If general surgery makes you happy there is no need to do a fellowship. I would not leave your home program if you are happy there and feel you are getting good clinical training. Particularly if you did not enjoy a research year. Surg/onc generally requires ~2 years of research +/- some bench research. It isn't so much the name of your program (that does help) or where you did your research over the actual quantity of publications you manage to accrue and the impact of your research. That can be done anywhere. Does it help if you go to a big program with a pedigree? Of course. But it isn't totally necessary. However if you really didn't enjoy the research grind then... probably just scratch surg/onc off the list and go be happy doing surgery.
Would strongly encourage you to consider less competitive alternatives where you'll be well received. Onco is a hybrid of many other specialties and many surg/oncs end up practicing in other fellowship disciplines - colorectal, breast, endocrine, etc. This could supplement (or replace) your general surgical training in any capacity. You could do 50% gen surg and 50% breast, or 75% colorectal but still take gen surg/ACS call. Would require much less research, be much more open to a program without a big name, and be very attainable without doing a ton of things that you would really not enjoy doing based on your description.
Also if you're an IMG, not sure what your visa status is, but that needs to be accounted for. You get x number of training years. I don't know if the clock resets for fellowship but I'm pretty sure it doesn't. Make sure you are aware of those limitations.
If you're a happy general surgeon though, there is nothing wrong with being a happy general surgeon. There are also some really cool non-accredited things you could do. There's non-accredited surg-onc programs that are only one year to train you how to do more advanced HPB/retroperitoneal work, or complex abdominal wall/hernia fellowships that would make you a much more marketable general surgeon and allow you more options/paths to getting out of call and acute care later in your career, MIS stuff, non-accredited colorectal fellowships, etc. You don't need a board certification to be a specialist - you just need a job environment that requires that skill set and the correct training to do the job.
Thank you! I realized after a lot of soul searching that I want to be the general surgeon that can do the big HPB cases when needed. That’s really the only reason I ever wanted to pursue surg onc in the first place; and after your advice and discussing with my mentors I learned more about these one year HPB fellowships. I think this is my path forward.
Do thoracic if you're competitive for it and if you enjoy robotic lung cases. You'll get paid substantially more at most places and the general call pool enrolls you into either a straight thoracic call which tends to be much less painful than a general surgery call. You can definitely continue to keep a busy general surgery practice if you want, and the robotic experience for foregut surgery is generally superior to the laparoscopic experience and more robust in thoracic as chest surgeons have largely gone full robot where many MIS/foreguts are still using laparoscopy a lot. Which is not bad, but its not as current with our generation and while its just my opinion, is going to be further phased out in favor of robotics (including whatever the next phase of robotics is as it evolves).
~Tldr - do it for the quality of life. You will not be disappointed and it closes no doors. Pretty sure the thoracic job market is much hotter too but not 100% on that front. I know my current center is heavily recruiting and my past was as well.
Thank you! Thoracic is a great field and I enjoy the cases but there is just so much to do in the belly, it just appeals to me more (I know that this was meant for a different poster but still made me think). Trauma is something I explored to do both of these areas, but I don’t have a passion for it..
@theprince911
Your dilemma is extremely similar to what I am facing currently.
I am an IMG who did 3 years of research in HPB before landing a prelim position followed by another followed by a categorical 3. I did two additional years of research in HPB after my third year that are coming to a closure. I always thought that I wanted to be a surgical oncologist based on my rotations during med school, my research work and my rotations as a resident with awesome & in-depth exposure as a mid-level resident to major pancreatic & liver operations.
Now after two years of surg onc research, I disliked the field to the point that I decided to not apply next fellowship round.
My major dilemma that I am trying to figure out is whether to apply to thoracic (my second preference after surg onc) or to stick to MIS/Foregut & save myself a year of fellowship time since I have no major sub-specialties that I dislike.
I think that I am going to shoot for HPB. I have similar feelings to you regarding research but do not feel ready to give up doing HPB..
I think you still have the option of finishing at your home program and still apply to fellowship. Doesn't have to be surg onc. Could be something 1 year. You also dont have to choose academic practice even if you do surg onc and peds, which is a misconception that i previously held as well. I also wouldn't commit myself to the idea that you're out of luck because you're at a small program. I have seen people from small programs match very well to fellowship. Strong cv and strong advocates are the winning combination. Peds and surg onc are difficult matches and nothing is a sure thing but it's not impossible. The key is to make yourself a recognizable face.
At the end of the day, you can still be a general surgeon and have a fulfilling life and career. But be honest with yourself. Are you the type of person that can live with the " what if?" You can still do a one year fellowship and help justify the time you took for research.
Your last paragraph is exactly why I’m going to shoot for the HPB/foregut fellowships. Let’s see what happens. I’ll keep you updated!
Thank you everyone for your responses! As I’ve been thinking things through, your advice has helped immensely.
As I’ve been discussing things with my mentors, I discovered that I can shoot for HPB and complex foregut surgery without doing surg onc. I discovered that there are one- and 2- year programs, though I will probably shoot for the 1-year programs. I always had surg onc on my mind because I thought that that or transplant were the only realistic ways to practice HPB. I actually went into surgery because biliary surgery fascinated me, and wanted to be the guy that would do the open gallbladders and biliary reconstructions, chronic pancreatitis/pancreatic cancer cases. Always had the most fulfilling experiences in those cases despite the fact I know that patients can do terribly, especially since I’ve experienced this with my own family members and my own patients in training, but I connect with them very well and really feel that I can help them.
After doing a ton of research on how to get into this field, I still am not sure if I will be able to make it into one of the few HPB/foregut fellowships, but figured I will do what I need to do and see where the cards fall. The place that I want to work is pretty underserved in those areas and this would allow me to practice as a general surgeon while also doing those more advanced HPB and foregut cases (though we may have to work on building resources further to properly care for those patients).
So, with that said, that’s my goal. If it doesn’t work out I’d be happy doing general surgery. If it does work out I’ll be living my dream. I’m working on strengthening old connections and forming new ones in this field; hopefully this helps. Other than that, I’ll work on improving the things I can improve. Can’t change the fact that I’m an IMG (though do not require a visa). Can’t change that my GPA in med school wasn’t the best. I will try to participate in more field-specific research but that may be difficult this late in the game; hopefully my research in other fields will help here (should have 5-6 first author papers and the same amount of second/third author papers by the time I’m done, mixed between basic and clinical research). My ABSITE was kind of all over the place, going from 50s->30s->90s percentile (it really clicked for me in my third year); I’ll try to keep it in the 90s going forward. I have stellar evaluations and letters from almost everyone I’ve worked closely with and will continue to impress the attendings that really seem to support me and trust my clinical decision making while helping me improve at my home program. They also genuinely have my best interests at heart and I aim to make them proud.
Are there any other things that I should focus on to strengthen my application? I plan on applying this year and am willing to do what it takes. I no longer feel confused about what I want to do for the first time in a long time, and feel really excited about what the future may bring.
Again, thank you all for your advice throughout the years.
