Prelim year in surgery before FM

[wcw_justtosay]

I'm closing in on defining my ideal practice qualities. I would like to treat a wide variety of illness and injury, using a range of skills and approaches. I would like to treat patients with limited access to medical care, both here in the States and abroad. In particular, I want to spend a significant portion of my career working with MSF or similar organizations providing care in profoundly resource-poor situations. As such, I want to pursue the training that will grant me the greatest flexibility in my scope of practice.

My thought is that rural family medicine would fit quite well into these parameters, potentially with some post-residency training. My concern is that it will be difficult to develop the kind of surgical skills that I would need in order to be as useful as possible if I were to go spend a year working in a place like Syria. If I were to do a prelim year in surgery, would this significantly expand my scope of practice as a family physician working in rural and international settings? I understand that interns rarely get much operative experience, but I'm mostly looking to develop the assessment skills of a surgeon and strong abilities as a first assist.

TL;DR Would a prelim year in surgery significantly expand the surgical skills of a family physician?

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[deleted480308]

I'm closing in on defining my ideal practice qualities. I would like to treat a wide variety of illness and injury, using a range of skills and approaches. I would like to treat patients with limited access to medical care, both here in the States and abroad. In particular, I want to spend a significant portion of my career working with MSF or similar organizations providing care in profoundly resource-poor situations. As such, I want to pursue the training that will grant me the greatest flexibility in my scope of practice.

My thought is that rural family medicine would fit quite well into these parameters, potentially with some post-residency training. My concern is that it will be difficult to develop the kind of surgical skills that I would need in order to be as useful as possible if I were to go spend a year working in a place like Syria. If I were to do a prelim year in surgery, would this significantly expand my scope of practice as a family physician working in rural and international settings? I understand that interns rarely get much operative experience, but I'm mostly looking to develop the assessment skills of a surgeon and strong abilities as a first assist.

TL;DR Would a prelim year in surgery significantly expand the surgical skills of a family physician?

not if you love your patients. a prelim surgery year doesn't make you a qualified surgeon

 

[witzelsucht]

what, ah, year are you in med school? that's a terrible idea. prelim surgery year is like being a secretary combined with a punching bag combined with a really bad hospitalist. you won't get any surgical skills.

 

[SansaStarkMD]

Terrible idea. Sorry. Hugs.

 

[cabinbuilder]

No, better off doing a bunch of surgery electives in residency and become a good surgical assist. Learn your basic suturing, etc. Learn pre-and post op care. Learn wound care management. Let the attending you are rotating with know what you have in your future plans so they can teach you accordingly. Don't expect to be able to be the surgeon overseas but you can at least be helpful with minor wounds, lac repair, fractures, etc.

I suspect if you go to Syria, you will learn A LOT of on the job training there. I would think the "rules" of practice are much different in an underserved war zone.

 

[JustPlainBill]

Heck, why go to Syria -- you can go to Combat Zone Detroit or Chicago or Houston and work with the underserved --- or go to West Virginia for that matter. Plenty to do here in the US unless you just enjoy getting shot at or visiting 3rd world countries. Got a med school colleague that finished an orthopedic residency last year, worked locums for a bit and then up and moved his entire family (wife and 5 small children -- 4 of which were born during residency) to Somalia as part of Samaritan's Purse.....

 

[wcw_justtosay]

Thanks for the replies. @cabinbuilder, are there any fellowships after family med residency that you would recommend? I know you have extensive rural experience; is there anything you picked up on the job that you wish you had learned in residency? My family medicine professor mentioned to me a colleague of his who had developed relationships with the surgeons in his area such that he was able to be first assist on many of his patients' surgeries. Have you encountered that kind of situation in your work?

@witzelsucht I can see what you mean. The PGY1s I know in surgery are certainly tired and overworked. However, they also seem to be getting excellent training from some amazing attendings and senior residents. While they don't do much more than the medical students in the OR, I have to imagine that spending a year in that environment must teach a great deal in terms of pre- and post-operative management, assessing surgical needs, understanding and managing trauma calls, etc. I definitely see what you mean about being part secretary; why do you say bad hospitalist?

 

[akilysa]

Hello! I think if you think for sure that you want to do surgery, it is better to do a general surgery residency. It is incredibly broad and I think it is easier for a general surgery with a residency 5 years long to do family medicine than for a family medicine resident to do general surgery. I was impressed at how much the general surgery residents at my medical school knew about preventative medicine and management of long term diseases.

On the other hand if you aren't as interested in surgery specifically and want to do underserved medicine in a more general way, I think family medicine is perfect. General surgery doesn't include management of pregnancy which I think is incredibly useful in underserved situations abroad. You can learn how to take care of kids, adults, and also deliver obstetric care. In my opinion it is the most ideal specialty for underserved medicine (although could tie with gen surg and psych if you are interested in those like I said above).

I think that prelim in general surgery isn't going to offer you much. Like any intern year you are focused more on learning management and may not even get that much chance to practice surgery like you would in the 2nd year of a general surgery residency. You will get plenty of good first assist experience in a good family medicine residency (after all you will become proficient at being primary surgeon on C sections and as a patient's PCP there are also often opportunities to first assist on other types of surgeries). I think it would make more sense to go to a 4 year program at a place like JPS where (If I remember correctly) you can specifically choose a track that focuses on operative family medicine for global health situations. Or you could do a 1 year fellowship in obstetrics or global health that would enable you to get more operative and/or global experience.

Another words it's better to do your extra training after residency not before since as an intern you're going to be learning the basics no matter what field you choose. If you do extra time after residency you will already be proficient and will get more out of it instead of just having to basically repeat intern year again.

Just my two cents as I went through exactly the same thought process when choosing a specialty

 

[teacherman84]

Agree with above. You would be better served doing a 4 year fm residency at a place like this.
www.jpshealthnet.org/academics_research/residency_programs/family_medicine/curriculum

They have a global or rural health focus.
If you look under procedures, people are graduating with over 100 primary c-sections, others with a lot of endoscopy, and some surgery focused (choles)

 

[wcw_justtosay]

@akilysa and @teacherman84 thank you! That program is exactly what I was looking for! Now I have to figure out if I can handle living in Dallas for 4 years (nothing against Texas, I just miss Colorado) .

 

[teacherman84]

It's

@akilysa and @teacherman84 thank you! That program is exactly what I was looking for! Now I have to figure out if I can handle living in Dallas for 4 years (nothing against Texas, I just miss Colorado) .

It's only a 10 hr drive or an even shorter flight

 

[cabinbuilder]

Thanks for the replies. @cabinbuilder, are there any fellowships after family med residency that you would recommend? I know you have extensive rural experience; is there anything you picked up on the job that you wish you had learned in residency? My family medicine professor mentioned to me a colleague of his who had developed relationships with the surgeons in his area such that he was able to be first assist on many of his patients' surgeries. Have you encountered that kind of situation in your work?

@witzelsucht I can see what you mean. The PGY1s I know in surgery are certainly tired and overworked. However, they also seem to be getting excellent training from some amazing attendings and senior residents. While they don't do much more than the medical students in the OR, I have to imagine that spending a year in that environment must teach a great deal in terms of pre- and post-operative management, assessing surgical needs, understanding and managing trauma calls, etc. I definitely see what you mean about being part secretary; why do you say bad hospitalist?

or this residency: http://www.akfmr.org/
I never did a fellowship - didn't feel it was necessary given that I tailored my residency for working in rural areas alone. I knew what I needed to learn from growing up in Alaska and working in an Alaskan hospital for many years before going to medical school.

The one thing I wished I had learned or knew more about was how to deal with severe eye injuries, how to use a slit lamp, and how to extract foreign bodies from the eye. I have never assisted in the OR at work because most places I work don't have an OR or a surgeon on site. If they are lucky enough to have a surgeon usually it's a traveler who comes up 1-4 times a month to do clinics and elective surgeries/scopes. Urgent care is way too busy to stop seeing patients to assist in the OR. Other sites I have worked are large enough to have a surgical staff that would not need my assistance. It's not really practical to expect to do surgical assist unless that is your primary occupation. Generally FP is so overwhelmed with the volume of patients to be seen I cannot imaging justifying the time to assist on one of your own patients. Of course if you were hospitalist only in a very small 10-15 bed hospital that happened to have a working OR, I could see that being possible if needed. Really depends on the location and the volume. DO NOT PLAN on it.

 

[cabinbuilder]

@akilysa and @teacherman84 thank you! That program is exactly what I was looking for! Now I have to figure out if I can handle living in Dallas for 4 years (nothing against Texas, I just miss Colorado) .

Ugh, check out the FM residency in Anchorage, Alaska. They train you well and it's much better than Colorado any day.

 

[akilysa]

Greeley and St. Mary's are both good FM programs of that style in Colorado if you are looking for ones there.