why DIDN'T you go into surgery?

[Dire Straits]

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as some of you may know i'm trying to decide between anesthesiology and general surgery. some of you may have considered going into surgery before deciding on anesthesiology. what were the factors that ultimately made you decide to do anesthesiology instead of surgery?

 

[cak]

I am replying to your post as someone who is leaving gs to go into anesthesiology. My story starts in third year of med school when, after 1 week of my syrgery rotation, I had decided what I was going to do for the rest of my life. I loved the OR, I loved cutting and sewing, and I couldn't see myself doing anything esle in medicine that would make me as happy or be as fun. And like many students at other med schools, we did not have adequate exposure to anesthesiology until our fourth year. By that time I had already applied for surgery and was scheduling interviews. After my anesthesia rotation I began to question my decision.
So, anyway, I matched and started my internship. I hated it! There is so much more to the practice of gs that you don't think about as a student. I still love to operate, and I did a lot of that this year, but there is too much I don't like to justify my staying in surgery. For example, MANY surgerons/gs residents are not happy people, and some of them are even miserable people. Surgery is still, and probably always will be, a very egocentric specialty and I have a hard time dealing with people who are too full of themselves. Many surgerons practice CYA medicine because the current environment in medicine (esp surgery) is "patients vs. doctors" and it makes everybody hostile and on-edge. Many of my attendings are divorced and many of the residents don't have anything else in their lives other than work. One last thing is that the 80-hr work week, although they try to enforce it, rarely exists.
So although I still love the actual act of surgery, I cannot justify knowingly/willingly doing this to myself for longer than I have to.
Anesthesiology, on the other hand, is at the other end of the spectrum. Attendings/residents are generally much happier/nicer and are much more pleasant to work with. Not very many people have the God complex (that I have come across anyway). It's still a very hands-on specialty and I will still be in the OR, which I love. And the hours, in general, are better than gs which will allow me the time get back the things I used to do to that made me a human being (i.e. visiting my parents, playing the violin, working out, reading for pleasure, etc).
To me, this decision should be a no-brainer. But some people just love to operate so much that they are willing to put up with all the other stuff or they just don't think about it. And from personal experience, I really believe that by the end of a gs residency, many residents are not the same people that they were when they started, and that's sad. A job should never do that to someone.
Anyway, that's my personal experience. I am so glad I made the decision to switch and I can't wait to finally start my CA-1 year.
If you're really not sure, do as many rotations as you can in each field before you have to apply. And if you find that you made the wrong decision down the road, it's not the end of the world, you can always switch.
I hope this helps a little. Good luck.

 

[chicamedica]

I am replying to your post as someone who is leaving gs to go into anesthesiology. My story starts in third year of med school when, after 1 week of my syrgery rotation, I had decided what I was going to do for the rest of my life. I loved the OR, I loved cutting and sewing, and I couldn't see myself doing anything esle in medicine that would make me as happy or be as fun. And like many students at other med schools, we did not have adequate exposure to anesthesiology until our fourth year. By that time I had already applied for surgery and was scheduling interviews. After my anesthesia rotation I began to question my decision.
So, anyway, I matched and started my internship. I hated it! There is so much more to the practice of gs that you don't think about as a student. I still love to operate, and I did a lot of that this year, but there is too much I don't like to justify my staying in surgery. For example, MANY surgerons/gs residents are not happy people, and some of them are even miserable people. Surgery is still, and probably always will be, a very egocentric specialty and I have a hard time dealing with people who are too full of themselves. Many surgerons practice CYA medicine because the current environment in medicine (esp surgery) is "patients vs. doctors" and it makes everybody hostile and on-edge. Many of my attendings are divorced and many of the residents don't have anything else in their lives other than work. One last thing is that the 80-hr work week, although they try to enforce it, rarely exists.
So although I still love the actual act of surgery, I cannot justify knowingly/willingly doing this to myself for longer than I have to.
Anesthesiology, on the other hand, is at the other end of the spectrum. Attendings/residents are generally much happier/nicer and are much more pleasant to work with. Not very many people have the God complex (that I have come across anyway). It's still a very hands-on specialty and I will still be in the OR, which I love. And the hours, in general, are better than gs which will allow me the time get back the things I used to do to that made me a human being (i.e. visiting my parents, playing the violin, working out, reading for pleasure, etc).
To me, this decision should be a no-brainer. But some people just love to operate so much that they are willing to put up with all the other stuff or they just don't think about it. And from personal experience, I really believe that by the end of a gs residency, many residents are not the same people that they were when they started, and that's sad. A job should never do that to someone.
Anyway, that's my personal experience. I am so glad I made the decision to switch and I can't wait to finally start my CA-1 year.
If you're really not sure, do as many rotations as you can in each field before you have to apply. And if you find that you made the wrong decision down the road, it's not the end of the world, you can always switch.
I hope this helps a little. Good luck.

DITTO!! I very much enjoyed surgery during MS3, but not enough to pretty much "marry" myself to it and be miserable surrounded by bitter/cutthroat colleagues. Likewise i recognized exactly what you did about the happier, more collegial environment in anesthesiology vs. surg. And, unfortunately all these nice, happy classmates going into surgery now are prob not going to be that way in a few years. I also was lucky enough to work with some nice and down-to-earth surgery residents and select few attendings (especially on transplant), it takes a very special person to stay that way, b/c the surg culture forces people to become like what you said cak. But i do recognize that surgery needs to have that kind of culture/hierarchy because they are the ones cutting people's organs and vessels. Just count me out of it. . . 😉

 

[cchoukal]

I interviewed in both Anesthesiology and Otolaryngology. It was a really tough decision, but I think ultimately, I knew I wanted my expert body of knowledge to be "how do the really important systems of the body work so I can take care of sick people" and not "what are the 12 causes of unilateral sensorineural hearing loss." One of the toughest parts of the decision involved the egoentric nature of the specialties. Frankly, I was (and maybe still am) concerned that as an anesthesiologist I won't feel like I'm really in charge of my patient in the OR, or that I'll be made to feel not as important as the surgeon. I decided that these concerns weren't significant enough to offset what I perceived to be the downsides of an ENT practice:

Tied to my practice/patients (clinic schedules of ENTs can be out 3-4 months)
Feeling like once I'm in ENT, my role is very circumscribed
No critical care fellowships for ENTs
Didn't want to spend all my saturdays drilling out temporal bones.

Anyway, like I said, I still wrestle a little with the perception of the relative roles of the two fields, but I know anesthesiology, with such a crucial knowledge base and such a diverse scope of practice, was the better choice for me. That said, it did sting a little when my ENT mentor told me after match that he knew my #1 choice ENT program ranked me to match before I withdrew.

So, I don't know where that leaves you, but I guess the important thing to remember is that none of these decisions is permanent, especially the one you have to make. Because a surgery internship is acceptable as a clinical base year for anesthesiology programs, and because many programs hold some spots for year 2 transfers, trying out GS first and then switching is possible (if not easy?).

 

[Epidural]

Frankly, I was (and maybe still am) concerned that as an anesthesiologist I won't feel like I'm really in charge of my patient in the OR, or that I'll be made to feel not as important as the surgeon.

If you still enjoy or want to do surgery, one option to consider would be to do an Interventional Pain Fellowship after Anesthesia. I know several Pain fellows who switched from surgery (even one Neurosurgeon) to Anesthesia + Pain Fellowship. Common surgeries that you would do after fellowship include spinal cord stimulators, intrathecal pumps, occipital and other peripheral nerve stimulators, percutaneous discectomies, and whatever else comes out in the future.

If you think that you might want to go this route, a general surgery internship isn't a bad idea. The advantage is that you can also jump into PGY-2 surgery spot if one opens up and you decide that you really did want to do surgery. Additionally, the year of surgery will be helpful to you both in your Anesthesia residency and during your fellowship. Anyway, just wanted to let you know that there's still a spot for you on the other side of the curtain if you want it.

 

[2ndyear]

2 reasons:
1) Surgeons still have to spend a lot of time in the office meeting people before and after surgery, and rounding on them post-op. Not for me, not bad mind you, but not for me.

2) I was inspired by a great group of surgeons who don't operate much at all but only do critical care. I can do this too from anesthesia.

 

[Justin4563]

everyday i have at least one general surgeon who bitches about how their life sucks

 

[gaslady]

I knew I loved the OR, but I came to realize that didn't mean that I had to be the one doing the surgery, I just like being able to see all that cool stuff. I much prefer to be the one who is in charge of the patient's overall well being.

 

[IlianaSedai]

I'm a medical student applying during the next cycle. I enjoyed my GS rotation as well, although my anesthesiology rotation beat that and my other choice, EM, by a long shot.

For anesthesiology, in no particular order:

1. Heart-lung pathophysiology in real time. Had I done GS I might have been interested in vascular or cardiac for the same reason, but all those belly cases did nothing for me.
2. Technology and engineering. Monitors. I love monitors. Compare to breath sounds and egophony.
3. Airway management.
4. Much more congenial people than GS.
5. Better hours than GS in the long term. This is an important point to me.

6. More intellectually stimulating. This is hard to explain, and you shouldn't take my explanation at face value because different people find different things intellectually stimulating. For example, I found OB to be too simplistic. Pre-eclampsia? Mag. Meconium? Suction, call peds. GBS+? Amp. Whereas circulation, ventilation, and everything you administer pharmacologically are dynamic, they all affect each other, and they constantly evolve. There are multiple ways to achieve one goal, all with advantages and disadvantages, and you get to weigh them, make choices, adjust, and so on.

For GS:

1. Fun to cut and sew
2. Hands-on
3. Pathology (as opposed to physiology or pathophysiology)

Against GS:

1. Work environment/culture
2. Hours
3. Post-op rounds, diet advancement, wound checks
4. The GI system in real time is not nearly as interesting as heart-lungs physiology and hemodynamics in real time. 😉

Against EM:

1. Found myself on the computer and phone all the time, checking labs, calling consults and admissions. And the attendings have to do this too.
2. Vague, poorly defined complaints and histories.

 

[VentdependenT]

My surgery residents were cordial enough to talk me out of it. If I could just sit in the OR all day cranken out cases then surgery would have been perfect. However all the floor work and clinic work PLUS constant consult slams not only from ER ("we got a hot one here folks") but for stuff like "GOMER MRSA stage 4 decub wound debridement" and "BMI >35 nursing home pt with 4 prior abd surgeries has non working gut and zero pulmonary reserve" were major deterrents. Plus those darn IR (better imaging---> less invasive procedures) and GI guys are creeping in on cases.

Surgical management is (or damn well should be) a last resort and as such there is a lot to weigh as far as risk vs benefit is concerned for pts. Many of whom are very decompensated. Its a challenging and potentially rewarding field none the less. Plus laproscopy is cool.

Regardless I respect my GS colleagues.

 

[MD Dreams]

For those who changed over from surgery, did anyone consider a more benign surgical field such as urology or ophthalmology before switching over to anesthesiology.

This is a great post, and thanks to all who contributed. I too share your love of surgery, but fear of being miserable.

 

[powermd]

I was attracted to surgery because in a way they are the "Jedi Knights" of medicine. Not only are they wise (ideally), but they're also armed to the teeth with cool weapons. They can fix problems no other doctor can solve, or even improvise on. The doctor-patient relationship in surgery is uniquely rewarding. Operating is just plain cool, and at times a real adrenaline rush. The camraderie of working with a surgical team is awesome; as a third year student rotating through surgery, scrubbing in to a case with my team felt like what I would imagine going to war might be like. Finishing the case and taking the patient to recovery was a satisfaction unlike any other.

Of course, the downside is that you have almost no life, and the residency would probably turn me into a miserable person. Clinic and rounding on the wards is another major bummer. So I compromised with anesthesiology. I get to enjoy many of the satisfactions of surgery (and medicine), but very little of the glory, in exchange for free time and a flexible schedule. Sounds like a great deal to me, I can't wait for my CA-1 year to start! I've already got a cool pad lined up in NYC!

 

[Dupree]

Sounds like a lot of excuses. And you know what they say about excuses.

 

[powermd]

Sounds like a lot of excuses. And you know what they say about excuses.

Mmmm... fresh troll. (licking chops..)

 

[VentdependenT]

Sounds like a lot of excuses. And you know what they say about excuses.

The intelligent individual doesn't misconstrue rational observations and experiences with the term "excuses."

Keep it real Jermaine. Real provincial. You're doing a fine job.

 

[JudoKing01]

You guys are makin me want to go into anesthesiology dammit.