Really like surgery, not so much the hours

[DD214_DOC]

I've probably posted this before but I am at sort of an empasse. I had decided to apply for FM (just because i can't think of anything else I really care to do) but I know I would enjoy surgery a lot more. I love procedures, and I was viewing FM with the perspective of doing Urgent Care so I could get my procedure jollies. I also considered the OB fellowship through FM so I could at least be in the OR for c-sec and some other routine OB/gyn surgeries but realize I wasn't planning to do it because I give a crap about OB/Gyn -- I just wanted to be in the OR doing stuff.

I thought about EM, but there was something about the ED that left a bad taste in my mouth.

Having said that, I really don't like working long and arduous hours. I don't know that I would be able to deal with it, even if it's related to something I like doing.

I really don't have any questions, just some advice. Also, I'm applying Army and wonder what my chances would be. Below average COMLEX I. I did Honor my actual surgery rotation, but did not honor the exam (we have a >60% fail rate on our surgery departmental exam) but still passed, so I ended up with a "High Pass" for the rotation. I did get a letter out of it from the surgery attending (an old Army surgeon) saying I was awesome and could probably get a good LOR out of the other attending (who is an Army surgeon).

Another caveat that I should point out is that, although I may not be a super awesome reader of books, I am a complete badass when it comes to using my hands and doing procedures.

I am wondering if my best bet isn't just to do an audition rotation at the location I would want to do a GS residency and seeing if I love it or hate it.

I like surgery, but it's not something I feel I would be willing to put before my family. I've missed a big chunk of my young son's life already because of school and don't like the idea of missing a lot more. But, I also don't want to feel like I never really did what I wanted to do.

*shrug*

Some help would be appreciated.

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[goooooober]

Sounds like surgery is not for you at all. Good Luck in FM.

 

[PostCall]

I've probably posted this before but I am at sort of an empasse. I had decided to apply for FM (just because i can't think of anything else I really care to do) but I know I would enjoy surgery a lot more. I love procedures, and I was viewing FM with the perspective of doing Urgent Care so I could get my procedure jollies. I also considered the OB fellowship through FM so I could at least be in the OR for c-sec and some other routine OB/gyn surgeries but realize I wasn't planning to do it because I give a crap about OB/Gyn -- I just wanted to be in the OR doing stuff.

I thought about EM, but there was something about the ED that left a bad taste in my mouth.

Having said that, I really don't like working long and arduous hours. I don't know that I would be able to deal with it, even if it's related to something I like doing.

I really don't have any questions, just some advice. Also, I'm applying Army and wonder what my chances would be. Below average COMLEX I. I did Honor my actual surgery rotation, but did not honor the exam (we have a >60% fail rate on our surgery departmental exam) but still passed, so I ended up with a "High Pass" for the rotation. I did get a letter out of it from the surgery attending (an old Army surgeon) saying I was awesome and could probably get a good LOR out of the other attending (who is an Army surgeon).

Another caveat that I should point out is that, although I may not be a super awesome reader of books, I am a complete badass when it comes to using my hands and doing procedures.

I am wondering if my best bet isn't just to do an audition rotation at the location I would want to do a GS residency and seeing if I love it or hate it.

I like surgery, but it's not something I feel I would be willing to put before my family. I've missed a big chunk of my young son's life already because of school and don't like the idea of missing a lot more. But, I also don't want to feel like I never really did what I wanted to do.

*shrug*

Some help would be appreciated.

a lot of med students like surgery but not the hours. therein lies the rub and what often seperates those who go into *and* finish surgery residency from those who don't. something like 1 in 5 residents who start surgery residency don't finish it and they must of enjoyed it too in med school to go into it. it's not enough to enjoy the OR because you have to honestly ask yourself if you'll enjoy it enough to take 24hr q3-q4 call for 5 years and all the other things involved in a surgery residency apart from the OR and work just as hard as a junior attending starting out.

 

[Winged Scapula]

You have to be committed (in more ways than one, ha ha) to want to do surgery. People who go in with second thoughts often end up quitting, IMHO.

However, you haven't really convinced me that you'd be happy doing something else. You've talked about a lot of other things but I don't see that they are anything but a sorry second to surgery. For what its worth, people who go into other specialties half-hearted also aren't very happy.

Its too bad that your COMLEX is subpar because there are an awful lot of surgical subspecialties with much better lifestyle, hours, etc and still give you the "jollies" of being in the OR. I'm not sure about Military/Osteo residencies, but I'd venture that ENT, Uro, PRS, etc. would be just as competitive.

The problem I see with FM is that you are doing "procedures". Is that enough for you or will you wish you were doing surgery? There are SOME FM residencies which do teach you to do scopes, hernia repairs and appys - these are pretty competitive I understand but perhaps worth a look.

I'm not a parent so it wouldn't be fair for me to comment on being away from your son except to say that almost all residencies involve long hours and call. But there are going to be times when your career does have to come first...I am fairly sure that all of my parent colleagues have missed some important things in their children's lives because of the unpredictability of surgery residency and practice. Some of this is just out of your control.

But if you haven't done a surgical Sub-I or audition rotation, I'd definitely suggest that. If you find that its for you, then you have some soul searching to do.

 

[mercaptovizadeh]

I'm not in surgery or even a resident, but I think you really have to consider the fact that there are a lot of things we may like, but can't/shouldn't do. I might like to paint, but trying to be a professional artist would be a huge mistake because there's no job stability there, no reliable income, family depends on me, etc. You need to sometimes put practical considerations ahead of what you like most. Because if you go with just your (a)vocation, things outside of it can start falling apart. And then you'll be miserable because your wife has divorced you, your kids don't know you, your elderly parents are in a nursing home 2000 miles away, you don't have time for activities you enjoy, etc.

You have to realize that surgery is an intense long-hours career during and AFTER residency. It is unavoidable. Your family life will be curtailed, and you have to decide whether you want to see your kids for 3-4 hours a day or 0-1 hr a day (maybe I exaggerate, but you understand the point).

Some other specialties have much better attending hours. Since many of the procedures in GI (subspecialty of IM, but very competitive) are elective, you could probably work the hours to your liking. Also, FM sounds like a great option for doing procedures and controlling hours, although compensation is relatively low. Many FMs choose to work 4 days a week so they have more time for their personal lives.

 

[asmallchild]

Its too bad that your COMLEX is subpar because there are an awful lot of surgical subspecialties with much better lifestyle, hours, etc and still give you the "jollies" of being in the OR. I'm not sure about Military/Osteo residencies, but I'd venture that ENT, Uro, PRS, etc. would be just as competitive.

Perhaps as an attending but I thought that ENT, Uro, PRS residencies are sometimes just as grueling as a general surgery residency?

 

[RussianJoo]

I've probably posted this before but I am at sort of an empasse. I had decided to apply for FM (just because i can't think of anything else I really care to do) but I know I would enjoy surgery a lot more. I love procedures, and I was viewing FM with the perspective of doing Urgent Care so I could get my procedure jollies. I also considered the OB fellowship through FM so I could at least be in the OR for c-sec and some other routine OB/gyn surgeries but realize I wasn't planning to do it because I give a crap about OB/Gyn -- I just wanted to be in the OR doing stuff.

I thought about EM, but there was something about the ED that left a bad taste in my mouth.

Having said that, I really don't like working long and arduous hours. I don't know that I would be able to deal with it, even if it's related to something I like doing.

I really don't have any questions, just some advice. Also, I'm applying Army and wonder what my chances would be. Below average COMLEX I. I did Honor my actual surgery rotation, but did not honor the exam (we have a >60% fail rate on our surgery departmental exam) but still passed, so I ended up with a "High Pass" for the rotation. I did get a letter out of it from the surgery attending (an old Army surgeon) saying I was awesome and could probably get a good LOR out of the other attending (who is an Army surgeon).

Another caveat that I should point out is that, although I may not be a super awesome reader of books, I am a complete badass when it comes to using my hands and doing procedures.

I am wondering if my best bet isn't just to do an audition rotation at the location I would want to do a GS residency and seeing if I love it or hate it.

I like surgery, but it's not something I feel I would be willing to put before my family. I've missed a big chunk of my young son's life already because of school and don't like the idea of missing a lot more. But, I also don't want to feel like I never really did what I wanted to do.

*shrug*

Some help would be appreciated.

if the army is paying for your med school then you don't have to worry about your grades and scores as long as you pass. a friend of mine just graduated from derxel med school and had the army pay for him to go to med school and he applied through the army match and got exactly what he wanted. he told me that in this years match, 2009 the ENT specialty was very unpopular and basically they had a 1:1 ratio of applicants to spots. so everyone who applied got an ENT residency. He also said that the guy with the lowest USMLE step1 score who got it had a 198, which if you don't know is very low. the average is about 220 and 185 is passing. Like someone mentioned above a lot of the surgical sub specialties don't work as hard and have much better hours. so i suggest you apply through the military match and try to get one of those cushy sub-specialty residencies, which are super hard to get in the civilian world but very easy to get for the military. Another one that's not popular in the army is Derm and they do a good amount of procedures too. So the army is the way to go, they'll hook you up as long as there are spots, which most of the time there are.

 

[Winged Scapula]

Perhaps as an attending but I thought that ENT, Uro, PRS residencies are sometimes just as grueling as a general surgery residency?

These specialties generally take home call for the vast majority of their residency and rarely have to in unless there was a relevant Trauma (Plastics was probably the worst as they took Face and Hand Trauma). All of course have to do a Prelim Gen Surg year. In some places they may have it good enough that the gen surg residents actually take their call (which was the case for all the surgical subspecialties, including Ortho, at our VA. )

Don't get me wrong, these guys still work hard, but the hours are less, the census smaller and the home call is a wonderful way to spend more time with family.

 

[logistic]

Think about Obama...he's probably pretty busy as Prez, but yet has time to exercise, read for leisure at bedtime, and spend time with his family. Tap into your inner Obama and stop worrying about the hours. You can do it!

 

[DHT]

Think about Obama...he's probably pretty busy as Prez, but yet has time to exercise, read for leisure at bedtime, and spend time with his family. Tap into your inner Obama and stop worrying about the hours. You can do it!

If obama has time for all of that, then he is not working as hard as I am now (and I'm not even a surgical resident yet).

 

[GH253]

Why would you go into medicine at all if you don't want to work long hours?

 

[Miami_med]

I applied and matched general surgery this year with small children at home. I think at the end of the day, the answer is to know oneself. Life is about sacrifices, and you have to make a determination as to what you want to sacrifice. In this case, you will clearly have to sacrifice something.

In my opinion, doing FM because you like procedures is probably a poor long term choice. Urgent care is not the logical (or usual) long term outcome of FM, and if you're doing FM to do urgent care, you really might as well do EM and expand your potential scope to real EDs. FM is really suited to people who want to do FM, and while a tolerance or taste for procedures is helpful in providing comprehensive medical care, it will be the minority of your work in any sort of realistic practice setting. You'd probably get more honest procedures going into IM and chasing Cards, GI, or Pulm/CC.

Have you considered Anesthesia? They have lots of procedures, better hours, and a good deal of time in the OR. The downside for a surgery wanna-be is that you have to sit and watch other people do surgery. Most of the anesthesiologists that I know don't think that this is a bad thing.

If you have any questions about applying to G-surg as a parent, feel free to PM me or ask them here. I haven't started yet, so any questions about internship will have to wait a few months

 

[smq123]

Have you considered Anesthesia? They have lots of procedures, better hours, and a good deal of time in the OR. The downside for a surgery wanna-be is that you have to sit and watch other people do surgery. Most of the anesthesiologists that I know don't think that this is a bad thing.

Or ophtho. Some OR time, lots of procedures, but it's (for the most part) a 9-5 job.

The only downside is that anesthesia and ophtho are somewhat more competitive. But they're definitely something to think about.

 

[logistic]

If obama has time for all of that, then he is not working as hard as I am now (and I'm not even a surgical resident yet).

Requiring harder work?
1) medical student on a surgery rotation
OR
2) running the country

Obama is just efficient.

 

[Miami_med]

Requiring harder work?
1) medical student on a surgery rotation
OR
2) running the country

Obama is just efficient.

Come on now, nobody actually runs the country.

 

[RussianJoo]

Or ophtho. Some OR time, lots of procedures, but it's (for the most part) a 9-5 job.

The only downside is that anesthesia and ophtho are somewhat more competitive. But they're definitely something to think about.

Gen surgery is harder to match into than Anesthesia or at least just equally hard.

 

[DD214_DOC]

I get the impression that most of the FM residents/attendings i have worked with feel about the same way I do. They may not *love* what they do, they actually don't mind it, but at the end of the day it's just a job that pays pretty well in comparison to most other jobs and gives them ample free time to do "other stuff".

Medicine isn't my life. It's a job. Would this make me unhappy as a GS? I dunno, my guess is probably.

 

[46&2]

if the army is paying for your med school then you don't have to worry about your grades and scores as long as you pass... so i suggest you apply through the military match and try to get one of those cushy sub-specialty residencies, which are super hard to get in the civilian world but very easy to get for the military. Another one that's not popular in the army is Derm and they do a good amount of procedures too. So the army is the way to go, they'll hook you up as long as there are spots, which most of the time there are.

That's some of the worst advice I've seen in these forums. It's much harder to get into surgery or a subspecialty in the military. If you don't do very well in medical school, then you'll likely be made a GMO / flight surgeon. Although the military is more accepting of osteopaths in their programs.

Military + surgery... your family will suffer. They may take it, but they will suffer.

 

[RussianJoo]

That's some of the worst advice I've seen in these forums. It's much harder to get into surgery or a subspecialty in the military. If you don't do very well in medical school, then you'll likely be made a GMO / flight surgeon. Although the military is more accepting of osteopaths in their programs.

Military + surgery... your family will suffer. They may take it, but they will suffer.

maybe for general surgery. and Ortho. but ENT this year was very unpopular and had a 1:1 ratio, and like i said above a guy with a 198 on step1 which is way bellow average matched into an ENT spot. So while some residencies are still hard to get others are not cause many soldiers don't want to do them. I know a foreign grad who got a derm residency with the army just because there were empty derm spots that year and she just moved to the US from Russia and just got her citizenship. sure it's all on a year to year basis but it can be done and it has been done. and if there are empty spots in the match that year they'll take you as long as you just passed which isn't hard. Also I heard that the Navy is the only branch that still regularly enforces the GMO tours, and that the army has pretty much done away with them.

you can have your opinions but they're just that, opinions. what i have said are facts, you can look up the 2009 match results if they're even out. but the older results i have seen some specialties that would be considered very competitive in the civilian world don't fill 100% in the military. And that's where the military will pretty much take anyone with a pulse to fill the spot.

 

[RussianJoo]

I get the impression that most of the FM residents/attendings i have worked with feel about the same way I do. They may not *love* what they do, they actually don't mind it, but at the end of the day it's just a job that pays pretty well in comparison to most other jobs and gives them ample free time to do "other stuff".

Medicine isn't my life. It's a job. Would this make me unhappy as a GS? I dunno, my guess is probably.

looks like you made your choice.. just know that you can be busy and not have time for your family in any field. and the same goes for being in surgery and making time for your family. residency is just a small part of your life. you should do what makes you happy for the rest of your life. being miserable at work will reflect how you are at home too. FM is nothing like GS.

 

[deegs]

ENT this year was very unpopular and had a 1:1 ratio, and like i said above a guy with a 198 on step1 which is way bellow average matched into an ENT spot....I know a foreign grad who got a derm residency with the army just because there were empty derm spots that year and she just moved to the US from Russia and just got her citizenship. sure it's all on a year to year basis but it can be done and it has been.

ENT might have been 1:1 this year, but was 4:1 the year before. The Derm blip occured last year, but was plenty competitive before and since.

the military match is a much smaller match, and as result there is occasional UNPREDICTABLE variability due to student preferences from year to year. The pendulum can just a easily swing the other way and make a slam dunk into an uber-competitive specialty. As with finance, the adage "Past performance is no indication of future returns" holds true.

 

[RussianJoo]

ENT might have been 1:1 this year, but was 4:1 the year before. The Derm blip occured last year, but was plenty competitive before and since.

the military match is a much smaller match, and as result there is occasional UNPREDICTABLE variability due to student preferences from year to year. The pendulum can just a easily swing the other way and make a slam dunk into an uber-competitive specialty. As with finance, the adage "Past performance is no indication of future returns" holds true.

and since? there hasn't been a match since... this i was in the 2009 match. so we'll see what the trend is next year. However, you're correct it is a small match and can swing in any direction without prediction. We'll see what next year brings.

 

[deegs]

and since? there hasn't been a match since... this i was in the 2009 match. so we'll see what the trend is next year. However, you're correct it is a small match and can swing in any direction without prediction. We'll see what next year brings.

I hate to nitpick, and this probably belongs in the mil med forum, but all 7 derm slots in the army filled this year (2009), from a pool of 9 applicants. It was the 2008 where they only got 4 applicants. The Army had no trouble filling those 3 empty seats this year with people who had already completed internship previously, but this was done outside of what is commonly considered the "military match" and does not show up in published data.

 

[RussianJoo]

I hate to nitpick, and this probably belongs in the mil med forum, but all 7 derm slots in the army filled this year (2009), from a pool of 9 applicants. It was the 2008 where they only got 4 applicants. The Army had no trouble filling those 3 empty seats this year with people who had already completed internship previously, but this was done outside of what is commonly considered the "military match" and does not show up in published data.

that's fine. i would surprised if they couldn't fill their spots. I am sure one way the army fills their spots is by "suggesting" to the applicants where to apply, especially if the applicant seems to not know 100% what he/she wants. Thus they try really hard to have an even distribution and fill every spot. But I bet the Step scores of those that got derm or any specialty that's considered super competitive are considerably lower than a civilian's step scores who's trying to get a derm residency in the civilian world. And that was my whole point to the OP, he was concerned that his below average comlex score will keep him out of surgery, and my reply was if you go through the military match it won't keep you out and you might even match into a subsurgical specialty depending on the year. The civilian match is considerably harder. to use derm as an example. there are 28 pgy1 derm spots and 200 people applied for them that's almost a 1 to 10 ratio. and there are 310 pgy2 derm spots and 583 people applied to those almost a 1to 2 ratio, while the army has 7 spots and only 9 applied there. Do you think it's easier to out screo 9 people on step1 and 2 or 500 people?

 

[Slack3r]

These specialties generally take home call for the vast majority of their residency and rarely have to in unless there was a relevant Trauma (Plastics was probably the worst as they took Face and Hand Trauma). All of course have to do a Prelim Gen Surg year. In some places they may have it good enough that the gen surg residents actually take their call (which was the case for all the surgical subspecialties, including Ortho, at our VA. )

Don't get me wrong, these guys still work hard, but the hours are less, the census smaller and the home call is a wonderful way to spend more time with family.

Really? Is this pretty isolated? Because most of what you see in the ENT/plastics forums are that they work just as hard (sometimes harder) than the g-surg residents. And the plastics guys say they get a ton of facial/hand consults. Maybe I'm wrong, and not trying to call you out, just curious.

 

[Hampster10]

[qu.

 

[Winged Scapula]

Really? Is this pretty isolated? Because most of what you see in the ENT/plastics forums are that they work just as hard (sometimes harder) than the g-surg residents. And the plastics guys say they get a ton of facial/hand consults. Maybe I'm wrong, and not trying to call you out, just curious.

They do work very hard and I absolutely have great respect for them. And yes, they can get tons of face and hand consults. But IMHO the total hours worked per week and the total number of hours in the hospital, are more for the general surgery residents.

This clearly will vary with where you trained.

In my program, the plastics guys took hand call, alternating with ortho, and face call. They were busy, but call was from home and most nights on call required only a few hours in the hospital. Face and hand call did not often require emergent operations, so while you had to come in to asses the patient, you were often home back in your bed within an hour. Obviously it sucked those nights when you had to come in multiple times (my limit was no more than 2).

ENT took call as well from home, and rarely had to come in. I did a month of ENT and Plastics and was first call for both and I worked much fewer hours than I did on a general surgery service and got a lot more sleep. Perhaps it was luck of the draw, but this was the experience in my program. When they rotated at the VA, the general surgery residents took their call.

A program with a lot of trauma may be very busy, a program without may not. YMMV.

 

[dapmp91]

I really like spending money, but I sure as hell don't like working for money