Discuss trauma surgery

[skee lo]

Not much talk here about trauma surgery so I thought I'd start a thread. This is the speciality that I find most attractive in terms of content, but but the continuous hours may keep me out. I have no problem working big hours but piling them up consecutively 40 at a time is just so unsound and unhealthy IMO.

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[Mr Cookie Pants]

My undergrad mentor is a Trauma/CC guy. He's 41 and has two kids and gets to see them. He also has an understanding wife, I think that's pretty important. Lifestyle was one of the first questions I asked him. Like anything, its all about priorities. He goes to soccer games after 27 hour shifts, but its what he loves.


There isn't much talk about trauma here because generally speaking most trauma patients come in at 3 am after they were just "minding their own business" and viewed as more of a nuisance. And generally speaking, they have a tendency to not pay their bills.

 

[dynx]

Not much talk here about trauma surgery so I thought I'd start a thread. This is the speciality that I find most attractive in terms of content, but but the obscenely long shifts may keep me out. I have no problem working big hours but piling them up consecutively 40 at a time is just so unsound and unhealthy IMO.

I cannot for a single moment even pretend I understand why someone would do trauma surgery. With the rare, rare, rare exception your patients (if you're at a high level trauma center) are going to be drunk or high, likely both, and always stupid. Their injury, even if shot or stabbed by someone else will be largely self inflicted by way of thier life choices. They have no gratitude and can't pay for the medical care that they demand. They will however, have plenty of free time to pick up the phone and dial the lawyer's number they see on the TV in between snorting lines of coke, and the nice job you did fixing up thier face for free, will make them that much more presentable and sympathy worthy in court when they sue your ass so they can buy some rims.

 

[Chronic Student]

Lets see, as a general rule, trauma patients are the most ungrateful, demanding, most likely to sue and the least likely to pay you.

As for trauma surgery itself: Lots of waiting around, moments of sheer terror, trainwreck cases or babysitting the multi-trauma and lots of times not a lot of operating to do.

Follow-up with people who don't give a damn about themselves or anyone else.

That was my cynical side talking. There are those times when you make a great save and every thing is rainbows and butterflies. However, they are few and far between.

The more common scenario is the drunk who plowed into a family that all died and the drunk is the only one that walked away.

 

[roja]

I actually loved trauma surgery. I still do. One of my favorite months of residency was my month at Ryder. I spent alot of it in the OR. One of my closest friends is a trauma surgeon.


I can see why they love it. The patients are exciting (well, thier presentation), cool procedures, etc.

However, the lifestyle is horrible. He often works 40 hours straight, crashes and then, starts the next day all over again. But he loves what he does so he doesn't mind.

 

[DrDre311]

I liked trauma, until I got over the excitement/craziness part of it. Now I'm just glad that I'll be the guy fixing the patient's face instead of working 40 straight and dealing with all the BS that comes with most trauma patients...

I actually loved trauma surgery. I still do. One of my favorite months of residency was my month at Ryder. I spent alot of it in the OR. One of my closest friends is a trauma surgeon.


I can see why they love it. The patients are exciting (well, thier presentation), cool procedures, etc.

However, the lifestyle is horrible. He often works 40 hours straight, crashes and then, starts the next day all over again. But he loves what he does so he doesn't mind.

 

[roja]

I liked trauma, until I got over the excitement/craziness part of it. Now I'm just glad that I'll be the guy fixing the patient's face instead of working 40 straight and dealing with all the BS that comes with most trauma patients...

but you are giving up the sexy part.

 

[DrDre311]

but you are giving up the sexy part.

You've never seen me put something really nasty back together. Trust me, I've got sexy covered.

 

[roja]

lol. I don't know. It just lacks the drama.

 

[ESU_MD]

the obscenely long shifts may keep me out.

If you are using the word "shift" when talking about a surgical career, then you probably are looking in the wrong specialty.

Most surgeons get really mad if you think they are shift workers. We do not dump off our patients when the 5 o'clock whistle blows and the nite shift comes in.

er doctors and some hospitalists may work shifts. Maybe you should check out those fields. Lots of trauma there, and lots of shiftwork. good lifestyle, but little career satisfaction professionally.

but I guess thats the kind of poor mentality the ACGME fostered with the 80hr workweek. The downfall of medical education. residents are quickly becoming glorified medical students

BTW: you are crazy if you want to waste all your years of surgical training to do trauma. Think of this- 5yrs of general surgery residency- then a 1 (or 2) yr NON OPERATIVE fellowship, followed by a NON OPERATIVE career.

When will you learn to operate? on who? How will you keep up your skills?
doing emergency general? the garbage surgery at nite (appy, dead bowel) so the real surgeons can stay in bed? have fun with these cases.

Being an ICU jockey? might as well just do medicine- its shorter
Plus trauma does ALOT of babysitting for neurosurg, and ortho.

 

[skee lo]

If you are using the word "shift" when talking about a surgical career, then you probably are looking in the wrong specialty.

Sorry, I'm alware of this, I just use the word 'shift' ubiquitously. My apologies.

 

[DrDre311]

lol. I don't know. It just lacks the drama.

I chose to replace drama with art.

 

[Kikaku21]

Sorry, I'm alware of this, I just use the word 'shift' ubiquitously. My apologies.

Don´t apologize, the guy was being a jerk.

There are plenty of ER docs and hospitalists that find great satisfaction in what they do. I will say that it is the kind of attitude expressed by ESU_MD that push bright students away from wanting to pursue surgery. Seeing as surgery, more than other specialties, is facing a pretty serious shortage problem, projected to grow in the next 20 years or so, you´d think people would reconsider this kind of mentality.

 

[Castro Viejo]

There are plenty of ER docs and hospitalists that find great satisfaction in what they do. I will say that it is the kind of attitude expressed by skee lo that push bright students away from wanting to pursue surgery. Seeing as surgery, more than other specialties, is facing a pretty serious shortage problem, projected to grow in the next 20 years or so, you´d think people would reconsider this kind of mentality.

Yes, in fact, the surgical leadership in this country has put significant time into analyzing the various factors keeping the "bright" students away from surgery as a career.

The conclusion of the various reforms?

Let me offer some insights from my interns over the past year while I served my time being a General Surgery Chief Resident.

"Castro, I can't come to the OR because I've got a crazy list of 15 patients to deal with today. Can you get one of the other interns to do my cases?"

"You know, where I went to medical school, the interns were responsible for the service's primary patients and the Chief Resident dealt with all the consults."

"I'm so beat... I can't stay awake... I only got four hours of sleep last night on call."

"Let's go for lunch!"

"I don't have time to see the consult down in the ED right now. I'm having lunch."

The list just goes on. Before you decide, as a medical student, to tell anyone what surgery can do to make itself more attractive as a field for the "bright" students, try your hand as a Chief Resident and then get back to me with your thoughts on the subject.

 

[roja]

I chose to replace drama with art.

Touche. Reminds me of one of my favorite quotes: We have art so that we don't die of the truth.


And kikaku is right. There are many of EM docs who love what we do and have great professional satisfaction.

And the trauma surgeons I know operate more than your average surgeons. They do all the trauma stuff, then they do all the emergent operations (appys, gallbladders, dead bowel, etc) and then many of them do plenty of other non-emergent cases (hernia repairs, etc).

while I am not familiar with all trauma fellowships, the ones I am familiar with are 2 years of surgery and critical care.

It certainly has down sides (ie for me these were the reasons I ultimately chose not to do it): crappy crappy hours, all those uncool hernia repairs and lap surgeries. 5 years of general surgery, filled with lap choley and lap appys.... (*shudder*)

but you did get to do really cool trauma surgeries and alot of critical care (which I love).

 

[Winged Scapula]

Trauma Surgery can be operative if you are at a real knife and gun club with excellent resources (ie, the victims get to your door before they lose vitals). Most trauma surgeons are not at Ryder, Shock Trauma, Memphis, LA County, etc. and therefore, spend most of their time doing critical care and "acute care" general surgery (ie, SB obstructions, appys, choles, etc.). Most trauma in the US is blunt and non-operative.

The majority of trauma/CC fellowships in the US are one year in length (you only need 9 months of CC training to be BE), with some having an optional 2nd year. Very few are two years required.

At any rate, Castro and ESU are right that the ACS does not need to be bothered with attracting more students to surgery regardless of potential shortages. At this point, with surgery filling nearly all of its spots during the match, we don't need to attract more students, we need more residency positions or to encourage people to stay in general surgery. THAT is where the potential shortage is, not for surgeons in general.

They also need to be more concerned with attracting the RIGHT students, who have realistic expectations of what is to be required of them. If this comes across as having an "attitude" or being mean, so be it...I don't blame them for being bitter. Its awfully hard as a Chief/senior resident to stay behind and pick up the slack for residents who think their "shift" is over and its time to go.

 

[Anka]

Don´t apologize, the guy was being a jerk.

No, he wasn't. ESU_MD was giving the same good advice he usually does. If you want to be a shift worker, you shouldn't do surgery... there are other options which give you the lifestyle benefit of shift work, as he pointed out. If you do surgery expecting to work 8s and 12s, you're going to be hurting in a few years. So, how is it mean to tell someone that? It's actually pretty kind given that he no doubt knew he would get the response you just gave from someone.

On the other hand, if the OP really didn't mean to use the word shift, and didn't understand the negative connotation it would have for most surgeons, then by warning him of those connotations, ESU_MD was kind yet again.

Anka

 

[SLUser11]

No, he wasn't. ESU_MD was giving the same good advice he usually does.....

Anka

I reread his post just to make sure, and I didn't find any good advice.

 

[BlondeDocteur]

Practically everyone coming in to med school thinks trauma is unbelievably sexy. Why on earth would people-- surgeons, nonetheless!-- settle for doing something as unglamorous as re-vascularizations or lymph node dissections when they can bring car wreck victims back from the edge of death?

I'm a newly-minted MS4, but I'd like to think I'm seeing this whole thing with fresh eyes. Obviously, surgeons dislike trauma/CC because it is non-operative. The only thing that sets surgery residents apart from others is their ability to operate. That might sound like a reductio ad absurdum, but that one thing-- the ability to operate-- is what pushes people through the training. Even though perioperative care, the medical management of surgical patients, ICU work, etc are all thrilling and very challenging, the only real way to justify the sacrifice a surgical residency represents is by getting into the OR.

But that alone doesn't explain the disdain. Think about this: you know how, in your local newspaper, when someone is stabbed or shot it's reported in one of two ways, depending on who the victim is? If it's an upstanding father of four, it's front page news with double columns. For a larger subset, however, it's one line in the police blotter.

You'd be surprised how many 'one-liners' there are out there, and how often they're stabbed and shot. You will absolutely be devoting your career to patching them back up, and they're some angry sons of bitches who see an angle where others would see gratitude.

 

[Kikaku21]

Yes, in fact, the surgical leadership in this country has put significant time into analyzing the various factors keeping the "bright" students away from surgery as a career.

The conclusion of the various reforms?

Let me offer some insights from my interns over the past year while I served my time being a General Surgery Chief Resident.

"Castro, I can't come to the OR because I've got a crazy list of 15 patients to deal with today. Can you get one of the other interns to do my cases?"

"You know, where I went to medical school, the interns were responsible for the service's primary patients and the Chief Resident dealt with all the consults."

"I'm so beat... I can't stay awake... I only got four hours of sleep last night on call."

"Let's go for lunch!"

"I don't have time to see the consult down in the ED right now. I'm having lunch."

The list just goes on. Before you decide, as a medical student, to tell anyone what surgery can do to make itself more attractive as a field for the "bright" students, try your hand as a Chief Resident and then get back to me with your thoughts on the subject.

Sure, there is always another side of the story. I am sure there are lazy/arrogant/unwilling/beat down/terrible residents out there. Having worked in several industries myself, I will venture to surmise that there is probably a distribution of attitudes out there. Some good, some bad. Now, having read quite a few of your posts on this forum (enjoy your sense of humor, btw) I am going to further surmise that it is the negative stories that will end up in your post. At the very least, they are more fun to write about. Furthermore, this sight is clearly a good place for venting.

Now, since you are a believer in free markets, I present to you the labor market for surgery. Seeing as medical school prepares you to enter any residency you want, and that being a "bright student" ensures, at least to some degree, that you could successfully pursue a career in something competitive, I submit to you that there are a high amount of substitutes for the consumer here. Now, surgical residency programs saw their peak number of applicants in 1981, when 12.1 percent of M4s applied. It has steadily droped off. (5.3% in 2002) I am going to go out on a limb, and suggest that the 6.8% are not just the folks who piss and moan about having to work hard. Instead, I would bet that the 6.8% is a sample, fairly representative of the population of good and bad that I mentioned earlier.

Just a quick read in these forums indicates that many other reasons, besides being a lazy resident, that someone might pick something other than surgery. Decrease in pay, increase in lawsuits, Democrats taking over with Universal Healthcare, patients having less respect for physicians, deadbeats, etc, etc.

Now, you can always play the "you are only a medical student, just wait till you get here and then you´ll understand" card. But I argue that I, the medical student, am the consumer in your labor market. Telling me I don´t know what I am talking about is like Coke telling me I don´t understand what its like to run a soda production line, when Pepsi is offering a better product. I will just drink Pepsi, who cares about your supply chain? So, why not always strive to improve the one thing that you CAN control? (b/c everything else in that list is out of our hands.) Why not try to make residency programs as NICE as possible? Why not have people thinking surgeons are a friendly bunch, instead of alpha males? In short, why not do what little you have control of to increase the demand for your product? Afterall, there are somethings about the medical labor market that are still free.

 

[smq123]

I will say that it is the kind of attitude expressed by ESU_MD that push bright students away from wanting to pursue surgery. Seeing as surgery, more than other specialties, is facing a pretty serious shortage problem, projected to grow in the next 20 years or so, you´d think people would reconsider this kind of mentality.

Why not try to make residency programs as NICE as possible? Why not have people thinking surgeons are a friendly bunch, instead of alpha males? In short, why not do what little you have control of to increase the demand for your product? Afterall, there are somethings about the medical labor market that are still free.

You obviously don't understand the mindset of the average surgeon.

Surgeons don't WANT people who need to be "persuaded" into a career into surgery.

They want people who, because of personality and innate work ethic, are willing to sacrifice a fair amount for their work, their patients, and their fellow residents. If that means that there is a dwindling number of people going into surgery...well, then that's just the way that it is.

And there is a fear that people who need to be "sold" into a career into surgery will not take it seriously enough - will not stay to help out their fellow residents, or will only think of themselves, without considering how it affects other members of their team.

(And if I'm reading your other posts correctly, you're NOT a medical student yet. You're going to start MS1 this coming August, which isn't quite the same thing. And, honestly, your arguments would carry more weight if they came from an MS3 or an MS4 - i.e. someone who is actually trying to really figure out which residency they'd like to do.)

 

[SLUser11]

You obviously don't understand the mindset of the average surgeon.

Surgeons don't WANT people who need to be "persuaded" into a career into surgery.

They want people who, because of personality and innate work ethic, are willing to sacrifice a fair amount for their work, their patients, and their fellow residents. If that means that there is a dwindling number of people going into surgery...well, then that's just the way that it is.

Agree 100%.

We don't have a product that we're trying to sell. We see being accepted into surgical residency as a privilege that should go to worthy medical students. Competitive programs have no problem getting enough "interested parties."

I understand that many people become doctors for the money, but there are plenty of jobs that make money, and we're arguably all smart enough to succeed in these careers. I like to think that we all chose surgery for the same reason: We like playing god. Just kidding....sort of.....

As for the impending surgeon shortage, obviously we don't care all that much as a community, whether that is OK or not. Otherwise, we'd all be selflessly pursuing careers in rural general surgery instead of trying to succeed in saturated subspecialty markets.




That being said, I do try to create a desirable, healthy learning environment for medical students, but not because I'm trying to suck up to them. It's because I have an obligation to teach them about surgery, and I like to do that in a comfortable, non-malignant fashion.

 

[SocialistMD]

As for the impending surgeon shortage, obviously we don't care all that much as a community, whether that is OK or not. Otherwise, we'd all be selflessly pursuing careers in rural general surgery instead of trying to succeed in saturated subspecialty markets.

Have you ever thought that this happens because of all of the trainwreck transfers we see from outside hospitals and we don't want to be "that guy/girl?" It's a strong motivator to me to ensure I have the necessary facilities and staff to do what is best for the patient, and I don't think that exists in many community hospitals. I would do rural general surgery (as I love general surgery) if I knew I could take care of my patients without having to transfer the complicated ones, not for my lack of knowledge and skill, but for a lack of resources.
But I digress...

Now, since you are a believer in free markets, I present to you the labor market for surgery. Seeing as medical school prepares you to enter any residency you want, and that being a "bright student" ensures, at least to some degree, that you could successfully pursue a career in something competitive, I submit to you that there are a high amount of substitutes for the consumer here. Now, surgical residency programs saw their peak number of applicants in 1981, when 12.1 percent of M4s applied. It has steadily droped off. (5.3% in 2002) I am going to go out on a limb, and suggest that the 6.8% are not just the folks who piss and moan about having to work hard. Instead, I would bet that the 6.8% is a sample, fairly representative of the population of good and bad that I mentioned earlier.

The practice of surgery and the practice of dermatology will never be the same. If someone likes surgery enough, s/he will choose it as a career in spite of its shortcomings (long hours, more "emergencies" than other specialties, dwindling reimbursement, etc...) and those are the people who will be the best surgeons because they are the ones who enjoy what they do. It doesn't take a 272 on Step 1 to be able to diagnose appendicitis, to recognize an ischemic leg or to perform an ex-lap on someone with a gunshot wound in the left upper quadrant. I don't think surgery should (nor does it) define its "competitiveness (or labor market appeal)" by the numbers of the people it recruits. I don't even think any field in medicine should try to "recruit" people (although, if you want to see a field that is doing so, look at your primary care specialties), as it is dishonest to try to sell someone on a career without presenting all of the picture.
What should be important to surgery is to work on decreasing attrition. That is how you know you are getting people who enjoy their work, are in the field for the right reasons and how you know you are appealing to the right people. In fact, I'd say that (with attrition remaining around 20%), we own a larger portion of the market than we should, as we are taking people who don't really want to be here.

Telling me I don´t know what I am talking about is like Coke telling me I don´t understand what its like to run a soda production line, when Pepsi is offering a better product. I will just drink Pepsi, who cares about your supply chain?

Nice, but here is the flaw in your analogy. I'm not trying to get you to drink Coke, I'm trying to get you to work on the production line, and I don't think it is fair (to you or me) to "sell" you on my specialty. Drinking all the free sugarwater in the world couldn't get me to do internal medicine, even though when I was a med student on that rotation the hours were fewer, the work was less demanding and the residents were "nicer."

 

[Kikaku21]

Surgery is the medical equivalent of Colt. They have a crappy website, their guns are difficult for dealers to obtain, and their customer service is notoriously poor. Nonetheless there is a consistent demand for their firearms because they make a killer product and have excellent brand recognition and reputation.

They may not be the biggest manufacturer out there, and they will never again have a majority market share. But they don't care, because their interest is in producing a quality product not selling the most guns.

Now do you get it?

I get it. This is basically like comparing surgery to a "boutique" market. A good example is Fazioli pianos. Its an Italian brand that sells about 120 a year, and demand is far greater than supply. There are certain sail boats that are similar. You want one, add your name to the list, and we will start building it in 5 years. Both examples are very, very high quality items, with excellent brand recognition, and reputation.

The difference between surgery and sailboats is the mentality that everyone who needs surgery should get it. (Or, everyone who needs, and can afford surgery can get it. Depending on how much of a Capitalist you are.) Pianos and sailboats, on the other hand, are luxeries. Nobody will be on the street protesting that they didn´t get a nice piano.

So, if there is an impending surgery shortage, as there is, your analogy would hold up only if surgeons are ok with a shortage, and the consequences resulting from said shortage. Maybe this is, in fact, the case. Based on the studies that are being done to tease out the reasons why people are turning away from the field (in record) numbers, I am guessing such is not actually the case.

 

[Kikaku21]

Oh, it is absolutely a privilege. No doubt. But privileged people have the opportunity to choose the field in which they practice. Now, there are undoubtely some people who are sitting on the fence right every year, thinking that they love a lot of things about Cardiology, but also a lot about surgery. Ignoring the difficulties of landing the cards fellowship in 3 years, this person (assuming they are qualified) could get whatever they wanted. If this person chooses cards, then you may, in turn, be filling his surgery seat with a less qualified person--or no one at all. See, it really is a market, whether you like the feel of it or not.

Now, I understand the mentality... wanting someone to enter your chosen field for the right reasons. i.e. We only want someone who wants to be a surgeon enough, that they are willing to deal with the bad hours, hard work, etc. But if the now cards fellow that we are talking about really would have been a great surgeon, that is a loss for the field of surgery. And honestly, most people in this world are not die hards. They could be happy doing many different things. This is true in all walks of life. Its kind of like losing the swing votes.

This would be perfectly acceptable if the demand were met. But, as we have been discussing, there is a shortage. While surgeons may or may not care about that. Society does. At some point, if the surgeon shortage really makes people hurt, there will be a lot of pissing and moaning about it. Then Mr. Obama will step in and "fix" it for you. I doubt that is the preferred solution.


For the market in surgery, number one is irrelavent, but number two is worth discussing.

Agree 100%.

We don't have a product that we're trying to sell. We see being accepted into surgical residency as a privilege that should go to worthy medical students. Competitive programs have no problem getting enough "interested parties."

I understand that many people become doctors for the money, but there are plenty of jobs that make money, and we're arguably all smart enough to succeed in these careers. I like to think that we all chose surgery for the same reason: We like playing god. Just kidding....sort of.....

As for the impending surgeon shortage, obviously we don't care all that much as a community, whether that is OK or not. Otherwise, we'd all be selflessly pursuing careers in rural general surgery instead of trying to succeed in saturated subspecialty markets.




That being said, I do try to create a desirable, healthy learning environment for medical students, but not because I'm trying to suck up to them. It's because I have an obligation to teach them about surgery, and I like to do that in a comfortable, non-malignant fashion.

 

[barcalounger]

Any medical students interested in trauma surgery should read up on some of the recent literature regarding possible changes in the field, including "Making the Case for a Paradigm Shift in Trauma Surgery" in the Journal of the American College of Surgery from 2006 and "Trauma Surgery: Discipline in Crisis" in the Annals of Emergency Medicine from April of this year.

The discipline of trauma surgery, much like the trauma systems it serves, is in the throes of an identity crisis that threatens its future.1-5 This crisis exists within the larger context of questions about the current and future professional persona of general surgery as a discipline. Various efforts initiated by a number of organizations are underway to redefine what actually constitutes general surgery and trauma surgery, and the training path required to attain and maintain certification as such, either within the current constructs, or as a new surgical specialty is defined.

 

[Kikaku21]

The practice of surgery and the practice of dermatology will never be the same. If someone likes surgery enough, s/he will choose it as a career in spite of its shortcomings (long hours, more "emergencies" than other specialties, dwindling reimbursement, etc...) and those are the people who will be the best surgeons because they are the ones who enjoy what they do. It doesn't take a 272 on Step 1 to be able to diagnose appendicitis, to recognize an ischemic leg or to perform an ex-lap on someone with a gunshot wound in the left upper quadrant.

Sure, it doesn´t take a 272. But you may be losing the 272 to some other field. You, therefore, get a lower quality applicant. Its not about filling all the spots, its also about the quality of applicants. Now, I´d be willing to bet that there are plenty of people who would be happy in surgery, as well as some other field. In fact, poll a group of medical students, and you will find people who are flip flopping between two fields. This is not an uncommon situation. When this happens, smaller and smaller issues become important in decision making. Enter hours worked, nice/mean bosses, etc, etc. Are you really ok with lossing the 272 kid if it means you lose a better qualified guy? Even if there is a shortage?

Nice, but here is the flaw in your analogy. I'm not trying to get you to drink Coke, I'm trying to get you to work on the production line, and I don't think it is fair (to you or me) to "sell" you on my specialty. Drinking all the free sugarwater in the world couldn't get me to do internal medicine, even though when I was a med student on that rotation the hours were fewer, the work was less demanding and the residents were "nicer."

Why not? You were obviously "sold" on the specialty. Albeit for reasons that we would deem more importatn than a few thousand dollars salary in either direction. Now, while you love your field enough sacrifice that few thousand dollars, you may not be typical. It doesn´t take someone who hates surgery to care about the few thousand either. Again, there is the guy who really likes two different fields. The small stuff gets important for this guy. Why lose this guy?

 

[smq123]

Sure, it doesn´t take a 272. But you may be losing the 272 to some other field. You, therefore, get a lower quality applicant. Its not about filling all the spots, its also about the quality of applicants. Now, I´d be willing to bet that there are plenty of people who would be happy in surgery, as well as some other field. In fact, poll a group of medical students, and you will find people who are flip flopping between two fields. This is not an uncommon situation. When this happens, smaller and smaller issues become important in decision making. Enter hours worked, nice/mean bosses, etc, etc. Are you really ok with lossing the 272 kid if it means you lose a better qualified guy? Even if there is a shortage?

Okay.

I know that this sounds condescending and mean, but you really don't have a clear idea of what you're talking about. Your perspective and understanding will change once you hit third year.

a) There's no real reason why the kid with a 272 on Step 1 is, by default, a better clinician than a guy with a 212. So saying that the guy with a 212, who is a dedicated surgeon and is devoted to his patients is, by default, a "lower quality" applicant is BS.

b) Your definition of "better quality" is NOT necessarily the surgeon's definition of "better quality."

You may be smart, and a good test-taker, but if you don't have the dedication and are always the first one to sign out to night float, then you don't fit the surgeon's definition of a "better quality" applicant.

Now, I´d be willing to bet that there are plenty of people who would be happy in surgery, as well as some other field.

Uh....well...not quite.

Most people who would be happy in surgery would be happy only in other surgically-related fields (i.e. ortho, neurosurg, urology, etc.) Honestly, for most of the surgeons that I have worked with, the idea of doing an easier and shorter internal med residency is like hell on earth.

 

[SocialistMD]

So, if there is an impending surgery shortage, as there is, your analogy would hold up only if surgeons are ok with a shortage, and the consequences resulting from said shortage. Maybe this is, in fact, the case. Based on the studies that are being done to tease out the reasons why people are turning away from the field (in record) numbers, I am guessing such is not actually the case.

You are confusing two issues. The studies to which you are referring have nothing to do with the applicant pool and everything to do with attrition of the matched applicants. You imply that the "surgeon shortage" is the result of people not applying. This is incorrect. After the match, there were less than ten available spots in the entire country that went unfilled. After the scramble, there were zero. Six years ago, 25% of the available spots went unfilled after the match. Attrition is the same now (20%) as it was ten years ago, so we can rule that out as the source of the shortage (although, I'm sure the reason for attrition has changed over that time, but that is a discussion for another thread). If there is a surgeon shortage (I say if because I don't think it is a global phenomenon but rather a factor seen more in Bowie, TX, than Boston, MA), it is due to the limitation of residency spots, not due to a lack of applicants.

But you may be losing the 272 to some other field. You, therefore, get a lower quality applicant. Its not about filling all the spots, its also about the quality of applicants.

My point is that the 272 may not be the best surgical resident just as the 42 MCAT isn't the best med student just as the 1600 SAT isn't the best undergrad. Sure, it is nice to have someone who is booksmart, but I bet diligence and hard work save more lives on the floor than knowing the half-life of daptomycin.

It doesn´t take someone who hates surgery to care about the few thousand either. Again, there is the guy who really likes two different fields. The small stuff gets important for this guy. Why lose this guy?

I'd say the person who is on the fence between a surgical and non-surgical specialty is much more rare than the person who is "sold" on surgery and willing to make the sacrifices necessary to operate. After third year, most students have chosen a side and there are very few interlopers.

 

[SocialistMD]

Okay.

I know that this sounds condescending and mean, but you really don't have a clear idea of what you're talking about. Your perspective and understanding will change once you hit third year.

a) There's no real reason why the kid with a 272 on Step 1 is, by default, a better clinician than a guy with a 212. So saying that the guy with a 212, who is a dedicated surgeon and is devoted to his patients is, by default, a "lower quality" applicant is BS.

b) Your definition of "better quality" is NOT necessarily the surgeon's definition of "better quality."

You may be smart, and a good test-taker, but if you don't have the dedication and are always the first one to sign out to night float, then you don't fit the surgeon's definition of a "better quality" applicant.



Uh....well...not quite.

Most people who would be happy in surgery would be happy only in other surgically-related fields (i.e. ortho, neurosurg, urology, etc.) Honestly, for most of the surgeons that I have worked with, the idea of doing an easier and shorter internal med residency is like hell on earth.

Why didn't I just leave it to you to say basically what I had to say?

 

[smq123]

Why didn't I just leave it to you to say basically what I had to say?

Thanks. But I'm glad that we confirmed each other's points - more convincing that way.

 

[Kikaku21]

Okay.

I know that this sounds condescending and mean, but you really don't have a clear idea of what you're talking about. Your perspective and understanding will change once you hit third year.

a) There's no real reason why the kid with a 272 on Step 1 is, by default, a better clinician than a guy with a 212. So saying that the guy with a 212, who is a dedicated surgeon and is devoted to his patients is, by default, a "lower quality" applicant is BS.

b) Your definition of "better quality" is NOT necessarily the surgeon's definition of "better quality."

You may be smart, and a good test-taker, but if you don't have the dedication and are always the first one to sign out to night float, then you don't fit the surgeon's definition of a "better quality" applicant.

You are missing the point. The board score was just an example. The point is, there is some measure of quality. Whether you want to talk about board scores, references, personality. As we both know, all of these factors go into play, and they are difficult to quantify.

Now, unless a surgeon has an entirely different set of factors for measuring quality than other specialties, he risks losing the ambivalent 4th year to those specialties. I would image good work ethic, dedication, etc, are high on anyones list! So, in short its hard to imagine that a surgery programs criteria for "better quality" is entirely different than some other specialty. I imagine there is at least enough overlap for my argument to stand up.

Uh....well...not quite.

Most people who would be happy in surgery would be happy only in other surgically-related fields (i.e. ortho, neurosurg, urology, etc.) Honestly, for most of the surgeons that I have worked with, the idea of doing an easier and shorter internal med residency is like hell on earth.

I have met plenty of people who stradled surgery, and something else. You can´t tell me that people with many, often divergent interests exist.

 

[Kikaku21]

You are confusing two issues. The studies to which you are referring have nothing to do with the applicant pool and everything to do with attrition of the matched applicants. You imply that the "surgeon shortage" is the result of people not applying. This is incorrect. After the match, there were less than ten available spots in the entire country that went unfilled. After the scramble, there were zero. Six years ago, 25% of the available spots went unfilled after the match. Attrition is the same now (20%) as it was ten years ago, so we can rule that out as the source of the shortage (although, I'm sure the reason for attrition has changed over that time, but that is a discussion for another thread). If there is a surgeon shortage (I say if because I don't think it is a global phenomenon but rather a factor seen more in Bowie, TX, than Boston, MA), it is due to the limitation of residency spots, not due to a lack of applicants.

Hmm... If this is true, then you are right, the current limitation must be residency spots. I recently read an article that talked about dwindling interest in surgery being an issue. Specifically, they mentioned a drop from around 12% of M4s applying to 5% applying. The article went on to say that this would be an issue with the shortage. Perhaps they meant that 5% is not adequate, even if there were enough residency spots. If this were the case, you have two problems creating a bottleneck. If not, then I concede.

My point is that the 272 may not be the best surgical resident just as the 42 MCAT isn't the best med student just as the 1600 SAT isn't the best undergrad. Sure, it is nice to have someone who is booksmart, but I bet diligence and hard work save more lives on the floor than knowing the half-life of daptomycin.

I completely agree. Board scores don´t make the better applicant. This was not the point I was trying to get at. There is some group of qualities that make a better applicant. Namely, as you say, diligence and hard work. In order for my argument to work, the important qualities need only be similar across different fields. Regardless of which items make a better applicant, in a relatively efficient market, you will lose the better applicants to the more attractive program, or field. Its the same reason that Goldman Sachs get better MBAs than a two bit investment bank in Detroit.

I'd say the person who is on the fence between a surgical and non-surgical specialty is much more rare than the person who is "sold" on surgery and willing to make the sacrifices necessary to operate. After third year, most students have chosen a side and there are very few interlopers.

This is awful hard to prove one way or the other. I happen to know quite a few people who had a hard time deciding between something surgical and a medicine specialty.

 

[smq123]

I have met plenty of people who stradled surgery, and something else. You can´t tell me that people with many, often divergent interests exist.

Of course. A lot of people will have diverging interests. Heck, there are threads like that all over SDN.

But, from what I've seen on rotations, it's rare to be equally torn between general surgery and something internal medicine related. And from my own experience, I can very easily see why.

One rounds at lightening speed. The other rounds for hours.

One has short patient notes that take up half a page. The other can take up to three pages.

It's just hard to equally love both, because they're so different from each other. That's all.

Hmm... If this is true, then you are right, the current limitation must be residency spots. I recently read an article that talked about dwindling interest in surgery being an issue. Specifically, they mentioned a drop from around 12% of M4s applying to 5% applying. The article went on to say that this would be an issue with the shortage. Perhaps they meant that 5% is not adequate, even if there were enough residency spots. If this were the case, you have two problems creating a bottleneck. If not, then I concede.

Dwindling interest in surgery?

Definitely, definitely not. The number of applications has been going up recently.

 

[SocialistMD]

In order for my argument to work, the important qualities need only be similar across different fields.

And that is why your argument doesn't work; the important qualities are not the same across the different fields. The technical prowess they seek on plastics interviews mean jack to someone applying for radiology. The patient skills necessary in psychiatry mean nothing to a pathologist. I liken it to Street Fighter 2; everyone has the same basic attributes, but each at a different level thus creating different strengths and weaknesses. I could never play as Chun Li, but a friend of mine couldn't be beaten with her. Each specialty has certain characteristics and strengths that are sought, and not all of them are best discovered using a standardized exam.

I happen to know quite a few people who had a hard time deciding between something surgical and a medicine specialty.

I bet that, to a person (or at least >90%), they all decided against surgery. I bet that, in reality, it wasn't all that hard of a decision. I bet the reason they chose against surgery was because, while they really enjoyed their surgery rotation and they liked being in the OR, they didn't like the lifestyle or didn't want to be in the hospital that much. I've heard those excuses from my anesthesia, emergency medicine and radiology colleagues, all of whom I respect and who are great physicians. It just gets at what Castro says below; it is best for a residency program, the potential surgical coresidents and (most importantly) the patient to have those people go into something other than surgery, as people who don't buy into the surgical team are a cancer to it and adversely affect patient care (and I cite most of the non-surgical residents who rotate on surgical services as examples).

 

[Castro Viejo]

So, why not always strive to improve the one thing that you CAN control? (b/c everything else in that list is out of our hands.) Why not try to make residency programs as NICE as possible? Why not have people thinking surgeons are a friendly bunch, instead of alpha males? In short, why not do what little you have control of to increase the demand for your product? Afterall, there are somethings about the medical labor market that are still free.

Your perspective is flawed. I believed in it once too, probably around the time I was a medical student and probably around the time I was getting ram-rodded during my internships by my Chief Residents.

As others have already mentioned, this isn't a popularity contest.

Granted there is more talk today at various surgical specialty meetings of the leadership trying to figure out why they're not as popular as they once were in the schoolyard, but there are limits and bounds to how far a surgeon will care. It's not that we like being known as a$$holes. In fact, I'd submit to you that most of us really aren't the jerks or scumbags most of the non-surgical community stereotypes us with...

As a community we're interested in attracting the medical students who want to care about their patients 24 hours a day/7 days a week, who don't operate with their left eye while the right eye is constantly looking at the clock, who consider post-call a good thing if and only if the next guy picking up the service knows anything and everything about the patients. I really don't give a crap that my intern is an Ivy League medical school alumnus who was AOA and scored in the 99th percentile on his boards. I want my intern to care about learning and about his patients and believes that what we do in the OR is the ultimate insult to another human being to effect the greatest cure.

If that makes us a bunch of jerks, as WS said, so be it.

Unfortunately most medical students don't graduate into a surgical internship knowing how it's done, and so the process of converting and indoctrinating an intern into the fellowship of surgeons can be quite painful. Trust me in that if it were all about sitting around a campfire eating smores and singing folk songs, your future surgeons won't give a damn whether you live or die postop.

 

[Blade28]

Unfortunately most medical students don't graduate into a surgical internship knowing how it's done, and so the process of converting and indoctrinating an intern into the fellowship of surgeons can be quite painful.

 

[BlondeDocteur]

I bet that, to a person (or at least >90%), they all decided against surgery. I bet that, in reality, it wasn't all that hard of a decision. I bet the reason they chose against surgery was because, while they really enjoyed their surgery rotation and they liked being in the OR, they didn't like the lifestyle or didn't want to be in the hospital that much.

I'll be the lone voice of dissent here, speaking from my n of 1. I was very, very torn for a good few months between general surgery and neuro/psych. They simply appealed to two halves of my personality-- one action-oriented, one analysis-oriented. In the end, though, I realized I was extremely unhappy without something to do, and that I'm one of those cheerful freaks who enjoys long hours in the hospital (despite having significant sources of happiness outside of it). I have a surgical personality, I enjoy the challenges of the field, and I'm sold.

But that process of getting sold did mean giving up a lot of things I enjoyed about neurology and psychiatry-- the discussions, the rapport with patients, and the fact that cultivating the skills necessary to succeed in those fields made me feel like a better person (ya know, listening to people and focusing on my reactions and stuff). While there are a few individuals I know who were "surgery or bust" throughout third year, most approached it with a somewhat open mind, and nearly everyone tries to talk himself out of it by focusing on those aspects of less hours-intense fields which appeal to them.

 

[Winged Scapula]

Not to read too much into your response above, but why do you feel you have to give up "discussions, rapport with patients..." to be a surgeon?

Those skills are not mutually exclusive to non-procedural specialties and can certainly set you apart from the stereotypical surgeon who does what he wants, without discussing it with his colleagues or patients and has little rapport with them.

I pride myself on having lots of the above and have chosen a specialty where it is not only allowed, but encouraged if not required.

 

[Kikaku21]

I'll be the lone voice of dissent here, speaking from my n of 1. I was very, very torn for a good few months between general surgery and neuro/psych. They simply appealed to two halves of my personality-- one action-oriented, one analysis-oriented. In the end, though, I realized I was extremely unhappy without something to do, and that I'm one of those cheerful freaks who enjoys long hours in the hospital (despite having significant sources of happiness outside of it). I have a surgical personality, I enjoy the challenges of the field, and I'm sold.

But that process of getting sold did mean giving up a lot of things I enjoyed about neurology and psychiatry-- the discussions, the rapport with patients, and the fact that cultivating the skills necessary to succeed in those fields made me feel like a better person (ya know, listening to people and focusing on my reactions and stuff). While there are a few individuals I know who were "surgery or bust" throughout third year, most approached it with a somewhat open mind, and nearly everyone tries to talk himself out of it by focusing on those aspects of less hours-intense fields which appeal to them.

As I was getting at, people in what was your position are bound to exist.

Having read the other posts here, however, it is becoming clear to me that the assurance that residents possess a certain dedication is worth losing applicants who may be otherwise qualified, but not willing to put up with quite "that much" agony. At least, it is worth it to the powers that be. While I still think there may be a losing side to this for the surgical community, they obviously value this assurance more than whatever they are losing. I will now stand down, as they obviously know better than I do, about whether this trade-off is worth it to their profession.

Thanks to all for a fun, and insightful conversation.

 

[DrDre311]

Not to read too much into your response above, but why do you feel you have to give up "discussions, rapport with patients..." to be a surgeon?

Those skills are not mutually exclusive to non-procedural specialties and can certainly set you apart from the stereotypical surgeon who does what he wants, without discussing it with his colleagues or patients and has little rapport with them.

I pride myself on having lots of the above and have chosen a specialty where it is not only allowed, but encouraged if not required.

In medical school I worked with a breast surgeon who spent more time with his patients, expressed more empathy, and had greater rapport with his patients than any psychiatrist, medicine doctor, or family physician I've ever seen. I've never seen any physician who was more supportive or cared more about whether his patients really understood their disease processes and "what's really going on" than he did. I try to model my patient interactions after his.

 

[dilated]

Not to read too much into your response above, but why do you feel you have to give up "discussions, rapport with patients..." to be a surgeon?

Maybe as an attending. Castro was applauded widely for his post several pages above which included "let's eat lunch" as an example of horrible intern behavior. Somehow I doubt "I spent time reassuring the patient about their upcoming surgery" passes muster with the "how DARE you expect to be allowed to eat food" crowd.

 

[smq123]

Maybe as an attending. Castro was applauded widely for his post several pages above which included "let's eat lunch" as an example of horrible intern behavior. Somehow I doubt "I spent time reassuring the patient about their upcoming surgery" passes muster with the "how DARE you expect to be allowed to eat food" crowd.

I guess it depends on your personal experience.

It was never phrased "how DARE you expect to be allowed to eat food!" If any of the residents got upset with a student for eating it was because

a) the student took the time to eat at the expense of doing something else that was more important, or

b) because the student took the time to eat, but wasn't mindful that, actually, everyone ELSE on the team was just as hungry.

Some of my most meaningful patient interactions were on surgery. Even on a predominantly surg onc service, I got to know the patients well - I was the one who fought PT on the phone for them, I was the one who talked about their pain management with them, I was the one that they showed photos of their grandkids to.

Even on other rotations in that same hospital, I still snuck away during the day and stopped to visit with them for 5 minutes. One of the patients that I visited always mentioned the chief resident, and how wonderful he was (he really did have a great way of interacting with patients), and how grateful she was to everyone. If that isn't good patient rapport, then I don't know what is - it certainly beats most of my patient interactions in IM!

 

[MossPoh]

Once again, I'm going to start by saying my input means jack and I know that...not going to say otherwise, but I do agree with you guys that you don't need to try and sell the product. The last thing you need to do is sell snake oil to people. Reading over most of your descriptions, surgical training seems very similar to military training. Aside from the fact that surgery really progressed/began because of warfare, there appears to be a legit reason; you want the person that you can depend on in the trenches when times are tough. They don't need to be your best friend, but they do need to be dependable and hold themselves accountable. I see what Castro mentioned earlier with the excuses every day. It begins at a very young age. Heck, go into an undergrad chemistry lab and watch as many of the premeds take tons of short cuts and then ditch a messy lab on their counterparts. (I'm sure non-premeds do this too...but I don't notice it as much) They all feel they are a beautiful and unique snowflake. Things like this are happening in all careers right now. A "me first" mentality. You aren't buying surgery, internal medicine, accounting, teaching, etc., it is buying you. Sometimes one doesn't have enough solid options, and still gets ditched with the best of the worst. I think some of these people should be put somewhere doing backbreaking manual labor for a bit. The kind of job that you can't leave till its done. That helped me more than anything....but some people are afraid of a couple of blisters.

 

[zeitgeist]

i think that one of the main reasons why new interns may not have the correct mindset regarding hours and such is because of the way the surgical clerkship is geared at medical schools. at my school, we took overnight call once a week, and, when we did, we'd often get sent to bed by the resident. it wasn't until my subI that i was exposed to the real surgical lifestyle. i did three straight months of q3... and, for me, that was when i knew for sure that surgery was for me. i probably violated work hours every week but i never ever felt that i wanted to leave the hospital. i wanted to stay and see what was going on and help out. but, this was my choice... i couldve not taken any call at all if i didn't want to. my attendings didnt care one way or another... so, i think it is on us, as residents and attendings, to push medical schools to make the surgery clerkship more intense so that people get a better sense of what it's like. granted, a week left before internship, i don't really know what's it's like... but i think i have a better idea given last summer as opposed to my clerkship experience.

 

[Kikaku21]

Once again, I'm going to start by saying my input means jack and I know that...not going to say otherwise, but I do agree with you guys that you don't need to try and sell the product. The last thing you need to do is sell snake oil to people. Reading over most of your descriptions, surgical training seems very similar to military training. Aside from the fact that surgery really progressed/began because of warfare, there appears to be a legit reason; you want the person that you can depend on in the trenches when times are tough. They don't need to be your best friend, but they do need to be dependable and hold themselves accountable. I see what Castro mentioned earlier with the excuses every day. It begins at a very young age. Heck, go into an undergrad chemistry lab and watch as many of the premeds take tons of short cuts and then ditch a messy lab on their counterparts. (I'm sure non-premeds do this too...but I don't notice it as much) They all feel they are a beautiful and unique snowflake. Things like this are happening in all careers right now. A "me first" mentality. You aren't buying surgery, internal medicine, accounting, teaching, etc., it is buying you. Sometimes one doesn't have enough solid options, and still gets ditched with the best of the worst. I think some of these people should be put somewhere doing backbreaking manual labor for a bit. The kind of job that you can't leave till its done. That helped me more than anything....but some people are afraid of a couple of blisters.

I have to clear the air here, because my example of a labor market is being miscontrued.

While, it is easy to caricature my example with talk of "buying," there is indeed a labor market in surgery--just as there is for ANYTHING, whether a buying a good or service at the store, or selling your labor. You are on one end of a transaction.

Every person looks at the options presented to them in pursuing various careers, and they choose to "buy" into one of them. (That is, they sell there services for a given wage and certain opportunities. In this case the opportunity to for placement in the career of surgery, and all that comes with it.) That being said, my argument above was about whether surgeons were on the losing side of transaction because of what they were offering and how it effecting what kinds of people are biting. It was widely agreed upon that they were not losing.

But a transaction is INDEED taking place, and you are indeed being SOLD on entering surgery if thats the route you choose. Whether you want to apply a negative connotation to the word "buy" or not is up to you. If you decide to go into surgery for the most valient and selfless reasons, or you do it just for the almighty dollar (an irrational decision), you are involved in a transaction on the labor market.

(Technically, the buyer is the surgery program, you are selling labor, but for the sake of the argument, the term "buy" on the opposite end of the transaction is legitimate. Think of it as a "trade" if you want. The logic holds.)

 

[Winged Scapula]

Maybe as an attending. Castro was applauded widely for his post several pages above which included "let's eat lunch" as an example of horrible intern behavior. Somehow I doubt "I spent time reassuring the patient about their upcoming surgery" passes muster with the "how DARE you expect to be allowed to eat food" crowd.

My point was not whether or not interns should be eating lunch in the cafeteria when there are consults to be seen. I agree with Castro...eating comes after the work is done (or at the very least, WHILE the work is done), otherwise you end up staying later, patients are waiting, etc.

And it IS ok to spend time with patients developing a rapport with them as an intern.

My point was that Blonde Docteur made it sound like she felt that surgery was devoid of these attributes and nothing could be further from the truth. You do not have to spend hours with patients to "talk with them" and develop a rapport, nor do you have to be a cowboy and refuse to discuss cases with your medical colleagues.

Do I have more time now than as an intern to talk with patients? In some cases yes, and in some no. Do I balk at bringing patients back for additional visits or talking on the phone with them? Sometimes because it is non-reimbursed time, but its the right thing to do for the patient. Remember in PP I am not on salary but paid for my interactions so it does not behoove me either to spend a lot of time with post-op patients because I cannot bill for it during the global.

At any rate, whether or not the "crowd" agrees that they have the time to develop and/or maintain these skills as residents, I'm sure they will verify that these are not in short supply in surgery and that it is worthwhile making sure your patient interactions contain some element of support, rapport and empathy.

(off my soapbox)

 

[dilated]

b) because the student took the time to eat, but wasn't mindful that, actually, everyone ELSE on the team was just as hungry.

I suppose it is in how you look at it. If the team is regularly too overworked to even eat lunch, I would humbly suggest that the solution is not dragging a banana bag on rounds with you to prove you're hardcore, it is for the hospital to stop being so damn cheap and understaffing. The fourteen hour days are one thing; not even being able to pause to eat makes me think of the hospital CEO off somewhere laughing hysterically in his Bentley. Guessing they don't skip too many lunches.

 

[Winged Scapula]

I suppose it is in how you look at it. If the team is regularly too overworked to even eat lunch, I would humbly suggest that the solution is not dragging a banana bag on rounds with you to prove you're hardcore, it is for the hospital to stop being so damn cheap and understaffing. The fourteen hour days are one thing; not even being able to pause to eat makes me think of the hospital CEO off somewhere laughing hysterically in his Bentley. Guessing they don't skip too many lunches.

I don't think many of us (who have done this) are proud of being "hardcore" but rather realistic that this is what it takes to get the job done.

You are absolutely right that the hospitals need to be more invested in hiring ancillary help and that the CEOs probably don't miss many meals.

However, I highly doubt the CEOs are laughing hysterically as they are usually so out of touch with their "servants" that I am sure that:

a) they have no idea how many hours residents work
b) how little money they make for those hours
c) how many meals they skip

etc...

 

[Castro Viejo]

Maybe as an attending. Castro was applauded widely for his post several pages above which included "let's eat lunch" as an example of horrible intern behavior. Somehow I doubt "I spent time reassuring the patient about their upcoming surgery" passes muster with the "how DARE you expect to be allowed to eat food" crowd.

You've missed my point. Others have addressed it, but since it's my quote, allow me to explain.

I don't mind eating with my team. I'd love it if we could sit down and have a power lunch and discuss stuff or have a general banter-fest. It'd be great. But that's not the reality of running a service in a program worth its mustard. Most General Surgery services in most programs are extremely busy, and every member of the team has a function. It's too bad that most of the scut falls on the shoulders of the intern, but that's the way our hierarchy works. The statement "Let's go for lunch!" is an intern's non-appreciation for how truly busy we are as a service and that the act of getting together and having lunch would be entirely impossible unless we ignored our clinical duties as surgical residents. So I take issue with the statement because it means that the intern hasn't figured it out yet. He hasn't matured to the level that's expected of him.

If he's hungry -- great. Go to the cafeteria and do a drive thru and eat on the way back upstairs to get $hit done. That's what I did and that's what the guys and gals who came before me did. To suggest that we should do lunch together means that you haven't a clue what's going on and that's what is so disappointing. Not that you are desperately hungry -- that's only human and we are, after all, just demigods.

As I said, it's difficult for anyone but a surgical resident who's been in a position to lead a team and have responsibility for the patients on the service to understand. I surely don't expect most non-surgeons to understand and they don't.