Surgery 2001

[jylu]

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Anyone notice how unpopular general surgery is these days?

General surgery is starting to look like anesthesia, circa 1994 -- an unpopular residency choice amongst American grads. The recent decline in reimbursement rates, the difficulties and stress of the residency, and the recent desire by American grads to go into the "lifestyle" fields, have started to take a severe toll on gen surg.

I've talked to friends in some competitive programs and I've been told that a number of good programs had to reach down deep into their rank lists this year for applicants. Case in point, I remember seeing last April, for the first time in my life [and in some of my attendings' lifetimes], ads in the New York Times for PGY1 general surgery residents.

If you want to be a surgeon and you're a pretty mediocre US med student, this may be one of the best times to get into the field. I have a feeling that, like anesthesia in the mid 1990s, a steady drop in the number of residents over the next few years and an aging American population will eventually lead to much better salaries for general surgeons in the future.

 

[fourthyr]

general surgery rules the house! and I agree with the above post.... I hope it'll help us all going into general!

 

[Winged Scapula]

I'm sure the decline in popularity helped me! 😉

 

[yigit]

What's the story with starting in general surgery and then becoming more specialized later in your residency? For instance, can one switch to plastics or orthopedics or any other surgical subspecialty later or would you have to start from scratch?

 

[fourthyr]

After completing your general surgery residency, you can further your education with plastics, trauma, transplant, surgical oncology, cardiothoracic, pediatric, colorectal, or laparoscopic fellowships. Sometimes, unofficial endocrine fellowships, too.

For plastics, you can apply in the middle of your residency, but...good luck.

For transfering to ortho, urology, ENT, or integrated plastics, you'd better have a private deal/setup beforehand or they have to REALLY need someone (and that better be you), otherwise you won't be transferring to those fields...and you'll be stuck in general surgery and it's future fellowship options, as described before......

Hey, and general surgery isn't bad..... that's what I wanna do (for now......)!

 

[Winged Scapula]

4thyear is correct - to be able to "switch" into surgical fields with their own residencies is very difficult. You *may* find that your preceding years in General Surgery is given credit (but usually no more than a year or less) but in most cases you would be asked to start as a PGY1 in fields like Ortho, ENT, Urology, etc. which have their own residencies after completing a PGY1 Surgical Prelim year.

The other fields, such as CT, Vascular, Surg Onc, etc. are done after you complete the entire (usually) General Surgery residency. Hence there is no "switching".

Hope this helps.

 

[Justin4563]

gen surg sucks the you know what..

I did a year of gen surg in a extremely busy and renowned institution.. I found it to really suck ass....... You work so hard. being someones slave being treated as less than human for what.. so you can make 110,000 a year when you graduate, take trauma calls, fight with nurses, x ray techs radiologists( who make 4 times what you make) to get studies done....

IF you go out on your own if the job doesnt kill you the politics will, who sends you patients?? split fees?? there are too many surgeons.. The only subspecialty to do is prob CT..

so I opened my eyes in like november and said Im out of here,, im graduating anesthesia in may and i have offers in the midwest for over 250000 first year, guaranteed 400000 my 3rd year and partner.. what do you think about that

 

[fourthyr]

As long as your happy man, that's all that matters, right? That sounds like a sweet deal dude.....but

For now, I'm happy in the OR. I'm happy about trauma call, in general. I'm OK with the idea of living in the hospital.

Maybe, someday, it'll get old and suck more than it's worth. But, until then, I'm sticking with the guns I've had drawn since elementary school.... And if I change my mind, I hope I'll be happy where I land...

sounds like you're doing fine man.... but, didn't it take going thru general surgery to find out where you wanna be in life... at least, it gave you that much.

sorry, for the late night ramblings...

 

[jimjones]

Surgery sounds pretty cool to me. But do surgeons speak to patients much? They do rounds, inform them what is going to happen, and check in after, etc? Do surgeons actually have an office or just work in the hospital?

 

[SniperBubble]

Can someone talk about how difficult it is to actually to learn the surgical techniques? Is surgery something is easy to pick up? I don't want to match into surgery and discover that I have trouble learning how to do surgery.

 

[arthur v]

Surgeons do speak to their patients quite a bit, but not anywhere near as much as those on the medicine side of things. While an internist or family practitioner will sit and listen to a patient's exhaustive history, a surgeon's attention span for conversation (of necessity, but still annoying if you're the one talking to them) is shorter than that of a child. Surgeons generally maintain busy clinics where they evaluate the patients, schedule them for surgery, inform them of the procedures and risks, and follow-up with them after they leave the hospital.

As with everything in life, there are two types of surgeons with regard to technique: those that have a natural ability and those that work hard to develop the practiced equivalent of natural ability. Good surgeons are born as well as trained. Unless you're an absolute clutz and suffer from both resting and intention tremors (and I've worked with a competent surgeon with a resting tremor!), you'll do just fine with surgical techniques.

AV

 

[jargon124]

Surgeons making 110,000 when they graduate? Is this accurate? I didn't think so...but then I'm a med school applicant! Shed some light, please.

 

[godfather]

110,000 is a little low but it's still sad how little compensation the general surgeon receives for 5 long years of training. the 2 or 3 graduating residents that i know who decided knot to further specialize were receiving offers of 140 to 160k to start. This is obviously pretty sad considering the 5 years of hell you go through. Although i loved surgery the fact that the anaesthesiologist in the room is making at times more than 100k more than the surgeon basically ruled surgery as a career out. The ****tist thing about general surgery is they could probably condense the residency from 5 years to 3 but they purposefully keep it at 5 so they can get two years of slave labor out of you. I mean i was shocked as hell when i found out that in pgy1 you literally don't even step into the or. Furthermore as a pgy2 the amount of surgical exposure is at best about 2-3 % of the total time your in the hospital. And the stuff you mostly get to do as a pgy2 during those rare moments you are in the or is something any braindead medical student like me even could do which is basically retract and close. i mean they are really going to have to revamp the whole way in which they train surgeons if this field is ever going to be popular among US grads again.

 

[Fah-Q]

I heard from a very reliable source that ERAS is expecting about 50% of the usual number applicants for general surgery this year. A ton a programs didn't fill all their spots last year...looks like its going to be worse this year.

 

[fourthyr]

At my first gen surg interview last week, I found out that applications are decreasing drastically for general surgery. More so than last year.

Better matching for the rest of us, I guess.....

 

[smuoracledba]

I am new to this forum and a non-traditional student making good money in the IT field, but I hate sitting and staring at a computer all day long. I like people much better, and I would love to be a Surgeon. That is my goal. There is no greater joy to me than being able to help someone. My mom had a life-saving heart operation at the age of 23(three holes in her heart), and if she did not have it, she would be dead now. This was back in 1973. Her Surgeon was absolutely wonderful, and showed a tremendous amount of compassion. I would love to be able to do that for someone one day. 🙂

 

[meandragonbrett]

How long is a CT fellowship?

 

[Winged Scapula]

Originally posted by meandragonbrett:
•How long is a CT fellowship?•••

2 years. You can further specialize if you wish, at the cost of additional years.

 

[turtleboard]

How difficult is it to snag one of the gen surg fellowships? I've *heard* that CT and Plastics fellowships are abundant with enough to go around, and that the only really tough fellowships nowadays are surgical oncology and pediatric surgery.

 

[Winged Scapula]

Originally posted by turtleboard:
•How difficult is it to snag one of the gen surg fellowships? I've *heard* that CT and Plastics fellowships are abundant with enough to go around, and that the only really tough fellowships nowadays are surgical oncology and pediatric surgery.•••

That's what I've heard as well-matter of fact when I screw up, I think "there goes that surg onc/peds fellowship!" As with everything, obtaining these fellowships can depend on who and what you know...

 

[edmadison]

I'd like to posit one reason why the popularity of general surgery is decreasing. With the explosion of surgical subspecialists, the general surgeon is becomming restricted in what types of operations they will do. With more colorectal, breast, trauma, endocrine, transplant. et al. surgeons, the generalist ends up with gallbladders, hernias and appendicies. For me this is a major factor in choice of specialty. Of course, one can live in a rural area and have a little more diversity.

Ed

 

[Goofy]

Surgery is declining for a number of reasons

1. Compensation - Surgeons recieve perhaps the poorest compensation per training/work hours. In philadelphia area for example, a starting surgeon makes around 80,000. This is almost a slap in the face. No wonder why there is strife between many surgeons and anesthesiologists. The surgeon works twice as many hours for a 1/3 the pay. You gotta either really love surgery and nothing else (like life, family, hobbies) to go into the field. As a surgeon, your career consumes every bit of your life, with next to nothing left for family and other pleasures.

2. Shrinking need - Despite population dynamic changes (which will benefit all fields) many surgical cases will be outmoded. Better medical modalities mean fewer cases. The interventional radiologist will be a huge winner in this respect.

3. lifestyle - We as physicians already enjoy a very low life expectancy rate. The rigors of surgery only serve to exacerbate this.

4. Intellectual deficit - Surgery is more of a glorified technical field. Certainly you need to have a high level of smarts to do it, but in terms of the medical echelons, it aint rocket science taking out a gall bladder. CT surgery is certainly a bit more stimulating, but the training is as rigorous as it is long. And the cases are virtually the same thing day in and out. Fields like medicine and it's subspecialties have far more 'thinking' going on. Additionally, internists can do a wide variety of procedures once they become proficient (without specific fellowship training), a little fact they are starting to realize. Plus they get to use their brains a bit more.

5. Cycle - Everything in medicine revolves around the cycle. Anesthesia is getting enormously popular, but competition for the better programs remains fierce, and the better anesthesia jobs require you to get ivy league training (unless of course your willing to move to kallamazoo, where virtually any medicine field can be potentially lucretive). I have several friends who were recently employed in this field in the past 3 years, and they tell me that despite the dearth of anesthesiologists, the 'good jobs' (in ideal locations, with partnership potential, and less call) are still be tough to get. So surgery is becoming what anesthesia and radiology were 5 years ago.

6. Poor peer morale - Surgeons as a group can be impossible personalities. The workload and reimbursement schedule fuel this animosity. The result is quite obvious if you have done any kind of meaningful rotation in the O.R. Certainly there are model citizens in the bunch, but they are few and far between. If you are someone who is affected by the morale and attitude of those around you, you are likely to be miserable.

6. Work Schedule - surgeons frequently work long hours, very long hours. Imagine being called in at midnight for an acute abdomen that will take 8 hours after having been in the OR for 12 straight hours. And than having scheduled patients the next day. This is enough stress to dampen care from even the most seasoned and knowledgeable surgeon.

*** I wouldn't recommend this field just because its easy to get a great position. It is really a rigorous, demanding, blood and life sucking profession that requires an inhumane level of dedication. There are many excellent fields of medicine that even students with poor scholastic/boards can do. JMHO

 

[rickmyster78]

Klebsiella,

Thanks for your input. I don't know about surgery anymore. Where is the reward for working your ass off? A divorce and a miserable life?

 

[Z]

Klebsiella had some very interesting things to say. Mostly I am an observer of the forums and occasionally will offer an opinion when I can't stand to sit tight any longer. Well, this is one time when I cannot sit tight. I am a surgery resident at a University program. I have been here 6 years. Currently I am a clinical 4th year resident. I spent two years in the lab doing research, thus the time difference. I have many friends who are in academics and some in private practice. I know some who have completed fellowships. In know those who are in large towns...some who are in small towns.

While I appreciate the fact that there are some kernels of truth to what Klebsiella was saying...it is not the whole story.

There is objective evidence that there is a decline in reimbursement for procedures performed by not only general surgeons but also by ortho, ENT, CV etc. Because of this income has fallen. However, if one looks at objective data compiled by the government concerning income trends (easily found on many job search web sites and even on the American College of Surgery Web site) in general surgery you will see that the average income hovers around $180,000-220,000 depending on the part of the country and length of practice. It is true that in large metro areas income can be much lower for starting surgeons because competition is fierce. However, in smaller towns incomes can be very high. I have a good friend who just finished residency last year and is practicing in a large southern city. He was offered in the ballpark of $110,000 for first year with incentives (If he produced more than this he would get 80% of the profits). He took this job. Another friend wanted to live in a small town and was able to find a nice practice with a starting salary near $200K plus incentives. So, not all of the horror stories are true.

I also would take issue with how Klebsiella portrays the work hours of a practicing general surgeon. Surgery residency is different. You expect to be busy for 5-7 years and then things will change. Again, the typical work week (see the AMCGME web site for info here) is about 60hrs. This is the way my two friends handle call. The guy in the large city is in a large group and he takes call every 5th night and every 5th weekend. So, Tuesday is his day. He could get pounded that night or maybe not. But the rest of the week he can do what he likes. Also, 4 out of 5 weekends he can do what he wants. Others cover his patients and consults until Monday. The guy in the small town takes call every 4th night and every 4th weekend. Usually, the call is not bad since he is in a small town and the ED is not terribly busy at night. So, again, it is possible that you can work hard for 12hrs than have to operate all night and then have to operate the next day...but this does not happen every night. Otherwise, I would go into some other specialty.

One final point I would like to make. I truly take offence to the comment that surgeons or surgery suffers from an intellectual deficit. Of course, it does not take a rocket scientist to figure out that someone with gallstones, RUQ crampy pain after eating a fatty meal needs their gallbladder out. However, not all cases are this easy. Someone does not tell me to operate and then I go do it. I decide that an operation in a particular patient is indicated and then recommend the patient pursue that coarse of action. No one tells me to do it. Therefore, some clinical judgment must be made behind which some thought must go. For example, I had a case the other day where a patient had undergone an ERCP with sphincterotomy. The patient had multiple medical problems the worst of which was CHF with an EF about 25%. The ERCP was difficult and a post procedure CT showed air in the retro-peritoneum. However, his clinical exam had not changed. What do you do? Do you haul this guy off to the OR because the GI doc asks you to? No. You think about it. You examine the patient. You decide the best coarse of action by consulting the available literature and weighing its merits. Then you decide if an operation is indicated or not. Also, I would dare say that the decisions that I make on a daily basis could potentially be more life ending or altering than many decisions made by other...non surgeon physicians.

Those are my thoughts and I would recommend the field of surgery to any bright, motivated individual who enjoys an intellectual and technical challenge.

 

[Goofy]

Originally posted by Z:
•Klebsiella had some very interesting things to say. Mostly I am an observer of the forums and occasionally will offer an opinion when I can't stand to sit tight any longer. Well, this is one time when I cannot sit tight. I am a surgery resident at a University program. I have been here 6 years. Currently I am a clinical 4th year resident. I spent two years in the lab doing research, thus the time difference. I have many friends who are in academics and some in private practice. I know some who have completed fellowships. In know those who are in large towns...some who are in small towns.

While I appreciate the fact that there are some kernels of truth to what Klebsiella was saying...it is not the whole story.

There is objective evidence that there is a decline in reimbursement for procedures performed by not only general surgeons but also by ortho, ENT, CV etc. Because of this income has fallen. However, if one looks at objective data compiled by the government concerning income trends (easily found on many job search web sites and even on the American College of Surgery Web site) in general surgery you will see that the average income hovers around $180,000-220,000 depending on the part of the country and length of practice. It is true that in large metro areas income can be much lower for starting surgeons because competition is fierce. However, in smaller towns incomes can be very high. I have a good friend who just finished residency last year and is practicing in a large southern city. He was offered in the ballpark of $110,000 for first year with incentives (If he produced more than this he would get 80% of the profits). He took this job. Another friend wanted to live in a small town and was able to find a nice practice with a starting salary near $200K plus incentives. So, not all of the horror stories are true.

I also would take issue with how Klebsiella portrays the work hours of a practicing general surgeon. Surgery residency is different. You expect to be busy for 5-7 years and then things will change. Again, the typical work week (see the AMCGME web site for info here) is about 60hrs. This is the way my two friends handle call. The guy in the large city is in a large group and he takes call every 5th night and every 5th weekend. So, Tuesday is his day. He could get pounded that night or maybe not. But the rest of the week he can do what he likes. Also, 4 out of 5 weekends he can do what he wants. Others cover his patients and consults until Monday. The guy in the small town takes call every 4th night and every 4th weekend. Usually, the call is not bad since he is in a small town and the ED is not terribly busy at night. So, again, it is possible that you can work hard for 12hrs than have to operate all night and then have to operate the next day...but this does not happen every night. Otherwise, I would go into some other specialty.

One final point I would like to make. I truly take offence to the comment that surgeons or surgery suffers from an intellectual deficit. Of course, it does not take a rocket scientist to figure out that someone with gallstones, RUQ crampy pain after eating a fatty meal needs their gallbladder out. However, not all cases are this easy. Someone does not tell me to operate and then I go do it. I decide that an operation in a particular patient is indicated and then recommend the patient pursue that coarse of action. No one tells me to do it. Therefore, some clinical judgment must be made behind which some thought must go. For example, I had a case the other day where a patient had undergone an ERCP with sphincterotomy. The patient had multiple medical problems the worst of which was CHF with an EF about 25%. The ERCP was difficult and a post procedure CT showed air in the retro-peritoneum. However, his clinical exam had not changed. What do you do? Do you haul this guy off to the OR because the GI doc asks you to? No. You think about it. You examine the patient. You decide the best coarse of action by consulting the available literature and weighing its merits. Then you decide if an operation is indicated or not. Also, I would dare say that the decisions that I make on a daily basis could potentially be more life ending or altering than many decisions made by other...non surgeon physicians.

Those are my thoughts and I would recommend the field of surgery to any bright, motivated individual who enjoys an intellectual and technical challenge.•••

You know, I just looked back at my post, and have to offer my apologies. It was shortsighted for me to stress the cognitive deficits in surgery. This was my own personal experience, and avoided it for that very reason. Others might certainly find it intellectually stimulating. One mans garbage is another mans gold. I hope you accept my humble apologies. I'm certain others might say the same thing about my career interests.

 

[Voxel]

I agree that surgeons do take on tremendous responsiblity and have to make life altering decisions. I am thankful that there are people in this world who love to do general surgery so that I can practice the field I love. One point I would like to stress is that there are many physicians in other fields who have to make life altering decisions and this is NOT limited to the field of surgery. Some have to deal with these situations more than others.

Do what you love, but be willing to pay the price to get there and do it.

 

[Z]

Thanks klebsiella...Apology accepted. Also, Voxel, you are right. Other physicians make life altering decisions as well. I guess I meant that sometimes the results of a surgeons decisions are more immediate.

 

[droliver]

Klebsiella,
at what stage of your medical career are you in (premed,medstudent,intern,etc)?

 

[Leotigers]

Originally posted by jylu97:
•Anyone notice how unpopular general surgery is these days?

General surgery is starting to look like anesthesia, circa 1994 -- an unpopular residency choice amongst American grads. The recent decline in reimbursement rates, the difficulties and stress of the residency, and the recent desire by American grads to go into the "lifestyle" fields, have started to take a severe toll on gen surg.

I've talked to friends in some competitive programs and I've been told that a number of good programs had to reach down deep into their rank lists this year for applicants. Case in point, I remember seeing last April, for the first time in my life [and in some of my attendings' lifetimes], ads in the New York Times for PGY1 general surgery residents.

If you want to be a surgeon and you're a pretty mediocre US med student, this may be one of the best times to get into the field. I have a feeling that, like anesthesia in the mid 1990s, a steady drop in the number of residents over the next few years and an aging American population will eventually lead to much better salaries for general surgeons in the future.•••

Even in CA, there are programs that have seen a 50% decline in applications from AMGs from what I hear.

 

[hosskp1]

I have wanted to be surgeon for many years. I went to medical school with the hope of becoming a surgeon. I never really gave a crap about the money-- I am already well off from my parents and scholarship. IF some people are worried about monetary comepnstaion for hours spent-- surgery has never really been that high yeild. It is actually good for the specialty because it will leave only the people that really want to go into it. I hope that this trend continues as I am applying next year. Maybe it will help me get a better residency than I would have gotten. let us hope and pray that it gets even less competitive. Now let us see if we can't do the same thing for Orthopedics.

 

[dr.evil]

hosskp1,

good to have another future surgeon on board. I think the trend will continue next year and applications will continue to be low (good for you).

orthopedics is an entirely different entity. my classmates going into ortho cite lifestyle and compensation as a large reason why they chose ortho over general. on the average, ortho makes more money and has a better lifestyle after residency. shallow maybe but a couple have told me that they even like the persona that they are the jocks of med school (i.e. cool). that part is ego. i guess all surgeons have to have some ego. i actually thought about doing ortho, did an elective, and found the lack of medicine boring.

anyway, surgery is the best although with terrible hours, long residency, and often times poor compensation (a dermatologist gets paid more to remove a skin cancer than a general surgeon gets for a hernia repair). sad but true, but the surgeon's having more fun (at least to me) 😛

 

[carddr]

Bummer. Everyone is forgetting THAT Anesthesiologists have the HIGHEST mal practice insurance and the HIGHEST suicide rate. So which is better, driving a Cadillac and living or driving a Mercedes and leaving it to the wife,(God forbade.)) Know I am going to take some grief for this one. Just thought you'd like to know!!!!

 

[Voxel]

Actually as a percentage of one's salary and total dollars, I believe OB/Gyn has the highest malpractice insurance payments. I'm not sure about anesthesiologists have the highest suicide rates. I'd like to see the study that showed this to be true. I have heard that the drug addiction in anesthesiology may be higher. That is what would be truly frightening.

Anyway, I have to commend all the surgeons out there who are overworked and underpaid for choosing to make a difference with the scapel. Thank you. True.

 

[dr.evil]

I re-read my comments and think I sounded like someone I hate.

"Poor compensation" for general surgery is of course relative. I, in no way, think I'm going to be poor or am not going to receive enough money. Money has to be secondary, it just has to be. Surgery is fun, fun, fun and your attitude is crucial when your working your tail off in residency. PLEASE choose your future specialty with your heart. Then use your brain to justify if your decision.

 

[fourthyr]

cross your fingers everyone.... time to wait for a month...

 

[dr.evil]

Ah man, do you have to keep reminding me. 🙁 This whole thing is just another hoop and another wait. It seems I waited for my MCAT scores, I waited for an interview for med school, I waited for the acceptance to med school, I waited for my USMLE Step 1 & 2 scores, and now I wait to see where I'll be living for the next 5 years. Man, I love medicine.

Then I'll match and wish I had 6 more months to relax before the madness begins but I guess that's the fun in it all.

 

[dr.evil]

Preliminary surgery is not necessary for your PGY-1 training prior to beginning your training in anesthesia. As a matter of fact, most anesthesia residents will complete either a transitional year or an internal medicine preliminary year prior to beginning anesthesia training.

Those would be much better choices if you don't actually want to do much actual surgery.

 

[neutropeniaboy]

Don't forget about waiting for fellowship and/or job...

•••quote:•••Originally posted by LionTrees:
•Ah man, do you have to keep reminding me. 🙁 This whole thing is just another hoop and another wait. It seems I waited for my MCAT scores, I waited for an interview for med school, I waited for the acceptance to med school, I waited for my USMLE Step 1 & 2 scores, and now I wait to see where I'll be living for the next 5 years. Man, I love medicine.

Then I'll match and wish I had 6 more months to relax before the madness begins but I guess that's the fun in it all.•••••

 

[godfather]

they do have the highest suicide rates, because they have the greatest access to lethal drugs however the highest malpractice rates is not really true. Although the malpractice is high it's almost always paid by the hospital from what i've seen and doesn't cut into their earnings.

 

[carddr]

The hospital doesn't pay if you are a private contractor and I understand this is the way to go if you are going for the big bucks...and in small, privately owned, community hospitals they often will contract out. Either way Anseis...make a great living.