Frogger27

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Just an M1 but I have noticed in talking to the older students at my school who are interested in surgery that they all mention the surgical subs (ortho, ENT, urology, plastics, etc) and rarely mention general surgery.

Is this common that students who are interested in surgery gravitate towards the subs?

Is it because of better compensation/lifestyle?

Or is it that general surgery/fellowships through general surgery do not interest students as much?

All insights appreciated!
 

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Of the surgical fields, general surgery has overall the worst lifestyle:money ratio. For example general surgery and neurosurgery both have tough lifestyles but neurosurgery gets paid more. General surgery and ENT make similar money but ENT has better hours and less call. That's not to say GS isn't a great specialty because it is for the right type of person, but that's why people gravitate towards the subs.
 

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To add to WedgeDawg, the time spent in training is also "worse". Some GS programs are 5 years, but Academic GS programs are 7 years (2 research years). Considering that the more sought-after fellowships are highly competitive, many people have to opt for Academic GS.

On the flip side, Orthopedic surgery, Urology, and ENT are 5 years. Neurosurgery is 7 years (as long as an Academic GS program), but within that 7 years many programs offer the ability to obtain an enfolded fellowship.

Plastic Surgery (integrated) is 6 years, or you can go through GS and then you're looking at 5-7 from Academic GS plus an additional 2-3 years fellowship (which is difficult to match into, and thus not guaranteed). Vascular Surgery is 5? years integrated, or 5-7 years GS plus 2 years fellowship.

Basically, doing a subspecialty or categorical will save you training time - in some cases with a better attending lifestyle for similar salary (ENT, Urology), or a better salary for a similar lifestyle (NSG, maybe ortho, vascular). Or you can make more money and have a better lifestyle (plastics).

One thing people forget is that hours worked - even the lifestyle specialties - in residency is about equally brutal.
 
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@WedgeDawg @sovereign0 Thank you both for your insight. I figured it was probably due to the factors above (compensation, lifestyle, training) but was not sure if their were many other underlying reasons for this. Makes sense though.
 

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Frogger27

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sooo any good things to gen surg minus getting to cut?
 

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The factors you listed are accurate but I would add prestige. It can become a vicious cycle where students pursue ENT/ortho because they are competitive and thus there is the perception that there MUST be a reason everyone wants ENT over GS. While there are obviously pros to surgical subspecialties and many can be decent lifestyles, it doesn't mean you won't work hard. Similarly, not all general surgeons are grumpy and over-worked. Most surgeons in any surgical field will work hard and make good money, what a concept?!

The pros of GS are many - diverse pathology, high acuity, ability to practice just about anywhere in the world, etc. General surgery also involves quite a lot of medicine as general surgeons take very complete care of their patients. In the right setting, you can practice as a jack of all trades. Not to mention that GS opens doors for all the fellowships that don't have independent residencies.
 
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Having wanted to do ENT, not matched, done a general surgery internship, and then ultimately trained in radiology the acuity bothered me the most about surgery. So much of the field is high acuity/high stress and that naturally leads to grumpy, overworked people.

One of the things that was really appealing about the sub-specialties is the solving of chronic, quality of life issues. In the process of fixing someone's hearing/vision/(urination?) you can build a long term relationship with the patient and they are usually super appreciative of the work you do. For the more acute stuff like an a perforated appy or trauma, I don't think there was as much of the positive feedback mechanism. If you're satisfied with the inherent goodness of the job you're doing then that's fine. But if you not then it's just a tough, stressful job.
 

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sooo any good things to gen surg minus getting to cut?
Cutting out dead gut in grandma, and then watching her walk out of the hospital later with her family is pretty appealing.

A lot of general surgeons in the community do operations for cancer (hemicolectomy, breast surgery), and those can also be satisfying.

There is decent breadth in general surgery that you don't appreciate in medical school unless you're rotating in a community hospital. There are a lot of gallbladders, appys, and hernias, but depending on where you set up shop you can broaden your practice.

I picked urology because I thought the pathology was very interesting, I've drawn penises on everything since I was 13, and endourology is a giant video game (and for other, more serious reasons). We had to do 2 years of gen surg at my program, though, and I can say that if I didn't do urology gen surg would be my second choice.
 
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Cutting out dead gut in grandma, and then watching her walk out of the hospital later with her family is pretty appealing.

A lot of general surgeons in the community do operations for cancer (hemicolectomy, breast surgery), and those can also be satisfying.

There is decent breadth in general surgery that you don't appreciate in medical school unless you're rotating in a community hospital. There are a lot of gallbladders, appys, and hernias, but depending on where you set up shop you can broaden your practice.

I picked urology because I thought the pathology was very interesting, I've drawn penises on everything since I was 13, and endourology is a giant video game (and for other, more serious reasons). We had to do 2 years of gen surg at my program, though, and I can say that if I didn't do urology gen surg would be my second choice.
IIRC, a certain SDN favorite does nothing but breasts- with breast cancer being so prevalent, it's a pretty high demand field on both the treatment and reconstructive end.
 

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I don't have much more to add. A lot of factors have already been well stated by previous posters. The other thing about general surgery that can make it a difficult residency and QoL afterwards is that it is a common denominator for many different specialties to dump onto. The buck often gets passed in medicine and it usually stops at surgery. There are myriad reasons I chose general surgery over other fields and part of it was the diversity in pathology. My PGY-3 year was one of my favorites as I rotated through HPB, transplant, peds, etc. as an operating surgeon instead of the intern doing the trench work. There is a lot that we are required to master in five short years and it can be both daunting and rewarding. In the end though, I would recommend for any aspiring med student that if they are interested in a sub-specialty, they should just apply for that ie plastics, vascular, CTS. It's a more direct route to what your endgame is and much more focused on surgical techniques, parlance and pathology that has far more lasting applicability. After I finish my fellowship, I have zero intention of doing anything general surgery related, but am incredibly thankful for the training I have received during these years.
 
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Thank you everyone for adding to this post! As an M1 interested in surgery, this has been extremely informative.

I know that medicine is shifting towards more of an employement model, but is another reason the surgical subs are popular compared to general due to more opportunities for PP? From my understanding, it seems like some of the subs (ENT, ortho, urology, plastics in particular) have a lot of freedom in this regard to set up shop (if they have capital, market, etc) if they desire.
 
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My PGY-3 year was one of my favorites as I rotated through HPB, transplant, peds, etc. as an operating surgeon instead of the intern doing the trench work. There is a lot that we are required to master in five short years and it can be both daunting and rewarding.
This is exactly what draws me into general surgery. The breath of training in transplant and peds and trauma, etc. Also, one thing no one has mentioned yet: anatomy. I love anatomy. I can spend hours going through a surgical anatomy text and still have my OMS-I anatomy notes at home. I think general surgery attracts students who also really enjoy broadening their understanding of human anatomy (or maybe it's just me)
 

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Cutting out dead gut in grandma, and then watching her walk out of the hospital later with her family is pretty appealing.

A lot of general surgeons in the community do operations for cancer (hemicolectomy, breast surgery), and those can also be satisfying.

There is decent breadth in general surgery that you don't appreciate in medical school unless you're rotating in a community hospital. There are a lot of gallbladders, appys, and hernias, but depending on where you set up shop you can broaden your practice.

I picked urology because I thought the pathology was very interesting, I've drawn penises on everything since I was 13, and endourology is a giant video game (and for other, more serious reasons). We had to do 2 years of gen surg at my program, though, and I can say that if I didn't do urology gen surg would be my second choice.
So is urology as competitive as it seems? I've been reading 245+ or don't bother...

I don't have much more to add. A lot of factors have already been well stated by previous posters. The other thing about general surgery that can make it a difficult residency and QoL afterwards is that it is a common denominator for many different specialties to dump onto. The buck often gets passed in medicine and it usually stops at surgery. There are myriad reasons I chose general surgery over other fields and part of it was the diversity in pathology. My PGY-3 year was one of my favorites as I rotated through HPB, transplant, peds, etc. as an operating surgeon instead of the intern doing the trench work. There is a lot that we are required to master in five short years and it can be both daunting and rewarding. In the end though, I would recommend for any aspiring med student that if they are interested in a sub-specialty, they should just apply for that ie plastics, vascular, CTS. It's a more direct route to what your endgame is and much more focused on surgical techniques, parlance and pathology that has far more lasting applicability. After I finish my fellowship, I have zero intention of doing anything general surgery related, but am incredibly thankful for the training I have received during these years.
Isn't vascular/plastics starting to trend more toward integrated programs now?
 

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Isn't vascular/plastics starting to trend more toward integrated programs now?
Yes they are. Plastics continues to contract programs and although it's unlikely the traditional pathways will ever entirely go away, it will eventually settle into an equilibrium similar to what we have today. In some ways, I don't think we'll see the contraction of independent pathways in vascular programs to the same extreme as plastics though.

I know that medicine is shifting towards more of an employement model, but is another reason the surgical subs are popular compared to general due to more opportunities for PP? From my understanding, it seems like some of the subs (ENT, ortho, urology, plastics in particular) have a lot of freedom in this regard to set up shop (if they have capital, market, etc) if they desire.
There may be a component to this but the reality is that all fields except a very few are moving towards an employment model. Even if you join a large multi-specialty group, that in essence is an employment model to an extent.

This is exactly what draws me into general surgery. The breath of training in transplant and peds and trauma, etc. Also, one thing no one has mentioned yet: anatomy. I love anatomy. I can spend hours going through a surgical anatomy text and still have my OMS-I anatomy notes at home. I think general surgery attracts students who also really enjoy broadening their understanding of human anatomy (or maybe it's just me)
I don't want to give the wrong impression with what I wrote previously. I think general surgery is a fantastic gig, but you have to be mindful that fields like transplant/peds requires large tertiary referral centers to maintain that kind of practice along with fellowship training. The entire class of graduated chiefs all took jobs in general surgery and are making good money. They are all making more than my wife does as a fellowship trained ENT and without a fellowship. Those jobs are out there and they are bountiful. We have a rural surgery rotation here and it's actually been quite an enjoyable experience. Within a given week you will do EGDs/c-scopes, open/lap/robotic hernias, gallbladders galore, colon resections, and some breast cancer stuff. You get to see firsthand your role as a community general surgeon in a mid-sized hospital in a small->mid-sized town and quickly realize that the lifestyle isn't that bad and the money can be quite good.

In the end, you have to do you. What keeps you going and since we're all going to be woken up at 2AM for something, what do you want to be woken up for? Good luck to those deciding. Keep the questions coming. Don't forget to have fun along the way. Cheers.
 

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So is urology as competitive as it seems? I've been reading 245+ or don't bother...
Hard to tell because it's a separate match and the only real data set comes from an excel spreadsheet filled out by applicants. The alleged average last year was 245, but people reported matching with lower scores. If you make up for it in other areas and do well on away rotations it is feasible.
 
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Osteoth

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Hard to tell because it's a separate match and the only real data set comes from an excel spreadsheet filled out by applicants. The alleged average last year was 245, but people reported matching with lower scores. If you make up for it in other areas and do well on away rotations it is feasible.
Yeah. Probably a good level of self-selection bias considering those are the people who found their way onto a website for the urology match. Though 125/290 is significant sample size if valid.
 
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Slightly off-topic, but has anyone else noticed that there has been an increase in shift work style general surgery setups being adopted in their communities ? (Surgicalists if you will that work like a week on) I know TACS has used a similar system for years and I'm wondering if anyone further along in training believes this trend will continue for the run of the mill staff surgeons at non-rural, non-academic sites. It seems to me that this would be favorable for a lot of people as handoff is minimized, but people still have some time to jump off the proverbial treadmill so to speak.

Perhaps @lazymed could comment on this.
 
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@TypeADissection I have heard of the large multi specialty group set up. Correct me if I am wrong, but isn't this sort of a hybrid between an academic vs PP job? How does this type of set up work for a general surgeon trained doc? Do they work as more general or do they pursue fellowships in something where there is a large enough market to support their services?
 
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Slightly off-topic, but has anyone else noticed that there has been an increase in shift work style general surgery setups being adopted in their communities ? (Surgicalists if you will that work like a week on) I know TACS has used a similar system for years and I'm wondering if anyone further along in training believes this trend will continue for the run of the mill staff surgeons at non-rural, non-academic sites. It seems to me that this would be favorable for a lot of people as handoff is minimized, but people still have some time to jump off the proverbial treadmill so to speak.

Perhaps @lazymed could comment on this.
This job model exists and will probably become more common.

In my Midwestern city of 500,000 people, 3 private hospitals have acute care surgery jobs. This job model offers one form of work-life balance, because you work hard and get time off in return. The jobs I've seen vary from very busy when you're on, to fairly reasonable when you're on, and you're totally off when you're off.
 
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Hard to tell because it's a separate match and the only real data set comes from an excel spreadsheet filled out by applicants. The alleged average last year was 245, but people reported matching with lower scores. If you make up for it in other areas and do well on away rotations it is feasible.
It's kind of weird to me that the AUA isn't more transparent about their numbers. Wouldn't take that much work and would make things easier for applicants.
 
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It's kind of weird to me that the AUA isn't more transparent about their numbers. Wouldn't take that much work and would make things easier for applicants.
Yea, I really don't have a good answer for why they don't publish it. I'm sure they've stated it somewhere. Would certainly make it easier for applicants.
 

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It's kind of weird to me that the AUA isn't more transparent about their numbers. Wouldn't take that much work and would make things easier for applicants.
Yea, I really don't have a good answer for why they don't publish it. I'm sure they've stated it somewhere. Would certainly make it easier for applicants.
Also very weird that while 2/3 of the "lifestyle" surgical fields have separate matches (Optho/Uro) ENT does not.
 

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And all of the crap...
QFT.

The day I decided against gen surg, was the day my attending used that sigmoidoscope. Thank god for face shields.
 

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Also very weird that while 2/3 of the "lifestyle" surgical fields have separate matches (Optho/Uro) ENT does not.
ENT has you write a separate essay for every program though
 
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I was interested in gen surg until I did more research into the field. Brutal residency, high hours as attending, low pay compared to subspecialties, and low prestige are reasons I found. In comparison every ortho resident Ive ever talked to, although very busy, is happy. I guess theres a reason people interested in surgery say ortho or bust.
True. Also, gen surg is a lot of guts, pus, and poop. No thanks :barf:
 
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Try suturing an eye as shown below with the some of the smallest 10-0 monocryl that is made.
Holy s***, I hate eyes.

Edit: and now I'm watching creepy plastic surgery videos instead of studying. According to these YouTube comments there are a loooooot of 13 year old future surgeons out there, so cute haha! :rofl:My favorite is, "I've wanted to be a surgeon since I was 3!" Like, I don't even have any memories from before the age of 5...
 
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@TypeADissection I have heard of the large multi specialty group set up. Correct me if I am wrong, but isn't this sort of a hybrid between an academic vs PP job? How does this type of set up work for a general surgeon trained doc? Do they work as more general or do they pursue fellowships in something where there is a large enough market to support their services?
I think you are going to see more blending between academia and private practice going forward. You will always have both but there are "privademic" types of gigs out there where you're working for your RVUs but not under the same pressure to publish or obtain grants. You may have residents/fellows also rotating through and be an active participant in journal clubs, M&Ms and other advisory roles. This type of model is the most appealing to me but who knows where my career will take me. You can still work in a multi-specialty group and essentially be in PP in regards to your day-to-day workflow. Being a general surgeon in such a group, you may be working alongside a surg onc, colorectal, and bariatric surgeon. Let's say your schtick is minimally invasive and those are the kinds of cases you're going to do. You take down a gallbladder and it comes back as cancer, now you can go talk to your surg onc or HPB colleague and go from there. I think with close to 80% of general surgery residents pursuing fellowships, that's probably where the future job market is going, but it all depends on where you want to live and work.

The reality is, it's not about choosing a field because of perceived prestige or income because that only takes you so far. You have to choose the field that actually genuinely interests you. Surgery, regardless of the specialty, is just too painful that unless you love it, it doesn't really matter.
 

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Ophthalmology is not surgery. Let's just be real. Neither is derm, or family med.
Lulwut.

ENT has you write a separate essay for every program though
Jesus Christ...

The reality is, it's not about choosing a field because of perceived prestige or income because that only takes you so far. You have to choose the field that actually genuinely interests you. Surgery, regardless of the specialty, is just too painful that unless you love it, it doesn't really matter.
Depends on your value system, friend.

Don't hate on the pus. Draining a bad perirectal abscess is so gratifying. Patients feel better quickly.
Gotta choose your fluid.
 
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Already covered, money and lifestyle is better in subspecialties.

Not covered so far in this thread, is personalities.
  • Orthos have been some of the nicest bros I've met.
  • Ophthos have been super passionate about lasers.
  • Urologists joke around left-and-right
  • ENT: dry people
  • Neurosurgery: always busy, quiet, or thinking
  • General Surgery: angry, hostile, malignant. Always going on about "incompetent nurses," their "bitch ex," or yelling at a student/resident. Literally zero pleasant interactions.
General surgery has a strict hierarchy in it as well. If tradition has set that students come in at 4:30am for prerounds, and you show up at 4:31am ONCE, you'll be yelled at and belittled. They'll unironically call you stupid and worthless, even thought you've got a stronger step 1 (by 15 points), clinical grades, and research than any resident they've ever accepted.

Every M3 got yelled at 1-2x per day for things that was not our fault. None of us had a single pleasant interaction. Only the M4s were spared since the program was trying to recruit them. And you could tell the prospective surgery applicant M4s were ****ty people as well because they smiled/enjoyed watching the M3s get yelled at, even when an m4 made the mistake.

Meanwhile the ortho residents just wanted the pre-rounds done by 6:00. They didnt care if you started at 04:10 or 5:30. Just get the work done and come do cool things in the OR. And if there is nothing going on, they chitchat with you. They grab lunch with you. They talk about sports, movies, hobbies.

And I'm unbiased in this as I'm not going into any surgical field.
 
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One other thing I forgot, the GS residents played this punitive game where if they were oncall, they'd keep the students they dont like past signout.

Say, Bob the resident doesnt like you and he's q4 call, your schedule just turned into q4 0430-2400. And another particularly bitchy resident just did it to 3/4 students every time she was on call.
 
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Already covered, money and lifestyle is better in subspecialties.

Not covered so far in this thread, is personalities.
  • Orthos have been some of the nicest bros I've met.
  • Ophthos have been super passionate about lasers.
  • Urologists joke around left-and-right
  • ENT: dry people
  • Neurosurgery: always busy, quiet, or thinking
  • General Surgery: angry, hostile, malignant. Always going on about "incompetent nurses," their "bitch ex," or yelling at a student/resident. Literally zero pleasant interactions.
General surgery has a strict hierarchy in it as well. If tradition has set that students come in at 4:30am for prerounds, and you show up at 4:31am ONCE, you'll be yelled at and belittled. They'll unironically call you stupid and worthless, even thought you've got a stronger step 1 (by 15 points), clinical grades, and research than any resident they've ever accepted.

Every M3 got yelled at 1-2x per day for things that was not our fault. None of us had a single pleasant interaction. Only the M4s were spared since the program was trying to recruit them. And you could tell the prospective surgery applicant M4s were ****ty people as well because they smiled/enjoyed watching the M3s get yelled at, even when an m4 made the mistake.

Meanwhile the ortho residents just wanted the pre-rounds done by 6:00. They didnt care if you started at 04:10 or 5:30. Just get the work done and come do cool things in the OR. And if there is nothing going on, they chitchat with you. They grab lunch with you. They talk about sports, movies, hobbies.

And I'm unbiased in this as I'm not going into any surgical field.
I'm sorry you had a bad general surgery experience but I don't want anyone to walk away thinking this is generalizable to all programs. There are plenty of happy, friendly, pleasant general surgeons.
 

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It's as much a surgical specialty as uro and ENT.
Lol no.

Uro & ENT have to do a surgical intern year. Ophtho can do a med/surg/transitional.

Ergo, in terms of baseline general surgical prowess, Uro = ENT > Ophtho based on minimum training requirements.

One other thing I forgot, the GS residents played this punitive game where if they were oncall, they'd keep the students they dont like past signout.

Say, Bob the resident doesnt like you and he's q4 call, your schedule just turned into q4 0430-2400. And another particularly bitchy resident just did it to 3/4 students every time she was on call.
Rough.
 
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This job model exists and will probably become more common.

In my Midwestern city of 500,000 people, 3 private hospitals have acute care surgery jobs. This job model offers one form of work-life balance, because you work hard and get time off in return. The jobs I've seen vary from very busy when you're on, to fairly reasonable when you're on, and you're totally off when you're off.
Are these all acute care fellowship trained docs and what is the biggest difference between this type of work and the trauma fellowship trained docs that came before them?

I have also noticed a large amount of PP general surgeons become staff hospital surgeons at my home hospital and suddenly work probably 1/3 as much as they did beforehand all while claiming to make nearly the same amount of money. They seem really happy compared to the years I knew them beforehand.

It's not all about lifestyle, but I do think it's important to know how the landscape may be changing.
 
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AnatomyGrey12

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In addition, were I generalizing and making stereotypes, ortho bros may seem cool to students, but they are among the most disliked specialties in the hospital by medicine, ED, and surgery for the way they treat their peers (...and patients...)
My n=1 experience of working in a large community hospital fits this to a T. The ortho guys were extremely whiny, entitled, and some were just downright a**hats to staff. I saw one guy honestly just not write post-op orders for one of his patients because "I'm done with this EMR" and then not answer his phone when the PACU nurses were calling him because they couldn't send the patient to the floor without floor orders. Now not all orthos are like this but the stereotype exists for a reason.
 

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Are these all acute care fellowship trained docs and what is the biggest difference between this type of work and the trauma fellowship trained docs that came before them?

I have also noticed a large amount of PP general surgeons become staff hospital surgeons at my home hospital and suddenly work probably 1/3 as much as they did beforehand all while claiming to make nearly the same amount of money. They seem really happy compared to the years I knew them beforehand.

It's not all about lifestyle, but I do think it's important to know how the landscape may be changing.
Most are general surgeons without any fellowship training. I'm actually the only one in town with critical care fellowship. It's nice because my week off can be spent picking up extra critical care time or just being off. All these groups realize ideally you'd have critical care trained surgeons doing acute care and critical care, but there's a shortage of CC- fellowship trained surgeons. I'm hoping my group over the next 5-10 years will include a couple more surgery/CC folks so we can run the surgical icu and acute care entirely.

The training is similar to trauma doctors, but if you're at a level 3-4 trauma center, you'll be doing minimal trauma work.
 

VincentAdultman

Senior Member
10+ Year Member
Jun 18, 2005
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In addition, were I generalizing and making stereotypes, ortho bros may seem cool to students, but they are among the most disliked specialties in the hospital by medicine, ED, and surgery for the way they treat their peers (...and patients...)
Hey! I resent tha-

*Reflects on Ortho residency*

As you were...
 

sliceofbread136

7+ Year Member
Nov 5, 2011
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In addition, were I generalizing and making stereotypes, ortho bros may seem cool to students, but they are among the most disliked specialties in the hospital by medicine, ED, and surgery for the way they treat their peers (...and patients...)
I'm generally curious what you specifically mean as I definitely though the ortho people were nice when I was a student. Is it that they pawn a lot of work off to other people?
 
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