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Surgical Attending Lifestyle Options

ChymeofPassion

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From every physician I've shadowed, they have been very upfront with the amount of hours they work. Surgeons have tended to work the most, 60-70 hour weeks being common. I have found, through reading and first-hand anecdotes, that in other areas of medicine it may be possible to have in your contract working 4-5 day weeks for 50 hours (with reduced compensation compared to crazier hours, of course). Is this possible for surgical specialties? Or does the nature of the work prevent these kinds of agreements.
 
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slowthai

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It really depends. Multiple factors like the specific surgical subspecialty, subspecialization, practice setup, call pool, where you are in your career, etc all factor into your lifestyle.

If you're looking for lifestyle, you want to maximize the ratio of elective cases to emergent cases. So fields like breast, gyn onc, and opthalmology can be pretty cush. A field like neurosurgery is often times pretty bad, but it can also have a good lifestyle if you subspecialize in something like functional neurosurgery. Even a field like ENT ("Early Nights and Tennis"), which is known for having a decent to good lifestyle, could have a horrendous one if you subspecialize in head and neck reconstruction at a major hospital.

Another thing to consider is that in a lot of cases, if you do want that cush life, it may take a while because you'll need to build a practice, whether that's in private practice or academia. That takes time and hustling, so it may not be until your first 2-5 years of practice before you can really take your foot off the gas.
 
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ChymeofPassion

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With ortho it’s very practice dependent and how much call you take and what you do with the things you get on call.
Ortho is something I'm interested in, by subject matter, but lifestyle is something that's really important to me; a friend of mine barely saw his father growing up because he worked 6-9 M-F with call on the weekends. It is possible, though, to negotiate for a more family-friendly contract?
 

ChymeofPassion

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It really depends. Multiple factors like the specific surgical subspecialty, subspecialization, practice setup, call pool, where you are in your career, etc all factor into your lifestyle.

If you're looking for lifestyle, you want to maximize the ratio of elective cases to emergent cases. So fields like breast, gyn onc, and opthalmology can be pretty cush. A field like neurosurgery is often times pretty bad, but it can also have a good lifestyle if you subspecialize in something like functional neurosurgery. Even a field like ENT ("Early Nights and Tennis"), which is known for having a decent to good lifestyle, could have a horrendous one if you subspecialize in head and neck reconstruction at a major hospital.

Another thing to consider is that in a lot of cases, if you do want that cush life, it may take a while because you'll need to build a practice, whether that's in private practice or academia. That takes time and hustling, so it may not be until your first 2-5 years of practice before you can really take your foot off the gas.
I'm certainly willing to put in a few hard years if there is a lighter load at the end of the tunnel, that's nice to hear
 
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HBSlim

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As a lot of previous posters have mentioned, this is very practice dependent. From what I've seen though, there are plenty of opportunities for more manageable lifestyles in any surgical specialty. This is my N=1, but I'm a 5th year ortho resident and I've signed with a group for after fellowship that will be 4.5 days a week (2 OR, 2.5 clinic), with 1 in 13 call at a level II trauma center. I don't feel like I've sacrificed on compensation or location either.

One of my mentors in residency told me the 3 main factors when looking for a job are location, work environment, and compensation. Most people have a pretty good shot of getting what they want for 2 out of the 3 factors, the lucky ones get all 3, and the unlucky ones only get 1 out of 3 (and need to decide whether the 1 is worth giving up the other 2).
 
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HBSlim

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I'm certainly willing to put in a few hard years if there is a lighter load at the end of the tunnel, that's nice to hear

That's good to hear. I'm enjoying residency/my career now, but I was absolutely miserable for the first 2.5 years of residency. Based on where I am now I'd say it was worth it, but there were many times during those years that I fantasized about quitting during the middle of a bad call night.
 
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Smurfette

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This will all depend on the job. Some places are not so busy that a surgeon must work crazy hours. You just have to find the right practice, although it make take a few tries to find that balance you are looking for. Hours is only part of the equation.
 
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Ortho is something I'm interested in, by subject matter, but lifestyle is something that's really important to me; a friend of mine barely saw his father growing up because he worked 6-9 M-F with call on the weekends. It is possible, though, to negotiate for a more family-friendly contract?

When you are a little ways out and have more negotiating power, yes. But in the beginning, much less likely.
 
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CyrusHabs7695

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Don't forget the 6-7 years of intense residency hours that go along with surgery. So based on what the surgeons in here say (takes a couple years as an attending to land a cushier practice), youre looking at like 10+ years post-medical school until you land that lifestyle
 
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Dr G Oogle

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It really depends. Multiple factors like the specific surgical subspecialty, subspecialization, practice setup, call pool, where you are in your career, etc all factor into your lifestyle.

If you're looking for lifestyle, you want to maximize the ratio of elective cases to emergent cases. So fields like breast, gyn onc, and opthalmology can be pretty cush. A field like neurosurgery is often times pretty bad, but it can also have a good lifestyle if you subspecialize in something like functional neurosurgery. Even a field like ENT ("Early Nights and Tennis"), which is known for having a decent to good lifestyle, could have a horrendous one if you subspecialize in head and neck reconstruction at a major hospital.

Another thing to consider is that in a lot of cases, if you do want that cush life, it may take a while because you'll need to build a practice, whether that's in private practice or academia. That takes time and hustling, so it may not be until your first 2-5 years of practice before you can really take your foot off the gas.

gyn onc is one of the worst schedules out there, they are in most cases the go to call for Cesarean related complications and surgical misadventures by obgyns. Plus they manage chemo and post op debulkings are often quite ill especially if they older. FPMRS on the other hand is quite cush.
 
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slowthai

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gyn onc is one of the worst schedules out there, they are in most cases the go to call for Cesarean related complications and surgical misadventures by obgyns. Plus they manage chemo and post op debulkings are often quite ill especially if they older. FPMRS on the other hand is quite cush.

Hmm, I coulda sworn I heard gyn onc has a nice lifestyle multiple times. Maybe I mixed it up or something

Edit: I guess it's more dependent on the institution
 
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Dr G Oogle

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Hmm, I coulda sworn I heard gyn onc has a nice lifestyle multiple times. Maybe I mixed it up or something

Edit: I guess it's more dependent on the institution

I think in most places if you’re dealing with ovarian and cervical cancer, morbidly obese with endometrial cancer, and managing chemo you will not have a great lifestyle. There are some community programs and residency where majority of cases are early stage endometrial and vulvar cancer where you’ll have a pretty decent lifestyle. One of the hospitals i trained At was a county hospitals but surrounded on all sides by quarternary care centers so must of the really sick went over there and county just dealt with the “mild to moderate” cancer. I am now employed by one of the Quaternary centers and the onc patients here are sick as and my onco peeps don’t look well rested
 
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DarkHorizon

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Ortho is something I'm interested in, by subject matter, but lifestyle is something that's really important to me; a friend of mine barely saw his father growing up because he worked 6-9 M-F with call on the weekends. It is possible, though, to negotiate for a more family-friendly contract?

what kind of lifestyle do you envision? How much money do you want to make? That will answer it.
 

DarkHorizon

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45-55 hours a week by (hypothetical) 33 (I will graduate medical school at 27), I'm not averse to weekend work or call, but nothing crazy.

you can easily find that in ortho in a small to mid sized town, making average ortho salary (500k). If you want a bigger desirable location, you’ll work harder. These are just working hours, there’s a lot of work behind the scenes preparing for cases.
 
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ChymeofPassion

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you can easily find that in ortho in a small to mid sized town, making average ortho salary (500k). If you want a bigger desirable location, you’ll work harder. These are just working hours, there’s a lot of work behind the scenes preparing for cases.
Small to mid-sized town is actually my preference, so that's great to hear. I shadowed an orthopedic surgeon and it seemed like for more simple cases he did not have more than an hour for prep, but for more complex cases it was on the order of a full working day spread out over other work he had. Would you say this is typical for prep? Sorry if these are very basic questions haha.
 
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DarkHorizon

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Small to mid-sized town is actually my preference, so that's great to hear. I shadowed an orthopedic surgeon and it seemed like for more simple cases he did not have more than an hour for prep, but for more complex cases it was on the order of a full working day spread out over other work he had. Would you say this is typical for prep? Sorry if these are very basic questions haha.

For simple cases, no specific prep is required other than looking at the records and going over everything. But if you have an elective joints/spine practice, there’s quite a bit of planning with cases, from templating to teeing up the patient with clearance and everything. If you have a trauma practice, quite a bit of perpetration is needed.
On average, probably 5-10 hours a week is spent on behind the scenes work, including prep, admin, lit review.
 
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MediCane2006

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From every physician I've shadowed, they have been very upfront with the amount of hours they work. Surgeons have tended to work the most, 60-70 hour weeks being common. I have found, through reading and first-hand anecdotes, that in other areas of medicine it may be possible to have in your contract working 4-5 day weeks for 50 hours (with reduced compensation compared to crazier hours, of course). Is this possible for surgical specialties? Or does the nature of the work prevent these kinds of agreements.
Plastics, ENT, or urology can lend themselves to this model rather nicely, particularly some of the sub specialty practices. Basically the more elective your “bread and butter” cases are, the more you are able to have a structured and predictable schedule.
 
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Detective SnowBucket

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Wow, I'm so proud of SDN as a whole rn. This is the first post from someone who hasn't started med school talking about residency where the community has collectively crashed down upon the OP telling him to "just focus on getting through med school and you probably won't even want to do surgery by the time you graduate". :)

(Also about to start med school and interested in ortho but have reservations about surgical lifestyle so I know that getting info out of SDN for people like us is like pulling teeth)
 
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ChymeofPassion

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Acute care general surgery/trauma surgery lends itself well to the shift work model. You might work hard some of the time, but you have time off to make up for it. Money isn’t bad either.
That's interesting, I'd expect trauma and acute general surgury to be more sporatic/shift work would often not work. What would an average week of shifts look like for this kind of surgeon, if you dont mind?
 

ChymeofPassion

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Wow, I'm so proud of SDN as a whole rn. This is the first post from someone who hasn't started med school talking about residency where the community has collectively crashed down upon the OP telling him to "just focus on getting through med school and you probably won't even want to do surgery by the time you graduate". :)

(Also about to start med school and interested in ortho but have reservations about surgical lifestyle so I know that getting info out of SDN for people like us is like pulling teeth)
Also true, I was expecting something like that actually but as a whole the MD forum is much better than the pre-md forum. So much golden advice and insight here from physicians who donate their time!
 
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ACSurgeon

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That's interesting, I'd expect trauma and acute general surgury to be more sporatic/shift work would often not work. What would an average week of shifts look like for this kind of surgeon, if you dont mind?

it can be disorganized and hectic or streamlined and allow for time off.

there are many models. Depends on workload and manpower etc.

- four week rotation trauma/ACS/elective GS/ off is one model
- week on/ week off with 3-4 calls per week is another
- week on, back up week, 2 weeks off.
- academic position with some number of trauma/ACS/elective time and time off. Time off here is more research and academic time but nonetheless.
 

ACSurgeon

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Just out of curiosity, what would be a run of the mill average income for an ACS/Trauma trained surgeon?

Academic could be under 300k. Private the sky is the limit but would depend on region. Would be comparable to general surgery job with potential to make more if you were paid separate for critical care time.
 
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you can easily find that in ortho in a small to mid sized town, making average ortho salary (500k). If you want a bigger desirable location, you’ll work harder. These are just working hours, there’s a lot of work behind the scenes preparing for cases.

Graduate med school at 27 means they’ll be 32 if they don’t do a fellowship, 33 if they do. So basically they are saying that their first job would be cushy- 45 hours a week? Unlikely when you’re the one everyone craps on as the new guy and you’re taking more call than the others in the practice. You have to put in your time. 2-3 years out, sure. Also most of my friends who started in private practice started at 350K on average and worked their way up. Academia starts higher but doesn’t go up.
 
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Frogger27

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Just out of curiosity, what would be a run of the mill average income for an ACS/Trauma trained surgeon?

I hung out with the chief a lot on my surgery rotation who was doing an ACS/trauma fellowship and talked about 500k+ offers in pretty cool west coast cities. Not sure about lifestyle, but seemed like a pretty good gig
 
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