on call

[voltron]

I'm an M3 (future gsurg hopefully) on call right now during my medicine rotation. I just went down to the conference center to get some free lunch where I ran into a neurosurg who was a pretty nice guy, but just kept telling me that gsurg sucks, people make squat(150-200), and they work they're asses off for it. He was saying uro, ENT, plastics, optho is the way to go. And this is NOT the first guy I've heard it from. I gotta admit that all this talk does make me think twice. Are they exaggerating, or are we all just kidding ourselves here? Is it a dying field, that treats residents like crap, and you get out and make barely more than a FP? I love surgery, but after hearing this kind of stuff, even from my own family members in the field, it does kind of get to you.
-feeling discouraged

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[mark md]

he is correct 100%. I know of a gen surgeon 2 yrs out whose making 100 K/year and can't believe he chose the field. Overall, all surgeries are down going now as reimbursements have gone down and malpractice is disproportionately skyrocketing. You're right about getting beaten basically in residency too (as we've heard from sooo many people for the Univ of Chicago program).

 

[voltron]

**** it, I'm doing anesthesia

 

[neutropeniaboy]

I hope you're kidding.

Almost all surgical residencies are tough, and they all build character.

I'm sure there are some general surgeons out there who regret going into general surgery -- just as I am sure there are otolaryngologists, neurosurgeons, urologists, etc. who regret going into their fields.

Surgical residencies and careers aren't for everyone. They aren't always predictable, and the fields advance very rapidly, which may make keeping pace difficult.

Issues like money, family, free time, and location are all very important when choosing the appropriate medical/surgical career, but I honestly feel that if you're not doing what you find the most exciting and enjoyable, all the other facets may not compensate for your crappy job.

 

[Skylizard]

Originally posted by voltron
**** it, I'm doing anesthesia

Originally posted by athena21
...the overall population divorce rate is 50%, last I heard (could be wrong though). In that case, surgeons have a lower divorce rate than the general american population, while psychiatrists are right on par with society.

I kind of heard the same thing, i.e. about 2/3 of American marriages end in divorce.

I was talking with some practicing surgeons the other day and a senior FP resident. They were telling me how their life works and some of the scenarios you can find in the community.

Surgeon A: Work like a dog year 1 and possibly year 2. 110-120 hours per week. Takes call for your practice about Q3. Partnership will require "buy in" for some pretty good cash. For the hospital, the community surgeons take turns on trauma call and it comes out to around Q8-9. As you are not partner, you pay the practice for the clinic overhead. Earn <150k before taxes.

Surgeon B: Works like a dog too. Not partner either. However, NO "buy in". Just works for a year or two and then get to become partner and profit share with the group. The "practice call" is around Q4-5. Also in the trauma call rotation Q8+/-. Earn 150k before taxes and do NOT pay for/cover overhead...straight salary. get a raise of 50+k in one year and make bonuses and percentage of your billing.

FP senior resident: She has a contract to go and work for the VA. She starts at 120k, no mal-practice insurance issues, no overhead or partner issues, NO CALL! All outpatient clinic, off on all fed hollidays, federal employee benefits, etc...

It all depends on what you enjoy and what will keep you happy, intellectually sharp and interested. If you like anesthesia EQUALLY to Gsurgery, you might be making an excellent choice. However, if you are doing it predominantly for life-style and cash, you will likely be unhappy in the long run. Remember, 120k or more for doing what you love is not a bad deal! 200k for doing something that does not excite you will definately not be enough in the long run....IMHO.

The other issue is that salaries and income are definately regional specific and career focus specific. Not all Gsurgeons make 200+k/year and not all make 120K/year.

 

[phil123]

my cousin is a general surgeon (actually did fellowship in surg onc) and will be retiring at the age of 35. Why? because his malpractice is now >100K/yr (100% increase over 2 yrs) and his net income after taxes is 70k. for this, he puts in 100+ hours/wk and takes call q4. he'd much rather do business.

 

[Skylizard]

Originally posted by phil123
...because his malpractice is now >100K/yr (100% increase over 2 yrs) and his net income after taxes is 70k...

There are clearly some states in which tort reform has made it better for surgeons and their are states in which the lack of tort reform makes it a hostile environment. Ultimately, these are things you need to evaluate when choosing your residency & career. Choose where you would like to practice and investigate what the tort law issues are in that state.

I am surprised he works so many hours in surge-onc. Was he doing whipples?

I know a couple of surge onc guys that make close to a million/year. Their work schedule isn't that hectic and they don't do whipples. They do have 1 or 2 AMs per week that they do colonoscopies/EGDs. Scoping brings a pretty bundle if you build a good client base and are fast (~15-20 minutes per complete colon). (The scopes is how some of the med-GI guys make huge bucks, I knew a group of med-GI guys that were EACH billing one million every ~45 days predominately with scoping). They (surge-Onc) also do alot of vasc-access for chemo & TPN, biopsies, IVC filters, in addition to the colectomies etc... It really depends on the communitee and the nich you carve.

 

[pjr]

Unfortunately, voltron, your concerns about making money in medicine are warranted. Especially if you do surgery, you really will work like a dog for your first couple of years out for relatively little compensation. My college roommate graduated with a B.S. in Electrical and Computer Engineering from U of Illinois, and got a job right out of college with Motorola in FL making about $100K/year. Medicine isn't something to do nowadays if your main concern is financial, but as other posters have pointed out, it is very region dependent. Another friend of mine that finished a medicine residency last year interviewed for a job with Kaiser-Permanente Northern California, and they offered him a full-time hospital based position making $35,000/year. We were absolutely stunned. He ended up taking an outpatient-based job in Ohio for $90,000/year pre-tax with malpractice paid for. From the surgery standpoint, I have been offered several jobs right out of residency that start at between $150K and $250K/year with malpractice paid for, again region-dependent. Just depends on what you want to do and where you want to go. Don't be discouraged. As the population gets older, there will be more and more surgery to do.

 

[voltron]

Thanks for all the replies. I know it shouldn't be about the $ if you like what you do, but you also gotta be practical here. Thats cool pjr that you got pretty good offers. Would you mind sharing what cities they are from?

 

[dr barb]

Originally posted by voltron
He was saying uro, ENT, plastics, optho is the way to go.

Is money and lifestyle not a concern for these specialties? Is general surgery the main one to avoid? What about surgical subspecialties like neurosurg and cardiothoracic?