Why Gen. Surg applicants are down

THe thing to remember is that ALL residencies have their peaks and troughs. Right now surgery is in a trough and anesthesia is on a peak. PM&R was hot a couple of years ago and now it has cooled. Who knows what the future will bring, but in my opinion, the future of surgery is going to be fine.

 

I agree with most of what you said, but it appears that PM&R is peaking, not cooling.

 

As a surgeon in training I interpret most of the tail-off in applicants to declining reimbursements for a very tough job. That situation changing (or more importanly, the perception by students that it is changing), will affect the aplicant pool. The situation is in parallel with the decline in cardio-thoracic surgery among general surgery residents, if those guys were still making $1 million+ a year it would be as competative as it used to be. When they get paid 50% or less of historic levels & work harder on sicker patients, it curbed a lot of people's enthusiasm

 

I agree with droliver. reimbursement as been hit hard in all surgical fields, but especially general surgery. Young attendings are having to work harder than ever to attempt to make half of the salaries of the early 90s. All in all, sad as it may be, i think that external forces have changed medicine from a profession to a job. While general surgery used to be a great profession, it is kind of a ****ty and very difficult job with often more headaches than gratification. Add to it the finances, and it is a very unappealling career for medical students. I am not sure this will change very soon, and I expect the trend to continue for many years. This is not an up or down thing as the other fields that have mentioned. It is the result of some very serious problems with the current medical system. The applications in surgery have been steadily dropping for 15 years. Program directors were blind to this because there were always more applicants than available positions. We will see what happens....If I were a fourth year medical student, I would be very weary about a career in surgery. If I were a graduating college student, I would have to look very hard at the medical field in general. I enjoy my job lots, but I could not strongly recommend a career in medicine to a close friend.

 

Wow Juice,

Those are very strong feelings toward surgery and the medical profession. As I matriculate to medical school this Fall it sounds depressing. However, I suppose if one has the passion and aptitude for becoming a physician its the field of choice (for me)!

care

 

</font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> if those guys were still making $1 million+ a year it would be as competative as it used to be. When they get paid 50% or less of historic levels & work harder on sicker patients, it curbed a lot of people's enthusiasm </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">

Although I doubt I will ever chose the field of thoratic or vascular surgery later in life, mainly because of the amount of residency years you have to go through.. but if I truly loved surgery and thoratic surgery and I knew I would be making $500,000 a year.. I think that would push me to strive for it. Sure it isn't $1 million a year but you can live a very extravegant life when making half a mil a year.

 

To live an extravagant life you have to have time to spend it. But your significant other can have a blast!

 

I just had a question. Is being a Cardiac Thoracic Surgeon under the SURGERY residency or is at fellowship of IM (like cardio)? Sorry to be so ignorant.

Secondly, I've always thought surgeons are considered the best docs. I mean hands down, you have to understand that these guys actually have hte lives of people in their own hands! I mean that to me is a great responsibility which should receive the utmost respect and money.

I know my stand on this might be a little unrealistic, I'm only going to be starting med school. However, I think the sheer honor and respect that a surgeon receieves is truly unbeatable.

I would like to one day become a cardio thoracic surgeon, partly because it sounds great; however, partly because you have a human body in your hands. I just find it fascinating and interesting that these guys can truly make or break a person.

 

Nobadwords,

Kimberly is very right in saying that the respect and "awe factor" that docs enjoyed has cooled down in recent years.

</font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> I would like to one day become a cardio thoracic surgeon, partly because it sounds great; however, partly because you have a human body in your hands. </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I agree with you that it is a FASCINATING subspecialty. But believe me....your perspective WILL change once you spend time on the surgical service, you will be on the other side of picture....not the glamorous, exciting, wealthy, 'godly' image people have of surgeons, but the sleepless nights, tiring days, stressful, no-time-for-loved ones side of the picture.

 

</font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by docronmd1:
<strong>Nobadwords,
But believe me....your perspective WILL change once you spend time on the surgical service, you will be on the other side of picture....not the glamorous, exciting, wealthy, 'godly' image people have of surgeons, but the sleepless nights, tiring days, stressful, no-time-for-loved ones side of the picture.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">This statement is just as incorrect to me. Your perspective as a student rotating on a service for a short period of time just doesn't acurately reflect the ebb & flow of training as well as the lifestyles available in practice.

 

From personal experience I can say that I always thought I wanted to do surgery, for years, that was my primary reason for going to medical school. Then I did my surgical rotation, and it changed. I began to realize that I didn't want to spend my entire time in the hospital. I saw many attendings spending all kind of crazy hours in the hospital. Although I saw a lot of interesting things, and I enjoyed my rotation very much, I began to eliminate the surgeries I didn't like, and was left with only really liking ortho and plastics, both which are extremely competitive and not a likely option for me as an FMG. And when I summed it up, I couldn't see myself doing 5 years of GS--sacrificing my prime social years, to then do 2 years of a fellowship, etc. SO wait until you actually do your clerkships before you decide, I didn't think it would change for me, but it did. To do surgery, you would have to love it to the point where you could not imagine yourself possibly doing anything else in medicine.

 

hey guys

I mean i do agree with NOBADWORDS. surgery seems to be prestigious, etc. I would love to do it one day also. HOwever, going to be only a first year in med school ( a carib one) i understand that my chances are lowered.

Nevertheless, it's still a dream.

 

I had always heard it before, but now in med school, I've seen it to be true: most of your profs will be physicians and they will never pass up a chance to put down a surgeon. ie. a name of a drug: "Here's one even a surgeon can spell!" so I guess there's also that bias against surgery that develops in med school.

 

I don't know what bias against surgeons you guys are talking about (ortho yeah, but not general surgery). Pretty much everyone I in my class I have discussed it with respects surgeons greatly as diagnosticians and physicians. I, for one, have the utmost respect for my surgical colleages. The fact is, that not many people want to go through the rigors of residency or have the perceived lifestyle after residency. Only those who could not imagine doing something else go into general surgery.

For those who here the occasional flippant comments about surgeons not being bright, you have to realize that every specialty talks about every other one in a mostly jokingly derogatory way. I've heard many a surgery resident talk bad about medicine residents. Every specialty says rude comments about radiologists (just check out DigableCats wonderful comments on the <a href="http://forums.studentdoctor.net/ubb/ultimatebb.php?ubb=get_topic;f=11;t=002016" target="_blank">Why Anesthesiology</a> thread). Despite all of this, every physicians in every specialty realize the necessity of other ones.

To all those who want to do surgery, and there are still many who do, congratulations on choosing such a rewarding and difficult career.

 

I think many of you are missing the point. You should not choose a specialty based on the percieved image of the specialty, but rather on what you want to do, and what fits with your own strengths. If you like procedural skills, like taking care of sick patients, like spending 120+ in the hospital, than sure choose surgery. Don't choose it because you like the image of the surgeon.

As for is it that bad??? HAving just completed the first 11 months of a general surgery residency i can say from personal experience that it is that bad. I am exhausted and tired of being worked beyond the point of exhaustion, and being abused by seniors, staff, nurses, and patients. OK, i still think it's worth it, but there are many times during the day that i have to remind myself of it. Be sure you know what you're getting into when you choose surgery.

 

So we only want surgeons that are masochistic?
Somehow I think we should broaden the base of potential applicants. It will be better in the long run for patients and applicants. The hospitals would lose some money, of course. And that is the reason they will fight anything that treats residents as employees (ie: human beings).

I have to say, the medical industry is one of the most self-destructive, evil, collusive industries I have ever seen.

 

tussy,

You make an excellent point. One's aptitude and desire to do a certain job should be one of the main criteria for choosing a career. Do not choose surgery just because you like the idea of becoming a surgeon. I actually thought about surgery for a while during my rotation because I enjoyed being in the OR and I liked the idea of being a surgeon. As I thought through what really excites me about medicine regardless of the perceived prestige, I realized surgery was not for me. I chose radiology because I realize that I am not that procedural. I prefer to think about things and figure them out. I also love the high tech aspects of the field.

 

One's desire and competence as a surgeon has nothing to do with his willingness to work 120+ hours/week as a resident.

I venture to say that it has more to do with blind and naive faith in authority figures.

 

I on the other hand always knew I was going to do surgery and then plastic surgery since I was a teenager

 

How much do general surgeons make? On this web site, it lists the average salary of genral surgeons as 150,000. That seems WAY to low. Do general surgeons only make 150K a year????

 

I see $261,276?

Are you looking at the starting average?

 

Remember though that academic physicians get cut a break on malpractice insurance, which is partly, if not completely subsidized by the institution. So don't feel too sorry for em.

 

Oops. My bad. My figure was for starting. Your figure of 261K is average salary for physicians who have been in practice for 3 years. What's disappointing is that during the same time period, orthopedic surgeons make on average 346K.
That's almost 80K difference. Hmmm...maybe orthopedics isn't such a bad idea afterall, assuming I can swing a spot...out of curiosity, why would someone choose general surgey over orthopedic surgery, especially considering the salary discrepancy and lifestyle differences?

Incidentally, vascular surgeons make quite a bit of cash. Vascular surgery is a 2 year fellowship after general? How many years of research after the 5 years of general do applicants need to be competitive?

 

loneseal,

if you're making a decision based on monetary and lifestyle issues, maybe you should consider something outside of medicine. almost all fields in medicine, with a few exceptions, have tough hours and have lower rates of reimbursement than what perhaps you envision. being on the admission committee, it is intersting to see how many people think that they are going to be making a lot of money when they come into medical school. true, you do make money, but not a lot, or at least not as much as in non-medical fields. bottom line is you need to find out what you like because if you make 250k/year and you hate it then what type of choice is that? i'd rather make 160k/year and love to go to work everyday.

people go into general surgery and not become orthopods b/c they like the field of general surgery. by the questions/comments you posted, i would really think twice about a surgical profession. as kim said, if you want to make more $, become a crna.

 

I agree with you--money is important to me. However, money is NOT the be all and end all for me. although judging from just my post alone, it's possible to think that. For me, money is just one aspect--albeit an important one-- when it comes to choosing the field that I want to do the rest of my life. In the end, I'm going to choose a field that I LOVE to do but that will also provide a comfortable compensation. I'm a realist not a dreamer. And to accomplish that, it naturally follows that one will ask questions and learn to trust oneself.

If you take offense to my questions, that is certainly your prerogative and your problem. In the end, you can keep your "thou-is-holier" attitude to yourself.

 

From what I've seen throughout 3rd year, even in "easier" residencies, you still potentially may take q3-q4 in-house overnight call, depending on the month. When I was on Pediatric wards, students and residents put in 80 hour weeks at least. Granted, general surgery residencies are at least 5 years (compared to 3 on med, FP, and Peds), I think it is worth it given that you'll be doing it for the next 30- 40 years of your life.
Also, since most med schools don't offer much exposure to private surgical practices, most people only see surgery through the university setting. Private practices are often much less brutal that what we are exposed to in medical school.
I wonder if it is possible in the near future that 80 hour work weeks with one day off per week (like in N.Y.) will be enforced nationwide? If that becomes the case, I think that will remove one of (which most people view as) the biggest drawbacks of entering a surgery residency. JMO

 

It is a big topic of discussion as to why interest in general surgery is down amongst the surgical fields.

What are your thoughts on the subject.

I was asked this question when I interviewed for G.S. last year on more than one occasion. My answer was simply that the pay and lifestyle stink. However I think it is more complicated than that.

I think big considerations are:
length of residency
resident work hours
Bad pay post residency
Life style during and after residency
Attitudes of current surgeons

What are the reasons you would or would not go into general surgery? What can be done differently to generate more interest amongst medical students?

 

Hours after residency would be the biggest one for me. I have the perception that general surgery is not conducive to a healthy family life. Maybe that is a faulty perception, but I think that perception is pretty common among pre-meds.

Also the perception of current surgeons doesn't help either. I am a fairly driven and motivated person, but that is different from being an egotistical prick, which is what many people think of when they think of surgeons.

I think it is may be more a matter of bad PR than of anything else, at least when you are talking about premeds and MSIs and MSIIs. Maybe 3rd and 4th year students feel that way for different reasons.

 

I used to think I wanted to be a surgeon. It seemed like the most fascinating specialty, where one could make the biggest difference and often see the results right away. But the more research I did into it the less appealing it became. The money factor doesn't matter to me, no matter what specialty I choose I will make enough money to be comfortable. To be honest the insane work hours I've heard surgeons must put in is what has turned me off the most. Working 100 hours + / week would change who I am. Friends are important to me and working 100+/week would ensure I had no time for friends. I want to be a doctor but I also want some semblance of a life and 100 hrs/week the only thing I'd have time to do is work and sleep.

As it stands I am currently leaning towers IM as a specialty. But I won't really know until I've done rotations and seen it all first hand... if I loved surgery enough, and I think it is possible that I could, then maybe I would say to hell with it and do it anyway.

A few months ago in my city a fairly prominent surgeon retired early, he was about 45 years old. It made the news and I remember thinking it reflected poorly on surgery as a specialty because he said, in his interview, the reason he was retiring is he had no time for his family. His children were tired of not knowing who their father was and his wife was tired of being married to a man who was never there. He said he worked well over 80 hours/week and he couldn't take it anymore. He had made enough money, and been able to save it since he had little time to spend, that he could retire comfortably and so he did so. He looked like a good enough guy, he was charismatic and I found myself unable to look away. His slumped shoulders and his whole demeanour was that of a man who was defeated. He enjoyed his work but he did not enjoy it to the point of excluding everything else from his life. The fact that he had been forced into such a position for me was a big strike against surgery.

I guess all of these things combined has battered away at my notions of becoming a surgeon. I still haven't given up the thought completely though and I won't decide for sure until I've done rotations. I wonder what would happen if a surgeon of a hospital suddenly said 'Look I am only going to work 50 hours/week. If you ask for more I simply won't show up. This is the choice cut my hours to 50/week or fire me' Would they fire him without hesitation? I'm just curious

 

A trauma surgeon told me once that he never missed a single soccor game his kid played because he would take the chance to work at night and spend the day with his family. He also reassured us that if you want to, you can fit your career to conform to the lifestyle you want, no matter what field. I am not sure how correct he is. But I have seen some physicians working part-time or get involved in research projects and spend only 2 afternoons a week seeing pts so they can be with their family more.

 

Physicians can almost always adapt their professional lives to their social lives; but, to work only nights, only work part time, or take time to do research, you also take a huge pay cut. And also, these jobs are hard to come by. Can you imagine a part-time surgeon in the middle of a 10 hour operation saying "oops, my shift is up, gotta leave"?

I thought about surgery when I was a pre-med but now that I have more exposure to that specialty, I realized that its probably not for me. I want to pursue my non-medical interests, which I have been very successful prior to getting in to medical school. No amount of money is going to force me to give up that aspect of my life.

Another aspect that turned me off was the people in surgery. I haven't had a lot of contact with attendings or residents (they might be different), but a number of surgeons-to-be in my class are not exactly the most popular/easy to get along with people(this is not to say that there aren't nice surgeons around...I just haven't met that many). The worst/most arrogant kind that I have come in contact with are those have had no prior success in their lives who take the idea of "becoming a surgeon" as their life-achievement too seriously. This is not to say there are no people like that in other fields. I just think that if people have had been successful before, then maybe they will get a more well-rounded perspective on medicine-I can get on an entire tangent on this last sentence but that is for another thread and another time.

 

I'm pretty ignorant about this stuff (admittedly I rarely leave the pre-allo forum) so I would appreciate it if someone could explain to my just WHY surgeons are forced to work such hours. I've worked 80 hour weeks in the business world, and though nasty and life-draining, I know I can do it. But 120 hours?!!? I mean there are only 168 hours in a week total. I think someone even said earlier that 140 hour weeks are possible. THAT'S TWO HOURS PER DAY NOT AT WORK!!

Why?

Is is jut hazing by the superiors i.e. 'I did it, now you have to too'? That is a pretty silly reason, but a pretty hard cycle to break. Is it just that there aren't enough qualified people around, such that one qualified surgeon has to do the work of two?

 

I think there a couple of reasons for the long hours that a residency requires.

1. The "fraternity" aspect that Zoobaby mentions. It is sort of an initiation ritual to make the young doctors work an ungodly amount of hours.

2. Changing the system will cost more. Though they are in training, they perform a huge amount of work. If they cut down on the amount of hours, someone still has to do the work. My infant nephew was in the hospital for 7 days last month and at least one of his parents were at the hospital 24/7. They did not see an attending physican once. Not once. The resident handled everything.

3. Residents are young and residencies are for a relatively short, predefined period of time. Residents could fight hard for short working hours and would probably win eventually. But by the time they do actually win, they are done with their residency, and have probably screwed their careers. It is sort of like age discrimination for youth. Young people (18-25) are severely discriminated against in many ways: higher insurance, can't drink, can't rent a car, etc. No one really cares, though, because by the time you are done fighting, you are old enough to do those things.


Those are the main reasons, as I see it. If the public would every realize that a surgeon on their surgury team has been up for 30+ hours straight, the laws will change.

 

Things ARE changing. The Residency Work Hours Bill, H.R. 3632, was introduced to the House a few months ago, and it is quickly gaining support. This bill would limit work hours to 80 per week and limit shifts to no more than 24 hours. A corresponding bill was subsequently introduced to the Senate by Sen. Corazine. Now, more than ever, the lay public is beginning to get a better picture of what is going on in the training process, and I anticipate that we will see changes over the next few years.

As for residents not wanting to fight, I think you're absolutely right. Medical students typically are rather apathetic about activist issues, and they and residents alike are too busy (or at least think they are) to fight these issues. If you do want to be involved, though, in changing the system, there is no better way to do so then to join in the fight yourself. American Medical Student Association (AMSA), for example, is an organization of medical students and other physicians-in-training that represents the causes and issues relevant to students and residents. We helped introduced both the House and Senate bills, and we fight on many other issues as well. So if you want to fight for your rights and for better working conditions as a resident, there's no better time to start than now!

 

what I find sad in this story is that he saw it as an either/or choice - either 80 hrs/wk or 0 (retirement). What about cutting down the number of patients he sees or otherwise changing his practice so that he can work less hours - if he can afford to quit it seems like he can afford to just cut down ... of course the malpractice $ might cut into what is left ...

 

It sounds like this guy didn't need much sleep. If he worked during the night, then he should've slept during the day. If he was at his son's soccer games during the day, then that may have been cutting into his sleep.....perhaps he didn't need much sleep ?

 

Now I'm wondering, for all of those people who say they do not want to do surgery because of the horrible hours will you guys change your mind now that residency hours will only be 80hrs/week?

It seems like the biggest gripe is the hours. Now that will be alleviated.

Surgeons as "pricks"? Well, that will be eliminated if less pricks enter the field. (Hopefully I'm not one of those pricks.) Surgeons do have to be extremely confident in their skills and make rapid assesments/plans at times which is often misconstrued as being a prick.

 

Why are there so many grammatical errors and misspelled words in the surgery forums? Remember:"He who works with his hands is a laborer. He who works with his hands and his mind is an artisan."

 

OH JEEZ!! He who works... blah blah blah. It's a FREAKIN' forum on the dang internet. CHILL OUT and go edit some manuscript and leave the forums alone.

I ain't carin' bout nothin you says anyways cuz i gots the best grammars of anybodys and i write just as good as everybody else does

I love critics.