Why GS gets such a bad rap

[blu]

I was previously very interested in the more "lifestyle" surgical fields, but have become enamored with general surgery lately. However, I worked my tail off through med school to be competitive for those fields, and am finding it hard to turn to a "lesser" field -- I put that in quotes because that's what the general perception is and that's why I'm posting here. Every time I told someone I'm interested in surgery, the reaction is "ew, why?! what kind?" Then when I responded "urology, plastics, or ortho" (back when I thought plastics was a lifestyle field), people always said "oh, ortho, that's a good one."

After my surgery rotation, however, it seemed like the general surgeons were still the bad-ass gunslingers in the hospital. Sure the ortho and uro guys were living nice cush lives and always relaxed, but when the feces hit the fan, you send in the marines (or the samurai?).

I'm sure this forum's a little biased toward GS as it is ... but I'm curious what your most honest perspective on this is. Why does GS get such a bad rap? The general surgeons seem to be the best trained -- they have to deal with both medical and surgical issues, and typically issues that could cause significant bodily harm or death. They seem to spend the most time with patients, of all the surgeons (and some of the IM guys). They seem to do the biggest variety of procedures (at least as residents, when you do a little of everything -- pedi, vascular, plastics, etc).

Lastly, it seems that ortho doesn't have the best lifestyle either. Unless you're doing just joints, in which case it's a easy life with great money, you're probably doing a good deal of trauma.

What do you forsee in the future of GS? Will GS get fewer and fewer interesting cases, as they get edged out by specialists? What are the procedures that we will likely hold onto?

Thanks,
b

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[Smurfette]

I think a lot of the bad rep is the lifestyle (long hours, unpredictability) and personality (the old school surgeon attitude giving grief to his subordinates/the need to have "thick skin" to be in the field). If you take out those two factors, I think that takes out the "ew" factors most people probably think of first.

GS is getting very subspecialized, but this is evolving with the increasingly complicated surgeries...but non-urban areas will always need the true general surgeon since smaller hospitals can't support having a vascular surgeon, CT surgeon, etc. all on staff. GS IMO will hang onto appys, choles, colectomies/bowel cases/colostomies, biopsies/excisions, breast cases, LNDs, possibly thyroid/parathyroid, etc....the common stuff.

 

[Dire Straits]

i've noticed a lot of the bad rap stems from one source: people who don't really belong in the specialty in the first place. there are several types of these. for example the people who want to be general surgeons but at the same time want to have a "normal" social and family life during residency and beyond. they somehow convince themselves that they'll make it happen and when their family life suffers during residency and beyond they become the classic embittered surgeons that give the specialty a bad rap. or the ones that go into it so they can be a "bad ass" or whatever and then find out nobody really cares that you're a general surgeon. in fact some people will wonder why you chose to be just a general surgeon and not some other "badder ass" like a neurosurgeon. again this can lead to one becoming a walking cliche of the abrasive surgeon. and then of course there are ones who wanted to use gensurg as a stepping stone to a more lucrative/prestigious fellowship (i.e. plastics) and for one reason or another couldn't get the fellowship so they have to do general surgery, which will lead to resentment. there are other examples but the theme is that of people who didn't really belong in the specialty in the first place. i've been advised over and over that one should go into gensurg only if they like to work hard, don't mind compromising their family and social life for the duration of their ENTIRE career, and (very importantly) actually enjoy to do the type of procedures in gensurg.

 

[blu]

in fact some people will wonder why you chose to be just a general surgeon and not some other "badder ass" like a neurosurgeon ... don't mind compromising their family and social life for the duration of their ENTIRE career

You make some good points ... on the badass point, it is quite interesting that before being in the hospital, orthopedics and other competitive subspecialties seemed so badass. That's probably the layman's view of things. After being in the hospital and seeing the reality of things, you get an insider appreciation of GS. Like I said, they're like the grunts, the marines.

As far as the family comment though, I wonder what general surgeons say. It's interesting that every surgeon will tell you family comes first, yet you obviously have to make compromises. I'm not sure if that's because they're delusional and are compensating for their guilt, or because it is indeed possible to maintain a strong family life with a GS career. If it's not possible, I sure do wonder what all you general surgeons are doing ... because I'm sure all of you would say that life is first and foremost about family.

The thing I'm most concerned about is the part of the bad rap that comes from GS getting edged out of procedures. I realize in the boonies you can do whatever you want, but I for one am a city person.

 

[cchoukal]

With regard to the "family first" claim, I have to share a funny story. As a med student on a surgery rotation, I had to attend grand rounds, and this particular week, the topic was the "chief's talk," which was an opportunity for an outgoing chief resident to talk about whatever he wanted for an hour. This particular guy was graduating the residency to take a CT fellowship at the same institution. He went on and on about how important his wife and children were, but the only time he cried during the talk (and the closing "thank you" to the talk) was when he was talking about how great his boss was (no tears when thanking his wife, who was in attendance). Earlier in the talk, he outlined his academic path, which included college, dragging his wife across the continent for a PhD, then again for med school, then again for residency, and now he's taking on a CT fellowship. The idea that he really valued his family seemed kind of absurd in light of all these moves cross-country and the additional arduous training he chose at every turn. Of course, I'm a believer that a person has to do what they have to do to reach their potential and be happy, but, come on; don't give me this crap about how important your family is. I was very amused.

 

[LovelyRita]

One thing I try to remember goes along the lines of what Dire Straits was saying. The people who say "ewww" are usually residents, who observe their colleague-GS residents working their tails off during residency. I have yet to meet an attending who said "eww". Most are intrigued by my interest, and have even stated that it's tough, especially for women, but once they see my interest and enthusiasm around the patients and the OR, they have turned pretty supportive.

I think that half the time you have to build your thick skin to protect yourself from your OWN doubts, that are cast by those around you who have absolutely NO idea what it's like to be you.

 

[quicksilver2000]

I'm currently a gsurg resident at a busy urban based university medical center and I've now worked with around 20-30 different surgeons. A good family life is different for each individual. Going to work at 9am and coming home at 5pm with weekends off will definetly lend you plenty of time to spend with your wife and kids. However, coming home at 6pm and having two-three weekends completely off in a month is just as good in my opinion. Once you are an attending surgeon most cases start between 7-8am. EVERY SINGLE surgeon I've worked with is home by 6pm on MOST (95%) of days. Even if they're on call, they're still home. They just get called on the phone. When you're an attending at a center with residents, you almost never have to come in in the middle of the night when you're on general surgery call. We have a 5 hospital system with two being heavy on Trauma with an in house trauma attending taking all traumas and emergency surgeries such as hot appy's, perfs, etc. That leaves the other three hospital urgent cares barely having any emergencies coming in and the general surgery attending on call just gets called for admissions. In one year, I have seen a general surgery attending on call come in only once. The only time was when his own bariatric patient had suspected perf/anastamotic leak. The call schedule for the g-surg attendings is 1 in 6. That ladies and gentleman, is not bad at all considering 9 out of ten calls you'll just have to pick up the phone say three words "admit the patient" and go back to sleep.

Ahhh, consults you say! Well, as my fellow g-surg residents know, most consults are bs and non-surgical. The beauty of having residents is that all these consults are screened. You immediately will know this can wait till tommorow during the day for me to deal with someone who's constipated. Sure, once or twice a month when you're on call over the weekend, someone will have a complete bowel obstuction and will need to get operated on, but you come, operate (2-3hours) and go home and play with the kids.

My program director, who is probably the busiest surgeon, with all the admistrative bs he has to deal with coaches his daughter's basketball team. Another attending I have a particularly good relationship with, is so into his kids soccer and baseball team, that's all he talks about in the OR. This guy is super laid back. Does a whipple starting at 8AM, out at 1PM, does a couple mediport for the oncologists, gives a med student lecture and is home by 4PM. And that's a busy day for him. If you go up to our surgery department office at 5pm, you won't find 95% of the attendings. The only attendings you may find is our transplant surgeons or the trauma guy on call.

The guys who stick to hernias and gallbladders have it even easier, they for sure are home by 5pm.

So, yes there is some unpredictability, but come on! If you're significant other can't handle you changing plans on her/him one or two times a month, you're married to someone who I probably couldn't get along with even if I worked 40 hours a week. Hell, my fiance changes plans on me every week. Sorry, can't go out on you're off weekend, I have to go home for my sister's birthday. It doesn't bother me, and it doesn't bother her if I have to cover for a sick resident on my day off.

Just my two cents

 

[Leukocyte]

I do not know what do you mean when you say that a GS is "the bad ass" surgeon? Each surgeon is "the bad ass" of his/her field. There is no such thing as the "jack of all trades - the master of all".

-A GS is the "bad ass" of the abdomen.
-An Orthopod is the "bad ass" of the MS system.
-A Urologist is the bad ass of Urinary system.
-A NS is the "bad ass" of the CNS
-An ENT is the "bad ass" of the head/neck
-An Ophthalmologist is the "bad ass" of the Eye/orbit
-Plastics is the "bad ass" of soft tissue reconstruction.

 

[MDgonnabe]

-A GS is the "bad ass" of the abdomen.
-An Orthopod is the "bad ass" of the MS system.
-A Urologist is the bad ass of Urinary system.
-A NS is the "bad ass" of the CNS
-An ENT is the "bad ass" of the head/neck
-An Ophthalmologist is the "bad ass" of the Eye/orbit
-Plastics is the "bad ass" of soft tissue reconstruction.

... colorectal surgeons are the "bad ass" of the ass.

 

[sacrament]

And ob/gyns are just bad.

 

[Leukocyte]

And ob/gyns are just bad.

Ob/Gyns are surgeons according to the American College of Surgeons, and are eligable to be FACS!

 

[Celiac Plexus]

I do not know what do you mean when you say that a GS is "the bad ass" surgeon? Each surgeon is "the bad ass" of his/her field. There is no such thing as the "jack of all trades - the master of all".

-A GS is the "bad ass" of the abdomen.
-An Orthopod is the "bad ass" of the MS system.
-A Urologist is the bad ass of Urinary system.
-A NS is the "bad ass" of the CNS
-An ENT is the "bad ass" of the head/neck
-An Ophthalmologist is the "bad ass" of the Eye/orbit
-Plastics is the "bad ass" of soft tissue reconstruction.

ah... there are many, many general surgeons in practice who would bridle at being considered solely "bad ass"es of the abdomen... chest, breast, grafting/reconstruction, thyroid, vascular.... there are plenty of general surgeons who are masters of these domains and have not completed fellowships...

 

[doc05]

ah... there are many, many general surgeons in practice who would bridle at being considered solely "bad ass"es of the abdomen... chest, breast, grafting/reconstruction, thyroid, vascular.... there are plenty of general surgeons who are masters of these domains and have not completed fellowships...

Not to mention the surgical crit care guys who can manage complex medical problems better than any internist.

 

[blu]

I do not know what do you mean when you say that a GS is "the bad ass" surgeon?

Well anyone can be the bad ass of anything, true. My point isn't to put down other fields, but to say that's more the essence of general surgery than other fields. It's not a criticism, it's like saying fighter pilots are bad asses, whereas a really good accountant may not be a "bad ass," but is extremely skilled in an extremely important field.

I'm basically commenting on the fact that a big part of general surgery is being there when the feces hits the fan -- even more so are the trauma surgeons. That's what you train for ... you can stop the bleeding and stop the dying better than, say, a plastic surgeon. But after it's all done and over with, damn right you call the plastic surgeon to make the patient look purty again.

So it's like this ... general surgeons get trained to deal with the body as a whole, even if they're not operating on everything all the time. You kinda need to know medicine and cardiac medicine and critical care pretty well just to be able to take care of your patients, not to mention operate.

So anyway, that's what I'm saying about bad ass. Yes, if you want to pee stright, you call uro. If you want to look sharp, you call plastics. If bone break, ortho fix. But when you get hit by a train, you'll likely see the general surgeons first (I know that's trauma surgery, but most programs' trauma teams are covered by GS residents, and the trauma surgeons generally come from GS backgrounds).

... colorectal surgeons are the "bad ass" of the ass.

Too funny. So true.

 

[Dire Straits]

yes general surgery handles the feces when it hits the fan. figuratively, and more so literally.

 

[Leukocyte]

Every speciality is Important. There is no one better than the other. It might not appear this way to you, when you are not the patient with the problem, but:

-Ask a pt with an acute cholecystitis, who is your hero?

-Ask a patient with a c-spine fracture, who is your hero?

-Ask a patient with a needle penitrating their eye-ball, who is your hero?

-Ask a pregnant woman with a complicated pregrancy, who is your hero?

-Ask a patient who was just on the verge of suicide, who is your hero?

It is very naive to think that one speciality is better than the other. Each play their own role in saving lives.

 

[blu]

Every speciality is Important. There is no one better than the other. It might not appear this way to you, when you are not the patient with the problem, but:

Um, Leuk, that was my point. I was just pointing out that "bad ass" does not equal "better." Bad ass is a descriptor. When you're depressed, I would think you wouldn't be looking for a "bad ass" to treat your depression. Similarly, when you need a face lift, I don't think you'd necessarily be looking for a "bad ass."

I equated it to the non-medical world, where you may not necessarily be seeking a "bad ass" accountant, but you probably want some "bad asses" in the military. Then again, you probably want some calm accountant types in charge too so they don't gung-ho us into situations.

But anyway ... I digress.

 

[Dire Straits]

"how can God have a God complex?"

rumor has it this quote is from court transcripts of a surgeon being cross-examined during a trial. if it's really true then it's a sweet one-liner if he actually thought of it on the spot. i think that's what you people mean by "bad ass".

 

[Winged Scapula]

Isn't that a quote from the movie, "Malice?"

 

[Dire Straits]

no kim this is the quote from that movie:

The question is "do I have a God complex". Which makes me wonder if this lawyer has any idea as to the kind of grades one has to recieve in college to be accepted at a top medical school. If you have the vaguest clue as to how talented someone has to be to lead a surgical team. I have an MD from Harvard. I am board certified in cardiothoracic and trauma surgery. I have been awarded citations from seven different medical boards in New England and I am never, ever sick at sea. So I ask you, when someone goes into that chapel, and they fall on their knees and they pray to God that their wife doesn't miscarry, or that their daughter doesn't bleed to death or that their mother doesn't suffer acute neural trauma from post operative shock, who do you think they're praying to? Now, go ahead and read your Bible, Dennis, and you go to your church, and with any luck you might win the Annual Raffle, but if you're looking for "God", he was in operating room #2 on November 7th, and he doesn't like to be second-guessed. You ask me if I have a "god-complex"? Let me tell you something: I am God.

 

[Winged Scapula]

yeah, I remember that quote, I just thought the other was ALSO from the movie. Perhaps not...or perhaps I just prefer to think of that quote as fictional rather than something someone would really say.

 

[Celiac Plexus]

what's the differnece between god and a surgeon?

god doesn't think he's a surgeon.

 

[Justin4563]

the problem with general surgery is that more and more of your diseases are being treated medically, ie ulcers, crohns, thyroid, etc, the subspecialists are taking away cases from genreal surgery, you dont have a gimmick(gI has scopes, cardiology has angiograms, ortho has knee scopes ) so its hard to have a steady stream of business, and there are too many surgeons.. way too many.. Nobody goes to see a surgeon.. you have to be referred... so you have to grease palms.. and its a dirty specialty.... operate at odd hours.. this may seem exciting but trust me when you are trying to live a life..... it gets old.... Not a productive way to spend 5 years.. now radiology is good, pathology, these lend itself to a lifestyle plus lots of money..

 

[tony v]

you dont have a gimmick

I beg to differ. GS has been steadily coming up with better techniques, minimally invasive techniques, robotic surgery, etc. And ultimately, there will always be stuff that needs to be cut out, one way or another. There are also classically medical diseases that are now treated surgically, with improvements in surgical technique.

now radiology is good, pathology, these lend itself to a lifestyle plus lots of money..

You know how, sometimes, they schedule those durned late afternoon conferences/lectures? And the speaker turns out the lights and starts droning on about something absolutely mind-numbing, accompanied by bland monochrome slides? Yeah ... that ...

 

[droliver]

now radiology is good, pathology, these lend itself to a lifestyle plus lots of money..

I wouldn't count on the money being there for much longer with radiology. Imaging studies are squarely in the cross-hairs (its one of the fastest growing costs along with pharmaceuticals & implantable devices) for cost-containment by the 3rd party payers & the feds. The increase in physician efficiency in reading studies has likely peaked, which has maintained the impressive salaries to this point. You don't have to imagine much to see the writing on the wall for what could be pretty dramatic pay cuts for radiology in the future.

 

[MDgonnabe]

so is this gsurgeon a "bad ass" of everything?

 

[Leukocyte]

No. He is a member an extinct breed of "Old Fashioned" / "Country-side" primary care General Surgery. We are in the 21st Century now, and we do have "flying transportation things" called H-e-l-i-c-h-o-p-t-e-r-s, AND MALPRACTICE LAWYERS. You do need to transfer complicated cases to major centers so that they can be treated by experts (Vascular, CT, Urology, Orthopaedics, Neuro.....).

 

[MDgonnabe]

i think i finally have this "bad ass" thing figured out: