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How many residents do you know from your faculty that has switched out of surgical residencies? I cant imagine some of my classmates who have matched into surgical specialities actually making it through a 5 year intense residency.. although you never know what someone is capable of till they’re faced with the challenge

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On 3/3/2018 at 1:30 AM, F508 said:

How many residents do you know from your faculty that has switched out of surgical residencies? I cant imagine some of my classmates who have matched into surgical specialities actually making it through a 5 year intense residency.. although you never know what someone is capable of till they’re faced with the challenge

True you never know :) There is only so much that clerkship can do to prepare you for the real thing - anyone can do one month of call,  but doing it for years is the real problem. 

I mean "most" do get through their problems in surgery and some of this is field and school specific. Most programs I have run into might have one person give or take per year not make it to the end in a mid sized program (I do know know specific ones where it is worse mind you)

Edited by rmorelan

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9 hours ago, F508 said:

How many residents do you know from your faculty that has switched out of surgical residencies? I cant imagine some of my classmates who have matched into surgical specialities actually making it through a 5 year intense residency.. although you never know what someone is capable of till they’re faced with the challenge

I think it really comes down to how much do they love the OR. Some people cannot imagine their life without returning to an OR and that’s where the adage “if you can imagine yourself doing anything other than surgery, you should do that other thing” comes from. I think people just need to be honest with themselves as to how much of their interest in surgery is the cool or fun factor in med school, vs an intrinsic need to continue in a surgical specialty (ophtho somewhat excluded from this thought process in my view). 

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hahah not jealous, I'm really happy with my match result. Was just surprised by some match results. This one person is kind of a slacker, always late, does the minimum and they got into a surgical specialty lol.. I guess they were on their best behavior for their surg rotations. 

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When I went through residency (7 year experience), dropout rate across the surgical specialties was about 20%. I could talk for hours as to why I think surgical residents drop out, however, I believe one of the biggest factors is 'expectation' vs 'reality'. I feel that medical students these days are getting a 'softened' exposure on their surgical rotations - reality hits hard when you are a PGY1 (especially when you do all the crap work - taking care of inpatients, consults, etc. without the 'fun' suff - operating). You find out pretty quick whether you truly believe the 'juice is worth the squeeze' in the first 1-2 years. Interestingly, many of the dropouts came in years 2-3 - my belief - this is when you start operating, and I believe that some realize at this point that they actually don't enjoy operating as much as they thought they would. Coupled with all the other sh$t that comes with being a surgical resident (long hours, surgical persona's, etc) and it's not surprising that many head for greener pastures. 

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7 hours ago, F508 said:

hahah not jealous, I'm really happy with my match result. Was just surprised by some match results. This one person is kind of a slacker, always late, does the minimum and they got into a surgical specialty lol.. I guess they were on their best behavior for their surg rotations. 

In some of the more intense specialties, it's as much about willingness to put up with the $&#€ thrown your way as it is about performance. Those who want to give it their all 100% of the time often burnout faster than those who are willing to coast a little. Don't get me wrong, failing to live up to basic expectations of performance will get any resident held back or even kicked out, but transfers from surgical programs often aren't transferring for performance reasons.

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2 hours ago, ralk said:

In some of the more intense specialties, it's as much about willingness to put up with the $&#€ thrown your way as it is about performance. Those who want to give it their all 100% of the time often burnout faster than those who are willing to coast a little. Don't get me wrong, failing to live up to basic expectations of performance will get any resident held back or even kicked out, but transfers from surgical programs often aren't transferring for performance reasons.

Agreed - though there is a balance. Surgical residency (residency in general) often amounts to a 5+ year job interview (especially in surgical disciplines that have few jobs available). So you want to pace yourself, but you also want to impress (typically with work ethic and competence + a willingness to 'fill a role (usually amounting to fellowship training in a less popular area of subspecialty - aka - fill a need; with a graduate degree on top of that)). I agree though - it wasn't the crap residents transferring out of programs (in fact, many of the best residents did); and your sh#t tolerance level better be at maximum capacity coming into a surgical residency.

1 hour ago, #YOLO said:

i know ortho programs are hemorrhaging residents

I suspect this relates to job shortages. Though it's actually a fairly tactical move matching to a surgical specialty and then transferring out. Many of the residents who transferred moved to some fairly nice specialties - radiology and emergency medicine were quite common transfers during my time. Plus you have 5 years of funding attached to you. Pretty smart move for the forward thinking student (though if you can't transfer - you F$cked).

PMD

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48 minutes ago, PilotMD said:

Though it's actually a fairly tactical move matching to a surgical specialty and then transferring out. Many of the residents who transferred moved to some fairly nice specialties - radiology and emergency medicine were quite common transfers during my time. Plus you have 5 years of funding attached to you. Pretty smart move for the forward thinking student (though if you can't transfer - you F$cked).

???

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16 minutes ago, DermJuly2018PGY1 said:

???

What's your confusion with what I said? I personally know some individuals who were gunning for competitive non-surgical specialties (like emerg) - instead of backing up with family and securing only two years of funding, they also applied to surgical disciplines. Here they get five years of funding (easier to transfer into another five year program). Plus surgical residents often have many desirable quantities (whether they actually possess these qualities or are assumed to have them as surgical residents is another issue topic altogether) for other programs (hard working, motivated, etc). 

That being said - that was nine years ago - CARMS is a different beast these days. I'm not even sure how one would backup these days. But I suspect the dropout rate in surgery hasn't changed much in these last 9 years.

Congrats on the match btw (I'm assuming you matched derm)

PMD

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When I was a resident (starting 7 years ago now...Jesus....) the drop out rate was highly variable. It depended on the program. My program hasn't had someone drop out since the mid 2000s I believe (maybe even earlier than that). Another program at my center routinely lost about 50% of it's residents.

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They are high numbers. I'll echo what NLengr said - it is program dependant for sure. General surgery/neurosurgery seemed to lose more residents than any of the other programs (when I was in residency, general surgery lost 75% of their residents one year - but this was an anomaly). The other thing is you have to take the number of residents in a given program into consideration when interpreting these high drop out rates. If 1 or 2 residents transfer out of a smaller program (around 10 residents - think urology/plastic surgery/neurosurgery/cardiac surgery), that can be 10-20% of the program. When I went through, a few urology folks transferred out, a few plastic people left, a few cardiac people left and many general/neurosurgery residents left. 

Don't let these numbers deter you from a surgical specialty. No doubt, surgery is very tough (see prior posts on why). If you want to improve your chances of not transferring out, my advice is to experience a resident life-style as much as you can while on surgical rotations/electives. Again, I believe the trouble is that medical students are getting more of a 'attending-level' experience while on rotation. When they hit residency, life suddenly sucks much more than anticipated and you were not mentally prepared for that. Some argue (and I agree) that unhappiness reflects the distance between expectation and reality - when reality aligns with expectation, life is better. When reality differs greatly from expectation, life sucks. Mimic your residents life (especially the juniors) and see what your life will really be like in a few years (and then you can better judge if its worth it): do lots of call like they do, including weekends, stay post-call if they are (I know - there are 'rules' that you can't stay post call: you will find, however, that many residents do stay post call to maximize their experience while in residency, especially when good learning opportunities are available. Little fun fact for you - attending surgeons do not have post call restrictions), help out with scut work, consults, etc. Get the most realistic experience you can because its a big commitment.

PMD

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1 hour ago, PilotMD said:

They are high numbers. I'll echo what NLengr said - it is program dependant for sure. General surgery/neurosurgery seemed to lose more residents than any of the other programs (when I was in residency, general surgery lost 75% of their residents one year - but this was an anomaly). The other thing is you have to take the number of residents in a given program into consideration when interpreting these high drop out rates. If 1 or 2 residents transfer out of a smaller program (around 10 residents - think urology/plastic surgery/neurosurgery/cardiac surgery), that can be 10-20% of the program. When I went through, a few urology folks transferred out, a few plastic people left, a few cardiac people left and many general/neurosurgery residents left. 

Don't let these numbers deter you from a surgical specialty. No doubt, surgery is very tough (see prior posts on why). If you want to improve your chances of not transferring out, my advice is to experience a resident life-style as much as you can while on surgical rotations/electives. Again, I believe the trouble is that medical students are getting more of a 'attending-level' experience while on rotation. When they hit residency, life suddenly sucks much more than anticipated and you were not mentally prepared for that. Some argue (and I agree) that unhappiness reflects the distance between expectation and reality - when reality aligns with expectation, life is better. When reality differs greatly from expectation, life sucks. Mimic your residents life (especially the juniors) and see what your life will really be like in a few years (and then you can better judge if its worth it): do lots of call like they do, including weekends, stay post-call if they are (I know - there are 'rules' that you can't stay post call: you will find, however, that many residents do stay post call to maximize their experience while in residency, especially when good learning opportunities are available. Little fun fact for you - attending surgeons do not have post call restrictions), help out with scut work, consults, etc. Get the most realistic experience you can because its a big commitment.

PMD

I agree with this. 

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What happens to the call schedule if 20-50% of residents drop out? Do the rest of the residents have to pick up the slack or is the program open for transfers to fill those spots? I can't imagine how the rest of the residents would make up for a 50% drop out rate..

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13 hours ago, F508 said:

What happens to the call schedule if 20-50% of residents drop out? Do the rest of the residents have to pick up the slack or is the program open for transfers to fill those spots? I can't imagine how the rest of the residents would make up for a 50% drop out rate..

I think they sometimes will just short staff the services or in some programs rely more heavily on surgical assists/NPs/fellows.

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12 hours ago, Edict said:

I think they sometimes will just short staff the services or in some programs rely more heavily on surgical assists/NPs.

true - with say it more like 20% then you are just getting call redistributed among the residents

All programs have to deal with that when it happens :)

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I'd say being a surgical resident has been better than what I expected. I mean, there are days when I constantly question why I chose the field, but at the end of the day, the type of work I get to do still gives me a smile. 

Having said that, trying to constantly impress people (or trying not to piss off anyone) and questioning whether I can get a job at the end are the more stressful factors of surgical residency... at least from my experience

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I've always wondered what percentage of surgical staff would pick surgery again if they went back in time.. Sure, laparoscopy is super fun at first.. but once you're doing your 129th cholecystectomy at 2am, is it still fun?

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On 4/1/2018 at 12:34 AM, Edict said:

I think they sometimes will just short staff the services or in some programs rely more heavily on surgical assists/NPs/fellows.

There are always off-service residents rotating through general surgery, i.e: radiology, family medicine, pathology residents etc. The extra calls will be distributed equally among every resident. I heard that there are always a few residents switching out of surgical specialties in R1-R5 (included!), you have to ask yourself if you are ready for the lifestyle of surgical residency (a lot of residents do not take post-call days and remain for round + OR), surgical staff personalities (some are not that nice tbh), and if you love OR so much that you can't see yourself do anything else. 

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The off-service residents are generally PGY1 and should be backed up by a more senior general surgery resident on call. These are the people who run the teams during the day as well, so short-staffing would increase the number of patients assigned to each of the other teams/residents.

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