Questions about surgery as a career

[ayndim]

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I am a premed student and am starting to research fields I might like. I have a couple of questions for all of you surgery residents or attendings.

What was it like the first time you cut a real live person? I am not normally squemish. I have 3 kids afterall. I don't think it would bother me at all. Did anyone else feel that way and have it bother them?

What are the hours like, both during and after residency?

How much is the pay? Although, this isn't my first consideration I will have 3 kids to put through college. My husband makes good money but we will be using most of our savings for school for me as I don't think I will qualify for much financial aid? And what I get will probably be loans that have to pay back.

I want to work in a hospital not private practice. Is that possible?

How hard is it to get into a surgical residency? I had a 4.0 when I got my bachelor's degree (many years ago). I am getting A's in the classes I am currently taking (chem and bio) and imagine I will make A's and B's in med school (all fingers crossed).

Am I going to be hurt because I am older and a mom? I will be 39 when I graduate from med school. I have also been a stay-at-home mom for the last 5 years. My kids will all be in school and also I will have an au pair. As next September. Yeah!!!

I am also thinking about ob/gyn and em. I am a little concerned about ob/gyn as the malpractice insurance seems to be going up and some are having a hard time finding any at all. Plus, I couldn't do it if I had to perform circs as part of a residency.

I would appreciate any advice.

Thanks,

Andrea

 

[VentdependenT]

Get into medical school first and then see what rotations you enjoy. It will come to you then. There is absolutely no use in trying to direct yourself into a field at this time. Even when most of us pick a field we end up changing our minds 2-3x.

Surgery is back breaking, eye reddening, mind maddening, tireless, never ending work. You are the hands of the hospital and will be consulted as such. You must enjoy loads of intolerable stress, bitter attendings, ICU, sleepless nights, and trauma cases post call when you can't even stand up any more. Operating on people is just one small part of what goes into a surgical residency. If you make a mistake, and you will (part of learning), someone is going to die. These folks are hard core.

My experience, but I think others will agree. Of course I'm playing up the negatives, its not entirely like this. However, after a long day it can feel like this. Lots of positives in the field too. OR time, acute life-saving interventions, and fast thinking draws folks into the grinder.

 

[Goober]

I concur- worry about getting into and through medical school first.

Surgery is one of the toughest specialties physically to get through. In your third year you will get to rotate through surgery and you will be able to determine if it is for you.

 

[Castro Viejo]

Originally posted by ayndim
What was it like the first time you cut a real live person?

The first time I cut a real live person (for the purposes of a surgical procedure in the operating room) was nerve-wracking. I shook so much the attending asked, "Hey do you want fries with those shakes?"

What are the hours like, both during and after residency?

The official answer for the question "How many hours do surgical residents put in during the course of a week?" is 80 hours, according to new rules established by the ACGME. The reality is that more than a few surgical programs continue to have their residents work more than 80 hours. Surgical attendings don't really have set hours as surgical emergencies can, and do, occur in the middle of the night. There are also no rules set against the number of hours surgical attendings may work.

How much is the pay?

There are a number of different physician salary surveys out there on the internet that can better answer this one. From my research into this question, I've read that the starting salary can be anywhere from $110,000 to $160,000 for a general surgeon, dependent primarily on geographic location.

I want to work in a hospital not private practice. Is that possible?

Perhaps a more senior resident can answer this question.

How hard is it to get into a surgical residency? I had a 4.0 when I got my bachelor's degree (many years ago). I am getting A's in the classes I am currently taking (chem and bio) and imagine I will make A's and B's in med school (all fingers crossed).

The application process for residency goes beyond college grades, and most programs only asked me why I chose to be a mathematics major in college. Among other things, surgical programs look at board scores (USMLE or COMLEX), grades in medical school, and letters of recommendation. You sound like you're doing a good job now in post-bacc work, so I'd suggest keeping yourself in that zone and do well in med school.

Am I going to be hurt because I am older and a mom?

One of the other surgical residents in my class is a mom. She's handling the work well. I used to think it would be really difficult for moms to do a surgical residency, but I've met more than a few lady residents who are moms. I even think one of the Vandy surgical residents on TLC's "Resident Life" is a mom.

My advice is to continue doing well as a post-bacc student and keep up the good work in med school. You'll find, as most med students do, that their career choices entering med school and graduating usually differ. I started med school wanting to be an orthopedic surgeon and through many twists and turns decided to become a general surgeon.

Good luck.

 

[Winged Scapula]

It is entirely possible to "work in a hospital" (ie, academic surgery) rather than private practice. Since this usually entails teaching, many in this track trained at academic/university programs.

BTW. in many (if not most or all) hospitals the circs are done by Surgeons not OB-Gyns (and you will do them when you rotate on Peds Surg).

 

[njbmd]

Originally posted by Kimberli Cox
It is entirely possible to "work in a hospital" (ie, academic surgery) rather than private practice. Since this usually entails teaching, many in this track trained at academic/university programs.

BTW. in many (if not most or all) hospitals the circs are done by Surgeons not OB-Gyns (and you will do them when you rotate on Peds Surg).

Hey Kimberli,
Didn't "sharpen a single pencil" on my Peds Surgery rotation. Did do plenty of lap appys. Here at UVa, the circs are done by the OB-Gyn folks. Dodged that bullet.

njbmd😀

 

[Winged Scapula]

Originally posted by njbmd
Hey Kimberli,
Didn't "sharpen a single pencil" on my Peds Surgery rotation. Did do plenty of lap appys. Here at UVa, the circs are done by the OB-Gyn folks. Dodged that bullet.

njbmd😀

Hmm...interesting. My BF and I were talking about this and neither of us had ever rotated anywhere where the Ob-Gyns did circs. Goes to show ya how experience can color one's beliefs. Thanks for setting me straight.

 

[maxheadroom]

At my medschool, the neonatologist who ran the nursery did most of the circs. If the parents asked, though, Peds Uro did them.

 

[droliver]

I did a ton on peds surg @ a dedicated peds hospital. I bet the referral patterns differ @ non-specialty hospitals with OBGYN doing more as there's likely to be fewer peds surgeons around

 

[Winged Scapula]

Originally posted by droliver
I did a ton on peds surg @ a dedicated peds hospital. I bet the referral patterns differ @ non-specialty hospitals with OBGYN doing more as there's likely to be fewer peds surgeons around

Yep...most likely the answer. Since my Peds Surg was in a Children's Hospital (albeit with OB right down the hall) we did them all.

 

[Winged Scapula]

Off the OP's topic, but related to circs...

I did one recently on a patient who was having trouble retracting his foreskin because a) he had a tender scrotum and penis and b) he was a right hand amputee.

Q. How are both of these events related?


A. The patient had an extensive psych history and over the years, because of "bad thoughts" eminating from his nether regions, he had amputated his right hand (to prevent himself from mastrubating) with a saw and more recently attempted to cut off his testicles. It only came to "light" when one of the residents at his group home complained that this patient "stunk" more than usual - guess the dirty pocket knife and lack of appropriate prep and post-op care he got was the reason.

 

[avendesora]

Originally posted by Kimberli Cox

BTW. in many (if not most or all) hospitals the circs are done by Surgeons not OB-Gyns (and you will do them when you rotate on Peds Surg).

At the private hospital where I did L&D my third year, the OB/GYN's did them all. My impression was that it was a pretty big cash-cow for them. (Hundred$ a slice 🙂 ?? )

 

[DoctorDoom]

What was it like the first time you cut a real live person? I am not normally squemish. I have 3 kids afterall. I don't think it would bother me at all. Did anyone else feel that way and have it bother them?

*Didn't bother me at all, because I had done so many animal dissections/vivisections, and done so much work on cadavers. You'll be eased into it so that you'll know long before applying for residency whether you can do it or not.

What are the hours like, both during and after residency?

*Residency like Dr. Wu said depends on the degree of adherence to new ACGME regulations. As an attending you'll have more opportunity to control your hours depending on the practice you join, the subspecialty/focus (eg. trauma at a busy urban practice vs. breast surgery in a community setting), and the size and volume of your practice.

How hard is it to get into a surgical residency?

*According to my former Chairman, it is easier. Even though more spots are filled each year fewer applicants are applying overall.


Am I going to be hurt because I am older and a mom?

*Unfortunately, possibly. But if you continue to get good grades and do research in medical school, and come across as a good candidate, someone will be sure to match you.

I couldn't do it if I had to perform circs as part of a residency.

*May I ask why?
*Best of luck.

 

[Winged Scapula]

Originally posted by DoctorDoom

How hard is it to get into a surgical residency?

*According to my former Chairman, it is easier. Even though more spots are filled each year fewer applicants are applying overall.

Unfortunately, your Chairman's info is a bit outdated. There are MORE applicants these days, not fewer and they are filling more positions. Compared to 20 years ago? Perhaps there are fewer but the numbers have jumped up significantly over the last couple of years.

 

[DoctorDoom]

Thanks for the clarification Dr. Cox, I probably misquoted him somehow.

 

[ayndim]

[I couldn't do it if I had to perform circs as part of a residency.

*May I ask why?
*Best of luck. [/B][/QUOTE]

Thank you.

I have a strong objection to circs. I don't want to start a debate as I know this can be a touchy subject. The U.S. is one of the few countries that still do routine circs for non-religious reasons. And the men in those countries don't have any of the problems that people (some drs, not all) say boys/men will have. I was lucky enough to live in Europe for 3 years in my early 20's and have many friends still there. None of my friends husbands or sons have problems. So I feel that it is unnecessary.
My own boys are uncirced. I actually didn't realize that they circed baby boys until I got pg. The ped asked if we were going to circ. I was taken aback. He seemed relieved when I said no. His sons aren't done. He is not originally from America which is probably why. I see a CNM but the OBs there refuse to perform them.

The second reason I object is that I question the legality of a parent giving consent to what I view as a cosmetic procedure (although personally I find the uncirced penis more attractive, but that is just a personal opinion and my husband is circed and I love him just the same). Since I view it that way I would feel unethical performing one.

I also just couldn't do that to a baby. Especially as I feel that is the most sensitive part of the penis. I certainly like my equivalent and am glad no one removed it. What I really can't understand is why female circ is illegal and why there is such an outcry against it but boys aren't afforded the same protection. It is a case of reverse gender discrimination. Does anyone know how many nerve endings are cut away in a circ?

Neither of my boys has every had a urinary infection. As for the higher risk of penile cancer (which is about 1% risk as I understand it, please correct me if I am wrong) my daughter and I have higher risk of breast cancer, but we have decided to keep those. These are the reasons other moms (not medical professionals) give me as to why I should have circed my boys. I don't know if I have great medical professionals in my area but my decision has always been respected and never questioned.

I respect others opinions and these are my own. I certainly don't mean to put anyone else's views down. I do welcome others opinions I just don't want it to get nasty.

Do you think circing a newborn is necessary? Do you think drs just do it because the hospitals push it? Or because it is a quick buck? Does your hospital sell the foreskins? If so, do they get consent? Will you do them if asked? Could you perform one on you own son? I am curious of the next generation of drs opinions and not trying to be sarcasitc/judgemental.

 

[powermd]

I have a strong objection to circs. I don't want to start a debate as I know this can be a touchy subject.

Liar. Anti-circ folk always want to start a debate.

You anti-circ people are so passionate about foreskin. Mmmmm.... foreskins. Ahhhh..

 

[ayndim]

I don't want to debate. You have your opinion, you will do what you want and I have mine. I personally don't consider it my business if you want to circ your children or patients. It doesn't affect me in the least unless one of my children is your patient. And then it doesn't matter because it would still be my decision.

I think you have most of the anti-circ people wrong. There are those who consider it their duty and right to impose their opinion on others. I am not one of them and I despise them. They give those of us who want to inform people of our views when asked(they usually already have the other view) and allow them to make an informed decision. Mostly I find the people who do that uneducated and not willing to accept that other people have beliefs other than their own. And that one size does not fit all. All I am doing is sharing my opinion.

When you are on the other side of the fence it seems like you are being attacked too. I have heard from American friends and family such things as "He will hate you when he is older and has to have it done" . When I reply at least he has a choice you have taken that away from yours, they get offended. But I am not supposed to be offended by their statement. Just goes to show you feel attacked no matter what your views are. I have never started attacking another person for circing their child, unless they attack me. It is not MY child and not MY decision.

I do object to it and will never perform one. I also object to abortions. And although I won't perform one I won't judge people who do. But I would gladly refer a patient to a doctor who does them (circs and abortion). Will I inform my patient of the medical research and other issues that can be backed up (and I have done my research with circs when convincing my husband we should circ our children). Absolutely. Yes I do wish they would be illegal (circs) but while it is legal people have a right to do what they want.

I hope my previous post was non-judgemental and not offensive. I guess debate was not the right word as I do welcome respectful debates. It is the "my opinion is right and you are wrong" arguments that I don't want to get into. I have left circ debate boards for that. Isn't that what has brought science so far. Other scientist challenging one another.


Forgive my grammar, spelling and anything else that doesn't make sense as I am holed up with the flu and am miserable.

 

[NE_Cornhusker1]

Originally posted by Kimberli Cox
Off the OP's topic, but related to circs...

I did one recently on a patient who was having trouble retracting his foreskin because a) he had a tender scrotum and penis and b) he was a right hand amputee.

Q. How are both of these events related?


A. The patient had an extensive psych history and over the years, because of "bad thoughts" eminating from his nether regions, he had amputated his right hand (to prevent himself from mastrubating) with a saw and more recently attempted to cut off his testicles. It only came to "light" when one of the residents at his group home complained that this patient "stunk" more than usual - guess the dirty pocket knife and lack of appropriate prep and post-op care he got was the reason.

why'd anybody stop him? it's pry best if he's out of the gene pool.

 

[DoctorDoom]

Originally posted by powermd
Liar. Anti-circ folk always want to start a debate.

You anti-circ people are so passionate about foreskin. Mmmmm.... foreskins. Ahhhh..

That's unnecessary. Why be rude?

ayndim, I have to say that circs are not something I have thought a lot about. If you feel as strongly about them as you do about abortion I would say I think it's a poor comparison, as I would with female circumscision. There are ostensible health reasons for circs, unlike female circumcision. Anatomically the two are not entirely comparable either, but that's really a secondary point. However, if that's how you feel, then that's how you feel. For me, my personal ethics have to be pretty seriously challenged for me not to perform a procedure on my patient, and neither circs nor abortions fall into that category. You may wish to leave the choice to your children, but some parents are looking out for their children's welfare and therefore want to have that done, as fulfillment of their parental duties.

As you can see I disagree with you in many ways, although not vehemently. If you find yourself actually choosing surgery, then it's possible to avoid circs, but I would challenge you as whether circs are truly comparable to abortion or female circumcision. Is this really something where your personal opinion overrides the needs and desires of the patient? That's a matter of personal opinion. I'm just sharing some thoughts off the top of my head.

Good luck.

 

[DoctorDoom]

Originally posted by NE_Cornhusker1
why'd anybody stop him? it's pry best if he's out of the gene pool.

Lovely sentiment for a person who is about to become a doctor.

 

[powermd]

Originally posted by DoctorDoom
That's unnecessary. Why be rude?

Rude? Hah.. that's funny. There's a reason these people care so much about foreskin. It's a fetish. It may be true that this poster's is not a fetishist, but I've seen enough anti-circ people over the years who can be found posting to straight newsgroups about their "position" on circumcision, and then talking about how erotic it is in the sex forums. One guy even had a website dedicated to foreskin that made it plainly obvious his interest went well beyond protecting newborns from mutilation.

 

[DrBodacious]

Originally posted by powermd
Rude? Hah.. that's funny. There's a reason these people care so much about foreskin. It's a fetish. It may be true that this poster's is not a fetishist, but I've seen enough anti-circ people over the years who can be found posting to straight newsgroups about their "position" on circumcision, and then talking about how erotic it is in the sex forums. One guy even had a website dedicated to foreskin that made it plainly obvious his interest went well beyond protecting newborns from mutilation.

LOL Sounds like you've "investigated" this issue pretty extensively, good work studying up on foreskin fetish websites and sex forums!


Seriously now, I have a couple questions for you surg residents (hope they weren't already answered somewhere). When, in what year, do you usually start making incisions?

Or more generally, I'd like to know the sequence of what sort of roles you play in yrs 1, 2, etc. (i.e. sutureing, incisions, different procedures of various complexities) But, w/ 80 hour work weeks and all you may not have time to fill me in on all that. If anyone knows where I could find this info elsewhere, that'd be cool too.

Thanks.
.

 

[DrBodacious]

Anybody?

 

[Winged Scapula]

Originally posted by DrBodacious
LOL Sounds like you've "investigated" this issue pretty extensively, good work studying up on foreskin fetish websites and sex forums!


Seriously now, I have a couple questions for you surg residents (hope they weren't already answered somewhere). When, in what year, do you usually start making incisions?

Or more generally, I'd like to know the sequence of what sort of roles you play in yrs 1, 2, etc. (i.e. sutureing, incisions, different procedures of various complexities) But, w/ 80 hour work weeks and all you may not have time to fill me in on all that. If anyone knows where I could find this info elsewhere, that'd be cool too.

Thanks.
.

Depends on the complexity of the case and whether I was FA (first Assist), SA (second assist) or SJ (Surgeon Junior). I made some incisions as a medical student and most of them on FA and SJ cases as an intern. Obviously as you become more senior you do more (ie, sewing vascular anastomoses, doing the case rather than assisting) - how much you do depends on the attending , the complexity of the case, your skills and interest. I know some attendings who still try and do most of the case and others who let medical students make the incisions and suture.

There will be no hard and fast rules, it will vary from program to program and attending to attending. I would expect that on "junior level" cases that you are doing more and more as time goes by (ie, interns should be doing a least a fair bit of the incision, suturing, etc. during an inguinal hernia, appys, lumps and bumps - although maybe not on the face) and more senior residents everything.

 

[DrBodacious]

Sweet, Thank you Kim. I wasn't familiar with the breakdown of FA, SA, and SJ. Very helpful.