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extendablelungs

Neurosurgery vs Peds General Surgery vs Orthopedics Lifestyle

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Incoming M1 here. I did some surgical research/shadowing prior to med and absolutely loved what I saw, so I'm trying to set my eyes on a couple surgical specialties so that I can hit the ground running when it comes to research and observerships in med school. I love working with kids, I love the brain/brain anatomy (but not sure if I would enjoy operating on it -- will decide later lol), don't mind dealing with death, but would prefer to have some semblance of a lifestyle (I think so at least). I also have tons of external interests outside of medicine that I would like to pursue in the future (arts, politics, etc). 

 

Can someone please compare the lifestyle/practice pros and cons of neurosurg, peds general, and ortho? These are what have caught my interest so far, but I'm also open to suggestions for other specialties to consider when building my CV over the next couple years (except for optho maybe ... the eyes kinda freak me out? but maybe I just need more exposure). 

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Well if you want a job and/or a life, I would forget about neurosurg right now. 

Ditto for ortho if you want a job in Canada. 

Peds surgical specialties are awful unless you like spending 50% of your time negotiating with kids. 

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The 3 you listed (gen surg, ortho and NSx) are arguably the worst for lifestyle, with CV also up there and plastics coming up close behind. There’s minimal point comparing lifestyles of these, but I agree with the above that NSx is he worst followed close by ortho. 

 

The fact you listed lifestyle style as a priority this early (ie before M1) tells me you should be looking more at ophtho, urology or ENT if you really want a surgical specialty, or consider a procedural specialty like cardiology, gastroenterology, anesthesia, dermatology or interventional radiology instead. You have to live for the OR, as in love it more than any other hobby you have if you want to pursue a surgical specialty like NSx, ortho, gen surg, CV, plastics because if not residency will do you in. 

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24 minutes ago, ZBL said:

The 3 you listed (gen surg, ortho and NSx) are arguably the worst for lifestyle, with CV also up there and plastics coming up close behind. There’s minimal point comparing lifestyles of these, but I agree with the above that NSx is he worst followed close by ortho. 

 

The fact you listed lifestyle style as a priority this early (ie before M1) tells me you should be looking more at ophtho, urology or ENT if you really want a surgical specialty, or consider a procedural specialty like cardiology, gastroenterology, anesthesia, dermatology or interventional radiology instead. You have to live for the OR, as in love it more than any other hobby you have if you want to pursue a surgical specialty like NSx, ortho, gen surg, CV, plastics because if not residency will do you in. 

Urology is not a lifestyle surgical specialty. It can be pretty busy in my experience. The only surgical specialty that I would say if amenable to lifestyle would be Optho (and even then you would probably have to tailor your practice). Plastics and ENT may also be reasonable but still not great.

If you value lifestyle, don't chose anything that involves making holes in things (surgical specialties, interventional rads) or important body parts (cardiology etc.).

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13 hours ago, Edict said:

https://www.cma.ca/En/Pages/specialty-profiles.aspx 

This is what you are looking for!

so it's the on-call hours that really detriment any chance at a decent lifestyle! how're your experiences as a surgical resident? 

 

obviously i still have some ways to go before i can even concretize my interest in a surgical discipline, but it's rather unfortunate that wanting a shot at a life outside medicine means sacrificing what you may be most interested in ... especially with all this talk about physician shortages despite under/unemployed fully-trained surgeons in canada. 

 

what are the prospects of working at less-than-full capacity (i.e. humane hours?) in surgery by choice?

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33 minutes ago, extendablelungs said:

so it's the on-call hours that really detriment any chance at a decent lifestyle! how're your experiences as a surgical resident? 

 

obviously i still have some ways to go before i can even concretize my interest in a surgical discipline, but it's rather unfortunate that wanting a shot at a life outside medicine means sacrificing what you may be most interested in ... especially with all this talk about physician shortages despite under/unemployed fully-trained surgeons in canada. 

 

what are the prospects of working at less-than-full capacity (i.e. humane hours?) in surgery by choice?

Define humane hours. Ignore resident lifestyle. It blows but its temporary. You will spend most of your life as a staff. The unfortunate truth of almost all surgical specialties are they are high stress and demanding. But at least staff life is better then residency. 

On call hours doesn't necessarily mean you are in the hospital or working. You might just be carrying a pager at home. If you are in an academic center your slaves do 95% of your work anyway. If you are in the community you can bump non urgent stuff off till the daytime or to your clinic pretty easy. 

I would honestly just shadow some surgical specialties you are interested in. You'll be able to better de ide if its something you like enough to do. 

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7 minutes ago, NLengr said:

Define humane hours. Ignore resident lifestyle. It blows but its temporary. You will spend most of your life as a staff. The unfortunate truth of almost all surgical specialties are they are high stress and demanding. But at least staff life is better then residency. 

On call hours doesn't necessarily mean you are in the hospital or working. You might just be carrying a pager at home. If you are in an academic center your slaves do 95% of your work anyway. If you are in the community you can bump non urgent stuff off till the daytime or to your clinic pretty easy. 

I would honestly just shadow some surgical specialties you are interested in. You'll be able to better de ide if its something you like enough to do. 

humane as in having the ability to retain our humanity, i guess. being able to see your family every once in a while, go on vacation, pursue interests outside of medicine, etc. i don't expect to have a cushy life by any means, but some of these hours seem to make it impossible to even find the time to foster a sense of individuality, if that makes sense. like i wanna be able to recognize my kids at a soccer game, know what their lives are like, be able to write a book if i wanted to, etc. 

 

when i look at on-call hours i mostly focus on direct patient care hours -- is that not time literally spent with the patient? 

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19 minutes ago, extendablelungs said:

humane as in having the ability to retain our humanity, i guess. being able to see your family every once in a while, go on vacation, pursue interests outside of medicine, etc. i don't expect to have a cushy life by any means, but some of these hours seem to make it impossible to even find the time to foster a sense of individuality, if that makes sense. like i wanna be able to recognize my kids at a soccer game, know what their lives are like, be able to write a book if i wanted to, etc. 

 

when i look at on-call hours i mostly focus on direct patient care hours -- is that not time literally spent with the patient? 

Self reported stuff might not be that accurate. There is probably lots of recall bias etc.

I'm a busy staff surgeon and I am able to spend time with my family. You just need to prioritize what's important to you. Most of the people I know who never see their families are like that because, honestly, they don't really want to see them and don't put the effort in. It's the same in any profession. 

Honestly, you are best off just shadowing and asking various staff. 

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On 5/29/2018 at 8:39 PM, NLengr said:

Urology is not a lifestyle surgical specialty. It can be pretty busy in my experience. The only surgical specialty that I would say if amenable to lifestyle would be Optho (and even then you would probably have to tailor your practice). Plastics and ENT may also be reasonable but still not great.

If you value lifestyle, don't chose anything that involves making holes in things (surgical specialties, interventional rads) or important body parts (cardiology etc.).

As a urologist, I would warn you that urology, as NLengr has stated, is not a lifestyle specialty. If you want lifestyle (again, as NLengr stated - notice a trend amongst surgeons?), do not go into a surgical discipline. 

PMD

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I would just add that pediatric gen Surg is subspecialty, at least if that's all you want to do. Speaking to one of the ped-gen Surg attendings in BC, they said that a one job may come up every 5-7 years. For all of BC. If someone could correct me, my understanding is that you don't necessarily set your goal to be a subspecialty this early as the kind of fellowship you do (if you do one) will be dictated by factors such as demand, target location to practice as much as your interest and proficiency. Thus, to set your sights on Peds Gen Surg, you have to first go through gen-surg resisdency then a fellowship and then hope for an opening. Granted you said you were interested in gen Surg anyway so it might not be a big deal to end up doing just that. I would say that if 'working with kids' is a driving factor (doesn't seem like it is) then do Peds and only then do a procedural subspecialty  (Peds GI) but I imagine still super competitive.  

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3 minutes ago, ToxicMegacolon said:

...they said that a one job may come up every 5-7 years. For all of BC. 

Christ

Can someone comment on job availability for other surgical specialties? Neuro, cardio, more niche ones?

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41 minutes ago, kirraea said:

Christ

Can someone comment on job availability for other surgical specialties? Neuro, cardio, more niche ones?

Short answer: terrible for all. 

Neurosurg: very very bad. Expect multiple fellowships and an advanced degree before even getting looked at for a job. I think there are issues with working in the states too, so no easy outlet. 

Cardiac: Very very bad. Multiple fellowships and advanced degree required before getting looked at. Might be able to work in the US but jobs aren't that plentiful. 

Ortho: Very bad. Need 2 fellowships for a Canadian job which is hard to land. Easy to work in the US

Urology/ENT/Gen Surg/Plastics: Will need one fellowship to work in a medium/bigger community center. Fellowship plus advanced degree in academic programs. Can land a job without a fellowship in select smaller centers in crappy locations. Easy to get work in the US if you want to.

Optho: not too sure because they are a mystery to non optho people. I would expect a fellowship is needed. Advanced academic degree for academic jobs. Issues with fighting for OR time with established surgeons. 

Anything peds: No jobs. Need fellowship obviously. Probably need advanced degree since every peds hospital except one in the country is academic. Just to give an example: when I was a resident we hire a new peds specialist and it was the only peds job that had opened up for a few years in canada. Ton of people applied. 

Vascular/Thoracics: not too sure. I know some people who finished fellowships (vascular was a fellowship only thing until about 6 years ago). Couple of them got a full time job. One does locums. One bailed to the US. 

 

I agree that you shouldnt go into a specialty of you only are interested in one subspecialty area. Like was said above, fellowships are frequently decided based on market demand or requests from the hospital group where you want to work.

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12 minutes ago, NLengr said:

Short answer: terrible for all. 

Neurosurg: very very bad. Expect multiple fellowships and an advanced degree before even getting looked at for a job. I think there are issues with working in the states too, so no easy outlet. 

Cardiac: Very very bad. Multiple fellowships and advanced degree required before getting looked at. Might be able to work in the US but jobs aren't that plentiful. 

Ortho: Very bad. Need 2 fellowships for a Canadian job which is hard to land. Easy to work in the US

Urology/ENT/Gen Surg/Plastics: Will need one fellowship to work in a medium/bigger community center. Fellowship plus advanced degree in academic programs. Can land a job without a fellowship in select smaller centers in crappy locations. Easy to get work in the US if you want to.

Optho: not too sure because they are a mystery to non optho people. I would expect a fellowship is needed. Advanced academic degree for academic jobs. Issues with fighting for OR time with established surgeons. 

Anything peds: No jobs. Need fellowship obviously. Probably need advanced degree since every peds hospital except one in the country is academic. Just to give an example: when I was a resident we hire a new peds specialist and it was the only peds job that had opened up for a few years in canada. Ton of people applied. 

 

I agree that you shouldnt go into a specialty of you only are interested in one subspecialty area. Like was said above, fellowships are frequently decided based on market demand or requests from the hospital group where you want to work.

.... wow. 

 

why are the odds so grim if there's clearly a shortage and the majority of surgeons are brutally overworked?

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4 minutes ago, extendablelungs said:

.... wow. 

 

why are the odds so grim if there's clearly a shortage and the majority of surgeons are brutally overworked?

There isn't a shortage of surgeons avaliable. There is a shortage of jobs and OR time. If you employed all new grads at the end of residency/fellowship, wait times would plummet. 

There aren't enough jobs for everyone because the government won't fund the OR time and positions. As a result, patients wait. 

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11 minutes ago, kirraea said:

soo what I'm looking at is 12+ years of training for maybe a chance at a job? assuming i like what i see during med school surgery wise

Yup. Expect residency plus minimum 1 year of fellowship. Depends on specialty and where you work but that's probably safe. 

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11 minutes ago, kirraea said:

soo what I'm looking at is 12+ years of training for maybe a chance at a job? assuming i like what i see during med school surgery wise

 

8 minutes ago, NLengr said:

Yup. Expect residency plus minimum 1 year of fellowship. Depends on specialty and where you work but that's probably safe. 

What, no PhD? How are you going to find a job???

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15 minutes ago, NLengr said:

There isn't a shortage of surgeons avaliable. There is a shortage of jobs and OR time. If you employed all new grads at the end of residency/fellowship, wait times would plummet. 

There aren't enough jobs for everyone because the government won't fund the OR time and positions. As a result, patients wait. 

sorry, that's what i meant - a shortage of employment opportunity.

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21 minutes ago, PhD2MD said:

in addition to*....so 15-17 years ;)...at least that's around where mine training is going to end up

Are you interested in neurosurgery? Does the 15-17 years include your education since the beginning of undergrad??

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1 minute ago, count123 said:

Are you interested in neurosurgery? Does the 15-17 years include your education since the beginning of undergrad??

Neurology. My break down is:


Undergrad - 4 years - done
PhD - 5 years - done
MD - 3 years - 2/3 done
Residency - 5 years
Fellow ship - 2 years
Total = 19....oh God, I didn't realize how bad it was until I wrote this post. I think I was in denial haha.

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14 minutes ago, PhD2MD said:

Neurology. My break down is:


Undergrad - 4 years - done
PhD - 5 years - done
MD - 3 years - 2/3 done
Residency - 5 years
Fellow ship - 2 years
Total = 19....oh God, I didn't realize how bad it was until I wrote this post. I think I was in denial haha.

Good luck !! You are almost there :) 8 more years lol

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16 minutes ago, PhD2MD said:

Neurology. My break down is:


Undergrad - 4 years - done
PhD - 5 years - done
MD - 3 years - 2/3 done
Residency - 5 years
Fellow ship - 2 years
Total = 19....oh God, I didn't realize how bad it was until I wrote this post. I think I was in denial haha.

Oh lord your post made my heart sink hahah

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