Tuesday, November 17, 2009

David breaks down Surgery

3 reasons to become a surgeon:

1. You get to do stuff and see if it works

Surgery is the pinnacle of immediate feedback; you identify a problem, do something concrete to fix it, and then evaluate whether or not it worked. More than any other specialty, the outcomes are measurable, tangible, and observable. You may sacrifice the continuity of primary care fields, but you also experience the unique satisfactions of knowing what’s wrong and getting your hands dirty trying to make things right. Fields like neurology, psychiatry, and others may involve long battles with nebulously defined disease processes where victories are measured in small, incremental improvements over years. That process yields its own personal and professional rewards and frustrations, but may not provide the same acute results that some students may find particularly appealing and which surgery deals out in spades.

2. Certified badassery

Few things in medicine are cooler than surgery. Though it may not be for everyone, no one can deny the sheer awesomeness of removing tumors, transplanting organs, and augmenting breasts (just kidding…?). Perhaps more commonly than in other fields, decisions are realistically life or death; a miscue here or a careless error there in the OR could have disastrous results. What’s more, the wealth of new technologies and general trend towards minimally-invasive procedures ensure that general surgery and the many surgical subspecialties will only further badassify in the future. Sure, more surgeons spend their lives in the bread and butter world of inguinal hernias and appendectomies than in the rarified air of reconstructive plastics and neurosurgery, but even the more vanilla procedures provide all the benefits listed above and below and may, due to volume, be even more targeted for technological advancement in the coming years.



















I can’t believe Da Vinci painted the Mona Lisa and invented this robot…

3. Options like whoa

It is generally believed that medical students should first and foremost decide whether they want to be surgical or medical. If surgery is your cup of tea, there is a seemingly limitless array of opportunities to pursue. A general surgery residency is a common gateway to further subspecialty options such as burns, cardiothoracic, vascular, and pediatric surgery, among others, while other students choose to enter fields such as orthopedics, plastics, and ENT straightaway. Going further, many surgeons identify a specific procedure or set of similar procedures that becomes their uber-specialty within their broader branch of surgery. Basically, if there’s some type of cutting you want to do, you can probably make a career out of it.

3 reasons not to:

1. Training don’t quit

More than any other field, surgery demands an extensive period of training. A typical general surgery residency lasts five years, and further subspecialty fellowships can push that requirement into the two-digit territory. An R3 I worked with recently is pursuing a career in pediatric cardiothoracic surgery, a path that, with a general surgery residency, two years of research, a three-year CT fellowship, and a one-year peds CT fellowship, will ultimately require 11 years of training after medical school. Assuming one entered medical school immediately after undergrad at 21-23 years old, this would push off attending status – and the benefits of a legitimate salary and some semblance of a personal life – until one’s mid-to-late 30s. And though in a badass field like peds CT surgery you’d make it rain early and often thereafter, you’d still be spending the majority of the prime of your youth before ever realizing many of your career goals.

2. The hours never stop

Similar to OBGYN, surgery in nearly all of its forms is notorious for an extremely demanding workload and long hours on call. Though some subspecialties and practice settings may be less demanding, the fact remains that surgeons spend more time in the hospital than almost any other type of physician. When you factor in the extensive training required before even reaching the attending level, the demands of the subsequent career may simply not be something many medical students want in their future. (On a related note, it's worth mentioning that the hours / training demands take their toll on relationships as well; some surgical residencies have been known to have divorce rates exceeding 100%. In other words, residents get divorced, remarry and get divorced again. Just FYI...)

3. High-intensity work environment

By its nature, surgery is a high-stress world. The patient is commonly under general anesthesia and the manipulations of the procedure often entail significant blood loss. Small or careless transgressions can kill a patient either immediately or as a post-operative complication, and the surgeon running the show is ultimately responsible. Many surgeons trumpet the philosophy “trust no one,” something potentially disheartening on its surface but logical in a world where the surgeon is held accountable for any number of errors in the pre-, intra-, and post-operative setting. All these truths foster an environment some find less than hospitable, especially to those lower in the training hierarchy. Surgeons, on average, may be blunter and less forgiving in a professional environment than other physicians, and this, coupled with the long hours, can create a working world some students may choose to avoid.

14 comments:

pinky said...

David, do you have the ability to be an a$$hole? I am not kidding. I wish I was. Surgeons, especially cardiac or lung are a$$holes on a general basis. They can be nice. They are often very nice people other than the times the throw the dressing across the room.

Second question: Are you brilliant and you know it? You have to feel you are pretty special to start hacking at someones insides.

My dear SIL is a general surgeon. She thinks it sucks at this point but likes her 2 homes and nice boat. So I don't feel all that bad for her.

I think cosmetic surgery is the place to be. Many folks are paying cash. Also having worked on a plastics floor there is some variety.

Jesse said...

You clearly don't know David or you'd know the answer to #1...

D said...

...a resounding "No."

Julia said...

Pretty sure the Da Vinci deserves it's entire own paragraph on why it counts AGAINST a career in surgery. Those surgeries are so painfully long and tedious...

Albinoblackbear said...

I am enjoying these installments with the morning coffee. Your insights are appreciated.

Have now decided that if I choose surgery I am going to say I am applying in the field due to the fact that it will 'only further badassify' in the coming years.

If that doesn't seal the deal, nothing will.

pinky said...

David if you are a nice person and want to do surgery. Cancer surgeon. Cancer folks are known to be the nicest patients going and the Cancer people are lovely. Especially, Dana Farber, they are especially nice folks.

D said...

Surgical oncology it is.

Zac said...

Dude, don't do general surgery. They're the most miserable residents anywhere in the hospital, and turn into the most miserable attendings when they realize their lives have been sucked away into the bowels of the hospital.

ER is the place to be :)

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