what surgery is best suited for the 3rd world and army???

[bbaek]

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i have heard that trying to do residency in general surgery is no longer the norm and since surgery is becoming so specialized, general surgery is pretty much non-existent. is this true?

also, i want to be able to know what type of surgery is most suitable in the war zones (such as the US army) and in third world countries (war-torn or not, doesn't matter).

also, if general surgery does still exist, how many years of residency/internship does it take??

thanks!

 

[vtucci]

General surgery does still exist and it is usually a 5 year program. If you want to go military, look into the Health Scholarships for the services and check out their residency programs-- the recruiters should be able to tell you about this.

For the army et al, trauma surgery is a good idea and will take longer (I don't know how many years for a fellowship on top of the 5 for general surg).

There is also plastics (burns, cleft lip and palate are included here).

 

[Brainsucker]

It's true that lots of people do fellowships on top of g-surg, but that's the way to go for the third world stuff. You can always do trauma or whatever later. I don't know the details, but I've heard noises about matching into your residency of choice, then committing to the military later. Apparently, you get to go where you want, and they'll still pay off your bills. (Of course, you'll have to work for them for a while, but that seems like your goal.)

 

[bbaek]

It's true that lots of people do fellowships on top of g-surg, but that's the way to go for the third world stuff. You can always do trauma or whatever later. I don't know the details, but I've heard noises about matching into your residency of choice, then committing to the military later. Apparently, you get to go where you want, and they'll still pay off your bills. (Of course, you'll have to work for them for a while, but that seems like your goal.)

well, i would like to join the army (for a 2-3 year term) simply to serve. i understand the great financial benefits as well, especially joining the medical corps, but that part of the package is one of the most insignificant reasons why i want to join.

so, it seems that a general surgery residency takes on average of 5 years to complete? how many additional years would i have to tack on for a trauma fellowship?

and if i got the gist of the 2 posters (which i want to thank for their participation), simply doing general surgery is probably the most effective skill needed in the third world?

thanks for all your comments!

 

[zek]

If you don't get many responses here then you might try the military medicine forum. There are probably a lot more people there who would know the answers to your questions.

 

[Dimoak]

well, i would like to join the army (for a 2-3 year term) simply to serve. i understand the great financial benefits as well, especially joining the medical corps, but that part of the package is one of the most insignificant reasons why i want to join.

so, it seems that a general surgery residency takes on average of 5 years to complete? how many additional years would i have to tack on for a trauma fellowship?

and if i got the gist of the 2 posters (which i want to thank for their participation), simply doing general surgery is probably the most effective skill needed in the third world?

thanks for all your comments!

I'm ofcourse, no expert, but I do believe that GSurg is basically the most commonly desired one, as you're flexible enough to treat just about any sort of injury soldiers may sustain. Trauma/Critical/Acute Care is essentially an advanced specialization that better prepares you to treat especially difficult injuries and difficult conditions more effectively. Orthopedics is another surgical specialization greatly desired in the military for fairly obvious reasons. I think they also use some Internists incase soldiers begin contracting weird diseases. But in short, GSurg is probably the best to do if you want to hit the military straight after residency.

 

[Blade28]

G Surg or Trauma/Critical Care.

 

[sscooterguy]

General surg is the way to go to get to most types of trauma. I believe the fellowship is 1-2 years depending upon the program. I'm not too sure about how competative they are. Gen Surg programs are at least 5 years now, almost all academic programs are 6.

However, if you join the army and go into Gen Surg, you may be able to bypass the fellowship, as trauma is not an accredited fellowship anyways. The US army is in such a dire need for shock trauma surgeons that no matter what kind of surgeon you are, they send you to do trauma. There was a great article about this in the NEJM by Atul Gawande (author of Complications: A surgeon's notes on an imperfect science), in which the author describes urologists, ENT, and other non general surgeons being called to duty and working as trauma surgeons too. If you end up joining up, I'm sure finishing either your civilian residency (if they let you do one) or military residency in general surgery, you will be put to work as a trauma surgeon even in spite of your wishes to do a fellowship.

Battlefield trauma as discusssed in the above article is very different from civilian trauma, and its not the gun shot wounds that are the problem. Its the IUD concussion injuries, injuries that injure areas unprotected by body armor (like the armpit), and such. This type of trauma is very different, and as a surgeon, you'll be working to just save their life, then hopefully their limb and stabilize them enough to be transported off of the battlefield hospital.

By the way, there are also other types of trauma surgeons such as Neuro as well as Ortho, however, again, if you are in the army, maybe the Neuro surgeon would not, but I'm sure the Ortho surgeon and everyone else would be doing shock trauma.

Hope this helps.
sscooterguy

 

[8744]

Now I'm going to show my ignorance but isn't trauma surgery essentially just fast abdominal surgery? When I was in medical school I did several trauma surgery rotations and the "trauma surgeons" were mostly general surgeons who could asssess, open, and suture really fast.

Be gentle. I'm just askin'.

 

[Brainsucker]

General surg is the way to go to get to most types of trauma. I believe the fellowship is 1-2 years depending upon the program. I'm not too sure about how competative they are. Gen Surg programs are at least 5 years now, almost all academic programs are 6.

However, if you join the army and go into Gen Surg, you may be able to bypass the fellowship, as trauma is not an accredited fellowship anyways. The US army is in such a dire need for shock trauma surgeons that no matter what kind of surgeon you are, they send you to do trauma. There was a great article about this in the NEJM by Atul Gawande (author of Complications: A surgeon's notes on an imperfect science), in which the author describes urologists, ENT, and other non general surgeons being called to duty and working as trauma surgeons too. If you end up joining up, I'm sure finishing either your civilian residency (if they let you do one) or military residency in general surgery, you will be put to work as a trauma surgeon even in spite of your wishes to do a fellowship.

Battlefield trauma as discusssed in the above article is very different from civilian trauma, and its not the gun shot wounds that are the problem. Its the IUD concussion injuries, injuries that injure areas unprotected by body armor (like the armpit), and such. This type of trauma is very different, and as a surgeon, you'll be working to just save their life, then hopefully their limb and stabilize them enough to be transported off of the battlefield hospital.

By the way, there are also other types of trauma surgeons such as Neuro as well as Ortho, however, again, if you are in the army, maybe the Neuro surgeon would not, but I'm sure the Ortho surgeon and everyone else would be doing shock trauma.

Hope this helps.
sscooterguy

Nah, neurosurgeons do trauma. Who else is going to yank that shrapnel out of your head or put your skull back together (besides the undertaker)?

 

[bbaek]

thanks for all the wonderful feedback!

in terms of what the army would need, i feel that i have a better picture than before.

however, for people who are in third world countries, is general surgery the way to go as well? or is it internal med or something else? and if it is g surg, then would trauma help as well or g surg enough?

 

[Brainsucker]

IM is probably more necessary for 3rd world countries, but medicine is boring. You'll figure out in med school what's for you. (The first surgery I scrubbed in, I was sure surgery was the way.)

 

[Brainsucker]

I should add that infectious disease is a classic choice for those who want to practice in poor countries.

 

[OSUdoc08]

i have heard that trying to do residency in general surgery is no longer the norm and since surgery is becoming so specialized, general surgery is pretty much non-existent. is this true?

also, i want to be able to know what type of surgery is most suitable in the war zones (such as the US army) and in third world countries (war-torn or not, doesn't matter).

also, if general surgery does still exist, how many years of residency/internship does it take??

thanks!

Nope. You've heard wrong. This is the most common surgeon to be found in any hospital. It is also the residency that almost all specialty surgeons must complete. The residency is 5 years.

 

[Blade28]

Now I'm going to show my ignorance but isn't trauma surgery essentially just fast abdominal surgery? When I was in medical school I did several trauma surgery rotations and the "trauma surgeons" were mostly general surgeons who could asssess, open, and suture really fast.

Be gentle. I'm just askin'.

It's a fair question.

Yes, the majority of OPERATIVE tramua surgery involves ex-laps, hemorrhage control, repair or removal of damaged organs, etc. But then there's rapid evaluation of a whole host of trauma-related injuries that you may not see as a regular general surgeon - crichs and thoracostomies in the ER for airways and pneumothoraces/hemothoraces, respectively; proper evaluation of major fractures including skull, c-spine, extremity and pelvis; at my instutition, trauma surgeons also help manage these injured patients in the SICU/NSICU.

Don't forget that there's a ton to know, specifically, in trauma surgery, more than just being able to do a good FAST exam. 🙂

 

[OSUdoc08]

It's a fair question.

Yes, the majority of OPERATIVE tramua surgery involves ex-laps, hemorrhage control, repair or removal of damaged organs, etc. But then there's rapid evaluation of a whole host of trauma-related injuries that you may not see as a regular general surgeon - crichs and thoracostomies in the ER for airways and pneumothoraces/hemothoraces, respectively; proper evaluation of major fractures including skull, c-spine, extremity and pelvis; at my instutition, trauma surgeons also help manage these injured patients in the SICU/NSICU.

Don't forget that there's a ton to know, specifically, in trauma surgery, more than just being able to do a good FAST exam. 🙂

At most places, general surgeons are responsible for this trauma surgery.

 

[Blade28]

Not here at our county hospital, the second busiest trauma center in the country.

 

[Dimoak]

At most places, general surgeons are responsible for this trauma surgery.

Most places also aren't Level 1 Trauma Centers and so on average, don't deal with too many particularly nasty shocks or triages. In such a case, most of the traumas the aforementioned hospitals would treat would likely be handled by a GSurg without too much trouble. I believe that Trauma/CritCare/AcCare surgeons are specifically trained to deal with particularly unusual or difficult cases. While GSurg's may be perfectly capable of dealing with the majority of issues (and most, if not all T/CC/AC Surgeons begin with GSurg), the specialization in Trauma focuses on the surgeon being able to perform various techniques with some odd-circumstance presenting patients or even masscas situations. Once again, I'm not an expert, but it also seems that Trauma surgeons spend the majority of their time doing GSurg, focussing usually on Critical and Acute Care stuff such as blood vessel ruptures and perioperative care. Many of the big dawgs in the field also have other specializations that they focus on such as Thoracic or Vascular surgery.

Trauma.org is a great resource of the topic. If you also look at the imagebank, you may notice that many of the cases presenting with particularly unusual and difficult traumas were actually taken by doctors working in some of the poorer countries, suggesting that citizens of many "third world" countries can summer some particularly nasty traumas due to living conditions and availability of medical care facilities. 🙂

 

[OSUdoc08]

Not here at our county hospital, the second busiest trauma center in the country.

Obviously a level I trauma center would have trauma surgeons. Non-trauma centers greatly outnumber trauma centers, however.

 

[Uncle Izzy]

With regards to the military aspect, I recommend treading very lightly as once you are enlisted and want to do graduate med education (residency), the military really controls what specialty you go into.

Also, the gen surgeons have all done basic trauma stuff... all licensed gen surgeons know damn well how to evaluate an acute abdomen, GSW, and other sorts of general trauma, etc.. The specialists (i.e vascular/trauma) specialize in it but the general guys are all qualified to do an amputation, whether that be due to diabetes or a car accident or shrapnel wound. They can all fix a bowel perf, liver lac, ruptured spleen, etc etc etc..

 

[bbaek]

With regards to the military aspect, I recommend treading very lightly as once you are enlisted and want to do graduate med education (residency), the military really controls what specialty you go into.

Also, the gen surgeons have all done basic trauma stuff... all licensed gen surgeons know damn well how to evaluate an acute abdomen, GSW, and other sorts of general trauma, etc.. The specialists (i.e vascular/trauma) specialize in it but the general guys are all qualified to do an amputation, whether that be due to diabetes or a car accident or shrapnel wound. They can all fix a bowel perf, liver lac, ruptured spleen, etc etc etc..

well, i plan to go to a civilian med school and do a residency in a civilian teaching hospital, and then enlist into the army through the medical corps that they have there. so all in all, i'll be trained through civilians and not through military personnel or institutions.

looking at the past comments, it seems that being a g surgeon, and possibly specializing in trauma and/or vascular, would be the best possible option, but for working the third world, internal medicine or infectious disease would be the best? is it possible for a general surgeon to specialize in IM or infectious disease or is this an impossible route to take due to large time committments or large discrepancies between these two specialities.

 

[Hersey]

A finer point, but once you've finished your medical degree, you'll undoubtedly be commissioned an officer, rather than enlisting.

 

[skypilot]

well, i plan to go to a civilian med school and do a residency in a civilian teaching hospital, and then enlist into the army through the medical corps that they have there. so all in all, i'll be trained through civilians and not through military personnel or institutions.

looking at the past comments, it seems that being a g surgeon, and possibly specializing in trauma and/or vascular, would be the best possible option, but for working the third world, internal medicine or infectious disease would be the best? is it possible for a general surgeon to specialize in IM or infectious disease or is this an impossible route to take due to large time committments or large discrepancies between these two specialities.

The third world needs both surgeons and internal medicine. If you decide to become a surgeon, you won't have time to do any internal medicine and infectious disease because you will be so busy doing surgeries all day and night.

If you decide to take time out of your busy surgical career to treat people with infectious diseases and chronic medical conditions you can do that too, but you will have more than enough surgeries (plus pre and post operative responsibilities) to fill your day.

 

[tiger_lily]

If you're focusing on the third world, it probably comes down to what you'd enjoy more. I spent 3.5 months in east Africa and there were in dire need of both surgeons and, well, pretty much everyone else. OBGYN was another big one (where I was at least). So if you love surgery, go for it. If not, do IM or another area that really interests you. Truly, many 3rd world countries are in need of a variety. If you're looking at med corps I can't really say, as I don't have any experience in the military, but it may be worth asking a recruiter about which specialties are best. In my experience in Africa, it depended where I was. In the major centres, it was all about hernia repairs, as well as the other usual cases (mostly laps). The orthopaedic theatre was separate (and the only one which had an autoclave, if you can believe it!) and I found it much more interesting, but then I like power tools 🙂 Most of their day was spent dealing with club foot and osteomyelitis and external fixaters, though it varied quite a bit. I did spend several weeks in an active war zone, and though we did get some trauma and GSW, there were still plenty of tumours and calcified guinea worms (ugh!) to be removed. There were far fewer "non-essential" surgeries (such as hernia repairs) in this area, obviously. With only 1-2 surgeons in the entire area, it was busy. Plus it's a whole different style of medicine when you have to wait WEEKS on a biopsy result, while worrying about whether your hospital is going to be attacked that night. Believe it or not though, that was my absolute favourite part of the trip, and is where I plan to go back to when I finish.
Ok, my $0.02 🙂

 

[Arginine]

for people who are in third world countries, is general surgery the way to go as well? or is it internal med or something else?

If you check out the website for Doctors without Borders, you will see that surgeons are in great need in third world countries

http://www.doctorswithoutborders.org/ (the home page)
http://www.doctorswithoutborders.org/volunteer/field/surgeons.cfm (specific info about surgeons in the field)