updated thoughts on the most competitive general surgery residencies

[surgeon2b forev]

Rumor has it that general surgery is becoming more and more competitive in the last few years. I'm a bit surprised given the national trend seems to be that "medical students are smarter now-a-days and strongly consider lifestyles when they think about their future"; nonetheless, facts are facts. That said, what are the general surgery programs that are "up-and-coming" or becoming more competitive. Annalogous to this on the med-school front would be a school like the Univ of Pittsburgh, who 10 years ago was a spot on the map, but now is a top 15 if not top 10 program.

But what about for surgery?

I have heard from residencts and the like that programs like MGH and Hopkins are not what they used to be, and many schools have caught up, or are catching up. Yale, for example, used to be almost half-filled with FMG's and had random mediocore residents a few years ago, and nearly lost it's accreditation >5 years ago because work-house non-compliance. However, now it's filled with all US-grads from top institutions, has surgeons doing all kinds of prestigious research (robert wood johnson fellows, etc), and all I hear are good things; furthermore, they have recruited many prestigious faculty from top institutions, and continue to grow. I've actually never visited Yale, but I hope to interview there and see what their perspective is. Likewise, the University of Michigan doesn't seem to get the recognition it deserves. I cant' tell you how many attendings strongly STRONGLY encourage me to apply to Ann Arbor because the UofMichigan trains fantastic surgeons. Who would have thought, michigan? I mean, it's a really good medical school, but surgery in ann arbor michigan? Do they even see trauma?

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[Dr JPH]

Every specialty, including surgery, is cyclical.

Things seem to come in waves as far as competitiveness.

There will always be a few specialties that are near the top, mostly because of the small number of spots available every year. Conversely, there will always be a few specialties near the bottom because of the great number of spots available each year.

The rest seem to wax and wane.

Seems that surgery has been more and more competitive the last few years. My program saw twice as many applicants last year than they did 2 years prior, ENT and Ortho from the same school were the same way.

Anesthesia seemed less competitive this year than in years past, at least according to the people I know on the gas trail.

I dont know if I would worry about medical school selection simply based on their surgery program. First of all there is no guarantee that you will get a spot and thats even if you still want to do surgery when its all said and done.

Work hard in school, get good board scores and grades, and do the right rotations and you should end up in a program that you like.

 

[surgeon2b forev]

Thanks for the reply. Any other thoughts? BTW, i'm a 4th year medical student applying into general surgery; i'm not applying to medical school. I was just using the analogy.

Any thoughts on the best programs?

MGH, hopkins, UCSF?

next tier

Columbia, Penn, Michigan, Baylor?

 

[geekgirl]

up and comers and others of note not as intuitive as "big names" but are good:

u michigan
indiana
pitt
washington
iowa

there are loads more but these off the top of my head...

 

[Celiac Plexus]

up and comers and others of note not as intuitive as "big names" but are good:

u michigan
indiana
pitt
washington
iowa

there are loads more but these off the top of my head...

well michigan and washington have traditionally been powerhouses. dunno much about indiana or iowa. pitt is a power, and has been for a while. i wouldn't call it an up and comer... more of a sleeper since it's often outglammed by penn.

for the up and comers i put forth: wake forest, unc, lsu, and uab (though uab has long been considered a powerhouse by southerners...)

hope everyone is enjoying their summer. trauma chiefin' it here. argh.

 

[idiot07]

I wouldn't get caught up too much in the name game. At one point in time MGH, B and W, Hopkins, etc were the end all be all and are are all means still excellent, but it's not necessary to go to a program like that to be a good surgeon or accomplished academic. After interviews and hearsay I would argue that many of the programs in the south and midwest have much better operative experiences due to more autonomy and less fellowship creep. However, unless you're from the south or the midwest you generally don't want to live there so these programs tend to be less competitive, and honestly most of the residents/students on here really don't have much of an idea other than hearsay.
The programs listed above are all pretty good. So are Cinnci, Vandy, Louisville, UVA, Emory, UTSW, UF, UC, Duke, Washu, UW, OHSU, OSU, Utah. I'm not going to do the whole tier thing. You get a good education and fellowship placement at all of these. I interviewed at 13 places, thought I would get a solid education at 12. The most important thing is to find a program you're comfotable with personality wise, that's going to meet your career goals, and is in a location you at minimum can stand and hopefully really like.

 

[toxic-megacolon]

A recent, relevent thread:

http://forums.studentdoctor.net/showthread.php?t=265892

 

[mirakate]

Can anyone give me some perspective on Hopkins?

Ignore the sig line. 😀

 

[NDESTRUKT]

How does one not know about Indiana? Dr. Lillemoe is the chair there, he's also a coauthor of Surgery: Scientific Principles and Practice and many many other top rated textbooks. The university got a major deal out of getting him to be the chair there. That being said, the hours bite!

I'm doing a general surgery sub I at a major community hospital (it's huge here) and even then it's been busy - getting up at 4:30 to preround at 5, then operating, then working until 5 pm usually.

I always wondered - why can't attendings (or when you're done with residency) start seeing their inpatients at 8 am like other doctors, do a case starting at 10 and then operate for 8 more hours, then go home? You'd have an 8 to 6 workday.

Most of the community surgeons I know say they work 45 hours a week not including call. Including call it's 65. Residency is such a bitch to have to get through.

 

[Blade28]

I'm doing a general surgery sub I at a major community hospital (it's huge here) and even then it's been busy - getting up at 4:30 to preround at 5, then operating, then working until 5 pm usually.

Unfortunately, in residency, your hours can get much worse than 5 am - 5 pm.

 

[I am Hans]

How does one not know about Indiana? Dr. Lillemoe is the chair there, he's also a coauthor of Surgery: Scientific Principles and Practice and many many other top rated textbooks. The university got a major deal out of getting him to be the chair there.

Well, I for one was not aware that he had left Hopkins. Guess I've been busy. That said, being an author of a textbook doesn't always make for a good educator or someone that is a pleasure to work with.

That being said, the hours bite! I'm doing a general surgery sub I at a major community hospital (it's huge here) and even then it's been busy - getting up at 4:30 to preround at 5, then operating, then working until 5 pm usually.

Not to play the "back in my day" card, but it sounds pretty easy to me. 12 hr days? With the exception of Psychiatry and maybe a few subspecialties, you're going to do 12 hr days on most every rotation, and certainly as a resident, even if it isn't a surgical residency. Many "normal" human beings work 12 hr days as well.

I always wondered - why can't attendings (or when you're done with residency) start seeing their inpatients at 8 am like other doctors, do a case starting at 10 and then operate for 8 more hours, then go home? You'd have an 8 to 6 workday.

Here is the real reason I responded. While your plan sounds feasible it would entail a reworking of the entire OR system. Most hospital operating rooms have limited staff after about 3 or 5 pm; rooms are closed down, the PACU has minimum personnel, etc. While obviously there are still cases going at that time, either planned or unplanned, to have a large number of expected cases at the end of the day and extending into the evening would entail hiring another full shift of workers.

In addition, the later you operate, the later the patients stay in the PACU and the fewer hospital resources are available. I don't want my patient crashing in the PACU with the "cross cover" intern who doesn't know him from Adam being paged, minimal nursing assist (or even perhaps the "B" team) or without full allied service support should we need to return to the OR.

Finshing cases at 6 pm or later means that same day surgery patients (if you're doing those late) are going home late, possibly finding that their pharmacy is closed and if they have problems, entails late night phone calls or returns to the hospital. Setting up VNA is very difficult after hours and sometimes you aren't sure you'll need it pre-op (it can be done early, but in my experience, the PACU nurses wait until the patient comes out before calling Social Services to set up VNA). If being admitted, it means moving to the floor late at night, being woken up at midnight for their post-op check, etc. Patients would have to suffer being NPO for much longer hours if you extend the operating day (while occasionally people suggest that afternoon cases can eat breakfast, us real world types realize that cases get moved around, cancelled, etc. and those who have eaten wouldn't be able to go any earlier if need be). I'm sure there are many other reasons which are eluding me at this point,

I am not unsympathetic to your concerns, as I have tried to book elective cases after hours or on Saturdays (which would be convenient to me and my patients) and have been shot down every time as those times are reserved for emergencies because of the minimal staff available.

 

[NDESTRUKT]

Good points!

Lillemoe came to Indiana in 2003. He's awesome to work with and a really really nice guy.

My statement about working 12 hours at a community hospital was stating that even in less harsher environments you're still going to be working longer than most people.

When I was an engineer I worked 10 hours the most - and that was with managing projects.

So lemme ask you this: how does vacation work for you? How do you find cover while you're gone on vaca? How often can you take vaca (or how often does the community gen surg guy take vaca?)

 

[I am Hans]

Good points!

Lillemoe came to Indiana in 2003. He's awesome to work with and a really really nice guy.

That long ago, huh? I guess I have been busy!

My statement about working 12 hours at a community hospital was stating that even in less harsher environments you're still going to be working longer than most people.

True...although I'm not sure I would equate community hospitals with necessarily being less "harsh". It really is program dependent. I trained in an academic environment and my ex in a community one - mine was harsher in some respects (well, ok...in most) and his in others.

When I was an engineer I worked 10 hours the most - and that was with managing projects.

I think if you look around these pages you'll see people talk about stockbrokers, investment bankers, attorneys, etc. working 12 hr days. Of course, over the long run physicians probably do it on a more regular schedule.

So lemme ask you this: how does vacation work for you? How do you find cover while you're gone on vaca? How often can you take vaca (or how often does the community gen surg guy take vaca?)

The same way as it works in an academic practice - you have your partners cover for you when you're gone and you cover for them. That is really one of the reasons solo practice has gone the way of the dinosaurs...not only is it really expensive to set up, its tough finding coverage, although if there is another solo guy in town you can usually work something out.

As for how much vacation, it depends on what your contract says. In the beginning you probably don't take much because since you're not on salary, if you don't work you don't make money. Besides, unless you were hired as p/t, you don't wanna be the guy taking 6 weeks off while his partners are working 50 weeks a year. But there is no set rule about how much vacation you can take - you negotiate it with your partners or the hospital (if you are a hospital employee) - and the others cover for you when you're gone (and you try not to do big cases the day before you leave...I know some who do that, but its really bad form, IMHO).

 

[NDESTRUKT]

So can you pay someone to take your call?

I've always wondered if people did that - or hired PA's or something to help with their floorwork.

 

[I am Hans]

So can you pay someone to take your call?

I've always wondered if people did that - or hired PA's or something to help with their floorwork.

You can; it is not unheard of for surgical subspecialists who are required to take general surgery call to pay someone to take that call for them.

Would get expensive if you were on call frequently.

Many large groups do have PAs or NPs who can see patients and bill for them, although many surgeons are a bit too anal for that (sorry, but I want to see my own post-op patients and not worry that I'm being told something that isn't true). Besides, its unlikely, at least during the week when everyone is seeing their own patients, that you have so many patients in house that you can't do the work yourself.

But if you wanna pay a PA $90K a year to help you out, go ahead...I'd rather work a little harder and keep the money myself! 😀