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Just a General Surgeon

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damusiel

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Can you become just a general surgeon without any fellowships? Are there any jobs open to non-fellowship trained general surgeons? What are there bread and butter cases and how is their salary? Is the field of general surgery dying?
 
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Winged Scapula

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Can you become just a general surgeon without any fellowships? Are there any jobs open to non-fellowship trained general surgeons? What are there bread and butter cases and how is their salary? Is the field of general surgery dying?
Not sure why a pre-dent would need to know, but the trade magazines and specialty websites are full of jobs for "just general surgeons" especially if you'll take trauma call.

Bread and butter: hernia, app, gallbladders, breast, colons, thyroids etc. Very few still doing vascular.

Salary will vary but $400K is probably about right.

There is a high demand for "just general surgeons", so no its not dying.
 
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VincentAdultman

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    Pretty sure my hospital just hired a couple of "just" general surgeons. They're pretty busy. Seem happy. That being said my hospital is in a pretty rural county.
     
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    TypeADissection

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    Yes. I could write more, but the answer is yes. Being just a general surgeon will make you quite sought after.
     
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    Smurfette

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    Given a large amount of the current GS workforce is currently over age 55, those who are willing to do more than just their subspecialty will have no problem finding a job, at least at the community level. Would be nice if that impending shortage will help increase salaries down the road too (I know, wishful thinking on my part...).

    Academics and huge cities with zillions of superspecialists are a different story.
     
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    AcademicNeurosurgery

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    Not sure why a pre-dent would need to know, but the trade magazines and specialty websites are full of jobs for "just general surgeons" especially if you'll take trauma call.

    Bread and butter: hernia, app, gallbladders, breast, colons, thyroids etc. Very few still doing vascular.

    Salary will vary but $400K is probably about right.

    There is a high demand for "just general surgeons", so no its not dying.

    $400k starting or after a few years? Maybe I'm out of touch but seems low.
     
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    Winged Scapula

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    $400k starting or after a few years? Maybe I'm out of touch but seems low.
    You may be out of touch with what employed general surgeons make.

    Certainly you can make more than that in private practice and there are variations around the country but locally our employee general surgeons were making around 365 to 400.

    MGMA 2014 ( latest year documentation we had laying around here at the office ) 75th percentile for general surgery was 367,000
     
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    AcademicNeurosurgery

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    You may be out of touch with what employed general surgeons make.

    Certainly you can make more than that in private practice and there are variations around the country but locally our employee general surgeons were making around 365 to 400.

    MGMA 2014 ( latest year documentation we had laying around here at the office ) 75th percentile for general surgery was 367,000

    Yeah, I looked into the MGMA data and saw the ~$370K. Pretty crazy considering the hours. A good friend of mine started as an ER attending at $400K right out of residency. He works a lot of shifts but probably nowhere near as much as an attending surgeon. I figured gen surg salaries would clear $500K.

    And yes, as you mentioned, these salaried numbers are for employees. The numbers outside of salaried employees vary so much....I know two general surgeons who are late in their careers and are polar opposites, one is in private practice and involved with hospital admin and he pulled in $1.2 million (so I was told). Another is similar age, makes $250K as salaried medical school faculty.
     
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    Winged Scapula

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    Yeah, I looked into the MGMA data and saw the ~$370K. Pretty crazy considering the hours. A good friend of mine started as an ER attending at $400K right out of residency. He works a lot of shifts but probably nowhere near as much as an attending surgeon. I figured gen surg salaries would clear $500K.

    There are plenty of specialties which make more money and work fewer hours; EM often brags about that and you will see quotes of 120-150 hours per month which is about half of what most general surgeons work.

    But the sooner you disabuse yourself of the fantasy that hours worked = more money, you will be better off.

    And yes, as you mentioned, these salaried numbers are for employees. The numbers outside of salaried employees vary so much....I know two general surgeons who are late in their careers and are polar opposites, one is in private practice and involved with hospital admin and he pulled in $1.2 million (so I was told). Another is similar age, makes $250K as salaried medical school faculty.

    Yep, I believe the medical school faculty salary. When I left residency, they were paying $150-$160K for new grads which was laughable but was industry standard 10 years ago.

    There are many avenues for income in private practice and wide variation; I see it in my own group. Some of us make more than others despite similar patient volumes. Our biller told me today that I am the only one who bills for extended time consultations (and document appropriately); the end result is that I will make more for the same amount of time spent with a patient than my partners because I billed correctly. Ownership of ASCs, speaking grants, higher reimbursing procedures/patients, administrative positions, etc. are all income generators. But you have to question significantly high or low quotes because of what those numbers include and don't include.
     
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    AcademicNeurosurgery

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    So if anyone is curious, MGMA for 2016 has general surgery median nationwide at 409k, mean at 455k, 75th percentile 529k, 90th at 701k.

    Academic median is 280k.

    Interesting. Medscape has the average general surgeon at $352K. No idea which one is more accurate.
     
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    Mad Jack

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    Interesting. Medscape has the average general surgeon at $352K. No idea which one is more accurate.
    They are both likely correct. MGMA is total compensation, while Medscape is salary only. Total compensation is salary+benefits (insurance, CME, retirement account payments, malpractice, life insurance, disability insurance, tuition and student loan reimbursement/repayment). MGMA is not what you will be paid, it is what you will be paid plus all of your perks. Medscape is just what you see on your paycheck.
     
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    Winged Scapula

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    They are both likely correct. MGMA is total compensation, while Medscape is salary only. Total compensation is salary+benefits (insurance, CME, retirement account payments, malpractice, life insurance, disability insurance, tuition and student loan reimbursement/repayment). MGMA is not what you will be paid, it is what you will be paid plus all of your perks. Medscape is just what you see on your paycheck.
    And THIS is the problem with all salary surveys - you gotta know what they include.
     
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    AcademicNeurosurgery

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    Too many of my generation jump to the "Salary and Results" section before reading the "Methodology." Being a nerd can literally pay with things like this.

    You're really going to pump the "millenials suck at everything" rhetoric over this? These are largely flawed compensation surveys, not Nature publications.

    Forgive me for Googling out of curiosity while on-the-go and overlooking the difference you so graciously identified, would you?
     
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    Mad Jack

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    You're really going to pump the "millenials suck at everything" rhetoric over this? These are largely flawed compensation surveys, not Nature publications.

    Forgive me for Googling out of curiosity while on-the-go and overlooking the difference you so graciously identified, would you?
    Oh, it wasn't a dig at you, it was a general statement about the topic. It's basically something I have to explain with a great deal of regularity, mostly to younger people that have never analyzed a compensation package before and just think of salary, thus 95% of the time it is millennials. Most of them are simply used to acquiring data quickly, and try to jump to the meat of a given study without bothering to analyze what, exactly, the type of creature they are eating is beforehand.
     
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    AcademicNeurosurgery

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    Oh, it wasn't a dig at you, it was a general statement about the topic. It's basically something I have to explain with a great deal of regularity, mostly to younger people that have never analyzed a compensation package before and just think of salary, thus 95% of the time it is millennials. Most of them are simply used to acquiring data quickly, and try to jump to the meat of a given study without bothering to analyze what, exactly, the type of creature they are eating is beforehand.

    Fair enough. I would hope by the time people are looking at compensation packages, they are mature enough to analyze them carefully. Maybe wishful thinking. That said, the happy docs I talk to are usually more concerned with call schedule, admin responsibilities, etc. than take-home pay.

    And sorry-not-sorry for getting slightly off-topic but "just general surgeons" and "is general surgery dying" lol...general surgeons are some of the most well-rounded physicians in the hospital as they actually take care of their patients pre and post-op. And while there may be a push for fellowship-trained surgeons in certain fields, general surgeons will always be needed.
     
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    DrYoda

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    with compensation surveys you should be careful. I haven;t looked in awhile but for my specialty (which is not gen surg) most of them are totally off.
     
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    Osteoth

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    So is there a way to reasonably estimate what a general surgeon in private practice would command coming out of residency?
     
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    Winged Scapula

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    So is there a way to reasonably estimate what a general surgeon in private practice would command coming out of residency?
    1) generally less in California and other popular areas

    2) if you are a current medical student it will be very difficult to tell you what the market will be like in 5+ years

    3) what you can command will depend on your skills, how desperate the employer is and the market
     
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    Mad Jack

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    So is there a way to reasonably estimate what a general surgeon in private practice would command coming out of residency?
    If you want an estimate for right now, I believe Merritt Hawkins breaks it down by years in practice in their detailed analysis, but that costs money.
     
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    ACSurgeon

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    So is there a way to reasonably estimate what a general surgeon in private practice would command coming out of residency?

    My large Midwest city experience: expect close to 400k in pp and a lot less in academics. The trend has been a slow rise over the last 3-5 years.
     
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    Osteoth

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    1) generally less in California and other popular areas

    2) if you are a current medical student it will be very difficult to tell you what the market will be like in 5+ years

    3) what you can command will depend on your skills, how desperate the employer is and the market

    So my understanding of the medicine job market rn is that everyone is under fire, so most sub-specialties, especially in surgery are heavily restricting the number of new trainees they put out to artificially elevate the market in terms of salary/demand.

    Is this a trend that can be appreciated in general surgery as well, or do the increased overall number of trainees and other factors lead to decreased control?

    What do you guys think is going to be the hallmark of the general surgery job market going forward?
     
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    Winged Scapula

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    So my understanding of the medicine job market rn is that everyone is under fire, so most sub-specialties, especially in surgery are heavily restricting the number of new trainees they put out to artificially elevate the market in terms of salary/demand.

    Is this a trend that can be appreciated in general surgery as well, or do the increased overall number of trainees and other factors lead to decreased control?

    What do you guys think is going to be the hallmark of the general surgery job market going forward?
    i'm not sure sure where you heard this and I don't have much time to discuss it this morning. Perhaps others would like to give some input.

    There is no artificial restricting of positions that happens at the specialty level. If anything the number of positions has increased. One reason for not having unlimited number of surgical positions is that you have to have enough patients and cases to be trained. In the United States, the process to add on another resident is extremely complicated and has nothing to do with these so-called artificial restrictions but rather whether there are educational resources available to support additional trainees.

    There is no evidence that we have a shortage of general surgery or subspecialty trainees. What we may have is a distribution problem and issue with people not wanting to go into general surgery but rather picking subspecialty fellowships. I've never heard someone say this is because of salary so employers need to do a better job of trying to attract people to a general surgery only practice. for many it's more about lifestyle such as more reasonable call schedules and workload and how much money they make.
     
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    Osteoth

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    i'm not sure sure where you heard this and I don't have much time to discuss it this morning. Perhaps others would like to give some input.

    There is no artificial restricting of positions that happens at the specialty level. If anything the number of positions has increased. One reason for not having unlimited number of surgical positions is that you have to have enough patients and cases to be trained. In the United States, the process to add on another resident is extremely complicated and has nothing to do with these so-called artificial restrictions but rather whether there are educational resources available to support additional trainees.

    There is no evidence that we have a shortage of general surgery or subspecialty trainees. What we may have is a distribution problem and issue with people not wanting to go into general surgery but rather picking subspecialty fellowships. I've never heard someone say this is because of salary so employers need to do a better job of trying to attract people to a general surgery only practice. for many it's more about lifestyle such as more reasonable call schedules and workload and how much money they make.

    Guess thats what happens when you get a good chunk of your medical knowledge from SDN :rolleyes:

    And so based on this Becker's Review of Most Recruited Specialties 3 surgical specialties round out the top 20, albiet toward the late-teens: General Surgery, Ortho & ENT. In addition to this, some large hospitals groups, including HCA & CHS offer stipends, some up to $2k/month during residency for trainees willing to commit to their national health systems long-term in the fields of urology, among others. I can't imagine they would do such a thing if it was easy to find surgeons, and these programs apparently do not limit the geographic distribution their surgeons can choose.

    Given that need, how does it make sense that there are not enough surgeries to go around for all the subspecialties? Especially general surgery? Furthermore, if programs are willing to pay $2k/month($24k/year), why wouldn't they just lump the full amount and pay for an extra residency spot themselves?
     
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    Winged Scapula

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    I can't speak for CHS but HCA is a fairly unpopular employer. We have a thread going on right now in the Practicing Physicians forum where HCA jobs are being discussed:

    "sucks balls and bites them!"

    "high pay for high risk"

    "I may or may not work for them. You have been warned to stay away"

    "everything is metricized; you'll be told how to practice"

    Soooo....perhaps there is a good reason HCA is advertising for jobs. Nonetheless, as @SouthernSurgeon notes, you can't just start up a residency program, at least not an accredited one. This is not a case of "just make more Lays".
     
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    balaguru

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    For the OP, post #3 nailed it.

    I don't know of any jobs that pay a straight salary but if such a job exists I'm sure you would be expected to give up a disturbing amount of autonomy and/or somebody is making a lot of money off your back. If the salary is suspiciously high you may be involved in some self referral scheme or other shady practice. I wrote a post a while ago that pretty much sums up my thoughts on physician income that I think still holds true. Surgeon professional fee for various procedures
     

    Osteoth

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    HCA and CHS wanting more employed surgeons doesn't equal a shortage of surgeons.

    And you can't just say, oh we got some moneys, let's add a residency slot.

    A residency program needs (a) infrastructure, (b) accreditation, (c) volume, and (d) funding. You need all of those to exist in the same environment. Many (most?) HCA hospitals aren't affiliated with training programs. Starting one is a huge effort both in manpower and cost

    Ok, so if you concede that C&D are taken care of due to the aforementioned points, then that leaves infrastructure, because I assume once those are all fulfilled it would be enough for accreditation.

    What constitutes residency program infrastructure? How hard would it be for hospitals to form their own? What would you say would be the single most difficult problem hospitals would have in forming their own residencies?

    I can't speak for CHS but HCA is a fairly unpopular employer. We have a thread going on right now in the Practicing Physicians forum where HCA jobs are being discussed:

    "sucks balls and bites them!"

    "high pay for high risk"

    "I may or may not work for them. You have been warned to stay away"

    "everything is metricized; you'll be told how to practice"

    Soooo....perhaps there is a good reason HCA is advertising for jobs. Nonetheless, as @SouthernSurgeon notes, you can't just start up a residency program, at least not an accredited one. This is not a case of "just make more Lays".

    Yeah, kind of detailed my point above but my subsequent question would be why not? What makes it so difficult for hospitals to start their own residency programs if they have both the volume & money to accomodate trainees?
     

    Osteoth

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    I don't think it's a given that (C) and (D) are taken care of.

    For (C) you are just assuming the volume is there, and I'm not sure why.

    I don't pretend to know the complexities of training an orthopedist, but just having a private hospital that does some elective scopes and joints doesn't fit the bill. You need case volumes across the spectrum of practice (trauma, peds, etc, like I said I don't know what ortho pods need for training). To start a residency program you need to carefully demonstrate adequate volume across the spectrum for the ACGME to approve a program.

    For (D) starting a residency involves a lot of start up cost that a hospital may just not want to undertake.

    More importantly perhaps is the issue of whether these hospitals want a residency or not. You need an administration that wants to start a program and a body of teaching faculty that want to run it. That's just not always the case in private practice.

    Well I'd assume if you're a big national hospital chain you'd easily be able to accommodate a concentration of cases through corporate restructuring, but I could be wrong.

    So the more you explain the more it seems as though it would require a serious diversification of facilities which may not necessarily lead to the most cost-effective implementation model, which would make a lot more sense in terms of explaining why private groups aren't really interested in taking on that economic burden. Much easier to just throw money at grads instead of disrupting your entire business model to train them.
     

    vitamorior

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    So quick question based on all the finance talk, I've never really seen it as a goal to achieve a certain salary with my job, and thought the medical field frowned upon financial greed, especially when 99.99% of docs break six figs some 7.
    So question is, is it really that prevalent in the field of medicine to go for the big checks rather than what you like in a job?
     

    vhawk

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    Are you asking if human beings like money, or are you asking if doctors are human beings? The answers are "yes" and "many of them", respectively.
     
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    balaguru

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    So quick question based on all the finance talk, I've never really seen it as a goal to achieve a certain salary with my job, and thought the medical field frowned upon financial greed, especially when 99.99% of docs break six figs some 7.
    So question is, is it really that prevalent in the field of medicine to go for the big checks rather than what you like in a job?

    You are absolutely right. It is impossible to make good money doing something you enjoy. Thank you for pointing out our folly.
     
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    vitamorior

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    You are absolutely right. It is impossible to make good money doing something you enjoy. Thank you for pointing out our folly.

    The satire seems unnecessary but none the less, I was trying to emphasize two previous points that were stated:
    1. Private practice vs public - do people go private purely because of the finances? Other benefits you can list please do.
    2. The post that this thread is aimed towards asks about GS salary, as in that is a main contributing factor to which specialty they choose - So do most people choose specialty based on pay or on specialty?

    Hope that clears everything up,
     

    vhawk

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    Obviously the benefits or comparison of private vs academic vary by the person and the specific situation, but I will try to explain what the tradeoffs are from my perspective and how I made my decision.

    Private:
    Pros- pay is generally higher, probably in the range of 20% higher, with a higher ceiling depending on how busy you are. Less oversight and management from above, more autonomy. No responsibility to teach medical students or residents. No mandatory committee meetings or yearly evaluations.
    Cons- Most are guaranteed salary only for 1-2 years, then its eat what you kill. So constant pressure to be busy and productive and no guarantee that your salary remains high. Depending on the practice, you may be responsible for day to day operations, overhead, hiring and firing, marketing yourself, building relationships. May need to cover multiple hospitals. Call responsibility is usually more frequent and onerous. May not have the OPPORTUNITY to teach medical students, if this is of interest to you, but more importantly, may not have resident coverage for overnight floor calls, ED consults, etc.

    Academic:
    Basically the reverse of above.

    I am an academic surgeon, because I valued the ability to teach students and residents and the stability and "guarantee" of the academic environment, as well as the infrastructure for research and innovation, more than the 20% salary bump. Other factors that went into my decision are things like the relative ease of going from academic to private compared to the going from private to academic, i.e. if I decided after 5 years that I hated academic, it is easier to transition to a private job, compared to the reverse. This may be incorrect thinking on my part as I dont have first-hand knowledge of the ease of either transition but it seemed likely to me at the time.
     
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    balaguru

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    The satire seems unnecessary but none the less, I was trying to emphasize two previous points that were stated:
    1. Private practice vs public - do people go private purely because of the finances? Other benefits you can list please do.
    2. The post that this thread is aimed towards asks about GS salary, as in that is a main contributing factor to which specialty they choose - So do most people choose specialty based on pay or on specialty?

    Hope that clears everything up,

    What was unnecessary was the suggestion that the posts above rise to the level of "financial greed". People considering medicine need to disabuse themselves of the notion that honest discussions about money are somehow taboo.
     
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    Winged Scapula

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    The satire seems unnecessary but none the less, I was trying to emphasize two previous points that were stated:
    1. Private practice vs public - do people go private purely because of the finances? Other benefits you can list please do.
    2. The post that this thread is aimed towards asks about GS salary, as in that is a main contributing factor to which specialty they choose - So do most people choose specialty based on pay or on specialty?

    Hope that clears everything up,

    I can't think of anybody that I went to medical school with who, at least openly, chose their specialty because of the income potential.

    I think my experience is fairly common in that I went to medical school with the goal of doing family or internal medicine, found myself thoroughly enjoying surgery and utterly hating the first two. I had certainly heard that Specialists made more money but don't recall ever hearing actual figures nor had I ever even met a surgeon prior to medical school. no one in my family is in the medical field so I had no idea what kind of income was normal or possible and it would've been considered gauche in my family to ask such things. I was aware that physicians made good money but the idea of making seven figures would have never occurred to me in the least.

    So while there certainly may be some who choose their specialty based on pay ( A phenomenon you'll find in every profession ), i'd venture that most people are bright enough to realize that picking something you enjoy doing is more important.
     
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    SLUser11

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    Obviously the benefits or comparison of private vs academic vary by the person and the specific situation, but I will try to explain what the tradeoffs are from my perspective and how I made my decision.

    Private:
    Pros- pay is generally higher, probably in the range of 20% higher, with a higher ceiling depending on how busy you are. Less oversight and management from above, more autonomy. No responsibility to teach medical students or residents. No mandatory committee meetings or yearly evaluations.
    Cons- Most are guaranteed salary only for 1-2 years, then its eat what you kill. So constant pressure to be busy and productive and no guarantee that your salary remains high. Depending on the practice, you may be responsible for day to day operations, overhead, hiring and firing, marketing yourself, building relationships. May need to cover multiple hospitals. Call responsibility is usually more frequent and onerous. May not have the OPPORTUNITY to teach medical students, if this is of interest to you, but more importantly, may not have resident coverage for overnight floor calls, ED consults, etc.

    Academic:
    Basically the reverse of above.

    I am an academic surgeon, because I valued the ability to teach students and residents and the stability and "guarantee" of the academic environment, as well as the infrastructure for research and innovation, more than the 20% salary bump. Other factors that went into my decision are things like the relative ease of going from academic to private compared to the going from private to academic, i.e. if I decided after 5 years that I hated academic, it is easier to transition to a private job, compared to the reverse. This may be incorrect thinking on my part as I dont have first-hand knowledge of the ease of either transition but it seemed likely to me at the time.

    I think the academic world is changing quite a bit, and many places have higher ceilings on salary, but more similarities to the private practice model with a focus on clinical productivity. From what I've experienced, I would opine that the money is getting better in academics, but the headaches are getting bigger as well. Still, I love it.

    I do think you can be a clinician educator to students and/or residents in private practice. In fact, it may seem advantageous because the resident expectations are different, and they go away periodically and allow you to get your work done, etc, while still providing coverage. Many people I know are very happy "clinical professors" and have residents in many/most of their cases and clinics. I only bring this up so that people still in training don't choose academics simply because they "love to teach."
     
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    hurtem&healem

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    I do think you can be a clinician educator to students and/or residents in private practice. In fact, it may seem advantageous because the resident expectations are different, and they go away periodically and allow you to get your work done, etc, while still providing coverage. Many people I know are very happy "clinical professors" and have residents in many/most of their cases and clinics. I only bring this up so that people still in training don't choose academics simply because they "love to teach."
    Can you go a little more in depth on this? Would this just be a PP physician who works in an academic hospital, or some other arrangement?
     

    hurtem&healem

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    I can't speak for CHS but HCA is a fairly unpopular employer. We have a thread going on right now in the Practicing Physicians forum where HCA jobs are being discussed:
    As an HCA employee (allegedly, at some point in the past, present, or future), I really wish I had access to this thread.
     
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