How passionate are you about the organ system you operate on?

[zombietrainer1]

Hi everyone,

I'm a third-year medical student trying to finalize my specialty choice. I've been pursuing neurosurgery for a couple of years now, mostly out of a profound interest in the brain. I didn't feel like I was interested much in the subject matter of other surgical specialties, and didn't explore them very much. Now that I've completed my clinical rotations in them, I've realized that there are many aspects of neurosurgery that I don't enjoy nearly as much as I thought I would; for example: spinal surgeries (and the fact that they often make up 50-70% of all cases for most neurosurgeons), the sheer length of some surgeries (routinely 5+ hours, up to 12+ hours), generally poor outcomes, the intense personalities, etc.

In sharp contrast, I enjoyed my time on general surgery a lot more than I thought I would. I meshed well with both staff and residents, really enjoyed the pace and the procedures, loved the thought of getting good at laparoscopic surgeries, enjoyed that many (most?) of our patients had great outcomes, and appreciated that the staff surgeons had enough time to pursue a reasonable life outside of the hospital (unlike in neuro surg). I also like the idea of trauma surgery, although I haven't had a chance to explore it yet.

My biggest dilemma right now is that I don't find the organ systems of general surgery to be particularly fascinating. I really enjoy the anatomy, but I'm not especially interested in most of the research happening in the field (e.g. gut microbiome, molecular biology in surgical oncology, etc.), except for maybe medical devices and innovation. So my question is: how important is it to be "passionate" about the organ system you are operating on? Am I doomed to eventually become miserable if I go for gen surg without feeling the same fascination as I do for the brain in neurosurg? Is enjoying the anatomy and procedures good enough to keep you going?

These are of course very personal questions, but I have no way of knowing if my current interest in gen surg is enough to keep me going for the long haul. It's hard to tell with only a 3-week exposure in the specialty. Would love to hear from residents who are or have been in a similar situation.

Thanks for your help and sorry for the long post!

P.S. In case it matters, I'm studying in Canada, and feel like I have a reasonable shot at matching neurosurgery if that's the path I end up choosing.

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[daenschl]

I'm just a 4th year student, so I don't have a ton of insight into this, but I've had a similar journey to you, so I'll share my thoughts.

Like you, I was gung-ho for Neurosurgery, for years before medical school and until half-way through my 3rd year. Then I rotated on it and had a very similar feeling. I didn't actually enjoy the long surgeries with incredibly long set-up times. The poor outcomes for cranial surgery and back surgery weighed on me. As much as I was fascinated by the brain, there was just a lot of tedious surgery with not a lot of neuroscience. Every single resident told me that I needed to absolutely LOVE neurosurgery to make it through training. Several attendings confessed regret regarding the time they missed with their families. I continue to have great respect for those who choose this specialty, but I had to realize that for me and my life goals, it was not the right choice. A very small part of me still misses the idea of me doing Neurosurgery, but I know I've made the right choice moving on. Part of it was also a difficult self-realization that what had attracted me to neurosurgery, at least in part, was the prestige and money. I was not consciously aware of this, but once I seriously considered abandoning neurosurgery, it became clear to me that those things were part of my motivation. This might not have been the case for you at all; I'm just sharing my process.

I also enjoyed general surgery more than I thought. But I ended up deciding on Urology. Now to your question, is it because I'm absolutely passionate about the genitourinary/renal system? No. I enjoy the anatomy of the kidneys and pelvic surgery just fine. I like the outcomes and patient population. I like doing surgery. I really like the residents and attendings I met. I just kind of found the people that I'll be happy working with, both as colleagues and patients.
Obviously I'm not a Urologist yet, so maybe you do have to be super passionate about the organ system in question. But I feel very happy with the choice I made.

 

[doc05]

Hi everyone,

I'm a third-year medical student trying to finalize my specialty choice. I've been pursuing neurosurgery for a couple of years now, mostly out of a profound interest in the brain. I didn't feel like I was interested much in the subject matter of other surgical specialties, and didn't explore them very much. Now that I've completed my clinical rotations in them, I've realized that there are many aspects of neurosurgery that I don't enjoy nearly as much as I thought I would; for example: spinal surgeries (and the fact that they often make up 50-70% of all cases for most neurosurgeons), the sheer length of some surgeries (routinely 5+ hours, up to 12+ hours), generally poor outcomes, the intense personalities, etc.

In sharp contrast, I enjoyed my time on general surgery a lot more than I thought I would. I meshed well with both staff and residents, really enjoyed the pace and the procedures, loved the thought of getting good at laparoscopic surgeries, enjoyed that many (most?) of our patients had great outcomes, and appreciated that the staff surgeons had enough time to pursue a reasonable life outside of the hospital (unlike in neuro surg). I also like the idea of trauma surgery, although I haven't had a chance to explore it yet.

My biggest dilemma right now is that I don't find the organ systems of general surgery to be particularly fascinating. I really enjoy the anatomy, but I'm not especially interested in most of the research happening in the field (e.g. gut microbiome, molecular biology in surgical oncology, etc.), except for maybe medical devices and innovation. So my question is: how important is it to be "passionate" about the organ system you are operating on? Am I doomed to eventually become miserable if I go for gen surg without feeling the same fascination as I do for the brain in neurosurg? Is enjoying the anatomy and procedures good enough to keep you going?

These are of course very personal questions, but I have no way of knowing if my current interest in gen surg is enough to keep me going for the long haul. It's hard to tell with only a 3-week exposure in the specialty. Would love to hear from residents who are or have been in a similar situation.

Thanks for your help and sorry for the long post!

P.S. In case it matters, I'm studying in Canada, and feel like I have a reasonable shot at matching neurosurgery if that's the path I end up choosing.

Sounds like you'll be miserable in neurosurgery.

Keep in mind that you may be "fascinated" by the brain, but if your perspective is that it's generally poor outcomes and excessively long surgeries, you'll probably burn out.

Most community-based general surgeons aren't "passionate" about research, but you need to like the basic aspects of the work.

Give it some time. There are other fields out there as well.

 

[DoctwoB]

I also was in a similar situation where I came in interested in neurosurgery and also ended up in Urology and for similar reasons. While I found the neuroscience fascinating, the day to day of neurosurgery with incredibly sick patients, often poor outcomes, and spine, spine, and more spine surgery wasn’t what I was looking for. I have a lot of respect for my neurosurgery colleagues, but after taking ego out of the equation I realized I liked the idea of being a neurosurgeon more then the reality of becoming one.

I find GU physiology interesting as well, but it’s not like I entered medschool with an undying passion for it. What drove me towards urology was that the “bread and butter” procedures include a good mix of clinic, endoscopic, minor open, and lap/robotic procedures that I saw myself enjoying over the course of a career. I liked that on a given day you might operate on patients for cancer, stone disease, BPH, structure disease, infertility, etc, mostly doing elective cases on healthier people with mostly excellent outcomes.

Whatever field you choose, I’d pick one where you could see yourself being happy doing the bread and butter of that field, because the likelihood of you developing that perfect practice where you only do X procedures is pretty low.

 

[kitsunepixie]

It's good to be honest with yourself, but if you are truly on the fence, please look for other shadowing experiences. As for myself, I was interested in neurosurgery since I was a kid and gravitated to the neurosciences, and also surgery. Neurology was easy enough to rule out because I felt you couldn't do much to help the patient. I loved my trauma surgery and peds general surgery rotations, and was looking at Plastic Surgery (craniofacial) as well, but neurosurgery won out. One breast surgeon I shadowed tried to convince me to go into her field because of better work-life balance (she also wanted to do neurosurgery but switched) and I was nearly swayed. I'm sure I could have been happy as a breast surgeon, but I wondered if I would get bored doing that. I also don't really like butt pus and guts gross me out, so the idea of doing general surgery in order to do breast surgery didn't really appeal to me. (No offense to any gen surgeons). Sage advice from one of my neurosurgeon mentors was, "Pick the bodily fluid that grosses you out the least, like I did. Spinal fluid is the only fluid that you would rather have from someone else on you than your own."

Interestingly, there were a few patient cases that really solidified to me what I wanted to do. One was a young mom who presented with cauda equina syndrome from a massive disc herniation incurred from a roller skating accident. Removing the disc was gratifying, and she went home the next day completely back to normal. Another was an epidural hematoma who recovered and did well, and on my sub-I a patient with a meningioma compressing her spinal cord and another who underwent microvascular decompression for trigeminal neuralgia. I did several sub-Is that were different from my home program.

Do I still love neurosurgery? Yes. Do I love EVERYTHING about it? No. I groan at the 8 PM shunt headache in the ER. I do pediatrics now, and although MOST of my patients are healthy, we have some very difficult and sad cases (DIPG, shaken babies, severe congenital malformations), but these are the MINORITY. My favorite cases would be a mix, like a tethered cord release or a herniated disc, a brain tumor or Chiari, a minimally invasive sagittal synostosis, and a brachial plexus or moya moya case now and then. I like the fact that pediatric neurosurgeons FOLLOW most of their patients for years and watch them grow up. I'm happy to not do acoustic neuromas or other million-hour skull base cases, or complex spinal deformities and send those out. I do like short segment fusions for spondylolisthesis or atlantoaxial instability and keep those.

 

[DrGoon]

Hi everyone,

I'm a third-year medical student trying to finalize my specialty choice. I've been pursuing neurosurgery for a couple of years now, mostly out of a profound interest in the brain. I didn't feel like I was interested much in the subject matter of other surgical specialties, and didn't explore them very much. Now that I've completed my clinical rotations in them, I've realized that there are many aspects of neurosurgery that I don't enjoy nearly as much as I thought I would; for example: spinal surgeries (and the fact that they often make up 50-70% of all cases for most neurosurgeons), the sheer length of some surgeries (routinely 5+ hours, up to 12+ hours), generally poor outcomes, the intense personalities, etc.

In sharp contrast, I enjoyed my time on general surgery a lot more than I thought I would. I meshed well with both staff and residents, really enjoyed the pace and the procedures, loved the thought of getting good at laparoscopic surgeries, enjoyed that many (most?) of our patients had great outcomes, and appreciated that the staff surgeons had enough time to pursue a reasonable life outside of the hospital (unlike in neuro surg). I also like the idea of trauma surgery, although I haven't had a chance to explore it yet.

My biggest dilemma right now is that I don't find the organ systems of general surgery to be particularly fascinating. I really enjoy the anatomy, but I'm not especially interested in most of the research happening in the field (e.g. gut microbiome, molecular biology in surgical oncology, etc.), except for maybe medical devices and innovation. So my question is: how important is it to be "passionate" about the organ system you are operating on? Am I doomed to eventually become miserable if I go for gen surg without feeling the same fascination as I do for the brain in neurosurg? Is enjoying the anatomy and procedures good enough to keep you going?

These are of course very personal questions, but I have no way of knowing if my current interest in gen surg is enough to keep me going for the long haul. It's hard to tell with only a 3-week exposure in the specialty. Would love to hear from residents who are or have been in a similar situation.

Thanks for your help and sorry for the long post!

P.S. In case it matters, I'm studying in Canada, and feel like I have a reasonable shot at matching neurosurgery if that's the path I end up choosing.

Your story sounds very similar to me. I’m a M4 and came to med school extremely interested in neuroscience with plans to pursue neurosurgery. In 3rd/4th year I did a couple rotations and was turned off from the field for essentially the same reasons you listed. Ended up applying psych and am very happy with decision at this point.

 

[Chillbo Baggins]

Enjoying the bread and butter cases is pretty important. This article covers my feelings of my specialty very well:

https://gomerblog.com/2014/09/bones/

 

[OrthoTraumaMD]

I love operating on the musculoskeletal system because it makes sense to me. I enjoy translating biomechanical concepts into reality. I think passion is necessary if you want to become great in your field, but it is not necessary if you want to be good.


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[kitsunepixie]

Enjoying the bread and butter cases is pretty important. This article covers my feelings of my specialty very well:

https://gomerblog.com/2014/09/bones/

Reminds me of when I let a Ortho intern drill into the skull so I could put in an EVD. He started twisting the hand drill in anticipation while I put a mark on the head at Kocher's point and he gleefully said, "Me drill here?" He did a fine job.

 

[Med0123]

That is funny, I too was interested in neurosurgery when I was in medical school, I hesitated between NS and ortho, published in NS... and then when I shadowed neurosurgeons and saw what were their outcomes and general practice, I quickly decided that it was not for me.

I ended up doing general surgery, and then general thoracic surgery. I am really happy with my decision. It is challenging, highly technical (minimally invasive thoracic surgery is intense!), rewarding especially with the cancer patients population, etc.!

 

[Dr. Retractor]

It's crazy how many ex-NS people there are! I had similar reservations about the research aspect and departing from the brain but there are so many interesting (to me) fields you can do research in as a surgeon that don't require you to be passionate about a certain organ system per se - clinical outcomes, epidemiology, health systems, education, even surgical instrument design! Only made the switch recently as an M3 so obviously I don't know anything, but I'm pretty excited at the prospect of doing gen surg.

 

[TypeADissection]

This is a bit eerie. I too went into med school with a strong interest in NS and did all of my research and got some posters out of it during M1-2. Then after rotating through it, I realized how much I didn't enjoy spine surgery and also knew that I was not built for academia where a large chunk of the intracranial work resides. So I switched gears and found general surgery to be quite enjoyable in its scope and breadth of practice. Then I discovered vascular surgery towards the end of my intern year and considered re-entering the match as a PGY-2 for an integrated position, but ended up sticking it out and finishing. In my humble opinion, I just find the aorta and more specifically the descending thoracic aorta up to the left subclavian to be one of the most fascinating parts of the human body. From an open and endo standpoint, the solutions to attempt to fix pathologies in this area both challenging and intellectually stimulating. So yeah, long-winded answer to say yes - I am very passionate about the system I operate on. Cheers.

 

[Psai]

This is a bit eerie. I too went into med school with a strong interest in NS and did all of my research and got some posters out of it during M1-2. Then after rotating through it, I realized how much I didn't enjoy spine surgery and also knew that I was not built for academia where a large chunk of the intracranial work resides. So I switched gears and found general surgery to be quite enjoyable in its scope and breadth of practice. Then I discovered vascular surgery towards the end of my intern year and considered re-entering the match as a PGY-2 for an integrated position, but ended up sticking it out and finishing. In my humble opinion, I just find the aorta and more specifically the descending thoracic aorta up to the left subclavian to be one of the most fascinating parts of the human body. From an open and endo standpoint, the solutions to attempt to fix pathologies in this area both challenging and intellectually stimulating. So yeah, long-winded answer to say yes - I am very passionate about the system I operate on. Cheers.

Your username tho

 

[TypeADissection]

Your username tho

I know right? TAD just sounded better than TBD.

 

[ThoracicGuy]

I know right? TAD just sounded better than TBD.

Beta is as beta does! Gotta be that alpha!

 

[TypeADissection]

Beta is as beta does! Gotta be that alpha!

"They don't think it be like it is, but it do."
- Oscar Gamble

 

[VincentAdultman]

Enjoying the bread and butter cases is pretty important. This article covers my feelings of my specialty very well:

https://gomerblog.com/2014/09/bones/

Sounds about right. Except the part about the heart. It’s not confusing. It pumps the ancef to the bones.