Surgery/ER choice

[CaliforniaDream2026]

Hello,
I've been a bit too stressed thinking about choosing a specialty. Some of the ideas I had about what was important to me have changed after spending more time in the OR and wanted to see if there are some elements I perhaps haven't considered.
In order to pursue medicine, I left a successful career that gave me lots of free time. I've always thought my choice made sense as long as I picked a lifestyle speciality in order to have a family and a serious hobby related to my original field. However I've completely fallen in love with general surgery and now I'm going around feeling stressed about the fact that no matter what I choose I loose out because I cannot have: enough sleep, an okay career as a surgeon, a family, a serious hobby all at the same time.

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[Angus Avagadro]

Any OR specialty is going to require night call. As you know l, Gen surgery has a lot of night call. It might not be perfect, but you can still have a life and raise independent,problem solving children. Medicine is hard enough doing something you like, rather than doing something you aren't excited about

 

[ACSurgeon]

Hello,
I've been a bit too stressed thinking about choosing a specialty. Some of the ideas I had about what was important to me have changed after spending more time in the OR and wanted to see if there are some elements I perhaps haven't considered.
In order to pursue medicine, I left a successful career that gave me lots of free time. I've always thought my choice made sense as long as I picked a lifestyle speciality in order to have a family and a serious hobby related to my original field. However I've completely fallen in love with general surgery and now I'm going around feeling stressed about the fact that no matter what I choose I loose out because I cannot have: enough sleep, an okay career as a surgeon, a family, a serious hobby all at the same time.

Acute care surgery is gaining traction outside of trauma centers. This is essentially a surgical hospitalist kind of gig. Will require some amount of in house or home call and still give you every other week off on average. Something to look into.

 

[Styrene]

I'm not a surgeon, but from my friends experiences, surgery seems potentially misery-inducing if it is not the #1 priority by quite a bit. I'm sure there are less time-intensive subspecialties and practice types, but for at least several years of training, free time outside of work will be quite limited.

 

[eyeeye_captain]

Have you considered ophthalmology? Clinic can be as busy as an ER shift if you want it, 1-2 days of surgery, probably 40 or less hours a week of patient care. And I say this as someone who does complex work. Worth a look.

 

[operaman]

Have you considered ophthalmology? Clinic can be as busy as an ER shift if you want it, 1-2 days of surgery, probably 40 or less hours a week of patient care. And I say this as someone who does complex work. Worth a look.

Agreed. Surgical subs are where it’s at in terms balancing being surgeon and having a life.

In Gen surg there are some areas that are supposedly more lifestyle friendly, but nothing like the subs.

Trauma/ACS can also be nice for some people - no pager, shift work, no call. Just lots of nights and weekends, but can have nice stretches of days off. Issue comes as you get older it’s harder to bounce back after a stretch of nights. Also, as you get older it’s harder to find other people to spend time with when you have weekdays off. Your kids will be in school and friends will be working, so it’s harder to enjoy that free time than when you’re 26 and your friends are always available for mid week fun.

Truly though, look at the subs. Super competitive but that’s because they really do give you the balance you’re looking for.

 

[CaliforniaDream2026]

Thank you very much for all these suggestions. I know that I don't have a shot at ophtalmo really. I do have a soft spot for Peds Surgery but that sounds extremely busy. I feel like I don't really have in-depth knowledge about most subs but I'm pretty sure I'd be happy with almost anything as long as it's surgery and I have enough free time no call. It's good to know it's sort of possible to have free time though. Shift work doesn't sound bad to me at all, that's why I was initiall considering EM. Most of my friends from my previous industry also work on weekends, holidays, evenings.

 

[EthylMethylMan]

Thank you very much for all these suggestions. I know that I have a shot at ophtalmo really. I do have a soft spot for Peds Surgery but that sounds extremely busy. I feel like I don't really have in-depth knowledge about most subs but I'm pretty sure I'd be happy with almost anything as long as it's surgery and I have enough free time no call. It's good to know it's sort of possible to have free time though. Shift work doesn't sound bad to me at all, that's why I was initiall considering EM. Most of my friends from my previous industry also work on weekends, holidays, evenings.

As an EM grad, I gotta parrot the complaints of many in my field: it’s perhaps the worst time ever to get into EM. Market is getting supersaturated. And the “it’s a lifestyle specialty” line is basically propaganda; circadian rhythms shifts steal days of your life, and you’ll be away for weekends and holidays regularly. If you just know you gotta be cutting people and you’re a strong applicant, do a surgical sub or IR. If you’re not as stellar, but wanna do cool procedures and want a decent lifestyle, be a kickass resident and shoot for GI, critical care, interventional cards, or something else in that vein.

 

[LIFS7]

Acute care surgery is gaining traction outside of trauma centers. This is essentially a surgical hospitalist kind of gig. Will require some amount of in house or home call and still give you every other week off on average. Something to look into.

How often do you get to operate vs covering SICU?

 

[ACSurgeon]

How often do you get to operate vs covering SICU?

Every job is gonna be a little different.

My full time job is surgery. Icu is my side gig. Full time is a week of call per month, a week of secondary call per month and the rest of the month is off. I carve out my time off and fill the rest with icu shifts. 3-6 per month.

Some jobs are a combination of surgery and icu in one FTE.

Some acute care jobs are pure surgery with no ICU component (and you don’t need to be fellowship trained).

Some will have more trauma than others. Most trauma is non-op unless you’re at a level 1 trauma center. These become a lot less lifestyle friendly.

Feel free to pm me if you Have specific questions along the way

 

[CaliforniaDream2026]

Thank you very much for all these suggestions. I know that I have a shot at ophtalmo really. I do have a soft spot for Peds Surgery but that sounds extremely busy. I feel like I don't really have in-depth knowledge about most subs but I'm pretty sure I'd be happy with almost anything as long as it's surgery and I have enough free time no call. It's good to know it's sort of possible to have free time though. Shift work doesn't sound bad to me at all, that's why I was initiall considering EM. Most of my friends from my previous industry also work on weekends, holidays, evenings.

Thank you for all the replies! BTW typo about ophtalmo: I know that I DON'T have a shot because I'm average.

 

[aldol16]

It's a real choice. It's a hard one. Surgeons don't have a lot of free time and you will have to make tradeoffs between your career, sleep, your family, and your other side gigs. It's hard to have a side gig as a surgeon. Not impossible, but does require a lot of help from others and commitment. It also takes time away from other things that matter.

 

[CaliforniaDream2026]

Thank you!! I think I have landed on EM and I'm okay loving surgery from afar. ACS doesn't look like a realistic option for me because of where I want to live. The possibility to work in shifts and truly be off the rest of the time means more to me than one OR day a week, tons of consults and random night calls. There are still cool procedures now and again.

 

[Arcan57]

Thank you!! I think I have landed on EM and I'm okay loving surgery from afar. ACS doesn't look like a realistic option for me because of where I want to live. The possibility to work in shifts and truly be off the rest of the time means more to me than one OR day a week, tons of consults and random night calls. There are still cool procedures now and again.

There are significantly bigger difference between surgery and EM than the fact that one of them is shift work. Disregarding the fact that this is a truly terrible time to be going into EM (which you absolutely shouldn't do), the work environments are completely opposite of each other. Med students get shown a highly curated version of EM where it's a team sport full of patients with cool diseases and most shifts have multiple procedures while carrying just enough patients to not be bored. The truth is that outside of the main academic hospitals, EM is a solo sport (even when you're on with multiple other docs) full of patients who mostly have no discernable cause for their symptoms or are presenting because of failure to manage what should be a stable chronic disease due to economic, social, or psychiatric reasons. Even in high acuity EDs, most shifts won't involve an intubation or a central line and you'll learn to hate lacs because patients don't stop coming in while you spend an hour stitching someone's face back up. And you'll be managing 6-15 active patients with the expectation that each one will be dispo'd in around 2-2.5 hrs, which will cause a not-insignificant amount of your mental energy to be spent keeping track of a dozen+ timers trying to decide if that CT scan is taking a normal amount of time to read or if something systemic screwed up that you have to hunt down.

But other than that, EM (currently) does pay ok for the length of training and burnout is something that happens to other, weaker docs.

 

[operaman]

There are significantly bigger difference between surgery and EM than the fact that one of them is shift work. Disregarding the fact that this is a truly terrible time to be going into EM (which you absolutely shouldn't do), the work environments are completely opposite of each other. Med students get shown a highly curated version of EM where it's a team sport full of patients with cool diseases and most shifts have multiple procedures while carrying just enough patients to not be bored. The truth is that outside of the main academic hospitals, EM is a solo sport (even when you're on with multiple other docs) full of patients who mostly have no discernable cause for their symptoms or are presenting because of failure to manage what should be a stable chronic disease due to economic, social, or psychiatric reasons. Even in high acuity EDs, most shifts won't involve an intubation or a central line and you'll learn to hate lacs because patients don't stop coming in while you spend an hour stitching someone's face back up. And you'll be managing 6-15 active patients with the expectation that each one will be dispo'd in around 2-2.5 hrs, which will cause a not-insignificant amount of your mental energy to be spent keeping track of a dozen+ timers trying to decide if that CT scan is taking a normal amount of time to read or if something systemic screwed up that you have to hunt down.

But other than that, EM (currently) does pay ok for the length of training and burnout is something that happens to other, weaker docs.

You hit on an excellent point here that doesn’t get emphasized quite enough:

As a student you get a very skewed view of a given specialty.

The student experience is often geared toward showing you the most interesting parts and you end up with an experience made up of the most interesting parts of multiple attendings’ days. This is great for learning but sub optimal for trying to pick a career unless you make it a point to find individuals whose overall practice is something you’d like to emulate.

 

[CaliforniaDream2026]

That's interesting thank you! In a way I sort of had a similar experience with surgery. Tons of hernias, a late cleaning team so the surgeon often had to clean between patients because she didn't want to wait and get home even later, bad anesthesia with patients reacting making it hard for her to work, etc... Also very lonely, no lunch/bathroom break, etc.
I think EM definitely has its issues but I like the more direct patient contact. To make it short I had a significant career in the arts before. Between chronic pain from overuse, annoying industry politics and hierarchy and the monotony I decided to transition into medicine and I'm super happy. But I think the possibility to still do a little bit thanks to a flexible schedule is not something I can pass on I think.

 

[Arcan57]

That's interesting thank you! In a way I sort of had a similar experience with surgery. Tons of hernias, a late cleaning team so the surgeon often had to clean between patients because she didn't want to wait and get home even later, bad anesthesia with patients reacting making it hard for her to work, etc... Also very lonely, no lunch/bathroom break, etc.
I think EM definitely has its issues but I like the more direct patient contact. To make it short I had a significant career in the arts before. Between chronic pain from overuse, annoying industry politics and hierarchy and the monotony I decided to transition into medicine and I'm super happy. But I think the possibility to still do a little bit thanks to a flexible schedule is not something I can pass on I think.

There are a lot of specialties that can accomodate a flexible schedule (including ACS if you find the right group). EM has politics, hierarchy, and monotony in spades in addition to a more chaotic and grueling work environment than most other specialties. If you are good at what makes EM distinctly EM (forging rapport with strangers quickly, staying calm and being able to think something through while the world melts around you, ability to task switch like the wind, maintaining calm despite being interrupted routinely during critical moments, developing and maintaining pattern recognition despite going years between similar presentations) then I heartily recommend EM provided you can deal with the circadian swings. But if that's not the case, you'll probably spend a lot of your PGY-3 year scheming how to not have to work a full-time clinical job and be burned out by your 3rd-5th year out.

 

[eyeeye_captain]

I think a significant problem through this thread is the OP’s desire for a lifestyle job while simultaneously looking at two burnout-prone specialties, especially when the OP has already burned out of a different profession. There are other options within medicine.

 

[CaliforniaDream2026]

Thank you very much for your replies! Which other specialities would you say give schedule flexibility? I'm OK not making tons of money, but unfortunately so far I'm scoring pretty average so as I mentioned dermato and ophtalmology will not be accessible to me but I have considered rhumato. Since I live and study in Western Europe, ACS is actually not really a thing. Cases that would be handled by one trauma/AC surgeon in the US are handled by several different surgeon specialists. In recent years, more and more hospitals have implemented a 48h max per week both for residents and attending EM physicians to lower burnout rates. That's not the case for surgical specialties. The EM shifts are 12h or 24h. EM physicians typically go on 1-2 ambulance calls per shift in addition to being at the hospital. The threshold for sending in an ambulance with a physician (over an EMT) is high so those cases tend to involve interesting procedures. It does mean some overtime when the ambulance is dispatched at the end of a shift. Some people are hired on a part-time basis and can increase their income by taking extra, high-paying shifts in underserved areas or on national holidays. It's a 4-year residency with possibilities to subspecialize in Peds EM or ECMO. A different system... anyways I would love to hear from people who've worked in shifts if they think 2*24h or 4*12h is truly exhausting or if it leaves room for a comfortable family life and a hobby.

 

[Angus Avagadro]

I dont mean to be harsh, just direct. Consider a physician executive MBA . You don't appear to like medicine or want to work hard, so go into something administrative. It appears the executive lifestyle might suit you. Good luck and best wishes.

 

[CaliforniaDream2026]

Maybe it comes across that way for some reason but I love it. Enjoying every class even though I'm slow and working hard while scoring average. First in last out at the hospital among the students and excited for the future. I'm just trying to get as much information as I can and prepare myself for a specialty I can enjoy for 30-35 years.

 

[operaman]

That's interesting thank you! In a way I sort of had a similar experience with surgery. Tons of hernias, a late cleaning team so the surgeon often had to clean between patients because she didn't want to wait and get home even later, bad anesthesia with patients reacting making it hard for her to work, etc... Also very lonely, no lunch/bathroom break, etc.
I think EM definitely has its issues but I like the more direct patient contact. To make it short I had a significant career in the arts before. Between chronic pain from overuse, annoying industry politics and hierarchy and the monotony I decided to transition into medicine and I'm super happy. But I think the possibility to still do a little bit thanks to a flexible schedule is not something I can pass on I think.

As another person with a significant career in the arts before medicine:

Give strong consideration to surgical fields.

I’ve found operating to feel strangely akin to performing and gives a similar rush. If you were on the performance side of things, you may find that aspect of surgery enjoyable. I never really felt that in training, but definitely do now.

The hours can be tough but I’ve managed to keep my toes in the performing waters. I probably did 1-2 professional gigs /yr in Med school as well as many local volunteer ones, and 1 per year in residency. Now as an attending im getting more and more active with probably 2-3 solid gigs per year thus far which is plenty for me.

Depending on the type of arts work you do, also consider how the variable hours of shifts may impact it. I work M-F 8-4 most days, and that leaves all evenings free which is often when rehearsals are held. I think I’d have a hard time with shift work as many shifts might be nights or partly night and make it harder to mesh with rehearsals and performances. Maybe not an issue for you, but possibly worth considering.

 

[aldol16]

There are significantly bigger difference between surgery and EM than the fact that one of them is shift work. Disregarding the fact that this is a truly terrible time to be going into EM (which you absolutely shouldn't do), the work environments are completely opposite of each other. Med students get shown a highly curated version of EM where it's a team sport full of patients with cool diseases and most shifts have multiple procedures while carrying just enough patients to not be bored. The truth is that outside of the main academic hospitals, EM is a solo sport (even when you're on with multiple other docs) full of patients who mostly have no discernable cause for their symptoms or are presenting because of failure to manage what should be a stable chronic disease due to economic, social, or psychiatric reasons. Even in high acuity EDs, most shifts won't involve an intubation or a central line and you'll learn to hate lacs because patients don't stop coming in while you spend an hour stitching someone's face back up. And you'll be managing 6-15 active patients with the expectation that each one will be dispo'd in around 2-2.5 hrs, which will cause a not-insignificant amount of your mental energy to be spent keeping track of a dozen+ timers trying to decide if that CT scan is taking a normal amount of time to read or if something systemic screwed up that you have to hunt down.

This highlights the exact problem with EM. At the academic places, it's not just the students who are exposed to a highly curated set of patients - it's also the residents. That's why the top EM places aren't at the ivory tower places - they're out in the community where EM docs are actually doing all these things. You think an EM doc at the academic place is spending an hour suturing a face lac when they can call plastic surgery or OMFS residents to do it? Those EM residents end up not having those experiences and can't get hired at places outside of the highly academic ones and it becomes a vicious cycle.

 

[aldol16]

I dont mean to be harsh, just direct. Consider a physician executive MBA . You don't appear to like medicine or want to work hard, so go into something administrative. It appears the executive lifestyle might suit you. Good luck and best wishes.

Definitely recommend looking into this route not just for OP but for anyone in medicine who is looking to the future and may be dissatisfied with prospects on where medicine is going. You have a real chance to influence the trajectory of health systems - we need more physician MBAs in those roles who are compassionate and understand the clinical care aspect of healthcare in addition to the business.

 

[CaliforniaDream2026]

Yes, I feel that rush just holding the retractor . I was staying an extra 4+ hours to watch more surgeries when I was in the abdominal surgery unit. It's hard to say how much I need to perform. Quality is more important than quantity for me and that requires a time commitment of 10 hours per week on average in order to stay in shape. I'm naturally a slow thinker, slow worker and anxious, fixated person and hope I will find ways to deal with that as it's an obstacle to creating a balanced lifesty. Anyways, all the replies are super interesting, thank you everyone! What comes through is that either of these choices has the potential to allow for a good life that includes hobbies and a family if done right and if I focus on efficiency, mindset and burnout prevention. This also gives me parameters to consider when choosing rotations and more shadowing including trying to get an experience of EM outside an academic center and seeking out mentors that are known for efficiency in the OR or ER. I don't think I could bear having an executive job but thanks for the suggestion; if anyone has more ideas for me to consider I'd love to hear them.

 

[MedBoardTutors]

Hello,
I've been a bit too stressed thinking about choosing a specialty. Some of the ideas I had about what was important to me have changed after spending more time in the OR and wanted to see if there are some elements I perhaps haven't considered.
In order to pursue medicine, I left a successful career that gave me lots of free time. I've always thought my choice made sense as long as I picked a lifestyle speciality in order to have a family and a serious hobby related to my original field. However I've completely fallen in love with general surgery and now I'm going around feeling stressed about the fact that no matter what I choose I loose out because I cannot have: enough sleep, an okay career as a surgeon, a family, a serious hobby all at the same time.

Your training will be brutal and you might not have lots of free time, but remember that your life as an attending can be more flexible--you'll make it how you want life to be. There's VA jobs, ACS jobs, trauma call, etc. that can all be massaged to fit your schedule in many cases. It might mean a paycut, but it definitely allows flexibility if you want it.

 

[Arcan57]

I'm naturally a slow thinker, slow worker and anxious, fixated person and hope I will find ways to deal with that as it's an obstacle to creating a balanced lifesty.

Please don't go into EM. EM actively punishes all of the qualities you just mentioned. I've known several high functioning, highly intelligent people whose lives were/are absolutely miserable in EM because of having one of those 3 traits. Efficiency can be learned but people have natural set points for how fast they process information and how much information they need to feel comfortable with making a decision. The pace of being an EM attending pushes most people past their comfort zone, which (combined with the circadian shifts) is part of what makes our job so exhausting. If your set point is slower than average, that discomfort often becomes intolerable. We don't reward deep thought but rather rapid pattern recognition. Our training environment often feels like you're failing as a person if you can't keep up. Especially if you're used to being perceived as a high performer, it's a really adversive environment for those that need to take their time to get it right.