Giving up on my dream of surgery

[failedatlife]

You should congratulate every surgeon you meet on your surgery rotation for rocking the step 1 as you shake their hand.

When they ask you to close and suture in the OR ask them if they're sure if they should let a <230 step 1 score even near scissors.

I developed an inferiority complex around nsg, ent, ortho, optho residents because I know 99% of them here had higher board scores than me. I do my best to hide it though. I would congratulate them but then they would know of my disaster in life and think even less of me. Sub Is are going to be painful. I can't wait for this nightmare to end.

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[Anicetus]

I developed an inferiority complex around nsg, ent, ortho, optho residents because I know 99% of them here had higher board scores than me. I do my best to hide it though. I would congratulate them but then they would know of my disaster in life and think even less of me. Sub Is are going to be painful. I can't wait for this nightmare to end.

Sub-Is? Why? Are you still going to be doing surgical sub-Is? If you end up doing IM Sub-I's you won't need to worry about your step 1 being inferior. It could be a whole new life for you. You may find solace in that realm of medicine with others who couldn't cut the 250 step score unless your research bumps you up to JHU IM. The nightmare may end in that world.

 

[anotherdecision]

Another NSGY resident here.

When I submitted my rank list >5 years ago one thing was certain in my mind - should I not match, I was going to leave medicine all together ( I came from a lucrative career that I could have returned to). I simply had no interest in anything else. This sentiment has not changed - Working alongside every other medical specialty - I couldn't stomach doing anything else (ER shifts, endless rounding...). Neurosurgery is definitely a passion. Furthermore, consider the expendability of your chosen field. Things are changing - and people want a slice of your pie.

Lastly as far as the "procedural specialties" go. There is no comparison. If you are a surgeon - you want to operate.

As far as the lifestyle: one poster above touched on the program specific nature. The experience varies dramatically. Choose your program carefully. Working a lot of hours does not translate into good training. In my mind the most important factors are: resident independence (above all) coupled with case volume and diversity. Then there are bonuses: my residency has an army of PAs that do all scut work: discharge notes, rounding on patients that no longer need decision making (regular floor patients). This translates into excellent quality of life during 4 of 7 years (chief year and junior years are obviously brutal).

Post-residency: It is what you make of it. I know some 30 hour/week neurosurgeons. They don't do interesting cases but their careers don't interfere with their 3pm daily Tee time. Or you can be a workaholic doing the most exciting type of surgery medicine has to offer.

Do what you love - don't be distracted by perceptions.

PS: I have children and have plenty of family time.

Can you explain what you mean by plenty of family time? One of the neurosurg residents here said he had plenty of family time too. When I asked him to explain, he said he typically takes Sunday afternoon off for his family. Not my idea of "plenty". Thanks.

Your post caught my eye. Does this mean that you had a child during medical school? How did you handle the finances of that? Did you give birth or your partner?

I am starting school this Fall and my partner mentioned that maybe we should have a child during medical school. It kind of sounds impossible but if you did it, I want to hear how!

To be honest, I rationalized that this may be a bad idea but I was told by a resident that waiting for perfect timing to marry or to have children doesn't usually work and that letting it happen when it happens is the best thing to do... Do you think this is valid?

My wife gave birth. She is currently staying at home working part-time. We weren't planning to get pregnant but when it happened it seemed like as good as a time as any! Time during med school is not that hard to find because many things are flexible like studying and elective rotations. Only difficult year time-wise is clinical year. Many wait until after all of their training is done but that is often mid-to-late 30's and we didn't want that.

 

[anotherdecision]

Still can't decide...

 

[DNC127]

Still can't decide...

Don't be a quitter, be a surgeon.

 

[OTOSwap]

As a surgeon, I can tell you that if you really want to be in an OR, going into a field that does "procedures" as opposed to "operations" is not going to be equally satisfying. I'd much rather do a lap chole any day than an I&D/chest tube/LP or whatever else is deemed a "procedure". Procedures are not an equal substitute for me (or any surgeon I know). Would you be ok not setting foot in an operating room again? If not, you may be a surgeon and just need to figure out your specialty. GU and ENT come to mind as two fields that are pretty good for lifestyle balance once you get through residency. But you have to get through residency and realize residency does not represent what actually being in practice is like.

ENT is very location dependent. Some of the private practice guys locally are miserable. Many get destroyed on call. Many have neck issues and herniated disks. That is common through the field of ENT. It is not "early nights and tennis".

They are not taking trauma call but they still get called a lot. In addition, hospitals without ENT coverage will transfer their ENT issues to a hospital with ENT. Foreign bodies in the ED (kids swallow quarters, put things up their noses), neck abscess, retropharyngeal abscess, the list goes on and on. You will take ER call, but also be on call for your own patients 24-7. ENT is not a lifestyle field the way it is depicted on this board. Ask any of my attendings that are not residents. The procedures they go in the middle of the night do not even pay well but have a lot of liability. When someone complicates a PERC TRACH, guess who they call to come and fix the problem? ENT. I am just trying to give you an accurate portrayal of things versus those posting what they have heard before. It is far from an easy lifestyle.

Think really hard about your life. You will give up a lot of time with family to do surgical training. It is not 80 hours a week. As an ENT resident, I frequently go over 100 hours a week. When I am home, I am reading for cases, doing presentations, reading for inservice exam, working on residency research. Guess what I am not doing, the other important things in life.

Lot's of ENT is not "surgical", it is putting tubes or scopes in things. So do not get hung up on the whole "operating" not equal to "procedure". You can do procedures in every field of medicine. You just need to explore them more. Have you thought about complications aspect of procedures? Think long an hard about what you like. Is it the "procedure" or the impact you have on the patient? Procedures and surgeries will change as time goes on. However, your impact on the patients will not. Think about what things you like and do not like in medicine. Try to minimize the things you do not like and maximize what you like. You also haven't experience what call is like. The stress of call takes a toll on a lot of people.

When you working over 100 hours a week and hearing brief stories of how your kids growing up and you missed them all, it will be very hard to accept not being part of that. You will never get these experiences in life back. You never now when your time is up. I don't want to scare you but only want you to realize the other parts of life. Medicine is full of gunners and people ego bating. Look beyond your colleagues and the easiness to get wrapped up in the chase for career.

I caution you, as medicine changes, speak to your attendings. Many are looking for a way out of medicine. Many get MBA and other degrees hoping to get an administrative job. People are burned out in medicine as a whole. Good luck in your decision and process. Hope I was able to give you some help if any.

 

[OTOSwap]

Honestly, I wouldn't do it. To be fair, this is coming from someone who couldn't imagine missing the majority of my child's early life. Sure, once you get through, your life would be more manageable, but you'll never get those years of your toddler back. If that's your top priority, which it sounds like to me in your posts and responses, I'd move on to something else. Keep in mind though, there are surgical subspecialties with very reasonable hours, even in residency, so maybe you should consider those of you really want to be in the OR.

Also, since it's neurosurg, I'm going to tell you about a friend of mine that always planned to be a neurosurgeon. After 3.5 years outside of the state he grew up in, away from his family, it was time to apply for residency. He also liked Neuro a lot, so he applied to both NS and Neuro, with most of his programs in his home state. When it came time to submit his ROL, he decided it was more important to him to be home than the difference between NS and Neuro, so he ranked NS, Neuro, NS, Neuro, etc.

In the end he matched Neuro in his home state at a program he really liked, and he managed to spend the last couple years of his father's life at home with him. Looking back, he is really glad not only that he ranked the programs the way he did, but that he matched Neuro. My point is that sometimes you have to figure out what's most important to you (and it might be NS). For most people it's not one field or bust. They can be easily happy in their job doing something else. Medicine is versatile.

You could also do what my friend did, and delay your decision until you actually go to those programs on your interviews, talk to NS residents outside of your own program, and then submit your ROL. Obviously, it's not the easiest thing applying to 2 different specialties, but people do it all the time. Maybe you just need some more time to decide.

EDIT: Just to be clear, I'm saying you need to prioritize what you want. If you can't see yourself being nearly as happy doing something else, then do NS. Obviously don't choose something else and then blame your family, that's not fair to them or you. This is your decision, and yours alone (given that your wife is on-board with what you want). Pick what you feel is most important and don't look back.

Good post. I know a guy who started out in Neurosurgery then transferred into ENT. He finished ENT, did facial plastics as well. He worked for a number of years before going back and doing Dermatology. He is board certified in both specialties. He echo's what this post says. Think long and hard about what you like to do.

 

[Kahreek]

Interesting that Urology has higher hours worked than Ortho when anecdotally everyone says that Urology universally has a better lifestyle. Not sure if only call hours would make up for this difference

Ortho Trauma hours can aswell count as x2.

 

[Kahreek]

Good post. I know a guy who started out in Neurosurgery then transferred into ENT. He finished ENT, did facial plastics as well. He worked for a number of years before going back and doing Dermatology. He is board certified in both specialties. He echo's what this post says. Think long and hard about what you like to do.

i think his case is more about personal choices than workload. I mean surely ending the NS residence would have been cushier than doing ENT then Derm. Maybe not?

 

[MediCane2006]

Still can't decide...

Oh, my god.

No one likes standing around and retracting. When you're actually operating, it's a completely different feeling.

Do what you love. If surgery makes you happy, do surgery and pick a subspecialty that will give you plenty of elective cases and little emergent call. You may not be a big academic superstar but you will be JUST FINE in terms of being able to get to soccer games, piano recitals, and be home on weekends for family time.

DO NOT do something you aren't passionate about for a life outside the hospital, because honestly unless you're doing derm or allergy you need to love whatever you do, because the hours aren't all that great regardless. People don't get sick 9-5. And it's way, way easier to get burned out if you're not all that enthused about your career choice.

I can tell you that as an academic surgical attending I work 7am-4pm most days, earn a very solid salary, and have weekends completely free. I would argue that's pretty comparable to "lifestyle" specialties and very amenable to a family life.

 

[Cyberdyne 101]

I don't know if this makes a difference but there are some Nsg that work less than primary care docs.but on average work 5 hours per week more.

ENT seems like a good compromise with reasonable hours compared to pc and or time.

According to the graph, the range of neurosurgery hours is 418 to 958 above family practice, which makes more logical sense. It looks like someone accidentally inserted a negative sign in front of the 418 when they were entering the data.

Edit: Whoops, didn't realize I was quoting a post from March.

 

[anotherdecision]

I will be doing IR. Thanks everyone.

 

[libertyyne]

I will be doing IR. Thanks everyone.

Lifestyle is just as brutal with extended length of training, any reason for opting for IR vs surgery?

 

[libertyyne]

According to the graph, the range of neurosurgery hours is 418 to 958 above family practice, which makes more logical sense. It looks like someone accidentally inserted a negative sign in front of the 418 when they were entering the data.

Edit: Whoops, didn't realize I was quoting a post from March.

More likely they forgot the - in front of 418.
(-418+958)/2=270

As (418+958)/2= 897

 

[Cyberdyne 101]

More likely they forgot the - in front of 418.
(-418+958)/2=270

As (418+958)/2= 897

The latter equation is more likely to be correct. Wouldn't you expect neurosurgeons to be at the top of the list? Why would they work less than family practice docs?

 

[libertyyne]

The latter equation is more likely to be correct. Wouldn't you expect neurosurgeons to be at the top of the list? Why would they work less than family practice docs?

Because there is large variation in practice set ups. The first equations is more likely to be correct as it requires less errrors to be in the paper.
1. Missing minus sign.


The second equation requires the following errors
1. Wrong number used in calculation.
2. Wrong number graphed

 

[Kahreek]

Lifestyle is just as brutal with extended length of training, any reason for opting for IR vs surgery?

He will probably end up doing DR with some procedures thrown in.
In the end rads is a pretty good choice and that is why despite job market saturation claims it is more competitive than GS.

 

[Kahreek]

He will probably end up doing DR with some procedures thrown in.
In the end rads is a pretty good choice and that is why despite job market saturation claims it is more competitive than GS.

I will be doing IR. Thanks everyone.

Dont be fooled prety much any residency and/or money is hard work. We need more sensible levelheaded people in surgery. Neurosurgery can be for you, depending on the program and call schedule. Doing a craniotomy at 2 am or placing a image guided cateter at 2 am is pretty much the same lifestyle.

 

[dr.d00m]

Delete

 

[vernhart]

More likely they forgot the - in front of 418.
(-418+958)/2=270

As (418+958)/2= 688

418+(958/2)=897...not that it changes anything, it was just bugging me lol

 

[libertyyne]

418+(958/2)=897...not that it changes anything, it was just bugging me lol

Copying mistake.

 

[aalamruad]

According to the graph, the range of neurosurgery hours is 418 to 958 above family practice, which makes more logical sense. It looks like someone accidentally inserted a negative sign in front of the 418 when they were entering the data.

Edit: Whoops, didn't realize I was quoting a post from March.

More likely they forgot the - in front of 418.
(-418+958)/2=270

As (418+958)/2= 897

The latter equation is more likely to be correct. Wouldn't you expect neurosurgeons to be at the top of the list? Why would they work less than family practice docs?

Because there is large variation in practice set ups. The first equations is more likely to be correct as it requires less errrors to be in the paper.
1. Missing minus sign.


The second equation requires the following errors
1. Wrong number used in calculation.
2. Wrong number graphed

I just contacted the author of that research paper to clarify which mistake was made (he and I work in related departments at the same institution), I'll post back here when I get his response.

 

[aalamruad]

According to the graph, the range of neurosurgery hours is 418 to 958 above family practice, which makes more logical sense. It looks like someone accidentally inserted a negative sign in front of the 418 when they were entering the data.

Edit: Whoops, didn't realize I was quoting a post from March.

More likely they forgot the - in front of 418.
(-418+958)/2=270

As (418+958)/2= 897

The latter equation is more likely to be correct. Wouldn't you expect neurosurgeons to be at the top of the list? Why would they work less than family practice docs?

Because there is large variation in practice set ups. The first equations is more likely to be correct as it requires less errrors to be in the paper.
1. Missing minus sign.


The second equation requires the following errors
1. Wrong number used in calculation.
2. Wrong number graphed

Just got his response, it should have been -418 to 958, the confidence interval lines and the 270 are correct.

 

[Cyberdyne 101]

Just got his response, it should have been -418 to 958, the confidence interval lines and the 270 are correct.

Wow, didn't think there would be that much variation!

I wonder what sort of neurosurgery practices have these friendlier hours...
@tiedyeddog

 

[aalamruad]

Wow, didn't think there would be that much variation!

I wonder what sort of neurosurgery practices have these friendlier hours...
@tiedyeddog

Their requirement for including a specialty in that study is a minimum of 20 respondents, so if only 20 neurosurgeons responded then that kind of variation is understandable I guess. @axiomofchoice says s/he knows some neurosurgeons who work 30-hour weeks (with relatively uninteresting cases), and of course some work 100-hour weeks, so the small sample size and huge variability in nsg practices combine to give a ridiculously big 95% confidence interval

 

[libertyyne]

Just got his response, it should have been -418 to 958, the confidence interval lines and the 270 are correct.

 

[anotherdecision]

Lifestyle is just as brutal with extended length of training, any reason for opting for IR vs surgery?

A few reasons.

First, the residency isn't nearly as bad. Yes, the IR years are tough but the DR years are around 50 hours per week. A surgical intern year is not required despite what many med students try to say.

Second, I despise clinic. IR is heading towards the clinic type specialty but it is much less than most surgical specialties (especially the "lifestyle" surgical specialties like ophtho, ENT, uro).

Third, after spending some significant time shadowing, I believe those procedures will be enough to satisfy my itch for intervention.

Finally, IR is more lifestyle friendly compared to most surgical specialties. There is call. It has longer hours than DR. But more manageable.

 

[libertyyne]

A few reasons.

First, the residency isn't nearly as bad. Yes, the IR years are tough but the DR years are around 50 hours per week. A surgical intern year is not required despite what many med students try to say.

Second, I despise clinic. IR is heading towards the clinic type specialty but it is much less than most surgical specialties (especially the "lifestyle" surgical specialties like ophtho, ENT, uro).

Third, after spending some significant time shadowing, I believe those procedures will be enough to satisfy my itch for intervention.

Finally, IR is more lifestyle friendly compared to most surgical specialties. There is call. It has longer hours than DR. But more manageable.

My understanding in speaking with ir docs has been it is moving to the same model where the surgeon admits and covers pre and post procedure as the primary attending. Leading to similar call to surgery. Probably less clinic ,but clinic schedule isn't what causes lifestyle issues it hospital coverage

 

[DrfluffyMD]

A few reasons.

First, the residency isn't nearly as bad. Yes, the IR years are tough but the DR years are around 50 hours per week. A surgical intern year is not required despite what many med students try to say.

Second, I despise clinic. IR is heading towards the clinic type specialty but it is much less than most surgical specialties (especially the "lifestyle" surgical specialties like ophtho, ENT, uro).

Third, after spending some significant time shadowing, I believe those procedures will be enough to satisfy my itch for intervention.

Finally, IR is more lifestyle friendly compared to most surgical specialties. There is call. It has longer hours than DR. But more manageable.

If you don't want to have clinic or dislike long hours you should not go for IR, but DR instead. You can still do an IR independent residency but you could be stuck doing IR if you decided you want to do DR at the end

 

[badasshairday]

If you don't want to have clinic or dislike long hours you should not go for IR, but DR instead. You can still do an IR independent residency but you could be stuck doing IR if you decided you want to do DR at the end

100% agree. OP is well suited for DR. A lot of people come into radiology thinking IR, but few actually end up doing it. Especially those with that mentality. Future of IR is patient centered. If you want a good life style and some procedures you can do diagnostic radiology and subspecialize in musculoskeletal, though many diagnostic radiologist across su specialities also do many procedures. You will find that while a med student vascular angiography may satisfy your interest in procedures, as a DR resident you will then feel that angiography is too intense and find solace in things like arthrograms, bone biopsies, steroid injections for pain relief, etc.

 

[badasshairday]

A few reasons.

First, the residency isn't nearly as bad. Yes, the IR years are tough but the DR years are around 50 hours per week. A surgical intern year is not required despite what many med students try to say.

Second, I despise clinic. IR is heading towards the clinic type specialty but it is much less than most surgical specialties (especially the "lifestyle" surgical specialties like ophtho, ENT, uro).

Third, after spending some significant time shadowing, I believe those procedures will be enough to satisfy my itch for intervention.

Finally, IR is more lifestyle friendly compared to most surgical specialties. There is call. It has longer hours than DR. But more manageable.

If you want to do high end IR you are signing yourself up to hours that are more comparable to a surgeons including clinic. Also if you want IR I would suggest doing a legitimate surgery internship or TY that gives you surgery, vascular, cardiology, GI, icu. As a pgy5 myself and other colleagues going into IR are trying our best to pick up and refresh some of our dormant clinical skills by going off service to spend time in the ICU or vascular surgery clinic or other domains. We do not have the luxury that those who are coming after us have. Looking at my own program's dedicated IR residency curriculum it is rolling out, the next generation of IR is going to be very clinically competent and full on hardcore clinicians as they have multiple rotations including vascular surgery, ICU, GI, cards etc. check out auntminnie and you will quickly see that the most reputable and highly sought after IR programs have extensive clinic and inpatient services.

 

[tiedyeddog]

Wow, didn't think there would be that much variation!

I wonder what sort of neurosurgery practices have these friendlier hours...
@tiedyeddog

It is highly variable, comparing academic to private practice can even be drastically different. Really wouldn't be that hard to pull 400K with around 40-50 hours a week put in if you're private practice. Doing 5-6 single level ACDF's or PLIFS a week would probably earn you around 400K, or so one of the minimally invasive spine attendings at my program says is true. Many in practice would rather work the average of 77 hours a week and make 700+. How much trauma call you take can drastically alter your quality of life as well and is highly variable. Trauma call is also a hotly debated topic within neurosurgery as many private practice neurosurgeons are refusing to even cover emergency cranial call due to the low amount of reimbursement they get out of it, the lawsuits generated from it, and the lower quality of life it brings with it.

Within subspecialities, functional is known to be a great gig with minimal call and little emergencies within the field (outside of infected devices/baclofen pump malfunction) if you can swing a practice that is tailored only to that field. Vascular is known to have a terrible lifestyle, especially if covering endovascular stroke interventions.

 

[badasshairday]

Vascular is known to have a terrible lifestyle, especially if covering endovascular stroke interventions.

Good thing stroke call can be shared among disciplines if available since it can be draining no doubt.

 

[tiedyeddog]

Good thing stroke call can be shared among disciplines if available since it can be draining no doubt.

I have zero interest in vascular neurosurgery/endovascular intervention so I have no dog in this fight. Only thing sharable would be interventional ischemic stroke while obviously hemorrhagic stroke/ischemic stroke requiring decompressive crani's are never shareable among disciplines. At my institution neurosurgery owns all endovascular procedures, your burden of call as a vascular neurosurgeon would be very institutional dependent.

 

[libertyyne]

I have zero interest in vascular neurosurgery/endovascular intervention so I have no dog in this fight. Only thing sharable would be interventional ischemic stroke while obviously hemorrhagic stroke/ischemic stroke requiring decompressive crani's are never shareable among disciplines. At my institution neurosurgery owns all endovascular procedures, your burden of call as a vascular neurosurgeon would be very institutional dependent.

Dont NIL trained neurologists also do post stroke vascular interventions?

 

[tiedyeddog]

Dont NIL trained neurologists also do post stroke vascular interventions?

Yes. We don't have neurology trained interventionists at my institution, just varies based on where you are at.

 

[badasshairday]

I have zero interest in vascular neurosurgery/endovascular intervention so I have no dog in this fight. Only thing sharable would be interventional ischemic stroke while obviously hemorrhagic stroke/ischemic stroke requiring decompressive crani's are never shareable among disciplines. At my institution neurosurgery owns all endovascular procedures, your burden of call as a vascular neurosurgeon would be very institutional dependent.

Yeah I mean ischemic stroke. Good to clarify hemorrhagic stroke as this is a med student forum.