Surgery and Developing World

[jrouwhorst]

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This may seem a little "out there", but this is my current thinking:

I want to divide my time after residency between working in a developing country, (teaching local staff and operating) and also maintaining a salary in the US, to support myself.

Right now, I'm an MS3 trying to choose a specialty. I'm drawn to general surgery for the breadth of training one receives, especially as a trauma surgeon. My hope is that I could find shift-work as an acute care surgeon and therefore free myself for relief work during off-shifts.

I'm also considering Ob/Gyn, for the reason that the training is broad, provides for surgical training and it also offers a hospitalist career as a laborist (1 to 2 24-hour shifts per week) that would seem to be compatible with my goals.

Which speciality would seem most appropriate for what I'm trying to do?

And, frankly, is this a realistic plan? I know the general surgeon's lifestyle can be strenuous without trying to incorporate a simultaneous career in another country.

 

[maxheadroom]

This is a frequent idea floated by medical students. While your altruism is commendable, this type of practice is a rare find. There is a surgeon in St Louis who is very active with MSF (I think he's featured on their website) and spends a substantial portion of his time outside of the U.S.

Why this is a difficult practice:

1. Your partners are not going to want to cover your patients for half of the year.

2. Your partners will want you to pay a whole year's overhead -- your share of a nurse, receptionist, office space, utilities . . . things like that

3. You will have to pay for (expensive) malpractice insurance for an entire year, but only generate income for part of the year.

4. PCPs will get tired of trying to refer patients, only to find out that you're gone for an extended tour.

5. It will wreak havoc on the call schedule at wherever you have privileges.

6. When you only collect income for 6 months work and still pay overhead for 12 months, your take-home pay will be disproportionately reduced.

7. What about your family?

This is a noble idea, but it's probably better to do short-term work and take occasional longer tours with MSF (I think they only require 4 week commitments from surgeons).

This may seem a little "out there", but this is my current thinking:

I want to divide my time after residency between working in a developing country, (teaching local staff and operating) and also maintaining a salary in the US, to support myself.

Right now, I'm an MS3 trying to choose a specialty. I'm drawn to general surgery for the breadth of training one receives, especially as a trauma surgeon. My hope is that I could find shift-work as an acute care surgeon and therefore free myself for relief work during off-shifts.

I'm also considering Ob/Gyn, for the reason that the training is broad, provides for surgical training and it also offers a hospitalist career as a laborist (1 to 2 24-hour shifts per week) that would seem to be compatible with my goals.

Which speciality would seem most appropriate for what I'm trying to do?

And, frankly, is this a realistic plan? I know the general surgeon's lifestyle can be strenuous without trying to incorporate a simultaneous career in another country.

 

[JackADeli]

...Why this is a difficult practice:

1. Your partners are not going to want to cover your patients for half of the year...

4. PCPs will get tired of trying to refer patients, only to find out that you're gone for an extended tour...

Aside from everything previously posted and specifically the points quoted above, your patients, aka primary paying clients will not like it either. To practice rural, low tech, 3rd world care well, you need regular high acuity practice. The surgeons in the third world/developing nations are more then capable of the simple procedures. Can they use a hand? sure. but, your greatest assets will be your ability in providing for more serious cases, i.e. colectomies, open gall bladders, gastric, esophageal, pancrease, renal, vascular, +/-trauma, etc... cases. Your not going to stay that sharp by functioning stateside in a ~locums/itinerant surgeon role (i.e. hemorrhoid king/queen).

Skill in complex/major surgery requires continued high volume practice. Most of the surgeons I know that do "mission" work, maintain a full time practice in the USA and then spend two two week stretches or one four week stretch per year. Other then that, everyone else seems to spend 8+months abroad chasing disasters, being poor and returning to the USA to fund raise for continued existence.

IMHO, those are the only two workable and ethical approaches. Too many think they can go to developing nations and behave like cowboys because.... the natives have no alternative. Compassion and caring is not a short cut.... and it's not an excuse. Not to mention "malpractice" abroad can be far more brutal as you don't pay in cash. In some countries you pay in prison sentences or worse.

 

[PlutoBoy]

There are lots of missions from the US that go to PUBLIC city hospitals to do highly specialized surgery to patients that cannot afford it, i.e. pediatric heart surgery, general cardiac surgery, etc...

Sometimes, surgeons go not only to operate but also to practice uncommon cases in America and (!) try new procedures/research... Don't worry, they are not allowed to inject viruses into patients so no hard feelings 😉

I can't help feeling a little bit disturbed by Jack's comment (no offense) about the developing nation's surgeons being able to do appendicitis cases but not a colectomy... Really man, what's up with that? There is more than enough capable doctors doing those procedures in any moderately developed nation. There are specialized surgeons (neuro, cardiac, ENT...) in any major city as well (in private and public hospitals).

That being said, I just want to say how I think you can help:

1- TEACHING! You can try to do surgery with the residents and attendings. Sometimes, these American medical groups go to a hospital in a developing nation and create some sort of bubble, a mini US hospital. That way you are not going to promote the American standard of care and teach proper surgical techniques. What I mean is that you are going to help more patients if you can help the native doctors to be better doctors.

2- Promote research! Developing nations tend to be lagging in this regard. You can try to promote the need to do research or even lead a research project. Believe me, you are not going to face so much restrictions as in the US (a good or bad thing?)

3- Things that you take for granted in the US are needed in many countries. If you can raise the funds, providing the hospitals with good basic surgical equipment, surgical clothing, good anesthetic drugs, good antibiotics, etc., can be of tremendous help. You can get many of those things from drug companies 🙂

4- Be humble. They know you are from a developed nation. They know they are not. Nobody wants to see your "OMG WTF is going on here!" face. If you see something that could be better, tell them about your experience in the US and if you can do something to help, do it.

5- If you go to a moderately developed nation and spend some time there, you will probably notice that large private hospitals are equipped as any US hospital. A lot of the time these hospitals can help as well. I've seen this done many times: You go to the public hospital, see the patients and then do the required procedures in the private hospital. Of course the private hospital is not going to charge you. Remember, you probably don't want to help those people any more than their fellow citizens. You can lead the initiative to do free surgery with a high standard of care on people that could not afford it and work side by side with the natives.

Good luck! I like your approach!

 

[JackADeli]

...I can't help feeling a little bit disturbed by Jack's comment (no offense) about the developing nation's surgeons being able to do appendicitis cases but not a colectomy... Really man, what's up with that? There is more than enough capable doctors doing those procedures in any moderately developed nation...

Be disturbed if you must. your interpretation is neither the point nor what was stated. And, if you want to distract on the issue we can do that too and start trying to define degrees from 3rd world, developing world, to ?"moderately developed", etc, etc.....

Having traveled to numerous countries with drastically varying degrees of resources, I stand by my original post as stated and in its complete context.

 

[PlutoBoy]

Be disturbed if you must. your interpretation is neither the point nor what was stated. And, if you want to distract on the issue we can do that too and start trying to define degrees from 3rd world, developing world, to ?"moderately developed", etc, etc.....

Having traveled to numerous countries with drastically varying degrees of resources, I stand by my original post as stated and in its complete context.

Yeah, thank you 👍

 

[BlondeDocteur]

There are people who do this. The one I know best is independently wealthy and does not operate in the US, or see patients here.

http://www.adamkushnermd.com/

 

[treehorsio]

We have a peds surgeon who wrote into his contract that he spends 6 wks a year with MSF, which he has successfullly done.

We have at least 2-3 surgeons who go back to the same hospital/country every year and can bring a resident. However, these are only 1-2 week stints, which is about all that is reasonable to subject yoru partners to in private practice.

There is a new International Surgical Fellowship at MGH. There are also rural surgery fellowships. However, know that the majority of most international surgeons need to have extensive OB experience and rectovaginal fistula repair experience.

Search "Operation Giving BAck" on the ACS website for an idea of opportunities.

But, to echo JAD, what developing countries really need is training and access to surgical technologies and techniques. They can take out colons, many of them quite well. It should be considered to be a cooperative relationship, not patriarchial: we fancy white guys are going to do all your surgeries for you for a week then leave. what about complications? who pays for the medications afterwards? etc.

I once heard John Tarpley give a great lecture about this.