Is general surgery residency significantly worse than other surgical residencies?

[Vivid_Quail]

Other than maybe neurosurgery, general surgery residency seems to be the consensus for the most sucky, soul crushing residency in American medicine, at least at my school anyways. However, it seems like ortho, ENT, urology, etc also spend a lot of time in the hospital and have an arguably worse call schedule due to the combination of small classes and their home call doesn't count for post call days.

Is it true that GS sucks the most of any surgical residency? What I have heard is that GS is the dumping ground for other surgical specialties so maybe it isn't as much that they work more hours than ENT, ortho, etc, but that their work itself just sucks a lot more? Curious what you all think. My school doesn't have surgical sub-specialty rotations until late M3/early M4. I haven't really noticed a huge difference in the specialties residents' workloads when shadowing...only the dead looks in the GS residents' eyes...

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[Dr.LeoSpaceman]

You're starting from the wrong direction.

If you love it, it will be tolerable. If you think it's just "interesting", it will suck. That goes for whichever subspecialty you choose.

I'm sure path, rads, EM might be "easier" for those who choose them, but I doubt that would have been my perception as someone who doesn't find those fields specifically compelling.

And I don't think it's the issue that some of the subspecialties have training that's perceived as better. It's just that the payoff at the end may still tip the scales in their favor. But again, that's a highly personal decision.

 

[Vivid_Quail]

You're starting from the wrong direction.

If you love it, it will be tolerable. If you think it's just "interesting", it will suck. That goes for whichever subspecialty you choose.

I'm sure path, rads, EM might be "easier" for those who choose them, but I doubt that would have been my perception as someone who doesn't find those fields specifically compelling.

I see where you are coming from but the reality is that general surgery residents seem significantly more crushed than other surgical sub-specialties at my school. I am just wondering if that is 1) a fairly universal pattern and 2) if yes, why?

And these aren't exactly the kind of questions I can ask an attending or resident in real life...

 

[Dr.LeoSpaceman]

I see where you are coming from but the reality is that general surgery residents seem significantly more crushed than other surgical sub-specialties at my school. I am just wondering if that is 1) a fairly universal pattern and 2) if yes, why?

And these aren't exactly the kind of questions I can ask an attending or resident in real life...

Could just be because the residency sucks.

To answer your question, no, I don't believe it is a universal thing. I made it through and think I was pretty well-adjusted throughout. I can honestly say I don't remember a day where I dreaded being at work, and I had friends that seemingly felt the same.

Also, I know it's a catchy thing to say but I don't even know what "dead in their eyes" actually means. Maybe they're just tired. That certainly happens. If you mean they're purposefully avoiding work or missing things because they're not engaged, then that's a different story.

 

[Vivid_Quail]

Could just be because the residency sucks.

To answer your question, no, I don't believe it is a universal thing. I made it through and think I was pretty well-adjusted throughout. I can honestly say I don't remember a day where I dreaded being at work, and I had friends that seemingly felt the same.

Gotcha, thanks. I am mainly trying to confirm that I am dealing with a true n =1 and not some bigger pattern.

 

[longhaul3]

Figure out what you like first, then figure out (as best you can) whether you can handle the residency. There is no amount of days off or relief from call that would make me willing to do ortho or urology.

But I do think there is some validity to your question. Gen surg residents, at least where I've been, work hard. One thing that I think matters a lot is that their patients tend to be sicker than the ortho/urology/ENT patients.

 

[Vivid_Quail]

Figure out what you like first, then figure out (as best you can) whether you can handle the residency. There is no amount of days off or relief from call that would make me willing to do ortho or urology.

But I do think there is some validity to your question. Gen surg residents, at least where I've been, work hard. One thing that I think matters a lot is that their patients tend to be sicker than the ortho/urology/ENT patients.

I’ve heard/read the “figure out what you life first” advice a lot, but it feels pretty tough when my first real rotation in any surgical specialty other than gen surg will be 2 weeks long and 1-2 months before I have to apply for 2-4 aways if it is ortho, ENT, etc. Not to mention getting research in that field. So that leaves shadowing during M2-M3 but everyone says to not to commit to surgery until you’ve done an actual rotation. Should I just do generic surgery research in the meantime?

Oh, and my school has completely banned any shadowing because of COVID and has given no indication that that will change any time soon. So that’s great :/

 

[Lem0nz]

This is not universal at all. In my program (and programs across that city which there were another ~10) ortho, uro, and ENT got raked over the coals. Ortho got absolutely crushed by the gift that keeps on giving that is trauma. Uro and ENT at any given hospital wasn’t so bad, but our uro and ENTs had to cover at minimum 2-3 hospitals with 20 minute drive times or more between each and that turned it into absolute brutality.

Gen surg was tough but it was in one place with my pillow top call room bed that someone got ten years before I showed up there. It wasn’t much but it was a nice touch for those two hours a night I got to float on it.

The Iron Maiden springs sitting under it were less nice but you take what you get.

 

[WinslowPringle]

I think there’s a difference between working a lot, being a dumping ground, and being “dead behind the eyes” due to a combo of the above and a bad environment.

GS worked hard where I did residency - but the subspecialties had a brutal call schedule, too. It wasn't the hours that were annoying, it was being the dumping ground. Ortho could say 'admit to trauma' or 'admit to medicine'; there was very little that GS could admit to any other service if the patient truly needed admitting. We got all the 'surgical patients' the other services didn't want either - trauma admitted for ortho and (none-elective) neurosurgery; any ENT case needing an ICU went through SICU; vascular was in our GS department; and CV had long ago given up the perforated esophaguses to us. And there are few cases less medically or surgically satisfying to take care of than the morbidly obese "sick belly" that may or may not get some form of operative therapy but will regardless smolder in the ICU with hernias and fistulas all over the place, as she flirts along with varying forms of nasogastric tubes and PICCs for TPN and long term antibiotics for the myriad MDR-bugs as we wait for some EC fistula to heal - or form - and then ultimately totter off to LTACH land. Residency in terms of people/hierarchy for me was fairly benign - nicer in some ways than the ortho bros had it.

So, I think call schedules are variable; work environment/malignancy is variable; but the dumping ground of sick disaster bellies that is the bread and butter of acute care general surgery is fairly universal and is a leading cause of morbidity among general surgery residents.

 

[Vivid_Quail]

I think there’s a difference between working a lot, being a dumping ground, and being “dead behind the eyes” due to a combo of the above and a bad environment.

GS worked hard where I did residency - but the subspecialties had a brutal call schedule, too. It wasn't the hours that were annoying, it was being the dumping ground. Ortho could say 'admit to trauma' or 'admit to medicine'; there was very little that GS could admit to any other service if the patient truly needed admitting. We got all the 'surgical patients' the other services didn't want either - trauma admitted for ortho and (none-elective) neurosurgery; any ENT case needing an ICU went through SICU; vascular was in our GS department; and CV had long ago given up the perforated esophaguses to us. And there are few cases less medically or surgically satisfying to take care of than the morbidly obese "sick belly" that may or may not get some form of operative therapy but will regardless smolder in the ICU with hernias and fistulas all over the place, as she flirts along with varying forms of nasogastric tubes and PICCs for TPN and long term antibiotics for the myriad MDR-bugs as we wait for some EC fistula to heal - or form - and then ultimately totter off to LTACH land. Residency in terms of people/hierarchy for me was fairly benign - nicer in some ways than the ortho bros had it.

So, I think call schedules are variable; work environment/malignancy is variable; but the dumping ground of sick disaster bellies that is the bread and butter of acute care general surgery is fairly universal and is a leading cause of morbidity among general surgery residents.

Thank you so much for explaining this. Makes a lot of sense and something good to keep in mind. It is hard to appreciate the nuance of bad hours vs dumping ground vs jerk colleagues as a student and seeing only one department.

 

[Uro-surg]

And there are few cases less medically or surgically satisfying to take care of than the morbidly obese "sick belly" that may or may not get some form of operative therapy but will regardless smolder in the ICU with hernias and fistulas all over the place, as she flirts along with varying forms of nasogastric tubes and PICCs for TPN and long term antibiotics for the myriad MDR-bugs as we wait for some EC fistula to heal - or form - and then ultimately totter off to LTACH land.

This is 100% the experience I had on general surgery as an intern. There's something so demoralizing about these difficult patients - and their often terrible outcomes. It felt like a whole lot of effort without ever feeling like we had "fixed" them. I think you have to make sure to take into account not just the hours worked but the work you do during those hours. I would much rather have a full day of elective outpatient surgery that finishes at 4-5pm and take home call covering 3 hospitals once a week. Sure some nights are terrible on call, but others will have 0 consults. Most of the time the consults don't really require much to be done overnight anyways. For instance, we may get consulted for an obstructing kidney stone in the ER, but we'll typically just place a stent (a procedure which takes 10 minutes) and schedule their outpatient stone procedure electively a few weeks later.

 

[Vivid_Quail]

This is 100% the experience I had on general surgery as an intern. There's something so demoralizing about these difficult patients - and their often terrible outcomes. It felt like a whole lot of effort without ever feeling like we had "fixed" them. I think you have to make sure to take into account not just the hours worked but the work you do during those hours. I would much rather have a full day of elective outpatient surgery that finishes at 4-5pm and take home call covering 3 hospitals once a week. Sure some nights are terrible on call, but others will have 0 consults. Most of the time the consults don't really require much to be done overnight anyways. For instance, we may get consulted for an obstructing kidney stone in the ER, but we'll typically just place a stent (a procedure which takes 10 minutes) and schedule their outpatient stone procedure electively a few weeks later.

Interest in penises intensifies

 

[deleted941485]

I remember it well as a med student who actually thought about doing surgery. The damn residents were absolutely miserable human beings. Contrast that with the orthopods and urology residents, there wasn't this overwhelming feeling of absolute hopelessness and utter disdain for humanity that I got when I rotated on gen surg.

 

[Vivid_Quail]

I remember it well as a med student who actually thought about doing surgery. The damn residents were absolutely miserable human beings. Contrast that with the orthopods and urology residents, there wasn't this overwhelming feeling of absolute hopelessness and utter disdain for humanity that I got when I rotated on gen surg.

Yeah that’s what I was trying to describe lol. I mean it’s no accident that every surgical speciality other than general surgery and vascular surgery are extremely competitive. Neurosurgery is arguably more soul crushing but the nsgy residents at my school actually don’t appear as dead as gen surg…I think because they were such natural gunners who needed less sleep and legit loved saying they did brain surgery. That and the $1MM waiting for them in private practice.

 

[Lem0nz]

I'm not sure how relevant these anecdotes are. Many people here have said, and will continue to say, do what you love and you are passionate about. Those patients that burn you out in general surgery are offset by an equally number of diverse and super cool experiences across a HUGE spectrum of surgery you won't get elsewhere. Every specialty has good and bad with it. Ortho may have had less call but I slept wwwwaaayyy more on my calls than on ortho because even if they got 4 consults to my 15 each of those four required admission, setting a bone, washing out a bone, taking that bone to the OR in the middle of the night, wrapping that leg... whatever. Their consults were an hour to my ten minutes. I also had a team of three to four people to their team of two if they were lucky, one if they weren't.

Its just different. I don't think general surgery worked more or less hard or had it better or worse than subspecialists at the end of the day.

 

[Vivid_Quail]

I'm not sure how relevant these anecdotes are. Many people here have said, and will continue to say, do what you love and you are passionate about. Those patients that burn you out in general surgery are offset by an equally number of diverse and super cool experiences across a HUGE spectrum of surgery you won't get elsewhere. Every specialty has good and bad with it. Ortho may have had less call but I slept wwwwaaayyy more on my calls than on ortho because even if they got 4 consults to my 15 each of those four required admission, setting a bone, washing out a bone, taking that bone to the OR in the middle of the night, wrapping that leg... whatever. Their consults were an hour to my ten minutes. I also had a team of three to four people to their team of two if they were lucky, one if they weren't.

Its just different. I don't think general surgery worked more or less hard or had it better or worse than subspecialists at the end of the day.

Ortho definitely seems to get destroyed on call at my school so I see what you’re saying. I think we are more talking about how it seems like ortho seems happier (or maybe more accurately, less depressed…fine line for residents) even though they work similar hours to gen surg.

 

[Dr.LeoSpaceman]

I mean it’s no accident that every surgical speciality other than general surgery and vascular surgery are extremely competitive.

The fact that there are 2-5x more GS positions than any of these subspecialties might also have something to do with it. And integrated vascular programs are, in fact, quite competetive.

 

[Vivid_Quail]

The fact that there are 2-5x more GS positions than any of these subspecialties might also have something to do with it. And integrated vascular programs are, in fact, quite competetive.

Vascular is competitive by applicants vs spots but not by board scores.

 

[Dr.LeoSpaceman]

Vascular is competitive by applicants vs spots but not by board scores.

The definition of "competetive" in regards to residency is all-inclusive. Board scores aren't the trump card.

EDIT: And you may wonder why I (or others) may seemingly bristle at this logic. Implying that some of us basically got "stuck" doing GS because we weren't "competetive enough" to get one of the "good" subspecialties is pretty tone-deaf.

 

[Lem0nz]

Vascular is competitive by applicants vs spots but not by board scores.

I had 90th percentile board scores and got passed up by three trauma programs when I went into the trauma match. There is so, so much more to this then the over simplification. There is also a MUCH higher need for vascular surgeons and general surgeons by volume out in the world than there are many of the other sub disciplines.

 

[Lem0nz]

I also don't think you can even compare the call. The vast majority of larger gen surg residencies have moved to night float which is way more humane and easier to deal with. I never took overnight Q whatever call, ever. I just did my two or three months a year all at once and slept (even if it was during the day).

Its just different. Ortho is happier because they're doing ortho and want to do ortho. Bones make me cringe AF. Eyes make me cringe AF. Tongues, jesus christ, burn those things. Foleys and cystos for days would make me pull my hair out.

On that same token, I bet none of those people would want to do my job even a little.

 

[TypeADissection]

You're starting from the wrong direction.

If you love it, it will be tolerable. If you think it's just "interesting", it will suck. That goes for whichever subspecialty you choose.

General Surgery serves as a common denominator for so many different specialties, that when the buck gets passed around; it usually stops with general surgery. For some, they're good with that. For some, it can become soul crushing. But this applies to any surgical specialty really. My wife's ENT residency wasn't a walk in the park and she worked her ass off for 5 years. You really have to love it. I worked more hours in my fellowship than residency, but I just enjoyed the specialty so much that although exhausting; it really wasn't that bad. Cheers.

 

[LucidSplash]

Also, practice is not residency. Keep that in mind. Things that are “soul crushing” dumps get easier when you are getting paid.

 

[SpliceOfLife]

I see where you are coming from but the reality is that general surgery residents seem significantly more crushed than other surgical sub-specialties at my school. I am just wondering if that is 1) a fairly universal pattern and 2) if yes, why?

Imho yes this is true. All surgical residencies are hard but I find that general surgery residents (and really the residency itself) is particularly soul-crushing. My two cents as to why:

1. The culture. General surgery, like general medicine, is old school and most old school attendings take particular joy in berating the new generation. It's what they went through, goddamnit, and it's what they know, so they're going to do it to the youth. You don't get this kind of backwards thinking in other specialties as frequently. The goal is to identify the weak and to break them and re-mold them, which doesn't fit with the paradigm of modern generations.
2. Residents have to do **** they don't want to do. A lot of people go into general surgery with an open mind, but some people know what they want to do (e.g., surg onc, breast, endo, etc.). Those who know what they want to do don't necessarily enjoy having to slog through the other services. Those who go to residency then figure out what they want to do in year 3 or 4 then take on this attitude sometimes as chief residents. Anyone who has to be on a service they don't like is going to perform less and give off a negative vibe.
2. The time it takes to train is too long. You can do brain surgery, spine surgery, and now heart surgery in just as much time (or sometimes less) as you need to become a specialist in say, the colon. Kind of ridiculous if you think about it. Especially since most of general surgery is now stapling, core knotting, and robotics, which in my opinion take less technical skill than say hand-sewn anastomosis.
3. The "general" training paradigm is not as well suited to modern medicine. The general training paradigm is a solid one, and it provides good breadth of exposure, but it is somewhat at odds with the focus of hospitals and payor programs today. People want specialists, not generalists, because we live in a consumer-driven world. Why take the guy who does a procedure twice a month when you can take the guy who does it everyday? That's what patients want and that's what companies/hospitals feel reduces risk.
4. The pay afterwards isn't that great. General surgery is about middle of the road when it comes to incomes an attending. Not great considering they work some of the worst hours in the hospital.

I'm not saying I agree with all of these but there is a glimmer of truth in many of them. That being said, I know plenty of people who love operating in the gut and for them all this stuff makes it worth it for them. No field is perfect.

 

[mikeGR]

Imho yes this is true. All surgical residencies are hard but I find that general surgery residents (and really the residency itself) is particularly soul-crushing. My two cents as to why:

1. The culture. General surgery, like general medicine, is old school and most old school attendings take particular joy in berating the new generation. It's what they went through, goddamnit, and it's what they know, so they're going to do it to the youth. You don't get this kind of backwards thinking in other specialties as frequently. The goal is to identify the weak and to break them and re-mold them, which doesn't fit with the paradigm of modern generations.
2. Residents have to do **** they don't want to do. A lot of people go into general surgery with an open mind, but some people know what they want to do (e.g., surg onc, breast, endo, etc.). Those who know what they want to do don't necessarily enjoy having to slog through the other services. Those who go to residency then figure out what they want to do in year 3 or 4 then take on this attitude sometimes as chief residents. Anyone who has to be on a service they don't like is going to perform less and give off a negative vibe.
2. The time it takes to train is too long. You can do brain surgery, spine surgery, and now heart surgery in just as much time (or sometimes less) as you need to become a specialist in say, the colon. Kind of ridiculous if you think about it. Especially since most of general surgery is now stapling, core knotting, and robotics, which in my opinion take less technical skill than say hand-sewn anastomosis.
3. The "general" training paradigm is not as well suited to modern medicine. The general training paradigm is a solid one, and it provides good breadth of exposure, but it is somewhat at odds with the focus of hospitals and payor programs today. People want specialists, not generalists, because we live in a consumer-driven world. Why take the guy who does a procedure twice a month when you can take the guy who does it everyday? That's what patients want and that's what companies/hospitals feel reduces risk.
4. The pay afterwards isn't that great. General surgery is about middle of the road when it comes to incomes an attending. Not great considering they work some of the worst hours in the hospital.

I'm not saying I agree with all of these but there is a glimmer of truth in many of them. That being said, I know plenty of people who love operating in the gut and for them all this stuff makes it worth it for them. No field is perfect.

I think many of these are quite exaggerated and certainly not the norm, but obviously, experiences are subjective. Here's my .02 regarding the "glimmer of truth" in the above comments:

1. The culture bit has some basis, perhaps more relevant when general surgery is compared to some "lifestyle subspecialties" (ENT/uro etc), but I don't think it applies to ortho/neurosurg/CT/vascular etc. As it was mentioned before, it really depends on the hospital/leadership/faculty.
2. Every specialty has aspects that are less attractive. I have not met a single (categorical) resident who hated the breadth of general surgery residency unless gen surg was their backup plan (typically those who didn't match ortho, plastics, neurosurg etc). But the same would apply to any "backup" plan. Most skills you get from general surgery are transferrable to whatever subspecialty one wants to do (if they wish to do one).
2#2. I agree that there may be opportunities to decrease the length of training for some subspecialties, however, I find this entire statement reductive and somewhat ignorant. While a straightforward colon case may be simpler technically than a CABG, there are a lot of intricacies in the care of patients with CRC and IBD, tons of trials coming out every year, new drugs, new surgical techniques (ie TAMIS, TaTME etc), and the landscape of management of CRC/IBD is constantly evolving (which is why I refer these patients to the specialists). Also, to say that most of general surgery is stapling and core knotting - I never expected to hear this from a surgeon in the 21st century. IMO, the technical part of the operation is about 20% of the overall surgical skills.
3. It is true that "generalists" are not well-equipped for the modern academic/urban healthcare systems where specialists thrive (for a good reason). However, once you get out of the academic/urban bubble, that system is not sustainable, and you need the "generalists" who can do a bit of everything - otherwise, the patients do not get any surgical care.
4. Can't disagree with that, unfortunately.

Overall, it's a matter of fit. If you are worried about lifestyle much, can't stand poop/pus, or want to have a yacht collection, gen surg is probably not a good fit. I went into gen surg because it would afford me the luxury to become an overall competent physician (who knows a bit about every part of the body, can manage the patient as a whole, and does not always depend on a bunch of other specialties) AND a subspecialist in the part of the body that I wanted to focus on.

 

[oldman]

The work is hard and time consuming, but I always view surgery as a calling. It gets you through the bad times and gets you to the good times when you're in the OR fixing a problem.

 

[DoctwoB]

Saw OP is no longer with us, but for any lurkers out there, the answer is it depends and will be highly program dependent.

General surgery residency is hard. But so is every surgical residency. Where I trained (in Urology) at a high volume center, I'd say Ortho, Uro, ENT, and Gensurg all were pretty similar, especially as a junior resident. The gensurg residents took more in house call then we did, but taking q3-4 call with a post-call day is in many ways better then what we had, which was q5 home call where you were covering 5 hospitals and rarely home, + no official post call day (good chiefs would help get you out earlier, but it was chief dependent). On the other hand their chief years probably were tougher then ours with more coming in on chief call for operative issues. You need to be into what you're doing, as in surgical residency the "carrot" at the end of dealing with BS is getting to operate. So if that isn't a reward to you, residency will feel tough.

The TLDR is surgery residencies are hard. General surgery may on average be somewhat tougher then Uro or ENT (probably similar to Ortho), but this will be highly program dependent.