What surgical procedures do General Surgeons end up doing?

[mini67]

I was looking around on a couple of threads and it seems to me that cases that General Surgeons get are usually abdomen related. Anything not related to the abdomen seems to be taken by the specialties.

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[ACSurgeon]

I was looking around on a couple of threads and it seems to me that cases that General Surgeons get are usually abdomen related. Anything not related to the abdomen seems to be taken by the specialties.

Depends on so many things, especially the access to more specialized surgeons. But a general surgeon could end up doing some vascular, breast, endocrine, skin and soft tissue cases in addition to the breadth of abdominal surgery.

On average, more likely to be limited to “bread and butter” cases.

 

[TypeADissection]

Practice patterns will obviously vary and will depend on what your interests are and how you generate referral patterns but if I could summarize the four-man group of general surgeons that we worked with during our rural surgery rotations, here goes:

- Lots of lap/open hernias of all sorts.
- Lots of gallbladders, to the point that I'm fairly certain people in the community are re-growing them for us to take out. This is where the hot gallbladders come in and occasionally we do go open and we also did our fair share of lap CBD explorations and cholangiograms. A truly awesome experience to have because it really taught us how to get facile doing a lot of these maneuvers.
- Lots of breast. Each guy had at least 20-40% of their practice be breast cancer patients. There's no fellowship-trained breast surgeon and not because they haven't been trying for the last five years, it's just that no one wants to come out to nowhere.
- No scopes. The most common procedure a general surgeon does today is something endoscope related, but at this practice they worked it out with the GI group that they wouldn't do any. But we'd get called weekly to come do the belly portion of a PEG. So obviously, if you want scopes to be a part of your practice, this wouldn't be the kind of practice you'd go to.
- Lots of lap colons.
- Good amount of Nissen work robotically. No bariatrics thank goodness.
- Occasional thyroids, parathyroids, thoracic. We'd get the calls for pneumothoraces and place chest tubes. We'd place central lines in the ICU. Pleurodesis here and there.
- Occasional melanoma.
- Steady stream of amputations for gangrene since there were no vascular surgeons in the system.
- Then your fair share of emergent stuff like free air, Fournier's, dislodged PEGs with tube feeds everywhere, compartment syndrome requiring fasciotomies, abscess along the ass stuff or anywhere else for that matter, trachs, etc.

So you can see that if you get into a practice in a small community of around 9000-ish, you can actually have quite the varied practice. You do what you're comfortable doing and if you get in and start doing bad work you don't have to worry because people will stop referring to you. In a community setting like this you also really get to know the other attendings and they actually talk to you and want to engage in dialogue to figure out what's best for the patient.

Each dude had 1.5 days of clinic a week. Each dude was happy with the money they were making, which I'm going to speculate at around $350K/year. Each dude was on the golf course by noon once a week as well. Not a bad gig. They were obviously trying to recruit each and every one of us to consider joining them when we finished, and there's a senior resident who wants to stay in general surgery that will probably join them in the future, and he's gonna do great.

I'm sure I forgot stuff but I'm getting bored just writing this all down now. Cheers.

 

[Gurby]

Practice patterns will obviously vary and will depend on what your interests are and how you generate referral patterns but if I could summarize the four-man group of general surgeons that we worked with during our rural surgery rotations, here goes:

- Lots of lap/open hernias of all sorts.
- Lots of gallbladders, to the point that I'm fairly certain people in the community are re-growing them for us to take out. This is where the hot gallbladders come in and occasionally we do go open and we also did our fair share of lap CBD explorations and cholangiograms. A truly awesome experience to have because it really taught us how to get facile doing a lot of these maneuvers.
- Lots of breast. Each guy had at least 20-40% of their practice be breast cancer patients. There's no fellowship-trained breast surgeon and not because they haven't been trying for the last five years, it's just that no one wants to come out to nowhere.
- No scopes. The most common procedure a general surgeon does today is something endoscope related, but at this practice they worked it out with the GI group that they wouldn't do any. But we'd get called weekly to come do the belly portion of a PEG. So obviously, if you want scopes to be a part of your practice, this wouldn't be the kind of practice you'd go to.
- Lots of lap colons.
- Good amount of Nissen work robotically. No bariatrics thank goodness.
- Occasional thyroids, parathyroids, thoracic. We'd get the calls for pneumothoraces and place chest tubes. We'd place central lines in the ICU. Pleurodesis here and there.
- Occasional melanoma.
- Steady stream of amputations for gangrene since there were no vascular surgeons in the system.
- Then your fair share of emergent stuff like free air, Fournier's, dislodged PEGs with tube feeds everywhere, compartment syndrome requiring fasciotomies, abscess along the ass stuff or anywhere else for that matter, trachs, etc.

So you can see that if you get into a practice in a small community of around 9000-ish, you can actually have quite the varied practice. You do what you're comfortable doing and if you get in and start doing bad work you don't have to worry because people will stop referring to you. In a community setting like this you also really get to know the other attendings and they actually talk to you and want to engage in dialogue to figure out what's best for the patient.

Each dude had 1.5 days of clinic a week. Each dude was happy with the money they were making, which I'm going to speculate at around $350K/year. Each dude was on the golf course by noon once a week as well. Not a bad gig. They were obviously trying to recruit each and every one of us to consider joining them when we finished, and there's a senior resident who wants to stay in general surgery that will probably join them in the future, and he's gonna do great.

I'm sure I forgot stuff but I'm getting bored just writing this all down now. Cheers.

This sounds freaking amazing. Would you mind sharing your thoughts on why you're going into vascular?

 

[ACSurgeon]

Practice patterns will obviously vary and will depend on what your interests are and how you generate referral patterns but if I could summarize the four-man group of general surgeons that we worked with during our rural surgery rotations, here goes:

- Lots of lap/open hernias of all sorts.
- Lots of gallbladders, to the point that I'm fairly certain people in the community are re-growing them for us to take out. This is where the hot gallbladders come in and occasionally we do go open and we also did our fair share of lap CBD explorations and cholangiograms. A truly awesome experience to have because it really taught us how to get facile doing a lot of these maneuvers.
- Lots of breast. Each guy had at least 20-40% of their practice be breast cancer patients. There's no fellowship-trained breast surgeon and not because they haven't been trying for the last five years, it's just that no one wants to come out to nowhere.
- No scopes. The most common procedure a general surgeon does today is something endoscope related, but at this practice they worked it out with the GI group that they wouldn't do any. But we'd get called weekly to come do the belly portion of a PEG. So obviously, if you want scopes to be a part of your practice, this wouldn't be the kind of practice you'd go to.
- Lots of lap colons.
- Good amount of Nissen work robotically. No bariatrics thank goodness.
- Occasional thyroids, parathyroids, thoracic. We'd get the calls for pneumothoraces and place chest tubes. We'd place central lines in the ICU. Pleurodesis here and there.
- Occasional melanoma.
- Steady stream of amputations for gangrene since there were no vascular surgeons in the system.
- Then your fair share of emergent stuff like free air, Fournier's, dislodged PEGs with tube feeds everywhere, compartment syndrome requiring fasciotomies, abscess along the ass stuff or anywhere else for that matter, trachs, etc.

So you can see that if you get into a practice in a small community of around 9000-ish, you can actually have quite the varied practice. You do what you're comfortable doing and if you get in and start doing bad work you don't have to worry because people will stop referring to you. In a community setting like this you also really get to know the other attendings and they actually talk to you and want to engage in dialogue to figure out what's best for the patient.

Each dude had 1.5 days of clinic a week. Each dude was happy with the money they were making, which I'm going to speculate at around $350K/year. Each dude was on the golf course by noon once a week as well. Not a bad gig. They were obviously trying to recruit each and every one of us to consider joining them when we finished, and there's a senior resident who wants to stay in general surgery that will probably join them in the future, and he's gonna do great.

I'm sure I forgot stuff but I'm getting bored just writing this all down now. Cheers.

From what you describe, I wouldn’t be surprised if they made a bit more money than that.

 

[TypeADissection]

This sounds freaking amazing. Would you mind sharing your thoughts on why you're going into vascular?

Vascular surgery has a unique set of characteristics in the medical landscape that some practitioners will find appealing and others abhorrent. Although there have been landmark strides made in the field over the last 30 years, it still today remains today an incredibly challenging and dynamic field from a patient care and research standpoint. Many Americans over the course of their lives will experience some form of vascular-related symptoms. It is rewarding to have the ability to tailor each operation to achieve the best outcomes for individual patients in the goal of improving quality of life, limb salvage, or risk reduction for stroke or aneurysm rupture. Contemporary vascular surgery is also heavily technology dependent, and has manifested itself in the ability to perform hybrid procedures whether that is sewing in iliac/subclavian conduits for a complex EVAR or femoral endarterectomies and stenting to create ipsilateral in-line flow to the foot. So you're telling me that we have a rapidly evolving field that can have a large positive impact for many people while using cutting-edge technology, power tools and loupes? Well sign me up!

From what you describe, I wouldn’t be surprised if they made a bit more money than that.

I wouldn't be either. Fairly certain that they do make more but didn't want to overshoot either. General surgery is a great field and I have been encouraged by my own colleagues that are eager to stay in it and get to a small-to-mid-sized town somewhere and provide top notch care for a community. The strength of my program is that its unabashed goal is to train general surgeons who feel comfortable after 5 years to go out and provide solid care, and we have a good track record of doing so.

 

[Gurby]

Vascular surgery has a unique set of characteristics in the medical landscape that some practitioners will find appealing and others abhorrent. Although there have been landmark strides made in the field over the last 30 years, it still today remains today an incredibly challenging and dynamic field from a patient care and research standpoint. Many Americans over the course of their lives will experience some form of vascular-related symptoms. It is rewarding to have the ability to tailor each operation to achieve the best outcomes for individual patients in the goal of improving quality of life, limb salvage, or risk reduction for stroke or aneurysm rupture. Contemporary vascular surgery is also heavily technology dependent, and has manifested itself in the ability to perform hybrid procedures whether that is sewing in iliac/subclavian conduits for a complex EVAR or femoral endarterectomies and stenting to create ipsilateral in-line flow to the foot. So you're telling me that we have a rapidly evolving field that can have a large positive impact for many people while using cutting-edge technology, power tools and loupes? Well sign me up!



I wouldn't be either. Fairly certain that they do make more but didn't want to overshoot either. General surgery is a great field and I have been encouraged by my own colleagues that are eager to stay in it and get to a small-to-mid-sized town somewhere and provide top notch care for a community. The strength of my program is that its unabashed goal is to train general surgeons who feel comfortable after 5 years to go out and provide solid care, and we have a good track record of doing so.

Thank you for that! As a rising M2 leaning heavily towards either vascular or general, I really appreciate your insight. Though you certainly aren't making the decision any easier... (I would do 5+2 but I'm a non-trad and already old so saving those extra years by going to an integrated program would be nice)

 

[TypeADissection]

Thank you for that! As a rising M2 leaning heavily towards either vascular or general, I really appreciate your insight. Though you certainly aren't making the decision any easier... (I would do 5+2 but I'm a non-trad and already old so saving those extra years by going to an integrated program would be nice)

If you’re dead set on being a vascular surgeon, cardiothoracic surgeon or plastic surgeon; I’d recommend going the integrated route every time. It’s more time spent in the field that you’ll be doing for the rest of your life. More time spent reading the literature, sitting through case conferences and M&Ms. There are many nuances and you’re better off being immersed in it versus spending time in tumor board talking about thyroids, breast and esophagus. In my ideal scenario, I would’ve spent three years in general surgery and three in vascular.

 

[Jolie South]

If you’re dead set on being a vascular surgeon, cardiothoracic surgeon or plastic surgeon; I’d recommend going the integrated route every time. It’s more time spent in the field that you’ll be doing for the rest of your life. More time spent reading the literature, sitting through case conferences and M&Ms. There are many nuances and you’re better off being immersed in it versus spending time in tumor board talking about thyroids, breast and esophagus. In my ideal scenario, I would’ve spent three years in general surgery and three in vascular.

I think at integrated abbreviated route would be best, but for some it's hard to know you want to do vascular so far in advance. Furthermore, my general surgery time taught me overall sick patient management that I don't think immersion in solely vascular could teach. I like that I am well rounded. I do think we could cut back to 3 and 3 or 4 plus 2. I personally would not choose to go the integrated route as it stands now. I recognize that I am probably the minority on that.

 

[M1i]

If you’re dead set on being a vascular surgeon, cardiothoracic surgeon or plastic surgeon; I’d recommend going the integrated route every time. It’s more time spent in the field that you’ll be doing for the rest of your life. More time spent reading the literature, sitting through case conferences and M&Ms. There are many nuances and you’re better off being immersed in it versus spending time in tumor board talking about thyroids, breast and esophagus. In my ideal scenario, I would’ve spent three years in general surgery and three in vascular.

Would you feel comfortable saying what state/city your residency is in?

 

[TypeADissection]

Would you feel comfortable saying what state/city your residency is in?

For the sake of anonymity I'd much rather not, considering I've already left many self-identifiers that wouldn't take much Sherlock Holmes-ing to figure me out. The biggest one of which is how good-looking I am. And humble.

PS - You can call me Uncle Rick, or Pickle Rick, or Ron Mexico if you'd like.

 

[ThoracicGuy]

For the sake of anonymity I'd much rather not, considering I've already left many self-identifiers that wouldn't take much Sherlock Holmes-ing to figure me out. The biggest one of which is how good-looking I am. And humble.

PS - You can call me Uncle Rick, or Pickle Rick, or Ron Mexico if you'd like.

Carlos Danger?

 

[TypeADissection]

Carlos Danger?

My attorney has advised me to plead the fifth... Anyway, what're you wearing?

 

[DrDwayneJohnson]

Practice patterns will obviously vary and will depend on what your interests are and how you generate referral patterns but if I could summarize the four-man group of general surgeons that we worked with during our rural surgery rotations, here goes:

- Lots of lap/open hernias of all sorts.
- Lots of gallbladders, to the point that I'm fairly certain people in the community are re-growing them for us to take out. This is where the hot gallbladders come in and occasionally we do go open and we also did our fair share of lap CBD explorations and cholangiograms. A truly awesome experience to have because it really taught us how to get facile doing a lot of these maneuvers.
- Lots of breast. Each guy had at least 20-40% of their practice be breast cancer patients. There's no fellowship-trained breast surgeon and not because they haven't been trying for the last five years, it's just that no one wants to come out to nowhere.
- No scopes. The most common procedure a general surgeon does today is something endoscope related, but at this practice they worked it out with the GI group that they wouldn't do any. But we'd get called weekly to come do the belly portion of a PEG. So obviously, if you want scopes to be a part of your practice, this wouldn't be the kind of practice you'd go to.
- Lots of lap colons.
- Good amount of Nissen work robotically. No bariatrics thank goodness.
- Occasional thyroids, parathyroids, thoracic. We'd get the calls for pneumothoraces and place chest tubes. We'd place central lines in the ICU. Pleurodesis here and there.
- Occasional melanoma.
- Steady stream of amputations for gangrene since there were no vascular surgeons in the system.
- Then your fair share of emergent stuff like free air, Fournier's, dislodged PEGs with tube feeds everywhere, compartment syndrome requiring fasciotomies, abscess along the ass stuff or anywhere else for that matter, trachs, etc.

So you can see that if you get into a practice in a small community of around 9000-ish, you can actually have quite the varied practice. You do what you're comfortable doing and if you get in and start doing bad work you don't have to worry because people will stop referring to you. In a community setting like this you also really get to know the other attendings and they actually talk to you and want to engage in dialogue to figure out what's best for the patient.

Each dude had 1.5 days of clinic a week. Each dude was happy with the money they were making, which I'm going to speculate at around $350K/year. Each dude was on the golf course by noon once a week as well. Not a bad gig. They were obviously trying to recruit each and every one of us to consider joining them when we finished, and there's a senior resident who wants to stay in general surgery that will probably join them in the future, and he's gonna do great.

I'm sure I forgot stuff but I'm getting bored just writing this all down now. Cheers.

There's always more we could add to this list. I spent some time shadowing a gen surgeon in the absolute middle of nowhere and he did colonoscopies once/week, lots of hernias/choles, and even a few vasectomies. You can probably guess that there weren't any places with a population >150k in a radius of roughly 150 miles in any direction.

 

[bizdr]

As a non-surgeon, I felt the vascular surgeons are the hardest to deal with. Of course this is anecdotal, but quite a few of my colleagues agree. Not sure if it's more based on the personalities that choose it, or what the practice/lifestyle brings. One of my gen surg friends does some bread & butter cases, but also runs the wound care center in the hospital.

 

[AsianPersuasion]

As a non-surgeon, I felt the vascular surgeons are the hardest to deal with. Of course this is anecdotal, but quite a few of my colleagues agree. Not sure if it's more based on the personalities that choose it, or what the practice/lifestyle brings. One of my gen surg friends does some bread & butter cases, but also runs the wound care center in the hospital.

Really? The only time where I saw residents, fellow, attending surgeons show their fangs was when they were stuck in stupid situations where they're bailing people out for things that others shouldn't be doing.

What I'm finally seeing so far as fourth year is that almost every other surgical department wants to dump their patients at GS and trauma. I thought that was only an IM thing until now that I'm on surgery.

 

[Gastrapathy]

Wait, did you just say that GI calls a surgeon to do a PEG? That’s embarrassing as hell