Would a Peds Surgeon Still Feel Comfortable working on Adults?

[DoctaJay]

Since Pediatric Surgeons are usually labeled as the last true General Surgeon, I was wondering whether fellowship trained peds surgeons COULD still pick up general surgery in adults if they wanted to; or does the specialization cause them to be less comfortable with with adults even after 5 years of training?

Also is there at all a trend inside peds surgeon for sub-specialization?

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[SocialistMD]

Since Pediatric Surgeons are usually labeled as the last true General Surgeon, I was wondering whether fellowship trained peds surgeons COULD still pick up general surgery in adults if they wanted to; or does the specialization cause them to be less comfortable with with adults even after 5 years of training?

One benefit to specializing is that one can avoid those things out of one's area of expertise/interest. Most pediatric surgeons I know would rather not operate on adults (and the issues they bring). There isn't a paucity of pediatric cases, so there isn't really motivation to do operate on both adults and children. Would most of them be comfortable with it? Probably (they operate on teenagers who are sometimes bigger than most adults), but the interest isn't there.

Out of curiosity, what adult cases would you want to do as a pediatric surgeon? There are adult surgeons who do pediatric appys and hernias (some even do pediatric "index" cases), but if you are going to be a pediatric surgeon doing a lot of the "true" pediatric surgery cases(read: congenital defects), you'll likely be working at a free-standing pediatric hospital or at the very least a major academic hospital where you won't need or be encouraged to take adult call/see adult patients.

Also is there at all a trend inside peds surgeon for sub-specialization?

Only at the major academic hospitals (CHOP, Cinci, etc...) where they have so many surgeons they can afford to specialize.

 

[Winged Scapula]

Agree with SocMD...why would you want to?

We had some Peds Surgeons who would occasionally operate on adults, but these were always long term patients of theirs whom they felt no one else would really know that particular patient's anatomy as well as they did. In addition, as SocMD notes, some of these teenagers are pretty big "kids". Still remember seeing one 14 yo lug in the PICU dwarfing all the babies.

I know you are looking for the broadest surgical training to befit your interests in missionary work and that is admirable. But trying to do it all it not feasible or necessary. Peds Surgeons, especially those in academic hospitals, are doing lots of index cases that you won't be doing on adults. Don't get me wrong- you'll still do lots of hernias and appys, but most adults aren't in need of a TEF repair, a Soave or PSARP.

Finish GS residency, do a Rural GS fellowship if you like or an Acute Care one, and you will be well training for whatever you choose to do.

 

[DoctaJay]

I guess I was more so concerned as to whether fellowship training after 5 yrs of GSurg residency caused u to lose a little of what you previously learned; but u guys cleared that up for me. Thanks alot!

 

[mercaptovizadeh]

I guess I was more so concerned as to whether fellowship training after 5 yrs of GSurg residency caused u to lose a little of what you previously learned; but u guys cleared that up for me. Thanks alot!

Agree with WS. The need in the developing world for ANY medical help means that your skills will be in demand in most any specialty. It can be GS, NS, ortho, IM, peds, Ob/Gyn, ophtho, ENT, uro (radiology, rad onc, derm, anesthesia, neuro and path less so).

You (personally) don't have to do it all. You'll have more than enough on your plate as a GS (w/o fellowship) at a missions hospital. There aren't that many of them - most missionary docs I've met/seen are FM, peds, Ob/Gyn (no IM's or IM subspecialists, to be honest). GS will make you a prized commodity at any mission hospital.

If you're on the mission field one day and observe that a particular pediatric or orthopedic or what have you condition is repeatedly coming in, you can try to get in touch with an ortho or peds surgeon in the US interested in part time missions. They can fly out for a few weeks teach you how to deal with that condition. Think about this pathway, too. You can be a specialized physician/surgeon in the US who goes around the world and teaches physicians/surgeons in foreign countries new/better procedures and techniques.

One other point: don't do missions GS (or medicine, really), if the witnessing aspect is important to you personally. No doubt you will be a focus and a recruiter of patients to the hospital who may be witnessed to, but you will have little time for it, and won't generally have the sort of expertise in language and cultural nuance to be the best missionary. If your goal is to actively and personally witness, the medical (or at least surgical) route is probably not best.

 

[Winged Scapula]

I guess I was more so concerned as to whether fellowship training after 5 yrs of GSurg residency caused u to lose a little of what you previously learned; but u guys cleared that up for me. Thanks alot!

There is no doubt that increasing specialization comes at the price of losing some previously learned knowledge.

But in general, skillz is skillz. You can translate those into most procedures once you know the basics. Can I remember how to do a Whipple anymore? No, but I could do one if someone was holding up Zollingers for me. 😉

You can't be everything to everyone. The broadest based surgical specialties for missions would be, IMHO, GS, PRS and Ortho. And as mercapto notes, you can always get some training in specific procedures outside of your field if there is something really necessary that you cannot recruit a specialist to do.

 

[JackADeli]

Since Pediatric Surgeons are usually labeled as the last true General Surgeon, I was wondering whether fellowship trained peds surgeons COULD still pick up general surgery in adults if they wanted to; or does the specialization cause them to be less comfortable with with adults even after 5 years of training...

I guess I was more so concerned as to whether fellowship training after 5 yrs of GSurg residency caused u to lose a little of what you previously learned...

Short answer: NO

IMHO & based on my experience, pede surgery is a very unique bag. It truely is continued GENERAL surgery with some special twists. At M&M, the pede surgeons seemed to always have a better grasp of the nuances in general surgery. I also remember pede surgeons scrubbing in to help the adult guys when some unusual intra-operative finding showed up. What does a pede surgeon train in...

Plenty of hernias
numerous appies, probably more open appies then you do in GSurge residency, but plenty of lap as well
Plenty of Nissens, lap or otherwise
Pyloromyotomies
bowel resections and stoma formations young & old/er
colorrectal & anal disease
congenital gyn surgery & urology
liver and pancrease cases
Nuss, empyectomies, esophageal and tracheal procedures
Plenty of pediatric critical care
etc......

I think 5-10 years of practice (after fellowship) on patients under age 13-14 can skew your perspective and affect some aspects. I don't think the time in pediatric surgery fellowship would take away from your ability as a general surgeon. During your first year in fellowship, you will be focused on learning the material to pass your GSurgery boards. With time you may forget the issues of colon cancer or breast cancer or any other later onset adult disease. Not during fellowship though. **

JAD

**The one area it may take away is your operative comfort with true vascular surgery.