working less hours in surgery

[sjones]

Can a surgeon in private practice decide to give himself a 40 hour work week? Surgery is very appealing to me, but I don't want to work 70hrs/week.
How would this work?

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[Winged Scapula]

If you have partners who are willing to take you on as "part-time" you may succeed in working less hours per week. A solo practice working such few hours would not be feasible.

 

[Leukocyte]

Some medical specialties are not just jobs, but a way of life.

 

[surg]

Yes. You will probably make less money, but you can still make a comfortable living. It may require being in solo practice so there isn't any trouble with your partners, and thus being in a smaller town. I do know of at least 2 surgeons that are both in solo practice working <40 hrs/wk and making a decent living.

 

[carrigallen]

Hi Dr. Cox,
I know nothing about this, but can you really keep up your surgical knowledge and technique, and keep abreast of current field advancements, if you are working less than 40 hours per week on a yearly basis?

Note that I'm referring to general surgery. It would seem to me that this would not be feasible in the long term.

 

[dry dre]

Can a surgeon in private practice decide to give himself a 40 hour work week? Surgery is very appealing to me, but I don't want to work 70hrs/week.
How would this work?

Surg: How do these surgeons work solo, take call, and work less than 40 hours per week? Tattoo removal?

If you work as a surgeon part-time (particularly solo) in an area that has a full-time group established, consider this: surgery is a referral-based specialty....PCPs generally want to call a surgeon/group that will take a case every time they are called. If you work part-time, they never know when you are working. If you were a family doc, who would you call, solo or group?

I agree with Dr. C., that you should find partners willing to take you on with the understanding that you will take less cases. I think is very doable. Most importantly, I would imagine for the average group, they would require that you share/take call with the group.

All this being said, not all full-time surgeons work 60+ hour weeks. Find a large group of like-minded folks to work with.

 

[Celiac Plexus]

man, if you're worried about working more than 40 hours a week, i think that you should consider another line of work.

40 hours/week is nothing. i mean, how can anyone want to be a surgeon and be concerned about working only 40 hours a week? This BOGGLES my mind. BOGGLES.... nice word. Seriously though, there is a real disconnect going on there....

consider that 60 hours a week is really not that much... 6am to 6pm M-F... most of my friends are not in medicine, and a lot of them work these kind of hours... and that's with every weekend off...

i mean damn... 40 hours???? how can you be seriously interested in surgery and already be worried about working only 40 hours per week... man...

 

[LuckyMD2b]

I don't understand why working a resonable amount of hours as a surgeon is "mind-boggling." I don't see any logical reason why gen. surgery and not living in the hospital are mutually exclusive. -- I am a 2nd year so PLEASE can anyone educate me.

I think that general surgery would be awesome, but I am continously bombarded from everyone about how many hours it is, talk about discouraging. Honestly, I've never had a job and after 4yrs of college and 1 year of med school, I can't imagine working that many hours consistently.

I'm definitely smart enough to do other stuff and it doesn't seem fair that other folks will be making tons of dough with relatively little work prescribing acne medicine or reading x-rays or some BS like that.

PS: I don't care about making a lot of money, only having a career that I enjoy and find challenging and fulfilling.

 

[Pilot Doc]

Can a surgeon in private practice decide to give himself a 40 hour work week? ... How would this work?

There are any number of ways you could do this. I and other posters have discussed them before. They generally involve 1) making less money (potentially MUCH less), 2) living somewhere with a a surgeon shortage - typically somewhere rural or 3) doing elective, outpatient cases with minimal complication risk (e.g hernias, breast)

So, yes, you can be a surgeon and work limited and/or somewhat predictable hours post residency.

Surgery is very appealing to me

Consider carefully what appeals to you about surgery. There are lots of wonderful things in the field, but you will be very hard pressed to enjoy them on 40 hours/week. Big cases = big complications. If your whipple (or even your right colon) bleeds or gets septic post op, it's your ball game @ 2am. If you're looking for a field with procedures and a super controllable lifestyle, consider derm, family practice, or some of the surgical subspecialties. You can build a good practice around elective, outpatient surgery (i.e. potentially no ER call and no trauma) in urology, ophtho and plastics.

 

[Pilot Doc]

I don't understand why working a resonable amount of hours as a surgeon is "mind-boggling." I don't see any logical reason why gen. surgery and not living in the hospital are mutually exclusive. -- I am a 2nd year so PLEASE can anyone educate me.

The question here is what constitutes reasonable hours and at what point are you living in the hospital. I think Celiac makes a good, if aggressivle stated point, that you cannot practice the full scope of general surgery on 40 hours a week. I also think that 50-60 is a very reasonable and acheivable work week. Consider working 4 days a week with 1 night of call/week and 1 weekend a month.

Monday-Thursday averaging 6:30 am to 5:30 pm = 44 hrs
One call night = 3 hours in hospital
One call weekend = 20 hours in hospital (avg 5 hrs/wk)
Total is 52 hours. That's a manageable practice. Many people work more; not many work less, but plenty work similar schedules.

I'm definitely smart enough to do other stuff and it doesn't seem fair that other folks will be making tons of dough with relatively little work prescribing acne medicine or reading x-rays or some BS like that.
.

Physician reimbursement is a byzantine system influenced by many factors, but fairness is not high among them. The system will likely change dramatically during our lives - all the more reason to choose a career you enjoy.

 

[powermd]

I don't understand why working a resonable amount of hours as a surgeon is "mind-boggling." I don't see any logical reason why gen. surgery and not living in the hospital are mutually exclusive. -- I am a 2nd year so PLEASE can anyone educate me.

If you're only a second-year, you should acknowledge that there's no way you will really know if surgery is right for you until you experience the lifestyle during your third-year clerkship. This is the point at which most people who "think surgery would be cool" drop out and pick something else. I liked surgery very much, and loved being in the OR- it's my favorite place to be in the hospital - and I loved the relationships you develop with surgical patients, but the hours were depressing as hell. I can't live well enough getting up at 4:30-5am every day, coming home at 7pm, having little time to myself (gotta go to sleep by 9:30-10pm), having very little time off on weekends, and a q3 call schedule (or worse). Even if life as an attending got better, I just couldn't handle doing this for five years as a resident. So I did some soul-searching, vigorously investigated other specialties, and fell in love with anesthesiology. It's not qute as cool or glamorous as surgery, but it's a good balance of work and life.

 

[surg]

One of them is a thoracic surgeon. He typically operates 3 days a week. Starts 1st case at 9a and doesn't book past 4p. The other 2 days he does clinic from 9a-2p. Obviously sometimes he has evening cases that run over or the occasional emergency. Most of his patients are left on their internist's service and all of his ICU patients are co-managed by the intensivist group for the hospital. Thus, he rarely has to deal with the scut beyond the wounds and chest tubes.

The other one is a general surgeon. His typical week involves 1 1/2 days of clinic, 1/2 day of endoscopy, and 2 1/2 days of OR from 8-5. Most of his cases are straight forward cases. Doesn't do liver or pancreas stuff. Does a ton of hernia/lap chole/hemorrhoid type work. Since probably about 40% of his cases are outpatient, doesn't have a lot of calls at night.

Remember not everyone wants to or should perform whipples. Surgery is great. I fully intend to work more than 40 hrs/wk in my practice, but then again, I can also understand why some people may want other practice styles.

 

[Pir8DeacDoc]

interesting read power. I am in the midst of my third year surgery clerkship and having some of the same thoughts you've mentioned. I am in love with the OR and enjoy the variety of patients and cases that a general surgeon sees, I'm just trying to decide for myself if I can handle the lifestyle. The hard part for me is the hours, but I'm so used to being in the classroom that I can't determine how much is normal shell shock of getting used to having a "job" and how much is the rough hours of surgery. I guess I'll know a little better once I've had a few more rotations. I don't have too much to add, just sort of thinking out loud here.

 

[avgjoe]

interesting read power. I am in the midst of my third year surgery clerkship and having some of the same thoughts you've mentioned. I am in love with the OR and enjoy the variety of patients and cases that a general surgeon sees, I'm just trying to decide for myself if I can handle the lifestyle. The hard part for me is the hours, but I'm so used to being in the classroom that I can't determine how much is normal shell shock of getting used to having a "job" and how much is the rough hours of surgery. I guess I'll know a little better once I've had a few more rotations. I don't have too much to add, just sort of thinking out loud here.

I agree - I thoroughly enjoyed the rotation, and actually didn't realize just how crazy the hours were until after when I started doing a very easy rotation. That's when it really hit me as to how focused on just surgery/sleep/surgery/sleep i had been. I still don't know what to think about it - whether it shows soemthing about me that at that time I was okay with the schedule (albeit getting really tired by the end of the 8 weeks), or whether it was only because it was one of my first rotations, I was really excited, adn knew it was going to be only 2 months vs. 5-7 years. Advice as to how we can figure that out??

 

[dr.evil]

I don't have a good answer for any of the med students on how to figure out if the hours are going to be too horrendous for you. I'm not going to lie and say that it's really not that bad because sometimes it is. Days & Nights are long, sleep is gold, stress can be high at times, expectations are always high. Residency is tough. 5 years is long and unlike many medical specialties, we don't usually have rotations where our hours are suddenly better so breaks are usually called vacations. When you're an attending it's definitely better, you have more control of your schedule (except when you're on call), but coming in to the hospital at 2 am will still happen. I guess that's better than staying at the hospital all night though.

That's it. There is without a doubt better lifestyle specialties. Make your priorities and stick with them. Lifestyle, money, joy of the field, patient population, work environment. What will make you happy when your 50?

 

[powermd]

One thing that really solidified my decision not to go into surgery was recognizing that the best times in my life have NOT been in the hospital. The times I think back upon and remember with joy tend to be vacations with friends, or loved ones. While some of the best moments in my life HAVE occured in the hospital, usually in the context of forming a special relationship with a patient, those moments are fleeting.

During surgery I felt a compulsion to do it- I wanted to work hard, and be worthy. The challenge of putting out my best work both physically and mentally kept me going day after day. My next rotation was family practice- it didn't take too many 9-5pm days before I remembered what it was like to have a life again. I love being a doctor, but there's so much more to life than work. I'm so happy I'm entering a field that allows for a balance. Most anesthesiologists I have met have significant personal and professional interests that they otherwise wouldn't be able to enjoy without a flexible career.

 

[Leukocyte]

This is what I learned so far:

If you want a "life-style" specialty, do not go into General Surgery or IM.

Go into General Surgery, only if you cannot see yourself doing anything else. You have to be really dedicated to surgery. I mean, what will make you wake up every day at 3:00-4:00 AM, put up with the crap of nasty/ungrateful patients, accept to take a q3 call, have the energy to stay the extra 1-6 hours post call, and still have time to read/study?

To me, it seems that after going through 5 YEARS of General Surgery residency, your body just gets used to the lifestyle, and you might actually find it very difficult to go back to your relatively "cush" medical school days.

 

[Pilot Doc]

If you want a "life-style" specialty, do not go into General Surgery.

Agreed

You have to be really dedicated to surgery. I mean, what will make you wake up every day at 3:00-4:00 AM, put up with the crap of nasty/ungrateful patients, accept to take a q3 call, have the energy to stay the extra 1-6 hours post call, and still have time to read/study?

Hmmm. I'm glad my general surgery residency isn't like that. Though I'm sure many GS residents live that way, many do not. I assure you most attendings don't get up at 3am every day.

 

[supercut]

Very few jobs in this world that are interesing and challanging allow limiting your work hours strictly to 40 hours per week.

Even outside of medicine, most professionals work more than 40 (50-60 is not unusual in areas like business, law or finance for example)

The 40 hour week people are usually the lower level clock punchers...jobs like cashiers, assembly lines, secretaries. Nothing wrong with those jobs, but I'd venture that most folks don't consider them particularly challanging, interesting or intellecutally rewarding. It's just away to make a living.

That said, I'd agree with others... you should only do surgery if you can't see yourself doing anything else. I chose it because I knew that if I didn't, I would always feel like I settled for less than what I really wanted.

 

[avgjoe]

That said, I'd agree with others... you should only do surgery if you can't see yourself doing anything else. I chose it because I knew that if I didn't, I would always feel like I settled for less than what I really wanted.[/QUOTE]

So about the 'can't see yourself doing anything else" bit ... I've enjoyed pretty much every rotation (even FP which I didn't think I owuld like), although I don't think I'd want to do that for the rest of my life. However, for those 8 weeks I definitely wasn't complaining everyday. Did you all who really couldn't see yourself doing anything else dislike every rotation but surgery? Or is it just that you can't really imagine doing that for much more than 2 mos-year.

 

[supercut]

I'd have to say, yeah, I pretty much didn't like most of the other rotations. Can't say I hated them, and I wasn't miserable every single minute. THere were good things about every rotation, even psych (I did half of that in the psych ED where people were acutely decompensated, and often had some very bizzare stories...good for a laugh). But I the things about each rotation I disliked stood out dramamtically. The long rounds and endless debate of IM. Peds...admitting RSV after RSV after RSV night after night. Psych...you can't fix anything, and the continuous cycle of people going off their meds, getting comitted, being released, going off their meds...ugh. FP...day after day of clinic tweaking HTN meds by few mg. OB...don't like (OK, hate) doing pelvics and the operative experience is too limited.

I considered EM but realized I don't have the patience to deal with the stupidity that permeates the ER (I think there is more stupidity per square foot in the ER than any other area of the hospital). Anesthesia I considered briefly, but I knew it would drive me nuts being in the oR and not being the surgeon.

I liked surgery SO MUCH MORE than the other rotations. I just knew that if i picked something else, I'd wind up wishing I had done surgery. Surgery was the only rotation where I was reading becasue I WANTED to read about it. The rest I read because I had to.

I did go to a school which was VERY student friendly clinically, especially the surgery department. Students were encouraged to drop by the trauma center early, even as M1, and were allowed to get involved in many things. THey could learn to suture, or scrub cases. THe orthopods would always grab a student for help with splinting or traction pins. So I had acutally scrubbed my first case as M1 and by the time I did my 3rd year rotations, I was well known to most of the surgery residents. Somtimes when I was on other rotations, I would stop by the trauma center on my way out and basically it felt like it was where I belonged.

I didn't really consider the surgical subs because I like operating on the ABDOMEN the best. Even the neck cases in gen surg don't appeal to me the way going into the abdomen does.

That's not to say there are not some days when I wonder. On those days mostly, I wonder if I'll really be able to make it through residency, and I think that maybe I'll have to switch to something else due to physical limitiations. These days usually occur when I"m scrubbed but still not doing anything or holding retractors (still happens rather frequrently to jr residents) and my back pain has escalated expoentally. But then when I'm allowed to step up and put a few stitches in the bowel, or close the fascia, and then I forget about the pain. And usually, I'm not scrubbed on cases like that, I'm usually involved in ones that are more approprate for my PGY level.

As for social life, I don't have a typical one. Not so much because of the surgery schedule, but because since I was a little kid I've never been very popular. I'm not sure why that is. I've just never been the sort of person that gets included in activities. I'm also quite a bit older, and don't blame the young kids who are my fellow residents for not wanting to hang out with someone older. My fellow residents do hang out. The singles go to bars, the marrieds get togther for dinner. But I'm not really the type that enjoys going to bars and getting drunk anyway. I do travel on my vacations (been to Europe twice already), and am focusing on learning some sports and becoming more active, so it's not like I'm sitting at home miesrable. So in my free time, I'll go to the gym, rent a movie or go take a ski lesson, for example. I'm also currently reading Tom Clancy's latest.

So for me surgery clearly stood out. It just seemed to fit with how I think.