Category Archive: General Surgery

Which Residents Work the Hardest?

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Choosing a Specialty, Dermatology, General Surgery, Neurology, Neurosurgery

February 12, 2013

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No one will ever agree on which residency is the hardest, or which residents work the most. However, with some new data from the FREIDA website, we get a better idea than ever before.  (For more information about the FREIDA website, read my previous article) FREIDA reports diverse variables about each specialty including the average of numbers worked per week, the average number of days off per week, and the average vacation time of each specialty.  I have compiled these into one database so that for THE FIRST TIME EVER you can compare objectively which residencies work the hardest.  (Well, at least you can compare which work the longest).

The first figure demonstrates the average number of hours worked by each specialty. As expected, the surgical sub-specialties work the longest hours with neurosurgery leading the pack and general surgery following closely in second.  Of the medical specialties, suprisingly, neurology works the most hours, with pediatrics and internal medicine following close behind. And at the bottom of the list… you guessed it, Dermatology. I wish I loved skin!

Which Residents Work the Hardest?

The results of the average number of days off per week and the average vacation time during residency follows closely with the trend seen in the graph above. For your viewing pleasure I have the entire compiled dataset posted below.  

 

 

 

Hours worked per week

Days off per week

Vacation weeks per year

Dermatology

45.0

1.9

3.3

Nuclear Medicine

47.4

1.8

3.5

Medical Genetics

48.2

1.7

3.4

Radiation Oncology

50.0

1.9

3.4

Pathology

51.4

1.8

3.3

Ophthalmology

51.8

1.6

3.3

Radiology

51.8

1.7

3.5

PM&R

54.2

1.6

3.4

Psychiatry

55.7

1.5

3.3

Emergency Medicine

56.6

1.6

3.3

Transitional Year

60.5

1.3

3.1

Colon and Rectal Surgery

61.3

1.4

3.3

Anesthesiology

61.5

1.6

3.4

Family Medicine

62.8

1.3

3.1

Internal Medicine

63.7

1.2

3.4

Pediatrics

64.2

1.3

3.4

Neurology

64.6

1.3

3.4

Urology

66.0

1.3

3.4

Otolaryngology

67.7

1.2

3.1

Orthopaedic Surgery

69.6

1.3

3.1

Obstetrics and Gynecology

70.8

1.3

3.2

Plastic Surgery

71.2

1.2

3.0

Vascular Surgery

72.0

1.2

3.1

Thoracic Surgery

73.0

1.1

3.2

General Sugery

75.1

1.1

3.1

Neurological Surgery

75.6

1.2

3.1

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Spotlight Interview: Matching in General Surgery

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Choosing a Specialty, General Surgery, General Surgery Rotation, How to match in....?, The Match

May 31, 2012

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General Surgery1 Spotlight Interview: Matching in General Surgery

 

A General Surgery Resident’s Perspective:  From an interview with a general surgery resident at Orlando Health in Orlando, FL

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the general surgery match?

Moderately difficult. The average USMLE Step 1 score is usually in the high 220s, but higher for the sought after programs.

 

  •  What must a student do to match well in general surgery?

Your USMLE Step 1 score is the most important factor. Letters of Recommendation are very impotant and some should come from surgeons you have worked closely with. If you are interested in a research institution then research publications and presentations are very important.

 

  • What are residencies looking for in a general surgery applicant?
They are looking for someone who is Intelligent; they use Step 1 scores to establish this. They are also looking for someone who is passionate and hard-working; they can learn this through the activities you list and from the things mentioned in your letters of recommendation. It is important to be easy to work with, you can show this to programs during your interview.

 

  • What should students look for in a general surgery residency?

From a training standpoint, I think that surgical simulation experiences and structured education lectures/curriculum are something that every applicant has to be aware of. These experience are paramount in your surgical training. As you probably know, operative experience volume and variety is one of the most important factors (i.e. how many mastectomy vs whipple cases). You should know these statistics about each of your programs of interest.

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Letters of recommendation should be from faculty that can speak to your strengths in clinical decision-making and surgical skills. Personal statements should not be about how you always wanted to be a surgeon, but why you decided to be a surgeon. Rank programs that provide you with a high operative experience and well-defined simulation/education curriculum

 

  • What do you wish you knew before application/interview season?  

Be sure to prepare your  letters of recommendation early. Plan to interview at about 10-15 programs. If you plan to interview at highly competitive programs, you might need to plan on a bit more interviews.

Editor’s Note: I 100% agree with preparing your LOR early.  Many of the attendings are extremely busy and 1 month notice may not be enough. Start asking at the end of your third year if you find individuals who could write great letters.

 

  • What other advice do you have for students applying to general surgery residency?

The best advice I ever received about deciding to do general surgery was “If you can’t do anything but general surgery and be happy as a physician then you should do surgery. Otherwise do the other specialty”. General surgery is a much more family-friendly specialty than it used to be. The egos and personalities that used to predominate the specialty are gone, surgeons are expected to be calm and mild-mannered today and exist well with their non-surgical counterparts. The best part of being a surgeon is being able to diagnose and treat the problems our patients face. When all other options fail and other specialties are uncertain what to do they will consult a surgeon to help, so you will be the go-to person where-ever you practice

 

Editor’s Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match Spotlight Interview: Matching in General Surgery and The Successful Match: 200 Rules to Succeed in the Residency Match Spotlight Interview: Matching in General Surgery.







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Spotlight Interviews: Why did you choose general surgery?

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Choosing a Specialty, General Surgery, General Surgery Rotation, Why did you choose....?

May 31, 2012

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A General Surgery Resident’s Perspective: From an interview with a general surgery resident at Orlando Health, in Orlando, Florida.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to General Surgery?

I appreciate the combined operative and medical management of patients. Surgeons make definitive management of patient issues. There is a great variety of operative procedures. As a general surgeon I am able to care for both long and short term patient management scenarios. There is a great deal of job opportunities and availability. I enjoy team-based patient management.

 

  • Describe a General Surgeon’s typical work day?

I usually wake up at 0400,I am at hospital by 0500 to round on patients until about 0700. I will be in the OR from 0700 until about 1600 with intermittent 30-60 minutes breaks between cases to eat, follow-up on patients, and see new consults. From 1600-1800 we follow-up on outstanding patient issues and setup for following day. On good days, I return home and from 1800-2000 I study for following day cases and current patient problems. On non-operative days, simply change the OR times  to clinic from 0800-1600.

 

  • What type of lifestyle can a General Surgeon expect?  

As a general surgeon I work weekends at least 2-3 times per month. The amount of free time you will have is extremely dependent on your sub-specialty choice. Private practice surgeons enjoy significantly more free time while surgeons in academic practice spend more time with research and have less operative/clinic time generally. Call is usually taken for 24 hours periods and you will be working most of the day and night. Some surgeons have a tendency to scheduling elective cases during their call days, but this depends on how difficult your call is.

 

  • What is the average salary of a General Surgeon?

The overall salary of a surgeon is highly variable amongst sub-specialties, typically  between $250,000-$500,000.

 

  • What is the job market like for General Surgeon?

There is no lack of general surgery positions. I would say they are extremely available for both private practice and academic positions. There is some variability among sub-specialties. However, overall, we are one of the most high recruited specialties.

 

  • What can you tell us about General Surgery Sub-specialties?

Residency for general surgery is 5 years mandatory and more commonly 1-2 years research years during PGY2 or 3. Therefore, many general surgery residencies last 6-7 years before fellowship. Fellowships typically last 1-2 years. Subspecialties have more call and higher salary. Additionally, sub-specialties are generally in more demand than general surgeons.

 

  • What are the potential downsides of General Surgeon that students should be aware of?

The schedule is less flexible due to emergent surgical problems. Surgical shift hours are not reliable and typically cases will be delayed or run over and require staying at the hospital beyond a call or shift. This leads to a schedule that can be variable. Training programs are not as “intense” as they were historically, although there are still high expectations of surgical residents. There are not many other residents/doctors who work as hard as general surgeons.

 

  • What else would you tell medical students who are considering General Surgery?

One thing students should realize is that there is more peri-operative management being handled by hospitalist services for elective surgical problems. Therefore, some of the duties and responsibilities of a surgeon 20 years ago and being placed in the hands of non-surgeons. Additionally, surgical critical care services are beginning to  limit the medical management requirements of general surgeons.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interviews: Why did you choose general surgery?.


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Physician Satisfaction by Specialty

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Choosing a Specialty, Dermatology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, Neurology, Ophthalmology, Pathology, Pediatrics, Psychiatry, Radiology, Urology

April 26, 2012

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The most recent installment of the Medscape Physician Compensation Report was recently published. Along with some of the best information on the web about physician salaries by specialty, the new Medscape report also reports which specialties are the most satisfied with their jobs (click here to view the entire Medscape Report). The results may surprise you. There is no correlation with salary and satisfaction.  The highest paid specialties (orthopedics and anesthesia for example) are found in the middle of the list while pediatrics, ID/HIV, and pathology are all found at the top of the list.  Interestingly, plastic surgery is–by far–the least satisfying specialty. So, the most competitive specialty is by far the least satisfying…that’s odd!

 

Physician Satisfaction by Specialty Survey Physician Satisfaction by Specialty

From the 2012 Medscape Compensation Report

 

My conclusions from the Physician Satisfaction Survey:

  1. The age old adage is correct: Money does NOT buy happiness.
  2. Just because a specialty is desirable to match into does not mean it is desirable to practice in [plastics].
  3. I can find only one thing that links the most satisfying specialties: LIFESTYLE.  If you look at dermatology, psychiatry, emergency medicine, infectious disease, pathology, and ophthalmology they have a great lifestyle in common. They all have minimal call, good salary (but they are not the big earners), and few emergencies.  They all lend themselves well to family, recreation, and other hobbies outside of medicine.

 

My unsolicited advice:

  • I am sure there are my internists and plastic surgeons who are very satisfied with their jobs. I would bet that they knew exactly what there were getting into before they choose their specialty. Satisfaction in the workplace has lots to do with managing your expectations (and the expectations of your family and friends!)  If you really love some of the specialties that do not have the best lifestyle, that is great, just make sure you know that this will be an issue before you go into he specialty. Once you have made that decision, you will not be shocked (and neither will your family/friends) when you work a lot more than those around you.

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The Most Recruited Medical Specialties

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Choosing a Specialty, Dermatology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, Neurology, Ophthalmology, Pediatrics, Psychiatry, Radiology, Residency, The Match, Urology

April 25, 2012

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Now that I am in the first year of residency I am beginning to think about landing that first real job.  As a Transitional Year resident I am heavily involved with the Internal Medicine residents at my hospital.  I found out very quickly that these internal medicine residents are HIGHLY sought after. In fact, many of them receive job offers on a weekly, or even daily basis.  The jobs that are in highest demand for internists are outpatient primary care and inpatient hospitality.  Many of my senior residents are being offered salaries between $200,000 and $300,000 along with many benefits including loan repayment. There are even some offers higher than $300,000 for less desirable locations! This is in a stark contrast to the ophthalmology job market that I will face, where starting salaries are low and it is terribly difficult to get your foot in the door.

Recently, I came across the Merritt Hawkins database.  Merritt Hawkins obtains information about starting salaries and benefits for newly graduated residents. I speak about their great physician salary database in my Ultimate Guide to Physician Salaries. However, their database also contains a list of the 20 most recruited specialties in medicine. The list may shock you!  The ability to find a well paying job right out of residency is NOT AT ALL correlated with the competitiveness of the specialty.  Case in point: family physicians and general internists are the two most highly recruited specialists in medicine!

Merritt Hawkins the most recruited medical specialties The Most Recruited Medical Specialties

From Merritt Hawkins

 

This list represents the Top 20 most ‘requested physician searches by medical specialty.’ The numbers represent the number of times Merritt Hawkins was used to recruit a person from the respective specialties (Merritt Hawkins full PDF including physician compensation data is available here for free). So, when you are deciding on a specialty, don’t forget that competitive does not equal good job placement.  In fact, many of the least competitive specialties are very high on this list (pediatrics, psychiatry, family medicine)

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Which doctors get sued the most?

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Choosing a Specialty, General, General Surgery, Neurosurgery, Pediatrics, Psychiatry

September 23, 2011

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Have you ever wondered which physician specialties deal with the most malpractice lawsuits? While I was in medical school I often heard physicians discuss the rising costs of malpractice insurance and the lack of tort reform.  I knew that OB/GYN doctors had to deal with a lot of lawsuits, but I had no knowledge of which other specialties faced frequent lawsuits.  The New England Journal of Medicine recently published a great paper identifying which medical specialties are sued the most frequently.  The paper can be freely accessed by anyone (click here to see the full article).

The most interesting results can be summarized by the graph below, which demonstrates the percentage of physicians sued in a calendar year, separated by specialty. As you can see, neurosurgeons and cardio-thoracic surgeons lead the list with nearly 20% of all physicians in these specialties sued each year.  Wow, that seems excessive!  On the other side of the graph, only about 3% of psychiatry and pediatric physicians deal with lawsuits each year.

tort 265x300 Which doctors get sued the most?

Taken from NEJM, click the link below to see the full article

See the full article here

The article also presents data that demonstrate the cumulative probability of being sued during your career.  They find that by the time physicians in ‘high risk’ malpractice fields, such as general surgery and neurosurgery, reach 55 years of age nearly every singly physician has been sued at least once (95-99%).

Malpractice lawsuits are an important topic, especially when choosing a medical specialty during medical school.  Students need to know what problems the every-day doctors face so that we can make informed decisions.  If someone went into neurosurgery without knowing that nearly 100% of all neurosurgeons will be sued by the age of 55, this might result in a very unhappy professional life.  On the other hand, if you love neurosurgery and you are informed about this problem, you will be able to weigh all the pros and the cons of the specialty before making your decision.  When you know what you are getting into, you always have a higher chance of success.

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