General Surgery is a rigorous medical specialty that can overwhelm the unprepared. Because it is the ultimate option in curative therapy, surgical residents find their specialty to be among the most physical and psychologically demanding. Yet it is also one of the most gratifying and fulfilling paths a physician can take on the road to healing others.
The route toward becoming a surgeon is lengthy and filled with a plethora of choices, from the initial decision to go into general surgery to choosing a residency program to opting for a subspecialty fellowship to establishing a career as a practicing surgeon. Each decision has far-reaching, life-changing implications.
SELECTING THE SPECIALTY
The general surgery specialty, though exacting, is very popular with medical students seeking the best of all possible worlds. Its fast-paced and high-energy environment draws physicians passionate about the healing arts. Surgeons experience the gratification of seeing their efforts come to fruition much faster than those in other specialties. Many practicing surgeons were drawn to the specialty because it allows them to use not just their minds, but also their hands in creating an immediate curative effect.
Another appealing aspect of the surgical field is the opportunity to work with advanced medical technology. This begins with training in virtual reality surgical simulations and can extend into the burgeoning field of robotic surgery. Surgeons rely on such technologies as CT scans, ultrasounds, and MRIs in preparation for actual surgery. Additionally, new techniques and equipment enter the field all the time.
The educational path of general surgery is also unique in that much of the learning takes place without classrooms or textbooks. Working closely with experienced surgeons, you will learn many “tricks of the trade” in the operating room.
DEMANDS & REWARDS
As a general surgery resident, you will have to exhibit fierce dedication. During the five-year required surgical residency, work weeks in excess of ninety hours are commonplace, as are extended overnight shifts. However, a movement is afoot in light of the medical information explosion in recent years, and there is a trend toward outpatient care for all but the most serious cases.
The work day is lengthy and the physical demands are intense: You arrive early in the morning to go on rounds; then it's on to the OR (though not likely in the first year), where the emphasis is on surgical consulting and postoperative care. Despite the high demands, many surgeons look back upon these years as some of the most rewarding experiences of their lives.
After completing your general surgery residency and passing the American Board of Surgeons’ certification, lifestyle options are varied. The more flexible you are, the more options there are to choose from.
You may choose to continue to grow through subspecialty training. A fellowship in cardiothoracic surgery will run for two to three years in length. Fellows will practice such procedures as bronchoscopy, mediastinoscopy and pulmonary resections while treating conditions including congenital defects, blocked coronary arteries and cancer.
Surgical oncology fellowships last for one to two years. These fellows will perform a number of complex procedures, removing tumors and treating related complications. A surgical oncologist may also be heavily involved in cancer research.
Transplantation surgery is a two-year fellowship that provides training in the meticulous management of a patient's end-stage organ failure in addition to the actual practice of transplantation.
The trauma surgeon fellowship is one or two years in length, and provides a variety of unusual and challenging conditions--from accident casualties to crime victims and more.
Fellowships are also available in Colorectal, Pediatric and Vascular areas.
If you do not choose to pursue fellowship training, you will be presented with a variety of surgical career options. Joining a group practice can afford you a reliable schedule and regular referral patterns to ensure an abundance of patients. Solo practice provides a greater extent of control, but it also comes with the responsibilities that administrators would handle in institutional settings and in large medical groups. While in private practice, some doctors also serve as clinical attendings, making use of resident coverage.
Nearly fifteen percent of surgeons choose to seek employment in academia. Research and teaching, in addition to some clinical duties, maximize the general surgeon’s expertise. The operating room becomes not just a place of healing, but of education. You are still in direct control of a patient’s care, but have the option to delegate some aspects to residents, both for educational purposes and convenience.
As an academic surgeon, it is more likely that you will develop a particular area of expertise. Traveling to lecture at a number of institutions and conferences is also to be expected.
A very small percentage of surgeons leave clinical practice to apply their skills in industry, particularly in technological design of next generation surgical equipment and instruments.
Academic and industrial career options become more attractive as manual dexterity decreases with age, making complex procedures more difficult to execute. They also provide a means of continuing to use hard-earned experience while getting away from a high stress environment. Other surgeons see the transition away from a clinical setting as a way to spend more time with family.
OUTSIDE THE O.R.
While many medical students may select a surgical subspecialty, such as ophthalmology or urology, the general surgeon is the backbone of any hospital. As such, general surgery is the ideal specialty of the team player. Contrary to the stereotypes seen on television or through the narrow view of outsiders, the general surgeon is not a cold perfectionist who prefers the operating room to the patient's bedside.
A surgeon's work begins well before scrubbing in. Surgeons are often first called upon to provide consults for colleagues or to provide assistance by placing chest tubes or inserting a central line. Communications with physicians from all disciplines within an institution is essential for the well-being of the patient and the institution.
Additionally, a surgeon will provide counsel to a patient considering undergoing a surgical procedure. A surgeon must be versed in the hard facts of a patient's medical history, and be familiar with the patient on a more personal level. Many patients fear even the simplest surgical procedures, such as an appendectomy, and that fear must be handled delicately and with compassion by the physician being trusted to cut into a patient's body. Other procedures, such as hysterectomies and mastectomies, have a more profound impact and a surgeon must be prepared to address concerns that lie far outside the walls of the operating theater.
CAREER CONSIDERATIONS
According to the American Medical Group Association, compensation for the general surgery specialty tends to fall in the mid-$200,000 range. Subspecialties can impact this number significantly, with the median compensation for a cardiothoracic surgeon exceeding $400,000, while specializing in kidney transplants will bring the number under $220,000. Over half of those specializing in general surgery have reported to the American Medical Association that they have found their salary to meet or exceed their expectations. One to two year fellowships in subspecialties such as pediatric surgery, colon and rectal surgery and trauma/critical care can have a profound impact on both salary and lifestyle options.
Many surgeons find their work extremely rewarding and enjoyable. In some cases, retirement is postponed in order to continue doing the work they love. Beyond the realm of actual surgery is the opportunity to impart the knowledge that can only be obtained through actual practice to a new generation of medical students.
CLOSING STITCH
A general surgeon often takes the lead in setting a standard of care within a community. With a broad range of knowledge, he or she is also likely the most qualified individual to impart advice or act in the case of more advanced medical interventions.
With continuing advances in the general surgery field, the career is not a static one. In a sense, a general surgeon's training never ends. Many medical students find this irresistible in selecting the specialty. The promise of staying on the leading edge of medical care is enticing and rewarding.
Nothing, however, makes the years of hard work and dedication in the general surgery specialty more worthwhile than the indescribable sense of accomplishment derived from directly and immediately affecting the life of a patient. What better feeling can you have at the end of the day than knowing you’ve left a body in better condition than you found it?
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