Interested in surgery, please post your residency horror stories to dissuade me

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I'm starting to get an itching for surgery, but according to the MS4's who have done aways, our home GS program is a cupcake compared to others.

Please share some stories you have of residency that demonstrates why the attrition rate is so high.

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5min per page for the entire shift.
nonstop trauma.
perirectal abscess to drain in ED @2am
never sleep
never eat
never go home
never see sun
 
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Every person that has become a surgeon has died.
 
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What doesn't kill you only makes you stronger. Or only maims you a bit.

My program is considered a "workhorse" residency, not a cake-walk by any means. As my program director says "this program forms either diamonds or coal dust, depends on how the carbon responds to the pressure".
 
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Why are you trying to ask surgeons to dissuade you from surgery? Most of the people that post in this forum are happy with their choice. Quasi-Trolls like bannie aren't particularly good sources of info.

The fact that you want to be talked out of surgery is a good enough reason to choose something else; the experiences of others should have no bearing.
 
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Why are you trying to ask surgeons to dissuade you from surgery? Most of the people that post in this forum are happy with their choice. Quasi-Trolls like bannie aren't particularly good sources of info.

The fact that you want to be talked out of surgery is a good enough reason to choose something else; the experiences of others should have no bearing.

Others experience should have no bearing??

What's the point of SDN then?

Seems bannie answered OPs question. Pretty accurate (though not necessarily complete) as well, based on my own rotations. But that's what OP wanted to know.
 
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The attrition rate is actually higher in Psychiatry and Ob-Gyn.

Sure. But comparing anything to psych is a bit.....unfair. People that go into psych are a different breed. I would argue more different from the rest of their graduating class than the surgeons are.
 
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also never see ur family
and coworkers who might have no respect for others opinions and only singularly believe in the holyness and righteousness of general surgery
 
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Pretty accurate (though not necessarily complete) as well, based on my own rotations.

Med students don't really have an accurate perception of specialties based on their rotations, and shouldn't really attempt to talk about what life is like amongst a group that's actually got real experience.

I see my family plenty. I am out in the sun right now (doing my taxes, but still sitting out on a nice warm day). I cook dinner 4-5 nights a week because I like to cook and it relaxes me after work.

Surgery residency is hard, I'm not going to understate that.

But the melodrama on this forum from inexperienced posters is unbearable, particularly when nearly everyone on here that I know is an actual surgery resident is satisfied with their career choices.
 
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Med students don't really have an accurate perception of specialties based on their rotations, and shouldn't really attempt to talk about what life is like amongst a group that's actually got real experience.

I see my family plenty. I am out in the sun right now (doing my taxes, but still sitting out on a nice warm day). I cook dinner 4-5 nights a week because I like to cook and it relaxes me after work.

Surgery residency is hard, I'm not going to understate that.

But the melodrama on this forum from inexperienced posters is unbearable, particularly when nearly everyone on here that I know is an actual surgery resident is satisfied with their career choices.

Same to all of the above for me. I'd be outside right now but somehow I have time to moonlight for 24-hours at a rural ED.

OP already heard from Med students per their post and asked for people who enjoy what they do to convince them not to do it based on "horror stories" from people actually in surgery. I stand by my assessment of bannie as a quasi-troll who never really adds anything helpful or relavant to a conversation. And the OP can post in the Med student forums if they want more Med student opinions.
 
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Same to all of the above for me. I'd be outside right now but somehow I have time to moonlight for 24-hours at a rural ED.

OP already heard from Med students per their post and asked for people who enjoy what they do to convince them not to do it based on "horror stories" from people actually in surgery. I stand by my assessment of bannie as a quasi-troll who never really adds anything helpful or relavant to a conversation. And the OP can post in the Med student forums if they want more Med student opinions.

This consistently shocks and terrifies me.
 

Because the more emergency medicine I learn, the more I realize how little I know. If you are staffing an ED and don't understand the implications of wellen's waves, up to date stroke literature, the new black box warning for flouroquinolones, which kids with BRUE can go home vs. get admitted, stroke and stemi mimics, when to be concerned about kawasaki's, etc you are doing your patients a disservice and opening yourself up to a lot of liability.
 
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I just don't see why you would train for 5 years in one specialty and risk your career by trying to practice another specialty.

That's a beautiful aspect of medicine though, the ability to cross discipline and do so safely. That's the point of all of us taking the same boards leading up to residency.

We all get the same necessary tools to practice all of medicine.

Plus, as you said, we can always look something up or ask a colleague.
 
That's a beautiful aspect of medicine though, the ability to cross discipline and do so safely. That's the point of all of us taking the same boards leading up to residency.

We all get the same necessary tools to practice all of medicine.

Plus, as you said, we can always look something up or ask a colleague.

I assume you're saying this in jest, but sometimes things are lost without tone.
 
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No actually mean it.

As a surgery resident, I would think you'd have ability to take ED shifts. Pretty sure that ED rotations are part of surgery residency anyway.

That's crazy talk. You should be acutely aware of the need for residency training.

I've worked in rural ERs and gotten signout from non-EM docs moonlighting and it's terrifying. There's a reason we have specialty training. Sure, we both did med school, but when a patient comes in with hypoxic respiratory failure, you don't have time to look up the dosing and contraindications to succs.

Not trying to start a flame war. Some of my best friends are surgeons and I have tremendous respect for what you do. I just think it shows very poor insight to think that you have the knowledge to practice competently outside of your specialty because you did a month of EM in residency. I did a month of surgery in mine, should I have OR privileges?
 
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That's crazy talk. You should be acutely aware of the need for residency training.

I've worked in rural ERs and gotten signout from non-EM docs moonlighting and it's terrifying. There's a reason we have specialty training. Sure, we both did med school, but when a patient comes in with hypoxic respiratory failure, you don't have time to look up the dosing and contraindications to succs.

Not trying to start a flame war. Some of my best friends are surgeons and I have tremendous respect for what you do. I just think it shows very poor insight to think that you have the knowledge to practice competently outside of your specialty because you did a month of EM in residency. I did a month of surgery in mine, should I have OR privileges?

Very interesting...thank you for the insight.

Your honest and valid opinion should not start a war. It's your input, period.
 
Residency is very important and sometimes the ego of physicians make them believe they can practice in all other specialties.

However, I do believe that medical school should prepare all physicians to understand the basics of each specialty so as to refrain from frivolous consults to one another.
 
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I haven't been a surgeon, but I was an OR nurse.

I cannot tell you how many times I have had to call the surgeons' wives or husbands or significant others to say "Dr. says it will be a few more hours. Sorry about your dinner plans. Maybe tomorrow?" I've held the phone up to a scrubbed-in doctor's head so that she could tell her kids "Happy Birthday!" or "Merry Christmas!" "Mommy will see you tomorrow. No, I won't be home before you go to school, but I will see you after. I promise. Good night!" Their au pairs and I got to know each other a bit, because I was calling so often to check on how a kid's soccer game went or whether the vet was able to figure out what was wrong with the dog.

I got to know the surgeon's children, when Mom or Dad got called in on an emergency case on the weekend and brought their kids along and didn't have a babysitter. I kept a stash of crayons and coloring books in a drawer at the desk that I could set a kid up with while their mom or dad was fixing an epidural bleed or a testicular torsion or crashing someone else's child onto ECMO.

I'm not saying don't do it. Just really know your values and what matters to you when you make your decisions. Any doctor can find themselves needing to respond to an emergency now and again. But surgeons can find that a case that was scheduled for an hour turns into a 4 or 6 or 8 hour fiasco, and they really can't just walk away from the table until the case is done. There are a lot of under appreciated sacrifices that surgeons have to make for their craft and you should be sure that you know what they are and accept them before you jump in.
 
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Because the more emergency medicine I learn, the more I realize how little I know. If you are staffing an ED and don't understand the implications of wellen's waves, up to date stroke literature, the new black box warning for flouroquinolones, which kids with BRUE can go home vs. get admitted, stroke and stemi mimics, when to be concerned about kawasaki's, etc you are doing your patients a disservice and opening yourself up to a lot of liability.


This is true. There is so much nuance to emergency medicine that people don't realize. All we see is the "**** consult." I couldn't imagine picking up a moonlight ED shift. I guess in certain areas in the country, though, any doctor is better than nothing.


All residency sucks. Some suck a little less, but surgical residencies are definitely at the top. You shouldn't judge a specialty by the residency, though. For instance urology and ENT residency at my hospital can be very exhausting with you hitting or breaking duty hours every week. As an attending it's completely different though, unless you don't want it to be different. If you decide you want to make a ton of money and be that guy in the OR at all hours then sure, you'll be phoning in holidays and birthdays. This isn't the general job description for most anymore, though. You can choose your own adventure.

If you don't think you can deal with having a less than optimal life for 5-6 years while in residency with the end goal of becoming a surgeon then don't do it. In my opinion that's what it boils down to.
 
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Maybe lucid is a bit of a cowboy...
Not even close to being a cowgirl. I'm a chief general surgery resident. The most important things I know are knowing what I don't know.

Because the more emergency medicine I learn, the more I realize how little I know. If you are staffing an ED and don't understand the implications of wellen's waves, up to date stroke literature, the new black box warning for flouroquinolones, which kids with BRUE can go home vs. get admitted, stroke and stemi mimics, when to be concerned about kawasaki's, etc you are doing your patients a disservice and opening yourself up to a lot of liability.

That's crazy talk. You should be acutely aware of the need for residency training.

I've worked in rural ERs and gotten signout from non-EM docs moonlighting and it's terrifying. There's a reason we have specialty training. Sure, we both did med school, but when a patient comes in with hypoxic respiratory failure, you don't have time to look up the dosing and contraindications to succs.

Not trying to start a flame war. Some of my best friends are surgeons and I have tremendous respect for what you do. I just think it shows very poor insight to think that you have the knowledge to practice competently outside of your specialty because you did a month of EM in residency. I did a month of surgery in mine, should I have OR privileges?

Not trying to respond to this in an inflammatory way. Here's the skinny: not every surgery resident should do this... and it should definitely be limited to seniors and chiefs. At my program you have to get permission from the PD to do it and the ED attendings who have worked with you over the last X years of your residency also have to sign off. The two places I do this at are critical access stand-alone EDs which are affiliated with the main hospital in the city, about an hour from the main city I work in. As critical access hospitals, they can hire people like me to fill in a shift here and there. The only residents who do this are final-year EM residents and senior/chief surgery residents. That being said there are some FM/IM attendings who pick up the occasional shift. If there were enough EM attendings to work there, they wouldn't need or want me. I agree with you on that. But the one I'm filling in for this weekend already does 16-18 shifts a month.

I would never suggest I should be working at a tertiary-referral ED. But I do think I'm competent to work at an ED of this type. To do it, you need two things: the ability to quickly identify "sick vs not sick" based on clinical skills and have backup. Of all the specialties, the best two at recognizing "sick vs not sick" are EM and general surgery. You never hear any stories of IM or FM finding a patient admitted to surgery on the floor for days who is basically dying and rescued by IM.

Half of rural EM is the ability to take a damn good history and to know what you don't know. I would never do this without backup. I would argue that being a gen surg chief gives me the background to have developed the skills to do a damn good history and physical. I also have more dedicated critical care experience than the final-year EM residents/attendings. And honestly if you think I need to look up the dosing or contraindications to succ then I'm not sure what you really know about the skill set of a general surgery resident. I'm no anesthesiologist but I have good airway skills and I don't need a cheat sheet for intubation drugs.

Knowing what you don't know: I'm on a first-name basis with basically all the EM attendings at the main hospital downtown on both the adult and peds side; they've worked closely with me for twice as long as they have any of their own residents. If I have a question, I just pick up the phone. If I have a patient with a moderate risk heart score who I think can probably go home if they follow up with their cardiologist on Monday, I call their cardiologist and tell him the scenario and my plan and ask his opinion. I don't need to see a Wellen wave to diagnose unstable angina from clinical history. If I have a question for ortho, I call the on-call ortho resident downtown on his cell phone. I have the skill set to know who needs stabalization/pack and ship and who can go home with abx for CAP/strep/uncomplicated diverticulitis and I'm not an egomaniac so I have no problem asking a question when it needs to be asked.

No you shouldn't have OR privileges after a month of surgery. But I expect you to be able to I&D an abscess, I&D a thrombosed hemorrhoid, place a chest tube and CVL and to know what you don't know and call me for help when you need it. Same things applies to my work in the ED.

As for poor signout from non-EM docs being scary, I reject the premise that scary bad signout is only the pervue of non-EM docs. I can't count the number of times that I've tried to get info on a patient the ED is calling me about and the doc/resident can't tell me anything because "I haven't actually seen the patient, they were signed out to me by the person who left an hour ago and they said I needed to call surgery for their abscess/abdominal pain/suspected postop whatever." More than once I have seen the actual dx be: Fournier's/shingles/UTI rather than the ascribed diagnosis in the patient they've never laid eyes or hands on. Does this happen every time? Certainly not. But it happens more than a little. So I wouldn't use signout from non-EM docs as a pillar of your argument against a chief surgery resident taking the occasional shift in a critical access hospital. Plus I'm pretty sure you'd rather have me there than an FM doc or an NP or no one at all.
 
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Sure. But comparing anything to psych is a bit.....unfair. People that go into psych are a different breed. I would argue more different from the rest of their graduating class than the surgeons are.
Of course, but that's not the point.

The OP is implying (IMHO) that the attrition rate in GS is higher than any other.
 
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Not even close to being a cowgirl. I'm a chief general surgery resident. The most important things I know are knowing what I don't know.





Not trying to respond to this in an inflammatory way. Here's the skinny: not every surgery resident should do this... and it should definitely be limited to seniors and chiefs. At my program you have to get permission from the PD to do it and the ED attendings who have worked with you over the last X years of your residency also have to sign off. The two places I do this at are critical access stand-alone EDs which are affiliated with the main hospital in the city, about an hour from the main city I work in. As critical access hospitals, they can hire people like me to fill in a shift here and there. The only residents who do this are final-year EM residents and senior/chief surgery residents. That being said there are some FM/IM attendings who pick up the occasional shift. If there were enough EM attendings to work there, they wouldn't need or want me. I agree with you on that. But the one I'm filling in for this weekend already does 16-18 shifts a month.

I would never suggest I should be working at a tertiary-referral ED. But I do think I'm competent to work at an ED of this type. To do it, you need two things: the ability to quickly identify "sick vs not sick" based on clinical skills and have backup. Of all the specialties, the best two at recognizing "sick vs not sick" are EM and general surgery. You never hear any stories of IM or FM finding a patient admitted to surgery on the floor for days who is basically dying and rescued by IM.

Half of rural EM is the ability to take a damn good history and to know what you don't know. I would never do this without backup. I would argue that being a gen surg chief gives me the background to have developed the skills to do a damn good history and physical. I also have more dedicated critical care experience than the final-year EM residents/attendings. And honestly if you think I need to look up the dosing or contraindications to succ then I'm not sure what you really know about the skill set of a general surgery resident. I'm no anesthesiologist but I have good airway skills and I don't need a cheat sheet for intubation drugs.

Knowing what you don't know: I'm on a first-name basis with basically all the EM attendings at the main hospital downtown on both the adult and peds side; they've worked closely with me for twice as long as they have any of their own residents. If I have a question, I just pick up the phone. If I have a patient with a moderate risk heart score who I think can probably go home if they follow up with their cardiologist on Monday, I call their cardiologist and tell him the scenario and my plan and ask his opinion. I don't need to see a Wellen wave to diagnose unstable angina from clinical history. If I have a question for ortho, I call the on-call ortho resident downtown on his cell phone. I have the skill set to know who needs stabalization/pack and ship and who can go home with abx for CAP/strep/uncomplicated diverticulitis and I'm not an egomaniac so I have no problem asking a question when it needs to be asked.

No you shouldn't have OR privileges after a month of surgery. But I expect you to be able to I&D an abscess, I&D a thrombosed hemorrhoid, place a chest tube and CVL and to know what you don't know and call me for help when you need it. Same things applies to my work in the ED.

As for poor signout from non-EM docs being scary, I reject the premise that scary bad signout is only the pervue of non-EM docs. I can't count the number of times that I've tried to get info on a patient the ED is calling me about and the doc/resident can't tell me anything because "I haven't actually seen the patient, they were signed out to me by the person who left an hour ago and they said I needed to call surgery for their abscess/abdominal pain/suspected postop whatever." More than once I have seen the actual dx be: Fournier's/shingles/UTI rather than the ascribed diagnosis in the patient they've never laid eyes or hands on. Does this happen every time? Certainly not. But it happens more than a little. So I wouldn't use signout from non-EM docs as a pillar of your argument against a chief surgery resident taking the occasional shift in a critical access hospital. Plus I'm pretty sure you'd rather have me there than an FM doc or an NP or no one at all.

We're clearly going to disagree and that's fine. But a few point and then I'll leave this alone - my statement about bad signout isn't about a doctor taking a bad history of physical, it's about hearing a story in signout with bad medical decision making, i.e. - this person is just waiting for x test, then they can go home - then the patient is obviously not appropriate to be discharged. I've gotten signout from a moonlighting surgeon on a young child "that can go home" when the child was clearly septic. Missed TTP. Pregnant bleeding patients rh negative not getting rhogam, etc.

Also, if you are proficient with airways, good for you, but I find that extremely surprising. No general surgeon I know is comfortable intubating. I'm doing a critical care fellowship with some very highly qualified, competent surgical fellows and airway management just isn't in their wheelhouse. Even at the end of their fellowship, they're not great. Obviously ENT is an exception.

Finally, you're kind of making my point about wellen's waves. History and physical exam is nearly useless in a chest pain workup. Only 4 historical features had any statistically significant prognostic value. Wellen's waves don't help you work them up. Theyre usually in the patient you don't think has coronary disease. Even still, the problem isn't that you might miss it and therefore miss the diagnosis (which goes without saying), it's that you have to understand the mandatory management of them. They are a critical, proximal left lesion that requires urgent cath - these patients will occlude and likely arrest if you simply put them in for a stress test.

Like I said, I'll leave this alone now, but I think non-EM folks staffing and ED is extremely dangerous and extremely arrogant at the expense of patients. Obviously, it happens, but people just don't know what they don't know. And sure you can call ortho with a question, but if you aren't aware of the fact that posterior fat pads are pathologic in kids, you won't know to call. You just don't know what you don't know.
 
We're clearly going to disagree and that's fine. But a few point and then I'll leave this alone - my statement about bad signout isn't about a doctor taking a bad history of physical, it's about hearing a story in signout with bad medical decision making, i.e. - this person is just waiting for x test, then they can go home - then the patient is obviously not appropriate to be discharged. I've gotten signout from a moonlighting surgeon on a young child "that can go home" when the child was clearly septic. Missed TTP. Pregnant bleeding patients rh negative not getting rhogam, etc.

Also, if you are proficient with airways, good for you, but I find that extremely surprising. No general surgeon I know is comfortable intubating. I'm doing a critical care fellowship with some very highly qualified, competent surgical fellows and airway management just isn't in their wheelhouse. Even at the end of their fellowship, they're not great. Obviously ENT is an exception.

Finally, you're kind of making my point about wellen's waves. History and physical exam is nearly useless in a chest pain workup. Only 4 historical features had any statistically significant prognostic value. Wellen's waves don't help you work them up. Theyre usually in the patient you don't think has coronary disease. Even still, the problem isn't that you might miss it and therefore miss the diagnosis (which goes without saying), it's that you have to understand the mandatory management of them. They are a critical, proximal left lesion that requires urgent cath - these patients will occlude and likely arrest if you simply put them in for a stress test.

Like I said, I'll leave this alone now, but I think non-EM folks staffing and ED is extremely dangerous and extremely arrogant at the expense of patients. Obviously, it happens, but people just don't know what they don't know. And sure you can call ortho with a question, but if you aren't aware of the fact that posterior fat pads are pathologic in kids, you won't know to call. You just don't know what you don't know.

Will say that my statements about signouts have nothing to do with H&P. Again had to do with the fact that some of the worst "signouts" I've received from have been from ED docs and witnessed between ED docs so it is arrogant to suggest that non-EM docs are the only ones who give bad signout out.

Agree to disagree about everything else. You're welcome to come work at this rural ED when you're done with fellowship of it bothers you that much. Can't seem to get enough of your brethren to do it.
 
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We're clearly going to disagree and that's fine. But a few point and then I'll leave this alone - my statement about bad signout isn't about a doctor taking a bad history of physical, it's about hearing a story in signout with bad medical decision making, i.e. - this person is just waiting for x test, then they can go home - then the patient is obviously not appropriate to be discharged. I've gotten signout from a moonlighting surgeon on a young child "that can go home" when the child was clearly septic. Missed TTP. Pregnant bleeding patients rh negative not getting rhogam, etc.

Also, if you are proficient with airways, good for you, but I find that extremely surprising. No general surgeon I know is comfortable intubating. I'm doing a critical care fellowship with some very highly qualified, competent surgical fellows and airway management just isn't in their wheelhouse. Even at the end of their fellowship, they're not great. Obviously ENT is an exception.

Finally, you're kind of making my point about wellen's waves. History and physical exam is nearly useless in a chest pain workup. Only 4 historical features had any statistically significant prognostic value. Wellen's waves don't help you work them up. Theyre usually in the patient you don't think has coronary disease. Even still, the problem isn't that you might miss it and therefore miss the diagnosis (which goes without saying), it's that you have to understand the mandatory management of them. They are a critical, proximal left lesion that requires urgent cath - these patients will occlude and likely arrest if you simply put them in for a stress test.

Like I said, I'll leave this alone now, but I think non-EM folks staffing and ED is extremely dangerous and extremely arrogant at the expense of patients. Obviously, it happens, but people just don't know what they don't know. And sure you can call ortho with a question, but if you aren't aware of the fact that posterior fat pads are pathologic in kids, you won't know to call. You just don't know what you don't know.

Out of curiosity, how much time have you spent in stand alone EDs or EDs in hospitals with <200 beds? I mean I can list the last couple hundred things that I've caught that the EDs missed, but I certainly would rag on all EDs for those handful of things that happen, likely because of the specific people who were on, not their credentials. You sound like someone who has been well educated and spent a lot of time in busy, big hospital EDs, which is quite a different animal than where I suspect @LucidSplash spends her time...
 
Others experience should have no bearing??

What's the point of SDN then?

Seems bannie answered OPs question. Pretty accurate (though not necessarily complete) as well, based on my own rotations. But that's what OP wanted to know.

How much surgical residency experience do you and bannie have? Not a single one of the things on their list is accurate. In the past 5 years of residency...

I have never once been called every 5 minutes for an evening. Busy night? Sure. Happens. Didn't get to sleep at all? Sure. Happens. But, that can happen in any specialty. This is in general a) about how the practice is setup and b) more importantly, how good the resident is about heading things off to avoid the calls in the first place.

I haven't taken care of non-iatragenic trauma in 4 years.
I haven't taken care of a perirectal abscess in 4 years.
I could have slept 9 hours last night. I decided to play Hearthstone instead.
I ate fajitas last night at a friend's place.
I am at home right now.
I went for an 8 mile run this morning with the friend who made me fajitas last night.

Granted, I'm in vascular surgery, but I have a hard time imagining our GS residents disagreeing with any of those.
 
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Out of curiosity, how much time have you spent in stand alone EDs or EDs in hospitals with <200 beds? I mean I can list the last couple hundred things that I've caught that the EDs missed, but I certainly would rag on all EDs for those handful of things that happen, likely because of the specific people who were on, not their credentials. You sound like someone who has been well educated and spent a lot of time in busy, big hospital EDs, which is quite a different animal than where I suspect @LucidSplash spends her time...

A pretty good bit of rural EDs. None in FSEDs. I moonlit in residency at some pretty tiny hospitals. One town I would go to considered a 300 bed hospital the referral center. Over 2 years, I probably averaged 3-4 days a month moonlighting (I know, I overdid it and basically worked every day off). Also spent some time at a couple smaller affiliated hospitals in residency for our community medicine exposure.

I'd argue the docs at the smaller hospitals have the hardest jobs and need to be the most prepared. It's easy in the big academic center. Airway disaster? I have anesthesia, ENT and trauma surgery in house as well as a number of backup modalities. Rural ER? You have a scalpel and the bougie you hid in your backpack.
 
I saw the sun plenty during residency and hardly ever missed a meal. I got 9 hrs of sleep most nights I wasn't on call. Took 2 vacations every year and spent plenty of time with family (though yes, I did miss some holidays and come home late for dinner on occasion). We got along well with other residents and hung out together outside of the hospital with some of them and some of the nurses and allied health folks. It was hard work, but not insurmountable and not horrific.
 
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I know I should let this lie but argh....

Are you really arguing that an EM doc/resident is better prepared to perform an emergency surgical airway than a gen surg chief res?
I think he is arguing that without the backup and with his opinion that we are incompetent with airways that we would resort to surgical means when not actually indicated. I suppose it may be that it wasn't a focus where he trained or he is referring to surgeons who have been in practice for a while and therefore haven't done it in years. I am guessing you, like me, trained somewhere that you got lots of intubation training and practice (when a second year resident can be the highest ranking surgeon in house overnight you need them to be ready to get **** done).
 
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I know I should let this lie but argh....

Are you really arguing that an EM doc/resident is better prepared to perform an emergency surgical airway than a gen surg chief res?

No. I'm saying the odds of a surgical airway happening with an EM doc are less than if a surgeon is managing an airway.
 
I saw the sun plenty during residency and hardly ever missed a meal. I got 9 hrs of sleep most nights I wasn't on call. Took 2 vacations every year and spent plenty of time with family (though yes, I did miss some holidays and come home late for dinner on occasion). We got along well with other residents and hung out together outside of the hospital with some of them and some of the nurses and allied health folks. It was hard work, but not insurmountable and not horrific.
Gen surg?
 
No. I'm saying the odds of a surgical airway happening with an EM doc are less than if a surgeon is managing an airway.

Can't say that jives with my experience. Never had to do one on any of the patients I've intubated for trauma, respiratory decompensation on the floor, ICU, etc. Have been asked many times to stand at the bedside in the ED with a scalpel while the ED works on a difficult airway; only had to do it once for them but I always come when called because we respect each other. You know, the same guys that signed off on me to moonlight in the ED. Will be sure to let them know that your opinion of their judgment is so poor.

I'm sorry your experience with gen surg residents seems to think we're mostly cowboys with knives. But there are many places out there that train us well to handle the airway well without a scalpel. Again, suppose we'll have to agree to disagree. Again, I invite you to come on down to TN and take my spot at these rural spots when you're done with training. Sounds like you think they could use you. I'm leaving at the end of June anyway. :)
 
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Can't say that jives with my experience. Never had to do one on any of the patients I've intubated for trauma, respiratory decompensation on the floor, ICU, etc. Have been asked many times to stand at the bedside in the ED with a scalpel while the ED works on a difficult airway; only had to do it once for them but I always come when called because we respect each other. You know, the same guys that signed off on me to moonlight in the ED. Will be sure to let them know that your opinion of their judgment is so poor.

I'm sorry your experience with gen surg residents seems to think we're mostly cowboys with knives. But there are many places out there that train us well to handle the airway well without a scalpel. Again, suppose we'll have to agree to disagree. Again, I invite you to come on down to TN and take my spot at these rural spots when you're done with training. Sounds like you think they could use you. I'm leaving at the end of June anyway. :)

Didn't mean to ruffle feathers. I never said gen surgeons are cowboys with knives. All I said is that an EM doc is better prepared to intubated. I never thought that would be a controversial statement. We spend a significant portion of our training focusing on airway management. It's part of our core curriculum.

Do what you want. I don't care. I think ER docs should staff ERs.
 
I was planning on steering clear of this so as not to derail things further, but a few things have come up that I'd like to address.

Will say that my statements about signouts have nothing to do with H&P. Again had to do with the fact that some of the worst "signouts" I've received from have been from ED docs and witnessed between ED docs so it is arrogant to suggest that non-EM docs are the only ones who give bad signout out.

I think you're missing his point. It's not a matter of the sign out being bad in that the information wasn't conveyed to the oncoming physician, it's a matter of the person signing out having not having had a sufficiently broad differential, having anchored prematurely, not ordering the appropriate tests, or not interpreting the data appropriately. It's something I see frequently when getting sign outs from off-service residents or some of our EM interns, as I'm sure you see it when being called for a consult from another specialty. We have different training, and think about things differently.

You sound like someone who has been well educated and spent a lot of time in busy, big hospital EDs, which is quite a different animal than where I suspect @LucidSplash spends her time...

I'm not entirely sure what to make of this. They're a different animal in that they tend to be lower volume and patient acuity is lower. My understanding of rural Tennessee is that it's similar to my region, where the rural EDs are oftentimes staffed with a hodgepodge of people who formerly worked in different specialties who do not have formal training in emergency medicine. LucidSplash may very well be practicing better medicine than a lot of these practitioners, and in that sense it's a good thing she's there. It's certainly risky, though, since you'd be held to the standard of a board certified emergency physician should there be an adverse outcome. The lower volume and lower acuity makes the frequency and severity of these adverse outcomes less, but it's still Russian roulette. Play long enough, and you'll get burned, but in this version you're not the only one harmed when the gun goes off.

Can't say that jives with my experience. Never had to do one on any of the patients I've intubated for trauma, respiratory decompensation on the floor, ICU, etc. Have been asked many times to stand at the bedside in the ED with a scalpel while the ED works on a difficult airway; only had to do it once for them but I always come when called because we respect each other. You know, the same guys that signed off on me to moonlight in the ED. Will be sure to let them know that your opinion of their judgment is so poor.

I'm sorry your experience with gen surg residents seems to think we're mostly cowboys with knives. But there are many places out there that train us well to handle the airway well without a scalpel. Again, suppose we'll have to agree to disagree. Again, I invite you to come on down to TN and take my spot at these rural spots when you're done with training. Sounds like you think they could use you. I'm leaving at the end of June anyway. :)

Would you argue that you're as well prepared to handle the airway as an emergency physician? How about an anesthesiologist? Do you also know how to manage diabetes and hypertension as well as an internist? These are all things that a general surgeon could be called upon to do, but I'd hope that you can recognize that the people who trained specifically to manage these things and do them frequently are likely better suited to doing them.

I'd argue the docs at the smaller hospitals have the hardest jobs and need to be the most prepared. It's easy in the big academic center. Airway disaster? I have anesthesia, ENT and trauma surgery in house as well as a number of backup modalities. Rural ER? You have a scalpel and the bougie you hid in your backpack.

Amen. And I'd argue the cardiac/respiratory arrests and traumas that we see in abundance at the major academic centers aren't where an EM doctor really adds value to the system. That's mostly straightforward. It's the 50 year old with flank pain, the kid with a fever or who just won't stop crying, or the young lady with a headache that you're definitely going to see at your rural ED that needs someone with emergency medicine training.
 
I was planning on steering clear of this so as not to derail things further, but a few things have come up that I'd like to address.



I think you're missing his point. It's not a matter of the sign out being bad in that the information wasn't conveyed to the oncoming physician, it's a matter of the person signing out having not having had a sufficiently broad differential, having anchored prematurely, not ordering the appropriate tests, or not interpreting the data appropriately. It's something I see frequently when getting sign outs from off-service residents or some of our EM interns, as I'm sure you see it when being called for a consult from another specialty. We have different training, and think about things differently.



I'm not entirely sure what to make of this. They're a different animal in that they tend to be lower volume and patient acuity is lower. My understanding of rural Tennessee is that it's similar to my region, where the rural EDs are oftentimes staffed with a hodgepodge of people who formerly worked in different specialties who do not have formal training in emergency medicine. LucidSplash may very well be practicing better medicine than a lot of these practitioners, and in that sense it's a good thing she's there. It's certainly risky, though, since you'd be held to the standard of a board certified emergency physician should there be an adverse outcome. The lower volume and lower acuity makes the frequency and severity of these adverse outcomes less, but it's still Russian roulette. Play long enough, and you'll get burned, but in this version you're not the only one harmed when the gun goes off.



Would you argue that you're as well prepared to handle the airway as an emergency physician? How about an anesthesiologist? Do you also know how to manage diabetes and hypertension as well as an internist? These are all things that a general surgeon could be called upon to do, but I'd hope that you can recognize that the people who trained specifically to manage these things and do them frequently are likely better suited to doing them.



Amen. And I'd argue the cardiac/respiratory arrests and traumas that we see in abundance at the major academic centers aren't where an EM doctor really adds value to the system. That's mostly straightforward. It's the 50 year old with flank pain, the kid with a fever or who just won't stop crying, or the young lady with a headache that you're definitely going to see at your rural ED that needs someone with emergency medicine training.

I could respond to all of this but I think it is just better to ask if you read all my other posts in this thread. The answers to the things you posited are there.

But mostly if you take what TimesNewRoman has argued here in conjunction with his other posts on moonlighting, what he is really arguing is that:
a) he learned more during the moonlighting he did his 3rd year of residency than during his 3rd year residency shifts and that was ok for him and for patients
b) he "tried giving a trash sign out like he did for his residency shifts after his first moonlighting shifts" and didn't think it was wrong until he got called on it by his relief and that was ok for him and his patients but it's nonEM docs who he worries about getting signout from
c) it's ok for someone who has been a doctor for 2 years to moonlight and ok for their patients because it made him read more and become more comfortable with his practice overall over the course of his last year of residency but not ok for the patients someone like me (5.5 years of gen surg training: 6 year program if doing the math) sees in the same setting.

These points are drawn from his posting history.

I would argue that if he truly objects to me moonlighting he should object to himself doing it before finishing his own residency.

Apologies to everyone else here for participating in derailing the original topic of this thread. I'll stop now.
 
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This consistently shocks and terrifies me.

Don't worry dude as long as you know what you don't know you can also moonlight as a rural general surgeon.

But only if you're on a first name basis with all the GS attendings at the main hospital downtown...
 
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To get things back on track here's a few of my residency horror stories:

I've always been good at everything, really without a lot of effort. Getting feedback that you're behind or not good enough at something is tough. It will force you to reevaluate things, decide how committed you are - but in the end, the good feedback we want ruins us. The true feedback of deficiencies will help you improve.

Next horror story is about being up all night. When the consults won't stop, and you're being pulled in 10 different directions and all you want to do is sleep. That sick ICU patient needs babysitting, and there's the floor nurse that doesn't like your juniors' answers. The charge nurse wants to move your patients, but you don't know how the attendings are going to like that call in the morning - it's 3:30am all you want to do is close your eyes for 10 minutes. BAM - perforated diverticulitis. Maybe it won't be operative and you can see them and go to bed. Nope. Peritonitis. Next 5 hours will be spent in the OR.

Last horror story is that you'll hurt someone. You'll make a mistake either medically or surgically, or likely both at some point. It feels bad, and it's not a shake it off kind of thing. It sticks with you a bit. Mistakes in surgery, by their nature, can have dramatic effects on patient outcomes. Then just when you've processed it (or you haven't) then you get up at M&M and get beat up for it, or worse told it wasn't your fault when it was. Then you'll present the next case where you didn't make the decision, but suddenly everything is your fault.

But those are honestly rare things. Mostly it's just paperwork, routine surgery, and waking up early to do it again.


Sent from my iPhone using SDN mobile
 
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Some potential relevant data that I pulled off the ACGME website, the link to which is in another thread I created but don't want to cross-post. Something for the OP chew on, if he/she really wanted to be dissuaded.

Of the approximately 27 programs currently on probation by the ACGME, 17 programs are SURGICAL.


[0803521063] New York Medical College (Metropolitan) Program - Dermatology

[0601621068] Southern Illinois University Program - Colorectal Surgery

[1300512075] University of California (San Francisco) Program - Medical Genetics

[1404112389] Robert Packer Hospital/Guthrie Program - Internal Medicine

[1411121027] University of Florida College of Medicine Jacksonville Program - Cardiology fellowship

[1414121287] Robert Packer Hospital/Guthrie Program - Cardiovascular

[1601621026] Loyola University Medical Center Program - Neurosurgery

[1605621093] Medical College of Wisconsin Affiliated Hospitals Program - Neurosurgery

[2204721341] East Tennessee State University Program - OB/Gyn

[3000511047] Los Angeles County-Harbor- UCLA Medical Center Program - Pathology

[3003621404] Vidant Medical Center/East Carolina University Program - Pathology

[3623121138] University of Nevada Reno School of Medicine (Las Vegas) Program - Plastic surgery

[4202121235] Tulane University Program - Diagnostic Radiology

[4300521005] University of California (Irvine) Program - Radiation Oncology

[4400312420] St Joseph's Hospital and Medical Center Program - Surgery

[4400531030] Kern Medical Center Program - Surgery

[4400811066] Waterbury Hospital Program - Surgery

[4403512198] Nassau University Medical Center Program - Surgery

[4404112309] Robert Packer Hospital/Guthrie Program - Surgery

[4404131297] Mercy Catholic Medical Center Program - Surgery

[4503821100] Toledo Hospital (Jobst Vascular Institute) Program - Vascular Surgery

[4510821084] Yale-New Haven Medical Center Program - Vascular Surgery

[4604111080] Penn State Milton S Hershey Medical Center Program - Thoracic Surgery

[4614521087] Medical University of South Carolina Program - Thoracic Surgery

[4615621101] Medical College of Wisconsin Affiliated Hospitals Program - Thoracic Surgery

[4660513011] UCLA David Geffen School of Medicine/UCLA Medical Center Program - Congenital Cardiac Surgery
 
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Some potential relevant data that I pulled off the ACGME website, the link to which is in another thread I created but don't want to cross-post. Something for the OP chew on, if he/she really wanted to be dissuaded.

Of the approximately 27 programs currently on probation by the ACGME, 17 programs are SURGICAL.


[0803521063] New York Medical College (Metropolitan) Program - Dermatology

[0601621068] Southern Illinois University Program - Colorectal Surgery

[1300512075] University of California (San Francisco) Program - Medical Genetics

[1404112389] Robert Packer Hospital/Guthrie Program - Internal Medicine

[1411121027] University of Florida College of Medicine Jacksonville Program - Cardiology fellowship

[1414121287] Robert Packer Hospital/Guthrie Program - Cardiovascular

[1601621026] Loyola University Medical Center Program - Neurosurgery

[1605621093] Medical College of Wisconsin Affiliated Hospitals Program - Neurosurgery

[2204721341] East Tennessee State University Program - OB/Gyn

[3000511047] Los Angeles County-Harbor- UCLA Medical Center Program - Pathology

[3003621404] Vidant Medical Center/East Carolina University Program - Pathology

[3623121138] University of Nevada Reno School of Medicine (Las Vegas) Program - Plastic surgery

[4202121235] Tulane University Program - Diagnostic Radiology

[4300521005] University of California (Irvine) Program - Radiation Oncology

[4400312420] St Joseph's Hospital and Medical Center Program - Surgery

[4400531030] Kern Medical Center Program - Surgery

[4400811066] Waterbury Hospital Program - Surgery

[4403512198] Nassau University Medical Center Program - Surgery

[4404112309] Robert Packer Hospital/Guthrie Program - Surgery

[4404131297] Mercy Catholic Medical Center Program - Surgery

[4503821100] Toledo Hospital (Jobst Vascular Institute) Program - Vascular Surgery

[4510821084] Yale-New Haven Medical Center Program - Vascular Surgery

[4604111080] Penn State Milton S Hershey Medical Center Program - Thoracic Surgery

[4614521087] Medical University of South Carolina Program - Thoracic Surgery

[4615621101] Medical College of Wisconsin Affiliated Hospitals Program - Thoracic Surgery

[4660513011] UCLA David Geffen School of Medicine/UCLA Medical Center Program - Congenital Cardiac Surgery

Without knowing the reasons for probation, it's hard to draw conclusions.
 
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