Surgery FAQs

[delchrys]

I'll have to wait till I'm back at the hospital to look them up, I'll try to post them tomorrow morning. And your point is well taken, I'm just trying to keep this article from being blown out of proportion.

coolio. and trust me, i understand (partially) the difficulty in the situation--on one hand, if you cut hours FURTHER you have less-trained surgeons, which is bad, or you need a longer residency, which is crappy. on the other hand you have people who make mistakes that would otherwise not have been made, and lives lost as a result.

on a related note, does anyone have links (or names of "real" sources) for statistics showing the total number of dollars spent on all health care in america for given years. like, total money shelled out by insurance companies for health care services, total money paid by the gov't for healthcare, and total money paid by other sources, both directly to health care providers and to insurance companies...if anyone has anything that even comes close, or can point me in the right direction, i'd be REALLY grateful.

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[Seaglass]

These are all listed as # of "serious" events, sleep deprived vs. not, per 1000 patient days.

Medication errors: 99.7 vs 82.5

Diagnostic: 18.6 vs 3.3

 

[supercut]

The NEJM article was a 3 week study of 20 interns. And despite the increased errors, there was no difference in outcomes...ie pt morbidity or mortality. That's because the errors were caught before they were implemented. That doesn't mean it's not an important study. But we shouldn't rush to change all residency based on one small study.

For those that don't know, 80 hours is a number pulled out of a hat by burocrats in NYC. The rest of the country jumped on the bandwagon years later, when burocrats decided it was time to force it on the rest of the country. Fortunately, the ACGME took over so it would at least be better than what the burocrats might come up with. That number is not supported by any data that I am aware of.

So why are surgeons in general so much more upset about the hours limits than other areas of medicine? It's primarily because we worry about getting adequate training. I'm a surgery resident, and I don't relish the idea of working more than 80 hours a week (my program is very good about compliance) However, I worry that my training will suffer. I worry that we will have a generation of poorly trained surgeons. I worry that we are drifting toward the European system, in which you must log a certain number of cases to become an attending, and you stay a resident until you get that number of cases, no matter how many years that takes.

I do believe that it is probably possible to produce well qualified surgeons in 80 hours a week, and perhaps even less. However, in our current system, I don't think we know how to do that. THe hours limits were forced on us from forces outside our profession, without allowing us to adapt the method of training. Surgery training's old model was basically like an apprenticeship... you stayed mostly in the hospital and see as much as you can, and some things you'd only see a few times. We have yet to evolve into another model. I think it will require a drastic change in the way we go about training surgeons. But we don't know what those changes need to be yet.

What that means is that I am a gunia pig. Currently, I am mostly still in the apprentice model, but don't work as many hours as people used to. Any new methods of surgcial education will be tried out on me. I don't know how well they will work.

I worry becuase when I compare the skills of the chiefs at my current program in NY (where the 80 hours have been enforced for the past 4-5 years) to the chiefs at my med school (outside of NY and I graduated before the 80 hours went nationwide). I see a huge difference. The >80 hours guys were much, much better than the 80 hours guys. I realze that other things may come into play as well, but surely the 80 hours is one factor. Exam scores were also higher at my med school than they are at my current program. These differences were apparent to me within months of my arrival at my current program. And I wasn't happy to see that.

Interesting that the study at BWH didn't address whether the interns whose hours were limited emerged from that experience with the same knowlege base/skill level as those whose hours weren't limited. I am glad to see the study becuase we do need data to back up things like hours limitiations and training methods. We need to be very proactive in figuring out how to train surgeons well in 80 hours a week.

Bottom line: we know the old method worked. We don't know if the new method will work as well, better, or worse. Hopefully we won't find out in 5 years that we are producing surgeons who can't operate.

 

[jc7721]

I too am a surgery resident and here's my take on things. You can train a surgeon in 80 hrs a week. The trick is to make every hour count. This is the BIG difference between the pre and post 80 hr world. 5 yrs ago residents would work >80hrs, do enormous amounts of secretarial/discharge/social work/scut for a significant chunk of the day, plus go to the OR, clinic, and also spend time just running around the hospital not learning a damn thing. And the hours would just pile up. In the current work hours restricted environment, many of those tasks need to be relegated to others like PAs, nurse practioners, nurses, etc. It's essentially shift work now, and there is no time to waste. No more trial by fire. No more learning just by association. When I am at work I expect to spend most of my day in the OR, in clinic, at educational conferences and taking care of essential patient care. When I am off, I should be reading and preparing for cases, the next conference, etc. The attendings are definately starting to realize that they should, and rightly so, expect residents to be more prepared when they come to work. At my program, after the work hours were instituted, case numbers actually went up, not down, so I don't by the argument about case numbers. I think surgeons complain most about the 80 hr week because surgery is so unpredictable--cases go long, emergent cases pop up, they have many ICU patients, their census is often huge, and people are now supposed to be leaving at set times. i.e., we are now strictly regulating a previously unregulated, and unpredictable world. So there is often a disconnect amongst the residents and attendings on a surgery service: some are in the OR, some in clinic, some on the floor, in the ICU, in the ED, and to coordinate patient care/communciation and understanding amongst the team proves very difficult--especially when people are leaving at different times to make their hours. I am confident that it will work. It's also up to us to help the administration know when things aren't working. If we just bitch and moan amongst ourselves, and never tell the attendings, things will move very slowly. One thing they do at my program at the end of every week, at M&M, is put the work hours for every resident for the last four weeks up for all to see. This has proven a great way to involve all residents and attendings in the process of addressing the services that have problems with hours.

 

[supercut]

One thing they do at my program at the end of every week, at M&M, is put the work hours for every resident for the last four weeks up for all to see. This has proven a great way to involve all residents and attendings in the process of addressing the services that have problems with hours.

I think that's a great idea! Also, great for you that your program managed to increase cases when within the 80 hours. That is not the case at my program, though the numbers are still probably adequate. Like I said, there are other issues as well. You have to be careful with NP and PA...the PA at my program generally aren't team players, won't take signout from junior residents ("dont' let the residents push you around" is one of their mantras) and often just do what they feel like (ie they might write a discharge order but refuse to dictate) and have been known to go to the OR intead of a junior resident. You have to be careful not to turn over so much pt care that the residents don't learn how to manage pts outside of the OR. Any program that resorts to using PA/NP must carefully and thoroughly designate expectations and limitiations. I"m glad it works well at your program.

 

[Denial]

I always assume programs TRY to stick to 80 hr/wk, though I'm sure many occasionally go over. Some have exemptions to that rule, so they're allowed to go up to 88 hr/wk. However, during interviews, hopefully I'll be able to meet with residents and get their input.

My Program director cant belabor this more.He berates everyone for not putting in hours everyday ,,...and this way he can keep a critical eye on how many hours a resident is putting in

 

[JAMMAN]

I am here to chime in again. There 80 hour work week has led to a change in surgical mindset and has made surgery appeal to some less dedicated than traditional surgical residents. Examples from my own experience. I trained in NY so my experience goes back farther than most.

As a chief resident I rounded my team one Friday afternoon around 2:30 pm. Shortly after rounds we had three emergency surgeries. I had to to go to the OR and so did another senior resident. The highest available resident was an R2. I called paged her and asked her to go help with an emergency tracheostomy in the OR. This was not an unreasonable request in any way and it would have provided her with a learning opportunity and she would have helped someone in need.

Her reply is that she was already outside of the hospital and heading home. I told her that there was no other resident available. She said she was going home to see her husband and she had the weekend off. Junior residents were q7 at that time and she was definitely not post call.

I told her that her chief was telling her to go to the OR. She replied that I was lucky she replied to my page at all. Just then another more dedicated R3 came out of the OR and I gave the case to him and hung up on her.

If I had done that when I was an R2, I would have gotten into serious trouble. I probably would have ended up on probation. Unfortunately, these days, this seems to be becoming more of the norm. New residents rebelling against the old regime. A regime that has trained fantastic surgeons in America for generations.

Before, a resident like that would never finish her residency with that kind of attitude. Either she would become more deidcated and serious about the profession or she would simply wash out. Now, I am sure she will finish. She will finish with fewer cases and less experience than residents in the past.

She will pass her boards and practice surgery. She may be in your community hospital. Someday, you may emergently in need of a surgeon on a Friday afternoon and she will be thinking about heading home instead of concentrating on your bowel anastamosis.

I have many more examples of this, but this was the most blatant and alarming. I spoke to my program director about this problem and told him that I thought that the 80 hour rule was going to lead to us training alot of less prepared and less dedicated surgeons. His reply "I agree. At least they will be well rested and that is what NY wants right now."

 

[jc7721]

That resident was an idiot. The 80-hr rule is an average, and it is OK to be over a couple of weeks, especially when things are extra busy and better yet when you get to operate.

There are a lot of assumptions and speculation in the previous post. Not totally unfounded, but it's not that simple. I don't care how much you hate it, how much you disagree with it, the 80-hour week is here to stay. Unless you think you can change outside political pressure and public opinion, it's going to be here for a while.

Residents rebelling against the old regime, well the old regime is dying if not dead. If you are not on board, you go on probabation and that's it. Period. If you are at a program where the impetus for a successful 80-hour week does not come from the top down--I mean the Chair (especially from a operative/patient care/educational point of view), get out now, or lie, manipulate, and fake your way through. That'll work real well.

At my program attendings, fellows, chief residents and below make an effort to comply with the hours. There is protected, mandatory educational time (except obviously for trauma call) alternating between junior and senior level residents so that every resident isn't at a teaching conference each time. There have been PAs and NPs hired to help out with discharges, paper work, floor scut, which is monumental in freeing up the residents for more serious ICU/OR/Clinic time. Case #'s are staying the same, because as would be expected, it all comes full circle--when you leave early another resident picks up those cases, next time it gets reversed and everyone is happy. Unless cases are going uncovered, which would be bad, then the numbers work out. Northwestern actually reported an increase in case numbers. I guess it goes to how serious a program is to make it all work.

Are we sure that resident would finish? Have the written and oral boards become easier? Obviously not. If that resident's experience is poor and they don't get in the OR enough, and don't know how to work up/take care of/manage patients then she will not finish. Maybe in 3 years when the first batch of 80-hour residents become chiefs, and they are all so underprepared and inexpereienced, and fail their boards, or pass their boards and then go out and be awful surgeons, everyone will come to their senses. Come on. I would want the written and oral boards to be MORE grueling than they already are. The ABS also needs to revise its minimum requirements for surgical case #s. 500 as a minimum is too low.

Yes the old system produced great surgeons. But to say right now, after two years, that we are doomed to become inexperienced, unmotivated, uneducated surgeons is preposterous. Maybe if we put the effort into making the 80-hour week work, just as we should have put the effort into regulating our profession before the insurance companied did, we will actually end up as good or better for it. If not, I guess the governement will have to get miore involved.

 

[v-tach]

oops sorry I manipulated the thread to reflect the practical ratification of what goes on even after the 80 hour curfew. I just want to belabour that it is impossible to not lie about the 80 hour thing under duress. Surgical residency iunlike anyother faculty behooves you to be in the OR more than the floors. Residents have an axe to grind here. The OR cases they log in the better!!! Surgery fortunately is one those brancehed where you cant get by passive learning (osmosis).. it involves and active effort at a cellular level.
This why the 80 jour will be a farce. By the way I agree with the theory about more surgeons =less hours.

The 80 hour rule is a good idea in theory, but the problem I have with it is that people are often forced to lie about their hours due to the difficulty of keeping their hours under 80/week. That's just wrong. And to compound this, if people do report hours accurately and it's over the limit, they run the risk of getting their program in trouble and causing problems for themselves and their colleagues. There appears to be no truly ethical option here. I'm not even in med school yet, but have read a bit about this whole situation and believe that limiting the hours is a good thing, because it (hopefully) cuts down on errors due to people being excessively tired. However, to do this would require other changes--such as perhaps hiring more ancillary staff to reduce scut-- to ensure that residents still learn all they need to learn during their training. It seems to me that scut is a big part of the problem--takes up a lot of time while having little educational value. If residents had less scut to do, they would have more time to do things where they could actually learn--and still probably not go over the work limit for the week. If there's going to be a rule like this, there needs to be a workable way of actually abiding by it.

 

[vuillaume]

I agree wtih JC7721,
An actual training philosophy or doctrine didn't exist for surgery residents in the old days because they didn't need one; we were here all the time so our learning was brute force experiential learning. Now that 80 hours is the letter of the ACGME's law, we have no choice but be smarter about the way we train residents. The programs that only attempt to check off the boxes demonstrating compliance without being creative and innovative in reducing non-educational activities, maximizing the opportunities for learning are the ones that will crank out less than excellent surgeons. The decreased case numbers argument is spurious as several of you have been so good to point out because some places have actually increased case numbers.

If you resign yourself to the position that it is impossible to train a good surgeon within today's constraints, then the battle is lost--it's a self-fulfilling prophecy.

I refuse to surrender to this thinking. Mostly because we (1) have no choice; (2) as others have pointed out ad nauseum a tremendous amount of time that we spent prior to the new rules was a morass of crap amidst which we would find a rare pearl of an experience. I know we can absolutely reduce the crap and increase the pearls. For the most part, we've just been too lazy to do it.

It's time to become smart and active educators.

 

[v-tach]

One other thing...in order to make the 80-hour week work, good communication is ESSENTIAL for proper continuity of care. When there is a "shift change", the residents who are leaving must give detailed information about every patient to those coming on duty.

 

[jc7721]

One other thing...in order to make the 80-hour week work, good communication is ESSENTIAL for proper continuity of care. When there is a "shift change", the residents who are leaving must give detailed information about every patient to those coming on duty.

excellent point. Organizing the transfer of patient care information: the development of a computerized resident sign-out system. Van Eaton EG - Surgery - 01-JUL-2004; 136(1): 5-13

 

[DoctorDoom]

This isn't the NEJM article, but here's something about the two main Harvard guys doing residency-related sleep research:
http://www.news.harvard.edu/gazette/daily/2004/10/27-errors.html

Charles Czeisler and Chris Landrigan are the main researchers on this project.

Chris Landrigan was my roommate in medical school!

I don't know if you are still reading delchrys, but I think what was offensive about your posts was the insinuation that surgeons liked misery and had no life, thus we clung on to the high hours because we had nothing else.

Fact is, we don't love 120-hour weeks. No resident would defend 100+ hours as absolutely better than 80. We do them because that is what a professional does, occasionally sucks it up to do the job right. Sure, residency has a lot of worthless moments, but sometimes the only way to learn is to be johnny on the spot at 3AM. Furthermore, the time spent builds a professional, dedicated attitude. Something the resident JAMMAN described will never learn.

I'm glad that there are hours restrictions because frankly, some programs were abusing our presence as cheap labor. Until strict fines came in there would have been no way to force programs to reevaluate and revamp residency training to weed out the least educationally valuable tasks.

That does not mean your faith in the validity of the 80 hour limit is justified. The rather arbitrary limit was determined by the IM experience. There is no study that I know of objectively indicating based on evidence that 80 is a good number. Hopefully, as time goes on and GS training is restructured, there will be more leeway for a resident to stay a bit past the hard and fast 80-hour limit as imposed in certain programs.

To make the sweeping statements that you did was ill-considered. It is a work in progress. I am encouraged the the posts of the last few members. We all have to carry on more leadership roles for our education if we are to leave the worst of the apprentice system behind, without losing the best parts of bedside clinical teaching.

I'm certain also that as you progress into your profession in the law, you will discover that the same issues of HAVING to stay at work become germane for you as well. And sometimes you will choose to stay even though it means you won't get to see your wife for the 3rd weekend in a row.

 

[surg4me]

To clarify, program are NOT fined for violation of work hours. It is not a law, but one of many conditions for accrediation. The agency for accrediation does not have the power to fine anyone or any program. Sucks (unfortunately) to those in programs where hours are not enforced...I guess most places have difficulty enforcing them...but some are definitely better than others...one does not have to work 100 hours to become a good surgeon...lot of wasted time due to inefficiency are now being streamlined and made more efficient at some of the better programs that are able to adapt to the changing conditions of surgical residency in the country...I wouldn't mind working many hours as long as they're of educational value...taking crap or waiting around for labs or imaging to be done is non-educational and it's unfortunate for those residents who work at institutions where 80 hours are difficult to maintain due to inefficiency...I'd like to work hard but also have a life outside the hospital as well...be human and enjoy life once in a while is not a bad thing...

 

[Darth Asclepius]

I do not claim to know if the 80 hour week is good or bad since I am just a pre-med (beginning med school next year). I have spent a lot of time in the OR shadowing a surgeon. He's the best doctor I have ever met and I feel lucky to have had the chance to learn a few things about patient care from him.

One thing that I have noticed is that every day he has choices to make that put his personal life up against his patients. He has three sons and wife. He would very much like to get home to them, but he always chooses to do what is best for his patients, sometimes causing him to stay several hours longer. I know that it is the right thing to do, but I worry that people trained under the new system will not necessarily make the same choices. When I talk about these choices, it's usually between doing a job that is "good enough" or doing his best. Do you think that future surgeons will be more satisfied with "good enough" or do you think this is something that all good doctors would do and has nothing to do with rigorous training?

I have no desire to work 120 hours per week just because surgeons before me did, but will I be losing some valuable part of my training? I spent a lot of my undergrad time doing research and originally planned to do an MD/PhD, but after spending so much time in the OR, I was reminded of how much a wanted to be a surgeon when I was growing up. I realized that most of what I liked about the lab was working with my hands (setting up the PCR, cloning my genes, etc) and not analyzing data and writing grant proposals (which it turned out made me kind of miserable). I turned down one of those nice little MD/PhD offers because I decided that I could have a career where I could be a decent researcher and surgeon, but who wants to be a decent surgeon? I want to be an excellent surgeon and I think I should dedicate my time to just that. I want the best training I can get in residency. I'm just not sure if it's better the old way or the new way. I hope the new system isn't going to hurt my training.

 

[threepeas]

I will be 40 when done with med school. I currently have 3 children under 6yo and a devoted supportive wife. Does anyone know, or can you comment on the realistic viability of someone with a family surviving a surgical residency?
Thanks for your time.

three peas

 

[JAMMAN]

I will be 40 when done with med school. I currently have 3 children under 6yo and a devoted supportive wife. Does anyone know, or can you comment on the realistic viability of someone with a family surviving a surgical residency?
Thanks for your time.

three peas

Yes, your family can survive a surgical residency. If you decide to do it, make sure you have alot of important discussions about it with your wife before you start. Make sure she is prepared for your absence, your stress and your need to be dedicated to your training. Also it is important that she have an adequate support system. Because residency, surgical residency in particular can be very hard on a family. The divorce rate speaks for itself. Despite the divorce rate, your family can survive. Good luck in your decision.

 

[Dr JPH]

MS III here looking at General Surgery. I am currently on my surgery rotation and I have fallen into a world that fascinates me.

Wondering what type of training you would need to do things beyond general surgery ie: vascular, trauma, etc.

Any good books or websites out there to get the rundown on the different lifestyles of surgeons? Work hours, training requirements, etc.

Thanks a bunch.

 

[DO_Surgeon]

Trauma:

www.east.org
www.trauma.org
www.aast.org

Cardiothoracic:

www.ctsnet.org
www.tsranet.org

Vascular:
www.vascularweb.org

There are most likely a ton more sites, but those are a few that I look at occasionally.

 

[Blade28]

Try FREIDA (http://www.ama-assn.org/ama/pub/category/2997.html) or get a copy of Kenneth Iserson's book.

 

[dr.evil]

One of the reasons to go into general surgery that we never mention is the options available for you after residency. It's been posted quite a bit on these forums but I'll reiterate some of the fellowships available.

These are after your five years of general surgery:

Cardiothoracic - 2-3 yrs fellowship
Plastics - 2 yr fellowship
Critical Care - 1 year
Critical Care/Trauma - 1 or 2 years
Vascular - 1 or 2 years (most are 2 years now)
Pediatric Surg - 2 year fellowship (most people also have 2 years of research making this a 9 year program)
Advanced Laparoscopic - 1 year
Transplant - 2 years (liver and kidney/panc)
Hand - a rare fellowship following GS but 1 extra year
Surgical Oncology - 2 years
Colorectal - 1 year
Breast - These are beginning to pop up and are 1 year I think
Non Cardiac Thoracic - 1 or 2 years
Hepatobiliary - 6 months to 2 years


I may be missing some but these are the most common. As you can see, options are many. And of course, you can always stick with good ol' general surgery and do a lot of the stuff that fellowships teach (i.e. breast, non cardiac thoracic, vascular, colorectal, hepatobiliary, surg onc, etc). The advantage of the fellowship is marketing yourself and experience.

Really spend some time on the web and you can find a lot of the info you're looking for. I bought Iserson's when I was a med student and honestly didn't find it that helpful although many do.

 

[Dr JPH]

Thanks so much for the replies thus far. I honestly didnt realize there were so many post-residency training options for general surgeons.

I know of a few people who are trauma surgeons and one guy who specializes in colorectal stuff but none of them (to my knowledge) did fellowships in those areas.

Can you work in these areas without a fellowship or is the trend going towards more specialized surgeons rather than general surgeons learning by experience?

Thanks again

 

[avgjoe]

So which of those fellowships are relatively easy to get into (and vice versa)? Which usually require 1-2 years extra of research to get a spot?

 

[johnny_blaze]

These are after your five years of general surgery:

Cardiothoracic - 2-3 yrs fellowship
Plastics - 2 yr fellowship
Critical Care - 1 year
Critical Care/Trauma - 1 or 2 years
Vascular - 1 or 2 years (most are 2 years now)
Pediatric Surg - 2 year fellowship (most people also have 2 years of research making this a 9 year program)
Advanced Laparoscopic - 1 year
Transplant - 2 years (liver and kidney/panc)
Hand - a rare fellowship following GS but 1 extra year
Surgical Oncology - 2 years
Colorectal - 1 year
Breast - These are beginning to pop up and are 1 year I think
Non Cardiac Thoracic - 1 or 2 years
Hepatobiliary - 6 months to 2 years

General surgery rocks… look at all the options! I feel like a kid in a candy store

 

[Blade28]

General surgery rocks… look at all the options! I feel like a kid in a candy store

Amen to that.

 

[JAMMAN]

So which of those fellowships are relatively easy to get into (and vice versa)? Which usually require 1-2 years extra of research to get a spot?

With the exception of Plastics and Pediatric Surgery, they are not too difficult. Plastics is extremely popular and does not require 5 years of a general surgery residency. Pediatrics is difficult, mostly because there are so few spots. (Typically around 20/yr).

 

[Winged Scapula]

With the exception of Plastics and Pediatric Surgery, they are not too difficult. Plastics is extremely popular and does not require 5 years of a general surgery residency. Pediatrics is difficult, mostly because there are so few spots. (Typically around 20/yr).

While Plastics does not require the full 5 years of residency, the chances of matching (with an overall match rate these days hovering around 40%) with less than 5 years is almost nil.

 

[mddo2b]

I think another thing to take into account is where you will be practicing...I know many general surgeons who work in rural practices that do a little of everything, wheas in an academic institution, the trend is toward specialization.

 

[Celiac Plexus]

surg onc, and laparoscopy, are also fairly competitive residencies. they both have a relatively small number of positions per year. that may change for laparoscopy in the next few years since the number of fellowship positions is trending up.

another fellowship which is just starting to gain traction is "endocrine surgery". in the past, general surgeons have carved out a niche for themselves doing thyroids, parathyroids, adrenals... there are now only a handful of endocrine fellowships that will get you relatively big numbers of these procedures in only 1-2 years. i know of one program at miami, and one in chicago...the cleveland clinic has one as well i think....

 

[Dr JPH]

Is the role of general surgeons declining or are they still needed?

At a small community hospital here in Philly, the general surgeons do it all. Of course, the hospital doesnt get any really big cases...bowels, gall bladders, hernias, etc. is the norm.

Also, a colleague was talking about cardiothoracic surgery. He was telling me that the need for them is decreasing, mainly due to the interventional people doing most of the vascular and stent work.

He did say that he thought the demand would increase again in 8-10 years as not many people are going into CT nowadays. Thoughts?

Thanks

 

[Pir8DeacDoc]

Won't speak to the need for General surgeons as I honestly don't know.

However, the CT topic has been covered pretty well on this site. Just use the search function or look down the first page or two of threads. It should answer your questions pretty adequately. Best of luck!

 

[OrthoFixation]

Great thread. I have wondered about this pathway too. Thanks for the info and links

 

[fourthyear]

Anyone have a link to stats on how many g-surg resident grads are going onto fellowships vs. going straight into practice general surgery in the last few years? I know the fellowships are more and more popular, but by how much? Certian programs talk of their stats, but nationwide, does anyone know any numbers?

 

[mddo2b]

Is the role of general surgeons declining or are they still needed?

At a small community hospital here in Philly, the general surgeons do it all. Of course, the hospital doesnt get any really big cases...bowels, gall bladders, hernias, etc. is the norm.

Also, a colleague was talking about cardiothoracic surgery. He was telling me that the need for them is decreasing, mainly due to the interventional people doing most of the vascular and stent work.

He did say that he thought the demand would increase again in 8-10 years as not many people are going into CT nowadays. Thoughts?

Thanks

I have been told similiar things by my CT surgeons. Look, no one knows what willl happen 5, 10 years from know. I do know this, one of my attendings once told me that if you love what you do, you can always find a way to make a living. I really believe you should go into what you enjoy...call me a hopless romantic (believe me, you won't be the first)...but when med students ask me i have and will continue to give them this advice.

 

[Celiac Plexus]

Anyone have a link to stats on how many g-surg resident grads are going onto fellowships vs. going straight into practice general surgery in the last few years? I know the fellowships are more and more popular, but by how much? Certian programs talk of their stats, but nationwide, does anyone know any numbers?

i think it's around 70% pursue fellowship training... don't know where i heard this though....

 

[GMO2003]

vascular surgery sounds cool...yes indeed

 

[mddo2b]

FOr me its Trauma/Critical care....in my opinion nothing tops it.

 

[DO_Surgeon]

FOr me its Trauma/Critical care....in my opinion nothing tops it.

How competitive is trauma/critical care? What is the main difference between the 1 and 2 year programs? Is it just the BC you can get after completing the second year of Critical Care? Can you still get a job as a "Trauma Surgeon" without completing the second year??

 

[Winged Scapula]

How competitive is trauma/critical care? What is the main difference between the 1 and 2 year programs? Is it just the BC you can get after completing the second year of Critical Care? Can you still get a job as a "Trauma Surgeon" without completing the second year??

Not very competitive. The main difference between 1 and 2 year programs varies but in the longer programs you generally spend some research time and they are often more geared toward academic type of practice. You are eligible to sit for the boards with 1 year provided the program gives the required training in that time (ie, for example at Baltimore Shock Trauma only 3 months of the 12 are Trauma, the rest are CC). You can definitely get a job as a Trauma Surgeon without the 2nd year - heck, you can get one without the fellowship, albeit probably at smaller places without dedicated trauma programs.

 

[mddo2b]

How competitive is trauma/critical care? What is the main difference between the 1 and 2 year programs? Is it just the BC you can get after completing the second year of Critical Care? Can you still get a job as a "Trauma Surgeon" without completing the second year??

I agree with everthing that Kimberli Cox has to say...i would add that one of the biggest problems facing Trauma/CC fellowships is that at almost all fellowships the percentage of blunt trauma far exceeds penetrating. This combined with a trend toward less invasive management of trama pt's causes a deficiency in operative time during the fellowship. One solution to this is th addition of emergency surgery to the fellowship. From what I have heard at conferences, there will come a time when the majority of fellowships will be Trauma/Critical Care and Emergency surgery. This will increase operative experience during the felowship greatly.
Hope that helps...

 

[zealous]

So, this is just a simple question but, after you match prelim, then what? Exactly what do/can you apply for after that? What is the purpose of prelim year then? Why not just apply categorical? Thanks.

 

[mddo2b]

So, this is just a simple question but, after you match prelim, then what? Exactly what do/can you apply for after that? What is the purpose of prelim year then? Why not just apply categorical? Thanks.

2 types of people apply for prelim spots.....1st, those who want to do surgical specialities which require preliminary training such as ENT, ORTHO, Anesthesia Urology, Plastics. 2nd is for people who dont match in a categorical position for whatever reason, and want to spend the year in the field and bloster their chances at a catergorical spot the following year.

 

[THE instiGATOR]

I'm finding it very difficult to decide how many programs to apply to. I don't have a clue how competitive/non-competitive I am at each of these programs. Can someone please give me a rule of thumb or two about how many programs one interested in a general surgery program with good fellow placement should apply to? HELP?!? Is 35 too many for someone who is average in his/her class and has a Step I score in the low 220s. What is the yield on interview invitations? 25%? 50%? 75%?

 

[SteadyEddy]

This is a great question that I'm afraid you'll only be able to answer when you're just about to finish interviewing next year (if that makes sense). Here's what I mean...I think that our stats were similar so I applied to exactly 25 programs. I was invited to interview at 17. I ended up actually going to 10 and only ranked 8. I ended up matching at my number 1 choice. The difference maker(s) in my opinion:
1. LOR's-I got to read mine...and I was pleasantly surprised at times. I thought that the hard work I put in had gone unsee. I was wrong.

2. Med school reputation...Being careful not to come of smug, but our chair is the man in hepatobiliary surgery.

3. The interview...I was myself.

I'm finding it very difficult to decide how many programs to apply to. I don't have a clue how competitive/non-competitive I am at each of these programs. Can someone please give me a rule of thumb or two about how many programs one interested in a general surgery program with good fellow placement should apply to? HELP?!? Is 35 too many for someone who is average in his/her class and has a Step I score in the low 220s. What is the yield on interview invitations? 25%? 50%? 75%?

 

[klubguts]

This is a common problem. I put together a long list of possible programs early in 4th year and sat down with my surgery adviser who was very helpful in assessing my competitiveness at each place and suggesting how many i actually apply to based on my record. Your home PD or chairman may also be helpful in suggesting appropriate programs for you. The yield is variable but it is probably better to overapply and then narrow down after you get interview offers. It's wierd...i got some offers at top programs and rejected by others that are considered lesser programs (not by me, but people in the business)...so predicting this is not a perfect science. Best of luck.

 

[Winged Scapula]

As you probably have gathered from Eddy and klubguts, this is a difficult question to answer. Your Dept Chair should be able to give you an idea of how competitive you are and the usual advice applies: apply to more programs if you are less competitive, have geographical restrictions, or other reasons why your chances might be less.

25 is probably not unreasonable, but assess with your department and colleagues next year.

 

[Gator Fan]

Like everyone else has said, this is kind of difficult to say. It doesn't hurt to apply to a lot of programs. Once you get interview invitations back, you will be able to be selective about which ones to go on. IMO, better to apply to more programs and then be choosy about the interviews than to not get enough interview invitations and wish you had applied to more. I applied to 32 programs, got 25 interview invitations, went on 13 interviews and ranked all 13. Looking back, this was probably still a few too many interviews.

 

[DocWasabi]

I had the exact same dilemma with approx. the same Step I score. I wasn't really sure where I wanted to be geographically or what type of program (academic vs. community). The only thing I was 100% sure about, was that I wanted to leave Philly. Because I was so swamped during the beginning of 4th year (did 3 surgery sub-I's), I didn't have much time to do research on programs. I ended up applying to almost all of the university programs in major metropolitan areas...better to over-apply. I ended up applying to 70 programs, receiving invitations at 37, interviewing at 18, ranking 12, and ending up at my number one choice. I'm scared to go back and figure out how much that cost...but I've worked too long and hard to get to and through med school...I didn't want to risk not matching.

 

[SteadyEddy]

Might I also add that you are better to have ern than nern...that said, it is better to go to a middle of the road program and be doing surgery than to have the stress of not matching. We had some extremely impressive people go unmatched in surgery this year and I think a lot of it had to do with not applying to enough programs. Thanks for the backup Kim. Take care all!

SE

As you probably have gathered from Eddy and klubguts, this is a difficult question to answer. Your Dept Chair should be able to give you an idea of how competitive you are and the usual advice applies: apply to more programs if you are less competitive, have geographical restrictions, or other reasons why your chances might be less.

25 is probably not unreasonable, but assess with your department and colleagues next year.

 

[avgjoe]

Are there any folks out there who go to a top school, have good stats, were told by their advisors that htey don't need to apply to too many schools (<10) and then didn't match or had a hard time? How much can we really trust such advice?