Matching into General Surgery w/o intending to fellowship

[GenSurgONLY]

Hi,

I am performing a lot of research into possible general surgery residencies. I would like to match into GS and do not wish to go into a fellowship. I understand many programs nowadays structure their programs to prepare one to sub-specialize requiring you to research 1-2 years. My question for those who may have matched or are more familiar; are there any programs out there geared to just keeping an applicant as a General Surgeon?

One of the most exciting parts about GS is the broad scope of cases one may receive. I want to pursue GS for this; however, I feel the position is dwindling away because most people go into fellowship. I respect those who want to hone their craft in a particular area but that does not interest me. I don’t want to feel pressured into a fellowship because everyone else is doing it.

Any fruitful advice would be great! I am willing to research but still don’t wish to fellowship. Definitely intend to pass boards when the time comes. Thank you!!

Signed,

Non traditional student

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[libertyyne]

every single community gen surg program .

 

[GenSurgONLY]

every single community gen surg program .

Thank you! Eveytime I try looking into a program, it starts off the same, “We have a great General Surgery residency program and we have lots of research opportunities to prepare you for a fellowship. Many of our residents continue into them.” Or some variation of that.

It almost seems like EVERYONE seeks a fellowship and hardly anyone chooses to stay in GS.

Will definitely research these type of hospitals more heavily. Trying to put together a spreadsheet.

 

[libertyyne]

Thank you! Eveytime I try looking into a program, it starts off the same, “We have a great General Surgery residency program and we have lots of research opportunities to prepare you for a fellowship. Many of our residents continue into them.” Or some variation of that.

It almost seems like EVERYONE seeks a fellowship and hardly anyone chooses to stay in GS.

Will definitely research these type of hospitals more heavily. Trying to put together a spreadsheet.

I personally think you are going about it the wrong way though.
Every program wants to get the best and brightest, so they advertise opportunities that usually appeal to those folks. I could be wrong , but after completing residency at any of these places you can nope out of any further fellowship training by stating you are not interested. No one is forcing you to fellowship. This applies to most programs, but you might just want to exclude top tier academic university programs and you should be set. You should really be more interested in what the structure of the program is , what the call consists of , how far is it from family etc.

 

[GenSurgONLY]

I personally think you are going about it the wrong way though.
Every program wants to get the best and brightest, so they advertise opportunities that usually appeal to those folks. I could be wrong , but after completing residency at any of these places you can nope out of any further fellowship training by stating you are not interested. No one is forcing you to fellowship. This applies to most programs, but you might just want to exclude top tier academic university programs and you should be set. You should really be more interested in what the structure of the program is , what the call consists of , how far is it from family etc.

I see your point. Being a non traditional student, I have done many things that many who are entering Residency have yet to do. Such as, being married, having kids, buying a home, etc. I used to be an Accountant at a Big4 and have worked full time for many years. I am changing careers to follow a passion that had to be put on hold due to some unfortunate life circumstances.

My children will be in middle school by the time I do match. I agree, considering how the program structure will impact my family is very important. IMHO, it will be easier to do this with them being older compared to the ones I know entering residency with a baby, or a few young ones.

In the end, I am willing to do whatever it takes. Hs, HPs in clerkships, volunteering, research, etc. I plan to be the best but just in GS.

 

[libertyyne]

I see your point. Being a non traditional student, I have done many things that many who are entering Residency have yet to do. Such as, being married, having kids, buying a home, etc. I used to be an Accountant at a Big4 and have worked full time for many years. I am changing careers to follow a passion that had to be put on hold due to some unfortunate life circumstances.

My children will be in middle school by the time I do match. I agree, considering how the program structure will impact my family is very important. IMHO, it will be easier to do this with them being older compared to the ones I know entering residency with a baby, or a few young ones.

In the end, I am willing to do whatever it takes. Hs, HPs in clerkships, volunteering, research, etc. I plan to be the best but just in GS.

are you a premed or a med student?

 

[nimbus]

I do believe there are differences between surgery programs in terms of operative exposure and independent operative experience. The programs that groom you for fellowship may not be the ones that best prepare you for community general surgery practice doing bread and butter cases such as cholecystectomy, colectomy, breast lumps, anal cases, appys and hernias. You probably want a program where you get exposure to a high volume of these cases rather than a bunch of liver transplants, lung transplants, ICU time, and complex biliary reconstructions.

As a medical student I rotated at 2 different sites for OB/gyn. The residents at the community program were doing C-sections skin to skin by the end of their first year/beginning of 2nd year. The residents at the university mother ship were just holding retractors and helping to close at the same point in their training. It was obvious that the operative skills of the residents at the community program were much more advanced than their cohorts at the university program. Take that fwiw as one anecdote.

Also, I’ve seen many new surgeons join our staff throughout my career and it’s always easy to see which ones have some experience under their belt vs the newly graduated residents and fellows. Surgery is one of the fields where experience matters a lot. If you do go straight to private practice, make sure you go into a situation where you will get continued backup, support and mentoring during your first few years of practice. It is necessary.

 

[ACSurgeon]

Is your goal to save time or to remain a broad general surgeon?

You say that you don’t mind doing research, which for a non-trad student can be the bigger waste of time.

Doing a one year fellowship doesn’t preclude you from doing broad general surgery. It just makes you more marketable and easier to find a job. Many or most community surgeons who are fellowship trained still have to do general surgery (at least early on).

To answer your question: 80% of general surgery graduates do a fellowship. So, you don’t have to, but you very might want to when the time comes to enhance your skills or to get a job that you like.

In terms of program selection: the above advice on community vs academic is wrong. I’ve seen community residents who can’t operate, who have low numbers by graduation, who have low board pass rates, and who absolutely need fellowship training. The same can be said about some academic programs too. When the time comes, you want to find a program that 1- doesn’t require dedicated research years and 2- a program with at least some of its graduates going straight into practice. The rest will depend on word of mouth and will be a crap shoot to a large extent...

 

[sovereign0]

Just email some PDs. My home program is a 7-year academic program but I've personally worked with residents on my rotation who were foregoing the 2 years of research. One if them was a senior who already had a job lined up, and the other was a junior who was actually still planning to do a vascular fellowship.

 

[7331poas]

Wait, are you a premed?

 

[Psai]

Fellowships are overrated unless you're trying to do something that a group of people arbitrarily decided that you can't do without jumping through their hoops. Minimally invasive fellowship? Lol. What's next, a lap appy fellowship?

 

[7331poas]

Fellowships are overrated unless you're trying to do something that a group of people arbitrarily decided that you can't do without jumping through their hoops. Minimally invasive fellowship? Lol. What's next, a lap appy fellowship?

I assume you are not talking about CT surg or plastics? Not sure I exactly understand your comment.

 

[AnatomyGrey12]

There are a number of community or university programs that have great operative experience and would be well suited to someone wanting a pure GS practice post training as compared to someone seeking sub-specialization. The best way to find these programs is by talking with actual surgeons and residents and getting advice.

If you are a pre-med then don't worry about this for a long while lol

 

[mistafab]

I would talk to surgeons at your institution.

I spoke with some surgeons about interest in “being a real general surgeon” and they were always willing to give an earful. They will throw a list of programs at you that they think will more likely prepare you for operating, rather than for fellowship.

 

[GenSurgONLY]

are you a premed or a med student?

Post Bacc (so I guess I am “kinda” pre med)
I took a TON of Math in college (was a Math major before switching to Accounting for the sake of getting done and start working) but hardly took any Science so I am pursuing a program at University of Maryland.I will be volunteering in shock trauma over the weekends as well. I am very much committed to this.

Just trying to make a plan especially since I have to consider my family’s needs to a certain extent. Deciding where to live, schools, whether to rent or buy another home, my husband’s work, etc. For example, It took two years of planning to just buy our first home(considering it was built from the ground up). So definitely need to have a solid General plan.

I am new to these forums, so I do apologize in advance if my questions or my scope of things seem way off. I have been trying to research on my own but it’s a bit of a challenge especially when a lot of sites (that would offer me the best consolidated information) require one to be in med school at minimum.

 

[GenSurgONLY]

There are a number of community or university programs that have great operative experience and would be well suited to someone wanting a pure GS practice post training as compared to someone seeking sub-specialization. The best way to find these programs is by talking with actual surgeons and residents and getting advice.

If you are a pre-med then don't worry about this for a long while lol

Heheeheee

Thanks! I tend to over-prepare. I will touch base with you all in two years once I start prepping for MCATs. I have already started looking into practice questions on these too! Lol

 

[GenSurgONLY]

Fellowships are overrated unless you're trying to do something that a group of people arbitrarily decided that you can't do without jumping through their hoops. Minimally invasive fellowship? Lol. What's next, a lap appy fellowship?

Exactly! I mean the best way I could compare a fellowship would be like a subcontractor to a contractor. Example, a plumber to a project manager. A project manager knows the general idea of plumbing but a plumber may know a particular area more because that’s all they do everyday.

I respect specialists, but I still believe the need of “non-specialists” is very important especially in rural areas. A GS could serve most of their needs. I kinda felt like being a GS is becoming a dying breed. I could be wrong; maybe there will be a resurgence.

 

[GenSurgONLY]

Is your goal to save time or to remain a broad general surgeon?

You say that you don’t mind doing research, which for a non-trad student can be the bigger waste of time.

Doing a one year fellowship doesn’t preclude you from doing broad general surgery. It just makes you more marketable and easier to find a job. Many or most community surgeons who are fellowship trained still have to do general surgery (at least early on).

To answer your question: 80% of general surgery graduates do a fellowship. So, you don’t have to, but you very might want to when the time comes to enhance your skills or to get a job that you like.

In terms of program selection: the above advice on community vs academic is wrong. I’ve seen community residents who can’t operate, who have low numbers by graduation, who have low board pass rates, and who absolutely need fellowship training. The same can be said about some academic programs too. When the time comes, you want to find a program that 1- doesn’t require dedicated research years and 2- a program with at least some of its graduates going straight into practice. The rest will depend on word of mouth and will be a crap shoot to a large extent...

Thank you!!!
If you don’t mind me asking, would a critical care fellowship still allow me handle a broad scope of cases? I hear mixed reviews on General surgeon v. Trauma surgeon. When I get closer, this will be a bit easier; my “early” preparation is more so do to my family. But at the end of the day where I am accepted to med school, I am going(and they are coming) and when I am matched into residency, whether it’s across the coast, I am taking it(along with them).

A doctor once said he turned down a match, and it was one of the dumbest things he ever did. He was able to SOAP but that’s some risky business and not something recommended, I am sure.

 

[nimbus]

Definitely not a dying breed. We have so many young general surgeons they are fighting to take ER call.

 

[libertyyne]

Post Bacc (so I guess I am “kinda” pre med)
I took a TON of Math in college (was a Math major before switching to Accounting for the sake of getting done and start working) but hardly took any Science so I am pursuing a program at University of Maryland.I will be volunteering in shock trauma over the weekends as well. I am very much committed to this.

Just trying to make a plan especially since I have to consider my family’s needs to a certain extent. Deciding where to live, schools, whether to rent or buy another home, my husband’s work, etc. For example, It took two years of planning to just buy our first home(considering it was built from the ground up). So definitely need to have a solid General plan.

I am new to these forums, so I do apologize in advance if my questions or my scope of things seem way off. I have been trying to research on my own but it’s a bit of a challenge especially when a lot of sites (that would offer me the best consolidated information) require one to be in med school at minimum.

you shouldnt be concerned with non fellowship surgical residencies at this point. You should be focused on getting into medical school. If you manage to get in, your in your interests may drastically change.

 

[Smurfette]

Definitely not a dying breed. We have so many young general surgeons they are fighting to take ER call.

I assure you this is not the norm.

 

[nimbus]

I assure you this is not the norm.

Perhaps. I’m sure it’s location dependent. We recently had a medical staff brouhaha because one group of surgeons felt they were being unfairly obstructed by another group from taking their fair share of ER call.

 

[GenSurgONLY]

you shouldnt be concerned with non fellowship surgical residencies at this point. You should be focused on getting into medical school. If you manage to get in, your in your interests may drastically change.

I see your point. I think when you are a non trad, your commitment changes. It takes commitment for one to leave a career, take 2 additional years of schooling on top of whatever degree(s) held for the “opportunity” to attend med school and go onto practice medicine. By this, I mean, I know GS is what I want and that will not change.

“Put all your eggs into one basket and then watch that basket like a ****ing hawk.”—-Dr. Buck

 

[libertyyne]

I see your point. I think when you are a non trad, your commitment changes. It tamakes commitment for one to leave a career, take 2 additional years of schooling on top of whatever degree(s) held for the “opportunity” to attend med school and go onto practice medicine. By this, I mean, I know GS is what I want and that will not change.

“Put all your eggs into one basket and then watch that basket like a ****ing hawk.”—-Dr. Buck

Yes, but the reality of surgical training and the impact on family life, or the impact of medical school, or performance in medical school and match realities, may all change your perspective. Plus all of this is moot if you cant get into a program or any programs you look for right now may not exist or may become drastically different considering 7 years is a long time.

I am currently in medical school and I cant predict where I will end up come match day or what my step performance + clinical performance will allow me to end up.

Too many uncertainities makes planing counterproductive at this stage.

 

[nimbus]

“Put all your eggs into one basket and then watch that basket like a ****ing hawk.”—-Dr. Buck

“The department of anesthesia gets some of our best residents from the department of surgery.”—-Dr E.W., my old anesthesia program director

 

[Oso]

This dude hasn't even started studying for the MCAT yet

 

[Winged Scapula]

Perhaps. I’m sure it’s location dependent. We recently had a medical staff brouhaha because one group of surgeons felt they were being unfairly obstructed by another group from taking their fair share of ER call.

But that's not because they *enjoy* taking the call (which your earlier post implied) but because general surgeons often, especially early in their career, get many of their cases from ER call rather than referrals for elective cases.

We have the same here when a large local hospital system hired their own general surgeons and gave them the bulk of the ER call, squeezing out the community PP guys.

 

[GenSurgONLY]

Thanks for moving to pre medical. How can I link this to the non trad forum? I think their input would assist a little better because they understand my situation more.

 

[nimbus]

But that's not because they *enjoy* taking the call (which your earlier post implied) but because general surgeons often, especially early in their career, get many of their cases from ER call rather than referrals for elective cases.

We have the same here when a large local hospital system hired their own general surgeons and gave them the bulk of the ER call, squeezing out the community PP guys.

Yes I know. I was replying to a post implying that general surgeons are a dying breed. I was not implying that they actually enjoy taking ER call. I am saying we have a lot of young general surgeons trying to build up their practices to illustrate they are not a dying breed.

 

[Tenk]

Definitely not a dying breed. We have so many young general surgeons they are fighting to take ER call.

The day surgeons fight to take ED call is the day when it wasn’t anesthesia’s fault.

 

[deleted480308]

Post Bacc (so I guess I am “kinda” pre med)
I took a TON of Math in college (was a Math major before switching to Accounting for the sake of getting done and start working) but hardly took any Science so I am pursuing a program at University of Maryland.I will be volunteering in shock trauma over the weekends as well. I am very much committed to this.

Just trying to make a plan especially since I have to consider my family’s needs to a certain extent. Deciding where to live, schools, whether to rent or buy another home, my husband’s work, etc. For example, It took two years of planning to just buy our first home(considering it was built from the ground up). So definitely need to have a solid General plan.

I am new to these forums, so I do apologize in advance if my questions or my scope of things seem way off. I have been trying to research on my own but it’s a bit of a challenge especially when a lot of sites (that would offer me the best consolidated information) require one to be in med school at minimum.

Yoy are not “kinda” premed. If you aren’t accepted yet you are fully premed, which is fine, lots of people are

 

[Winged Scapula]

Thanks for moving to pre medical. How can I link this to the non trad forum? I think their input would assist a little better because they understand my situation more.

You can’t.

If you like I can move it to that forum if you prefer but most people check multiple forums so many non-Trads would be checking this forum anyway.

However, I’m not sure what is specific about your question that would mean that it’s better place there. If anything, you’re going to get more surgical residents at attendings here then in the non-Trad forum.

 

[RogueUnicorn]

Yes I know. I was replying to a post implying that general surgeons are a dying breed. I was not implying that they actually enjoy taking ER call. I am saying we have a lot of young general surgeons trying to build up their practices to illustrate they are not a dying breed.

Plenty of fellowship trained GSurg people take general call though, so this doesn't seem like a particularly illustrative example.

 

[mmmcdowe]

Thanks for moving to pre medical. How can I link this to the non trad forum? I think their input would assist a little better because they understand my situation more.

Moving to non trad forum