To Cut, or not to cut?

[DOone]

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Hello, fourth year medical student here.

I've been contemplating applying to neurosurgery and general surgery programs. However, I am wondering about the lifestyle afterwards.

Money isn't necessarily "high" on my list, but It could be pushed aside if needed.

Is it possible to go to say, "over-saturated" markets like say, California to avoid less call? I would imagine if there were say, 7 general surgeons, there would be little on call.

Also, what about any other places where Surgeons can have a 55-60 hours a week lifestyle? Surely when I graduate, I want to at least enjoy what I do and still have time to do other things. And I don't mind working a lot, I just want to at least have ONE OR TWO good days where I can take my son out to the movies or hang out with my wife and enjoy what my heard earned money has to offer.

Any suggestions?

What locations would be suited to be a "lifestyle" surgeon? what would the salary be like? 200? 190K?

How about the pathology? will it just be straight appendectomies? or more interesting cases?

 

[Arijos0222]

Bump

 

[mimelim]

The problem is finding a practice to join that will let you dictate how much you want to work. The more competitive a market (more saturated), the less power you have when negotiating calls and salary. If you are willing to go to a smaller city and join a medium/large practice, the call will be much lighter.

Also, how good you are and where you come out of residency do matter. If you are a highly sought after applicant, it is very different than an 'average' general surgeon just out of residency.

 

[sonofva]

I was talking with my attending about this and he said "I don't understand why students expect I go into surgery and maintain a lifestyle. If you think a surgeon for the first half of his career can maintain a lifestyle while working the number of cases necessary to pay loans, meet responsibilities, and sharpen skills...you're delusional."

 

[sonofva]

Also, on a personal level, I think if you're not trying to work that hard, I don't think you should be doing anything more intense than an appy. I don't want a rusty surgeon doing a whipple or transplant on me...

 

[Doctor D]

Don't cut. Thank me later.

 

[gravitywave]

My understanding is that it's pretty hard to find a true part time job in any surgical field, but it seems there are good reasons for this related both to professionalism and patient safety. Then again, attending general surgeons work less than ten hours more / week than their internist counterparts, on average. Most of it really depends on how you'd like to be spending your time once you come into whatever you're going toward.

Bottom line, I don't think anyone is forced to work resident type hours as an attending unless they want to.

 

[ophthope]

My understanding is that it's pretty hard to find a true part time job in any surgical field, but it seems there are good reasons for this related both to professionalism and patient safety. Then again, attending general surgeons work less than ten hours more / week than their internist counterparts, on average. Most of it really depends on how you'd like to be spending your time once you come into whatever you're going toward.

Bottom line, I don't think anyone is forced to work resident type hours as an attending unless they want to.

If 'part time' can mean 60 hour weeks - Ophthalmology is definitely surgical and lifestyle friendly. ENT can be very manageable as well.

And ten hours more/week is a huge difference. That's like working an extra 22 days every year. It's not 'just ten hours.'

And speaking with general surgeons my impression is that when you get out into practice at first you'll be working even harder or AT LEAST as hard as during residency for some years.

 

[gravitywave]

If 'part time' can mean 60 hour weeks - Ophthalmology is definitely surgical and lifestyle friendly. ENT can be very manageable as well.

And ten hours more/week is a huge difference. That's like working an extra 22 days every year. It's not 'just ten hours.'

And speaking with general surgeons my impression is that when you get out into practice at first you'll be working even harder or AT LEAST as hard as during residency for some years.

I guess when I said that, I was really gesturing more toward that whole "40 hours can seem like 80 if you don't like what you're doing" sentiment, which is certainly one that I subscribe to. So for people who know what they want, no, I don't think that's a huge difference.

As for your last, I guess my conversations with surgeons have gone differently from yours.

 

[MsKrispyKreme]

Don't cut. Thank me later.

^Agreed.

 

[WellWornLad]

Yes, it's possible.

Don't bother asking your local academic surgeon about these sorts of issues. I've got nothing but respect for them, but they do represent the hardest working, hardest studying surgeons out there and therefore naturally gravitate and perpetuate the old-school, no compromise surgeon philosophy. And that's kind of the way it has to be if you're planning on being an academic surgeon - on top of your teaching responsibilities, leadership responsibilities, and research responsibilities, every nearby community hospital is sending you the complicated cases they can't deal with at all hours. There's little room there for a personal life.

Likewise for any neurosurgery gig that isn't exclusively spine. Unless you're doing private practice lami's and fusions, you'll be working at an academic medical center with academic responsibilities.

That said, private practice is another world. There is a HUGE deficit of general surgeons at community hospitals across the country right now. Some smaller hospitals don't have any general surgeons, which pretty much excludes them some of their most lucrative revenue streams. That translates into huge leverage if you're a general surgeon looking for a job. Want to take no more than 3 nights of call a month? No problem, the hospital's just glad to have you. They'll ship all the surgical cases off to the academic medical center the other 28-29 nights of the month - they're shipping them all now anyway, so it's win-win. Even if you're on call, anything more complicated than an appy will probably get shipped out, since you're at a community hospital with no vascular, ortho, neurosurg, whatever services.

Do yourself a favor and do a private practice/community surgery rotation if your school offers one, or try to arrange one if they don't. Not only is it a great rotation (for example, I got to pick and choose all my cases, little to no rounding, and was first assist on all cases since there are no residents), you'll get some exposure to surgery outside of academics and get some real perspective without the chest-puffing attitude all too common with the old-school mindset.

Per your questions, the most desperate hospitals tend to be more rural, and the pathology will be anything you're comfortable with - which will be not much, if you don't put some serious time in early in your career. So there's a lot of factors to consider.

 

[ophthope]

I guess when I said that, I was really gesturing more toward that whole "40 hours can seem like 80 if you don't like what you're doing" sentiment, which is certainly one that I subscribe to. So for people who know what they want, no, I don't think that's a huge difference.

As for your last, I guess my conversations with surgeons have gone differently from yours.

Hey man I've got great, great friends going into surgery so for their sake I hope your conversations with surgeons have been more indicative of reality than mine! I also agree that 40 hours can seem like 80 if you hate what you do. I've been there and it sucked.

 

[gravitywave]

Hey man I've got great, great friends going into surgery so for their sake I hope your conversations with surgeons have been more indicative of reality than mine! I also agree that 40 hours can seem like 80 if you hate what you do. I've been there and it sucked.

yes indeed sir, yes indeed....

 

[meowkat444]

i don't have anything to add, but i'm concerned about a lot of the same things. i love doing procedures and i love neuroscience, but i have no idea about how to decide between neurosurg, ophtho, or neurology. if any of you have any thoughts....

 

[MCAT guy]

I guess when I said that, I was really gesturing more toward that whole "40 hours can seem like 80 if you don't like what you're doing" sentiment, which is certainly one that I subscribe to. So for people who know what they want, no, I don't think that's a huge difference.

As for your last, I guess my conversations with surgeons have gone differently from yours.

I agree with the 40 can seem like 80. The part where it goes wrong is people mistakenly believing they can only be happy in one specialty. There's usually some ulterior motive behind that belief. I bet most could be happy in 3-5 or more specialties if they tried.

 

[MCAT guy]

Don't cut. Thank me later.

Agreed.

 

[notbobtrustme]

What I've heard repeatedly is that you should go into surgery only if you cannot see yourself doing anything other than surgery.

 

[NightSwim]

Hello, fourth year medical student here.

I've been contemplating applying to neurosurgery and general surgery programs.

You mean 3rd year med student?

 

[genswim24]

You mean 3rd year med student?

Good point. I was thinking the same thing considering application deadlines for this year have come and gone.