What do you people think?

[derm83]

Long story short, I'm a med student from oversees and I've always wanted to becaome a surgeon. The problem is taht I herniated a lumbar disc 3 years ago and I get bad sciatica when i'm standing in the same posture.

So, I though I should be realistic and choose a non-surgical speciality. I did 2 Internal medicine electives in the states, but I didn't like it and I don't want to be an internist.

I'm thinking now about Rads but I'm not sure if it's worth it to spend 2-3 years doing research in the states to become a competitive applicant. Needless to say, IR isn't an option since the last thing I need is to wear that heavy gown for hours.

I shadowed a plastic surgeon for one week. He was operating sitting all the time as he was doing mostly skin lesions and tissue expansions. Im sure plastics isn't that simple. Any idea wheather I can tolerate plastics given my sciatica?

Any idea about Dermatosurgery? I'm sure this Dermatology fellowship exists in some countries but actually have no idea about their scope of work.

I'd really appreciate any input since this has become my worst nightmare lately.

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[Dimoak]

Given your situation, I don't think plastics would be a feasible route. If your sciatica is enough to prevent you from tolerating a surgical residency, plastics won't accomodate you much, as you still need to go through a considerable amount of GS before you start plastics. Certainly once a physician goes into practice, you may be able to focus only microsurgical and other procedures that you can do sitting down, but you still have to go through residency and potentially fellowship where you will generally be required and expected to perform under the physical requirements of your position. Dermsurg is a ferociously competitive subspeciality, and may be out of reach for most foreign graduates. ENT probably has the most microsurgery where one can be seated for most of the procedure, but that is also an extremely competitive speciality to get into, and the ability to sit down really shouldn't be one of the determining factors for someone trying to get into a competitive specialty. Have you considered just investing some time (and money) into treating your sciatica so you could pursue the specialty you're actually interested in?

 

[derm83]

I appreciate your thorough reply, Dimoak. Should I feel that Ican tolerate any surgical subspeciality, I'd consider doing my residency in a country other than the states. So this should partly eliminate the issue for competitiveness.

So, I'd really appreciat any input about Dermatosurgery. I'll try to google some info.

What about Ophthalmology? I did outpatient rotation but never had the chance to be in any surgery.

Given your situation, I don't think plastics would be a feasible route. If your sciatica is enough to prevent you from tolerating a surgical residency, plastics won't accomodate you much, as you still need to go through a considerable amount of GS before you start plastics.

Enough said.

ENT probably has the most microsurgery where one can be seated for most of the procedure

I thought they do a lot of neck surgeries. I believe I have to shadow some ENT surgeons since this might be potentially one option.

Have you considered just investing some time (and money) into treating your sciatica so you could pursue the specialty you're actually interested in?

Well, I've never considered a treatment since my sciatica is mild enough to enable me to walk, run, swim and round on patient withou the need to any analgesia. It's just standing upright in the same position what hurts me bad. So I spoke to a Spine surgeon while I was in the states last month after I figured out I didn't like IM and still want to be a Surgeon, he said there's nothing much to do. Anyway, I'm gonna see some other surgeons here for second opinion.

 

[Dimoak]

Dermatologic Surgeons are essentially Dermatologists who have focused on a certain approach toward treatment. I don't believe there is currently a board specifically for Dermsurg; they essentially board in Dermatology, and then do a fellowship, join societies, and do research that provides additional exposure to surgical interventions.

Ophthalmology may be a good option if you find it to be interesting. If competition isn't an issue for you and you feel you may be able to get a spot, it may be worth exploring, but there are other issues involved with that, including where you would like to practice, lifestyle etc., that go beyond the scope of this thread. As a specialty, it definitely involves microsurgery and would be condusive for someone who needs to sit while operating.

Neck surgeries can be complex, as both ENT and GS are oftentimes competent in dealing with certain cases. I mentioned ENT in part because it carries less GS time than other microsurgery-intensive specialties, and since you mentioned an interest in the aforementioned, you would be able to do an ENT plastics fellowship and perform such procedures.

 

[derm83]

So I believe I potentially have three options at this point: ENT, Ophthalmology and probably Dermsurgery.

Thank you so much Dimoak, appreciate it.

 

[SocialistMD]

I mentioned ENT in part because it carries less GS time than other microsurgery-intensive specialties, and since you mentioned an interest in the aforementioned, you would be able to do an ENT plastics fellowship and perform such procedures.

Again, though, the training in ENT carries with it some of the longest operative times. Some of those radical neck dissections can take well over 8-10 hours. I can't think of anything routinely done in general surgery that comes anywhere near those times. Most of our long cases are 5-6 hours. ENT might not be as appealing as you think.

Also, and not to sound like a surgical elitist, "dermatosurgery" isn't surgery. At most, they do Mohs procedures, which is performed under local anesthesia, or, in the extreme case, liposuction (I remember reading that somewhere and being floored by that). It is procedural, but not what most people think of when they hear "surgery," and there are other procedural specialties (GI, cardiology, pulmonology, emergency medicine, anesthesia, etc...) that do not require much standing while performing them or are short enough procedures that you can take a break between them to get off your feet.

 

[Dimoak]

Again, though, the training in ENT carries with it some of the longest operative times. Some of those radical neck dissections can take well over 8-10 hours. I can't think of anything routinely done in general surgery that comes anywhere near those times. Most of our long cases are 5-6 hours. ENT might not be as appealing as you think.

By GS time, I was referring to time spent on a GS service (as opposed to plastics and other subspecialties, closely related fields) during which the OP would essentially be in GS, which it seemed the OP wants to avoid.

 

[derm83]

Also, and not to sound like a surgical elitist, "dermatosurgery" isn't surgery. At most, they do Mohs procedures, which is performed under local anesthesia, or, in the extreme case, liposuction (I remember reading that somewhere and being floored by that). It is procedural, but not what most people think of when they hear "surgery," and there are other procedural specialties (GI, cardiology, pulmonology, emergency medicine, anesthesia, etc...) that do not require much standing while performing them or are short enough procedures that you can take a break between them to get off your feet.

I suppose Mohs procedures include excision of skin cancers. I'm not sure if they deal with other skin lesions like scars and so on. That would be more exciting to me than sticking a catheter in Cards or a tube in Gas. At the end of the day, nothing is like real surgery

 

[SocialistMD]

By GS time, I was referring to time spent on a GS service (as opposed to plastics and other subspecialties, closely related fields) during which the OP would essentially be in GS, which it seemed the OP wants to avoid.

The OP wants to avoid standing for prolonged periods of time during training because of his/her sciatica, not to specifically avoid general surgery. My point was that ENTs do longer cases than general surgeons, so going the ENT route wouldn't necessarily eliminate that standing time.

 

[JanetteBournes]

So I believe I potentially have three options at this point: ENT, Ophthalmology and probably Dermsurgery.

Thank you so much Dimoak, appreciate it.

Don't want to dampen any enthusiasm here but I'm afraid they are all uphill climbs. Especially dermatology.

I can speak more about procedural dermatology or MOHS surgery (we don't really call it dermsurgery here) as it's something I'm interested in.

As far as I know, the only pathway is to obtain a dermatology residency and then apply for a MOHS fellowship. I believe general surgeons and plastic surgeons do have some exposure as well but I do not know if they are "board-certified" to perform these surgeries. Since you are dealing with cancer excisions, I assume there are fewer non-certified MOHS surgeons than non-certified dermatologists/botox pushers.

The trickiest part is definitely the dermatology residency. I have never heard of an IMG getting in directly so I do expect it will take some research time (1-2 years?) if you wanted to go for that route. I wouldn't let my pessimism dampen your enthusiasm though. Perhaps you have an outstanding resume and won't need to go through all that.

I can tell you that once you're in, fellowships aren't horrifically difficult to obtain. Often, your PD can help you out with a phone call. Previous to this recession, a large number of graduates would proceed into private practice as general dermatologists which also helps for those opting for a MOHS fellowship. I'm unsure how this will affect fellowship placement in the future.

For those who are interested in this sort of thing, there is a growing sentiment that there may be too many MOHS surgeons. Couple that with decreasing compensation for the first time in a long time and we may be observing the decline of competitiveness for the MOHS fellowships. (Sadly, not the case for the dermatology residency)

 

[derm83]

Don't want to dampen any enthusiasm here but I'm afraid they are all uphill climbs. Especially dermatology.

I can speak more about procedural dermatology or MOHS surgery (we don't really call it dermsurgery here) as it's something I'm interested in.

As far as I know, the only pathway is to obtain a dermatology residency and then apply for a MOHS fellowship. I believe general surgeons and plastic surgeons do have some exposure as well but I do not know if they are "board-certified" to perform these surgeries. Since you are dealing with cancer excisions, I assume there are fewer non-certified MOHS surgeons than non-certified dermatologists/botox pushers.

The trickiest part is definitely the dermatology residency. I have never heard of an IMG getting in directly so I do expect it will take some research time (1-2 years?) if you wanted to go for that route. I wouldn't let my pessimism dampen your enthusiasm though. Perhaps you have an outstanding resume and won't need to go through all that.

I can tell you that once you're in, fellowships aren't horrifically difficult to obtain. Often, your PD can help you out with a phone call. Previous to this recession, a large number of graduates would proceed into private practice as general dermatologists which also helps for those opting for a MOHS fellowship. I'm unsure how this will affect fellowship placement in the future.

For those who are interested in this sort of thing, there is a growing sentiment that there may be too many MOHS surgeons. Couple that with decreasing compensation for the first time in a long time and we may be observing the decline of competitiveness for the MOHS fellowships. (Sadly, not the case for the dermatology residency)

Thank you for the details about MOHS surgery. It's certainlly extremely difficult to get into Dermatology but I was just trying to explore my options given my condition regardless of the competition.