Is there light at the end of the tunnel?

[chigirl]

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I've already posted this in the general residency section but i think people reading this section are better qualified to answer my questions.

how does everyone (especially women) feel about your choice of surgery at the end of the day? i am having major conflict of interest and my application is due in 25 days for a general surgery categorical position. I am in love with surgery. Its fascinating, it motivates me to learn, i can work all day and not notice, i love the complexity, the instant gratification, working with my hands, walking into the OR with my hands dripping and gowning for a case, seeing a patient recover within hours from something that could have killed them in minutes...etc. However, during each of the three months that i've done surgery clerkships/electives my life has fallen apart. I find it impossible to do anything besides sleep when i get home, i don't talk to my loved ones as much, i'm cranky more often, i stop exercising, and i don't even care about going out to dance (which is my favorite thing to do).

on the other hand, the only other specialty that i find interesting is medicine (i know, its weird). its ok, the cases seem repetitive, its ALOT more passive, i don't feel like I'm accomplishing much with the patients...however, i've noticed i'm happier outside of work, i talk more with people i care about, i talk to my patients more and have more compassion, i have a life, and I wear makeup.

Obviously my priorities aren't wearing make-up and going dancing but they symbolize aspects of my life that are diminished while working in surgery. I don't want to wake up 50 years old, look back, and say I've worked really hard. Period. No kids, few friends, lots of wrinkles.

so my question is, is it always going to be a horrible lifestyle or is there light at the end of the tunnel? i don't want to take the easy route but i don't know if i should value lifestyle more. What navy surgeon says about cases getting old scares the hell out of me. Any advice you can offer would be great. Thanks so much.

 

[Paulista]

Surgery as training is harder physically and mentally during the first three years.
I always tend to say if you can reach PGY-3 year then you have gone on the top of hill. Then as PGY-4 and PGY-5, you feel as if you are walking down the hill again. As you go up, more people you have underneath your rank.
Then, you have more time to reflect on many cases you do. You think more carefully about your patient, more as an independent surgeon not a automated years of first three years of training.

In a way, the first three years become more like habitual. You learn by doing why and how and when. It sort of molds into your body.

Now, medicine is not such a opposite field. I used to feel sorry for Medical residents. But, I admire Medical residents patience with dealing all different medical problems of many presents.

Some surgeon put medicine down, but to be a good or even an excellent surgeon you have to know medicine.

let me givee you a clear example:
if an intenist just diagnose cholelithiasis then following strict rules, you don't have a surgical case. Now, an internist who understands the future implications of gallstones such as gallstone pancreatitis, hepatobiliary obstruction, even cholangitis, would ask this patient "do you have a vague abdominal pain almost like bloating like one hour after meal. Most patient would say yes. Then he would change the diagnosis to biliary colic, and this is a surgical case.

Now, the drawback of medicine is you would have to see the same patient over and over again for the rest of their lives. if you enjoy long relationships with patients with a better lifestyle then Medicine is not a bad choice.

Regardless of your decision, always consider lifestyle when you become 45 or 50 years old. I always ask my friends what is your reaction on 3am phone call for a Small Bowel Obstruction when you are like 50 years old.
When you are young..one or two hours less of sleep would not matter..it is considered exciting, but when you get up there in age things do change.

Some guys only love doing Surgery. Opening and closing...abdomen or chest...and they get great feeling of power..a power to help and heal...

The final choice is yours...I think if you are unsure..I would consider a transitional year...before jumping the gun..

 

[doc05]

it's still early in 4th year. you can always apply to both medicine and surgery, interview, and rank according to what you've decided by February. Keep in mind that medicine isn't a lifestyle specialty either.

best of luck.

 

[thenavysurgeon]

you can tailor your gen surg practice and do what you want, and avoid what you don't like...if you like big cases, but no trauma, do an onc fellowship. if you like little cases with a lot of patient contact, do breast surgery. if you like foregut surgery, do a lap fellowship...if you like making money, do a plastic fellowship. think of gen surg residency as your ticket into 'the club', and start planning on what type of life you want AFTER you get yourself into the club. if you switched to medicine, you would miss surgery FOREVER.

 

[RedBlanket]

I don't know. Perhaps I'm the only one troubled by the OP's comments about what happens when she gets home. I think a fair number of people going into g.surg have somewhat opposite reactions. I found that I had more energy, was more likely to go out with friends, was more pleasant with my loved ones, etc when I was on surgery rotations. I would be working 80-120 hours/week versus 40-50 on medicine/family med rotations, but I found my life outside of work MORE fulfilling. Rotations in which I was apathetic about the work led to apathy at home. Surgery was a no-brainer once I realized this... I'm loving residency so far, and admittedly there are limits to the above rule, once you work a certain amount under high stress the positives fade fast.

Think carefully. I'm aware my positive feelings will fade somewhat over time, but if you start off being unsatisfied with your home life in surgery, life could become very unpleasant. The best advice for people considering surgery I've heard is "do something else, unless you can't see yourself doing something else". Residents who love their work are great to work with and much more pleasant than the few who obviously regret their decision and make poor colleagues.

 

[dr.evil]

I'm now a 3rd year surgery resident and can absolutely relate to what you are saying. During medical school I really enjoyed my surgical rotations but they absolutely put a halt to everything on the outside. I slept more, worked out less (or not at all), and lived at the hospital, but I actually was definitely more tolerable to be around than when on medicine.

Well, I'm over 2 years into it and I have no regrets. Do I still work out less and sleep more than I should? Yep. This year, the 80 hour work week has really made life more tolerable but my hours are still long. I definitely have had times where I wonder if it's really worth it all. I mean, it's really "just a job" when it all comes down to it, right? Is it really worth the stress on my family, my sanity, my physical condition? These thoughts have definitely run through my brain (especially at 3am, eating twinkies & Mountain Dew, taking care of abdominal pain in the E.R.). So why stay with it? I really, REALLY, love the operating room. It's a drug for me. I need my fix a lot. I love the sounds, smells, feel, procedures, people, lights, gloves, gowns, instruments. Do cases get old? Some do (your 50th appy in a 6 month period) but general surgery has enough variety to keep you on your toes.

Most of the staff will tell you that there is a "light at the end of the tunnel". I believe them.

 

[Celiac Plexus]

I'm a pgy-2 general surgery resident, and I am happy with my career choice. I am in the first batch to know nothing but the 80 hour workweek so I don't know if things are any different now that before the 80 hour work week, but all of the residents above me swear that life is a lot better now.

I still worked some looooooong hours as an intern. However, at my program the schedule gets more and more flexible as you progress through the program... lots of home call, lots of autonomy, lots of decision-making authority... But still, a surgery residency is still demanding.

I think that residency for just about anything is going to be tough. A lot of us owe a lot of money, have families, kids, have to spend the night away from home a lot, have much less time than we are used to to spend with family and friends outside of work.... the list goes on. We all have second thoughts. I have had my share... When I have to miss a lot of family events, holidays... that sucks. When I lost the girl I was dating because I was unable to give her the kind of time that I wanted to give her, and she wanted me to give her... when you have to leave to go to the hospital while you are having a teary exhange with your girl... These times suck so badly... No lie. I have thought at those times... what the f*** have I signed up for?

But, you get over things. Navysurgeon made an excellent point about how professional development in many fields is difficult. I have a few friends who went off to law school when I went to med school. They are are all in their 3rd year out of school now and 1 of them left law completely, and the other 2 are working in NYC at big firms working at least as many, and a lot of times more hours than I do. They have the same kind of personal problems/regrets that I sometimes have... One of them told me the other day that he wished he had gone to med school with me. He said that if he was going to work this hard, he would have preferred to do "something cool and wothwhile". Not that I'm trying to convince anyone here that medicine is better, or more worthwhile than law... it's just that I'm trying to point out that a lot of jobs are hard, and surgery residents aren't the only ones who have second thoughts.

But I think that surgery is worth it for me. I love surgery... not just the OR, but the confidence I am developing knowing that I can handle just about anything. That I can go down to the ER at 2AM after getting a weak H&P over the phone, and work up just about anything. I can put a chest tube in in about 1 minute. I can place a central line in just about anyone. I can do an appy pretty much unassisted. I know how to take care of just about any kind of post-op patient (excluding unit patients... still learning those). I know how to make a decision. I feel comfortable making those decisions. I know that these are basic things, but these things get me jacked up and I love being the guy who can handle the situation. I love talking to patients. I love changing buttpus dressings... just kidding...lol!

Also, I love the camraderie of surgery. Whenever any surgery resident calls me to help out with a personal matter, I never hesistate to say yes. If I have to spend my off day picking up one of my fellow resident's car from the shop, it's no problem. If I am asked to give one of my resident brothers/sisters a ride to the airport when I am post-call, no sweat. It's automatic. And they help me out as well, without any complaints. We have all become pretty close and I love that. I know all of the families of the residents at my program. I know all the kids, most of the parents/siblings, and friends of my resident cadre. We are a pretty tight knit group to the point that I can't think of a time in my life when I have been closer with such a big group of people outside of my immediate family.

Bottom line: I love the job. I don't always love the lifestyle. Do I regret my choice for a surgical residency.... occasionally. But I know that I am going to be a great doctor, and I am making lifelong friends in residency.

Oh, and for the $$$ questions... I do think about the financial aspects of surgery...I get job offers in the mail all the time... the most recent one was for a starting take home pay of 390K (with paid malpractice). The offers all have fallen in the range of 250K - 400K for grads str8 out of residency. One of the chiefs who graduated this year started a job in a smaller town at ~300K and partnership with no buy-in 2 years... partners make around 440-540K/year.

 

[ucsfer]

So it seems like to get fellowships doing research in those 'extra' years programs offer is pretty important .. fellowship then is another 1-3 years.

speaking of the light at the end of the tunnel, do some of you who've done it feel like it was just too long a road before the end? When I think of 'actually' starting a career after that many years vs. other things that would be shorter i.e. quicker to the time I can decide what kind of life I want to lead, starting to move up the academic/partnership ladder, etc, it feels a bit odd.

 

[GMO2003]

Oh, and for the $$$ questions... I do think about the financial aspects of surgery...I get job offers in the mail all the time... the most recent one was for a starting take home pay of 390K (with paid malpractice). The offers all have fallen in the range of 250K - 400K for grads str8 out of residency. One of the chiefs who graduated this year started a job in a smaller town at ~300K and partnership with no buy-in 2 years... partners make around 440-540K/year.

As a PGY-2, why would you receive job offers in the mail? Did you subscribe to a medical head hunting firm?

 

[Celiac Plexus]

As a PGY-2, why would you receive job offers in the mail? Did you subscribe to a medical head hunting firm?

Actually no, I did not subscribe to a head hunting firm. I really don't know why I get job offers in the mail. I do subscribe to a surgery journal at the resident rate, so maybe my name has been sold off to some lists. I really don't know.

I don't think I'm ready to take any of the jobs yet though... 😉

 

[mountaindew2006]

Ok..I had to ask this...

It seems like some of the surgeons I come into contact with always say that they feel more in 'authority' and that heck i have that to look forward too. Is that still true? Do you guys still feel like people are looking up to you in times of perplexity? Personally, I think surgeons are the $hit. But..as I wrote in my own post, i do want to have a good family life. I'm just concerned about whether surgery is amenable to this. The wifey (going into medicine) tells me constantly how she doesnt want a 'telephone' dad for our future kids.....

lol..i joke and tell her i'm going to make a sterile lil kids waiting room that has a one way glass window to the OR that I'm in. I suppose when my kids grow up they'll think that those people that are not wearing blue are not nl 🙄

So what do you all think?

 

[fourthyear]

I had a hard time making up my mind when I was applying to residencies 2 years ago. But I'm definitely sure I made the right decision to do surgery. I'm a female PGY2 right now.

I had the same feelings as many above about the OR and I still do. Yes, it sucks to miss out on fun stuff with friends and family b/c you're on call - but if you're going to miss Thanksgiving dinner to be on call (which you may have to do in nearly ANY residency specialty), wouldn't you rather be doing some emergent operation on someone than just taking a lengthy H and P and writing up some orders to manage someone's CHF? For me the answer is Hell, yeah!

So I know that over the course of my 5 years I will have more call and generally longer hours than my counterparts who will spend 5 years in Medicine and then some specialty fellowship. But for me the 5 years is still going to go by a whole lot faster than it would if I had to endure medicine rounds every day. I'd much rather spend 80 hours a week at the hospital with over 50% of my work being pretty enjoyable vs. 60 hours and 10% being fun. It all depends on what is "fun" for you. No job in this world is all excitement all the time. Everything has its mundane and frustrating aspects, and surgery is no exception. But if you feel that seeing all the BS ER consults is worth it to get a few really good cases where you can really fix someone by doing surgery on them...well, that's to me a lot more satisfaction that admitting all the stuff that medicine does. Again, you have to answer that for yourself.

As far as lifestyle, I'm glad you realize that 80 hours is still a tough life. Better than before, but not exatly normal. And you will be busy running around, standing for prolonged periods, never feeling caught-up on your work for more of a proportion of your days than most other specialities. The above comment about twinkies and mountain dew at 3am is no joke - happens quite often, except if you plan ahead and bring food (which I learned to do 1/2 way thru intern year), it would be a granola bar and a bottle of juice at 3am. Overall, I handled the hours much better by the end of intern year than the begginning - making more time to exercise at least a few days a week (at least on the post-call days or days off), planning a weekend trip on a weekend off and using the plane ride to sleep so I could enjoy the trip when I got there. You won't have a normal lifestyle, but after some adjustment period, the 80 hour rules make it liveable for me at least.

 

[fourthyear]

Now, for the point that mountaindew asks about his wife being concerned with not having him around to help with the kids much - you have to have a supportive spouse/sig. other who is okay with your hours and lifestyle and a support system to help with the kids. If she truly is going to feel upset by you having to miss out on family things b/c of work...well, this might be something you should be considerate about and really assess her limits in what she is willing to accept.

I do think you can control your lifestyle by taking on less work after residency, not being the classic workaholic surgeon...but emergencies can and always will come up. When your patient is sick post-op, a surgeon doesn't usually feel right to just leave and have the next shift take care of it - there is some level of personal responsibility for finishing what you started. If your family life will fall apart in situations like this...be honest with yourself that this may not work as a career for you.

Celiac made the point also that he lost a girl b/c he couldn't give her enough attention - this happens. When you are chosing a residency program, keep all this in mind too - pick an area or a program where your sig. other will likely be happy b/c you will not be around all the time to entertain them. Make sure they will have good job options/family/friends/some sort of good community support so they are not just home alone and bored all the time while you are away at work. It can be lonely to be the spouse of any resident and those looking into surgery need to be especially aware of this. Its the ones who don't realize the impact their carreer choice would make that are the ones who end up divorced.

 

[chigirl]

Thank you all for your advice...this is all very helpful.

More questions...Is it possible to avoid the workaholic surgeon lifestyle after residency? I have zero contact with any female surgeons much less those in the community so I have no idea what my options are. Is it possible to join a group practice and work part-time after a pregnancy or join a group where call is spread out? What do people do after residency if they want to have more of a balanced life?

 

[Pilot Doc]

I have zero contact with any female surgeons much less those in the community so I have no idea what my options are.

You've identified a major problem in medical training. Academic hospitals represent a small and very narrow slice of American medical practice in general. Finding information about other practice opportunities is difficult. If you do any community IM/FP rotations, try to meet the local surgeons. If you can go to any national surgery meetings (eg ACS, which has a great med student program), introduce yourself to random community attendings. Most are quite willing to tell you about what they and their colleagues do.

To answer your question, lifestyle after residency is your choice. There are a number of bread and butter community practices where the attendings work 4 days a week with call 1 weekday/week and 1 weekend/month. Once you finish residency - your life is your own and if you work 80 hours a week it is your choice. Don't want to take call? Only do outpatient cases at a day surgery center. Part time / extended maternity leaves are harder to come by. Essentially, the bills and patients don't stop coming because you're not working and most partners/departments are not keen to shoulder that load. Nevertheless, there are solutions. You could do locum tenens work or take trauma/ER call. I know of one female surgeon who only 1st assists and has no primary patients.

The key thing to remember is that you get to pick two from the following list (or a double serving of one): location, money and lifestyle. e.g. Want to make $$ in Boston - you'll be hustling; want $$ and time off, go somewhere (rural) where demand >> supply; Want to work 2 days a week, if you'll work anywhere for $80K a year, you can probably make it.

 

[ucsfer]

Speaking of the end of the tunnel - when I think about 7 years of residency (5 + 2 of research) and then another couple for fellowship, it at times seems like a really long time of training (and of not having any control over hours, lifestyle, etc). Did any of you who've been through it feel that way? Did that change as you went through the years?