Why Don't More People Do Surgery

[Guile]

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At my school we rotate through community hospitals where the surgeons pretty much work 8-5pm, maybe 50 hrs/week on average. The surgeons are all happy, laid back, and love teaching students. I guess surgery at teaching hospitals is a different animal. I love the surgery experience I'm having enough to want to go into surgery, but I'm afraid residency would be a big shock going from 40hrs/week to 80 (100).

In terms of attractiveness of the field as one surgeon put it to me: you get paid $400 for a cholecystectomy whether is takes you 30min or 2hrs. A GI doc gets $400 per colonoscopy, and he/she can do about 5 of those per hour. Same residency length, but more bang for your time in GI.

Interesting. Are they general surgeons or do you rotate with any subspecialties? Any vascular surgeons among them? What's the weekly schedule like if you don't mind sharing? Call schedule?

Sorry for the questions. I've just never heard this side of the story before.

 

[Winged Scapula]

At my school we rotate through community hospitals where the surgeons pretty much work 8-5pm, maybe 50 hrs/week on average. The surgeons are all happy, laid back, and love teaching students.

You are missing something here.

While they may be in the office or OR from 8 to 5, there are mounds of paperwork, patient charts, etc. to do. I have had students rave about my lifestyle specialty until they realized I worked on charts and paperwork until 10 pm most nights and on the weekends. Just because the patients aren't coming in after 5 doesn't mean the work stops. Most surgical offices also don't close for lunch whereas other specialties do.

They may seemingly work less than the surgeons in the academic medical centers, but PP general surgery is not a 8 to 5 gig.

 

[Doctor4Life1769]

The main turn off to general surgery to me is this, I don't want to do general surgery. I don't want to do appys, choles, colectomies, etc. all day long for the rest of my life. I was fortunate enough to scrub in on a hand case, and I really enjoyed it. I also enjoy cardiothoracic cases, too - I spent significant time with one prior to and during medical school over the summer before M2. However, I know that for the most part, for me to be able to get into a cardiothoracic or hand/plastics, I will have to go through a 5 year GS residency... which honestly, I don't know if I want to do that or not. However, I'm also interested in anesthesia ... and I can't decide still.

 

[kdburton]

The main turn off to general surgery to me is this, I don't want to do general surgery. I don't want to do appys, choles, colectomies, etc. all day long for the rest of my life. I was fortunate enough to scrub in on a hand case, and I really enjoyed it. I also enjoy cardiothoracic cases, too - I spent significant time with one prior to and during medical school over the summer before M2. However, I know that for the most part, for me to be able to get into a cardiothoracic or hand/plastics, I will have to go through a 5 year GS residency... which honestly, I don't know if I want to do that or not. However, I'm also interested in anesthesia ... and I can't decide still.

Does anyone actually really like anesthesia? Or do they just like the idea of sitting there reading a book or doing crosswords and getting paid to do it? It is the polar opposite of surgery.

 

[Guile]

You are missing something here.

While they may be in the office or OR from 8 to 5, there are mounds of paperwork, patient charts, etc. to do. I have had students rave about my lifestyle specialty until they realized I worked on charts and paperwork until 10 pm most nights and on the weekends. Just because the patients aren't coming in after 5 doesn't mean the work stops. Most surgical offices also don't close for lunch whereas other specialties do.

They may seemingly work less than the surgeons in the academic medical centers, but PP general surgery is not a 8 to 5 gig.

I just knew that Dr. Cox was going to swoop in here and drop a dose of reality on us.

 

[Winged Scapula]

I just knew that Dr. Cox was going to swoop in here and drop a dose of reality on us.

Sorry.

Back to the unicorns and rainbow life of a medical student.

 

[kdburton]

Sorry.

Back to the unicorns and rainbow life of a medical student.

I thought those terms only referred to Obama

 

[TeamZissou]

I thought those terms only referred to Obama

Well ya, after he takes care of my mortgage and car payment all I have left to worry about is what kind of rainbow color I want to paint my room and which puppies are hairless so I can be like Obama.

 

[Guile]

Well ya, after he takes care of my mortgage and car payment all I have left to worry about is what kind of rainbow color I want to paint my room and which puppies are hairless so I can be like Obama.

Reminds me of this: http://www.youtube.com/watch?v=P36x8rTb3jI

I think this lady has had a rude awakening.

 

[TeamZissou]

Reminds me of this: http://www.youtube.com/watch?v=P36x8rTb3jI

I think this lady has had a rude awakening.

Haha that's exactly where I got it from.

 

[Doctor4Life1769]

Does anyone actually really like anesthesia? Or do they just like the idea of sitting there reading a book or doing crosswords and getting paid to do it? It is the polar opposite of surgery.

I've never seen an anesthesiologist or CRNA sit there read magazines/books/do crossword puzzles/sudoku while in the middle of a case. I love the OR. I like watching (if I can't do) surgeries. I like the pre-op, periop, and post-op aspects of patient management. I love procedure, and in anesthesia there are lots of it. Intubations, bronchs, IVs, lines, epidurals/spinals, etc. You are the reason the surgeon is able to properly operate and if you screw up, you can cause the death of a patient. Yes, the surgeon gets the glory like the QB on a football team, but a QB alone doesnt win the game. It's a team effort when it comes to the management of the surgical patient. That is why I don't mind being an anesthesiologist if I decide surgery ultimately is not for me.

Plus, the attendings aren't as malignant as they are in surgery.

 

[Guile]

In private practice, they have many magazine subscriptions and burn through them during the cases. Following the stock market and making intraday trades also seems to be a popular activity. I've had to minimize etrade.com when using their computer on several occasions.

 

[Doctor4Life1769]

In private practice, they have many magazine subscriptions and burn through them during the cases. Following the stock market and making intraday trades also seems to be a popular activity. I've had to minimize etrade.com when using their computer on several occasions.

I've not had experience with PP Anesthesiologists, so I can only take your word for it.

So, only anesthesiologists do this in their office? I imagine physicians in other fields probably do the same (meaning, I think it's more or less an individual thing).

 

[kdburton]

I've never seen an anesthesiologist or CRNA sit there read magazines/books/do crossword puzzles/sudoku while in the middle of a case. I love the OR. I like watching (if I can't do) surgeries. I like the pre-op, periop, and post-op aspects of patient management. I love procedure, and in anesthesia there are lots of it. Intubations, bronchs, IVs, lines, epidurals/spinals, etc. You are the reason the surgeon is able to properly operate and if you screw up, you can cause the death of a patient. Yes, the surgeon gets the glory like the QB on a football team, but a QB alone doesnt win the game. It's a team effort when it comes to the management of the surgical patient. That is why I don't mind being an anesthesiologist if I decide surgery ultimately is not for me.

Plus, the attendings aren't as malignant as they are in surgery.

Haha are you serious? When we're in long surgeries at my school the CRNA or anesthesiologist (residents and attendings) is almost always playing on the iPhone, reading a book, doing crosswords, etc. The surgeon will ask "how's she/he doing?" about every 20 minutes or so but other than that there is no interaction with the anesthesiologist. And they are rarely, if at all, peeking over the blood-brain barrier to watch the surgery haha.

 

[dantt]

The other day I saw the anesthesiologist/CRNA fall asleep. The scrub nurse and circulator saw it too and quietly woke him. If the surgeon knew, he would have been toast.

 

[agranulocytosis]

Haha are you serious? When we're in long surgeries at my school the CRNA or anesthesiologist (residents and attendings) is almost always playing on the iPhone, reading a book, doing crosswords, etc. The surgeon will ask "how's she/he doing?" about every 20 minutes or so but other than that there is no interaction with the anesthesiologist. And they are rarely, if at all, peeking over the blood-brain barrier to watch the surgery haha.

In very long cases it actually wouldn't be unheard of for the resident(s) to get relief by the CRNAs or anesthesiologist. In one 90-minute case I remember the resident I was following got offered 5 breaks.

He only took 1, but still.

 

[PranBobbyJohnny]

In very long cases it actually wouldn't be unheard of for the resident(s) to get relief by the CRNAs or anesthesiologist. In one 90-minute case I remember the resident I was following got offered 5 breaks.

He only took 1, but still.

relief for a 90 min case? What has the world come to?

 

[Winged Scapula]

relief for a 90 min case? What has the world come to?

Haven't you heard that we sleep in 90 minute REM cycles? Sounds like perfect timing to me.

 

[Doctor4Life1769]

WS,

How did you know you wanted to be a surgeon? I can't decide, I'm truly 50/50 at this point.

 

[Noeljan]

I am finding surgery wayyyy easier and less tiring than my medicine rotation. At the end of the day on medicine (either in or outpatient) I always felt exhausted. In surgery I can be in 5 cases in one day and feel like I want to workout after. I love the focus and hands on approach in surgery. I also love anatomy and the skill set. I am also the kind of person that needs immediate feedback/results. I love being in the OR and seeing the inside of the human body. I would be unhappy/upset if I knew surgery was going on and I wasn't a part of it (ie working in medicine). The things that irritate me about surgery....it is more hierachial than any of the fields I have seen thus far. In medicine or family medicine for example, attending were more open to listening to what you had to say (and you didn't get the feeling that they thought they were ALWAYS correct unlike some attending surgeons that even if you read it in 6 different sources the night before they do NOT even want to consider the idea that their opinion/knowledge could use a tad of tweaking). Despite this, I'm going to put up with it because I know that surgery is what I will be happiest doing and love. When I think about it this is actually key...despite being in love with an attending on one rotation, or not as in love on another that wont guide my decision after all🙂 That being said, all the surgeons have been very very nice people (and are very straightforward with how they feel about something). It is just the extreme keeping your mouth shut/hierarchy no matter what that seems to differ a little bit from other fields that takes a tad getting used to I think.

 

[SouthernSurgeon]

relief for a 90 min case? What has the world come to?

We had a CRNA get relieved for a break before we even started the case once!

 

[GreenShirt]

You are missing something here.

While they may be in the office or OR from 8 to 5, there are mounds of paperwork, patient charts, etc. to do. I have had students rave about my lifestyle specialty until they realized I worked on charts and paperwork until 10 pm most nights and on the weekends. Just because the patients aren't coming in after 5 doesn't mean the work stops. Most surgical offices also don't close for lunch whereas other specialties do.

They may seemingly work less than the surgeons in the academic medical centers, but PP general surgery is not a 8 to 5 gig.

True but a family physician can sit in their office until 9pm everyday completing charts too and they have to see a lot more patients.

The GS's find extra time to finish paperwork through other means. For example, it can take up to an hour between cases to finish one patient and start another so the GS's are able to do paperwork, dictate, complete their rounds, and hang out in the lounge in that time. In the afternoons they go to the office and see a lot of patients in a short time(= paperwork afterward). However, the GS's I work with (we're talking 3 different hospitals) all take half a day off during the week and schedule less office patients on Fridays which gives 'em extra time to finish up on their paperwork.

I'll admit that when you include call and charts it can be more of 50 than 40 hr/week...but again that's true of a lot of specialties.

 

[Winged Scapula]

True but a family physician can sit in their office until 9pm everyday completing charts too and they have to see a lot more patients.

That's not relevant here. No one is claiming that FMPs don't also have a lot of paperwork to do. We all do. I am suggesting that your experience with General Surgeons is not typical and that you post made it appear that you were assuming that once they are done in the office the work is done.

The GS's find extra time to finish paperwork through other means. For example, it can take up to an hour between cases to finish one patient and start another so the GS's are able to do paperwork, dictate, complete their rounds, and hang out in the lounge in that time. In the afternoons they go to the office and see a lot of patients in a short time(= paperwork afterward). However, the GS's I work with (we're talking 3 different hospitals) all take half a day off during the week and schedule less office patients on Fridays which gives 'em extra time to finish up on their paperwork.

1) 1 hour turn over time is not typical in a community setting, so most of us don't have that luxury to do all of our paperwork and hang out in the lounge between cases. I barely have time to talk to family, dictate, write the post-op note, orders, scripts and get to see the next patient before the room is turned over. At surgery centers, its even quicker (although the paperwork is thankfully less).

If your surgeons are happy with a 1 hour turnover time, more power to them. But sitting in the lounge, doing paperwork, dictating = not making money and getting home later. They should be pushing the staff to turn over the room faster so they can book more cases in a day.

2) taking a half day off during the week and a light load on Fridays is again not typical of most general surgeons in PP especially given the looming cuts (and those already which have happened, ie, loss of consult codes)

Your school may be placing you with less busy surgical practices. I understand its a new school. The busier practices tend not to have students because it slows them down. My partner will no longer accept students or residents rotating with her for that very reason.

Again, I suspect that we have different experiences and that you may be underestimating the amount of work there can be. This is not meant to be critical but too many students see posts like this, or have a similar experience and assume that its typical for a general surgeon and come into residency and practice thinking they can find a 50 hr per week job. In most cases, it is very difficult unless you have a slow practice (ie, make less money), are tapering down toward retirement or aren't on a partnership track (ie, an employee).

You can make your own practice the way you want it, but most surgeons I've spoken to are working MORE given the rising costs of running a practice and the declining reimbursement.

 

[Winged Scapula]

WS,

How did you know you wanted to be a surgeon? I can't decide, I'm truly 50/50 at this point.

I became enamoured of surgery during my core surgical rotation, having never thought about it before medical school (and actually actively discounting it as a career choice).

I had wonderful faculty who encouraged me, were patient with me and like so many others, I enjoyed doing things with my hands, the fast paced nature, the decision making, the dark sense of humor and felt that I fit in. Once I did IM (which was my original choice) and FM, I was bored to tears, the days dragged on and I haunted the ORs after hours and on weekends looking for cases to scrub into. The residents would even call me at home if they had an add on they thought I would be interested in.

Really the same story as most people; interestingly, of those classmates who just knew they were going to be surgeons from day 1 of medical school, only 1 other did so (and he vasovagaled the first day in the OR). 😀

 

[PranBobbyJohnny]

I really like surgery but anesthesia sounds too chill. Then again, if I were an anesthesiologist I would probably envy the surgeon every day and think to myself, what could have been....


Btw, Dr. Cox, are you sad scrubs might be on its last season 🙁

 

[GreenShirt]

That's not relevant here. No one is claiming that FMPs don't also have a lot of paperwork to do. We all do. I am suggesting that your experience with General Surgeons is not typical and that you post made it appear that you were assuming that once they are done in the office the work is done.



1) 1 hour turn over time is not typical in a community setting, so most of us don't have that luxury to do all of our paperwork and hang out in the lounge between cases. I barely have time to talk to family, dictate, write the post-op note, orders, scripts and get to see the next patient before the room is turned over. At surgery centers, its even quicker (although the paperwork is thankfully less).

If your surgeons are happy with a 1 hour turnover time, more power to them. But sitting in the lounge, doing paperwork, dictating = not making money and getting home later. They should be pushing the staff to turn over the room faster so they can book more cases in a day.

2) taking a half day off during the week and a light load on Fridays is again not typical of most general surgeons in PP especially given the looming cuts (and those already which have happened, ie, loss of consult codes)

Your school may be placing you with less busy surgical practices. I understand its a new school. The busier practices tend not to have students because it slows them down. My partner will no longer accept students or residents rotating with her for that very reason.

Again, I suspect that we have different experiences and that you may be underestimating the amount of work there can be. This is not meant to be critical but too many students see posts like this, or have a similar experience and assume that its typical for a general surgeon and come into residency and practice thinking they can find a 50 hr per week job. In most cases, it is very difficult unless you have a slow practice (ie, make less money), are tapering down toward retirement or aren't on a partnership track (ie, an employee).

You can make your own practice the way you want it, but most surgeons I've spoken to are working MORE given the rising costs of running a practice and the declining reimbursement.

Oh, I believe you. I know that surgery didn't get its tough reputation through the scenarios I'm describing. I'm in fact a little worried that my experience differs so much from the norm that it would be a mistake to pursue this specialty without experiencing a teaching hospital where notes have to be on the chart by 5AM, days are 14hrs long and you're on call all night. Although, I think if I'm gonna spend 14hrs/day at work, I'd prefer to spend half of it operating rather than adjusting cholesterol medication.

 

[45408]

I've never seen an anesthesiologist or CRNA sit there read magazines/books/do crossword puzzles/sudoku while in the middle of a case.

Really? The most recent case I did, the anesthesiologist was browsing Russian MP3 sites for music downloads on her laptop and texting furiously every 1-2 minutes. When the 2008 election was coming up, the anesthesiologist was showing us the Tina Fey SNL skits over the drape while we were doing a herniorrhaphy.

 

[45408]

Oh, I believe you. I know that surgery didn't get its tough reputation through the scenarios I'm describing. I'm in fact a little worried that my experience differs so much from the norm that it would be a mistake to pursue this specialty without experiencing a teaching hospital where notes have to be on the chart by 5AM, days are 14hrs long and you're on call all night. Although, I think if I'm gonna spend 14hrs/day at work, I'd prefer to spend half of it operating rather than adjusting cholesterol medication.

You probably should do just that. I just finished all my gen surg interviews, and I'm nervous about residency, but I had several surgical rotations with 80+ hours weeks, overnight in-house call, etc. It was useful for me to see if I could handle it at all. If I had been overwhelmed as a student, it definitely wouldn't work as a resident.

 

[oliviastudent]

Oh surgery....surgery surgery surgery...
Well I wouldn't particularly enjoy doing general surgery. Maybe if I were to change I would perhaps consider Orthopedic Surgery. Still not even too sure about that. I've never really been a "artsy/craftsy" type either and I put surgery under that category. I think I'll stick with Pediatric Oncology..🙄

 

[Old_Mil]

Okay so general surgery defies the typical compensation to residency competition rule. Considering how relatively easy it is to get general surgery residency, its has pretty good compensation?
Why aren't more people taking this. The only thing I didn't like about it was the standing, but other than that it was low stress 😀

Because the quality of life in certain fields is so poor that no amount of money can really make up for it. In surgery and its associated fields the hell begins on your first day of training and ends at your funeral (maybe).

 

[Aphasic]

I think people go into surgery because they enjoy it. Yeah the hours can be long, but when you truly like what you are doing you don't mind working hard for it (hence med school). Honestly, I've never met a neurosurgeon who didn't love his/her job. I've been working >95h/w on my NS rotation (mostly because I choose to stay for cases and consults going late), and I really love it. Sure my feet hurt, my back hurts, and I'm NPO for the most part, but, for me, it hurts a lot less than my 25h/w on FM.

Compensation wise I'm pretty sure Gen Surg residents are working at least 80-100h/w, and prob 60-80h for attendings, depending on their practices. Though I'm not really well-versed when it comes to compensation, I still have a long time before my net income is positive.

 

[Jwax]

When discussing my interest in pursuing surgery with one of my attendings, I mentioned the lifestyle sacrifice involved. He interrupted with a mini-speech on how there is no lifestyle sacrifice, yadda yadda. Asked about how many hrs/wk he worked, the answer being on avg 65. He pointed out that if you work 12hrs/day x 5 days/wk that's 60 hours.

I must be sick, because that rationale made sense to me and I thought, yeah, that's not too bad!

 

[kdburton]

I was talking with some of the surgery residents at my school's program last night when I was on call and they said that in the event that the ACGME tries to further decrease the work-hours restriction (to <80hrs), there are a number of chairmen who are talking about withdrawing from the ACGME and developing their own accreditation council so that they no longer have to follow those rules. Anyone heard anything about this?

 

[Guile]

I was talking with some of the surgery residents at my school's program last night when I was on call and they said that in the event that the ACGME tries to further decrease the work-hours restriction (to <80hrs), there are a number of chairmen who are talking about withdrawing from the ACGME and developing their own accreditation council so that they no longer have to follow those rules. Anyone heard anything about this?

I have heard that many chairmen are threatening to resign in protest of a new, lower limit to work week hours but this is the first I've heard about a new accreditation council.

 

[Winged Scapula]

I have heard that many chairmen are threatening to resign in protest of a new, lower limit to work week hours but this is the first I've heard about a new accreditation council.

There is such talk and there would have to be a new accreditation council or an agreement from the American Board of Surgery to accept the interim training. Right now, BE/BC requires graduation from an accredited surgery residency.

 

[Guile]

There is such talk and there would have to be a new accreditation council or an agreement from the American Board of Surgery to accept the interim training. Right now, BE/BC requires graduation from an accredited surgery residency.

So to be board eligible/certified, you have to graduate from an accredited residency. BE/BC status is given by the American Board of Surgery, so if they decide to break with the ACGME then they could accredit residency training programs and set their own hour limit restrictions?

 

[Winged Scapula]

So to be board eligible/certified, you have to graduate from an accredited residency. BE/BC status is given by the American Board of Surgery, so if they decide to break with the ACGME then they could accredit residency training programs and set their own hour limit restrictions?

It likely would not be the ABS who would accredit surgical training programs but another body.

What is more likely to happen is that any additional lowering of work hours will be specialty specific, with surgical training programs being allowed to either lengthen training or function under longer work hours.

 

[Jolie South]

Oh, I believe you. I know that surgery didn't get its tough reputation through the scenarios I'm describing. I'm in fact a little worried that my experience differs so much from the norm that it would be a mistake to pursue this specialty without experiencing a teaching hospital where notes have to be on the chart by 5AM, days are 14hrs long and you're on call all night. Although, I think if I'm gonna spend 14hrs/day at work, I'd prefer to spend half of it operating rather than adjusting cholesterol medication.

I had the same experience with a private practice surgeon. There was an academic service and a private practice service at the facility where I worked and needless to say the differences in terms of hours and types of cases were huge.

I have to agree with 14 hours adjusting diabetes, HTN, and cholesterol meds. Not for me.

 

[radtacular]

I had the same experience with a private practice surgeon. There was an academic service and a private practice service at the facility where I worked and needless to say the differences in terms of hours and types of cases were huge.

I have to agree with 14 hours adjusting diabetes, HTN, and cholesterol meds. Not for me.

I've also seen some academic places where the attending's had fairly decent lifestyles. They usually didn't stroll in until right before their first operation, so save for having to go to grand rounds it really didn't seem like particularly terrible hours.

Was a pretty large practice group too so as far as I could tell the call wasn't too bad, definitely no q2's or q3's. That said, it seemed like it really did suck when they actually got called in, and even when they didn't get called in a lot of the time they had to answer a lot of 2-3 AM calls. Probably the calls more than anything else is a turnoff for people interested in lifestyle.