Quitting Surgery Part II

[anicha06]

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(Sorry this is a long post. I don’t like reading long posts myself but I just needed to vent.)
It’s that time of year again, and I’m forced to make a decision that I keep putting off. Do I quit surgery?

A year ago, I posted about my struggles as a surgery resident and asked for advice about taking a year off. I ended up going into the lab, and it was the best decision I ever made. I feel balanced, happy, free, and no longer have issues with my back. I’ve done good work in the lab (or so my PI says), so I regained a little confidence that was previously lost during residency. I don’t miss the OR nor do I miss clinical work, mainly because I associate it with stress. (I really think residency gave me PTSD.)

I now have to make a few decisions, and I never expected it to be so hard.
1. Do I quit surgery?
2. If I quit surgery and choose anesthesia (and most likely start 2 years from now in 2014 as a CA-1 unless an expected spot opens), what do I do in the meantime to get paid?
This decision seems really easy based on what people have written on this forum. They hate the BS, the hours, operating, the lifestyle. They are desperate to leave. I wish it was an easy decision for me, but I have been struggling with it for a long time and have talked this through with the closest people in my life (2 of them being in my program).

Like many on this forum, I was extremely driven and ambitious and made many sacrifices to get to where I am today. I knew since I was young that I wanted to be a surgeon. I took a hit in medical school and really lost the drive (though not the dream). When I was an MS4, I was really reluctant to pursue the dream because by then I was already becoming jaded and tired. I ended up going into surgery because I wasn’t interested in anything else (which wasn’t a good enough reason, per my Chairwoman).

Then during residency, I struggled. I was miserable. I hated coming into work each day. I felt anxious all the time. I was just waiting to be exposed as incompetent and not fit for surgery. I avoided the OR. I couldn’t enjoy operating (but still not sure if it was because I found it tedious and uninteresting or because I was too ridden with anxiety). And as I said in my previous post, I was a good resident, well-liked by my peers and most attendings, and even called a “superstar” by our neurosurgeon (who urged me not to quit). Attendings from the ED and SICU had written unsolicited letters to my PD saying glorious things about me (though I highly doubt my PD cares). If I’m doing such a good job, is it a waste to quit? The years of hard work, my skills, the potential of becoming an excellent and kind surgeon making a tangible difference in a patient’s life … wasted? With my background I’d have a chance in surg onc, so should I go for it if there’s an opportunity?

Then I stop to remind myself that this is how I have always idealized surgery. Yet the reality (for me) is that I’m so tired/exhausted/frustrated with people and the system that most times I don’t care about the operation or the patient interaction. I just want my cases to finish so I could go home, relax, and do something stress-free. And why should I sacrifice my life to help self-entitled, ignorant people who don’t even want to help themselves and treat me like a servant or a nurse?

Idealizing surgery and my ego has kept me going for awhile, but real life is smacking me in the face and reminding me that I’m unhappy. But aren’t all residents unhappy, especially surgical residents? It seems that the only thing that keeps residents going is operating. It seems clear that once you realize you don’t like operating, it’s time to get out. But I’m good at and confident with procedures. I feel like there’s no reason for me to not like operating. Sure, we all hate operating with certain people, but everyone still wants to be in the OR. In my case, I can get paralyzing anxiety so it’s difficult to want to be in the OR. Despite all the good feedback that I’ve gotten, my self-esteem plummets when an attending humiliates me in the OR and sometimes I never recover. I’ve had an attending say “did you really go to [prestigious school]? I find that hard to believe if you didn’t know the answer to [some stupid pimp question]” or “how do you not know how to [some procedure I was never taught]?! Get out of this case and call your senior”. But there are other times that I’m with an attending who is fair and likes to teach, and the case goes smoothly. But I don’t recall being excited about it or wanting to do more. Is my disinterest real or is it the mild depression that all residents have?

Regarding anesthesia, the lifestyle is flexible. You can be busy or scale back. There are fellowship options that involve more patient interaction if desired. I like critical care, and it seems like anesthesia could be a good fit. Problem is, I’ve never been interested in a career in anesthesia, never saw myself on the other side of the drape, and don’t know if I could put up with a surgeon’s attitude my entire life. Yes sometimes I look at the anesthesiologist and envy his life, but I never saw myself in his shoes. It just seems like a practical decision. But what if I never feel accomplished because I didn’t achieve “the dream”? Will I always feel like a failure and a quitter? Will I think I wasted any talent? Will I feel like I wasted all that hard work and sacrifice to end up with a job I felt “meh” about? Or will I be happy that I saved my own life instead of saving others.

Then there’s the issue of finding a program and how much risk I’m willing to take. I would take the risk if I absolutely hated surgery and had no doubts, but in this case it is a big factor.

I realize that any decision I make, I have to make some sort of sacrifice. And I realize also that my ego is holding me back from quitting. Either I follow my ego and pay the price or choose a lifestyle career and risk longing to be something more?
Maybe I’m not asking for advice since this is a choice I have to make, but it would be nice to know if others have gone through the same struggle.

 

[SLUser11]

Hi,

I remember your situation from a year ago, and I'm glad your lab year has allowed you to clear your head a little. I think the most important question to ask is whether you are unhappy with surgery as a profession, or just unhappy with your specific residency environment.

To answer your question, not all surgery residents are miserable, and it's not necessary to be miserable in order to get a surgical education. If work really makes you that miserable after being there for 3 years, I recommend changing your residency or changing your specialty.

As far as ego is concerned, I would take that out of the equation. It's silly to think you're too good for anesthesia, and quitting surgery would be wasting your talent.

Now for the hard questions: Do you really think you are a "well-liked superstar" at your work? If so, why are you getting yelled at by attendings in the OR, and why do you have a crippling fear of being "exposed" as a failure? How can you simultaneously be "good at and confident with procedures" while talking about getting kicked out of the OR and struggling and being miserable?

Why are ER and SICU docs writing letters of support to your PD? Are you not telling us about problems you're having that the program is aware of? If you want us to give you an educated opinion, we'll need more information.

 

[upright]

It sounds to me like the only real perceived "pros" of being a surgeon for you are related to nurturing your ego. When you step back and look at the reality of it all though, you'd much prefer a life of balance, some predictability, and most importantly, control.

I'm of the opinion that most surgeons are in that position because they needed to feed their ego and become SURGEONS. They completely masochize themselves for the honor of that title. After many years in the profession they find that sacrifice was all for the attainment of an illusion, and lo and behold, the *******, disgruntled surgeon is born.

There's also the small percent that are just genuine workaholics. They thrive on not having any free time to live life outside of the OR. They wouldn't know what to do with the free time they'd have anyhow. These are the ones whose wives are blowing the gardner, who eat dinner once a month with their family to the sound of silence, broken up by clanking glass and clearing of throats while his bitter emo daughter won't even make eye-contact with him because he's spent a lifetime away from his family and they have nothing to say to one another.

Get out while you can. Choose a life of balance. You're a doctor - read the studies. Happiness is a life of control, not extremes.

 

[SLUser11]

It sounds to me like the only real perceived "pros" of being a surgeon for you are related to nurturing your ego. When you step back and look at the reality of it all though, you'd much prefer a life of balance, some predictability, and most importantly, control.

I'm of the opinion that most surgeons are in that position because they needed to feed their ego and become SURGEONS. They completely masochize themselves for the honor of that title. After many years in the profession they find that sacrifice was all for the attainment of an illusion, and lo and behold, the *******, disgruntled surgeon is born.

There's also the small percent that are just genuine workaholics. They thrive on not having any free time to live life outside of the OR. They wouldn't know what to do with the free time they'd have anyhow. These are the ones whose wives are blowing the gardner, who eat dinner once a month with their family to the sound of silence, broken up by clanking glass and clearing of throats while his bitter emo daughter won't even make eye-contact with him because he's spent a lifetime away from his family and they have nothing to say to one another.

Get out while you can. Choose a life of balance. You're a doctor - read the studies. Happiness is a life of control, not extremes.

The vast majority of surgeons in the United States do not fit this caricature that you've described, and to be honest your description is a little insulting.

Still, I don't think it's your fault. Medical students are very susceptible to the histrionic, tunnel-visioned rants of their surgical residents and attendings. Residents have no experience in the actual practice of surgery, and their residency experience is limited to their home institution, so their opinions on the art of surgery should be taken with a grain of salt.

You don't have to be a martyr to be a good surgeon, and you certainly don't have to be maladjusted and unhappy.

 

[upright]

The vast majority of surgeons in the United States do not fit this caricature that you've described, and to be honest your description is a little insulting.

Still, I don't think it's your fault. Medical students are very susceptible to the histrionic, tunnel-visioned rants of their surgical residents and attendings. Residents have no experience in the actual practice of surgery, and their residency experience is limited to their home institution, so their opinions on the art of surgery should be taken with a grain of salt.

You don't have to be a martyr to be a good surgeon, and you certainly don't have to be maladjusted and unhappy.

I don't mean to insult you. My description is partly tongue-in-cheek. But we must admit, there is something askew with someone taking on the lifestyle burden that surgery demands.

And if I can be the one that uses the difference in our moments in training to prove my point. You are so far through the process that perhaps you've forgotten what brought you through it. My, being a meager 3rd year knows very well what drives my classmates into it. It's to be a SURGEON. It's glamour.

 

[joehuf]

It sounds to me like the only real perceived "pros" of being a surgeon for you are related to nurturing your ego. When you step back and look at the reality of it all though, you'd much prefer a life of balance, some predictability, and most importantly, control.

I'm of the opinion that most surgeons are in that position because they needed to feed their ego and become SURGEONS. They completely masochize themselves for the honor of that title. After many years in the profession they find that sacrifice was all for the attainment of an illusion, and lo and behold, the *******, disgruntled surgeon is born.

There's also the small percent that are just genuine workaholics. They thrive on not having any free time to live life outside of the OR. They wouldn't know what to do with the free time they'd have anyhow. These are the ones whose wives are blowing the gardner, who eat dinner once a month with their family to the sound of silence, broken up by clanking glass and clearing of throats while his bitter emo daughter won't even make eye-contact with him because he's spent a lifetime away from his family and they have nothing to say to one another.

Get out while you can. Choose a life of balance. You're a doctor - read the studies. Happiness is a life of control, not extremes.

Bitter much? I think in reality most of us are pretty happy doing what we do. It may be a little more difficult but we've found a work/life balance that I think is pretty normal and certainly acceptable to us and our families. But granted, it isn't for everyone. To the OP as previously stated, I think you need to separate out what are truly issues within your particular residency program and what are issues with the profession in general. I don't think it's unusual to have some doubts about your choice while in residency at all. My best advice is to talk to surgeons in practice, both inside and outside of your program. Determine if you like the lifestyle they have and make a decision based on that. I don't think being an anesthesiologist or emergency medicine doc is any less prestigous but it is different.

PS Just for everyone reading this to know, I just asked my wife and she is not "blowing the gardner"

 

[upright]

Bitter much? I think in reality most of us are pretty happy doing what we do. It may be a little more difficult but we've found a work/life balance that I think is pretty normal and certainly acceptable to us and our families. But granted, it isn't for everyone. To the OP as previously stated, I think you need to separate out what are truly issues within your particular residency program and what are issues with the profession in general. I don't think it's unusual to have some doubts about your choice while in residency at all. My best advice is to talk to surgeons in practice, both inside and outside of your program. Determine if you like the lifestyle they have and make a decision based on that. I don't think being an anesthesiologist or emergency medicine doc is any less prestigous but it is different.

PS Just for everyone reading this to know, I just asked my wife and she is not "blowing the gardner"

Do you have a pool man?

 

[anicha06]

Now for the hard questions: Do you really think you are a "well-liked superstar" at your work? If so, why are you getting yelled at by attendings in the OR, and why do you have a crippling fear of being "exposed" as a failure? How can you simultaneously be "good at and confident with procedures" while talking about getting kicked out of the OR and struggling and being miserable?

Why are ER and SICU docs writing letters of support to your PD? Are you not telling us about problems you're having that the program is aware of? If you want us to give you an educated opinion, we'll need more information.

Thanks so much for your response. To be absolutely and completely honest, I don't feel like I am a "superstar". In fact, I look up to my colleagues because I feel they all have strengths I don't have. I have no idea why anyone would write letters of support for me. I didn't know about it until my yearly evaluation with the PD, and the letters were in my file. I apologize if my original post came off arrogant, but truthfully I don't feel confident and never feel like I'm good enough, which is probably why I work so hard. My colleagues and seniors who I confide in are the ones who remind me what my own strengths are. My chiefs told me that no attending has ever said anything bad about me at faculty meetings even though they criticize a lot of residents. My seniors tell me these things because they know I'm struggling internally, and they want me to continue. So why did I get yelled at by that one particular attending? Because I didn't know an answer to his pimp question. Maybe he's just a jerk. The other attending who sent me out of the OR has done the same to 5 other residents. I just don't have thick enough skin as the rest of the residents to not let it get to me. I don't really have any more information to give. The program doesn't have problems with me or at least hasn't said anything to me about it. If my PD had issues with me, I'd hope that he would've shared them with me during our evaluation. Thanks again for your advice.

 

[SLUser11]

Do you have a pool man?

Nice. I LOL'd.

 

[anicha06]

I do respect the field of anesthesia and believe that an anesthesiologist's job is important. I don't want to give the wrong impression. It's just very, very different from surgery and not something I ever considered ... so the idea requires some adjustment.

I also respect what surgeons do, even moreso after going through residency. My fiancé is a CT surgery fellow, and I think for him, despite all the struggles, it was the best decision he could have made for himself. I just want to have the same passion in something so that whatever difficulties I have to go through, it would be worth it. Maybe my PTSD is clouding my ability to like operating. Maybe it is my program. Thanks everyone.

 

[davidjones]

Hi.

Sorry to hear about your struggles but thought this might help you out. I'm in radiology and one of our chiefs is had a very similar story to you, actually got accepted to
An HPB fellowship and decided to switch gears to do IR and is going to Hopkins next year. There are pathways for IR called DIRECT that count 2 years of surgical residency towards the 6 years of training. You still get to be on the other side of the drape but the lifestyle can be more manageable and there is a ton of research both translational and basic science.

I wish you good luck with your decision, ultimately it's about your happiness , a happy anesthesiologist, IR, family doc etc will take better care of patients than a miserable surgeon and vice versa.

 

[doc05]

I recommend that you quit now. Sounds like you don't enjoy the work -- why put up with all that nonsense if it's not the right field for you?\

Best of luck

 

[Margo]

(sorry this is a long post. I don’t like reading long posts myself but i just needed to vent.)
it’s that time of year again, and i’m forced to make a decision that i keep putting off. Do i quit surgery?

A year ago, i posted about my struggles as a surgery resident and asked for advice about taking a year off. i ended up going into the lab, and it was the best decision i ever made. I feel balanced, happy, free, and no longer have issues with my back. I’ve done good work in the lab (or so my pi says), so i regained a little confidence that was previously lost during residency. I don’t miss the or nor do i miss clinical work, mainly because i associate it with stress. (i really think residency gave me ptsd.)

i think you answered your own question here.

i now have to make a few decisions, and i never expected it to be so hard.
1. Do i quit surgery?
why is it so hard? You said you don't miss the or or the clinical work. Why would you want to continue the path that is clearly self-destructive, eg ptsd, lost confidence?

2. If i quit surgery and choose anesthesia (and most likely start 2 years from now in 2014 as a ca-1 unless an expected spot opens), what do i do in the meantime to get paid?

think about what else you can do with your degree.

this decision seems really easy based on what people have written on this forum. They hate the bs, the hours, operating, the lifestyle. They are desperate to leave. I wish it was an easy decision for me, but i have been struggling with it for a long time and have talked this through with the closest people in my life (2 of them being in my program).

like many on this forum, i was extremely driven and ambitious and made many sacrifices to get to where i am today.

the same drive will help you find a job your are happy with. You are intelligent and ambitious, and you will succeed. You just need to shift your gears and think outside the box.

i knew since i was young that i wanted to be a surgeon. I took a hit in medical school and really lost the drive (though not the dream).

so you became disillusioned. Not all that unusual, since a lot of us don't grasp the reality of medicine until it kicks in the butt sometime during the 3rd year: The hours, the rigid military style hierarchy, the erratic personalities, having little to no control of where we pursue the residency etc etc. The childhood dream got a dose of reality.

when i was an ms4, i was really reluctant to pursue the dream because by then i was already becoming jaded and tired. I ended up going into surgery because i wasn’t interested in anything else (which wasn’t a good enough reason, per my chairwoman).

then during residency, i struggled. I was miserable. I hated coming into work each day. I felt anxious all the time. I was just waiting to be exposed as incompetent and not fit for surgery. I avoided the or. I couldn’t enjoy operating (but still not sure if it was because i found it tedious and uninteresting or because i was too ridden with anxiety). and as i said in my previous post, i was a good resident, well-liked by my peers and most attendings, and even called a “superstar” by our neurosurgeon (who urged me not to quit). Attendings from the ed and sicu had written unsolicited letters to my pd saying glorious things about me (though i highly doubt my pd cares).

think about whether you'd want to be in this environment again. You've been out of the hospital for about a year now, so it may not seem so bad in retrospect. But more of the same for 5-7 years? It just sounds like all of your energy was spent not on acquiring the professional skills but on coping with daily job-related stresses. Surgery is a kind of specialty where you need to be comfortable with making life-and-death decisions and to be comfortable with discussing your mistakes in a public forum, both highly anxiety provoking situations for anyone, especially for people susceptible to stress. It does not matter what your letters say. How good do you feel about yourself and your capabilities to carry on?

if i’m doing such a good job, is it a waste to quit? The years of hard work, my skills, the potential of becoming an excellent and kind surgeon making a tangible difference in a patient’s life … wasted? With my background i’d have a chance in surg onc, so should i go for it if there’s an opportunity?

if this is really what you want to do, go for it. However i think it should not be done at the expense of your health or sanity. No dream is worth it, whether personal or career-related. And your skills and knowledge would never be wasted anyway. You just have not given yourself a chance to explore other possibilities.

then i stop to remind myself that this is how i have always idealized surgery. Yet the reality (for me) is that i’m so tired/exhausted/frustrated with people and the system that most times i don’t care about the operation or the patient interaction. I just want my cases to finish so i could go home, relax, and do something stress-free. And why should i sacrifice my life to help self-entitled, ignorant people who don’t even want to help themselves and treat me like a servant or a nurse?

idealizing surgery and my ego has kept me going for awhile, but real life is smacking me in the face and reminding me that i’m unhappy. But aren’t all residents unhappy, especially surgical residents?

no, not all surgical residents are unhappy. In fact, you don't necessarily have to be "unhappy" to walk away from a profession that does not suit you. people choose to quit residency for all kinds of reasons. some realize that they want to pursue a different specialty, others choose to walk away altogether.

it seems that the only thing that keeps residents going is operating. It seems clear that once you realize you don’t like operating, it’s time to get out. But i’m good at and confident with procedures. I feel like there’s no reason for me to not like operating. Sure, we all hate operating with certain people, but everyone still wants to be in the or. in my case, i can get paralyzing anxiety so it’s difficult to want to be in the or. Despite all the good feedback that i’ve gotten, my self-esteem plummets when an attending humiliates me in the or and sometimes i never recover.

once again, you answer your own question here. Even in the most benign program you will encounter personalities like this one, and need to have a tough skin. You cannot depend on other people's opinions of you, and there will be lots of them, as you have already seen.your coping mechanism should be concentrating on acquiring the skills necessary to someday practice surgery independently. You simply cannot afford to waste your energy on personalities. No criticism is personal, if it concerns the well-being of a patient. If you can do that, then you have a chance to succeed in residency.

i’ve had an attending say “did you really go to [prestigious school]? I find that hard to believe if you didn’t know the answer to [some stupid pimp question]” or “how do you not know how to [some procedure i was never taught]?! Get out of this case and call your senior”. But there are other times that i’m with an attending who is fair and likes to teach, and the case goes smoothly. But i don’t recall being excited about it or wanting to do more. is my disinterest real or is it the mild depression that all residents have?

it sounds more like you are extremely stressed out and beaten up by the environment you work in, and have not found a way to cope with it.

regarding anesthesia, the lifestyle is flexible. You can be busy or scale back. There are fellowship options that involve more patient interaction if desired. I like critical care, and it seems like anesthesia could be a good fit. Problem is, i’ve never been interested in a career in anesthesia, never saw myself on the other side of the drape, and don’t know if i could put up with a surgeon’s attitude my entire life. Yes sometimes i look at the anesthesiologist and envy his life, but i never saw myself in his shoes. It just seems like a practical decision. but what if i never feel accomplished because i didn’t achieve “the dream”? Will i always feel like a failure and a quitter? Will i think i wasted any talent? Will i feel like i wasted all that hard work and sacrifice to end up with a job i felt “meh” about? Or will i be happy that i saved my own life instead of saving others.

like i said, sometime your dream can become your worst nightmare, so don't feel bad that a childhood dream did not come true. Dreams can be based on illusions, and there are plenty that common folks have about medicine. And, second of all, you will never know until your try. Maybe arrange to do a rotation in anesthesia and see how you do.

then there’s the issue of finding a program and how much risk i’m willing to take. I would take the risk if i absolutely hated surgery and had no doubts, but in this case it is a big factor.

i realize that any decision i make, i have to make some sort of sacrifice. And i realize also that my ego is holding me back from quitting. Either i follow my ego and pay the price or choose a lifestyle career and risk longing to be something more?

you are not quitting. Your are making a choice that is right for you. The choice that will allow you to find a job you enjoy and become successful at what you do. If "something more" involves being humiliated on a daily basis and feeling like crap, then is it really worth crying over? No specialty or job is perfect. You need to find the one where you can tolerate the negatives and still feel like you've accomplished something at the end of the day, ie the rewards (and i am not talking about money here at all) have to be greater than negatives. Have some self-respect. Don't ask other people to make a decision for you. Many will probably will encourage you to carry on, b/c it "gets better every year" or "loans to pay off" or "your current program is not right" etc, simply because they don't see an alternative. It may take you some work and time to find a career that fits you, but that sure beats being persistent and miserable in a career that did not meet your expectations.

maybe i’m not asking for advice since this is a choice i have to make, but it would be nice to know if others have gone through the same struggle.

. .

 

[Buzz Me]

Not much to add to the excellent post by SLUser11 above. I agree that taking a critical look at your situation and trying to ascertain whether it's your program or the Gen Surg residency that's getting you down is key. Are your fellow residents also unhappy? How is the culture of your residency program? How are the Anesthesia residents there?

I don't mean to insult you. My description is partly tongue-in-cheek.

I would also caution you from making such blanket statements, especially as an M3. If you were joking in a deadpan manner, that's fine, but that's not how your initial post came across.

But we must admit, there is something askew with someone taking on the lifestyle burden that surgery demands.

You're thinking of going into Psych, right? So I would argue that residents/attendings in fields which place more value on lifestyle have diametrically opposed philosophies to those in the time-demanding fields. And it's therefore hard for either group to understand the other side's position. For instance (using Psych as an example), I know enough about myself to know I don't have the patience to talk to a patient for longer than 30-45 minutes, would feel frustrated not being able to see and touch their pathology, and would be too irritable and antsy rounding all day without using my hands. On the other hand, long operative cases, sick-as-hell, on-death's-door ICU patients, advanced surgical instruments ("toys")...that's what excites me and makes me look forward to come to work every day. It's precisely those elements that makes the tough lifestyle and occasional beat-down by an attending all worth it.

I've often said that, for the most part, med students like being in the OR when they're actively involved. Everyone likes to cut, suture, tie, get their gloves bloody. But the ones that go into surgery are the ones that like operating SO MUCH it's worth putting up with the bad lifestyle (at least during residency/fellowship).

 

[Thanatos]

Don't have too much to add to what has already been said, doesn't sound like you are very happy in surgery though and I think that's the real issue.


brb getting a job as a gardener or a pool guy though (semi srs)

 

[upright]

Not much to add to the excellent post by SLUser11 above. I agree that taking a critical look at your situation and trying to ascertain whether it's your program or the Gen Surg residency that's getting you down is key. Are your fellow residents also unhappy? How is the culture of your residency program? How are the Anesthesia residents there?



I would also caution you from making such blanket statements, especially as an M3. If you were joking in a deadpan manner, that's fine, but that's not how your initial post came across.



You're thinking of going into Psych, right? So I would argue that residents/attendings in fields which place more value on lifestyle have diametrically opposed philosophies to those in the time-demanding fields. And it's therefore hard for either group to understand the other side's position. For instance (using Psych as an example), I know enough about myself to know I don't have the patience to talk to a patient for longer than 30-45 minutes, would feel frustrated not being able to see and touch their pathology, and would be too irritable and antsy rounding all day without using my hands. On the other hand, long operative cases, sick-as-hell, on-death's-door ICU patients, advanced surgical instruments ("toys")...that's what excites me and makes me look forward to come to work every day. It's precisely those elements that makes the tough lifestyle and occasional beat-down by an attending all worth it.

I've often said that, for the most part, med students like being in the OR when they're actively involved. Everyone likes to cut, suture, tie, get their gloves bloody. But the ones that go into surgery are the ones that like operating SO MUCH it's worth putting up with the bad lifestyle (at least during residency/fellowship).

Fair enough. You make a good point. I guess I just get annoyed with many of my surgical classmates because they can be difficult to interact with. They don't seem to understand that not everyone has the inclination to be a "live to work" type.

 

[igap]

I just read your old posts, and the new ones in this thread.

No one enjoys every aspect of residency. Surgical training is hard, and sometimes unpleasant. Getting yelled at occasionally is par for the course. If your surgical training is not extremely humbling then chances are you are not being trained well.

I completed very rigorous training for my residency, and my fellowship. Sometimes I was unhappy, but that was unimportant to me at the time because I looked at the big picture. I was happy to have the opportunity to train where I did because I was trained by outstanding surgeons in high-volume environments. I accepted that the path to becoming very well-trained was rocky at times.

I have been in practice for a short time, and am happier than I have ever been. I am busy, but not stressed. I am well-paid, and have more free time than most lawyers, engineers, investment bankers, etc. I am excited about my profession, and am respected for my abilities by my peers and my patients alike. I know how to work up my patients, plan their operations, take care of complications, make decisions easily and quickly, and in short be a good surgeon. This ability was acquired through years of extremely hard work, sacrifice, and at times emotional turmoil. But, it was worth every second, and now I am reaping the rewards of my hard work and the efforts of my surgical teachers. I am still learning every day, and I love it.

I think in the era of 80 hours, no overnight call for interns, and the overall generation Y sense of having everything on your own terms, many folks are unwilling to train on others' terms. They want to constantly be told that they are a great resident, that in faculty meetings no one says anything bad about you, that you are great at this or that, or whatever. I can think of two or three times in residency and fellowship when I was told positive things, and countless times when I was told of my shortcomings. I liked it that way since I always was looking for ways to improve. I never worried about whether my attendings thought I was "strong" or not. The mentality of my training programs was, "if you f*** up we will let you know, otherwise just keep busting your behind". No cookies or gold stars.

You have to step outside of your current frame of mind, and decide what you want out of your life. Have you ever asked yourself what you want to become, how hard you are willing to work to achieve it, and answered yourself honestly? Until you do that, you will be a wanderer, always asking others for validation or advice. It's your life, and everyone else are just bit players. It is really very simple. Decide what you want to do, and then do it. But, also be prepared for a rocky path no matter what you want to do. Nothing worthwhile is easy.

 

[agranulocytosis]

I just read your old posts, and the new ones in this thread.

No one enjoys every aspect of residency. Surgical training is hard, and sometimes unpleasant. Getting yelled at occasionally is par for the course. If your surgical training is not extremely humbling then chances are you are not being trained well.

I completed very rigorous training for my residency, and my fellowship. Sometimes I was unhappy, but that was unimportant to me at the time because I looked at the big picture. I was happy to have the opportunity to train where I did because I was trained by outstanding surgeons in high-volume environments. I accepted that the path to becoming very well-trained was rocky at times.

I have been in practice for a short time, and am happier than I have ever been. I am busy, but not stressed. I am well-paid, and have more free time than most lawyers, engineers, investment bankers, etc. I am excited about my profession, and am respected for my abilities by my peers and my patients alike. I know how to work up my patients, plan their operations, take care of complications, make decisions easily and quickly, and in short be a good surgeon. This ability was acquired through years of extremely hard work, sacrifice, and at times emotional turmoil. But, it was worth every second, and now I am reaping the rewards of my hard work and the efforts of my surgical teachers. I am still learning every day, and I love it.

I think in the era of 80 hours, no overnight call for interns, and the overall generation Y sense of having everything on your own terms, many folks are unwilling to train on others' terms. They want to constantly be told that they are a great resident, that in faculty meetings no one says anything bad about you, that you are great at this or that, or whatever. I can think of two or three times in residency and fellowship when I was told positive things, and countless times when I was told of my shortcomings. I liked it that way since I always was looking for ways to improve. I never worried about whether my attendings thought I was "strong" or not. The mentality of my training programs was, "if you f*** up we will let you know, otherwise just keep busting your behind". No cookies or gold stars.

You have to step outside of your current frame of mind, and decide what you want out of your life. Have you ever asked yourself what you want to become, how hard you are willing to work to achieve it, and answered yourself honestly? Until you do that, you will be a wanderer, always asking others for validation or advice. It's your life, and everyone else are just bit players. It is really very simple. Decide what you want to do, and then do it. But, also be prepared for a rocky path no matter what you want to do. Nothing worthwhile is easy.

👍

I think this is what separates surgery programs from others.

 

[Buzz Me]

Fair enough. You make a good point. I guess I just get annoyed with many of my surgical classmates because they can be difficult to interact with. They don't seem to understand that not everyone has the inclination to be a "live to work" type.

Remember that there's a big difference between med students who are interested in surgery, and actual surgical residents/fellows/attendings. Many attitudes will change (involuntarily, at times) once you hit intern year.

 

[angleoflouise]

I just read your old posts, and the new ones in this thread.

No one enjoys every aspect of residency. Surgical training is hard, and sometimes unpleasant. Getting yelled at occasionally is par for the course. If your surgical training is not extremely humbling then chances are you are not being trained well.

I completed very rigorous training for my residency, and my fellowship. Sometimes I was unhappy, but that was unimportant to me at the time because I looked at the big picture. I was happy to have the opportunity to train where I did because I was trained by outstanding surgeons in high-volume environments. I accepted that the path to becoming very well-trained was rocky at times.

I have been in practice for a short time, and am happier than I have ever been. I am busy, but not stressed. I am well-paid, and have more free time than most lawyers, engineers, investment bankers, etc. I am excited about my profession, and am respected for my abilities by my peers and my patients alike. I know how to work up my patients, plan their operations, take care of complications, make decisions easily and quickly, and in short be a good surgeon. This ability was acquired through years of extremely hard work, sacrifice, and at times emotional turmoil. But, it was worth every second, and now I am reaping the rewards of my hard work and the efforts of my surgical teachers. I am still learning every day, and I love it.

I think in the era of 80 hours, no overnight call for interns, and the overall generation Y sense of having everything on your own terms, many folks are unwilling to train on others' terms. They want to constantly be told that they are a great resident, that in faculty meetings no one says anything bad about you, that you are great at this or that, or whatever. I can think of two or three times in residency and fellowship when I was told positive things, and countless times when I was told of my shortcomings. I liked it that way since I always was looking for ways to improve. I never worried about whether my attendings thought I was "strong" or not. The mentality of my training programs was, "if you f*** up we will let you know, otherwise just keep busting your behind". No cookies or gold stars.

You have to step outside of your current frame of mind, and decide what you want out of your life. Have you ever asked yourself what you want to become, how hard you are willing to work to achieve it, and answered yourself honestly? Until you do that, you will be a wanderer, always asking others for validation or advice. It's your life, and everyone else are just bit players. It is really very simple. Decide what you want to do, and then do it. But, also be prepared for a rocky path no matter what you want to do. Nothing worthwhile is easy.

Loved this! Thank you 🙂

 

[Jack is Back]

But we must admit, there is something askew with someone taking on the lifestyle burden that surgery demands.

My, being a meager 3rd year knows very well what drives my classmates into it. It's to be a SURGEON. It's glamour.

As others have said, I don't think this is the case.

Someone needs to take care of those patients, what if everyone had your attitude?

Also, I would say that most go into surgery because they are interested in it, not because of glamour.

 

[LongIslProdigy]

I just read your old posts, and the new ones in this thread.

No one enjoys every aspect of residency. Surgical training is hard, and sometimes unpleasant. Getting yelled at occasionally is par for the course. If your surgical training is not extremely humbling then chances are you are not being trained well.

I completed very rigorous training for my residency, and my fellowship. Sometimes I was unhappy, but that was unimportant to me at the time because I looked at the big picture. I was happy to have the opportunity to train where I did because I was trained by outstanding surgeons in high-volume environments. I accepted that the path to becoming very well-trained was rocky at times.

I have been in practice for a short time, and am happier than I have ever been. I am busy, but not stressed. I am well-paid, and have more free time than most lawyers, engineers, investment bankers, etc. I am excited about my profession, and am respected for my abilities by my peers and my patients alike. I know how to work up my patients, plan their operations, take care of complications, make decisions easily and quickly, and in short be a good surgeon. This ability was acquired through years of extremely hard work, sacrifice, and at times emotional turmoil. But, it was worth every second, and now I am reaping the rewards of my hard work and the efforts of my surgical teachers. I am still learning every day, and I love it.

I think in the era of 80 hours, no overnight call for interns, and the overall generation Y sense of having everything on your own terms, many folks are unwilling to train on others' terms. They want to constantly be told that they are a great resident, that in faculty meetings no one says anything bad about you, that you are great at this or that, or whatever. I can think of two or three times in residency and fellowship when I was told positive things, and countless times when I was told of my shortcomings. I liked it that way since I always was looking for ways to improve. I never worried about whether my attendings thought I was "strong" or not. The mentality of my training programs was, "if you f*** up we will let you know, otherwise just keep busting your behind". No cookies or gold stars.

You have to step outside of your current frame of mind, and decide what you want out of your life. Have you ever asked yourself what you want to become, how hard you are willing to work to achieve it, and answered yourself honestly? Until you do that, you will be a wanderer, always asking others for validation or advice. It's your life, and everyone else are just bit players. It is really very simple. Decide what you want to do, and then do it. But, also be prepared for a rocky path no matter what you want to do. Nothing worthwhile is easy.

👍 x 2

 

[LongIslProdigy]

And to further that... ' Bill Gates' ' 11 Rules of Life

http://urbanlegends.about.com/library/bl_bill_gates_speech.htm

 

[Buzz Me]

Also, I would say that most go into surgery because they are interested in it, not because of glamour.

Yeah. You quickly find out that being a general surgery resident is far from glamorous. This usually happens when you're dealing with the umpteenth crappy consult at 2 am that no one else wants to deal with.

Or you're examining people's rectums/anuses/bowel movements.

Or patients are vomiting on you during a trauma, or NGT placement.

Or you're draining butt pus.

Etc.

 

[blue2000]

I had days and weeks in residency that were tough. I struggled with my confidence and doubted myself a certain amount. After I had my son, I toyed with quitting, but never seriously.

I never, never had the abject, deep level of misery that you are describing. It seems pretty clear to me that you don't like general surgery. If you are having panic attacks (essentially) going to the OR, and enjoy research more than residency (I didn't do research, but my friends who did research were ultimately happier in residency than in research) then it doesn't seem like gen surg is the right place for you. Honestly, with all this talk about the egos of general surgeons, I find your ego issues a little perplexing. You hate the day to day, you don't like operating, you don't want to be at work. What part of that leaves you with any desire to do this?

As an attending, no one yells at me in the OR anymore. But if I got up on my OR days dreading things, that would be so so so miserable. And if I'd stayed out of the OR as a resident and lacked confidence and ability, that would be even worse. Honestly, I worry about your future patients. If you are avoiding training opportunities, how can you be well trained?

 

[45408]

Do you have a pool man?

Yes, but I don't know why. I don't even have a pool.

 

[SLUser11]

Yes, but I don't know why. I don't even have a pool.

Come to think of it, my daughter looks just like my milkman....and I didn't even know milkmen still existed.....

 

[45408]

Come to think of it, my daughter looks just like my milkman....and I didn't even know milkmen still existed.....

It's a good thing my son has my uncommon blood type, or I'd definitely be trying to figure that one out.

 

[Silent Cool]

. .

Beautiful and excellent response, Margo. 👍

 

[Paddington]

I don't get why surgery dropouts go into anesthesia. Are they just looking at the income? Neither field pays that well relative to number of hours worked, IMO.

Although the work of surgery is very different than anesthesia, the reasons why people quit surgery (early morning starts, overnight in house call, high pressure emergency situations, the OR, etc.) are shared by anesthesia.

 

[45408]

I don't get why surgery dropouts go into anesthesia. Are they just looking at the income? Neither field pays that well relative to number of hours worked, IMO.

Although the work of surgery is very different than anesthesia, the reasons why people quit surgery (early morning starts, overnight in house call, high pressure emergency situations, the OR, etc.) are shared by anesthesia.

Anesthesia hours are much more predictable. They have call, but it's often less frequent, and they have no patient responsibilities when they are off call. As a surgeon, you might not be on call, but if my patient comes back into the ED with an emergency, I'd feel fairly obligated to help out or take it myself.

Some of our anesthesiologists have no weekends, no call. They get paid less, but it's an option available to them. All of their call is ~18 hours. They come in at noon and leave at 7am. They have "early out" days when they leave at 12-1pm. If there's a long case, they get multiple breaks, and the CRNAs are usually doing the boring work. My friend's dad is an anesthesiologist who works 2 weeks, then gets an entire week off, every 3 weeks. If one of our vascular surgeons gets a ruptured AAA at 10pm that goes all night, after working all day, they still have to work all day the next day. They're on call for an entire week per month, and they have ~3-4 weeks of vacation all year.

And don't kid yourself: people don't leave surgery because of the OR. That was the whole reason they went into surgery. It's all the other crap that drives you out of surgery, and the best way to stay in the OR is to be an anesthesiologist.

 

[Paddington]

I'm in PM&R.

The anesthesiologists (who are now practicing Pain, whether fellowship trained or not) I interact with just trash their specialty.

For anesthesia, they have to take in house call once a week as attendings. They have to go to bed early so they can be into the hospital at 6. Very few get the cush well paying ortho outpatient surgery center type jobs in a metropolitan city with 9-5 no call, that they all think they will get in residency. They hate high stress, high stakes situations. It's odd, because many of them are people who went into anesthesia because they didn't want to "deal with" patients, but now they're pretty much giving up 90% of their specialty to deal with very difficult pain patients in clinic all day, in exchange for an improved lifestyle.

Of course, it could all be just a selection effect, those not liking the speciality leave it. But even, I just never got the appeal of anesthesia.

 

[BlondeDocteur]

Anesthesia & radiology are the most popular because there is overlap in the type of work (high-pressure situations, complex physiology, the OR in the first case; anatomy and diagnosis in the second). They are also advanced specialties meaning you don't have to suffer through an internship again. Lastly anesthesia in particular has such a hand-in-glove relationship with surgery it's easier to meet people and arrange a spot than in basically anything else. The lifestyle change is dramatic-- 80+ hours to 60 in residency; extremely predictable schedules; good remuneration.

EM, I would guess, would be #3. Even though most of us whine about the ER we know it well. A transferring surgery resident would get at least one year's credit, meaning they could finish in 2-3 years. Again, extremely flexible lifestyle that's pager-free and fairly remunerative.

What do you think would be #4? Pathology, maybe? It's easy to tell a story, if you can get a job it pays pretty well, and if you're so deadened by the endless crush of the workload it can seem like a perfect escape.

I would think medicine, pediatrics and FM would be the least common.

 

[rocketbooster]

Why don't you try to enter a surgical subspecialty instead? The residents are a lot more laid back and friendly to one another.

I just finished a few months of surgery (general surg and ENT) and I'll honestly tell you all my attendings in both rotations were laid back and seemingly happy with their lives.

The main difference I saw was in the residents. All the ENT residents were very happy and nice to one another, no matter what year they were. However, the general surgery residents were much different. The interns were abused like **** and belittled by their chief residents. It wasn't the attendings that were mistreating the resident, but rather the older residents. The older residents were actually pretty laid back to everyone but the younger residents. My guess is they were treated like **** as interns, so once they become in charge they do the same to the new interns. It's a perpetual cycle. Like I said, I only saw this behavior in general surgery. ENT didn't have it and I hear the other surgical subspecialties (ortho, neurosurg, urology) didn't, either. Seems like a problem you only have to deal with in the early years of general surgery residency. Either just push through it or go into pretty much any other field. There are many other (better IMO) surgical fields that don't have that atmosphere among residents.

But I don't blame you for hating it. I would never make the mistake to do gen surg residency since there are much better surgical subspecialties that are much cooler, more interesting fields and lack the abuse from older residents. The only ppl I know who like surgery and choose to do gen surg are the ones who didn't have high enough Step 1 scores to get into a subspecialty. If that's your case and without a doubt want to do surgery of some kind, then just push through those first crappy years. But if you did a year of research like you said, then you would probably now be competitive to get into a surgical subspecialty. Tons of research can overcome a low Step 1 for those fields.

 

[balaguru]

Are you aware of how offensive your ignorance is?

Why don't you try to enter a surgical subspecialty instead? The residents are a lot more laid back and friendly to one another.

I just finished a few months of surgery (general surg and ENT) and I'll honestly tell you all my attendings in both rotations were laid back and seemingly happy with their lives.

The main difference I saw was in the residents. All the ENT residents were very happy and nice to one another, no matter what year they were. However, the general surgery residents were much different. The interns were abused like **** and belittled by their chief residents. It wasn't the attendings that were mistreating the resident, but rather the older residents. The older residents were actually pretty laid back to everyone but the younger residents. My guess is they were treated like **** as interns, so once they become in charge they do the same to the new interns. It's a perpetual cycle. Like I said, I only saw this behavior in general surgery. ENT didn't have it and I hear the other surgical subspecialties (ortho, neurosurg, urology) didn't, either. Seems like a problem you only have to deal with in the early years of general surgery residency. Either just push through it or go into pretty much any other field. There are many other (better IMO) surgical fields that don't have that atmosphere among residents.

But I don't blame you for hating it. I would never make the mistake to do gen surg residency since there are much better surgical subspecialties that are much cooler, more interesting fields and lack the abuse from older residents. The only ppl I know who like surgery and choose to do gen surg are the ones who didn't have high enough Step 1 scores to get into a subspecialty. If that's your case and without a doubt want to do surgery of some kind, then just push through those first crappy years. But if you did a year of research like you said, then you would probably now be competitive to get into a surgical subspecialty. Tons of research can overcome a low Step 1 for those fields.

 

[rocketbooster]

Are you aware of how offensive your ignorance is?

haha, I like how you say that and have Gen Surg PGY5 under your name since it's honestly only your year that makes things intolerable for the younger residents, especially interns. Maybe you're one of the exceptions, but the generalization I made is definitely true at my program. And when I talked to other ppl from other programs, it seems pretty uniform across the board. I will admit one of our PGY5's was very nice, but the other 3-4 were very harsh on the interns, who hated their lives.

And you probably didn't like my Step 1 comment, either. Unless you're at a top 10 gen surg program, then my generalization also remains true here as well.

Considering you didn't actually give any examples to defend your stance, looks like you concede to my points.

 

[balaguru]

You changed my mind with your witty argument. Picking the specialty that you will practice for the rest of your life based on how current pgy5's treat current pgy1's at your program with <5 chiefs sounds like a wonderful plan. It's not like your perspective might be skewed because after all you talked to other people from other programs.

Yes, I'm a pgy5. Didn't you know that we have a secret mailing list where we exchange notes with other pgy5's on how to make interns miserable. I know your chiefs well and they are rockstars in this regard.

haha, I like how you say that and have Gen Surg PGY5 under your name since it's honestly only your year that makes things intolerable for the younger residents, especially interns. Maybe you're one of the exceptions, but the generalization I made is definitely true at my program. And when I talked to other ppl from other programs, it seems pretty uniform across the board. I will admit one of our PGY5's was very nice, but the other 3-4 were very harsh on the interns, who hated their lives.

And you probably didn't like my Step 1 comment, either. Unless you're at a top 10 gen surg program, then my generalization also remains true here as well.

Considering you didn't actually give any examples to defend your stance, looks like you concede to my points.

 

[rocketbooster]

You changed my mind with your witty argument. Picking the specialty that you will practice for the rest of your life based on how current pgy5's treat current pgy1's at your program with <5 chiefs sounds like a wonderful plan. It's not like your perspective might be skewed because after all you talked to other people from other programs.

Yes, I'm a pgy5. Didn't you know that we have a secret mailing list where we exchange notes with other pgy5's on how to make interns miserable. I know your chiefs well and they are rockstars in this regard.

Cool story bro.

I'm not the first person to ever make the argument about the hostility present in general surgery residencies. That's its reputation. Obviously it's not all residents, but that generalization doesn't come out of thin air. I think part of it is that the residency itself sucks so bad that by the time they're 5th years and in charge, they're just pissed off with life that they take it out on others (mainly interns, NOT patients since my chiefs had excellent bedside manner). Considering all my attendings were not like this, I'm assuming all that anger dissipates once residency is finally over and you choose your own type of practice, get paid, etc.

I like how all the surgery attendings/residents in this thread actually provided good, logical advice, while the one PGY5 gen surg resident acts like a 12 year old. Only furthering my point, broski.

 

[Winged Scapula]

Your post fails to recognize that many general surgeons are actually interested in the field and don't find ENT/Urology/PRS etc satisfying. To state that they are only general surgeons because they couldn't get into surgical subspecialties is offensive. I suggest you direct those comments to your attendings and see what sort of reaction you get. After all, since their anger has "dissipated" since residency is over, they should take your medical student insights as helpful.

BTW, coming into a specialty forum with the express purpose of insulting members of that forum is an SDN Terms of Service violation. You are welcome here to participate in mature professional conversations; you are not welcome to make unfounded and insulting posts which are akin to trolling.

 

[LucidSplash]

Your post fails to recognize that many general surgeons are actually interested in the field and don't find ENT/Urology/PRS etc satisfying. To state that they are only general surgeons because they couldn't get into surgical subspecialties is offensive. I suggest you direct those comments to your attendings and see what sort of reaction you get. After all, since their anger has "dissipated" since residency is over, they should take your medical student insights as helpful.

BTW, coming into a specialty forum with the express purpose of insulting members of that forum is an SDN Terms of Service violation. You are welcome here to participate in mature professional conversations; you are not welcome to make unfounded and insulting posts which are akin to trolling.

+1

RB, I'm sorry you seem to have had such a negative experience at your program. While I admit that such situations do exist in some places, it is not appropriate to extrapolate your n=1 to all surgery programs/residents. I have had a significantly different experience at both my medical school and my current training program, as I suspect is true for many of the residents/attendings here. If my experience had been malignant, I likely would have stuck with my original plan and gone into EM; I am fortunate that I didn't and I'm in a specialty that I really enjoy and I found a program without the sort of misery you seem to have experienced. I DID however have a pretty terrible OB/Gyn experience... but I don't extrapolate that to all OB programs everywhere.

Whatever you end up pursuing, I hope you enjoy your specialty as much as we enjoy ours.

 

[Winged Scapula]

+1

RB, I'm sorry you seem to have had such a negative experience at your program. While I admit that such situations do exist in some places, it is not appropriate to extrapolate your n=1 to all surgery programs/residents. I have had a significantly different experience at both my medical school and my current training program, as I suspect is true for many of the residents/attendings here. If my experience had been malignant, I likely would have stuck with my original plan and gone into EM; I am fortunate that I didn't and I'm in a specialty that I really enjoy and I found a program without the sort of misery you seem to have experienced. I DID however have a pretty terrible OB/Gyn experience... but I don't extrapolate that to all OB programs everywhere.

Whatever you end up pursuing, I hope you enjoy your specialty as much as we enjoy ours.

👍

Thank you for a lovely and thoughtful response to our "visitor".

 

[rocketbooster]

+1

RB, I'm sorry you seem to have had such a negative experience at your program. While I admit that such situations do exist in some places, it is not appropriate to extrapolate your n=1 to all surgery programs/residents. I have had a significantly different experience at both my medical school and my current training program, as I suspect is true for many of the residents/attendings here. If my experience had been malignant, I likely would have stuck with my original plan and gone into EM; I am fortunate that I didn't and I'm in a specialty that I really enjoy and I found a program without the sort of misery you seem to have experienced. I DID however have a pretty terrible OB/Gyn experience... but I don't extrapolate that to all OB programs everywhere.

Whatever you end up pursuing, I hope you enjoy your specialty as much as we enjoy ours.

I enjoyed my general surgery rotation a lot. Like I said, no one was malignant towards me. The chiefs were very hostile towards the interns, though, and I felt bad for them. All residents and attendings were nice to me. Interestingly, I also had a pretty bad experience in OB/GYN but with the gyn onc attendings. The only reason I personally wouldn't do general surgery is because I like both the OR and clinic and it was the clinic aspect that was lacking in gen surg. All the clinic appointments were either post-op wound checks or pre-op visits confirming the diagnosis of the PCP. There wasn't much actual diagnosis and medical management of patients. The PCP generally had the diagnosis correct already, so there were not many opportunities to come up with a fresh differential yourself.

I did gen surg and ENT rotations. I enjoyed the attendings in both equally, but the ENT residents definitely treated each other better and were all happy with their lives which was not always the case for the gen surg residents.

And my comments about board scores I can understand may come off as offensive. That is honestly the case at my program with the residents, though. It's not a top program. Most of the residents tried for ortho, plastics, etc. and had to settle for gen surg. Some of them are trying to get into plastics now after completing their gen surg residency. I stated that this would not be the case at top programs. Those residents needed to be just as well qualified to get into those programs as any ortho applicant.

Perhaps if you just take the time logically interpreting my points rather than instantly reacting with anger then you'll see I have no intent to "troll" here. I was just giving advice to the OP and then random ppl start attacking me. Chill out.

 

[SLUser11]

I enjoyed my general surgery rotation a lot. Like I said, no one was malignant towards me. The chiefs were very hostile towards the interns, though, and I felt bad for them. All residents and attendings were nice to me. Interestingly, I also had a pretty bad experience in OB/GYN but with the gyn onc attendings. The only reason I personally wouldn't do general surgery is because I like both the OR and clinic and it was the clinic aspect that was lacking in gen surg. All the clinic appointments were either post-op wound checks or pre-op visits confirming the diagnosis of the PCP. There wasn't much actual diagnosis and medical management of patients. The PCP generally had the diagnosis correct already, so there were not many opportunities to come up with a fresh differential yourself.

I did gen surg and ENT rotations. I enjoyed the attendings in both equally, but the ENT residents definitely treated each other better and were all happy with their lives which was not always the case for the gen surg residents.

And my comments about board scores I can understand may come off as offensive. That is honestly the case at my program with the residents, though. It's not a top program. Most of the residents tried for ortho, plastics, etc. and had to settle for gen surg. Some of them are trying to get into plastics now after completing their gen surg residency. I stated that this would not be the case at top programs. Those residents needed to be just as well qualified to get into those programs as any ortho applicant.

Perhaps if you just take the time logically interpreting my points rather than instantly reacting with anger then you'll see I have no intent to "troll" here. I was just giving advice to the OP and then random ppl start attacking me. Chill out.

There's plenty of clinic time in surgery. WS does A LOT of clinic I would presume, as is the nature of a breast oncology practice. I spend a lot of time in clinic as well. The PCPs almost never send the patient to me with a diagnosis, or at least not the right diagnosis.

You're allowed to like a different specialty. However, insinuating everyone in this forum had to settle for surgery due to bad scores, then running around calling people "bro" and "broski" is the exact behavior of a troll. If you don't like the label, look at your own actions rather than our reactions.

I am involved in the selection of residents on an adminstrative level, and I see plenty of CVs for general surgery applicants. I promise that there are plenty of people with scores similar or better to your own who are choosing this field. I do applaud you on your nice scores and AOA status, but I just want to remind you that it's not unique to surgical subspecialties.

 

[DoctwoB]

How residents are treated at your program says a lot more about your program culture and those specific chiefs than about the specialty at large.

In my n=1 experience, the gensurg attendings and residents were some great people to work with, especially the trauma folks. Residents are very busy, but treated with respect. I've heard of a lot more malignancy in plastics and ortho at my institution.

 

[thedrjojo]

How residents are treated at your program says a lot more about your program culture and those specific chiefs than about the specialty at large.

In my n=1 experience, the gensurg attendings and residents were some great people to work with, especially the trauma folks. Residents are very busy, but treated with respect. I've heard of a lot more malignancy in plastics and ortho at my institution.

exactly. Neurosurgery at my program is probably the worse. My wife in OB/GYN has a much harder time with her coresidents than i do. We work hard, and play hard well together. Some people aren't shy at correcting mistakes, but those are also the first people to acknowledge and reward hard and efficient work...

 

[LucidSplash]

I enjoyed my general surgery rotation a lot. Like I said, no one was malignant towards me. The chiefs were very hostile towards the interns, though, and I felt bad for them. All residents and attendings were nice to me. Interestingly, I also had a pretty bad experience in OB/GYN but with the gyn onc attendings. The only reason I personally wouldn't do general surgery is because I like both the OR and clinic and it was the clinic aspect that was lacking in gen surg. All the clinic appointments were either post-op wound checks or pre-op visits confirming the diagnosis of the PCP. There wasn't much actual diagnosis and medical management of patients. The PCP generally had the diagnosis correct already, so there were not many opportunities to come up with a fresh differential yourself.

I did gen surg and ENT rotations. I enjoyed the attendings in both equally, but the ENT residents definitely treated each other better and were all happy with their lives which was not always the case for the gen surg residents.

And my comments about board scores I can understand may come off as offensive. That is honestly the case at my program with the residents, though. It's not a top program. Most of the residents tried for ortho, plastics, etc. and had to settle for gen surg. Some of them are trying to get into plastics now after completing their gen surg residency. I stated that this would not be the case at top programs. Those residents needed to be just as well qualified to get into those programs as any ortho applicant.

Perhaps if you just take the time logically interpreting my points rather than instantly reacting with anger then you'll see I have no intent to "troll" here. I was just giving advice to the OP and then random ppl start attacking me. Chill out.

To me, a malignant environment is still malignancy, even if no one directs the negatively in my direction, and so I stand by what I said: I'm sorry this was your experience with gen surg residents and it is definitely not the case everywhere. Any moderately-sized group of people is likely to have one or two who rub people the wrong way but it sounds as if the problem was institutional at your program. I am just trying to let you know that the hostility you are describing just does not exist at my program, or seemingly at the programs of my several classmates who matched into gen surg (none of us "settled" after not matching into other specialties) and I agree with you that I feel sorry for anyone in that situation. Being an intern was both a lot of fun and really difficult and sometimes an emotional rollercoaster (actually this is still how I feel about residency) and I can imagine that as hard as I was on myself that it would have been absolutely awful if I felt like someone had it out for me just because I was an intern.

I personally was bored to tears during the ENT portion of my surgery rotation, and while my interactions with the residents were benign and they appeared to have a congenial relationship with one another, it just didn't attract me as a specialty and I didn't perceive the same level of camaraderie between the ENT residents as I did the gen surg residents. The lack of camaraderie may have just been a case of limited interaction and perception from a student perspective. Same goes for a lot of other sub-specialties. Like a lot of medical students I was bit by the trauma/acute care/critical care bug, arguably the most archetypal general surgery specialty; pus abounds. While many residents who start out this way go on to develop a strong dislike for the field, that hasn't happened for me and I don't believe I would be happy in ENT, etc.

I wonder if some of the perceptions of gen surg residents has to do with some of the situations we are called to address; maybe it is just my perception but sometimes we get called in when the proverbial feces are hitting the fan and something is a crisis that could have been more manageable had we been called earlier. I will admit that my biggest trigger for frustration and snappishness is perceiving incompetence or laziness. These situations include and have generally been limited to (in my time as a junior/intermediate-level resident):

1) As an intern, being called by a medicine intern to put in a line. That's all fine and good; even though medicine places their own lines, they should and do call us if they anticipate a difficult line. In this particular case, when I asked the rather routine question of the reason for the surgical line consult, the reply was "because I don't have time to do it."

2) Being called at 2am for an emergency chest tube placement because a radiology read came back reading 60% pneumothorax on a chest xray... that was taken 48 hours prior.

3) Being called to the ED to evaluate a patient who'd been sitting around over 6 hours waiting for radiology reads on what was obvious massive free air even to my medical student.

4) Being told by a particularly prickly cardiology attending that I (and by extension the entire surgical critical care service at the time) was incompetent and implying I was trying to assassinate a patient because we were holding anticoagulation on a patient with fresh stents (MVC 2 weeks post cardiac cath). The fact that the patient had an enormous fresh subdural with neuro deficits and that it was a rock-and-a-hard place clinical issue seemed completely lost on him.

5) Not my story but one of my co-residents was called in from home for an "EMERGENCY" peds surg consult for "acute abdomen/peritonitis/free air" and after rushing back to the hospital walked into the room to see the kid chowing down on a cookie as big as his head... helpfully provided by the peds resident. There'd been a recent string of similar issues with consults coming from the peds residents and this was the last straw for this particular resident. We do tend to get grumpy when you call us in from home or away from other duties with emergency consults which you are not yourself treating as an emergency.

The situations are the exception rather than the rule, and while I think I generally do pretty well at interacting with residents in other fields (and have received unsolicited feedback as such) but I will always get pissed off and sometimes I am not able to filter adequately on first pass to moderate my response if I perceive someone has harmed a patient and then gives me attitude about my questions regarding the reason for the delay or if I think someone is trying to pass the buck. I think gen surg residents tend to see more of these situations, relative to volume, than other surgical subspecialties, just because the nature of the surgical problems we are training to address are different. We all have our role to play in patient care and this is ours (at least for the time we are in residency for those who go onto less gen surg-oriented fellowships). I sometimes wonder if this is not some of the source of the perception of gen surg residents as "unhappy" or "miserable." I'm just spitballing here but maybe we're a little less relaxed appearing when other specialties interact with us because of these factors.

Lastly as far as giving advice to the OP, this thread was a bit of a necrobump; the OP posted a year ago and the thread had been dormant in that time until someone else revived it. While you've copped to the offensiveness of the reference to Step scores, if you were really unable to anticipate the negative response to:

I would never make the mistake to do gen surg residency since there are much better surgical subspecialties that are much cooler, more interesting fields and lack the abuse from older residents. The only ppl I know who like surgery and choose to do gen surg are the ones who didn't have high enough Step 1 scores to get into a subspecialty.

then I'm sorry for all the future miscommunications you're likely to have while interacting with other specialties that you didn't personally enjoy as a student. The hallmark of a troll is someone who says blatantly antagonistic things (in both actual diction and tone) with the perceived intention of provoking a negative reaction in others. You don't strike me as someone who lacks self-awareness to the point of inadvertently offending a bunch of surgery residents/surgeons with broad-based statements of personal preference passed off as fact, especially when accompanied by dismissive methods of address like "broski." I inferred intentionality from your post as well; if you really want to avoid the troll moniker in the future, I suggest you examine your personal style of communication.

 

[45408]

But I don't blame you for hating it. I would never make the mistake to do gen surg residency since there are much better surgical subspecialties that are much cooler, more interesting fields and lack the abuse from older residents. The only ppl I know who like surgery and choose to do gen surg are the ones who didn't have high enough Step 1 scores to get into a subspecialty. If that's your case and without a doubt want to do surgery of some kind, then just push through those first crappy years. But if you did a year of research like you said, then you would probably now be competitive to get into a surgical subspecialty. Tons of research can overcome a low Step 1 for those fields.

My Step 1 score was fine, thanks. I've rotated through ENT, urology, neurosurgery, ortho, OB/gyn, plastics, trauma, vascular, and general surgery. The one I enjoyed the most was general surgery. Sure, I like the lifestyles of some of the other specialties, but I decided that it was more important to enjoy what I'm doing when I'm at work than to try to get more time off. We should all be glad that people have different interests and goals. We can't all be orthopedic surgeons.

I like how all the surgery attendings/residents in this thread actually provided good, logical advice, while the one PGY5 gen surg resident acts like a 12 year old. Only furthering my point, broski.

How about the med student who comes in and starts making incendiary comments, broski?

The only reason I personally wouldn't do general surgery is because I like both the OR and clinic and it was the clinic aspect that was lacking in gen surg. All the clinic appointments were either post-op wound checks or pre-op visits confirming the diagnosis of the PCP. There wasn't much actual diagnosis and medical management of patients. The PCP generally had the diagnosis correct already, so there were not many opportunities to come up with a fresh differential yourself.

That's pretty specific to the type of clinic you're running. Sure, even a decent third year med student can diagnose biliary colic and an inguinal hernia and refer to surgery. The much bigger issue becomes a patient with atypical presentations or complex prior operative history. When someone needs an esophagectomy or biliary reconstruction, it's a *little* more than a simple pre-op visit. Did you ever go to a tumor board? Go to breast clinic? See a patient with complex hepatobiliary pathology?

Perhaps if you just take the time logically interpreting my points rather than instantly reacting with anger then you'll see I have no intent to "troll" here. I was just giving advice to the OP and then random ppl start attacking me. Chill out.

Really? What exactly is the logic here?

But I don't blame you for hating it. I would never make the mistake to do gen surg residency since there are much better surgical subspecialties that are much cooler, more interesting fields and lack the abuse from older residents. The only ppl I know who like surgery and choose to do gen surg are the ones who didn't have high enough Step 1 scores to get into a subspecialty.

You're being exceedingly rude, broski. I'm shocked that we didn't think your "advice" was worth the free account you're posting from.

 

[balaguru]

As much fun as it is to watch this beating unfold all this talk about subspecialties brought to mind a grand rounds from a while ago. Balch presented the data from http://www.ncbi.nlm.nih.gov/pubmed/21946217

There are some associated papers probably worth a look for med students.

 

[BlondeDocteur]

I read this paper when it came out in print and thought it was very much in line with what I've observed. I think a lot (the majority?) of people who go into all the surgical subspecialties besides ortho and neurosurg do so because they buy the controllable hours + high remuneration spiel. When they hit residency they find that their hours are extremely long and their lifestyle is as bad, or worse, than a GS senior resident (due usually to the small class size and the fact that they cover multiple hospitals when on call). They become bitter and dissastified which doesn't improve much after graduation. If they entered the field for *any* reason besides a deep love of its work, its principal diseases/operations, and its patient population-- like, as our friend above was insinuating, out of a perception of prestige or money-- that doesn't have much sticking power, long-term.

Of course that's painting with a broad brush. Plenty of people love their subspecialty and would be really unhappy in GS. Most of us in GS like the drama, the high stakes, and the extraordinary variety but most people find it stressful and overwhelming.

 

[Taty]

I would agree with you about intern abuse,but NOT ALL general surgery residencies are malignant. I transferred from one GS residency to another one and comparing them to each other its like night and day. For example at previous program it was OK to humilate interns, yell, call them names in front of patients' families, in patients' rooms, in cafeteria, elevator.. generally in public places... at my present program its not tolerated. And you are not right about Step 1 scores and GS. Personally I chose GS because I loved it as a student and my step 1,2,3 scores are good. I just could not envision myself doing something else. Anyway,best of luck to you in whatever you choose, keep your mind open🙂