Can we put an end to this debate once and for all?
As the stereotype goes, internal medicine, neurology, etc. are the intellectual fields. Surgeons, on the other hand, are regressive manual laborers and little thinking goes on inside their heads.
Of course, surgery is difficult, and so on. So it can't be entirely true. Where does the truth lie? Is it possible that surgery is every bit as intellectual (and then some) but they just don't show it?
Quite a few people have told me something along the lines of "anything besides internal medicine would be a waste of your brain." But then how do you explain that neurosurgery, ENT, etc, have higher board scores? And assuming Step 1 reflects intelligence...something doesn't add up.
Thoughts?
A few thoughts.
Tl;dr: Medical students gain an appreciation for medical management because they are beaten over the head with it throughout med school. Their exposure to surgery is a painful anatomy course and miserable or useless gen surg rotation.
Surgery is very intellectual, but not always in a way that is obvious to medical students and non-surgeons. Medical students are pounded with the minutiae of internal medicine throughout med school: physiology, pharmacology, huge blocks of inpatient medicine during M3/M4 year (peds, IM, family med, specialty rotations, etc). They get tested on the steps and whys and wherefores of basic inpatient care (rightly so). And they finish intern year with an appreciation for the complexity of quality and thoughtful inpatient care.
But what is the medical student's exposure to surgical science? The basis of surgery is anatomy, and most medical students learn to despise anatomy. It's a massive block of information with little clinical significance for an M1, the learning process is physically nauseating for many students, and when they get to M3 year, the limit of their use of anatomy is often being pimped by a surgeon while they are retracting from low-earth orbit. Then they get to the rotation where they get some exposure to clinical surgery -- their gen surg rotation.
Gen surg rotations tend to fall in one of two extremes: 1. extremely cushy rotations at community hospitals with 7am-5pm hours, no responsibility, and mostly standing around watching disinterested community docs operate, or 2. Hellish death marches with 5am-10pm hours, overnight call, dealing with overworked surgery residents who are as likely to strangle a med student as ignore them. Med students rarely leave these experiences with an appreciation for even the basics of surgery: wound care, perioperative medicine (fluids/ambulation/feeds/vital sign instability). And they definitely don't leave with an appreciation for the actually "intellectual" parts of surgery: deciding when a patient needs to go for surgery, deciding what operation they need, deciding what approach to use, what intraoperative factors to consider, and what postoperative care is necessary. There's a reason that takes 5-7 years of residency to learn: it's really, really complicated and "intellectual".
There's this idea that a lot of non-surgeons have, that being a surgeon = being able to do "procedures" or "operations". That's like saying being an rheumatologist is about being able to choose immune modulators. It's partially because non-surgeons usually have very little idea what goes into peri-operative and intraoperative decision making. And I think it's also partially because medical students' exposure to procedures is very rote. Central line = draping like this, putting the ultrasound there, and then sticking the needle in and doing all the steps in the right order. Suturing = pass the needle like this, make it very even, and then tie the knots like this. Being able to do a procedure is about doing all the steps correctly and in the right order, like a cookbook...not very intellectual.
But even in the simplest operations, there's a million factors that med students aren't considering. Look at nasal obstruction, one of the most common problems ENTs see. Even if we exclude all the medical causes of nasal obstruction and reduce it to a simple surgical problem, the management is complex. Where's the obstruction? Septum? Internal or external valve? Turbinates? Each one has it's own therapy. Now let's reduce it even further. Just septal obstruction. But how are we doing septoplasty? Is the deflection anterior enough that I need to use an alternate incision or even a rhinoplasty approach? What about extracorporeal septoplasty? What if the deflection involves structural elements that I can't resect? What if I make a perf? How do I approach spurs that impinge sidewall? Etc, etc, etc.
