What general surgery subspeciality...

[Taty]

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What general surgery subspeciality is the most life style unfriendly?

 

[TxMed]

What general surgery subspeciality is the most life style unfriendly?

vascular=lots of coming in in the middle of the night

transplant=organ harvesting generally starts late at night...then you have to actually do the transplant...

trauma/cc=stress...really sick patients (may or may not have tasted the blood of hundreds of individuals)

CT=very lifestyle friendly...b/c you have no patients

just off the top of my head


-tm

 

[Taty]

Thank you very much. I am just starting med school, but I am driven towards trauma and transplant....I asked because I wanted to know how to plan my future life...I mean I am getting married soon I want to prepare my hubby..as for me I dont really care about my lifestyle, as long as I am doing what I want to do I am fine 🙂

 

[toxic-megacolon]

Thank you very much. I am just starting med school, but I am driven towards trauma and transplant....I asked because I wanted to know how to plan my future life...I mean I am getting married soon I want to prepare my hubby..as for me I dont really care about my lifestyle, as long as I am doing what I want to do I am fine 🙂

Trauma isn't always bad, its relatively flexible. But transplant is always crappy. You cannot be a transplant surgeon without a crappy lifestyle. Lifestyle for Gen Surg specialites can be divided into the Good/Bad/Ugly

Good:
Breast, Endocrine, Colorectal, Surgical Onc, Bariatric, Thoracic (aka foregut), Hand

Bad:
Vascular, Bread and Butter General, Critical Care

Ugly:
Transplant, Hepatobilliary, Cardiothoracic (if you find enough cases)

Of course there are so many exceptions to this rule, many Surg Onc guys work 24/7, etc. I'm just talking about potential for having a good lifestyle.

 

[DO_Surgeon]

I would agree with this list with the exception of bariatrics. My program is fairly heavy in bariatrics and I cannot tell you how many of them come back in during the middle of the night with a internal hernia, perforation from a marginal ulcer, or just the constant worrying about them post op in terms of DVT's/PE's, leaks, etc.

Trauma isn't always bad, its relatively flexible. But transplant is always crappy. You cannot be a transplant surgeon without a crappy lifestyle. Lifestyle for Gen Surg specialites can be divided into the Good/Bad/Ugly

Good:
Breast, Endocrine, Colorectal, Surgical Onc, Bariatric, Thoracic (aka foregut), Hand

Bad:
Vascular, Bread and Butter General, Critical Care

Ugly:
Transplant, Hepatobilliary, Cardiothoracic (if you find enough cases)

Of course there are so many exceptions to this rule, many Surg Onc guys work 24/7, etc. I'm just talking about potential for having a good lifestyle.

 

[Taty]

Thanks a lot guys. Could you please give me an advice... if I want to do transplant surgery in the future how I should prepare myself while I am in medical school?

 

[TxMed]

learn how to sleep while doing surgery. start teaching you friends and family how to live without you. other than that...make decent grades and break 220 on step1 so you can get into a decent gen surg program.


-tm

 

[MD Dreams]

Thanks a lot guys. Could you please give me an advice... if I want to do transplant surgery in the future how I should prepare myself while I am in medical school?

Work as hard as you can, not only to be a good doctor (although some of the crap you learn in the first 2 years of medical school does not necessarily equate to being a good doctor) but also to have as many open doors available to you when it comes time for residency. Step 1 is the single most important determinant in getting the residency of your choice. Research is also very important for some specialties (especially if you publish).

Keep an open mind. I know you've heard this before, but many things will change in the third year of medical school.

All the best.

 

[Mr. McDuck]

I would agree with this list with the exception of bariatrics. My program is fairly heavy in bariatrics and I cannot tell you how many of them come back in during the middle of the night with a internal hernia, perforation from a marginal ulcer, or just the constant worrying about them post op in terms of DVT's/PE's, leaks, etc.

They're either crappy surgeons or we have the best, because the two that do them 3 days a week here have only brought a patient back to the OR once in probably 5 or so years since they've been doing it. I know bariatrics is risky stuff, but it's hard for me to appreciate it because these guys do it all the time and it's no big deal.

 

[SLUser11]

They're either crappy surgeons or we have the best, because the two that do them 3 days a week here have only brought a patient back to the OR once in probably 5 or so years since they've been doing it. I know bariatrics is risky stuff, but it's hard for me to appreciate it because these guys do it all the time and it's no big deal.

That's kind of an ignorant assumption to make.

If you're a big shot bariatric surgeon, you're also likely getting patients who didn't go to you initially, but are presenting from an OSH with complications. Either way, it is an extremely complicated (and often high maintenance) patient population, and you are definitely going to have occasional complications.

 

[GAdoc]

Couple of questions:

1. Does surgical critical care = trauma surgery?

2. If you do a trauma fellowship and work fulltime as a trauma surgeon, do you work a call schedule similar to an ER doc (i.e. on 12, off 12)?

3. What if you love the idea of being a surgeon, but HATE the idea that surgery is becoming as sub-specialized as it is...could you decide to practice in a rural and/or underserved area and do a wide range of cases (or does that open you up to the potential for litigation)?

Thanks!

 

[Bitsy3221]

Thanks a lot guys. Could you please give me an advice... if I want to do transplant surgery in the future how I should prepare myself while I am in medical school?

You could study immunology, and try to do an elective in transplant during third year to see if you really want to do it. Most important is to get into a residency with a good transplant program (that has research, that do livers and pancreas, not just kidney) and make sure the residents have a higher level of participation, rather than just scutting for the fellows or babysitting for the medicine teams. (Some places I interviewed at reported the transplant service is not surgically heavy, but any patient who has ever had a transplant gets admitted to their service, even if it is for a completely unrelated medical diagnosis. Kind of sucks if you have to do all that rounding without ever seeing more than a kidney every once in a while)

Having spent many years of my life involved with a general surgery resident turned transplant surgeon, I can tell you that the pre-80 hour work schedule of him as an intern was far better than him as the transplant fellow now. The number of cancelled dinners, missed plays, unused sporting event tickets are far greater now than they ever have been. We haven't had definitive plans for anything in ages. It is easy to say that you understand the lifestyle is bad, but I can tell you to the significant other it can be very, very bad. As someone posted, donor call means not being able to make plans, and if a donor happens you know you typically have 8-18 hours of work ahead of you--followed by another full work day. And the patients are really freaking sick. And you are at a significantly elevated risk of bloodborne pathogen exposure. And the job market is a little -eh- right now.

He has become a damn good surgeon, but he is much more tired and beat down than I have ever seen him. The attendings have a slightly better lifestyle, but not MUCH different.

 

[TxMed]

Couple of questions:

1. Does surgical critical care = trauma surgery?

2. If you do a trauma fellowship and work fulltime as a trauma surgeon, do you work a call schedule similar to an ER doc (i.e. on 12, off 12)?

3. What if you love the idea of being a surgeon, but HATE the idea that surgery is becoming as sub-specialized as it is...could you decide to practice in a rural and/or underserved area and do a wide range of cases (or does that open you up to the potential for litigation)?

Thanks!

1. trauma and cc generally go hand and hand.

2. you will work much, much, much more than an er doc. i believe they average ~36hr/week as attendings, whereas trauma/cc staff work close to 60hr/wk at my institution.

3. you could do GS with no fellowship, move out into the country and do ALOT of surgery. OR, you could do trauma/cc and go into academic practice and do many varied cases also. in many academic centers trauma/cc docs are a little like general surgery on steroids. many of the same surgeries and procedures.


-tm

 

[Mr. McDuck]

That's kind of an ignorant assumption to make.

If you're a big shot bariatric surgeon, you're also likely getting patients who didn't go to you initially, but are presenting from an OSH with complications. Either way, it is an extremely complicated (and often high maintenance) patient population, and you are definitely going to have occasional complications.

Now that I read it, it does sound kind of ignorant. I guess what I was really trying to say was that I always hear how dangerous and life threatening the surgery is, but I can't relate because the two guys I see do them have almost identical extremely low complication rates and they treat it like it isn't a big deal.

 

[Taty]

Can I do both trauma and transplant fellowships?

 

[TxMed]

Can I do both trauma and transplant fellowships?

i theory...yes. in reality...i don't think it has ever been done (with the surgeon practicing trauma/cc and transplant). i can't think of any hospital wanting or allowing someone to be employed in both areas...its just too much information to know. you could be the first, though...i would just go ahead and get some divorce papers and wish ur family luck in their endeavors...b/c you won't so much be seeing them again.

all jokes aside. most people just pick one. but, that is a far way off for you and i bet that by the time you need to make a decision like that (involving any field of medicine) that you will have all the info and the decision will be easy. <-----(just set record for longest run-on sentence in this thread.)

-tm

 

[Winged Scapula]

Couple of questions:

1. Does surgical critical care = trauma surgery?

In the sense of fellowship training, not necessarily. That is, you can complete either a critical care or trauma fellowship in a stand alone program, although they are often combined into one.

2. If you do a trauma fellowship and work fulltime as a trauma surgeon, do you work a call schedule similar to an ER doc (i.e. on 12, off 12)?

While technically it is possible to work shifts as a trauma surgeon, the problem lies in the very real fact that you don't go home when your shift covering trauma is over. You may have office hours, general surgery cases booked, meetings, inpatient rounds or even trauma cases from the night before that you have to complete. A friend of mine who is a trauma surgeon never goes home after his 12 hr "shift"; he is very busy.

3. What if you love the idea of being a surgeon, but HATE the idea that surgery is becoming as sub-specialized as it is...could you decide to practice in a rural and/or underserved area and do a wide range of cases (or does that open you up to the potential for litigation)?

Sure. There are even rural surgery fellowships which give you more exposure to ortho and neurosurg procedures. But you don't need to be in a rural area to do a wide range of procedures. Some of the community general surgeons I know do thyroids, breast, hernias, colectomies, choles, appys, ports, etc.

 

[GAdoc]

Thanks for the great tips...any idea what programs offer gs fellowships that would focus on rural medicine??? I never knew they existed but it sounds great (though the lifestyle is bound to stink)!

 

[Winged Scapula]

Thanks for the great tips...any idea what programs offer gs fellowships that would focus on rural medicine??? I never knew they existed but it sounds great (though the lifestyle is bound to stink)!

Off the top of my head, I know Cooperstown New York offers one. They tend to be word of mouth!

 

[GAdoc]

You're right! I just checked out Cooperstown (Bassett I think)...looks like a neat program. I don't think "Rural Surgery" is an ACGME approved sub-specialty as of yet, but in their proposal, Cooperstown makes some good points about why it should be.

I also noticed that OHSU also has a similar program. I think the debate is whether to make the training a one year fellowship, or just integrate special, rural-geared training into the traditional five year residency. OHSU general surgery is a six year program (five clinical + 1 research). However, they've decided to allow residents on the rural surgery track to use their research year to gain experience in a rural setting with specialists like oto, uro, ortho, and gyn. Kind of cool

The Cooperstown program is more geared to an entire residency experience.

What I would like to know, however, is how does ANY surgeon decide that a particular procedure is out of his/her scope? I mean, even the most urban, research-oriented GS residencies are going to expose you to all sub-specialties. Does the hospital decide? Does the doctor decide? Is it the fear of being sued?

 

[Winged Scapula]

..in the most urban, research-oriented GS residencies are going to expose you to all sub-specialties.

I think that would be overstating things a bit - unless you define "expose" liberally. For example, I saw plenty of trauma patients with neurosurg and ortho injuries but came no where close to operating on them. The neurosurg and ortho residents did. Some programs still have rotations in gyn, but these are not common. No urology. So, it really depends on the general surgery residency and what is required by ACS to be board eligible (no urology, neurosurg, ortho, ent [although you do need head and neck cases but can get these doing endocrine surgeries], gyne, etc.).

Does the hospital decide? Does the doctor decide? Is it the fear of being sued?

The hospital decides what you can be credentialed in. You apply for certain credentials - say you want to do the scope of general surgery, you will provide documentation that you are trained to do so, and the hospital will decide if you are qualified. So even if you wanted to do Ortho procedures, most general surgeons would not be given credentials to do so because they lack the training - if you can provide documentation that you have training to do procedures outside of the scope of your practice, they MAY offer you credentials, but it depends on the need. They are not going to give you Neurosurgical credentials if there are plenty of neurosurgeons available and you aren't as well trained.
Certainly the fear of being sued is what keeps hospitals from offering credentials for certain procedures to whomever asks for them.

 

[GAdoc]

OK, so the success of a "rural surgery" fellowship, or residency program would depend on the amount of hospitals willing to allow a general surgeon to perform the given procedures (most of which would probably be trauma). Of course, if the proposals of these programs are to be believed, there is definately a shortage of broadly trained, rural general surgeons.

One of the programs (I think OHSU) showed a case log for the fellow during his one year stint...it was pretty impressive. He had several ortho cases, quite a few thoracic (like 20+), several ENT and Urology, but no neurosurgery.

I would imagine that at some point, the funding to support a rural hospital's OR would also limit what procedures could and coudn't be performed as well.

Thank you for taking the time to answer questions. You're very thorough and I appreciate the info.

 

[Winged Scapula]

One of the programs (I think OHSU) showed a case log for the fellow during his one year stint...it was pretty impressive. He had several ortho cases, quite a few thoracic (like 20+), several ENT and Urology, but no neurosurgery.

The American College of Surgeons requires a minimum of 15 thoracic cases (currently) to be Board eligible as a general surgeon so you have to get that many regardless of where you go; Urology, Ortho and neurosurg are not required. You are required to have 27 (I think) head and neck cases which of course ENT would generally fulfill.