Is lifestyle alone a good enough reason to rule out general surgery?

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Or should it be taken as all residencies are going to suck anyway and might as well go through it if you love it kind of attitude? I keep hearing that post residency, you can basically mold your work hours and lifestyle, even as a general surgeon. But how true is that?
 

DermViser

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What is it with all these general surgery questions lately? (not you OP, just surprised in general).
 

circulus vitios

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SDN will tell you that you should choose what you love, but five years of working 10 hours a week more than other, cushier specialties...for five years...sounds miserable.
 

TraumaLlamaMD

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I've been told by multiple people to choose my career based on how the attendings live, not the residents - yes, some residencies require more time and hours in the hospital than others, but you won't be a resident forever, and then you have to like what you decided to do. GS might have some flexibility depending where you work and what kind of cases you do, but it's never going to be as flexible as a shift schedule. The surgeons I've worked with tend to work long hours when they're on service and on call, with many of them involved in research the rest of the time. It's been said here before, and I heard it a lot this year - "don't do GS if you'd be happy doing something else."
 

DermViser

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SDN will tell you that you should choose what you love, but five years of working 10 hours a week more than other, cushier specialties...for five years...sounds miserable.
General surgery also the ability to have 2 research years in between to get your life back to normal.

I've been told by multiple people to choose my career based on how the attendings live, not the residents - yes, some residencies require more time and hours in the hospital than others, but you won't be a resident forever, and then you have to like what you decided to do. GS might have some flexibility depending where you work and what kind of cases you do, but it's never going to be as flexible as a shift schedule. The surgeons I've worked with tend to work long hours when they're on service and on call, with many of them involved in research the rest of the time.
Except that can feel like an eternity with 5 years of GS residency.
 
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DermViser

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That's kind of like saying you can break up a 5 year prison sentence with 2 years of probation in between.
Yeah, I know, I didn't say it would make the 5 years any better. Just that you get back some semblance of normalcy. Personally I think the general surgeons on SDN tend to downplay the rigor of General Surgery residency out of modesty (like they'll talk about how it's so different with work hour restrictions which is true but all fields now have work hour restrictions). Initially when work hour restrictions came out there was like a surge in applications for GS residency, not realizing that it's still darn hard.

I think for most people it is very rigorous which is why the attrition is like 20-25% I believe.
 

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I personally don't plan on doing general surgery. Although I feel like some of older surgeons that are the attendings had it way worse than any of us are going to have it (this is the honest truth). These guys are tough [email protected]#$%^'s, and got martyred in residency. The one thing I fear most about residency and my future work in medicine is it's ability to change my personality. I don't want to become a morose, gigantic 4ssh0le. If general surgery does that to you (or so I hear), someone else can have my spot. I'll choose something else.
 

CherryRedDracul

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IMO, yes.

If you have doubts about general surgery, don't go into it. If you're torn between one specialty and general surgery, choose the other specialty, according to a trauma attending. And according to every general surgery resident I've talked to, it's a calling. Only go into it if you're sure.
 

DermViser

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IMO, yes.

If you have doubts about general surgery, don't go into it. If you're torn between one specialty and general surgery, choose the other specialty, according to a trauma attending. And according to every general surgery resident I've talked to, it's a calling. Only go into it if you're sure.
If it's not a calling for you, rest assured your surgical attendings will make sure it's a calling for you, in their beatings.
 

CherryRedDracul

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If it's not a calling for you, rest assured your surgical attendings will make sure it's a calling for you, in their beatings.
Interestingly enough, our surgery clerkship director told us that he has tried to dissuade every student interested in general surgery from going into it.

He's not malignant by any means though. Very easy to talk to kind of guy and almost always smiling.
 

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Any reason is a good reason not to do it. It's a horrible lifestyle for 5 years. 1800 or something days. Long crappy days. Count them out in your head imaging going through each one.

Choose your specialty based on the attending....:laugh:. That's a sprung trap if I ever heard one.

On the otherhand. I'm not doing it, and I'm sure glad somebody is, if I ever need and appendectomy or something. So...go for it.
 
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DermViser

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Interestingly enough, our surgery clerkship director told us that he has tried to dissuade every student interested in general surgery from going into it.

He's not malignant by any means though. Very easy to talk to kind of guy and almost always smiling.
Quite surprising he would do that. At most our surgery clerkship director didn't really care either way. lol. I think also he understands it is asking a lot of sacrifice from people who've already sacrificed a lot in terms of time and money.
 
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IMO, yes.

If you have doubts about general surgery, don't go into it. If you're torn between one specialty and general surgery, choose the other specialty, according to a trauma attending. And according to every general surgery resident I've talked to, it's a calling. Only go into it if you're sure.
That applies to everything.
 

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20 to 25% of General Surgery Residents drop out/switch specialties. What does that tell you? That statistic alone should be all that needs to be said.

The training is notoriously difficult. Hard work, abrasive personalities and long hours.
 

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While there is no doubt that the attrition rate is higher in longer specialties, including General Surgery, the oft quoted 20-25% includes Ob-Gyn and also ignores the attrition rate which is actually higher in other specialties (most notably Psych): https://www.aamc.org/download/185478/data/2011_pwc_pugno.pdf
 
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While there is no doubt that the attrition rate is higher in longer specialties, including General Surgery, the oft quoted 20-25% includes Ob-Gyn and also ignores the attrition rate which is actually higher in other specialties (most notably Psych): https://www.aamc.org/download/185478/data/2011_pwc_pugno.pdf
http://www.ncbi.nlm.nih.gov/pubmed/20739854

The data you linked indicates itself a 25% attrition rate over the 5 years of training. Only Psychiatry has a higher attrition rate. In the link above, the GS attrition rate is about 20%. 20-25% seems accurate.

OB-Gyn has a lower attrition rate than GS.

Psychiatry attrition is interesting. The residency isn't quite grueling-- my thought is many that pursue Psychiatry are FMG's who only recognized its lack of competitiveness in the match, and find spots in other specialties that better suit their interest? Complete guess on my part. Anybody have any explanation?
 
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It was for me. I was dreading surgery, but I actually ended up really, really enjoying it. Surgery appealed to the technically driven part of my personality in a way that many other specialties don't. But, at the end of the day, I just couldn't see myself going through hell for 5+ years to get through the training. That doesn't even take into account the life in practice, which might make reasonable hours more possible but seems to by no means be guaranteed.

You have to be honest with yourself about what's most important to you when choosing a specialty. Even though I found surgery awesome and could certainly see myself being a surgeon, the lifestyle was a non-starter for me. That's just how things go. People get into trouble when they try and ignore things that are important to them (e.g., lifestyle, interest in the field, etc. etc.) in pursuit of other things when choosing a field.

Just my two cents.
 

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http://www.ncbi.nlm.nih.gov/pubmed/20739854

The data you linked indicates itself a 25% attrition rate over the 5 years of training. Only Psychiatry has a higher attrition rate. In the link above, the GS attrition rate is about 20%. 20-25% seems accurate.

OB-Gyn has a lower attrition rate than GS.
Its not that the 20-25% is inaccurate, but rather that previous studies have included Ob-Gyn, and that the bulk of the attrition is in the first year. IMHO others forget that the attrition is not annual but cumulative over the length of the residency; thus longer residencies will have higher attrition rates. The reasons for that are not clear (unrealistic expectations, poor insight into specialty and ones fit for it).I'm not apologizing for GS because we do have work to do to reduce the negative stereotypes that exist and to reduce the attrition rates.

Psychiatry attrition is interesting. The residency isn't quite grueling-- my thought is many that pursue Psychiatry are FMG's who only recognized its lack of competitiveness in the match, and find spots in other specialties that better suit their interest? Complete guess on my part. Anybody have any explanation?
I was surprised by that and the higher rate for FM; perhaps that the choice of Psych and FM isn't the preferred specialty, hence the attrition?
 

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It was for me. I was dreading surgery, but I actually ended up really, really enjoying it. Surgery appealed to the technically driven part of my personality in a way that many other specialties don't. But, at the end of the day, I just couldn't see myself going through hell for 5+ years to get through the training. That doesn't even take into account the life in practice, which might make reasonable hours more possible but seems to by no means be guaranteed.

You have to be honest with yourself about what's most important to you when choosing a specialty. Even though I found surgery awesome and could certainly see myself being a surgeon, the lifestyle was a non-starter for me. That's just how things go. People get into trouble when they try and ignore things that are important to them (e.g., lifestyle, interest in the field, etc. etc.) in pursuit of other things when choosing a field.

Just my two cents.
I could have written this post myself. 100% agree. I knew going in what type of lifestyle I wanted, and even though I felt the pull of surgery when I held the knife, it wasn't enough for me to devote that much time (and possibly my marriage and children's future) to it.

My school just gave a talk to 3rd years about how they shouldn't go in saying "I want this out of life, so X specialty isn't feasible," because any specialty can have the lifestyle you want... I disagree to a point. I think you should definitely go into all rotations with a positive outlook, but at some point reality has to come to the table. There are only so many hours in a day and so many years in a life. Figure out what's important to you and what areas of medicine you love and set about compromising. ;)
 

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Its not that the 20-25% is inaccurate, but rather that previous studies have included Ob-Gyn, and that the bulk of the attrition is in the first year. IMHO others forget that the attrition is not annual but cumulative over the length of the residency; thus longer residencies will have higher attrition rates. The reasons for that are not clear (unrealistic expectations, poor insight into specialty and ones fit for it).I'm not apologizing for GS because we do have work to do to reduce the negative stereotypes that exist and to reduce the attrition rates.



I was surprised by that and the higher rate for FM; perhaps that the choice of Psych and FM isn't the preferred specialty, hence the attrition?
This really isn't directed at you specifically, but it's relevant to the thread and relevant to your specialty:

When I was in medical school on my 3rd year surgery rotation, one of our afternoon educational lectures was entitled "Yes, you can have a life in general surgery."

The lecturer was a breast surgeon, and the gist of her entire presentation was "as long as you go into breast surgery specifically, and do all the right things to build the right kind of practice, you can have a life. Otherwise......ehhhhhhhh."
 

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This really isn't directed at you specifically, but it's relevant to the thread and relevant to your specialty:

When I was in medical school on my 30 her surgery rotation, one of our afternoon educational lectures was entitled "Yes, you can have a life in general surgery."

The lecture was a breast surgeon, and the just of her entire presentation was "as long as you going to breast surgery specifically, and do all the right things to build the right kind of practice, you can have a life. Otherwise......ehhhhhhhh."
The title of that lecture was a tad misleading because unless that breast surgeon is taking general surgery call, its a bit disingenuous to label it "general surgery" and claim that you can "have a life".

But at any rate, it is definitely possible to have "a life" after general surgery and not only as a breast surgeon. Breast patients are very needy, so when I'm on call, I field a lot of phone calls, but fortunately, don't have to go in very often.

As I've mentioned before, my ex is a Trauma surgeon and works 3 weeks per month, shift based practice (albeit his week on Trauma can be very busy). He has a lot of down time. Two friends who are Colorectal surgeons, take no general surgery call, and have a largely elective practice with very reasonable hours. I have other friends who are employed general surgeons and work shifts, with call averaging 1 in 7; they trade their better lifestyle for a lower salary (and less control than they would have in PP). Friends who are pediatric surgeons in PP are pretty busy as well but have lots of partners which reduces the call requirements.

The friend with the worst lifestyle? The private practice plastic surgeon. Her lifestyle *could* be good but she sees a lot of patients, has no midlevel or partner, so takes all call, everyday 24/7, often operates after hours and has not been on a vacation in 4 years. When she complains, I shrug and tell her that she has elected to have the lifestyle she has.
 

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Its not that the 20-25% is inaccurate, but rather that previous studies have included Ob-Gyn, and that the bulk of the attrition is in the first year. IMHO others forget that the attrition is not annual but cumulative over the length of the residency; thus longer residencies will have higher attrition rates. The reasons for that are not clear (unrealistic expectations, poor insight into specialty and ones fit for it).I'm not apologizing for GS because we do have work to do to reduce the negative stereotypes that exist and to reduce the attrition rates.
I think it's to be expected that sunk-cost theory applies. People are less likely to quit the closer they are to finishing. Even if a 5th year GS resident has no desire to do GS anymore, it is probably best to finish the residency and apply for another residency than to quit it. Longer residencies have higher attrition rates, but even looking at ANNUAL rates, GS stands out. Actually, Psychiatry REALLY stands out. I don't know if I really buy those rates, particularly without an explanation. 1/3 of Psychiatry residents don't complete the residency? That just seems exorbitant.
 
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This really isn't directed at you specifically, but it's relevant to the thread and relevant to your specialty:

When I was in medical school on my 3rd year surgery rotation, one of our afternoon educational lectures was entitled "Yes, you can have a life in general surgery."

The lecturer was a breast surgeon, and the gist of her entire presentation was "as long as you go into breast surger
y specifically, and do all the right things to build the right kind of practice, you can have a life. Otherwise......ehhhhhhhh."
I disagree with that. Colorectal has a pretty good lifestyle as well. Not to mention plastics can be great- endocrine is not bad either as far as I know. Traumas is on and off.
 
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username456789

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The title of that lecture was a tad misleading because unless that breast surgeon is taking general surgery call, its a bit disingenuous to label it "general surgery" and claim that you can "have a life".
Oh, I agree. I was using that example to make the point that even administration had so little faith in General surgeons being able to convey the quality of life in a positive light to medical students that they had to deceive us by the old bait and switch.
 

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I disagree with that. Colorectal has a pretty good lifestyle as well. Not to mention plastics can be great- endocrine is not bad either as far as I know. Traumas is on and off.
Agreed. I think she was overstating the case (or probably didn't know any better. Just because someone's an attending doesn't mean they actually know what they're talking about. ;) ). Any surgical specialty which is largely elective, without general surgery call and with relatively healthy patients is going to have a better lifestyle.
 
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Winged Scapula

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Oh, I agree. I was using that example to make the point that even administration had so little faith in General surgeons being able to convey the quality of life in a positive light to medical students that they had to deceive us by the old bait and switch.
I suppose if you'd been as smart as a a Neurosurgeon you wouldn't have been fooled. ;)
 

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The answer to your question is : YES... I was interested in GS as well, but after I heard about the lifestyle and the dynamics in the OR, I said: HELL NO.
 
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Winged Scapula

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The answer to your question is : YES... I was interested in GS as well, but after I heard about the lifestyle and the dynamics in the OR, I said: HELL NO.
Why not wait and see for yourself rather than filter your impression through someone else's experience (and that includes what SDN users say about it)?
 

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Do surgery if the or makes you feel alive. My gen surg rotation was call q3, getting there at 430 am, 24 hour call turning into 30+ hour call (as a med student - residents has 36-48 call), and studying for three exams with no sleep. I was ten times happier on that rotation than i was on family, which was 9-5. Neuro was also miserable. So was internal, actually. As was peds. Psych sucked too.

Do surgery if this is your experience.
 
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For me lifestyle is in the top 3 things I will be using to determine what specialty I want to choose so to your question: absolutely.
 

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Do surgery if the or makes you feel alive. My gen surg rotation was call q3, getting there at 430 am, 24 hour call turning into 30+ hour call (as a med student - residents has 36-48 call), and studying for three exams with no sleep. I was ten times happier on that rotation than i was on family, which was 9-5. Neuro was also miserable. So was internal, actually. As was peds. Psych sucked too.

Do surgery if this is your experience.
Really? I find that hard to believe.

I trained in the "old days" and we were never on call for 48 hours straight. The longest "call" I ever did was 42 hrs . I've done q2 call and I once stayed in the hospital for 3 days straight as Chief on Vascular because we were so busy, but someone else more junior was technically on call for 2 of those days. I find it hard to believe that you are claiming a modern US surgical residency program has residents doing 36-48 hours on call, even as an exception.
 
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Winged Scapula

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I'm just tainted by our extremely busy, IBD heavy colorectal service.

30 inpatients, emergent consults for refractory UC needing a TAC, and take backs for leak do not make for a "lifestyle friendly" service
Yes, I had the same experience in residency as well, especially with attendings that felt that all IBD patients needed to be on the surgical service rather than GI. It wasn't until I was out of training and have a few friends doing CRS that I saw that you could tailor it to a more lifestyle friendly practice.
 

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I've heard this too and believe it. But I'm scarred.

That and I have no interest in scopes or benign anorectal procedures
I always liked scopes but share your disinterest in benign AR conditions/procedures.
 
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DermViser

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It was for me. I was dreading surgery, but I actually ended up really, really enjoying it. Surgery appealed to the technically driven part of my personality in a way that many other specialties don't. But, at the end of the day, I just couldn't see myself going through hell for 5+ years to get through the training. That doesn't even take into account the life in practice, which might make reasonable hours more possible but seems to by no means be guaranteed.

You have to be honest with yourself about what's most important to you when choosing a specialty. Even though I found surgery awesome and could certainly see myself being a surgeon, the lifestyle was a non-starter for me. That's just how things go. People get into trouble when they try and ignore things that are important to them (e.g., lifestyle, interest in the field, etc. etc.) in pursuit of other things when choosing a field.

Just my two cents.
Thank you. I felt the same way about my General Surgery rotation as well. 8 weeks of something is COMPLETELY DIFFERENT than 5 years of something esp. with a LOT more responsibility in terms of getting things done, preparing for cases, reading in Sabiston's, taking the ITE, etc.

The best thing an M4 can do is be completely honest about what they want from their career, where they see themselves 10 years from now, etc. I think part of the reason why general surgery has such high attrition is that people hyperfocus so much on the specialty without taking into account "lifestyle" (there's a better word but can't come up with it right now). They're very unrealistic and purposefully ignore other factors in their assessment. Every specialty will become "mundane" at some point in your lifespan. Choose a field in which you love the positives and are willing to tolerate the negatives.
 
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DermViser

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This really isn't directed at you specifically, but it's relevant to the thread and relevant to your specialty:

When I was in medical school on my 3rd year surgery rotation, one of our afternoon educational lectures was entitled "Yes, you can have a life in general surgery."

The lecturer was a breast surgeon, and the gist of her entire presentation was "as long as you go into breast surgery specifically, and do all the right things to build the right kind of practice, you can have a life. Otherwise......ehhhhhhhh."
But she's not doing General Surgery, she's a subspecialist in General Surgery. She's more saying you can have a life in general surgery but these are all the caveats: go into breast surgery, go into private, practice, etc.

Quite disingenuous of her.
 

DermViser

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I think it's to be expected that sunk-cost theory applies. People are less likely to quit the closer they are to finishing. Even if a 5th year GS resident has no desire to do GS anymore, it is probably best to finish the residency and apply for another residency than to quit it. Longer residencies have higher attrition rates, but even looking at ANNUAL rates, GS stands out. Actually, Psychiatry REALLY stands out. I don't know if I really buy those rates, particularly without an explanation. 1/3 of Psychiatry residents don't complete the residency? That just seems exorbitant.
I wonder which year this is as well that the people in Psych leave. For example in the first year, Psych does a lot of Internal Medicine, so I could see why they might. I also wonder if it's the specific program as well. Some Psych programs just aren't that great - and you can see based on who they are able to recruit.
 

DermViser

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Oh, I agree. I was using that example to make the point that even administration had so little faith in General surgeons being able to convey the quality of life in a positive light to medical students that they had to deceive us by the old bait and switch.
What's sad is that your medical school (or may be Surgery dept.) administration felt the need so badly to pull a bait and switch, to get more of their students to apply for general surgery, when students can see it for themselves on their rotation.

I guess it comes back to why medical schools have to so blatantly lie and mislead their students in many areas, but that's a topic for another discussion.
 

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What's sad is that your medical school (or may be Surgery dept.) administration felt the need so badly to pull a bait and switch, to get more of their students to apply for general surgery, when students can see it for themselves on their rotation.

I guess it comes back to why medical schools have to so blatantly lie and mislead their students in many areas, but that's a topic for another discussion.
lol
my schools anesthesia department wonders why so few people from my school stay to train with them when a lot of the faculty just don't care about students
 

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lol
my schools anesthesia department wonders why so few people from my school stay to train with them when a lot of the faculty just don't care about students
LOL! Surprising it's Anesthesiology, for you guys. Ours was OB-Gyn, and they would actually call the M4 students applying for OB-Gyn after the match and ask them why they didn't choose their home program so they had to make up stuff about having a fiancee in the city of the other place, etc. Or they would say they're interested in a specific fellowship offered (And not something like Gyn Onc, like Maternal-Fetal Medicine). Except it's like consistent every single year where none of the residents are from the home school. lol.

I can understand as a faculty member when you've taken the time to write an excellent LOR for someone and they jilt you for someone else.
 

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But she's not doing General Surgery, she's a subspecialist in General Surgery. She's more saying you can have a life in general surgery but these are all the caveats: go into breast surgery, go into private, practice, etc.

Quite disingenuous of her.
My experiences with CRS in residency mirror that of @southernIM . That was a service with long, unpredictable hours and unpredictable takebacks. Every surgical field has some unpredictability, because patients have complications, other surgeons run "late" and delay your room, etc. but CRS really seemed to have more than their fair share.

I do general surgery. Honestly, the overall negativity of many here regarding GS makes me hesitant to post on these threads. I was miserable on most of my med school rotations, and found surgery was the rotation where being there from 5a-7p was less painful than doing 6 hour days in other fields. I did not think when I went into med school that I would end up a surgeon, and was relieved when I actually found something I liked. Residency was a marathon; if I didn't like surgery, I wouldn't have gotten through. In five years at my program, we lost 5 categorical residents total (about 12% attrition) if you include a couple people who went right from PGY 4 into plastics fellowship rather than completing chief year (they converted the plastics fellowship to an integrated program which caused the residents hoping to stay there for plastics to slide over). Life after residency is better, obviously, but it's not 9-5 with no weekends. It's rare for me to be up all night, but it happens from time to time. I have some weeks where I'm home by 5-6 everyday, and some weeks that are more unpredictable, depending on the patients' issues. Most days, I probably average getting home between 6 and 7, which includes finishing all my charts and seeing all new consults. Fridays I am rarely working later than 5 unless I'm busy on call or still operating. I usually round at 7:30 am or later, depending on how many patients I have to see and my OR schedule. It is very important to ask the right questions when applying for jobs so you know exactly what you are getting into. The more people who are in your call pool, the more predictable your life is, as is knowing exactly what types of cases you would be getting while on call, and how many (and whose) patients you are covering. (Not taking trauma or vascular call helps immensely). Most things that come in on-call do not require immediate surgery; appys, choles, etc. can wait a few hours and my partners will work scheduling these cases around family time/kid activities. SBOs usually resolve without surgery. Consults for new malignancies and other stuff found on inpatients after work up or incidentally are generally not emergent and can be worked into my OR schedule as appropriate. For admissions late at night, I can usually wait until morning to do an H&P or a consult for a routine problem, but will go in if there's something concerning that makes me want to lay eyes on the patient. At an academic center, there's usually someone in house all the time and residents are at the mercy of the attending as to timing of surgery. Life is different when you are not the resident/student who has to stick around longer just to cover a case, and when you can take call from home and just come in when needed. But it still means fielding nursing and patient phone calls after hours, and being within a certain proximity to the hospital, which can be painful despite not having to go in. My call is busier than ENT and urology, equally busy here volume-wise as the general orthos (although I am more likely to get something that "can't wait until morning"), and better than OB/Gyn (in-house call). I should add that most high volume, large hospitals in my area are converting over to the acute-care surgery model with a surgeon just on call for traumas and emergencies without an elective schedule or busy clinic to work around, which has allowed the other surgeons to have more predictable schedules. Surgeons are also getting paid to take ER call in certain areas, which is a trend that will probably continue to spread. In other words, GS is changing in response to "call fatigue"and shortages of surgeons willing to take call.

The VAST majority of GS's are in community practice, where there is little tolerance for malignant personalities since you will quickly see your referrals dry up (this is also true for other specialists). In residency, my attendings were quick to point out to the residents that in PP, being affable, respectful and approachable is the key to successful practice. Although I know it happens, I personally have never witnessed or known a general surgeon to throw something in the OR; ortho and a certain CT surgeon were known to do this where I trained. A surgeon (regardless of specialty) who did that where I currently work would very quickly find hospital staff and nurses suggesting other surgeons when asked for recommendations or when working with other physicians, which will greatly impede one's ability to build a practice, and that is only assuming the inevitable HR complaint resulted in no suspension of privileges.

Sorry for the long post, but I hope that helps answer the OPs question (and maybe other related thread questions).
 

BrooklynBulls

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My experiences with CRS in residency mirror that of @southernIM . That was a service with long, unpredictable hours and unpredictable takebacks. Every surgical field has some unpredictability, because patients have complications, other surgeons run "late" and delay your room, etc. but CRS really seemed to have more than their fair share.

I do general surgery. Honestly, the overall negativity of many here regarding GS makes me hesitant to post on these threads. I was miserable on most of my med school rotations, and found surgery was the rotation where being there from 5a-7p was less painful than doing 6 hour days in other fields. I did not think when I went into med school that I would end up a surgeon, and was relieved when I actually found something I liked. Residency was a marathon; if I didn't like surgery, I wouldn't have gotten through. In five years at my program, we lost 5 categorical residents total (about 12% attrition) if you include a couple people who went right from PGY 4 into plastics fellowship rather than completing chief year (they converted the plastics fellowship to an integrated program which caused the residents hoping to stay there for plastics to slide over). Life after residency is better, obviously, but it's not 9-5 with no weekends. It's rare for me to be up all night, but it happens from time to time. I have some weeks where I'm home by 5-6 everyday, and some weeks that are more unpredictable, depending on the patients' issues. Most days, I probably average getting home between 6 and 7, which includes finishing all my charts and seeing all new consults. Fridays I am rarely working later than 5 unless I'm busy on call or still operating. I usually round at 7:30 am or later, depending on how many patients I have to see and my OR schedule. It is very important to ask the right questions when applying for jobs so you know exactly what you are getting into. The more people who are in your call pool, the more predictable your life is, as is knowing exactly what types of cases you would be getting while on call, and how many (and whose) patients you are covering. (Not taking trauma or vascular call helps immensely). Most things that come in on-call do not require immediate surgery; appys, choles, etc. can wait a few hours and my partners will work scheduling these cases around family time/kid activities. SBOs usually resolve without surgery. Consults for new malignancies and other stuff found on inpatients after work up or incidentally are generally not emergent and can be worked into my OR schedule as appropriate. For admissions late at night, I can usually wait until morning to do an H&P or a consult for a routine problem, but will go in if there's something concerning that makes me want to lay eyes on the patient. At an academic center, there's usually someone in house all the time and residents are at the mercy of the attending as to timing of surgery. Life is different when you are not the resident/student who has to stick around longer just to cover a case, and when you can take call from home and just come in when needed. But it still means fielding nursing and patient phone calls after hours, and being within a certain proximity to the hospital, which can be painful despite not having to go in. My call is busier than ENT and urology, equally busy here volume-wise as the general orthos (although I am more likely to get something that "can't wait until morning"), and better than OB/Gyn (in-house call). I should add that most high volume, large hospitals in my area are converting over to the acute-care surgery model with a surgeon just on call for traumas and emergencies without an elective schedule or busy clinic to work around, which has allowed the other surgeons to have more predictable schedules. Surgeons are also getting paid to take ER call in certain areas, which is a trend that will probably continue to spread. In other words, GS is changing in response to "call fatigue"and shortages of surgeons willing to take call.

The VAST majority of GS's are in community practice, where there is little tolerance for malignant personalities since you will quickly see your referrals dry up (this is also true for other specialists). In residency, my attendings were quick to point out to the residents that in PP, being affable, respectful and approachable is the key to successful practice. Although I know it happens, I personally have never witnessed or known a general surgeon to throw something in the OR; ortho and a certain CT surgeon were known to do this where I trained. A surgeon (regardless of specialty) who did that where I currently work would very quickly find hospital staff and nurses suggesting other surgeons when asked for recommendations or when working with other physicians, which will greatly impede one's ability to build a practice, and that is only assuming the inevitable HR complaint resulted in no suspension of privileges.

Sorry for the long post, but I hope that helps answer the OPs question (and maybe other related thread questions).
Fascinating post. Can you detail how often you take call, how many weeks of vacation you have, and how many hours of work you average per week? It is difficult for me to get a good feel for those things from your post. 7:30-5 or 6 is a decent 50 hours a week, but if you're taking weekly call, often staying later than that, you go from a decent 50 hour lifestyle to (what is to me) a hellish 70+ hour lifestyle with calls at home, and a tether to the hospital. I suspect the truth lies somewhere in the middle, but I'd love a breakdown.

Edited by Dermviser's judging.
 
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DermViser

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Fascinating post. Can you detail how often you take call, how many weeks of vacation you have, and how many hours of work you average per week? It is difficult for me to get a good feel for those things from your post. 7:30-5 or 6 is a decent 50 hours a week, but if you're taking weekly call, often staying later than that, you go from a decent 50 hour lifestyle to (what is to me) a hellish 70+ hour lifestyle with calls at home, and a tether to the hospital. I suspect the truth lies somewhere in the middle, but I'd love a breakdown.
You might want to hit reply to her post in your post so she gets the alert to respond back, just FYI.
 

DermViser

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Smurfette

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Fascinating post. Can you detail how often you take call, how many weeks of vacation you have, and how many hours of work you average per week? It is difficult for me to get a good feel for those things from your post. 7:30-5 or 6 is a decent 50 hours a week, but if you're taking weekly call, often staying later than that, you go from a decent 50 hour lifestyle to (what is to me) a hellish 70+ hour lifestyle with calls at home, and a tether to the hospital. I suspect the truth lies somewhere in the middle, but I'd love a breakdown.
Call for me is usually one weekend a month (fri/sat/sun) and one weekday per week on average. I cover just one hospital, but I know many surgeons who cover several when on call. It also depends on vacation schedules (everyone here still does the same number of calls a month, but you may end up on call more during one week if someone is gone, and not on call at all another week to make up for it). Some places split weekend call differently. It is unusual for me to work a 70+ hour week unless it was a truly brutal weekend on call where I did a bunch of long cases and had a lot of patients, or literally was up all night (prob happens to me 2-3 times a year). Call can be unpredictable but as I said before, many things can wait a few hours or until morning and allow you to have time with family. I think I average 50-55 hours a week when it's not my weekend on call. This week is my weekend on call and I'm at ~60 hours (monday thru sunday). I also will say that the type of patients, acuity and cases I have play a bigger role in how "bad" a week is than the hours.

Vacation for physicians on production is unpaid---you don't work, you don't bill, you don't get paid. So I can take as much vacation as I want, but the more I'm off, the lower my income. Usually you start off with a guarantee with a given number of vacation weeks (4 is average for GS based on my offers, but everything is negotiable). This year I'm taking 4 weeks. My senior partner will take 6.
 
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ACSurgeon

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Until you've been a surgical resident for a few years, you have no idea how grueling a surgical residency is; the toll it takes on you and your family. You also don't know the satisfaction of going through the process. You won't realize how fast you can learn, how much you can tolerate until you've been through it. Surgical residency is a challenge, but it's not miserable. It is normal to be apprehensive about the training process and lifestyle afterwards as a student, as you can't truly know what you're getting into until you're knee deep. If you know yourself to be hardworking and truly enjoy general surgery, you'll enjoy being a surgeon and a trainee.