Specialties with good mix of medical/surgical?

Burrell College of Osteopathic Medicine
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Leejwwc

Leejwwc

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I've heard that ENT and ophthalmology have a good mix of medical/surgical. Are there any others that come to mind?
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I like emergency medicine because it has a nice mixture of not having to do the surgery intern year and not being a surgeon.
 
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I think you might be surprised to see how much medicine a general surgeon ends up doing. Even a busy general surgeon probably won't do more than 3 full days in the OR per week.
 
Optho, Uro, OB/Gyn, and ENT are the 4 surgical specialties that you go into directly and have a good mix of medicine involved too. You can decide whether or not to do surgery in those fields in your ultimate practice, and you will learn the surgeries those fields do during residency.

EM is NOT a surgical field, we do not go to the OR, we do not perform surgeries, we do not fix traumas. Majority of our cases are medicine in nature and the surgical cases we send them to a surgeon We perform procedures and we stabilize patients. Do not consider EM if you want a surgical field.
 
If you're looking for a field that requires a good mix of internal medicine and is also very procedural, have you considered Anesthesiology? You do lots of procedures in that field, but they do not require the use of a scalpel. It's a lot of nerve blocks (including regional anesthesia and epidural/spinals), intubating, central lines, some TEEs during your cardiac/transplant months, and venous/arterial access. In addition, you go to the OR, but once the surgery is underway, you manage your patient medically.
 
Rendar5 said:
EM is NOT a surgical field, we do not go to the OR, we do not perform surgeries, we do not fix traumas. Majority of our cases are medicine in nature and the surgical cases we send them to a surgeon We perform procedures and we stabilize patients. Do not consider EM if you want a surgical field.
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Indeed. But that is kind of my point. I think that what a lot of people think they are looking for in surgery, can actually be found in EM. At the right place.
 
Thanks everyone. I'm starting med school in a couple weeks. Have always liked the idea of a mixed specialty. Just curious to see what options are out there.
 
What about ortho? They do casts/consult on broken bones, and once they do surgery, isn't there some form of follow up?
 
Doing a urology rotation right now, and yeah, it's definitely a good mix of the two. Even though it's not a field you enter into directly out of medical school, vascular surgery also seemed like to have a lot of elements of both. You're very much dealing with medical issues because your patients are sick, and it seems like they spend more time in clinic than general surgeons. Another thought would be derm. They're not in the OR, but they do do a lot of procedures in the office.
 
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yeah i think a lot of decision-making has to come down for people who like doing hands-on stuff if they want something procedural or something surgical. I didn't really think of that. The 4 I listed are mixed surgical specialties not obtained through a surgical residency.

GI, certain Cardiology subspecialties, Interventional Radiology, EM, Anastesiology, possibly Pulm (not sure), and Critical Care are all pretty procedural fields. Dermatology and FM also have their fair share of procedures. I've never done PM&R so don't know that one.
 
In terms of lifestyle, would you say that ENT, ophthalmology, and urology are pretty comparable?
 
Leejwwc said:
In terms of lifestyle, would you say that ENT, ophthalmology, and urology are pretty comparable?
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Ophtho is significantly better (during residency and as an attending).

Uro = ENT in terms of lifestyle.
 
EM is not a good mix of medical/surgical. While you are trained in a few surgical-type things your practice even at the most trauma-heavy inner city hospital will be 97% ambulatory medicine, acute care medicine, and critical care.

Some of this depends on how you define "surgical" but things like lac repairs and I+D of abscesses are not really surgery in my book and are considered pretty annoying by most EM grads (slow you down).

Surgery is a good mix of med/surg!
 
shiftingmirage said:
What about ortho? They do casts/consult on broken bones, and once they do surgery, isn't there some form of follow up?
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Ortho is just as much surgically oriented as general surgery. In general orthopaedic surgeons only have clinic to get people in the OR. Their main goal in clinic isn't to spend the day casting people and giving out muscle relaxers.
 
TheProwler said:
I think you might be surprised to see how much medicine a general surgeon ends up doing. Even a busy general surgeon probably won't do more than 3 full days in the OR per week.
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From what I've seen in my rural areas the GS is in the OR in the AM and clinic/rounds in the PM (except pre-surg rounds in the AM).

Good mix there, but it's an n=1
 
Interventional Radiology. The peripheral vascular stuff is lost to Cardiologists. However, IR has complete marketshare over interventional oncology. Reimbursement is much higher for minimally invasive oncology treatments. Plus, IR physicians are doing interventional pain procedures (kyphoplasty, local spine pain injections), varicose vein treatments, and interventional liposuction. I know an IR physician charging $2000 a leg out of pocket for varicose vein treatments. Needless to say he is loaded.

Interventional Pain
http://www.sirweb.org/patients/vertebroplasty-osteoporosis/

Varicose Vein Treatment
http://www.sirweb.org/patients/varicose-veins/

Interventional Liposuction
http://www.auntminnie.com/index.asp?sec=ser&sub=def&pag=dis&ItemID=75024
http://www.diagnosticimaging.com/display/article/113619/1183827

IR physicians are diagnosing patients and treating them medically and using minimally invasive techniques.

http://www.sirweb.org/patients/minimally-invasive-treatments/

IR will soon be a separate specialty with a separate match. The announcement will come out this fall. It will be very similar to ENT, Urology etc. There will only be 12 months of General Radiology and 36 months of core medicine and surgery such as ICU, CCU, Oncology, Vascular Surgery etc.

Plus the vacation times will always be up in the 3 to 4 months out of the year.

http://www.radworking.com/jobs/radiology-jobs.html?Skill=3074&State=&Duration=3&OrderBy=
http://www.radworking.com/radiology-jobs/438023.html

In the next 5 years, IR will be one of the most competitive specialties in medicine because of the few number of spots available for a direct match.

If you are NOT interested in IR but would like medicine and surgery I would look at Urology, ENT, Plastics, and Ortho.
 
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Amazing how far from the original point these threads get...

The ONLY surgical specialties I've seen with a decent amt of medical management on a regular basis is ENT and OB/GYN. I dont have a lot of experience with Urology, but from what I hear they do a TON of procedures, although having a decent portion of the practice being medical management makes sense once you shy inferior to the kidneys.

When you have areas with higher populations (urban/suburban), Gen Surg and Ortho are gonna turf anything not surgical on the pts PCP, as they dont often want to deal with that (I dont really blame them).

OP, from what I find as a general rule, a surgical specailty will have a good medical management portion when there isnt a clear medical counterpart to the surgical field.
 
If you wanted to be picky, many surgeons wouldn't consider ob/gyn a surgical speciality.
 
I don't really understand the question - why would you want a specialty that has a good mix of medicine and surgery? I'm assuming that you mean that you'd like to be in the OR occasionally but also see patients outside the OR? Just about every surgical specialty (and gen surg) will have clinics and other such patient interactions that don't involve being in the OR.

What aspects of medicine do you like that you would want to pursue in a surgical career as well? Diagnosis? Just about every surgical field involves a bit of diagnostic work-up, but you'll probably never get the 2 page differential you'll see in Medicine. Treating patients "medically" - that is, without ever taking them to the OR? Most surgeons see some patients in clinic that aren't surgical candidates and therefore are treated "medically".

What exactly are you looking for?
 
veenut said:
I don't really understand the question - why would you want a specialty that has a good mix of medicine and surgery? I'm assuming that you mean that you'd like to be in the OR occasionally but also see patients outside the OR? Just about every surgical specialty (and gen surg) will have clinics and other such patient interactions that don't involve being in the OR.

What aspects of medicine do you like that you would want to pursue in a surgical career as well? Diagnosis? Just about every surgical field involves a bit of diagnostic work-up, but you'll probably never get the 2 page differential you'll see in Medicine. Treating patients "medically" - that is, without ever taking them to the OR? Most surgeons see some patients in clinic that aren't surgical candidates and therefore are treated "medically".

What exactly are you looking for?
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i thought the question was essentially about which specialties allow the doctor to have a good mix between the medicine side with physical exams/histories/prescriptions/managing diseases/etc and the 'surgical' side in performing procedures that are not necessarily anything more than minor surgery (gastroenterology comes to mind with the endoscopes and stuff as a field that may be like that)
 
veenut said:
I don't really understand the question - why would you want a specialty that has a good mix of medicine and surgery? I'm assuming that you mean that you'd like to be in the OR occasionally but also see patients outside the OR? Just about every surgical specialty (and gen surg) will have clinics and other such patient interactions that don't involve being in the OR.

What aspects of medicine do you like that you would want to pursue in a surgical career as well? Diagnosis? Just about every surgical field involves a bit of diagnostic work-up, but you'll probably never get the 2 page differential you'll see in Medicine. Treating patients "medically" - that is, without ever taking them to the OR? Most surgeons see some patients in clinic that aren't surgical candidates and therefore are treated "medically".

What exactly are you looking for?
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I think its a pretty good question.

And whoever says Ortho is missing the point. Ortho clinic is not medicine. Outpatient does not mean the same thing as medicine. Most people who are not surgical candidates are treated by medicine, and surgeons have little, if anything to do with them. "If Im not cutting, dont call me" Oh, and pre and post-op rounds is not medicine. Driving a colonoscope is a procedure, its not surgery.

Sometimes, its easier to say what something is not, rather than what it is.

A mix of medicine and surgery would be... Patient comes in with a problem... H&P, do some labs, micro, path, imaging.... see the patient again in 2 weeks, give them a Dx, prescribe, advise.... follow up, and look for improvement in the physiology... tweak the meds..... repeat investigations.... follow up....tweak.... follow ... repeat.... finally, when nothing else is controling the disease, take the patient to the OR, and fix the anatomy yourself.

A good example of this is new onset incontinence in a female. Theres a whole bunch of medical and surgical causes for this. All of them are diagnosed, treated, managed, and surgically repaired by an OB/Gyn

So, to answer the question... Id say ENT, OB/gyn, and urology. Others have said Optho, and though I dont know much about it, I can agree with that.
 
stickshift said:
Pattern recognition not necessary. You'd be prescribing corticosteroids regardless of the diagnosis :laugh:
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If its dry, moisturize, if it is wet, dry it out. Where is my board certification in derm?
 
I mean, it's a gruesome surgery sure, you're cutting directly into an organ receiving 20% of the cardiac output without attaining prior vascular control. That's not something any gen surgeon would ever have to deal with. But it's still performing a procedure in the body cavity through an incision...
There's nothing in the definition of surgery that requires it to be pretty.

The most impressive surgeon I met in med school was a gyn-onc surgeon. Cleanest, most intricate 8 hour procedure I saw, especially considering it was in the pelvis and not abdomen.
 
Blesbok said:
Yanking someone's abdominals apart is hardly surgery.
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No, but a 2am ex-lap for hemoperitonium on a patient with a BP of 80/50 might be.

a pelvic cancer debulking and reconstruction, or a pelvic floor reconstruction. Thats surgery.
 
Rendar5 said:
I mean, it's a gruesome surgery sure, you're cutting directly into an organ receiving 20% of the cardiac output without attaining prior vascular control. That's not something any gen surgeon would ever have to deal with. But it's still performing a procedure in the body cavity through an incision...
There's nothing in the definition of surgery that requires it to be pretty.

The most impressive surgeon I met in med school was a gyn-onc surgeon. Cleanest, most intricate 8 hour procedure I saw, especially considering it was in the pelvis and not abdomen.
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Ditto. The most intricate procedures I saw were on urology. Second to that, was gynecology.

Given that there's an art to teaching. By far, the best teaching I (and so it seemed for the residents) was by two of the gyn attendings. I remember watching the gen surg residents fumbling with the laparoscopic instruments, and the attending saying... "up, no, yes, down, out, look at the screen not your hands, stop, wheres the gallbladder?"
However, one of my gyn attendings could teach laparascopic technique with such skill....

And while we're on that topic.... nobody is going to convince me that laparascopic procedures in the abdomen is considered surgery, whereas inside the pelvis it's not. Nobody. Thats just a case of general surgeons being egotistical.
 
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"Have you had any surgeries in the past?"

"I had my ovaries and uterus taken out, and had an operation because I couldnt hold my urine"

"Those arent surgeries"

"Oh... then, no"
 
Med/surg combos = ENT, Uro, Ob/gyn, ophtho
 
OB/GYN is more than C-sections, although the really intricate stuff usually requires a fellowship (gyn onc, laproscopy, etc.)
But as far as using internal medicine goes even if you know the medicine in practice you'd still have to phone for the consult making it pretty pointless if you really wanted to do all the medicine yourself.
 
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