rationale for categorizing residencies as "surgical"

[aggiecrew]

---

Members don't see this ad.

a

 

[fourthyear]

I guess it's partly a historical difference - specialists in the "procedure-oriented" medical specialties like cardiology and GI weren't doing any procedures a generation ago, they used medical treatment only. But many differences still persist and there is definitely a distinction between medical and surgical training. Surgical specialists do most of their procedures in the OR under a sterile environment. The other procedure-oriented medicine specialists tend to do theirs in procedure rooms, not full sterile OR's. The procedures tend to be much less invasive or at least the point of entry (vein, mouth), is not the same as making and incision and opening up to work inside. I suppose one could argue urologists do a lot of cystoscopies, which isn't much different than a GI doc's endoscopy, but the urologist is also trained to do open surgical procedures as well (like removing diseased or malignant kidneys, bladders, prostates), so the depth of training overall and overall procedures you can do is much different.

Yes, GI diseases are treated surgically and medically, but the surgical treatment of GI diseases is provided by a General Surgeon (or colorectal or hepatobiliary surgical specialist sometimes). GI docs and general surgeons learn how to do colonoscopies and upper endoscopies. For GI docs those are about the only "procedures" they can do, and those are mainly diagnostic and rarely therapeutic. Surgeons often choose not to make scopes a big part of their practice, but they learn them in training and can do them if they want, plus they can do all the surgeries needed to treat most GI disease. Surgeons also learn most of the medical treatment for all the diseases they treat and would be perfectly capable of managing it if they wanted to, but most are busy enough with their surgical practice that they prefer to refer the medical management of more long-term problems to GI doctors or gereral medicine doctors.

Yes, the med vs. surgical treatment can change with time. Surgery for perforated ulcers used to be a very common operation, but with all the new preventative medications available now, a surgery resident gets to see maybe a few cases of this a year. Don't worry about surgeons loosing out on having enough work b/c of this though - thanks to the movement towards routine screening colonoscopies, we have more ressections colon tumors found at earlier stages than we used to in the pre-colonoscopy era where people might instead die of some undiagnosed cancer. These are just a few examples of how things do change, there are many more of course.

 

[aggiecrew]

a

 

[fourthyear]

I don't think there are that many urologic problems that require long-term medical treatment that a primary care doctor is not perfectly capable of providing. Medically treated urology problems and their meds - incontinince/Detrol, erectile dysfunction/viagra or levitra - what else is in urology that requires long-term medical treatment over surgical? These medications are not all that specialized or complicated once the diagnosis has been made. There wouldn't be much for a medicine urology specialist to do I wouldn't think. If you haven't started med school yet, you might consider being a PA or NP or even a specialty trained RN and working with a urologist in their clinic to do only the clinical/non-surgical side of urology.

Why is it that you are in avoidance of urology surgical training if you are so interested in treating urologic diseases?

 

[LuckyMD2b]

I guess what I'm getting at is that I want to do what GI's do, a medical practice that refers patients on to others for procedures requiring surgery but keeps patients that need meds. EXCEPT that I want this for uro, not GI.

but it seems that because of convention, uro is over trained and GI is undertrained. I mean, why is it that uros should be automatically trained to do both meds and surg but that GI's are only trained for the meds, not surg. I don't see the meds:surg ratio for treatment to be different enough for these specialties to warrant such a drastically different training method.

any thoughts?

What are you talking about?

GI is a medical subspecialty, you apply to GI after finishing 3yrs of Internal Medicine.

Uro is a surgical specialty and you begin Uro training after 2yrs of general surgery.

They're trainded to do different things. A urologist's training focuses on surgical treatments of the urogenital tract while a GI is focused on diagnosis and medical management. It isn't accurate to compare GI to Uro, GI is like the medical side of general surgery/surgical oncology. GI does do some procedural stuff, but it's far from surgery, you'll never see these guys sewing two peices of bowel together.

Urology is different because their isn't really a medical specialty that focuses on the same field, except maybe nephrology, sort of. A surgeon can pick up the medicine required for urology, but you can't just pick up the surgical skills required to do it the other way.

I think you need to investigate a little more about these fields before you make comments about how much they have been trained.

 

[thenavysurgeon]

I guess I'm curious why the OP would NOT be interested in the surgical management of urologic disorders. One of the pleasures of being a surgeon is actually FIXING a patients problem. Medications deflect symptoms, they don't eliminate them. Handing out meds is something anyone can do, as evidenced by the proliferation of on-line pharmacy outfits. Another thing to consider is this: the procedural specialties are attractive because they are relatively lucrative. Dispensing Levitra for a living might bore you to death, before you starve to death. You're not going to be able to make a living unless you offer a broad range of services to a patient.

I think the above descriptions by 'fourthyear' of the scope of practice that GI and Uro enjoy are accurate. I would add that the GI docs are becoming more sophisticated and aggressive in some of their interventions. I'd argue that an ERCP with a sphincterotomy is in-fact a 'surgical' procedure. Endoscopic esophageal plication for GERD is 'surgical'...the difference between these providers, and a 'real surgeon' is that the latter has been trained to deal with the complications of their actions. GI docs, I can assure you, have not.