Love medicine AND surgery.... help!

[carson12]

Ok, so title says it all. i love general medicine and working up patients and figuring out what's wrong with them and medically treating them, but I also love doing procedures. I don't like 6 hour big whack cases, but do love being in the OR and love cases that run 2-3 hrs at most.

Now, I'm interested in Family Medicine because of the variety and ability to do procedures, but I hear stories of people doing surgeries in rural settings.... is it possible to do surgery (more common procedures like appy/chole/hysterectomies NOT whipples or anything complicated) in a non-rural setting?

I cannot see myself being a specialist because I have this ideal of being the complete doctor. I know some will say follow your heart and that's what i'm doing, but i do get discouraged when people speak of the doom and gloom of primary care and how medicine is going to be specialized in the future....

Is it possible to do medicine and surgery in a non-rural setting, or do i need to wake up and choose one?

Thanks!

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[VA Hopeful Dr]

Now, I'm interested in Family Medicine because of the variety and ability to do procedures, but I hear stories of people doing surgeries in rural settings.... is it possible to do surgery (more common procedures like appy/chole/hysterectomies NOT whipples or anything complicated) in a non-rural setting?


Thanks!

Nope

 

[deleted87716]

If you really like surgery, you should consider becoming a general surgeon. Rural FPs tend to to have broader scopes because of limited referral options, but they aren't going to be practicing anything like a general surgeon.

There are a handful of "cowboy" FM programs out West which include EMERGENT appendectomies and C-sections in their training, but you aren't going to run into those situations very often. You won't be taking out gallbladders or uteruses as an FP. You won't be taking out uteruses as a general surgeon, either (that's Gyn).

 

[lowbudget]

If you like working in the operating room, you should pursue the surgery route. There's plenty of general medicine in every specialty. The key issue is what craft do you want to spend the rest of your life perfecting. True "general surgery" may be going away by the way side though as most general surgeons will have limited scope (if any) in ENT, chest, ortho, uro, and gyn. I think the rural general surgeon will have a broader scope, with more trauma, but in some places general surgeons may have a more limited scope.

One option is critical care fellowship or trauma fellowship after general surgery. Both still maintain a general medicine feel, but gives you more experience in either settings.

The surgical FP is more of the exception than the rule in the US.

 

[Winged Scapula]

Now, I'm interested in Family Medicine because of the variety and ability to do procedures

Procedures are not surgeries. If you want to do surgeries, then be a surgeon.

...but I hear stories of people doing surgeries in rural settings.... is it possible to do surgery (more common procedures like appy/chole/hysterectomies NOT whipples or anything complicated) in a non-rural setting?

My FM colleagues are right as usual. As a non-surgeon you will not get privileges for these procedures in any non-emergent, non-very rural setting. In addition, if you do try and do them (presuming you could even get hospital privileges to do them), you can forget about your local surgeons seeing your patients in referral for more complicated cases. Medicine is a business, just like any other, and if you attempt to take away a portion of the surgeon's livelihood by doing surgery (for which you would not be as qualified), you better believe they will not be happy and will not be interested in seeing your complications or even worse, your patients who need surgery outside of your realm of <obviously limited> training. Your patients who need choledoscopy, a sigmoid resection, a mastectomy or melanoma excision with sentinel lymph node biopsy are also not going to be very happy to find out that they have to leave the community to find a surgeon to operate on them.

I cannot see myself being a specialist because I have this ideal of being the complete doctor.

No one can do it all. While there is a great deal of medicine in surgery, especially CC, please be advised that no one, not even the world's best FM or best surgeon "does it all" (or in your parlance, is a "complete doctor".)

Is it possible to do medicine and surgery in a non-rural setting, or do i need to wake up and choose one?

I know some elderly general surgeons who did both FM and GS. However, those days are gone. They trained in an era of general practice, non-BC, etc. Hospitals are unlikely to give you privileges to do GS without a surgical residency and as noted above the FMs that do procedures only do a very limited scope of them and only in emergencies when transporting a patient would be dangerous.

I would be interested in hearing what the malpractice liability is for those FM who do these emergent procedures. Anyone know?