plastics vs. general surgery

[artts]

Hello,

I'm an MS3 about halfway through clinical rotations. Plastics was one of my first rotations, and I absolutely loved it. I had never thought I would do any sort of surgery, and prior to 3rd year, had been thinking about some sort of medicine or medicine subspecialty, especially because I want to do research. Although I have yet to do my medicine months, and haven't ruled that out, so far I haven't done anything that I enjoyed half as much as I enjoyed plastics. My only concern, is I did not really enjoy general surgery, I'm not super crazy about the bowel or pancreas and quite frankly if I never see another lap chole again, I won't be too torn up. I know that part of the difference between my two experiences was that I got to do a lot more in the OR on plastics, just because of the nature of my attendings, which is definitely a major reason why I enjoyed plastics so much more. However, by most measures, general surgery was much less stressful-fewer hours, my residents were great, I learned alot, etc....I just did not really love it like I did plastics. However, with the two being so similar, I'm not quite sure why I enjoyed plastics infinitely more than general surgery, and I'm afraid it's making me think that perhaps I am not suited to any type of surgery in general (Aside from the reality that its extremely competitive, etc etc). Any thoughts? Advice? I'd greatly appreciate it!

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[Winged Scapula]

Almost all students like being in the OR, especially when they get to do things.

It is common not to like general surgery, however, the complaints tend to be the long hours, the malignant atmosphere, lack of interest in the types of cases.

I'm not sure I agree or even understand your statement, "I'm not quite sure why I enjoyed plastics infinitely more than general surgery, and I'm afraid it's making me think that perhaps I am not suited to any type of surgery in general (Aside from the reality that its extremely competitive, etc etc)."

Are you implying that because you don't know WHY you like plastics that means you aren't cut out for any surgical field? It is important to ascertain what interests you about a field. Enjoying it because the attendings let you do stuff is not a good enough reason, IMHO.

I find it interesting that you state that your general surgery rotation had better hours than your plastics, but that you liked the residents. Its ok not to enjoy the bowel or to be burned out on lap choles. Most medical students get to drive the camera during those cases at most, and often just stand around in a dark room. It would be odd if you weren't bored to tears with those...DOING cases is a LOT more fun than watching. So make sure you don't enjoy plastics more than anything else (not just GS) just because the attendings paid you attention, taught you and gave you the chance to do something.

Liking the people in the field is great (pretty much a prerequisite) but you also have to like the work. Make sure this is what draws you to PRS, and that you can tolerate the crappy aspects of the field (every field has 'em).

best of luck in the rest of 3rd year...

 

[artts]

I definitely enjoyed plastics in part because the attendings gave me the opportunity to do things. I also enjoyed it because I liked.... results...seeing the "Before and After", I liked dissection of fascial planes, I thought the surgeries were a lot more fun than many GS surgeries, even when all I could do was watch on plastics. Even the little surgeries on plastics like facial lipoma removals were fun, making sure incisions were within natural lines of the face etc...

I'm just worried because I feel like Gen Surg and plastics typically have strong overlap, so if you like one, you should at least kind of like the other. By most measures someone in my shoes would have enjoyed my General surgery rotation more (50 some hrs/week vs the easy 70+ I was putting in on Plastics, with all the extra time, I probably learned more from my general surgery residents, hell I even got more free food on General Surgery). There were also a lot of reasons to dislike my plastic surgery rotation (not eating lunch until 4 is never any fun, I had an attending who had the tendency to call me sweetheart, which I found condescending, etc...)Despite all that, overall I thought my plastics rotation was great and I just didn't like my General Surgery rotation very much, which in my (albeit inexperienced) mind, just doesn't make a lot of sense....

Thanks for the insight, I'm loving third year right now.

 

[Winged Scapula]

It sounds as if you had a very atypical general surgery rotation, at the very least in terms of hours. The problem is that if you do end up applying for PRS you have to realize that your GS experience may be wildly different in your new program. My medical school GS faculty was very supportive so it came as a shock to me to see people screaming and throwing things as a resident. Even your PRS rotation sounds light on the hours...are you at a place without residents, more of a community private practice setting? Don't be naive like I was and assume it would be the same everywhere.

Now, its not unusual at all to not like GS but want to go into PRS. It was common to hear the senior GS residents going into PRS whisper about how they couldn't wait to be done (this was in the days before Integrated programs). You won't like everything about any field, even PRS. BUT you have to go through GS, in some fashion to get to PRS. Whether its a full 5 years, 3 years, 2 or 1, there will be some GS in your training. The best residents are those that can get through the rotation taking from it what is helpful to them and recognizing the contributions all fields make to your education. You will be happier and most likely a better student and resident.

So, its not unusual to like one surgical subspecialty and not another or GS. There is nothing wrong with that except the need to do some GS as a PRS trainee. One of the reasons I ended up doing breast was because there was so little of General Surgery I really enjoyed. But I liked being in the OR, I liked a surgical practice, the pace, the mindset - there was a feeling of enjoyment I didn't have on any other rotations (I applied for, and did not match in Integrated Plastics).

At any rate, you've got several months and several rotations left and you may find that something else tempts you more. Keep an open mind and learn something from every rotation you do; nothing irritates faculty more than having a single focused student (not focused on their specialty) on service.

 

[maxheadroom]

Now, its not unusual at all to not like GS but want to go into PRS.

Amen, sister. I hated my time in General Surgery. I just don't like dealing with the GI tract. I got so tired of asking old people about their poop. Believe me, there's plenty of pain in Plastics, but at least it's the pain that I chose.

 

[Winged Scapula]

Amen, sister. I hated my time in General Surgery. I just don't like dealing with the GI tract. I got so tired of asking old people about their poop. Believe me, there's plenty of pain in Plastics, but at least it's the pain that I chose.

We could tell.

 

[skiz knot]

The OP should at least consider the other surgical specialties. Ortho, Uro, Neurosurg, etc...

Ortho is generally liked by those that are into surgery but not the whole lap chole thing... you know what I mean.

Best of luck

 

[artts]

Thank you for all the advice! I think it mostly boils down to I'm not a fan of dealing with feces...

My general surgery rotation was a little atypical, it was mostly bread and butter at a private hospital affiliated with the University, coupled with the fact that there was about a week in there that a few attendings took vacation-->extremely light service.

As for my plastics service, I probably worked less than I otherwise would have since there were 2 med students (somewhat unusual), and I had a weekend or so that I did not even come in.

That being said, I have seen expletives and flying objects (Although I've lucked out and neither of those have yet been directed at me!), and if I do end up doing PRS and am fortunate enough to have earned a position, I'm not afraid to work hard.

Take care and thanks again!

 

[Winged Scapula]

Thank you for all the advice! I think it mostly boils down to I'm not a fan of dealing with feces...

Who is? The surgeries are cool, mostly elective with interesting genetics and the poop is just something you learn to deal with.

I'm guessing you never did a flap for a sacral decub...those are pretty gross (and nearly destined to fail in some patients) PRS cases.

 

[maxheadroom]

I'm guessing you never did a flap for a sacral decub...those are pretty gross (and nearly destined to fail in some patients) PRS cases.

How about most? And I only flap patients who have been diverted. No ostomy, no flappy-flappy.

 

[Winged Scapula]

How about most? And I only flap patients who have been diverted. No ostomy, no flappy-flappy.

Well, I actually typed MOST first but changed it when I realize I hadn't done one in years, and I couldn't speak authoritatively about it any more (not that I wouldn't try ).

Yes good rule - no stoma, no flap. Poop on flaps not a good look or good for healing.

 

[cleopatra1710]

Given your dislike of general surgery and interest in plastics with some reservations due to the general surgery requirement, I'd recommend that you do an elective in ENT as you can still find many of the same aspects with facial plastics, head/neck recon, and flaps. Of course, you'd have to like bread and butter ENT stuff but perhaps you'd find their messy cases more palatable.

Best of luck. Having also had to recently decide between the two I would say it becomes obvious with electives where you fit best.

 

[LadyWolverine]

Liking the people in the field is great (pretty much a prerequisite) but you also have to like the work. Make sure this is what draws you to PRS, and that you can tolerate the crappy aspects of the field (every field has 'em).

This point is so, so cruicial. Remember this throughout 3rd year and into 4th year - it will guide you in choosing the right specialty. Your supervisors, mentors, teachers, peers, and patients will be different everywhere, as will your resources and facilities. Make sure you like THE WORK. That's the only thing that will remain constant.

 

[Slack3r]

(I applied for, and did not match in Integrated Plastics).

Pardon me asking, but why didn't you do a plastics fellowship after your GS residency if you originally applied for PRS? Because the breast fellowship fulfilled what you wanted to do? Are the plastics fellowships as competitive as the integrated route?

 

[Eta Carinae]

Plastic Surgery
Plastic surgery is a medical speciality concerned with the correction or restoration of form and function. Plastic surgery originated in ancient India in the Vedic period about 3500 B.C. It is well documented in Sushruta Samhita. Many of the surgecial procedures performed in modern times were practiced in Ancient India. Plastic surgery is a special type of surgery that can involve both a person's appearance and ability to function. Plastic surgeons strive to improve patients' appearance and self-image through both reconstructive and cosmetic procedures.

General Surgery
General Surgery is a medical specialty concerned with the treatment of a variety of disorders frequently requiring surgery. A board–certified general surgeon is required to complete five years of additional training after receiving the medical doctor degree. This training involves learning how to evaluate a patient’s medical condition and determining whether surgery is the best type of treatment available.

 

[Derma]

Hi everybody

I am a board certified dermatologist 4years back and i did my Mohs surgery fellowship 2 years back ....i can tell you that this fellowship just triggered my passion about surgery coz i applied for orthopedics after med school and i was not accepted and i found acceptence in dermatology with surgical fellowship but the bad thing is that i dont have much skin cancer cases in my home country (compare to US where i was trained )
so i start thinking in doing plastic surgery residency again...one thing to add i start suffering from depression and anexity which am taking medication for ( which can be triggered by stress as all of us know) i just dont know ? how difficult this would be? is there somebody how changed from medical to surgical speciaility

thanks

 

[asmallchild]

Hi everybody

I am a board certified dermatologist 4years back and i did my Mohs surgery fellowship 2 years back ....i can tell you that this fellowship just triggered my passion about surgery coz i applied for orthopedics after med school and i was not accepted and i found acceptence in dermatology with surgical fellowship but the bad thing is that i dont have much skin cancer cases in my home country (compare to US where i was trained )
so i start thinking in doing plastic surgery residency again...one thing to add i start suffering from depression and anexity which am taking medication for ( which can be triggered by stress as all of us know) i just dont know ? how difficult this would be? is there somebody how changed from medical to surgical speciaility

thanks

Assuming I'm not falling for a troll post, I don't think anyone can tell you how difficult this transition would be for you.

Going from dermatology to a surgical residency is not going to be fun for most people. But if it's your true passion, you'll find a way to push through it.

Out of curiosity, did you match in dermatology in this country? I understand spelling and grammar on an online forum are not representative of real-life intelligence but that is some egregious posting from an attending physician.....

 

[Winged Scapula]

Pardon me asking, but why didn't you do a plastics fellowship after your GS residency if you originally applied for PRS? Because the breast fellowship fulfilled what you wanted to do?

Several reasons. One reason was that my faculty wanted me to spend more time in the lab to be "competitive". Pardon me, but I spent nearly 10 years in a lab before medical school, am published and I thought the point of doing lab years was to learn about grant writing, getting published, etc. I had little interest, at my advanced age, to jump through someone's idea of hoops without any inkling if it really would increase my competitiveness.

I became more interested in Surgical Oncology and the Breast fellowship allowed me to dovetail most of my interests.

Finally, I realized I probably didn't have the skills I thought I needed to do plastics. My cosmetic outcomes are better (I'm told) than most general surgeons, and I have no doubt that with more training I would get better, but was not sure I wanted to be sub-par when compared to my plastics colleagues.

Are the plastics fellowships as competitive as the integrated route?

Perhaps not "as" but certainly still extremely competitive.

 

[medfriend]

Just how bad are the cosmetic outcomes of most general surgeons? Do a lot of them simply not care much about that aspect, or is it a lack of proper training or skill?

 

[tajlansell]

Plastic surgery is a medical speciality concerned with the correction or restoration of form and function. While famous for aesthetic surgery. General surgery is the surgical specialty that focuses on the abdominal organs.

​

 

[Zoom-Zoom]

Just how bad are the cosmetic outcomes of most general surgeons? Do a lot of them simply not care much about that aspect, or is it a lack of proper training or skill?

There are basic skills that all well trained surgeons learn and acquire with practice, and all the surgeons I've interacted with have been conscious of aesthetics to some extent. Many have been very knowledgeable. But there's a balance between perfectionism and what's practical to do on a mass scale with a field as large as surgery.

 

[reemeo]

Forgive my stupidity but what are the Integrated Programs?