K8E

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Hello all,
I am hoping to hear your thoughts on why you are choosing general surgery instead of ortho. I have always thought I was headed for G-surg – I picture my future working in a small city/town (<200 000) in the Pacific/Mountain states, with a large scope of practice (lots of variety, some trauma), ready to handle any cases that come my way. However, I spent time in ortho-oncology during my surgery rotation, and loved it. Then I pushed ortho to the back of my mind again when I started my G-surg rotation.

Now that I am doing G-surg as an MS3, I realize I have a lot of reservations about the field. First of all, it’s so much more medical management than I was expecting. Simplistic as it sounds, I like to fix people up and send them home – do I really want to still be following a SICU patient’s chem. panel on POD 30?

Second, I have had several G-surg residents sit me down and tell me to think VERY seriously about the surgical subspecialties. It’s not that they don’t love what they do – I think that they’re just very cognizant of the sacrifices they have made to do it. They really press me on whether I’m willing to surrender my 20s to my residency, whether I’m OK with not having a full weekend off in 2 yrs. I really don’t mind working very hard, but there’s hard, and then there’s too hard. If I’m going to operate through the night, it should be because the case couldn’t wait, not because there were empty OR’s begging to be used.

Third, now that I have had more experience with trauma surgery, I’m not as thrilled by it as I initially thought. It’s a lot of triage and then maybe an ex-lap/splenectomy, but it seems like for any definitive repairs, someone else is getting called in (ortho, neuro, vasc). I think I’d rather be on the other side of things – I’d rather be called in for my expertise in one area than be the first-line evaluator. I guess that’s why I never liked ER.

So as I spend more time in G-surg, I keep thinking back to my week in ortho and wondering if it isn’t a better choice for me. Good variety, some trauma, ability to operate all over the body, quick turnover, better lifestyle. I’m looking forward to your comments. What do you love about GS, or what are your reservations about ortho?
 

dr.evil

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I think you've evaluated the two specialties well and have evaluated what you dislike about trauma well. I went throught the same process my 3rd year of med school.

I honestly thought I would do ortho. When I did my ortho elective I felt just the opposite of you. I greatly enjoyed the ortho cases (granted, I loved gyn/onc cases too) but it really bothered me that they would consult medicine for any/every little thing post-op. My ortho friends actually like it when someone makes the comment that "an orthopedic residency is taking some of the smartest medical students and turning them into the dumbest doctors."

A big problem with your argument is that you're lumping GS into trauma. I really enjoy GS but I despise trauma with every ounce of energy (except operative penetrating trauma). You're really the medicine doctor for people with traumatic injuries who are often only operated on by Neuro/Ortho. I hate that. You're also married to these people for some time. I prefer evaluating, operating, taking care of the patient post-op, seeing them in clinic once or twice and then back to their PCP.

You're lifestyle after residency is variable but odds are you'll have a better life as an ortho. If you go to a smaller town like you plan (which you can do as a general ortho or general surgeon) then you may be busier with both. Residencies can both be tough. Ortho does have nice rotations like sports, shoulder, foot/ankle, etc that give you a little better life. GS, sadly, doesn't have too many cake rotations.

You'll make more money as an ortho on average also.

There are really a lot of positives to ortho over GS. My one big negative against ortho was that I didn't like it as well as GS. So the money, lifestyle, etc. really didn't matter. Derm has a better lifestyle, money, easier residency, very little medicine but not really my gig either.
 

surg4me

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I'm going into GS because I have options...I don't like ortho, but liked oncology, plastics, and vascular...at this early point in time, I just don't know...I wouldn't mind practicing GS as well. Maybe if I had the grades and scores and knew more ppl, I may have considered urology...???
 

Pilot Doc

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K8E said:
I picture my future working in a small city/town (<200 000) in the Pacific/Mountain states, with a large scope of practice (lots of variety, some trauma), ready to handle any cases that come my way.
This is the key point in your post. Private practice outside of a major metropolitan area is very different from what you are currently observing: 1) residents and 2) academic attendings who probably care for a mostly indigent population. In a private practice, you will not be managing lytes on your SICU pts POD1 or POD30 - the pulmonologist who runs the ICU will do that. Your specialty and your moneymaker is operating, and that's what will occupy 75% of your time.

Regarding GS training, it's clearly a sacrifice, though at the programs which comply (or try to comply) with the work hour regs, it's not nearly as bad as it has been. And although the subspecialties in general have a better lifestyle, ortho residents do not have much share in that. At my institution, the ortho trauma burden weighs quite heavily on the residents - they're not out golfing while the GS guys suffer. But truthfully, this is very institution dependent - the cush to malignant spectra of all ortho and GS programs will have substantial overlap.

I'll second the above comments on trauma. Many people despise it, but there's much more to GS.
 

pamchenko

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general surgery and ortho are very different. I think that alot of general surgeons take pride in their medical management skills. If you love medicine and love to be cerebral, but hate to write notes and BS all the time, and essentially want to do procedural work/patient care...then clearly general surgery is for you. Ortho and general surgeons both work hard...if you finish and go into private practice, you can make it as high or low volume as you'd like. Ortho does NOT seem like a lifestyle job to me. there are other procedure oriented fields with "better lifestyles." I think the deciding factor is that if you like medicine and want to take care of your patients.
 

tega

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dr.evil said:
I greatly enjoyed the ortho cases (granted, I loved gyn/onc cases too) but it really bothered me that they would consult medicine for any/every little thing post-op. My ortho friends actually like it when someone makes the comment that "an orthopedic residency is taking some of the smartest medical students and turning them into the dumbest doctors."

QUOTE]
this is my biggest concern with going into ortho.....
 

LuckyMD2b

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From this thread it sounds like people really don't like trauma.

I was wondering what it's like for a fellowship trained surgeon in trauma, surgical crit. care. or burn surgery. Do they do just truama or emergent general surgery procedures too? What is the call schedule like, do those docs still get to do a lot of basic gen surgery as well? I imagine there is a large diversity of patients -- trauma being the #1 killer of younger folks. How about income in compare to private practice gen surg.? How competitive is it to obtain a fellowship after gen surg residency.

Thanks any info will be greatly appreciated.
 

trauma_junky

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dr.evil said:
I think you've evaluated the two specialties well and have evaluated what you dislike about trauma well. I went throught the same process my 3rd year of med school.

I honestly thought I would do ortho. When I did my ortho elective I felt just the opposite of you. I greatly enjoyed the ortho cases (granted, I loved gyn/onc cases too) but it really bothered me that they would consult medicine for any/every little thing post-op. My ortho friends actually like it when someone makes the comment that "an orthopedic residency is taking some of the smartest medical students and turning them into the dumbest doctors."

A big problem with your argument is that you're lumping GS into trauma. I really enjoy GS but I despise trauma with every ounce of energy (except operative penetrating trauma). You're really the medicine doctor for people with traumatic injuries who are often only operated on by Neuro/Ortho. I hate that. You're also married to these people for some time. I prefer evaluating, operating, taking care of the patient post-op, seeing them in clinic once or twice and then back to their PCP.

You're lifestyle after residency is variable but odds are you'll have a better life as an ortho. If you go to a smaller town like you plan (which you can do as a general ortho or general surgeon) then you may be busier with both. Residencies can both be tough. Ortho does have nice rotations like sports, shoulder, foot/ankle, etc that give you a little better life. GS, sadly, doesn't have too many cake rotations.

You'll make more money as an ortho on average also.

There are really a lot of positives to ortho over GS. My one big negative against ortho was that I didn't like it as well as GS. So the money, lifestyle, etc. really didn't matter. Derm has a better lifestyle, money, easier residency, very little medicine but not really my gig either.
I agree. Trauma service is all other surgical services baby sitter. It sucks how many services dump on trauma.