what made surgery the right choice?

[med007]

MS3 here, nearing the end of a 12 week surgery rotation and 1/2 way point of the year (after initial 12 weeks of IM). Going into third year, I favored anesthesia above other options for specialty from an intellectual/research and lifestyle perspective, and I think I still do to some extent. However, I've been really surprised by my experience with surgery. I find the highs to be overwhelming, despite the lows. I love the OR. I love the sense of accomplishment after a procedure. I love working with my hands (trite, but true).

I've also had the good luck and pleasure to work with very patient residents/attendings who take the time to teach. One senior resident whom I've spent a lot of time in the OR with has told me that I am 'talented' (completely UNexpected). Don't know how much to read into that, but it was flattering nevertheless.

With still several more months of 3rd year ahead of me, I will definitely take my time to think things through. I am just curious: for those of you who chose surgery, what made it the right choice for you? Did the highs outweigh or outnumber the lows (given that any specialty has both)? Did you find that you couldn't see yourself happy in any other specialty? Did you find you had some inherent skill or aptitude for it?

Bottom line, how can I tell if I am someone who would be a good surgeon versus an MS3 who's just had an exceptionally good experience in his clerkship?

I know that's a lot of questions. Thanks for the input.

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[Dr.LeoSpaceman]

If you do a search, you;ll find any number of threads on this.

I think you would find that a fairly large number of people enjoy their surgery rotations. Many times, that's because you get to focus on the "fun" part of it--i.e. the OR. And the fact that you're resident had good things to say is certainly not a bad thing.

Bottom line, as many have said before: If you find something else you like, and can see yourself being happy with, do it. If not, then surgery might be something to think about. The issue is not whether you like surgery, but whether you passionate enough about it to make it your life.

 

[OtoHNS]

Yeah, being a resident, especially an intern or junior resident is a lot different experience than your medical student rotation. The advice I always heard was to only pursue gen surg/neurosurg/other horrendous lifestyle field if that was the only possible specialty you could see yourself doing.

Do an anesthesia rotation and see if you don't change your mind as you walk out of the hospital at 3:00 everyday.

 

[doc05]

I favored anesthesia ...lifestyle perspective

please do yourself a favor and choose a specialty other than surgery. It's too much work.

 

[Winged Scapula]

please do yourself a favor and choose a specialty other than surgery. It's too much work.

There is a world of difference between being a student and being a surgical resident, fellow or attending.

I chose surgery because I too enjoyed being in the operating room, received positive feedback from my attendings and the residents and liked doing things with my hands. However, I did not have "lifestyle considerations" and could not see myself doing anything else. At the very least do not choose general surgery; there are some surgical practices which have better lifestyles but you still have to get through the training.

As above, please do an anesthesia or other rotation before making a decision. People who go into surgery already thinking about lifestyle tend to be those that drop out when they find out the "80 hour lie", the unpredictability and yes, even the personalities in surgery (my medical school and my residency programs were vastly different in this. Its not as fun when you aren't being encouraged.)

 

[njbmd]

There is a world of difference between being a student and being a surgical resident, fellow or attending.

I chose surgery because I too enjoyed being in the operating room, received positive feedback from my attendings and the residents and liked doing things with my hands. However, I did not have "lifestyle considerations" and could not see myself doing anything else. At the very least do not choose general surgery; there are some surgical practices which have better lifestyles but you still have to get through the training.

As above, please do an anesthesia or other rotation before making a decision. People who go into surgery already thinking about lifestyle tend to be those that drop out when they find out the "80 hour lie", the unpredictability and yes, even the personalities in surgery (my medical school and my residency programs were vastly different in this. Its not as fun when you aren't being encouraged.)

+1 I like what I do and I do what I like very well. It's a good "lifestyle" for me.

 

[Sleeve]

I hated my 3rd year rotation so you are a step ahead of me and I went into general surgery. If you're thinking lifestyle from the beginning, general surgery is not your gig. That's the honest truth. It can be a beat down as a resident and as an attending (private practice that is). Do anesthesia and see if you enjoy it. If you do, choose it. I hated it and was bored out of my mind but honestly, I hated every rotation in 3rd year. Too much brown-nosing, look-at-me attitude instead of learning the field of medicine and trying to choose a field for the rest of your life. I also hated that I had to choose my life based on a bunch of stuff I knew I would never do like Peds, OB/GYN, internal med but that's the way it goes for everyone. Boy, that sounded bitter.

Now, there are surgical specialties that are markedly better lifestyles like ENT, Urology, Plastics, you may look into. Maybe radiology although interventional radiology is tough in many places but it is pretty fun.

I really enjoy what I do but "good lifestyle" does not enter my vocabulary especially compared to my anesthesia colleagues.

 

[LifetimeDoc]

I'm a fourth year and I've decided to apply only to General Surgery. My reasoning was that I love to be in the OR, I love to work with sick patients, and I wanted the continuity that emergency medicine didn't afford me. It's hard to make a decision, and I'll either confirm/enjoy or hate the decision later on. I simply love surgery (looking past the training) and can't see myself happy unless I'm continually challenged. Is this the right view? I have no earthly idea...and I think I'm crazy. Maybe that makes it right.

 

[Zoom-Zoom]

Lifestyle questions always get an interesting response from the surgeons. I love surgery but I think it's reasonable to inquire about these things. I mean, I love eating ice cream, but if I envision choosing a life that required me to eat ice cream all day, every day, for the rest of my life, with no time for anything else, I can imagine not being very happy with that decision. It's the same for surgery. Don't all people need some sort of personal satisfaction at home. Like, I like to watch movies. I like food. Will I have time to have some sort of diversity in life, despite the hours? Or does surgery require this kind of black and white thinking about life and lifestyle? I'm hoping there's something not coming through in the responses. I think I'd make a great surgeon and would love my career, and I know that in every other specialty it would just be a "job" where I clock in and out every day and collect my check...which I REALLY don't want...but the idea that my career can be my only pleasure in life seems a little intimidating. I think this is where a lot of the lifestyle questions are coming from.

 

[SLUser11]

I'm a fourth year and I've decided to apply only to General Surgery. My reasoning was that I love to be in the OR, I love to work with sick patients, and I wanted the continuity that emergency medicine didn't afford me. It's hard to make a decision, and I'll either confirm/enjoy or hate the decision later on. I simply love surgery (looking past the training) and can't see myself happy unless I'm continually challenged. Is this the right view? I have no earthly idea...and I think I'm crazy. Maybe that makes it right.

That's the most common explanation given by MS4s for choosing surgery. Nothing crazy about it.

Don't all people need some sort of personal satisfaction at home. Like, I like to watch movies. I like food. Will I have time to have some sort of diversity in life, despite the hours? Or does surgery require this kind of black and white thinking about life and lifestyle?

If there's anything that can be learned from SDN when choosing a surgical career, it's that there are more options/choices than you think. The "black and white thinking" you refer to is very common among medical students, but in real life there is a big grey area.

You can choose a high-powered academic surgical career in CT or whatever, and choose a program that has you working 120 hours/week for 7 years, then a career with similar demands and results.......but this is not the only way to become a surgeon.

As a surgical resident, and then as a practicing surgeon, you can find a balanced experience. Movies, exercise, wives, children, etc are all possibilities. Just apply intelligently, and find a residency that has a good pain to benefit ratio.

 

[Southpaw]

Yeah, being a resident, especially an intern or junior resident is a lot different experience than your medical student rotation. The advice I always heard was to only pursue gen surg/neurosurg/other horrendous lifestyle field if that was the only possible specialty you could see yourself doing.

Do an anesthesia rotation and see if you don't change your mind as you walk out of the hospital at 3:00 everyday.

Huh, I'm in anesthesia and I leave around 5:30-7:00 every day. I work around 65-70 hours a week, which is less than my surgical colleagues, but I really enjoy what I do. I considered surgery but found out I didn't like to operate so that sort of ruled the field out for me. Next year interns are only allowed to work 16 hours a day, and we already can only work 80 hours a week averaged over 4 weeks, so hours wise I honestly don't think workload during residency should ever be a deciding factor. I'd look at what the attendings are doing, and if you enjoy the lifestyle/workload of a surgical attending then I say go for it.

BTW, I do know of some big name anesthesia residency programs that get their residents out at 3PM for lectures/preops/postops/go home, etc. I don't understand that at all, and I certainly am glad I don't train in one of those programs.

 

[treehorsio]

More than just hours differentiate surgery from other more "procedural" specialties. Akin to the recent thread on clinic, surgery is quite heavy on longitudinal patient care. Personally, I get a lot of satisfaction from patient continuity although I recognize that as an attending that comes with really annoying answering service calls all weekend; things our anesthesia, ED, and IR colleagues do not have. Although many anesthesia programs (and IR, rarely ED) come reasonably closer to our hours than other specialties, when they are done, they're done. Whereas I will go home but still need to be available to come back in if my patient crumps or will spend the night worrying if my 'mosis will leak, etc. which the aforementioned specialties will not. They can scrub out of a case and pass it off, we cannot. They almost NEVER have to stay beyond their assigned shift (even if the shifts themselves are 12 hours) whereas our schedule is completely unpredictable (especially as residents). I might get out at 4, but if I get a post-clinic consult for perfed bowel, I may be in the OR until 10. This element of unpredictability is what drives our spouses crazy and what makes surgery uniquely more difficult life-style wise, even if the hours are in the same ballpark (which they still aren't - but getting closer). We are not interchangeable in the same way as other specialties are; medicine folks, which suffer all the joys and pains of having patient continuity, can pass off their DKA or CHF most of the time. Once you operate on a patient you own them in a way that few other doctors do.

 

[Southpaw]

More than just hours differentiate surgery from other more "procedural" specialties. Akin to the recent thread on clinic, surgery is quite heavy on longitudinal patient care. Personally, I get a lot of satisfaction from patient continuity although I recognize that as an attending that comes with really annoying answering service calls all weekend; things our anesthesia, ED, and IR colleagues do not have. Although many anesthesia programs (and IR, rarely ED) come reasonably closer to our hours than other specialties, when they are done, they're done. Whereas I will go home but still need to be available to come back in if my patient crumps or will spend the night worrying if my 'mosis will leak, etc. which the aforementioned specialties will not. They can scrub out of a case and pass it off, we cannot. They almost NEVER have to stay beyond their assigned shift (even if the shifts themselves are 12 hours) whereas our schedule is completely unpredictable (especially as residents). I might get out at 4, but if I get a post-clinic consult for perfed bowel, I may be in the OR until 10. This element of unpredictability is what drives our spouses crazy and what makes surgery uniquely more difficult life-style wise, even if the hours are in the same ballpark (which they still aren't - but getting closer). We are not interchangeable in the same way as other specialties are; medicine folks, which suffer all the joys and pains of having patient continuity, can pass off their DKA or CHF most of the time. Once you operate on a patient you own them in a way that few other doctors do.

Are you speaking from the resident or attending perspective? Where I train, what you describe is true of neither anesthesia, surgery, or internal medicine residents. But I know there is great variability between hospitals and programs. There is no shift work in anesthesia, but yes I do not get paged after I leave the hospital. That's a big reason why I chose anesthesia. However, I don't care for shift work and I don't like the ED, so EM was out for me. I do believe the EM folks have very difficult jobs. Regardless, I have great respect for the general surgeon's dedication to patient continuity of care. I would encourage any student who loves being in the OR, who loves operating, loves the clinic, and loves following up on their patients (for better or worse), to go into surgery.

 

[ACSurgeon]

That's the most common explanation given by MS4s for choosing surgery. Nothing crazy about it.



If there's anything that can be learned from SDN when choosing a surgical career, it's that there are more options/choices than you think. The "black and white thinking" you refer to is very common among medical students, but in real life there is a big grey area.

You can choose a high-powered academic surgical career in CT or whatever, and choose a program that has you working 120 hours/week for 7 years, then a career with similar demands and results.......but this is not the only way to become a surgeon.

As a surgical resident, and then as a practicing surgeon, you can find a balanced experience. Movies, exercise, wives, children, etc are all possibilities. Just apply intelligently, and find a residency that has a good pain to benefit ratio.

really... multiple? Surgery here I come!

 

[dpmd]

I chose surgery because while I enjoyed and did well in all my clerkships (except for psych which is the closest I have ever come to suicidal ideation, and except for not being fond of certain aspects-eternal rounding in IM for example), I could not see myself being happy in any other field. I wanted ortho because it fit best with my interests and personality, but when that couldn't happen I went with the only other thing that really drew me in gen surg (mostly because I enjoy trauma, but luckily the other stuff is slowly growing on me).

As far as the lifestyle issue, I love sleep. I am most happy when I get 8-10 hrs of uninterrupted sleep. However, I am willing to sometimes miss out on that because of the way that training goes, and later on because that is what is right for the patient. I will try to get it as much as possible, but I am flexible because I want to do my job well. Insert whatever particular lifestyle issue you have and see if you are willing to make the same sacrifice (I love spending time with family, but they are understanding that sometimes (but not always) I have to put the job first.

People who aren't ok with that should seek out other specialties, not because they are bad people, but because they will likely be much happier if they do.

 

[A Whole]

The aforementioned advice (i.e., if there's something else in medicine that you could be happy practicing, don't go into surgery) is ABSOLUTELY true. I made the mistake of going into a highly competitive surgical subspecialty, when I could have been happy in other fields. I switched into anesthesia this year, and I'm much happier.

It's hard to describe the emotional and physical toll of being a surgical resident. As a medical student, you never experience the pain of being the only surgical resident on call at a busy hospital overnight. You never experience the frustration of your pager going off every 5-10 minutes for THIRTY HOURS. You don't know the pain of constant extirpation on call (i.e., having to be in 4-5 places at once). You don't feel the wrath of the attendings when things don't go well. You're never truly responsible for another person's life overnight. Put simply: life as a surgical resident is absolutely INSANE.

The experience is transformative, and I can't say that in a uniformly positive way. Some of my colleagues in surgery who started at the same time as me are already changing--they're much "saltier" than they used to be. I noticed similar changes when I was in surgery. I was pissed off all the time, miserable, and very cynical. Patients started to genuinely annoy me.

The bottom line: please follow the advice at the beginning of the post. You don't have to be miserable in medicine, even as a resident. Choose something that will meet MOST of your goals in life (professional and personal). If you're concerned about lifestyle right now, stay away from surgery. The lifestyle is atrocious.

 

[BlondeDocteur]

I chose surgery because I don't really have any friends, and being in the hospital all the time made me feel needed and important.

 

[goinsurg]

I think the ultimate reason is that I'd rather work with surgery personality types then medicine ones.

 

[dpmd]

The experience is transformative, and I can't say that in a uniformly positive way. Some of my colleagues in surgery who started at the same time as me are already changing--they're much "saltier" than they used to be. I noticed similar changes when I was in surgery. I was pissed off all the time, miserable, and very cynical. Patients started to genuinely annoy me.

If you can't see yourself being angry at the patient for having a return of vitals en route to the facility, you have never been a resident on call for a busy trauma service. The first time I was happy the patient had the decency to stay dead, I knew something in me had fundamentally changed. I still enjoy trauma. I just prefer if people are going to die anyway that they not do it after operating on them and resuscitating them for hours.

 

[LifetimeDoc]

.

 

[Sleeve]

It's hard to describe the emotional and physical toll of being a surgical resident. As a medical student, you never experience the pain of being the only surgical resident on call at a busy hospital overnight. You never experience the frustration of your pager going off every 5-10 minutes for THIRTY HOURS. You don't know the pain of constant extirpation on call (i.e., having to be in 4-5 places at once). You don't feel the wrath of the attendings when things don't go well. You're never truly responsible for another person's life overnight. Put simply: life as a surgical resident is absolutely INSANE.

The experience is transformative

This is the most valuable answer to the question in my opinion. Someone who has walked the walk and switched to anesthesia. Surgical residency is very painful at times and can make you quite bitter. I got through it because not all residencies are a beat-down and it's only for 5 years.

What you need to look at it the life after. Don't look at your attendings unless you're going into academics. Look into the private practice world because that's where most of us live.

You have more control in private practice but never complete control. The pager going off on weekends and nights is still very painful. It will go off whether you are on call or not depending on your practice set-up. Many of us take call on our own patients 24/7. Some are in groups who take each other's patient calls. It's variable but much more livable than residency.

Is it an anesthesia lifestyle? Absolutely not. Not even close. Having to worry constantly about a patient's outcome and potential crash is always there. In anesthesia, once they are out of the recovery room, you're done with them. Once you go home, you go home and don't come back except for call. Surgeons come back on call or not on call. That's the pain. That's the part they don't tell you. You often get paid less than an anesthesiologist as well. They don't tell you that either.

General surgery's benefits lie in the fact that you are crucial for your patient's in many many ways. It's ego partly for sure. The pay is decent but compared to other specialties, hour per hour and calculating the amount of risk, it's not that good really.

Think hard about it. It's a great field but has many drawbacks. If you can handle the drawbacks, then go for it. If you hesitate because of lifestyle, don't do it. It will suck you down a dark bitter black hole.

The good thing is, you only sign a one year contract when starting residency. If it absolutely is unbearable and you have made the wrong decision, you can always switch....as painful as that is.

 

[Zoom-Zoom]

The good thing is, you only sign a one year contract when starting residency. If it absolutely is unbearable and you have made the wrong decision, you can always switch....as painful as that is.

While I'm sure every PD would hate to hear it, that's probably pretty good advice. It is kind of nice to know that you don't definitely pass the event horizon when entering a career that has the potential to totally depress a lot of people, and is impossible to really appreciate until you actually live it. I'm not even that concerned about lifestyle, but knowing the potential out there makes me concerned.

 

[Buzz Me]

I chose surgery because I don't really have any friends, and being in the hospital all the time made me feel needed and important.

I think that kind of humor might be a little dry for this forum. 😎

 

[DOtoCanada]

I chose surgery because I don't really have any friends, and being in the hospital all the time made me feel needed and important.

Unfortunately, I know two people who are like that and frankly, it's frightening.

I would do an away rotation at a program that has a reputation to be brutal. It sounds like the place you did surgery is pretty rosy and life is not like that in most places. Find a program that treats you like a dog and works you past the hour limit, gives you 30+ hour shifts, etc and see if you still like it. I have been lectured by EVERY attending during my rotations on picking something that gives you a decent lifestyle. This has been the "most important" advice given to me during my work, at least according to my attendings. Think about it.

 

[SLUser11]

I think that kind of humor might be a little dry for this forum. 😎

I thought her comment was great.


As for what made surgery right for me, I have 2 words: god complex.

 

[surg]

For me, surgery was the right choice because I liked what I was doing and taking care of. Surgeons often intervene at critical points in care that have the potential to change people's life course radically (positively and negatively). Maximum risk and Maximum benefit often go hand in hand in surgery. We aren't looking (generally) to tweak someone's trajectory a little, we are looking to make a wholesale change in their prognosis or quality of life. Not to denigrate making little changes (they add up to big changes over time), but the immediacy of making someone better or telling them they never have to worry about something again after working on them is a big part of the fun of being a surgeon for me. Sometimes, it's just about the only thing in my life that has immediate gratification (or punishment sometimes) built in.

Don't get me wrong, I like the technical aspects as well. Challenging myself to do something perfectly every time is something that works for me intellectually, but I suspect for many, that becomes just routine and not extraordinarily additive to their enjoyment of the specialty. Thus, I wouldn't get into it just to "work with your hands," although enjoying that is probably a prerequisite to enjoying surgery.

At the end of the day, the only other things I seriously considered were some of the interventional medicine specialties (GI in particular), so maybe I do fall into the "This is the only thing I can imagine doing" camp.