Interested in family medicine and something surgical?

[juicyprunes]

Hi,

 

Just wondering if any one has any advice for someone interested in both family medicine and a surgical specialty? What helped you finally decide (e.g. rotations? mentors?)? Strategies for CaRMs??

 

Thanks!

[BlackJack]

It's good to ask yourself the pros and cons of Surgery and FM.

 

Then, once you have those determined, you can decide which one best fits your lifestyle(or what you think your lifestyle will be for the next few decades).

[coastalslacker]

I was 100% rural family medicine, loved my family medicine rotation, and am now in Ortho......

 

I did observerships in Gen Surg, Urology and ENT in pre-clerkship and none of these appealed to me. I liked being in the OR, but hadn't actually gotten to do anything in any of these observerships. Coupled with family medicine's great lifestyle and the variety available if working in a rural setting, I didn't give surgical specialties a second thought.

 

Like I said, I loved my family medicine rotation in which I worked with a guy who took two hour lunches every day to either go to the gym or play hockey. He had a great life, lots of variety (OB, Gyne assists, ER, clinic one or two patients in hospital) and made excellent money. I was sold. However, I had two weeks of electives with nothing scheduled and thought I would give ortho a try because I didn't have it in my core surgical block and thought it might be cool (I had chosen Urology instead....figured it would be easier and the "slacker" in my nom de plume is not incidental). Bottomline I got onto the arthroplasty service, occasionally got to do stuff, and thought ortho was pretty much the best thing ever. I was kind of tired, but got used to it pretty quickly. I switched the rest of my electives around, used up summer vacation for more, and matched to my first choice. Very lucky.

 

A few things attracted me to the field: 1. doing stuff (true of any surgical field); 2. Orthopedic surgeries in particular-I later had my gen surg block and it wasn't nearly as interesting to me; 3. A difficult to define but immediate feeling that I "fit" in the field; I got along with the guys and thought the way they thought (incidentally, I've done some research on what motivates med students to choose particular fields and this vague "sense of fit" seems to be the most important, if most poorly defined, factor).

 

So, what would I recommend to decide between family and surgery (and I don't mean having a family...)?

 

1. Observerships in surgery don't count if you don't get the opportunity to actually do stuff. It is the DOING that makes it great. If you ask a surgeon what she likes about her job, the answer will likely be "operating". Try to find someplace where you will actually be able to get right in there. Surgeons in smaller centres are probably more likely to let you do stuff; go someplace without residents. Go to Africa (or someplace similar). And, do this stuff before clerkship so you don't have to go through the all the anxiety I did regarding CaRMS because I switched late.

 

2. Know how much you are willing to work. If you hate getting up early it ain't for you. However, keep in mind that attendings generally have much better lifestyles than residents (if they want-many of them are so old school all they seem to know how to do is work). Working alot isn't bad if you love your job. Working even a little can be painful if you chosoe not to do something you love just to have less hours.

 

3. Think about what kind of family doctor you would want to be. There are lots of options out there. Similarly, if surgery, what kind appeals?

 

4. Do you like to know alot about something or a little about everything. I thought I was the latter but have realized I was kidding myself.

 

5. Someone may mention the option of doing surgical assists as a family doctor. This is monkey-work. I can't imagine it being satisfying for someone who actually wanted to be a surgeon. Plus, MDs assisting may eventually be phased out in favour of RNs or someone else equally qualified to do surgical assists (ie 2 hands, 1/2 a brain, ability to follow instructions and tolerate occasional abuse from the occasional a-hole surgeon).

 

Hope this is helpful. Good luck!

[juicyprunes]

Thanks for the great advice!

[skvangs]

pretty sweet post

[Kathryn]

I was actually considering GP/General Surgery because my little home is so rural and north that there's not even anyone to pin a broken bone or do a C-Section. Every single little thing gets flown out to either Winnipeg or Thunder Bay. It seems to be a sensible thing to do since I fully intend to go back home to practice.

 

My question: How long would the training for this be again? Two years FM and another 5 for surgery? That doesn't seem right. For some reason, I'm thinking there's a program for general practitioners to learn simple surgical procedures. *scratches head* Maybe I shouldn't have posted this until after I had a nap.

[ploughboy]

I was actually considering GP/General Surgery because my little home is so rural and north that there's not even anyone to pin a broken bone or do a C-Section. Every single little thing gets flown out to either Winnipeg or Thunder Bay. It seems to be a sensible thing to do since I fully intend to go back home to practice.

 

My question: How long would the training for this be again? Two years FM and another 5 for surgery? That doesn't seem right. For some reason, I'm thinking there's a program for general practitioners to learn simple surgical procedures. *scratches head* Maybe I shouldn't have posted this until after I had a nap.

 

There's an "enhanced surgical skills" PGY-3 year offered at one or more Canadian universities. Unfortunately my google-fu is week and I can't just find a reference for you right now. Something tells me that it's either Calgary or Edmonton, but don't believe me when I say that. You're likely more motivated than I am to search the web for info.

 

I guess it kinda depends on the caseload up home. If there's enough work to keep a general surgeon busy and you want to do a bit of medicine on the side, you might be able to get away with a general surgery residency. I've been told more than once that there's a lot more medicine in surgery than there is surgery in medicine. But I don't know if the-powers-that-be at your hospital would be particularly happy with a general surgeon covering the emergency room and delivering babies. On the other hand, they might be happy to have anybody at all.

 

Seven years post-grad (5+2) seems like an awful long time, although you'd likely get credit for 6-12 months of training from the CCFP. I'm not clear on CCFP politics when it comes to retraining after an FRCPC/FRCSC residency, though lately I'm thinking that I should look into it. Six years post-grad might be palatable, depending on your circumstances, especially if it lets you be all things to all people in your community (and have some sort of official certification to back it up).

 

On the other hand, one of the options on my career differential includes more than a decade of post-graduate training, so I'm really not one to talk.

 

Good luck!

 

pb

[Kathryn]

That's just it. There probably isn't enough work to keep a surgeon busy in the OR, but they're dying to have one. Anyone at all. Even just someone who can do c-sections and broken bones would mean a lot to them.

 

I was still a little kid the last time we had a surgeon in the area. All I know is that he was military-trained and was sort of a jack-of-all-trades. He mainly practiced FM (I remember seeing him a few times when I was sick) but he also performed caesareans and other procedures when it was needed . I wish I could ask him but he retired years ago and moved away and the one doctor who was around when he was isn't sure what kind of training he had. She just figured they trained all military doctors to do everything during the war.

 

I'm going to go searching for that advanced year program. I knew FM+Surgery didn't seem practical for someone just looking to do simple procedures for an isolated area. Thanks PB!

[coastalslacker]

Even just someone who can do c-sections and broken bones would mean a lot to them.

 

You're going to have alot more luck learning to do basic gen surg emergencies like appendectomies than "just...broken bones"......

[grobz]

I am working in a rural area right now with a GP surgeon. He did a 3rd year by just asking a surgeon in Edmonton if he could be his personal resident for a year after the 2 years of family. now he is a family doc that operates about a half day a week plus emergencies. He does sections, appys, lap tubal ligations, hernias, hemorrhoids, tonsilectomies, and any other smallish stuff. No bones though, but I am sure you could do it with the right exposure.

If you ask me it is a radical combo. Family med variety, and you still get to cut.

 

g

[ploughboy]

I'm going to go searching for that advanced year program.

 

For future reference, U Alberta offers a "surgery" R3 and Ottawa U offers "advanced surgical skills". I don't know what either program involves...

 

http://www.cfpc.ca/English/cfpc/education/section of residents/resource/sor3-rdyear/default.asp?s=1

[harryd]

I was thinking of doing MOTP (army doctor thing) and that requires family med residency and then serving 4 years with the army.

I just wanted to know the difficulty of doing a surgical residency afterwards?

[ploughboy]

I was thinking of doing MOTP (army doctor thing) and that requires family med residency and then serving 4 years with the army.

I just wanted to know the difficulty of doing a surgical residency afterwards?

 

The answer depends on how committed you are to the military. If you leave the military after your FM return-of-service, you can only match in the second round of CaRMS (since you've already done one residency program). There are very few, if any, surgical residency positions open in the second round.

 

On the other hand, the army would likely be more than happy to sponsor you for a surgical residency position, provided you again do a return-of-service with them. I think it's year-for-year, so you'd be looking at 5 years of residency plus being on the hook for another 5 years. At that point, you're pretty much making a career out of the military.

 

The sweet part, if I understand it correctly, is that for most of your rosa you will be working as a surgeon at a civilian hospital leading a life that's not to much different from your non-military colleagues. The military does, however, have first dibs on your time and can send you to the middle of nowhere at the drop of a hat if they so choose.

[harryd]

Thanks for the info. So I guess I will be staying the military to do a surgical speciality. Unless I realy like family med.

 

And ya the military does have specialties it supports (gen surg and orthopedic surg included) and yes it would be another 5 years after res (2 years for every year for a max of 5). Another good thing is that you would be making what you made as a family med when returning to surgical residency (150k-200k).

 

By the end, that's 20 years of military service.

[scienceguy123]

any ideas on a good strategy for someone pursuing plastic surg and keeping family medicine as a back up. ideally, the family med program would be at U of T, so it's not even a guarantee as a back up i guess... How likely is it of switching in plastics if you match for family med the first time around, and then apply for a transfer?

[surgeondude]

any ideas on a good strategy for someone pursuing plastic surg and keeping family medicine as a back up. ideally, the family med program would be at U of T, so it's not even a guarantee as a back up i guess... How likely is it of switching in plastics if you match for family med the first time around, and then apply for a transfer?

 

Transfers into surgery, in particular plastics is highly unlikely, especially from family medicine. You're better off trying to get into general surgery (if you can't get in plastics directly) and try to switch.

[ploughboy]

I was thinking of doing MOTP (army doctor thing) and that requires family med residency and then serving 4 years with the army.

I just wanted to know the difficulty of doing a surgical residency afterwards?

 

SInce somebody cited this thread recently, I thought I'd tack on this recent Torstar article about Lt. Col. Dr. Homer Tien, who did "the army doctor thing", then retrained as a trauma surgeon via the military.

 

http://www.healthzone.ca/health/article/869892

[moo]

Actually, I know quite a few army docs who first did FM then retrained in anesthesia, ortho, and other specialties.

 

It's quite a deal too, as if you're still in the army, they pay you the salary of your rank, so I knew this anesthesia resident who was getting 150K a year to be a resident.