Thoughts on ortho vs. general surgery

[K8E]

Hello all,
I am hoping to hear your thoughts on why you are choosing ortho instead of general surgery. 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 a week 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, 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 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 an ex-lap/splenectomy, but it seems like for any definitive repairs, someone else is getting called in. 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 your field?

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[volkl7]

general surgeons are physicians in the truest sense. it is not a profession, it is life. one has truly be dedicated to be a good general surgeon. they have to manage everything medically and surgically for a patient. they have the worst lifestyle; their training is miserable, hence they become miserable; true general surgeon is a dying breed; their compensation is horrendous for the amount of work they do; their procedures aren't nearly as fun (obviously biased); people die no matter what you do. hum??? maybe that's why g. surg residency spots never completely fill each year.

on the other hand, orthopods have the coolest toys, doing the coolest procedures, can care less about a chem 7 (med consult please), lifestyle is reasonable, compensation is always near the top. there is plenty of trauma, but not much that you have to get up in the middle of the night for. oh yeah, variety and variety.

 

[doc05]

general surgeons are physicians in the truest sense. it is not a profession, it is life. one has truly be dedicated to be a good general surgeon. they have to manage everything medically and surgically for a patient. they have the worst lifestyle; their training is miserable, hence they become miserable; true general surgeon is a dying breed; their compensation is horrendous for the amount of work they do; their procedures aren't nearly as fun (obviously biased); people die no matter what you do. hum??? maybe that's why g. surg residency spots never completely fill each year.

on the other hand, orthopods have the coolest toys, doing the coolest procedures, can care less about a chem 7 (med consult please), lifestyle is reasonable, compensation is always near the top. there is plenty of trauma, but not much that you have to get up in the middle of the night for. oh yeah, variety and variety.

so you're illustrating why g-surg is a better choice??

yes, they are physicians in the truest sense. they receive more complete training than any other profession. oh -- they also save lives. ortho may be "cool", but you're not going to save anyone doing arthroscopies and joint replacements.

choosing a specialty isn't easy, so talk to lots of people (residents, attendings, etc) in each field and figure out what's more important to you.

 

[ortho2003]

ortho may be "cool", but you're not going to save anyone doing arthroscopies and joint replacements.

probably true, unless that arthoscopy is for a septic joint...I have seen at least three cases in which somone ended up in the ICU in MODS from a septic joint and the first step in saving their life was teh arthoscopy and debridement. Rare example, but a very real example...there are also the patients with complex spinal injuries or pelvis uinjuries that may never survive without a good orthopod.

Anyway, one of the great things about ortho is being able to focus on a specific problem, treat it and see the patient improve (in most instances) without having to deal with all medical problems. The biomechanics and all the "cool toys" is also a big plus, if this doesn't interest you, then ortho is not for you. Another nice thing about ortho is that it is one of the areas that most everyone other than orthopods are clueless. No one gets orhto training in med school or residency unless they are going into ortho. It is nice walking into a orthopadic trauma situation and knowing that you are the only person in the room that has a clue of what needs to be done. There are examples of this in every specialty, but it seems that orthopaedics, particularly ortho trauma (open fractures, pelvis injuries and spine injuries), is an area that other physicians are very intimidated by. I know it is an ego stroke, but it is one of the benefits of ortho that I didn't realize until I got into residency.

For me, the decision between ortho ane general was easy. I saw ortho as a specialty that allowed me to performe some very cool surgeries where I was often times "fixing" people, rather than throwing a diseased organ in a bucket and shipping it off to path...and I didn't have to worry about their chem 7.

 

[Ross434]

but you're not going to save anyone doing arthroscopies and joint replacements.

Yeah but what about when somebody comes in out of a major trauma with half their bones broken or shattered. You're going to be the one to put them back together. You might not save somebody's heart or critical organs, but, saving them from never being able to walk or use their arms again is just as important.

 

[tega]

probably true, unless that arthoscopy is for a septic joint...I have seen at least three cases in which somone ended up in the ICU in MODS from a septic joint and the first step in saving their life was teh arthoscopy and debridement. Rare example, but a very real example...there are also the patients with complex spinal injuries or pelvis uinjuries that may never survive without a good orthopod.

Anyway, one of the great things about ortho is being able to focus on a specific problem, treat it and see the patient improve (in most instances) without having to deal with all medical problems. The biomechanics and all the "cool toys" is also a big plus, if this doesn't interest you, then ortho is not for you. Another nice thing about ortho is that it is one of the areas that most everyone other than orthopods are clueless. No one gets orhto training in med school or residency unless they are going into ortho. It is nice walking into a orthopadic trauma situation and knowing that you are the only person in the room that has a clue of what needs to be done. There are examples of this in every specialty, but it seems that orthopaedics, particularly ortho trauma (open fractures, pelvis injuries and spine injuries), is an area that other physicians are very intimidated by. I know it is an ego stroke, but it is one of the benefits of ortho that I didn't realize until I got into residency.

For me, the decision between ortho ane general was easy. I saw ortho as a specialty that allowed me to performe some very cool surgeries where I was often times "fixing" people, rather than throwing a diseased organ in a bucket and shipping it off to path...and I didn't have to worry about their chem 7.

but dont u feel bad having to consult some pgy 2 medicine guy who couldnt touch u in med sch. for a simple elevated k+

i know im definitely going for ortho...but the above scenario would definitely put a dent on my ego....but hey....all about the patient ...right...

 

[volkl7]

but dont u feel bad having to consult some pgy 2 medicine guy who couldnt touch u in med sch. for a simple elevated k+

i know im definitely going for ortho...but the above scenario would definitely put a dent on my ego....but hey....all about the patient ...right...

feel bad about consulting medicine, never. it is not that orthopods don't know how to manage these medical issues, it is that we care not to. we didn't go through med school honoring all the rotations, getting 250's on step I & sometimes step II, managing SICU pts as interns, and not knowing how to give kayexalate or calcium gluconate or whatever. i'd rather not give a pill then check labs later; there is much more fun to be had. bottom line is I DON'T CARE...bone broke, me fix.
the ego comes from fixing a jacked up open pilon fracture and have the pt return to playing basketball and skiing 6 months later, or slap a new knee in so the pt can play tennis again.

 

[volkl7]

so you're illustrating why g-surg is a better choice??

yes, they are physicians in the truest sense. they receive more complete training than any other profession. oh -- they also save lives. ortho may be "cool", but you're not going to save anyone doing arthroscopies and joint replacements.

choosing a specialty isn't easy, so talk to lots of people (residents, attendings, etc) in each field and figure out what's more important to you.

just illustrating a little respect where it is deserved. hate to be there myself.

 

[DistantMets]

If you've only done a week in ortho, I would recommend doing a full month and maybe that will help clear some things up for you. Good luck!

 

[ortho2003]

but dont u feel bad having to consult some pgy 2 medicine guy who couldnt touch u in med sch. for a simple elevated k+

i know im definitely going for ortho...but the above scenario would definitely put a dent on my ego....but hey....all about the patient ...right...

actually, I smile the biggest grin in the world every time I write consult medicine for med management...I have no desire to hear about glucose or potassium...I am done with med school and internship, it is on to the good life now.

 

[Bull's eye]

actually, I smile the biggest grin in the world every time I write consult medicine for med management...I have no desire to hear about glucose or potassium...I am done with med school and internship, it is on to the good life now.

AHHHHH!! <4 months to go. Then all ortho all the time. Toss the stethoscope time!!

 

[Apollyon]

feel bad about consulting medicine, never. it is not that orthopods don't know how to manage these medical issues, it is that we care not to. we didn't go through med school honoring all the rotations, getting 250's on step I & sometimes step II, managing SICU pts as interns, and not knowing how to give kayexalate or calcium gluconate or whatever. i'd rather not give a pill then check labs later; there is much more fun to be had. bottom line is I DON'T CARE...bone broke, me fix.
the ego comes from fixing a jacked up open pilon fracture and have the pt return to playing basketball and skiing 6 months later, or slap a new knee in so the pt can play tennis again.

"Orthopedic surgery - taking the smartest students, and making the dumbest doctors" - my ortho buddies get a laugh out of this, because they think like you do: they don't care beyond the bones - and that's not a bad thing. Critical injuries involve those to life AND LIMB. A guy I went to college with (he became a SEAL, I became a paramedic, time went by) is now an ortho resident where I'm EM, and I asked him about hypotensive floor patients, and just flooding them with fluid until pulmonary edema occurs, and then you call medicine, and he says, "Yeah!"; likewise, an applicant last year was saying about a patient for a TKR was listening to the doctor transcribe, and he says, "the lungs are clear, the heart has no murmur", and the patient said, "You didn't even listen to my lungs", and the ortho says, "does it matter? Do you want me to?" - and he has a point.

Putting the C-clamp on CAN be a lifesaving maneuver, among other things. EM residents do ortho blocks both to realize when ortho needs to be called, and, also, to learn splinting so we don't have to call - like something as simple as a thumb spica (which I put on all the time, and have never called nor had need to call ortho to do it), or doing a good bulky Jones. Last time I called ortho? Whether we had a special splint or just the spica for gamekeeper's/skier's thumb. He told me (on the phone) that he had never seen a special splint at our hospital, and spica was fine. He appreciated that he got some more sleep, and I was able to manage this simple problem.

 

[NCHoosier]

When I was a third year med student one of my advisors told me something that might be applicable here. He said, basically, don't choose your specialty based on your anticipated lifestyle during residency. Residency is residency, and be it general surgery or a subspecialty, your hours are going to be long. Sure, there's the 80 hour rule and that's fine, but you should still expect to work many 100 hour weeks.

You also have to consider what you see yourself doing once you're done. Private practice general surgery is, from what I've observed, very different from academic general surgery. As a med student, you see almost exclusively the academic side and your perspective is skewed. You could ostensibly join a large group and do mostly bread and butter stuff, with some "new and hot" procedures thrown in, and make a good income and have a reasonable lifestyle.

That said, between general surgery and ortho, it really comes down to individual preferences. One isn't really "better" than the other. As an ortho resident, I can tell you that some of the positives in our specialty are generally satisfying patient outcomes MOST of the time, good variety, technology/biomechanics, more OR time versus clinic time, and generally top tier compensation. As an up-and-coming orthopedic surgeon you'll be able to work most anywhere.

For me, it was a pretty easy decision. Please PM or email if you have any questions -
-NCH

 

[DrGarfield]

I think the same you do- Fix ém up an send home! and for that Ortho is the thing to do.
You can take my word- because i have done 7 months of residency in General Surgery- in addition to the required G Surg rota for Ortho it self- after 7 months of G surg- i changed back to Ortho and Believe me i have never regretted!

 

[MD Dreams]

When I was a third year med student one of my advisors told me something that might be applicable here. He said, basically, don't choose your specialty based on your anticipated lifestyle during residency. Residency is residency, and be it general surgery or a subspecialty, your hours are going to be long. Sure, there's the 80 hour rule and that's fine, but you should still expect to work many 100 hour weeks.

You make a very good point. However, I think that most people are turned off by surgery because life, even after residency seems to be hectic. At least that is one of my concerns about surgery. Sure it's true that a general surgeon can tailor their practice to work less hours but I see two problems with that. The compensation of general surgeons or even some of its subspecialties seems to be fairly low compared to other surgical specialties (ortho, neuro). Therefore, it would be very dissapointing to go through all that training to be paid less than other surgeons and then take a cut on top of that in order to have more time. Also, I've been looking at some job postings for general surgery/subspecialties and most of them require 1:3/1:4 call. That doesn't seem much different than residency.

Having said all that, what is the life of an orthopedic surgeon like after residency. Are they as busy as the genral surgeons? Is it a "better" specialty because there is more free time or because there is a greater compensation for equal hours worked? Thank you.