where do all the surg dropouts go?

[neutropenic]

There was even a time when OB/GYN was really hot "back in the day."

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[LaCirujana]

When I was on the interview trail, I met a girl who was finishing her PGY1 in EM and was switching to G surg. We were interviewing at her home program... so they must have been open to it. I don't suppose it's any more difficult than any other switch.

One of our best PGY-2 surgery residents is a girl who did a year of EM (at our institution) and switched into surgery. Although she did have to repeat her intern year, she's a much better surgeon (and overall doctor) than a few of the guys in her class who matched straight out of med school.

 

[HTD]

I see many passionate opinions here from smart, motivated people. I think there is often a tendency to not see the forest for the trees in debates like this. Let me give you my persepctive. I have been in private GS practice for 3 years and I am married to an OB-Gyn in private practice for 8 months.

Your career and lifestyle is what you make of it. I chose surgery because I was extremely passionate about it. Had I been reading this as an intern, I would be making many an inflammatory comment about how "tough and committed" the genral surgeons are. The truth is more along the lines of loving your job or at least loving it more than other jobs.

I have a great lifestyle but isn't that really a subjective definition? Here are a few pearls that I have used to help me be the best doctor, surgeon, husband, father and son that I can be:

I don't go home and rest so that I can go back the next day and be ready for as much work as possible. Rather, I work hard to support and provide for my family. I do not work at the expense of my family. No one ever regrets not working more on their deathbed. Yes, I had to make many sacrifices in my training days. Now, I have the control to shape my future.

I do not count on my medical practice to deliver riches and retirement to me on a platter of high income alone. Physicians and Surgeons are service professionals. Thus, we trade hours for dollars. If you are in a University system, remeber that your professors are employees, not business owners. Even for private practice doctors, the IRS does not treat a medical practice like other businesses and our tax burdens are substantial. Bottom Line; enjoy your practice but have other sources of income and have a good retirement plan at a minimum.

Your field is what you make of it. Regardless of specialty, you can adapt it to your community and desires. I have a friend that did an Ivy League Trauma Critical Care fellowship but now is in a nice private practice with rare call. He defined his career, not the other way around.

Keep an open mind and good luck to you!

 

[drpectin]

Well said, thanks for your input.

 

[Dr. V]

Thanks for that input HTD. Good to know that.

 

[iliacus]

Pay scales fluctuate. Derms were bottomw of their class in the early 70's. In he mid to late 70s the top grads of the big ivy schools fought over hot spots in the new field of Rheumatology, and now make less in some cases than internists. Rads was all FMGs in the 80s because of pay. Anesthesia went unfilled in the past too.

Careful picking something thats hot now just for the money if it bores you.

 

[njbmd]

You have absolutely no idea what anesthesiologists do, do you? I would expect that statement from a layperson, not someone as educated as yourself. While the surgeons are busy cutting or suturing, the anesthesiologists are busy anticipating what will happen next, what to do if the surgeon cuts a vessel, etc. etc. It's more intellectually stimulating than most people think

Hi there,
Actually, the anesthesiologist(anesthetist) doen't know what I am doing on the other side of the drape. I have to tell them. "Give 5,000 units of heparin", "I don't want the patient paralyzed" etc. Even the most involved anesthesiologist is not standing there eagerly anticipating my next move or even looking at what I am doing. In the meantime, I ligete loads of vessels during most of my cases and the anesthesiologist never even notices.

I announce "incision" when I start and I give them the "two minute warning" when I am closing. The rest of the time, they are doing the crossword or chatting on the phone, drinking coffee etc. I like it that way and they like it that way because it means the the case is going well. They watch the patient and not the surgeon.

The "hours of boredom punctuated by seconds of sheer terror" applies most of the time to anesthesia. That's not to say that the anesthesia is not important but let us not kid anyone about the anesthesiologist "anticipating" anything that the surgeon is doing.

The best anesthesiologists anticipate the needs of the patient (not the surgeon) and make sure that things on their end run smoothly. If this is for you then go for it. But after having to wake up an anesthesiologist at the end of more than a couple of my cases because I was closing, I doubt the "anticipation" part.

njbmd

 

[zinjanthropus]

so what is the general consensus regarding these residents who leave a GS program after their PGY-1 year? From reading the thread, it seems like some programs (e.g. EM) might let them go straight into the PGY-2 year, while others will make them redo their PGY-1 year in the new department. Is this accurate?

 

[bigtimesmally]

I see many passionate opinions here from smart, motivated people. I think there is often a tendency to not see the forest for the trees in debates like this. Let me give you my persepctive. I have been in private GS practice for 3 years and I am married to an OB-Gyn in private practice for 8 months.

Your career and lifestyle is what you make of it. I chose surgery because I was extremely passionate about it. Had I been reading this as an intern, I would be making many an inflammatory comment about how "tough and committed" the genral surgeons are. The truth is more along the lines of loving your job or at least loving it more than other jobs.

I have a great lifestyle but isn't that really a subjective definition? Here are a few pearls that I have used to help me be the best doctor, surgeon, husband, father and son that I can be:

I don't go home and rest so that I can go back the next day and be ready for as much work as possible. Rather, I work hard to support and provide for my family. I do not work at the expense of my family. No one ever regrets not working more on their deathbed. Yes, I had to make many sacrifices in my training days. Now, I have the control to shape my future.

I do not count on my medical practice to deliver riches and retirement to me on a platter of high income alone. Physicians and Surgeons are service professionals. Thus, we trade hours for dollars. If you are in a University system, remeber that your professors are employees, not business owners. Even for private practice doctors, the IRS does not treat a medical practice like other businesses and our tax burdens are substantial. Bottom Line; enjoy your practice but have other sources of income and have a good retirement plan at a minimum.

Your field is what you make of it. Regardless of specialty, you can adapt it to your community and desires. I have a friend that did an Ivy League Trauma Critical Care fellowship but now is in a nice private practice with rare call. He defined his career, not the other way around.

Keep an open mind and good luck to you!

thank you for your posts. They keep a first-year surgery intern like me motivated instead of scared ****less.

 

[JackBauERfan]

so what is the general consensus regarding these residents who leave a GS program after their PGY-1 year? From reading the thread, it seems like some programs (e.g. EM) might let them go straight into the PGY-2 year, while others will make them redo their PGY-1 year in the new department. Is this accurate?

I think they would let them go into a pgy2 year in a program that is a 4 year that runs from pgy2-4 (with a prelim year in surg/im or transitional year). I'm pretty pretty sure they would not be a pgy2 in ANY pgy1-3 program. But there are 20 or so pgy2-4 programs and 100 3 year programs or pgy1-4 EM programs, so the options seem limited.

 

[JackBauERfan]

Yes, especially since you can read Ladies' Home Journal during cases.
Remember the ABCs of anaesthesia:

Airway
Book
Circulation

Many are shocked how much more the gas(wo)men are making compared to their GS colleagues. It's obscene. Even my general surgeon attending told me to go into gas.

I don't get that, I mean Anesthesiologist do airway and breathing for sure haha. I've always heard the joke as Airway, Breathing, Coffee, Donuts, Extubation.

But WE ALL know anesthesiologist do more than that, it takes 4 years for a reason!

 

[JackBauERfan]

I keep hearing all the stories about general surgery residents switching to anesthesia, EM, ets. Did anybody actually switch to general surgery from other specialties? Would that be hard to switch from EM to surgery?

I think it would be hard that unless you entered a 4 year EM program where you did a preliminary surgery year, you would definitely start all over in surgery.


I'm doing an prelim med year before 3 year EM, and if I wanted to switch at anytime I would have to start as pgy-1 for sure (I'm pretty sure)

So, I think unless you did prelim surg as the prelim year for your respective residency (anest, em, whatever else uses it) it would be a lot harder...and the fact a spot has to open up.

 

[VentdependenT]

I don't get that, I mean Anesthesiologist do airway and breathing for sure haha. I've always heard the joke as Airway, Breathing, Coffee, Donuts, Extubation.

But WE ALL know anesthesiologist do more than that, it takes 4 years for a reason!

LMAO

 

[mysophobe]

But WE ALL know anesthesiologist do more than that, it takes 4 years for a reason!

Sudoku is hard to learn.

 

[powermd]

Sudoku is hard to learn.

I'm still perfecting my Dopewars game...

Seriously, I thought anesthesia looked pretty boring as a medical student until I did a few rotations at good residency programs and discovered that the work is fun, cerebral, and at times, exciting. I based the rest of my interest in the field on the fact that everyone who does it is so damn happy with it, it MUST be good. For the most part, that's my opinion today as an almost-CA2. What you couldn't possibly know as an outside observer is how rewarding it feels to do a successful anesthetic having the patient wake up comfortable, smiling, and very thankful for the experience. Very often when I see my patients postoperatively the next day, they don't remember who their surgeon was, but they do remember me.

 

[mysophobe]

No, I feel very rewarded when my patients wake up comfortable and smiling. But, someone else can do that.

 

[avgjoe]

I'm still perfecting my Dopewars game...

Seriously, I thought anesthesia looked pretty boring as a medical student until I did a few rotations at good residency programs and discovered that the work is fun, cerebral, and at times, exciting. I based the rest of my interest in the field on the fact that everyone who does it is so damn happy with it, it MUST be good. For the most part, that's my opinion today as an almost-CA2. What you couldn't possibly know as an outside observer is how rewarding it feels to do a successful anesthetic having the patient wake up comfortable, smiling, and very thankful for the experience. Very often when I see my patients postoperatively the next day, they don't remember who their surgeon was, but they do remember me.

Sorry, but i find that last part very hard to believe, as the patients have had multiple pre-op appointments with the actual surgeon, they have seen that surgeon before the surgery as well, they drop by to talk to the patients after surgery/tell them what happened, etc. I've also heard multiple anesthesiologists tell me that you need very little ego to do it as many times the patient has no idea who you really are (if you are an MD etc even) and as they don't know how bad they 'could' feel after surgery, they don't quite appreciate the anesthesiologists' work..

 

[nimbus]

Sudoku is hard to learn.

Maybe for a surgeon. Most anesthesia programs require mastery of evil puzzles in order to be promoted to CA2 year.

 

[LADoc00]

the residents that i know who have left surgery have gone into less prestigious/ easier to get into fields...

-family medicine
-psychiatry
-anesthesia
-pathology

one of the surgery residents from my own program is currently a radiology resident at my own program. although he switched (went from pgy-3 surgery to pgy-1 radiology) before i arrived, now he wishes he had stuck it out. go figure.

also, it's my guess that people who leave surgery at the pgy-4 or 5 level are people that probably have been thinking about dropping out since they were interns, and were just waiting for a good reason to leave (e.g. - family). surgery is very demanding, no matter what specialty you are in. it's normal to second-guess yourself on occasion. but i guess that's probably true about every field.

That is a B.S., in all travels Ive only heard of 1 guy who left Surgery for path. It is absurdly rare. There would no meshing of personality types there.

 

[ilikescut3]

someone from my program is leaving to go into path

 

[jeff2005]

At my path program we have two former surgery residents, one former ENT resident and one neurosurg.