Is Surgery a dying field???

[HEME-ONC]

I just got off the phone with a close friend of mine that is completing his surgery totation in NY. He is planning on going into surgery because he loves it but he was very discouraged because he felt that most of the older procedures are were being rapidly replaced by less invasive procedures and that these procedures were being done by the interventionalist of there respective fields (Radiology and Cardiology).

So the question is what procedures will the general surgeons that are around going to be left with? Can these general surgeons learn and start doing these less invasive procedures as well?

I ask these questions because I am seriously considering going into surgery. He also said that most of the surgeons that he worked with were very discouraged by the fact that at the end of the day these general surgeons are making peanuts for the amount of work they have put into there training.

Can anyone shed some light on this topic for me?
THanks

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[Fermata]

Maybe general surgery.....

As time goes on....medicine becomes more specialized....

Hence all the surgery specialties.

I don't know, though....I can't see general surgery disappearing.

 

[Paulista]

Even with many advances in less invasive procedures, the need for general surgical procedures will remain pretty much the same.

There are many instances in which highly sophisticated imaging tools can't diagnose intraperitoneal processes. So, Surgeon is called to make the decision.

In the past, we have seen cases such as appendicitis with normal wbc counts and equivocal findings on CT of Abdomen and pelvis. In cases with uncertain diagnosis, celiotomy is indicated. Then Gaboom, bingo large angry looking appendix waiting for Surgeon's touch.

In the past, there were many procedures perfomed to address perforation of ulcer and others. Today, due to the prevalent use of PPIs, there is less stomach surgery for ulcers. However, I do recall once in a while you bump into a case only the surgery is the solution after the failure of endoscopic approaches.

The beauty of Surgery is you don't see the same patient if you can provide definite treatment. Unlike, FP who sees the same patients over and over again.

 

[DocM]

to add my two cents... I hear, but cannot confirm by any means, that there will be a shortage of general surgeons in the near future. Mainly due to the decrease in applicants who applly to programs. Further , I "hear" that there is talk of a "fast track" program in g-surg to attract more applicants. Can anyone shed light on this ?

 

[dry dre]

So the question is what procedures will the general surgeons that are around going to be left with?

Surgeons in many hospitals are still general surgeons. Believe it or not, there are a lot of people in America that will accept a worse outcome risk so long as they can stay close to home/family (eg stay at home hospital for colon CA treatment vs travel away to a larger center with specialist). If you are a surgeon in a rural town or otherwise are in an area where there aren't 40 subspecialists to take work away, then you'll still be busy. If you are a generalist and hang up a shingle amongst 50 subspecialists, plan on having a simple practice. This goes for every speciality in medicine, not just surgery.

I think that much of the pessimism about the future of general surgery on these boards comes from echo-chamber analysis where many people tossing in data have only worked/trained around centers where there is often indeed a surplus of subspecialists.

Many "invasive" procedures (IR, cath lab, etc) require that an appropriately trained surgeon is on call in case the invasive procedure really needs to earn its title.

Bottom line, all types of surgeons will always be needed. 250k isn't peanuts. There are a lot of Americans working 50+ hours a week making less than 50k a year (ie many of your patients).

 

[skb21]

to add my two cents... I hear, but cannot confirm by any means, that there will be a shortage of general surgeons in the near future. Mainly due to the decrease in applicants who applly to programs. Further , I "hear" that there is talk of a "fast track" program in g-surg to attract more applicants. Can anyone shed light on this ?

UMC in Jackson, MS, has such a program, I believe. I know a girl who will be a M1 this fall at UMC. She is interested in general surgery and has entered some mentoring program that seems to be similar to the fast track program you mention.

 

[Paulista]

Medical Students should learn basic medicine and surgery.

I always hear about fast track programs, fast track CT and Fast track....that.

Even with Fast track programs, it takes many years to learn the art of surgery and more importantly decision making in surgery.

Sometimes, I think five years is very short time to learn all basic surgical science well.

 

[Whisker Barrel Cortex]

I wouldn't worry about it too much. General surgery is will always be needed and will always have plenty of business. Interventional procedures can only do so much.

IR and cardiologists can only perform percutaneous angioplasty on specific types of lesions. Plus vascular surgeons are doing endoluminal procedures in greater and greater numbers (much to my chagrin).

Interventional procedures such as abcess drains are often performed to tide the patient over until surgery. The definitive solution is still more often than not surgical. Percutaneous biliary procedures are often performed on patients who have little surgical option, so no competition there. Perc nephs may affect urologists, not general surgeons. They usually have enough business to deal with (especially if it is late at night and they don't want to come in).

So, in summary, general surgery is not a dying field by any means of the imagination. Now if you could just get medicare to give you the reimbursement you deserve!

 

[FliteSurgn]

Now if you could just get medicare to give you the reimbursement you deserve!

AMEN!

 

[daredevil_2010]

General Surgery will advance just like any other field.

Our chiefs are being offerred $225,000 as starting salary. They say they get a call at least 1 a week for a job position.

 

[Yasergale]

General Surgery will not die out.

I agree with the above post, Medicare and hopelfully Medicaid should increase reinbursements. If its true that GS are decreasing in number and more are going FFS, then general surgeons might get their way (when they start doing more walk outs). Unethical but as always, for >50% of us, money is a factor.

A fast track GS program: chances are very little >1%. I don't care what any PD says and if they say otherwise, don't be fooled. There are still alot of fossils in the GS field, >90% are pissed about the 80 hour work week. The reason is because you will not learn as much if you worked a 120 hr week. Some say most of this is scut work and you learn nothing. True for the last few months of internship years but not for pgy 2 and above. You see consults, some of which you may not know what to do. ALthough there is always back up, 40% of the time either everyone is gone (80 hour work week), in OR, on vacation, or seeing other emergencies. You learn alot when under pressure (blazing through Camerons, Uptodate, Greenfield, and if need be Zollingers). I have also heard that fast track will not work. Why? Money. Why would you want to oversaturate the GS market? If anything, I think there are future plans to merge if not dissolve surgical programs.

 

[oldman]

to add my two cents... I hear, but cannot confirm by any means, that there will be a shortage of general surgeons in the near future. Mainly due to the decrease in applicants who applly to programs. Further , I "hear" that there is talk of a "fast track" program in g-surg to attract more applicants. Can anyone shed light on this ?

the last few years for the match have reversed the trend of less applicants for the surgery programs. in part this may have been aided by the restriction of the 80 hour workweek which will make surgical rotations seem more manageable. unfortunately it does reduce the amount of time a resident spends with the patient during their course in the hospital. so it has also resulted in complaints that the surgeons aren't getting enough time to learn.

 

[thenavysurgeon]

I think 5 years is an optimal time to train. I finished the year before the 80 hour work week. Even though I finished in the 90th percentile for case numbers in my log at the end of my Chief year...the first case I did as an attending was still intimidating and a little scary.

You've chosen to become a surgeon. Fine. Take the time to train right. 5 years goes by so quickly, especially when you are sleep deprived...seriously. Put the time into your gen surg training. Relish it. Dive in and become as technically adept as you can. See as many patients as you can. It won't be long before you are sprung apon an unsuspecting public.

 

[Docgeorge]

The program at Jackson is not a fast track GS program. We (The Surgery Club) are trying to get something similar to that here at my school. What it is, is a mentorship that is focused at 1st and 2nd year medical students who have an interest in Surgery. They match the student up with an attending and the student gets in to the OR and Clinic once a week and a research project over the summer. All of this is purley volunteer work. You dont get a grade, you dont get paid. If you want to do GS you go through the match and do your 5 years like everyone else.