Planning a residency in General Surgery, but now uncertain about fellowship...

[Blade28]

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I'm currently a fourth-year med student, planning to apply for a Categorical spot in General Surgery this fall. I've been interested in surgery since college, and have been leaning towards Cardiothoracic Surgery since starting med school. I studied the heart quite a bit during my Bioengineering classes in undergrad, and have always been fascinated with its workings (more than the lungs, or kidneys, or liver, or brain, etc.). Going through anatomy classes and an intense Surgery rotation, I know that I love working with my hands, solving problems in a short period of time, and seeing patients get better quickly.

I've also come to realize that I'm too inpatient for Medicine...I can't stand sitting (or standing) for hours every morning, rounding. Pre-rounds, then work rounds, then team rounds, then attending rounds...argh! 🙂 I don't like keeping patients in the hospital for weeks, just to tinker around with the med dosages, titrating this up, weaning this down, etc.

However, recently I've been starting to doubt the Cardiothoracic fellowship part. I know that I love General Surgery, and am most likely headed in that direction for residency; plastics doesn't interest me as much, nor does ortho or ophtho. ENT might be interesting, but I doubt I have the scores for that. 🙁 I've heard the debate over the past several years about CT surgeons' territory being invaded by interventional cardiologists and interventional radiologists, but I've always kinda brushed those comments aside, figuring I would still be OK in terms of patient load.

What I've come to realize, though, after finishing third year is that working hard sucks. 🙂 I used to not care about pulling all-nighters, or sacrificing everything for academics, etc. But it's tiring and it wears on you, and the grind of working many, MANY days in a row without a day off just leads you towards burnout. I felt kinda burned out after third year was over, but luckily had two weeks off (though I was supposed to be studying for Step 2 🙂 ).

Are there even any surgery attendings that don't work crazy hours, every single day? (Excluding plastics, ophtho, etc.)

I guess my question is (and sorry that I'm so long-winded), what should I do about fellowship? I realize it's a long way away, and I may gain additional knowledge and insight during residency, but I'm wondering what my options are. While General Surgery is great, I don't know if I could do that for the rest of my life. What else is left? Vascular? Oncology? Transplant? Critical care?

Should I just continue on my path towards General Surgery residency, and worry about all this later?

Thanks in advance for any suggestions or advice!

 

[fourthyear]

Yes, there are some surgeons who don't work crazy hours every single day. Of the specialties you listed, I think oncology has the least emergencies or outside-business-hours work, wheras transplant, critical care (which usaully includes trauma), and even occasionally vascular have middle-of-the night work to be done.

Unfortunately for you, cardiothoracic is probably amongst the worst of sugical specialties in terms of working crazy hours. The other probelm is peer pressure from others within your specialty to work a lot. If you're in a group practice, all the other CT surgeons working with you are going to want at least an even call schedule, not one where you somehow only get a few nights of call a month, and if you are routinely taking long weekends when others aren't, they probably arent' going to think you're pulling your weight in the practice.

Another problem for you is that you have to at least be able to make it through a 5 year residency of hard work. After that you may be able to find a job in general, oncology, maybe vascular, or other surgical specialty that isn't too rough (with the understanding that you'll probably make less money than others who work more in your specialty), but you still have to get through your residency first without being miserable. We have it easy now with the new work limitiations, but if that still doesn't feel easy enough to you, then this will be a problem. Five years of your life is a long time and even with the work hour restrictions it is by no means a normal life to get up in the dark every day to go to work, stay till it's done which often is long after happy hour and even a normal dinnertime, take call every month for 5 years (as compared to many other residency specialties with some non-call months) and have only 4 days off a month (plus a few weeks vacation of course). Most of us don't prefer this lifestyle, but this is what you do if you like surgery enough.

Maybe anesthesia would be something to consider if the hours are a problem for you. It is very procedure-oriented (altough a much narrower range of procedures), and very good for those who are interested in mechanics and phsyiology as you seem to be.

I'm not at all trying to discourage your decision of surgery. If you love it, and can get through the residency, go for it. You really dont' have to choose your subspecialty until at least 4th year of residency, and by then you have much more exposure to all the subspecialties to help you make your decision. So if you are set on doing some general surg subspecialty, just go for it and make the further decisons later.

 

[Vukken99]

Trauma surgeons do shift with some sugical critical care......on the side doing consults...

And, all surgical procedures are fast either open, explore or watch and open later or open explore then pack and re explore....or just watch for good then discharge....

Plus, if you have hand surgery on your belt you can do hand, some gen surgery and trauma....

I hate waiting for procedures....so it is all good...

gosh you have the time to wait like oncology surgeons...sure they do important work...

But, I rather wait for a chopper land and bring critical patients...
and, open them up wow exploratomy laparotomy...explore their entire peritoneal cavity.....in good 25 minutes....

But, my advice to you is concentrate day by day and
year by year.....

So many residents get ahead...learn your general surgery cold and do well in in service exams...and read a lot....that is more important that jumping the gun and saying you want this and that now at this stage....

Peole even residencies change their minds hundreds of times regarding their future and those are the ones who are not concentrating in their own present learning....

If you are good...doors open up..you want it you get it...

 

[Blade28]

Unfortunately for you, cardiothoracic is probably amongst the worst of sugical specialties in terms of working crazy hours.

Yeah, I had figured as much. The problem is, I really like this work...I've scrubbed in on some CABG and AAA cases, and they're just great. I don't feel like I'm working until my Biogels are all bloody. 🙂

Another problem for you is that you have to at least be able to make it through a 5 year residency of hard work.
...
We have it easy now with the new work limitiations, but if that still doesn't feel easy enough to you, then this will be a problem. Five years of your life is a long time and even with the work hour restrictions it is by no means a normal life to get up in the dark every day to go to work, stay till it's done which often is long after happy hour and even a normal dinnertime, take call every month for 5 years (as compared to many other residency specialties with some non-call months) and have only 4 days off a month (plus a few weeks vacation of course). Most of us don't prefer this lifestyle, but this is what you do if you like surgery enough.

I don't mind this at all, and am confident I can do well in a General Surgery residency. My third-year Surgery rotation was grueling - q3 call for 7 weeks, start pre-rounding every day of the week at 0400, home by 1700, no post-call - but I loved it. I loved the joking-around, light-hearted attitude of the residents (compared to the overly-obsessed medicine residents who need to relax 🙂 ); absolutely loved the technical aspect of the field; would rather be doing SOMETHING active rather than rounding all day and discussing meds.

Can I work 90-100 hours/week as an attending? Maybe not. I definitely could work 60-75, that's not so bad...and I don't mind having to take call 1-2 times per week.

Thanks for the advice, it's very much appreciated!

 

[Blade28]

But, my advice to you is concentrate day by day and
year by year.....

So many residents get ahead...learn your general surgery cold and do well in in service exams...and read a lot....that is more important that jumping the gun and saying you want this and that now at this stage....
...
If you are good...doors open up..you want it you get it...

I think this is great advice (the last sentence is applicable to almost any profession, for that matter). Thanks! 👍

 

[Vukken99]

Yup....

best thing is not to lose your head over stress....

On your little free time..do boxing or some biking and some beach or outdoor stuff to cool off your white matter...

And, my old attending used to say all you need is good 45min of reading daily..

Do rush... do the in service exam questions given by american college of surgeons to practice....

go over the management of your patients over and over..

Be compulsive....

 

[Blade28]

Yup....

best thing is not to lose your head over stress....

On your little free time..do boxing or some biking and some beach or outdoor stuff to cool off your white matter...

And, my old attending used to say all you need is good 45min of reading daily..

Do rush... do the in service exam questions given by american college of surgeons to practice....

go over the management of your patients over and over..

Be compulsive....

More good advice. 👍

Out of curiosity, what's your background? G-Surg resident?