Quitting Surgery

[anicha06]

Hey everyone, would appreciate ur feedback.

Not sure if I should quit surgery and how to do it.

Background: From a top 5 medical school, average board scores, prestigious research fellowship. Was pretty uncertain throughout medical school regarding what career I wanted to pursue. At the very last minute, I chose surgery. The dean and chair didn’t think it was a good idea to choose the specialty when 1) I wasn’t sure about it and 2) simply because I didn’t like anything else better. I didn’t want to waste a year thinking and just wanted to move forward.

Now: At a small program with a great PD. I’m considered one of the stronger residents in terms of being reliable, capable, efficient, etc. Did extremely well on ABSITE. Had an injury where I now have severe back pain after operating for an extended period.

Why I’m considering quitting (and have been since intern year):
1) My personality doesn’t fit, and it obviously makes work more difficult for me. I am a super nice, sensitive female (for example, I easily feel guilty if I had to dump on someone despite the fact that I’m always getting dumped on; I always take on more than expected; I always smile even when I’m frustrated). You need to be a tough and selfish (insert more adjectives) woman to make sure you’re not taken advantage of, but I can’t and don’t want to be that person. I look up to the women who are but I'm just different. But that makes me an easy target to get beat up on.
2) My back pain. I’ve done everything short of surgery. It’s gotten better but I have bad days too. Could this get worse over my career? Operating is no fun when you’re in pain.
3) Operating is no fun anymore. It was exciting as a med student, but now I’m always avoiding the OR for a variety of reasons including the one above. I’ve been told by a few attendings that I have good operating skills, but I honestly don’t feel good at it. I can’t enjoy it. I’m disappointed to feel this way and this is the primary reason why I think I should get out. But a part of me wonders is this just b/c of my attitude, and if so, should I change the attitude or change the job?
4) Surgery residency is hellish no matter how “benign” the program is, and I just feel extremely unhappy even though my program isn’t malignant.
5) I’d consider anesthesia, love working with my hands, love small/quick procedures, have been told by the anesthesia attdgs that they’d write me letters (don’t have a program at my hosp). I also like critical care and see that as an option.
Reasons why I’d stay:
1) To avoid trading in a Devil I know for a Devil I don’t know.
2) Although I don’t like breast cases, I might do it just for the lifestyle, patient interaction, and in-office procedures.
3) Critical care's an option (but don’t want to do the trauma/gen surg cases).
4) (not really a reason but) I love my colleagues, some of the bestest friends I’ve ever had.
5) I still don’t know what else I’d like better. Maybe anesthesia but again, don’t love anything else (not really any different than I was 3 yrs ago). Does this mean I should stay in surgery even though I don't enjoy operating? Can I make myself like it?

Options for leaving:
1) Take a year off for “research”, mainly researching other options while being in a lab (would have to decide this within the week). Would give me time to research, prepare, apply, and interview. Worst case scenario is that I decide not to switch and waste a year.
2) Continue into my 3rd year and make a final decision about quitting or not while working. Would be hard to research/prep/apply/interview b/c I’d be extremely busy and Q3/Q4. But at least if I decide to stick with it I wouldn’t have wasted a year. Worst case is I get stuck b/c I feel too deep into it.
As much as I hate residency, I just don’t want to hate my job for the rest of my life. Thanks for reading. Sorry that it’s long but I also wrote it for myself to get my thoughts straight.

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[filter07]

Few questions:
How bad is your back pain? If it is pretty bad then you might not be able to operate much.
What type of cases are you doing? Are you getting bored draining butt pus or are you bored doing colectomies and bypasses?
Do you find anything about surgery still fun, meaningful, or gratifying? I haven't seen you mention any positives other than your colleagues.

If you don't find any part of surgery enjoyable then you might as well switch out. Most people who stick with it have at least one or more things that keep their interest. My personality is similar to yours and I'm at a top heavy program so my interest in the OR is somewhat diminished... but surgery makes sense to me and I do enjoy using the skills I've learned, even if the process of obtaining those skills are painful.

I don't know many people who switched to anesthesia and wanted to do surgery again. I do know one person who quit general surgery after his 4th clinical year...

 

[anicha06]

thanks for replying

- The initial injury was significant and I could not operate/lift/etc. for weeks. Now I'm much better than how I used to be, but there are some cases and some days when I have pain. I had a breast reconstructive case where I got to do 65-70% of the case, which should be great for a junior resident, but I was in so much pain I thought I was going to pass out. It was just the awkward position I had to be in combined with the back prob.
-I actually don't mind the small stuff like I&Ds or debridements. I spent a month on liver transplant as the OR resident working with the fellow and attdg. Also did a thoracic month as operating resident. Overall I think I've gotten decent exposure for a junior (can't compare). I thought I would love operating. I'm an artist and love working with my hands. I remember how I excited I was as a med student holding a bovie for the first time. I don't know if residency just sucked out whatever "passion" I had, if I ever had any.
Most of the attendings at my program are not satisfied with the operative skills of any of the residents. I don't know if the real issue is with the attendings or the residents (but in our defense, we get enough cases; the attdgs don't teach in the OR .. mainly just complain). I do know that at my medical school, the chiefs would be taking the juniors through the cases. Not so here. And despite some good feedback, I feel really inadequate in the OR. How can you enjoy something you don't feel good at? I know I'm still learning, that I'm still in my infancy in terms of operating ... but I just thought I'd love it, at least love learning how to. I don't. It just makes me stressed. Don't really know where the stress comes from. But it did mainly start after the back incident.
- I really loved my SICU rotations. I loved taking care of my patients, knowing every single detail about them, actually getting things done for them (trachs, lines). I was very committed to truly taking care of them instead of just "getting stuff done". But that's the ICU and really doesn't have much to do with surgery .... besides the trachs which I did like doing. Small procedures I like best.
- I liked seeing patients in the ER and saving them from mismanagement. Although hated being bombarded with ER consults in general ...

 

[HitGirl]

Do a research year! Do anesthesia! I'm going into surgery and am excited but I did love my anesthesia and SICU months. I don't know any SICU docs that do anything but the trauma/gen surg stuff or who even want to. So why not go with what it seems your gut is telling you and do anes + critical care? I've met quite a few residents that have talked about choosing a specialty purely for lifestyle and they didn't even have any major problems restricting them from working harder, so with your back issues, I'd think lifestyle should be a bigger consideration for you. Its a huge plus that you have anes attendings who'd be happy to write letters for you so maybe that's a sign! Also, if you decide to leave now, your program may have an easier time of filling there spot with a scramble candidate come March.

 

[cpants]

The first issue is the back pain. Is that something that is going to go away, or is it going to be a chronic issue for you. If it is bad enough you might even be able to get time off on disability while you figure out a career change.

The second issue is your dislike of the work. If you don't like long operations you could do something in surgery which will not require many of them. Many general surgeons just do hernias, appys, choles, and other simpler cases. That is a lot of the work out there anyway. Trauma/CC fellowship might be a good choice. Less and less trauma is operative these days anyway, and you could focus on working in the SICU.

Anesthesia might be a good option for you, and it could even be possible to get into a categorical spot this year through the scramble, if you hustle. If you are going to switch though, you might as well sit down and really reconsider all the specialties out there. What made you choose surgery? I'm sure it wasn't at random. You need to think about why you thought it would be a good fit, and where you went wrong.

 

[Chirurgia magna]

In my humble opinion I would suggest to take a year off and do research or something similar.

It sounds like you are overworked, overstressed and probably need to take care of your health. All these factors combined can cloud your judgment and give you a "the grass is greener on the other side" mentality. Give yourself a year off to rehab your back and see how you feel in a year.

 

[braluk]

What is the nature of your back pain? Did you ever seek medical help for or is this something where you lifted something heavy one weekend and threw it out? Or is this something with a documented physical injury (disc problems, etc..). Have you had time to seek some form of physical therapy if its muscular in origin?

That aside, you have to ask yourself, would you continue this even if your back pain was not there? You sound kind of miserable with surgery itself, pain notwithstanding. Have you seen a good number of alternative surgical fields that may be more amenable to your happiness?

 

[kirurg]

Do you think anesthesia would be a good option for someone with back pain? There is a lot of moving patients, pushing stretchcers, awkward positioning associated with being an anesthesiologist. Maybe fields like radiology, pathology, dermatology, sleep medicine, rheumatology... would be a better option.

If the back pain is not the main issue, and you're just fed up with being a surgery resident, you should give the situation a lot of thought. I was a 2nd year last year, and really thought about leaving around the same time. End of second year is the worst- you are just starting to do bigger cases and feel inadequate, you still have a lot of scut work to do as a junior resident, it's been about 18 months since you had any semblance of a normal life... Things do get better though! I am very glad I decided to stick it out- maybe you'll feel the same way.

 

[ESU_MD]

Super nice sensitive female, chronic back pain, lack of interest in operating are some pretty big buzz kills for becoming a surgeon.
tough call though, since you really dont know jack when you are at the intern level.
ie... you think you want to quit, but everyone wants to quit at intern level. I suggest continuing for another year. in the grand scheme, 1 year really doesnt matter.
it IS tougher for females and you have to be a btch in some ways to succeed. not fair, but true.

on the other hand, in addition to the above... may want to reconsider your career if you have been diagnosed with fibromyalgia, any type of irritable bowel issue or if you are a vegetarian. then I would cut my loses.

****with the standard disclarimer that if you make life changing career advice based on an internet forum input.........

 

[ESU_MD]

I don't know many people who switched to anesthesia and wanted to do surgery again.

good point, does anyone?

I also have seen alot of people who quit surgery and wind up working in the er. what a weird scenario to see them in the er after they spent a year complaining about them. awkward.

after being through the ringer, i wonder if maybe the joke is on the surgeon since they get to leave the emergency room after 8hr shifts and cash their fat paychecks without carrying a pager!

 

[Winged Scapula]

In some ways, I've been in the OP's shoes.

Never had a critical injury which caused me significant pain nor did I question my motivation to pursue surgery.

But, as the residents above have noted (because the medical students, as helpful as they are, cannot comment on what residency is like), residency can be difficult especially the first few years.

I came from a medical school where I was adored, encouraged and motivated to do better on a daily basis. It did not occur to me that my surgical experience was situational because although I did away rotations, in no way was I psychologically prepared for a change in residency.

My program was not malignant, however, I was not adored, encouraged or motivated. The theme appeared to be a lack of interest in teaching, or at least in teaching me. I too started to avoid cases, especially those with certain attendings. I had little to no interest in being derided or at best ignored for several hours while mentally and physically exhausted. It was not a treat to scrub in when I'd been up all day and night only to be humiliated in some cases.

I was clinically depressed during residency and saw no way out. My SO was helpful by being supportive of "whatever <you> want to do" but often stated that perhaps I should just quit if I wanted to. Easy for him - no loans whatsoever; the interest on mine was becoming unwieldy. He didn't understand - he had support from his faculty and loved surgery. Interestingly enough, he is now pretty unhappy being a surgeon but cannot face telling his father (a surgeon) that he wants to quit.

But I digress...I had an education but not a particularly useful one, I couldn't think of what else I would do. Nothing else in medicine interested me. Nothing in surgery interested me. Most of my fellow residents were also depressed but I didn't know many who avoided the OR like I was doing.

At some point, I made the decision to finish what I started and I'm glad I did. I am once again loved, encouraged and motivated by my patients. Fellowship was much the same and I enjoyed it. I enjoy my work and feel rewarded by it.

Because residency can be so isolating and discouraging it can be difficult to tell whether you are situationally depressed (ie, it will get better elsewhere), professionally depressed (ie, it will get better with a different field), or if it is something that will pass.

I don't think its a bad idea to spend some time in the lab away from the OR and clinical duties and get a clearer head. IMHO those that leave surgery for anesthesia find something about it interesting; those that leave simply because they wanted something more lifestyle friendly find themselves peering over the curtain with something akin to lust - they miss it but made the decision that was better for them physically or for their family.

There are specialties which have shorter operations. You haven't told us how long you can go without discomfort and if it is positioning, or holding retractors, etc. which hurt. As you become more senior you aren't holding retractors in weird positions but you are doing longer and longer cases. I'm not sure if your program could make adjustments for you, and funnel the shorter cases to you as long as you met ABS requirements. Perhaps there is some treatment for your pain that you haven't tried.

The obvious choice is a CC fellowship; trauma cases also tend to be short, as do *most* breast cases (but there are the bilats with recon which can take 6 or more hours), etc. Every specialty will have its short cases and its long ones. When you are out in practice, you can refuse to do whatever you want if you are physically unable to do the longer ones. If you like SICU management then what does it matter how much it has to "do with surgery"? You aren't enjoying operating anyway and transitioning to a career in CC might make the most sense for you.

I'm not sure you have to be a bitch to get what you want as a female surgeon, although you can be perceived as one regardless of your behavior. You do need to be assertive about your needs and if you are liked, they will generally be met by staff. Being super nice is fine, and will be appreciated by your peers and patients. Being sensitive can make it more difficult; I am sensitive by nature as well, and am not the type to say, "just **** it" if someone does or says something hurtful.

At any rate, not sure if any of the above is helpful. But some of us have been there before, and for me it got better.

 

[youngdoc8205]

I was in a similar situation (though not female, and not super nice ) but in a different field (radiology) and switched into surgery. I talked to a lot of people about this, practically everyone in my department (which may not be an option for you depending on how supportive they are ) people in the field that I wanted to switch into, my parents, my SO etc. I wasn't really asking them for advice, just using them as a soudning board to work through it on my own.

And that's my recommendation to you. Talk to as many people as you can about this, and use those conversations as a way to work through this. As high functioning as people who go into medicine are, we are sometimes epically bad at working through stuff like this on our own. Often being blinded by the percieved perstige, financial obligations, how others will percieve us rather than listening to our own hearts and minds. I have a very strong belief that we as physicians worked extremely hard and sacrificed much to get to where we are and at the very least we deserve to be happy in our jobs. I think that is more important than any financial gain or prestige that people may get out of their chosen field because all of that is transient, but personal satisfaction is not. I would rather get up at 5 AM and cut into somebody or see a patient in surgery clinic then get up at 7 AM and be in the reading room. Others are the reverse.

There was some study (maybe quoted here) that people in geriatric medicine are among the most consistently satisfied of all physicians. I think it's because this group of people followed their heart into a career they loved.

All that being said, another career you might consider if you like procedures is IR. There are quick procedures, and there are 2-3 hr ones like GI bleeds/TIPS, and with the oncologic and female interventions there is opportunity to follow patients long term. The best IRs I've seen are those who switched from surgery because that's the mindset that needs to be there to practice it properly. There are actually pathways into doing a sort of IR residency of 2 years of clinical training (IM/surgery) I think it's called the DIRECT pathway.

Good Luck, from personal experience this is not an easy decision, but when you make the right one for yourself (whether that's staying in surgery or transferring out) it will be worth it

 

[JackADeli]

Do you think anesthesia would be a good option for someone with back pain?...

No.

 

[anicha06]

Thanks everyone for your insightful responses. I felt you guys were able to articulate my feelings and thoughts better than I could myself. It was really comforting just to know that people can relate. My PD wants to confirm my research year VERY soon and yet I can't commit to a decision.

Youngdoc: "I have a very strong belief that we as physicians worked extremely hard and sacrificed much to get to where we are and at the very least we deserve to be happy in our jobs." YES. I just don't know where I'll find my happiness. I can only make assumptions and hope for the best. I also considered IR (and even women's imaging) but know that radiology in general emphasizes board scores and mine are average. Don't think where I went to med school/did research would help as much, so I'd be concerned not getting a spot/having a job, and at least having a job is important to me.

Winged Scapula: I was most comforted by your response .. mainly because I felt that you really, really, really, really do understand. I'm ashamed of avoiding the OR and thought I was the only resident who avoided cases/certain attendings. Comparison to my colleague: He loves to do any case and finds everything interesting and exciting. He can work with the biggest tyrant of them all and still enjoy it. I thought I'd be like that but think I'm too sensitive to shrug off people's attitudes and behavior in the OR.
I also did very well in the past when I had mentors and people who believed in and supported me. When I didn't have good mentorship/encouragement, I didn't do too well. I think as a medical student, I was really influenced by the surgical attendings who encouraged me to go into surgery. I was told that I had some innate abilities in the OR, and (even if he was just BSing me) it was one of the most encouraging things anyone ever said to me. I guess at that point I thought maybe I could be a good surgeon if someone else saw something in me. Now, I am always feeling discouraged and highly doubt my skills. I don't really have anything concrete to back up my feelings of inadequacy, but the lack of confidence is a big hindrance.
My colleague also struggled in the early years but doing awesome now, one reason being that he found amazing mentors.

"Because residency can be so isolating and discouraging it can be difficult to tell whether you are situationally depressed (ie, it will get better elsewhere), professionally depressed (ie, it will get better with a different field), or if it is something that will pass. " This is one of the most important questions that I don't have an answer to .... what exactly is making me depressed? I think it's a mix of everything which makes it difficult to find a solution.

I'm really happy that things got better for you and see your story as a happy ending/success story. It would be a big gamble for me to stick it out and hope the same things happen to me. I do love helping people, and as cliche as it sounds, it was my primary reason for going into medicine. But I'm so disillusioned and jaded that sometimes I don't want to help anyone. Some days I feel like I'm killing myself to help people who treat me like crap.

ESU_MD: I'm a 2nd yr. If I do research/reapply this year, I'll be an intern or CA-1 during a period where I could've been a 4th year and almost done. Makes me just want to keep going though I'm unhappy.

kirurg: The back pain is a concern but the more I think of it (after reading all these posts), it might just be an excuse. It was serious however, I was out for some time, getting PT, was a documented injury, etc. There's an anesthesiologist at my program who told me he quit surgery when he threw his back out the first year.

Chirurgia: "It sounds like you are overworked, overstressed and probably need to take care of your health. All these factors combined can cloud your judgment and give you a "the grass is greener on the other side" mentality." You are spot on. That's why I really am struggling with the decision and want to make the right one.

Thanks everyone again .. will be updating you guys..

 

[proman]

No.

Why not? I'm in the most demanding subspecialty of anesthesiology and I don't think back pain would be an issue at all. For example, I had an attending in residency who used to be a cardiac surgeon in the late 1960s. Had a bad car wreck, bilateral femur fractures, DVT/PE. He recovered and went back to operating, and had recurrent PE. Decided to switch and had a very successful career. He's in his 80s now and still working.

 

[SLUser11]

Why not? I'm in the most demanding subspecialty of anesthesiology and I don't think back pain would be an issue at all. For example, I had an attending in residency who used to be a cardiac surgeon in the late 1960s. Had a bad car wreck, bilateral femur fractures, DVT/PE. He recovered and went back to operating, and had recurrent PE. Decided to switch and had a very successful career. He's in his 80s now and still working.

That's interesting...I would have reflexively agreed with JAD that anesthesia would also be hard on the lower back. I just think of the intubation practices that I see as being very bad ergonomics. Is the secret cranking the bed up super high for the tube? I guess you would be sitting during the case for the most part.

While we're on the subject, I can't stress enough to the students and junior residents how important good ergonomics is to a career in surgery. Also, you should invest in your feet and wear good, supportive shoes, and not skimp on the core workouts at the gym.

I remember an article I read less than a year ago in JACS called "Patients benefit while surgeons suffer." That's a title that will catch your eye. I think I'm going to have to spice up the title of my next submission so it gets more attention.


Here's the citation.

 

[smq123]

1) My personality doesn't fit, and it obviously makes work more difficult for me. I am a super nice, sensitive female (for example, I easily feel guilty if I had to dump on someone despite the fact that I'm always getting dumped on; I always take on more than expected; I always smile even when I'm frustrated). You need to be a tough and selfish (insert more adjectives) woman to make sure you're not taken advantage of, but I can't and don't want to be that person. I look up to the women who are but I'm just different. But that makes me an easy target to get beat up on.

To be honest, this is not a good reason to quit surgery, because I don't think it's unique to surgery.

I'm in FM, which is stereotypically depicted as a fuzzy, warm, feel-good specialty with kind and gentle coworkers. While it's not, perhaps, as intense as some surgery programs, you STILL need to stand your ground. In all fields of medicine, you will get dumped on by someone who is lazier or less confident than you.

While I don't advocate being selfish, being a physician requires a level of "toughness," regardless of the field.

 

[anicha06]

smq: you make a very good point .. I am tough in certain situations when I have to be (ie when I'm the ER consult resident). I don't have time or energy for BS and don't deal with it. I get especially pissed when patients are mismanaged, and I have to clean things up. I'm tough then but always professional and respectful (which I wish everyone could make an effort to be). But it's different as a surgical resident in a surgical program. I abide by the hierarchy. And I do think it's tougher to be a female in surgery than a female in most other fields.

While writing this another thought came to mind.. I have been looking for a female surgical mentor but unfortunately I don't have a lot of respect for the women in my program. They remind me of the OBGYN residents at my med school who were selfish, catty, gossipy, immature. As a med student also looking for female surgical mentors, I couldn't find a woman who was balanced, grounded, warm, and compassionate. One attending said that when her kids were in high school, they asked her why she even bothered having them when she was never around anyway. One eventually went to medical school, so the attending reassured herself that things must have been fine if one decided to practice medicine. It wasn't so reassuring to me. It's discouraging not having a mentor. I spoke with my male advisory attending who agreed that he didn't like the female attendings in the program either, but I don't know if for the same reasons or if he just doesn't respect women.

 

[Arch Guillotti]

That's interesting...I would have reflexively agreed with JAD that anesthesia would also be hard on the lower back. I just think of the intubation practices that I see as being very bad ergonomics. Is the secret cranking the bed up super high for the tube? I guess you would be sitting during the case for the most part.

I know guys who sit down to intubate because of back issues and they seem to do fine. Now that I supervise, I don't really intubate all that often (although when I do they are the tough ones).

I don't think the physical issues with anesthesia are a deal breaker although positioning and moving some of the patients can be a real pain.

i wouldn't go into anesthesia willy-nilly, make sure that you love it or at the very least like it enough to be sure that you can stick it out in residency and make a career of it. Despite all the naysayers and CRNA issues, it really is a great field for the most part.

 

[proman]

That's interesting...I would have reflexively agreed with JAD that anesthesia would also be hard on the lower back. I just think of the intubation practices that I see as being very bad ergonomics. Is the secret cranking the bed up super high for the tube? I guess you would be sitting during the case for the most part.

Well if they're really hunched over to intubate, it's likely poor technique. The heaviest thing I carry is a transport monitor. Transferring patients, we lift the head and maybe the torso, not problematic. Nothing that I do requires a lot of force. As you know, I'm a cardiac anesthesia fellow. I rarely sit, even during the bypass run (setting up for the next case, running labs etc). But if I really need to, I can take a break. My back almost never hurts, it's usually my feet and lower legs. I completely agree with you re: erogonomics. I will either sit down for a procedure or raise the table to a height that I'm comfortable. It boils down to what's important to you.

 

[anicha06]

The attendings who volunteered to write letters if I decide to switch are both CT anesthesia attendings .. I'd be in the OR when they'd come in to set up. I'd ask to intubate, place lines, and they were wonderful about teaching. Everyday I saw them extremely happy, joking, laughing. One of them finished surgical training as well. Working with them (even though I wasn't supposed to! just came in early) made me start really considering anesthesia.

When the surgeons would start the case, all they ever focused on was getting out as soon as they could. One CT attending asked what I was going into .. I said I didn't know. He said "I know a good one .... Anesthesia." So when I hear things like this constantly, it's tough to commit to surgery ..

 

[JackADeli]

Do you think anesthesia would be a good option for someone with back pain? ...

No.

Why not?...

...I would have reflexively agreed with JAD that anesthesia would also be hard on the lower back. I just think of the intubation practices that I see as being very bad ergonomics. Is the secret cranking the bed up super high for the tube? I guess you would be sitting during the case for the most part...

I know guys who sit down to intubate because of back issues and they seem to do fine. Now that I supervise, I don't really intubate all that often (although when I do they are the tough ones)...I don't think the physical issues with anesthesia are a deal breaker although positioning and moving some of the patients can be a real pain...

I will stick with my original opinion. I have yet to meet a single anesthesia attending that has a "good back". Yes, absolutely, good posture and ergonomics can help. I just don't see those practices as wisely utilized. On another point, I am sensing a great misunderstanding of ergonomics. If I remember my med-school PM&R lectures, sitting can apply up to 10x more for4ce on the back then standing.

The bottom line is you need to choose career that will work for you mentally and physically. Can anesthesia work for you? Only you can answer that. However, I would not just assume your back will be fine because you sit, probably slunched over the WSJ for several hours at a stretch or lean over intubating a crashing patient, etc... Whatever you choose, you need to maximize the ergonomics to decrease its impact on your already injured back.

PS: why don't you take a look at your anesthesia attendings and see how ergonomic their practice is... then quietly listen to the back complaints and back medical history....

...What can I do if I have acute low back pain?
The key to recovering from acute (abrupt, intense pain that subsides after a relatively short period) low back pain is maintaining the hollow or lordosis (the normal curvature of the spine). Supporting the hollow of your back will help shorten your recovery time.
For 10 to 20 days after you experience acute low back pain, follow these guidelines:

Sitting
- Sit as little as possible, and only for short periods of time (10 to 15 minutes).
- Sit with a back support (such as a rolled-up towel) placed at the hollow of your back.
- Keep your hips and knees at a right angle (use a foot rest or stool if necessary). Your legs should not be crossed and your feet should be flat on the floor.
- Here's how to find a good sitting position when you're not using a back support or lumbar roll: Sit at the end of your chair and slouch completely. Draw yourself up and accentuate the curve of your back as far as possible. Hold for a few seconds. Release the position slightly (about 10 degrees). This is a good sitting posture.
- Sit in a high-back chair with arm rests. Sitting in a soft couch or chair will tend to make you round your back and won't support the hollow of your back.
- At work, adjust your chair height and work station so you can sit up close to your work and tilt it up at you. Rest your elbows and arms on your chair or desk, keeping your shoulders relaxed.
- When sitting in a chair that rolls and pivots, don't twist at the waist while sitting. Instead, turn your whole body.
- When standing up from the sitting position, move to the front of the seat of your chair. Stand up by straightening your legs. Avoid bending forward at your waist. Immediately stretch your back by doing 10 standing backbends...
​

Office Chair Back InjuriesPeople who sit most of the day, such as those who work at a computer while sitting in an office chair, are also at high risk for non-accidental back injury. ...the risks associated with prolonged sitting in an office chair, such as neck strain, lower back pain and leg pain...

None of that really resembles the sitting of anesthesia attendings I observe.
​

 

[speyeder]

Have you thought about ophthalmology?

- Good mix of clinic and surgery
- Most surgical cases are short
- Very reasonable hours even during residency
- Personalities in ophthalmology are overwhelmingly laid-back and benign
- About 45% of residents are female (if that matters)

 

[Guile]

There was some study (maybe quoted here) that people in geriatric medicine are among the most consistently satisfied of all physicians. I think it's because this group of people followed their heart into a career they loved.

I read a similar study once that showed of all physicians, psychiatrists were the ones who were likely to respond in the affirmative if asked "if you could do it all over again, would you choose medicine." Talk about guys who were happy with their lives and professions.

 

[Guile]

Have you thought about ophthalmology?

- Good mix of clinic and surgery
- Most surgical cases are short
- Very reasonable hours even during residency
- Personalities in ophthalmology are overwhelmingly laid-back and benign
- About 45% of residents are female (if that matters)

Good luck getting an ophtho spot switching from another residency. They are hard enough applying with excellent credentials from a top school as a fourth year medical student. I don't think ophtho is on the table. Maybe if she did a few years of research in it first.

(You also left out that you sit down to operate.)

 

[anicha06]

Funny, I've always loved psychiatry .. intellectually. Not sure about being a psychiatrist. Would have to think about that one.

I'm sending out emails to labs right at this minute ..

 

[youngdoc8205]

anicha6: in regards to radiology, I'm not sure how competitive the DIRECT pathways are in terms of scores and grades, (are they average for surgery, or average for radiology?) and regardless of your answer I think the experience you bring should overcome that. Going the traditional route: diagnostic 4 years and IR 1-2 years should also not be a huge problem for you. Especially if you do a year of research.

I'm not trying to push radiology, I just want to let you know that if you are ruling it out because of grades, don't do that. People switch into rads all the time from other fields, not necessarily with the most stellar of scores.

also I have a few friends who are doing gas, and they tell me PDs keep CA1 spots open for just such occasions. I know for a fact that UW Madison does.

Again, do what you love, it seems hard and stressful right now, but you will be fine in the end.

Good Luck

 

[wtm1114]

Words of Wisdom: If you want to switch/quit, do it and do it early. It's much better to waste a year than suffer with a specialty you will hate for the rest of your life.

1. Personality - A real problem. To be surgeon you almost have to be assertive, decisive, and (excuse me here) demanding, and sometimes rude. It makes things happen. It doesn't mean you can't be nice. In fact, the majority of surgeons I've worked with are very nice people, but you got to have the mindset to tense up anytime you want. You are a nice/sensitive female and it's a virtue. I don't think you should *change* your personality, if it's at all possible. You should ditch surgery instead of ditching your personality.

2. Back pain - Not sure the exact problem here but I know back pain can be a very chronic problem. This can be a real limiting factor.

3. A REAL problem. The thrill in the OR during medical school will fade away during residency. But if the OR is the last place you want to be on a Monday morning, that's an absolute indication to quit surgery.

4. "Hellish" may be a too strong word. We have the worst lifestyle across the board either as resident or as attending. I may be politically incorrect here, but it's especially harder for females.

5. Anesthesia - In fact an excellent choice. Much better hours. Almost equivalent (or more) income. You are still working around the OR. A lot of critical care. And a much more female-friendly field.

Conclusion: My gut feeling is telling me you SHOULD quit surgery. You don't like it. You body doesn't like it. And it's unlikely anything will change in the future.

Remember, surgery does have a baseline 20% attrition rate, so you are by no means the only one.

 

[anicha06]

wtm: thanks for your response .. i know it seems clear to you, but in fact it's a lot more complicated .. are you by any chance a surgical resident?

 

[wtm1114]

wtm: thanks for your response .. i know it seems clear to you, but in fact it's a lot more complicated .. are you by any chance a surgical resident?

Yes I am. Categorical intern.

 

[Winged Scapula]

Yes I am. Categorical intern.

You might wish to change your user status then which is still listed as medical student.

 

[Buzz Me]

General Surgery is a tough field. While I haven't seen anywhere near the (oft-quoted) 20% of my fellow residents quit, over the years I have seen quite a few come and go. The ones that have left have gone into Anesthesia, Radiology and consulting. They all seem happier now (or at least from what I hear).

I started off with a pretty tough skin (had some malignant attendings in med school) and it just got thicker and thicker throughout my years of residency. While I sympathize with those who just can't stand the verbal/emotional/psychological abuse and I don't think there's a place for that in surgical education, my own stance on it is to just suck it up, take it, and become better trained for it (doing cases and trying to learn as opposed to avoiding said cases/attendings). While I may go home on occasion fuming at being screamed/cursed at during the day, I tend to be able to destress pretty easily and am fine by that evening. I've never felt depressed during residency - a little burned out, at times, sure - but you can be damn sure I'm very grateful for that.

I agree that so much of what motivates med students to go into surgery is their experience (often attending-dependent or resident-dependent) during their MS3 year. All it takes is a couple of inspirational, kind mentors and that student will feel that surgery is a good fit for them...unfortunately sometimes the reality of residency/internship hits and they realize surgery wasn't at all what they expected.

 

[Arch Guillotti]

I will stick with my original opinion. I have yet to meet a single anesthesia attending that has a "good back". Yes, absolutely, good posture and ergonomics can help. I just don't see those practices as wisely utilized. On another point, I am sensing a great misunderstanding of ergonomics. If I remember my med-school PM&R lectures, sitting can apply up to 10x more for4ce on the back then standing.

Do you really talk with all the anesthesiologists about their medical history and how their back feels???

Or do you just work with a bunch of old geezers that are hobbling around?

Seriously, I know one attending who had to miss some time because of back issues, and the issues weren't even caused by anything work-related.

The physical duties of anesthesiology are nowhere near those of a manual laborer.

 

[anicha06]

Spoke with one of my ICU fellows about quitting. She was surprised and tried to encourage me to stay, saying that I was the strongest resident in the ICU this month and can hack it.
What she said was encouraging and given the fact that I had no idea how good of a job I was doing really shows where my confidence level is (rock bottom). Now I'm trying to convince myself to just keep going, just to prove to myself that I can. I just don't know if it's right!

I'm quick to say I'm depressed but when I think about it, I think it's just from being tired. I do have a lot of anxiety however, and that's a big obstacle. Do I go into something that is less anxiety inducing or try to deal with the anxiety and operate?

Do I force myself to finish even though I'm not interested in any of the cases I've done or seen? But just do it because nothing else really interests me either?

Do I take the year off to think things through ... or just keep going and try to operate and see if I can get over my dislike of being in the OR?

 

[Guile]

I'm quick to say I'm depressed but when I think about it, I think it's just from being tired .. I do have a lot of anxiety however, and that's a big obstacle .. Do I go into something that is less anxiety inducing .. or try to deal with the anxiety and operate?

Anxiety can be really crippling and fortunately is quite treatable for most people. You should see someone about it. An SSRI could make a world of difference for you. Without the fog of anxiety, you might see surgery and operating in a very different light. (I really liked my psych rotation and thought that it was one of the specialties that made the biggest difference in people's lives.)

 

[anicha06]

Guile: I liked my psych rotation too and love reading up on anything psych. I did try different SSRIs but found that it never made a difference (since my mood was always fine). My anxiety is based on negative thinking, and it definitely is crippling - that is the best description of it. I need to retrain my brain.

I never had anxiety until these last 3 years and wonder if being in surgery is just making it worse. It doesn't affect my performance, but it makes me want to quit constantly.

 

[Guile]

Guile: I liked my psych rotation too and love reading up on anything psych. I did try different SSRIs but found that it never made a difference (since my mood was always fine). My anxiety is based on negative thinking, and it definitely is crippling - that is the best description of it. I need to retrain my brain.

I never had anxiety until these last 3 years and wonder if being in surgery is just making it worse. It doesn't affect my performance, but it makes me want to quit constantly.

Have you worked with a psychiatrist? Have you tried buspirone? (That and SSRIs are about the extent of what I learned in med school...)

 

[anicha06]

guile: yes and no ..

I think I'm one step closer to figuring things out. After talking to a lot more people than I expected to, I think I might know what the important problem is.

I have not been able to enjoy surgery because of the anxiety I feel. The anxiety is induced by the pressure I place on myself and the pressure I feel from everyone else's expectations. The anxiety further causes emotional distress, depression, and can be crippling at its worst (avoiding the OR). I start to form bad habits (not exercising, studying as much as I want to), and it snowballs. I end up feeling worse and worse.

The problem is I'm highly functional. I do a good job and even my SO doesn't know how bad I feel inside. I present myself as a happy person, and fake it so well that I do feel happy for that brief moment. When I talked to my chief about taking a year off, she discouraged me from it. She assured me that everyone at some point thinks of quitting, feels inadequate/depressed/anxious. But I'm not sure if it's so bad for others that they avoid the OR like I do. She thought I was a strong resident and would be able to suck it up and advised me to not care what attendings thought.

I know that professionally doing research might be a waste since I already have a research background and am not sincerely interested in it. It's just a way for me to buy time or take a break. I might not even publish or it may not be useful in whatever I end up going into.

My question to myself is ... is this mental health situation that bad that I need to take time off ... or do I just keep going and try to find some way to get out of the deep, deep rut I got myself into. Since everyone so far thinks I'm such a good resident, does that mean I'll find some way to fix my anxiety and unhappiness etc while in my 3rd year? Or will nothing change - I'll still do a good job, work hard, and want to hide/quit daily.

 

[Leforte]

My question to myself is ... is this mental health situation that bad that I need to take time off ... or do I just keep going and try to find some way to get out of the deep, deep rut I got myself into. Since everyone so far thinks I'm such a good resident, does that mean I'll find some way to fix my anxiety and unhappiness etc while in my 3rd year? Or will nothing change - I'll still do a good job, work hard, and want to hide/quit daily.

Talk with your PD - tell him/her exactly what you've written here. Indicate that you would like to seek assistance through student health counseling and that you may need a few hours a week to go to counseling for a few weeks/months to see what direction/career move that you need to take. The student health counselors are used to these issues with residents and can help you focus on why you are so unhappy. We've sent a couple of our residents to them - all have been able to work through there issues. Please don't feel like you would be "burdening the team" if you need to seek professional guidance. It is far more burdensome to have a resident leave a program than to help someone figure things out. In fact, I'd bet that a few of your colleagues are in a similar situation (maybe not with back issues), and, like you, are quite good at covering up their unhappiness at work.

While it is tough to ask for help - you'll never get if you don't put yourself out there. Personally, I think it a sign of character and personal integrity to ask for assistance when needed.

 

[anicha06]

Thanks Leforte.
I've avoided talking to the PD about these things because I don't want him nor any of the attendings to think that I'm weak.
I've looked for help on my own, but my hospital unfortunately doesn't have a student health office or counselor or anything of the sort for residents (it's a smaller program). I've even looked for a counselor out in private practice but given the hours that I work, I wouldn't have the time to talk to someone on a weekly basis, which is what I think I'd need...

A bigger part of me tells me to take the year off even if it would be a professional waste, so that I could take care of myself and get better. Perhaps I might realize I want to continue with surgery. At the very least I can be in a better state of mind to figure out what's right for me.

But a smaller part of me just tells me that I can do it, continue into my 3rd year, fake it til I make it, try to change my attitude/mental state, and somehow it might work in the end.

 

[Winged Scapula]

A bigger part of me tells me to take the year off even if it would be a professional waste, so that I could take care of myself and get better. Perhaps I might realize I want to continue with surgery. At the very least I can be in a better state of mind to figure out what's right for me.

While I didn't take a year off, I took some time off for much the same reasons I've outlined above. I tried coming back after a family issue and slogging through, but it was apparent, to almost everyone that I just wasn't myself. I finally figured it out and that I was hurting not just myself, but potentially patients and my colleagues.

But a smaller part of me just tells me that I can do it, continue into my 3rd year, fake it til I make it, try to change my attitude/mental state, and somehow it might work in the end.

It *might* work out and it might not. And you may find yourself hurting yourself, your patients, your friends and colleagues in the process. If you can support yourself while you have time off, I fail to see any real downside. Its a dark secret that many residents are clinically depressed and many do nothing about it for fear of seeming weak. This is especially common in surgery.

But you have to save yourself regardless of what others think. I was worried that my colleagues would be mad at me - there were certainly some pissing and moaning about the change to the call schedule, but in the end these fellow residents have become my closest friends because they were there for me when it mattered.

 

[wtm1114]

I really hate to sound like devil's advocate and the only person in this thread to talk you out of surgery. But here are my opinions:

1. You sound like a very competent and hard-working person in general. That means, you will most likely do well even if you switch to another specialty. You will most like do well even if you don't work as an MD at all. So the argument that "you are doing so well so you shouldn't quit" isn't a solid one. You will be a caring physician no matter what field you are in. The central question here is how to make your life happy.

2. If these people are available, talk to someone who has actually quit surgery. Ask them how they feel. It may be biased because they are more likely to curse at surgery.

3. Try to keep this idea private to yourself. If I were you I wouldn't tell anyone in the program unless they are really really trustworthy friends.

4. Most important: talk to some practicing attendings. We as residents are often so fixated on the life of a resident. Yes, residency is long, but remember we will spend the majority of our life as attendings. And I know the lifestyle of a surgery attending isn't that benign. If the lifestyle of an attending also bothers you tremendously, it's time to quit. You never want to regret something by the time you are 65.

5. Here's the BIASED perhaps politically incorrect part:
I've seen so many female surgery attendings who are just unhappy as hell. I honestly wonder if surgery is women-friendly at all. Of course, there are also a lot of happy female surgeons out there. Again, very personal opinion here. Potentially trolling?

Bottomline: If I had a daughter, I would discourage her from choosing surgery.

 

[JackADeli]

Do you really talk with all the anesthesiologists about their medical history and how their back feels???

Or do you just work with a bunch of old geezers that are hobbling around?...

Start at the end and work backwards.

1. definately some geezers. But, no, most are not geezers.
2. Nope, don't review their medical history but hear alot of talk about their backs. i also watch the attendings warning young residents to raise the bed cause, "anesthesia is hard on your back and you want to have a long career".
3. As I noted, sitting is not good for the back and I don't see anesthesia sitting in ergonomic, lumbar supporting chairs with good posture during these cases.

... is this mental health situation that bad that I need to take time off ... or do I just keep going and try to find some way to get out of the deep, deep rut I got myself into...

Maybe... But, I think WS and most surgeons here and senior residents will tell you, based on the calendar, you are about exactly at the right point in the year to make the wrong decision. Jan/Feb, ~ Mid to end of winter is about the deepest emotional trough during residency. Everyone is burnt out, exhausted emotonally and physically. The rash of blizzards and cold weather haven't helped. I have seen plenty about this time quit and/or arrange a different specialty. As spring comes, they enter the end of their year in residency they start to enjoy it and regret that they have already set in stone this change.

 

[dmal]

Start at the end and work backwards.

...I think WS and most surgeons here and senior residents will tell you, based on the calendar, you are about exactly at the right point in the year to make the wrong decision. Jan/Feb, ~ Mid to end of winter is about the deepest emotional trough during residency. Everyone is burnt out, exhausted emotonally and physically. The rash of blizzards and cold weather haven't helped. I have seen plenty about this time quit and/or arrange a different specialty. As spring comes, they enter the end of their year in residency they start to enjoy it and regret that they have already set in stone this change.

So then, when IS the right time to make a decision to take time off, quit or move on to a different specialty? WS mentioned taking time off...WS, what time of the year did you decide to do this and how much time off did you take?

 

[JackADeli]

So then, when IS the right time to make a decision to take time off, quit or move on to a different specialty? WS mentioned taking time off...WS, what time of the year did you decide to do this and how much time off did you take?

My comments are in reference to someone choosing to quit a demanding residency/specialty in mid-winter first year.

I am not opposing the suggestion of taking time off. Honestly, I think it is important to take some time, step back, catch your breath before you make potentially irreversible career changing decisions. I will leave it to everyone, including WS to comment on their opinion as to timing. But, some thoughts are as follows:

1. all else equal, I think a time off/vacation break/emotional recovery period should be undertaken before significant performance downslide occurs.

2. often the ideal time is not available based on over all residency scheduling

3. some program directors are in tune to their residents and may recognize some fail to take "me time" and thus mandate it. Others, "just don't want to hear about it... man up". So, I agree this is a very hard and difficult issue.

I wish all the best of luck. I encourage each to reach out and seek support. I have been surprised to find how supportive my "hard ass" senior chief residents were when I asked for help. It was pleasantly surprising and unexpected to find they could be compassionate. The senior/chief residents through out my training, when faced with a potential quit/resignation resident always rallied to restore confidence and encourage the individual. Not all programs have the same make-up.

 

[dmal]

My comments are in reference to someone choosing to quit a demanding residency/specialty in mid-winter first year.

I am not opposing the suggestion of taking time off. Honestly, I think it is important to take some time, step back, catch your breath before you make potentially irreversible career changing decisions. I will leave it to everyone, including WS to comment on their opinion as to timing. But, some thoughts are as follows:

1. all else equal, I think a time off/vacation break/emotional recovery period should be undertaken before significant performance downslide occurs.

2. often the ideal time is not available based on over all residency scheduling

3. some program directors are in tune to their residents and may recognize some fail to take "me time" and thus mandate it. Others, "just don't want to hear about it... man up". So, I agree this is a very hard and difficult issue.

I wish all the best of luck. I encourage each to reach out and seek support. I have been surprised to find how supportive my "hard ass" senior chief residents were when I asked for help. It was pleasantly surprising and unexpected to find they could be compassionate. The senior/chief residents through out my training, when faced with a potential quit/resignation resident always rallied to restore confidence and encourage the individual. Not all programs have the same make-up.

Ok, I see what you're saying, JackAdeli, thanks. As someone who is a resident in another specialty, thinking of switching into general surgery, it helps a little to read this. Though, I know ultimately, it boils down to me and what I think would make me happy professionally in the end.

 

[KWTRCSI]

I am a super nice, sensitive female (for example, I easily feel guilty if I had to dump on someone despite the fact that I’m always getting dumped on; I always take on more than expected; I always smile even when I’m frustrated.

OK... that made me cry

Surgery residency is hellish no matter how “benign” the program is, and I just feel extremely unhappy even though my program isn’t malignant.

Now thats a universal fact general surgery is always malignant regardless

love working with my hands, love small/quick procedures
simply because I didn’t like anything else better

So you want to be a surgeons why not consider or at least get exposure to other alternative surgical specialities such as
Ophthalmology, Urology, ENT ????

Anyway wish you good luck

 

[anicha06]

Hi everyone! just wanted to update you guys ..
I took the year off, which started july 1st .. spent the first week just decompressing after the last rotation I had. I have to admit I couldn't really relax, I wasn't used to not being extremely busy. I almost felt anxious even!
Today I'm off to interview labs. I did secure a lab months ago, but I'm not sure if I should be choosing labs based on what I think I might go into (which is almost impossible since I'm not even sure I'll stay in surgery) or pick a lab with a good PI/lab mates despite it being a field I wouldn't pursue a career in. Wish me luck!

 

[DoctorDoom]

Good luck to you. It's not easy to deal with these issues. Just remember that chronic pain can have a severe negative effect on your mood and thereby affect your clarity of thought. Some down time is the best choice IMHO.

 

[anicha06]

thanks guys