Like general surgery but don't think it's the life I want

[DOcter914]

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Long story short I like general surgery but I don't think I can go into it. I have observed in three hospitals that I've been with now that general surgeons get the pretty bad cases that are extremely messy and complicated (some of which they have no control over whether they get it or not too). They have no control over who they see and the hospital they work for demand they meet a quota of cases or else they fire or find another doctor to replace. I have observed this "quota" is met via overnight call or on the weekends very frequently b/c day cases "aren't present at the time". The gen surgeon also told me they (the surgeon) get a take home pay of $200 about for appendectomy...and then nothing no reimbursement for the follow-up care of the surgical patients (stated that non-OR days, follow up days, their visits aren't reimbursed or paid for). Additionally the residents for 5 years don't even see the OR most of the time (younger ones) and are there for cheap labor and internal med "house" 12 hr shifts and overnight shifts. The surgeon I worked with didn't operate as much as they couldve (4 operations every OR day, with 3 OR days a week) but they said semi-jokingly that the surgical tech (who worked their butt off, think about 70 hours per week with various surgeons) actually made MORE than the surgeon...
I have pretty good numbers and a good CV, Emergency med seems to win out as the cushy job but i could be wrong

 

[Spectreman]

Are you posting this looking for dissenting opinions? If EM sounds more appealing then go for that. I disagree with the majority of what you’re saying, but I’m not a surgeon. My brother is, and I worked med/Surge for many years just picking surgeons brains constantly. Ultimately though, go with your gut.

 

[IntheClouds4ever]

Long story short I like general surgery but I don't think I can go into it. I have observed in three hospitals that I've been with now that general surgeons get the pretty bad cases that are extremely messy and complicated (some of which they have no control over whether they get it or not too). They have no control over who they see and the hospital they work for demand they meet a quota of cases or else they fire or find another doctor to replace. I have observed this "quota" is met via overnight call or on the weekends very frequently b/c day cases "aren't present at the time". The gen surgeon also told me they (the surgeon) get a take home pay of $200 about for appendectomy...and then nothing no reimbursement for the follow-up care of the surgical patients (stated that non-OR days, follow up days, their visits aren't reimbursed or paid for). Additionally the residents for 5 years don't even see the OR most of the time (younger ones) and are there for cheap labor and internal med "house" 12 hr shifts and overnight shifts. The surgeon I worked with didn't operate as much as they couldve (4 operations every OR day, with 3 OR days a week) but they said semi-jokingly that the surgical tech (who worked their butt off, think about 70 hours per week with various surgeons) actually made MORE than the surgeon...
I have pretty good numbers and a good CV, Emergency med seems to win out as the cushy job but i could be wrong

ER has an extremely high burn out rate with most of them having 12 shift work and switch between days and nights. I wouldn’t describe ER or Surg as “cushy” as they are two of the highest stress positions for docs. If you want cushy go Derm

 

[hallowmann]

Long story short I like general surgery but I don't think I can go into it. I have observed in three hospitals that I've been with now that general surgeons get the pretty bad cases that are extremely messy and complicated (some of which they have no control over whether they get it or not too). They have no control over who they see and the hospital they worwk for demand they meet a quota of cases or else they fire or find another doctor to replace. I have observed this "quota" is met via overnight call or on the weekends very frequently b/c day cases "aren't present at the time". The gen surgeon also told me they (the surgeon) get a take home pay of $200 about for appendectomy...and then nothing no reimbursement for the follow-up care of the surgical patients (stated that non-OR days, follow up days, their visits aren't reimbursed or paid for). Additionally the residents for 5 years don't even see the OR most of the time (younger ones) and are there for cheap labor and internal med "house" 12 hr shifts and overnight shifts. The surgeon I worked with didn't operate as much as they couldve (4 operations every OR day, with 3 OR days a week) but they said semi-jokingly that the surgical tech (who worked their butt off, think about 70 hours per week with various surgeons) actually made MORE than the surgeon...
I have pretty good numbers and a good CV, Emergency med seems to win out as the cushy job but i could be wrong

Sounds like you're basing this off of a very specific experience you have had at the hospitals in your area. You're not really describing Gen Surg very well, but I absolutely wouldn't want it because of the hours/lifestyle. To address a few of your points:

-"get the pretty bad cases that are extremely messy and complicated (some of which they have no control over whether they get it or not too)" - welcome to all hospital medicine ever. The people are going to be the sickest and you will have little to no control of who you see if you're working in a hospital. If you want to be able to choose, go into private practice, but even then there are quotas, liability, and sometimes you deal with things you didn't want to deal with.

-"They have no control over who they see and the hospital they work for demand they meet a quota of cases or else they fire or find another doctor to replace." - sounds like a competitive area that likely has a saturated market. I know a few surgeons in not so desirable areas that bring so much money into the hospital that the hospital wouldn't dare threaten or fire them.

-"The gen surgeon also told me they (the surgeon) get a take home pay of $200 about for appendectomy...and then nothing no reimbursement for the follow-up care of the surgical patients (stated that non-OR days, follow up days, their visits aren't reimbursed or paid for)." - sounds about right to me. There's a lot of stuff in medicine that is not reimbursed. I would get used to it. How many of those appy's are they doing a day though? I rotated with a doc that was doing 4-5 of those a day with a few hours in clinic. If they're doing less and they're not getting more out of their base salary, then they should reevaluate their work.

-"Additionally the residents for 5 years don't even see the OR most of the time (younger ones) and are there for cheap labor and internal med "house" 12 hr shifts and overnight shifts." - Again, yeah and? You're describing a lot of training programs. You're definitely there for cheap labor. Years 1-2 you're learning how to manage the floor and observing/first assisting a bunch of cases in the AM. That's how it works. You build up to increasing autonomy as your skill set grows.

By all means go into EM, but be aware that a lot of the things you are worried about are present in a lot of hospital medicine. If its not, its usually replaced with something else to complain about. Do what you love doing. If that's EM, do that. If its Surgery, do that. Find what you enjoy, and spend 30 yrs of your life practicing it.

 

[AlbinoHawk DO]

Surprised that surgeon is only doing 4 or so procedures a day. The surgeons I rotated with were doing an appendectomy in like 25 minutes. Most of the time wasted was thanks to anesthesiologists that weren't stepping up their game. I'd say about 12 cases a day was the usual with a private practice next door where they'd get paid for follow-up. The guy was seeing 30-40 patients on clinic days. He had some overnight and weekends but generally it wasn't terrible and had a few weekends off.

 

[hallowmann]

Surprised that surgeon is only doing 4 or so procedures a day. The surgeons I rotated with were doing an appendectomy in like 25 minutes. Most of the time wasted was thanks to anesthesiologists that weren't stepping up their game. I'd say about 12 cases a day was the usual with a private practice next door where they'd get paid for follow-up. The guy was seeing 30-40 patients on clinic days. He had some overnight and weekends but generally it wasn't terrible and had a few weekends off.

The guy I was with worked from 7:30-4pm, and had half days in OR and half days in clinic 3 out of 5 days a week. Saw like 12-18 in a clinic half day, but spent most of the time looking up stuff on the internet. The morning would have either 4-5 normal cases (appys, lap choles, excisions - each done in 20-30min in the OR itself), then a 1.5-2hr lunch. On the other 2 days a week he would do 20-26 scopes and leave early around 2 or 3pm those days. He would round on the handful of floor patients in between cases. He was netting a ton of money and had a decent lifestyle, but it was in the middle of nowhere at least an hour from a real city. He was also on call every other weekend, but it seemed pretty laid back, some days worse than others.

 

[JamesPotterMS-3]

Surprised that surgeon is only doing 4 or so procedures a day. The surgeons I rotated with were doing an appendectomy in like 25 minutes. Most of the time wasted was thanks to anesthesiologists that weren't stepping up their game. I'd say about 12 cases a day was the usual with a private practice next door where they'd get paid for follow-up. The guy was seeing 30-40 patients on clinic days. He had some overnight and weekends but generally it wasn't terrible and had a few weekends off.

Yeah this is the normal GS schedule I've heard, but with less cases per day. Have never heard of a surgeon complain of salary. appendectomy for $200? Highly doubt it. All the surgeons I've worked with also bill for follow-ups, unlike what OP said. Weird.

 

[DOcter914]

Yeah maybe if your the only surgeon at the hospital in the middle of kansas....

and no they dont get paid for most of their follow up care for surgical patients, its included in the surgical reimbursement look it up

 

[studentdoct4281]

op I have noticed this too I feel you

 

[studentdoct4281]

The guy I was with worked from 7:30-4pm, and had half days in OR and half days in clinic 3 out of 5 days a week. Saw like 12-18 in a clinic half day, but spent most of the time looking up stuff on the internet. The morning would have either 4-5 normal cases (appys, lap choles, excisions - each done in 20-30min in the OR itself), then a 1.5-2hr lunch. On the other 2 days a week he would do 20-26 scopes and leave early around 2 or 3pm those days. He would round on the handful of floor patients in between cases. He was netting a ton of money and had a decent lifestyle, but it was in the middle of nowhere at least an hour from a real city. He was also on call every other weekend, but it seemed pretty laid back, some days worse than others.

This is not entirely realistic from what ive seen ha but then again he was super rural so there's that

 

[ASGD1983]

Long story short I like general surgery but I don't think I can go into it. I have observed in three hospitals that I've been with now that general surgeons get the pretty bad cases that are extremely messy and complicated (some of which they have no control over whether they get it or not too). They have no control over who they see and the hospital they work for demand they meet a quota of cases or else they fire or find another doctor to replace. I have observed this "quota" is met via overnight call or on the weekends very frequently b/c day cases "aren't present at the time". The gen surgeon also told me they (the surgeon) get a take home pay of $200 about for appendectomy...and then nothing no reimbursement for the follow-up care of the surgical patients (stated that non-OR days, follow up days, their visits aren't reimbursed or paid for). Additionally the residents for 5 years don't even see the OR most of the time (younger ones) and are there for cheap labor and internal med "house" 12 hr shifts and overnight shifts. The surgeon I worked with didn't operate as much as they couldve (4 operations every OR day, with 3 OR days a week) but they said semi-jokingly that the surgical tech (who worked their butt off, think about 70 hours per week with various surgeons) actually made MORE than the surgeon...
I have pretty good numbers and a good CV, Emergency med seems to win out as the cushy job but i could be wrong

It's good you realized it - better late then never. Guess what? A lot of sdn naive students think they want to be surgeons or do EM for life etc. There is a reason why smartest folks go to better lifestyle specialties. But shhhh - keep it a secret, let all those naive gunners go for worst lifestyle choices - they will regret it sooner or later.
Lol - we have about a dozen of such goofies in my class and they post photos after every "cool" rotation and they mention everytime how they are going to be surgeons etc. I can't help but chuckle. I mean it's sometimes painful to see such delusions and most importantly they themselves don't realize it yet.

 

[Angus Avagadro]

Yeah this is the normal GS schedule I've heard, but with less cases per day. Have never heard of a surgeon complain of salary. appendectomy for $200? Highly doubt it. All the surgeons I've worked with also bill for follow-ups, unlike what OP said. Weird.

Believe it. Insurers differ, but most pay flat fee for admission, surgery and follow up. 200 sounds about right

 

[SurgeDO]

I love surgery but absolutely hated general surgery. Thought they ended up getting a lot of the ****ty cases that none of the specialists wanted (sorry, g-surg colleagues--just my experience).

Look into the surgical subspecialties.

 

[hallowmann]

This is not entirely realistic from what ive seen ha but then again he was super rural so there's that

He was about 1 hr outside of a city of >500k. It was rural, but surprisingly close to a decent sized city. I honestly don't know how he managed it, but he did.

 

[kelminak]

@DOcter914 EM has one of the highest burnout rates every year.

Medscape: Medscape Access

EM at 45%, Gen Surg at 43%. It's probably not a substantial difference but you'd probably be happier if you choose the one you actually wanted to do for the rest of your life instead of looking at the $/hr. EM frequently has erratic hours and extremely taxing work.

Also remember that almost every single specialty is kill what you eat. Want to run yourself into the ground to make money? You can. Want a job with less hours? You'll take a paycut but that job is very likely out there somewhere.

 

[InternistDO]

Shift work EM is not a lifestyle specialty. With the bouncing around between days/nights/evenings you probably end up sleeping even less than surgeons do. Also, while gen surgery might get dumped on in the hospital (getting all the messy cases, etc), emergency med is the dumping ground of the entire world, and every crappy patient (whether that means sick and dying, or just a crappy personality, or literally covered in crap) that other doctors don't want to deal with is coming to you at all hours of the day and night with the expectation that you will deal with it immediately. I like EM (and many others do too), but it is not a perfect speciality by any means and unless you grab some rural sleepy day shift only EM job, it's not cushy.

 

[Black Coffee 24/7]

Shift work EM is not a lifestyle specialty. With the bouncing around between days/nights/evenings you probably end up sleeping even less than surgeons do. Also, while gen surgery might get dumped on in the hospital (getting all the messy cases, etc), emergency med is the dumping ground of the entire world, and every crappy patient (whether that means sick and dying, or just a crappy personality, or literally covered in crap) that other doctors don't want to deal with is coming to you at all hours of the day and night with the expectation that you will deal with it immediately. I like EM (and many others do too), but it is not a perfect speciality by any means and unless you grab some rural sleepy day shift only EM job, it's not cushy.

Hey, don’t tell everyone that.

EM is by far the hottest specialty among DOs right now. Every sucker wants to make 350K+ a year, work 14 days in a month, and do only a 3 year residency.

I’m young and I can handle the crazy hrs now. However, I can’t imagine switching my Circadian rhythm every 4 weeks.

 

[hallowmann]

Hey, don’t tell everyone that.

EM is by far the hottest specialty among DOs right now. Every sucker wants to make 350K+ a year, work 14 days in a month, and do only a 3 year residency.

I’m young and I can handle the crazy hrs now. However, I can’t imagine switching my Circadian rhythm every 4 weeks.

Try every few days to week. For that reason alone I knew I couldn't handle it, but as far as I'm concerned there are lots of reasons its not for me. A few EM rotations in residency is more than enough for me, thanks. More power to the people that enjoy it.

 

[LovelyRita]

General Surgery: When it's good it's AWESOME. Best career you could choose. Patients love you, hug you, thank you, bring you presents. Make a lot of money, smarter than most in the hospital, can save a life or scrape a wound. You're a badass. Lifestyles variable. You can find what fits you.
...And when it's bad, its AWFUL. You might find yourself wishing you picked something else. People die, have complications and people sue. All that hard work during residency and you can't make everyone happy. High stakes. Life or death sometimes. You have to be skilled at being balanced and keeping a level head and have compassion, which is not always easy.