So... what does gen surg actually do

[dbeast]

Hey guys, I really like the idea of gen surg... In theory, it has a lot of variety and is the most "medicine-ish" of the surgical specialties, and spends a good amount of time in the OR vs. the clinic... all things that appeal to me. However, I'm concerned that basically anything other than a lap chole gets sent to more specialized folks, especially if you practice in a reasonably big city. So, can anybody be super awesome and fill me in on what to *really* expect if I were to go into gen surg and not pursue an additional fellowship afterward? Thank you mucho!

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[remote]

Hey guys, I really like the idea of gen surg... In theory, it has a lot of variety and is the most "medicine-ish" of the surgical specialties, and spends a good amount of time in the OR vs. the clinic... all things that appeal to me. However, I'm concerned that basically anything other than a lap chole gets sent to more specialized folks, especially if you practice in a reasonably big city. So, can anybody be super awesome and fill me in on what to *really* expect if I were to go into gen surg and not pursue an additional fellowship afterward? Thank you mucho!

truth is, general surgery is a dying field these days in medium to large sized cities/communities as everyone wants to see a specialist. all true general surgeons do these days are lap appys, lap choles, hernias, and lipomas...that is literally >95% of what they'll do. don't let anyone tell you otherwise.

also you can not be more wrong on gen surg being the most medicinish of all surgical specialties. Urology and ENT have way more medicine than gen. surgery. There is no such thing as an office based general surgeon b/c they all have to operate to make a living; however, with ENT and urology, it is much much easier to quit operating and still have a very busy office practice.

just my two cents

 

[idiot07]

What this poster just wrote is just blatant misinformation. Yes, there are many surgeons who do mainly appys, choles, hernias, and lumps and bumps, and yes in larger cities much of the high end stuff is soaked up by specialist. What do you consider a reasonable city? Don't expect to move to Seattle, Chicago, or New York and do pancreatic cases without fellowship training, but many general surgeons in decent size cities (~1 million population) or exurban areas still do benign foregut, colon cancer, and breast cancer surgery. There are also you abdominal catastrophe type cases with ischemic gut/perfed tic's etc. Many still do thyroid stuff and take trauma call. A few even do pancreaticobiliary cases. It does help to live in rural areas, and someone who did all of the above stuff in a city would be an exception, but a general surgeon who takes trauma call and does lap nissens, lap spleens, lap colons etc would not.

With regard to the medicine component of things, it depends what type of medicine you're talking about. We do more ICU care and general medical management of our patients than any of the other specialities. Our operations tend to effect our patients physiology more than say ent or plastics and I think general surgeons tend to be more well rounded physicians in academia. In private practice, medical issues often are deferred to a hospitalist like other surgical specialties do, but again this depends on the individual surgeon's practice habits. If you consider medicinish to mean, that you see patients in the office and prescribe them meds for their bph/sinusitis then yes ent/urology have more medicine. Though if you wanted to stop operating wound care is a very lucrative and lifestyle friendly (if boring and disgusting) bail out from gs.

My response isn't meant to badmouth ent or urology which are both terrific fields.The lifestyle and pay in both of these is better than gen surg, though again this is somewhat practice dependant. It's more in defense of gen surg. Another point, is that even if you go into a surgical specialty, to do the big cases you're probably going to have to have additional fellowship training, i.e. your typical community ent or urologist is going to do some huge whack for head and neck cancer or bladder cancer. They have their meat and potatoes or tubes, tonsils, and cysto/turbt. These hwoever pay the bills

 

[Black Surgeon]

truth is, general surgery is a dying field these days in medium to large sized cities/communities as everyone wants to see a specialist. all true general surgeons do these days are lap appys, lap choles, hernias, and lipomas...that is literally >95% of what they'll do. don't let anyone tell you otherwise.

also you can not be more wrong on gen surg being the most medicinish of all surgical specialties. Urology and ENT have way more medicine than gen. surgery. There is no such thing as an office based general surgeon b/c they all have to operate to make a living; however, with ENT and urology, it is much much easier to quit operating and still have a very busy office practice.

just my two cents

You are extremely misinformed

 

[SLUser11]

Hey guys, I really like the idea of gen surg... In theory, it has a lot of variety and is the most "medicine-ish" of the surgical specialties, and spends a good amount of time in the OR vs. the clinic... all things that appeal to me. However, I'm concerned that basically anything other than a lap chole gets sent to more specialized folks, especially if you practice in a reasonably big city. So, can anybody be super awesome and fill me in on what to *really* expect if I were to go into gen surg and not pursue an additional fellowship afterward? Thank you mucho!

Truthfully, general surgeons do a wide variety of cases in cities both large and small. There are some that limit their practice to simpler procedures, but it's typically a choice they make rather that some forced situation. The largest, most complex surgeries will be delegated to specialists in certain urban environments, but these are typically difficult and rare cases that the general surgeons aren't very interested in performing.

However, if you do private practice, you may find that you are mistaken about the amount of "medicine" that surgeons practice. Typically, they focus on operating and clinic, as they are way too busy to take calls on blood sugars, etc. They leave management of HTN and DM to internists and hospitalists. This is different in a training environment, where surgeons rely on their residents to do this management.

truth is, general surgery is a dying field these days in medium to large sized cities/communities as everyone wants to see a specialist. all true general surgeons do these days are lap appys, lap choles, hernias, and lipomas...that is literally >95% of what they'll do. don't let anyone tell you otherwise.

just my two cents

Your two cents are worthless. General surgery has a higher demand than almost any of the surgical subspecialties. It would have been much easier for me to get a job doing GS than CRS. Perhaps I'm put off by the level of certainty that your post contains, but you sound clueless.

 

[remote]

Truthfully, general surgeons do a wide variety of cases in cities both large and small. There are some that limit their practice to simpler procedures, but it's typically a choice they make rather that some forced situation. The largest, most complex surgeries will be delegated to specialists in certain urban environments, but these are typically difficult and rare cases that the general surgeons aren't very interested in performing.

However, if you do private practice, you may find that you are mistaken about the amount of "medicine" that surgeons practice. Typically, they focus on operating and clinic, as they are way too busy to take calls on blood sugars, etc. They leave management of HTN and DM to internists and hospitalists. This is different in a training environment, where surgeons rely on their residents to do this management.



Your two cents are worthless. General surgery has a higher demand than almost any of the surgical subspecialties. It would have been much easier for me to get a job doing GS than CRS. Perhaps I'm put off by the level of certainty that your post contains, but you sound clueless.

well the reason why the demand for general surgery remains high (and no you're wrong if you think it is higher than all surgical subspecialties) is only because NO ONE wants to actually do general surgery. literally, every single gen surg resident i have met and i've met a lot of them, have told me that they do not want to do gen surg and every single one wants to do a fellowship. Why is that??? the answer is simple, b/c gen surg is an awful lifestyle and lower compensation than other surgical subspecialties.

but back to the original question, yes if you practice in a rural area, then gen. surgery offers you the opportunity to do more. but in relatively large cities (aka where most pple want to settle and live) general surgeons are left with very simple cases as i mentioned above. again, don't let anyone tell you otherwise.

 

[Rippy087]

well the reason why the demand for general surgery remains high (and no you're wrong if you think it is higher than all surgical subspecialties) is only because NO ONE wants to actually do general surgery. literally, every single gen surg resident i have met and i've met a lot of them, have told me that they do not want to do gen surg and every single one wants to do a fellowship. Why is that??? the answer is simple, b/c gen surg is an awful lifestyle and lower compensation than other surgical subspecialties.

but back to the original question, yes if you practice in a rural area, then gen. surgery offers you the opportunity to do more. but in relatively large cities (aka where most pple want to settle and live) general surgeons are left with very simple cases as i mentioned above. again, don't let anyone tell you otherwise.

When you say "surgical subspecialties" are you including fellowships that you do after general surgery, or only stuff like uro, ent, neurosurg?

 

[SLUser11]

well the reason why the demand for general surgery remains high (and no you're wrong if you think it is higher than all surgical subspecialties) is only because NO ONE wants to actually do general surgery. literally, every single gen surg resident i have met and i've met a lot of them, have told me that they do not want to do gen surg and every single one wants to do a fellowship. Why is that??? the answer is simple, b/c gen surg is an awful lifestyle and lower compensation than other surgical subspecialties.

but back to the original question, yes if you practice in a rural area, then gen. surgery offers you the opportunity to do more. but in relatively large cities (aka where most pple want to settle and live) general surgeons are left with very simple cases as i mentioned above. again, don't let anyone tell you otherwise.

Show me the stats.

You've experienced residents in one location, possibly two, and you know nearly nothing about the economics of general surgery, or the lifestyle and caseload of general surgeons outside your tiny snow globe.

 

[Smurfette]

I am a general surgeon and I do a wide variety of things. I could do MORE things, if I wanted to. Colons (lap and open), misc. bowel cases, breast, melanoma, traumas, spleens, Nissens, VATS, rectal stuff, lumps/bumps, choles, appys, hernias, access, etc. I choose not to do thyroids (my least favorite case of all), so I send those to my partner, but I could do those if I wanted. I also choose not to do hand stuff (don't feel well-trained enough and don't want the liability) or vascular (although the hospital and my partners would let me if I wanted to....I don't).

We send esophagus, pancreatic, liver, low rectal cancers out, because it's appropriate to send those to surgeons who do those cases in a larger volume than we get here.

@Slu--I'm in PP and I do not consult the hospitalists for DM and HTN unless they are uncontrolled. Most of my primary inpatients are followed by me alone, unless the patient started off on another service and transferred to mine postop.

 

[Winged Scapula]

well the reason why the demand for general surgery remains high (and no you're wrong if you think it is higher than all surgical subspecialties) is only because NO ONE wants to actually do general surgery. literally, every single gen surg resident i have met and i've met a lot of them, have told me that they do not want to do gen surg and every single one wants to do a fellowship. Why is that??? the answer is simple, b/c gen surg is an awful lifestyle and lower compensation than other surgical subspecialties.

but back to the original question, yes if you practice in a rural area, then gen. surgery offers you the opportunity to do more. but in relatively large cities (aka where most pple want to settle and live) general surgeons are left with very simple cases as i mentioned above. again, don't let anyone tell you otherwise.

As SLUser notes, show us the data.

I live in the 5th largest city in the United States. Its hardly rural. Large enough for you?

General surgeons here run the town and do a wide variety of cases from trauma, colon resections, spleens, adrenals, foregut, breast, thyroids etc. Most of them are doing SILS and robotic cases. About the only thing they don't do is plastics and vascular, and that's only because the hospitals require fellowship training in those specialties for privileges.

As a fellowship trained surgeon I can tell you that I do the bulk of the breast work in my area, only because the GS guys don't really want to but we all work well together and there's plenty of work to go around. Major surgical oncologic cases get sent out but most everything else in the realm of GS is handled here and done very well.

And I agree with Smurfette; most of us also don't consult out the medical management of our patients unless they are extremely complicated.

 

[Spikebd]

What this poster just wrote is just blatant misinformation. Yes, there are many surgeons who do mainly appys, choles, hernias, and lumps and bumps, and yes in larger cities much of the high end stuff is soaked up by specialist. What do you consider a reasonable city? Don't expect to move to Seattle, Chicago, or New York and do pancreatic cases without fellowship training, but many general surgeons in decent size cities (~1 million population) or exurban areas still do benign foregut, colon cancer, and breast cancer surgery. There are also you abdominal catastrophe type cases with ischemic gut/perfed tic's etc. Many still do thyroid stuff and take trauma call. A few even do pancreaticobiliary cases. It does help to live in rural areas, and someone who did all of the above stuff in a city would be an exception, but a general surgeon who takes trauma call and does lap nissens, lap spleens, lap colons etc would not.

With regard to the medicine component of things, it depends what type of medicine you're talking about. We do more ICU care and general medical management of our patients than any of the other specialities. Our operations tend to effect our patients physiology more than say ent or plastics and I think general surgeons tend to be more well rounded physicians in academia. In private practice, medical issues often are deferred to a hospitalist like other surgical specialties do, but again this depends on the individual surgeon's practice habits. If you consider medicinish to mean, that you see patients in the office and prescribe them meds for their bph/sinusitis then yes ent/urology have more medicine. Though if you wanted to stop operating wound care is a very lucrative and lifestyle friendly (if boring and disgusting) bail out from gs.

My response isn't meant to badmouth ent or urology which are both terrific fields.The lifestyle and pay in both of these is better than gen surg, though again this is somewhat practice dependant. It's more in defense of gen surg. Another point, is that even if you go into a surgical specialty, to do the big cases you're probably going to have to have additional fellowship training, i.e. your typical community ent or urologist is going to do some huge whack for head and neck cancer or bladder cancer. They have their meat and potatoes or tubes, tonsils, and cysto/turbt. These hwoever pay the bills

Why mention Seattle with those cities? It isn't anywhere close to the size of those two. I hate it when people think of Seattle as some HUGE city ala NYC, Chicago, LA.

 

[Winged Scapula]

Why mention Seattle with those cities? It isn't anywhere close to the size of those two. I hate it when people think of Seattle as some HUGE city ala NYC, Chicago, LA.

Seriously. Always amazes me that people somehow think of Seattle, Washington DC, Dallas or other cities way before they think of Houston and Phoenix

 

[Dissected]

Seattle is the perfect size. Not too big, not too small 😀

Thanks for the insight on general surgery SLUser and company. I am very interested in doing general sx and am semi-worried that I will be forced to do a fellowship so I can market my skills in order to live somewhere desirable.. that's kind of the attitude/angst of a lot us entering gsurg residency right now so it's nice to hear some testimonials from you guys.

 

[RIPSanto]

just curious, for those that do a fellowship, how often do you still get to do some general stuff? is it common for a fellowship trained surgeon (besides trauma/cc) to take trauma call for the heck of it (enjoy trauma, extra cash)?

 

[survivordo]

well the reason why the demand for general surgery remains high (and no you're wrong if you think it is higher than all surgical subspecialties) is only because NO ONE wants to actually do general surgery. literally, every single gen surg resident i have met and i've met a lot of them, have told me that they do not want to do gen surg and every single one wants to do a fellowship. Why is that??? the answer is simple, b/c gen surg is an awful lifestyle and lower compensation than other surgical subspecialties.

but back to the original question, yes if you practice in a rural area, then gen. surgery offers you the opportunity to do more. but in relatively large cities (aka where most pple want to settle and live) general surgeons are left with very simple cases as i mentioned above. again, don't let anyone tell you otherwise.

<----- General surgery resident who wants to do general surgery.

Survivor DO

 

[mimelim]

As SLUser notes, show us the data.

I live in the 5th largest city in the United States. Its hardly rural. Large enough for you?

General surgeons here run the town and do a wide variety of cases from trauma, colon resections, spleens, adrenals, foregut, breast, thyroids etc. Most of them are doing SILS and robotic cases. About the only thing they don't do is plastics and vascular, and that's only because the hospitals require fellowship training in those specialties for privileges.

As a fellowship trained surgeon I can tell you that I do the bulk of the breast work in my area, only because the GS guys don't really want to but we all work well together and there's plenty of work to go around. Major surgical oncologic cases get sent out but most everything else in the realm of GS is handled here and done very well.

And I agree with Smurfette; most of us also don't consult out the medical management of our patients unless they are extremely complicated.

I am in the 4th largest city and all of this holds true for most of the practices that we come in contact with except in the largest hospitals. We turf a lot of stuff to the hospitalists, even the easy afib, DM and HTN stuff because we simply don't have time for it with the volume of our programs, but that is definitely not the norm.

 

[Medicus2013]

just curious, for those that do a fellowship, how often do you still get to do some general stuff? is it common for a fellowship trained surgeon (besides trauma/cc) to take trauma call for the heck of it (enjoy trauma, extra cash)?

N=1 but at my med school we have at least one CRS guy and one vascular guy who both take trauma/acute care surgery call. I've seen them both take some interesting cases to the OR.

 

[SLUser11]

@Slu--I'm in PP and I do not consult the hospitalists for DM and HTN unless they are uncontrolled.

And I agree with Smurfette; most of us also don't consult out the medical management of our patients unless they are extremely complicated.

I'm glad to hear you guys don't do it, and neither do I (although I have a buffer between me and the phone calls), but do you both think this is the national norm? It's been my experience that in training environments, surgeons are happy to manage medical issues, but in a pure community setting without PAs or residents, they often utilize hospitalists to manage medical issues.

 

[mbe36]

OP: I did my core/Sub-I surgery in Brooklyn NYC and heavily considered GS. The GS surgeons here are "Soup to nuts" General Surgeons.

The hospital is Trauma I and that has a lot to do with the scope of practice. GS covers all cases i.e. GS doing a Hartmanns and pericardial repair on the same table. I have also seen GS do plenty of other breast, HB, colon, and renal cases.

 

[badasshairday]

In my experience, in a mid-size metro area with a few (not all) professional sports teams, the general surgery groups in the community shops did it all. Not every surgeon did everything, but they were all gen surg trained, a few had colorectal, MIS, vascular fellowships, most did not have fellowships.

They did it all. Breasts, colon resections, vascular (fem-pop and carotid endarterectomy done even by non-vascular guys), thyroids, burn, and obviously the bread and butter lap choles, lap appy's, hernias. But the majority of these guys finished training prior to 1999, so I'm sure things have changed in gen surg (work hours) training that makes this less common.

 

[SLUser11]

OP: I did my core/Sub-I surgery in Brooklyn NYC and heavily considered GS. The GS surgeons here are "Soup to nuts" General Surgeons.

The hospital is Trauma I and that has a lot to do with the scope of practice. GS covers all cases i.e. GS doing a Hartmanns and pericardial repair on the same table. I have also seen GS do plenty of other breast, HB, colon, and renal cases.

In my experience, in a mid-size metro area with a few (not all) professional sports teams, the general surgery groups in the community shops did it all. Not every surgeon did everything, but they were all gen surg trained, a few had colorectal, MIS, vascular fellowships, most did not have fellowships.

They did it all. Breasts, colon resections, vascular (fem-pop and carotid endarterectomy done even by non-vascular guys), thyroids, burn, and obviously the bread and butter lap choles, lap appy's, hernias. But the majority of these guys finished training prior to 1999, so I'm sure things have changed in gen surg (work hours) training that makes this less common.

I'm sorry guys, but I was told by a super-experienced poster that this is not the case, and I shouldn't let anyone tell me otherwise. How am I to believe that there are general surgeons in NYC that enjoy their jobs and have a broad scope of practice? It just can't be true....

 

[thedrjojo]

my University program, the surgical oncology attendings take general call... they might not be happy about it, but they do...

 

[45408]

well the reason why the demand for general surgery remains high (and no you're wrong if you think it is higher than all surgical subspecialties) is only because NO ONE wants to actually do general surgery. literally, every single gen surg resident i have met and i've met a lot of them, have told me that they do not want to do gen surg and every single one wants to do a fellowship. Why is that??? the answer is simple, b/c gen surg is an awful lifestyle and lower compensation than other surgical subspecialties.

but back to the original question, yes if you practice in a rural area, then gen. surgery offers you the opportunity to do more. but in relatively large cities (aka where most pple want to settle and live) general surgeons are left with very simple cases as i mentioned above. again, don't let anyone tell you otherwise.

You're full of it. I plan to do general surgery, as do many of my colleagues. At least 30% of general surgery residents don't do a fellowship, and a number of fellowships don't preclude you from doing general surgery regularly (you could do general surgery to supplement your practice as a colorectal surgeon, surgical oncologist, trauma/acute care, breast, etc).

You don't know what you're talking about. Don't let anyone tell you otherwise.

truth is, general surgery is a dying field these days in medium to large sized cities/communities as everyone wants to see a specialist. all true general surgeons do these days are lap appys, lap choles, hernias, and lipomas...that is literally >95% of what they'll do. don't let anyone tell you otherwise.

also you can not be more wrong on gen surg being the most medicinish of all surgical specialties. Urology and ENT have way more medicine than gen. surgery. There is no such thing as an office based general surgeon b/c they all have to operate to make a living; however, with ENT and urology, it is much much easier to quit operating and still have a very busy office practice.

just my two cents

Agree with the above comments that your two cents wouldn't buy you a darn thing.

General surgery is still in strong demand, although you are pretty unlikely to be doing Whipples and esophagectomies if you are a general surgeon in Chicago.

 

[europeman]

I'm in New York City. Manhattan! One of the large four big academics!

Most if the general surgeons are not fellowship trained! Though granted, the new guys/gals are.

Fellowship training in general surgery does not preclude you from doing general surgery either. For example if you do a minimally invasive fellowship or a trauma/critical care fellowship then the vast majority of your practice is always general surgery.

 

[illegallysmooth]

In my 4 wks on general surgery, I saw vascular, breast, parathyroid, thyroid, pancreas, spleen, lap band, fundoplication, colorectal, plus of course lipomas, hernias, choles - and only 2 appys the whole month. I'm probably forgetting a few things too. This was all with two general surgeons who are partners in private practice in Bradenton, FL (10 min north of Sarasota).

 

[Arcan57]

I'm glad to hear you guys don't do it, and neither do I (although I have a buffer between me and the phone calls), but do you both think this is the national norm? It's been my experience that in training environments, surgeons are happy to manage medical issues, but in a pure community setting without PAs or residents, they often utilize hospitalists to manage medical issues.

At my shop (same city as SLUser but not academic), age or comorbidities gets you a medicine admit with surgery consultation. One of our bariatric surgeons (also does GS work on patients he's seen before for bariatrics) has everything admitted to medicine. Only exception is trauma which our state mandates admission to a surgeon to retain accreditation.

 

[biophysicianai]

I'm in New York City. Manhattan! One of the large four big academics!

Most if the general surgeons are not fellowship trained! Though granted, the new guys/gals are.

Fellowship training in general surgery does not preclude you from doing general surgery either. For example if you do a minimally invasive fellowship or a trauma/critical care fellowship then the vast majority of your practice is always general surgery.

Do you find your attendings having as much variety in their practices as those described in the above posts?

I figure (major academic center) + (manhattan) = more likely to be hyperspecialized, no?

 

[Trauma Surgeon]

I'm amazed what an American general surgeon is able to do!!
Reading the replies here it seems like your residency prepares you for all aspects of surgery. In Europe no general surgeon would do lap hemis or gastric bypass without an additional fellowship training.
Over here the general surgeons do the stuff that the OP mentioned (Cholecystectomies, appendectomies, hernia and lump and bumps). So an additional fellowship is almost mandatory for complex laparoscopic and cancer surgery.
I also wonder how the general surgeon that does everything from esophageal/colon/ventricle/pancreas/breast and neck surgery is able to keep him/her self updated on the field. Also, we as European surgeons do have multidisciplinary conferences with rad/onc/radonc/medicine colleagues depending on the pathology, how is it in US? If you have these kind of gatherings it would be nearly impossible to have patients with all the pathologies that one-surg has to offer, or?

 

[SLUser11]

I'm amazed what an American general surgeon is able to do!!
Reading the replies here it seems like your residency prepares you for all aspects of surgery. In Europe no general surgeon would do lap hemis or gastric bypass without an additional fellowship training.
Over here the general surgeons do the stuff that the OP mentioned (Cholecystectomies, appendectomies, hernia and lump and bumps). So an additional fellowship is almost mandatory for complex laparoscopic and cancer surgery.
I also wonder how the general surgeon that does everything from esophageal/colon/ventricle/pancreas/breast and neck surgery is able to keep him/her self updated on the field. Also, we as European surgeons do have multidisciplinary conferences with rad/onc/radonc/medicine colleagues depending on the pathology, how is it in US? If you have these kind of gatherings it would be nearly impossible to have patients with all the pathologies that one-surg has to offer, or?

In your country, how long is general surgical residency? How many hours per week are worked during this time? How many cases do residents graduate with, and what is the case variety?

 

[europeman]

5 clinical years. Some require an additional 1 or 2 of research. About 70-90 hours a week depending on the rotation, year, and where you are at. I average 80 my chief year with additional phone calls while I'm home. Ill graduate with about 1050 legitimate cases and a bunch of other small ones (like when I was an intern) that I didn't log. Also we have to log a lot of upper and Lower endoscopies, and bronchoscopies. Variety depends where you train. Where I'm at there isn't much trauma or Hepatobiliary, but we have a lot of inflammatory bowel disease type cases, a lot of advanced minimally invasive stuff (bariatrics, hernia, paraesoph hernia, Nissan, etc; decent amount of stomach surgery (for cancer) And im very comfortable with standard thoracic surgery. Overall fantastic variety.

Anyway, in the USA residency are so carefully watched that no matter where you go you will get decent training. No matter though, most People need a fellowship to feel comfortable starting on their own.

 

[europeman]

To answer your question, newly graduated surgeons without fellowship are certainly not doing all the things you listed!

Say where I'm at though. If I was to start working I would be comfortable with lap nissen/paraesoph hernia (but not heller myotomy), lap subtotal gastrectomy D1 or an open subtotal D1 (I don't think is be comfortable with a d2), lap spleen, lap colon, lap extra and intraperitoneal inguinal hernia, lap ventral hernia (with or without lap component separation), distal pancreatectomy, and run of the mill emergency general acute abdomen stuff (I have done perf duodenal ulcer laparoscopic without attending and feel comfortable), below or above knee amputation, and easy retroperitoneal exposures for the spine guys (not higher than L2 though)


I would NOT be comfortable with whipple, total gastrectomy, bariatric procedures, liver rxn, anything near the porta, kidney surgery (I could probably do an emergency trauma nephrectomy if I had to without killing a patient but I'm certainly not comfortable, APR, very low rectal cancer surgery, any extremity vascular bypass procedures.


You can see, therefore, i would need a fellowship for a lot of things! But If I don't do one ill also be well equipped to have a nice practice.

 

[maxheadroom]

Anyway, in the USA residency are so carefully watched that no matter where you go you will get decent training. No matter though, most People need a fellowship to feel comfortable starting on their own.

I'm not a General Surgeon, but I'm sure that all of my friends who trained in General Surgery would vehemently disagree. Most of the folks who take a fellowship do it for the extra credential. I think that most of my friends would say that after residency in General Surgery that they were comfortable with most abdominal surgery (including a lot of laparoscopy), breast oncology, and some neck cases like thyroids and parathyroids.

More importantly, in any surgical training program you need to learn surgical technique and judgment. I've been in practice for three years and probably half of the cases that I do every week are cases that I never saw as a resident. If you know the principles and have solid skills, you should be able to provide patients with excellent care.

 

[Trauma Surgeon]

In your country, how long is general surgical residency? How many hours per week are worked during this time? How many cases do residents graduate with, and what is the case variety?

It is at least 5 clinical years minus internship (1.5 - 2 years internship before residency with at least 6 months surgery rotation, plus many programs have a 6-12 months "try-out" period before starting the residency, ie prelim). 50-60 h/w BUT some of us do lots of moonlighting (I average 70-80h/w). The case number and variety we graduate with is extremely individual mostly depending on the hospital. For example where I'm at I have done enough colorectal cases including APRs but lacking on the hepatobiliary and esophageal cases (at most I'm 2nd assistant). Lets not even mention vascular since we do all our aorta cases endovasculary.

My point was that even in the best residencies it is nearly impossible to train a general surgeon that has the surgical skills and knowledge for all the pathologies that are encountered in the field, and gaining skills to operate independently after finishin in the most challenging surgeries like onc-surg (hepatobiliary), laparoscopy surgery (lap colons, bariatrics), vascular (endovasc) and so on...