training period, hours, structure do you propose for pediatric surgeons before they are ready to stand on your own feet and diagnose, manage and successfully treat the complex problems as the lead surgeon.,,,,,,,,,,,,,,,if it was easy everybody would be singing Turandot at the Met

 

[voxveritatisetlucis]

This isn’t directed to the OP or anything but I’ve also noticed that one shouldn’t ask surgery professors “work life balance” questions in real life. Most of the time, the professors seem annoyed when this question is asked because
1. They’ve probably answered it 1000 times
2. It shows a lack of dedication and or somebody who wants to have their cake and eat it too (ie high paying prestigious job but wants to be on the golf course Fridays at 4pm)
3. I think residency used to be much worse before acgme limits. So comparatively, it may already seem “easier” to them

 

[Neopolymath]

I understand why, but recognize it could be better and it’s possible for it to be that way. However it would require a massive change in the way we go about graduate medical education in the US. Thinking that residency training is perfect the way it is and couldn’t possibly be tweaked is laughable.

Nice straw man. It comes down to more hours or more years with less hours to achieve some level of competency. US picked more hours for less years. Sorry for your luck.

 

[ChordaEpiphany]

Nice straw man. It comes down to more hours or more years with less hours to achieve some level of competency. US picked more hours for less years. Sorry for your luck.

Anyone who's lived it feel free to correct me. Every surgery resident I've talked to complains of scut work and inefficiency in their training. Not exclusive to surgery obviously. Seems like even a small investment in increasing efficiency of training opportunities would go a long way. There will never be a day when we're training surgeons on 40 hour weeks. I'd imagine you could build a good workforce on 60 hour weeks and some mix of 5 and 4+1 or 4+2 programs for specialties. The catch is you'd have to invest in strategies to get more quality time. That means hospitals would have to stop using residents as cheap labor. So I'm not betting on it.

 

[Mad Jack]

It’s seems clear you are to me. If I wanted an easy path I never would have chosen medicine. Someone wanting improvements doesn’t equal wanting an easy path. Not wanting to work insane hours after already sinking so much time, effort, pain (sacrificing everything outside of education) into this path already isn’t the same as wanting an easy path. That’s such an odd conclusion to come to. I’m pushing 30 and I haven’t even graduated med school yet. I’m not some young adult that has forever to build a family. The age of the average matriculant is getting higher as more and more gap years are necessary to be competitive for med school. You seem out of check with reality. The average suicide rate of med students is 3x higher than the population. The average suicide rate of physicians is 2x higher, in fact last I read it’s the highest of any profession. Y’all really think medical training has nothing to do with that? Harsh medical school demands and then hop into residency which is arguably worse. Spending 10+ years in which you’re unable to dedicate any time to a personal life essentially? Low pay in residency for long hrs? Barely being able to afford a place of your own as a grown ass adult with a MD? Barely having time to finally start building a life outside of medicine despite the pain and sacrifice already given? This is something y’all have an issue with people complaining about? Nothing needs to change? It’s so odd to see so many medical professionals promoting an unhealthy life balance for such an extended period of time that we would never promote to anyone else for their own sanity/mental health.

We could cut hours in half and double the time of training if you would prefer. Much if medicine is about repetition, gotta put in the hours somehow. Most would prefer things compressed rather than drawn out as they are in Europe, where even qualification as a general practitioner can often take 5-6 PGY years.

 

[ACSurgeon]

Of all the general surgery specialties peds would be nearly impossible to “accelerate” the clinical time. You have to be able to operate on little babies and kids of all ages and sizes. You are the general, thoracic, colorectal, hepatobiliary surgeon for these kids. Most of these surgeries are uncommon at most pediatric hospital, so you can really have a tracheal/esophageal atresia specialist at 90% of places. So, you have to have a good enough foundation that you can do it all, even when it’s just once or twice a year for most of these hard cases.

 

[DarkBluMage]

Anyone who's lived it feel free to correct me. Every surgery resident I've talked to complains of scut work and inefficiency in their training. Not exclusive to surgery obviously. Seems like even a small investment in increasing efficiency of training opportunities would go a long way. There will never be a day when we're training surgeons on 40 hour weeks. I'd imagine you could build a good workforce on 60 hour weeks and some mix of 5 and 4+1 or 4+2 programs for specialties. The catch is you'd have to invest in strategies to get more quality time. That means hospitals would have to stop using residents as cheap labor. So I'm not betting on it.

THIS
I’m not even responding anymore at this point. Graduate medical training is not as efficient as it could be and it negatively affects residents to the extreme. It’s delusional to say that there’s nothing wrong and things couldn’t be changed for improvement.

 

[Medstart108]

Oh don't get me wrong, the systemic abuse of medical residents is appalling and absolutely should change, but the actual work hours aren't the problem. The implementation of the 80 hour work week did nothing to improve resident wellness, multiple studies and data points have shown that.

Exactly, people needed to be weeded out somehow. Implement work hour restrictions and residents will just be expected to do more research or reading or teaching. They need to crack a few to keep the rest in line.

 

[Medstart108]

THIS
I’m not even responding anymore at this point. Graduate medical training is not as efficient as it could be and it negatively affects residents to the extreme. It’s delusional to say that there’s nothing wrong and things couldn’t be changed for improvement.

Okay, then how do we weed the bad ones out?

 

[VA Hopeful Dr]

Anyone who's lived it feel free to correct me. Every surgery resident I've talked to complains of scut work and inefficiency in their training. Not exclusive to surgery obviously. Seems like even a small investment in increasing efficiency of training opportunities would go a long way. There will never be a day when we're training surgeons on 40 hour weeks. I'd imagine you could build a good workforce on 60 hour weeks and some mix of 5 and 4+1 or 4+2 programs for specialties. The catch is you'd have to invest in strategies to get more quality time. That means hospitals would have to stop using residents as cheap labor. So I'm not betting on it.

I'm always curious what people think is scut work. It seems to cover a very wide range of tasks many of which actually are things doctors need to be able to do.