Do surgeons have control over their workload?

[pheochromocytoma]

Hey guys,

 

I am really interested in a career in surgery... general and cardiac are my main interests. I am not here to talk about job prospects for cardiac surgeons because I am going to go for what I am interested in no matter what so you don't have to tell me there are no jobs. What I am interested in learning about is whether, as a surgeon, you have any say in the amount of hours you work. While I have talked to some surgeons about I haven't received a crystal clear answer, and maybe that is because such an answer does not exist. I know I want surgery as a career and am trying to be interested in something else because I have a family that is my top priority and it seems that surgery is not a very family friendly career. However, I also want to be happy with my career and think I may end up resenting said family if I chose a less fulfilling career because of them.

 

Is there any way that a surgeon could work 50-60 hrs a week plus call? Can you say no to working more than that?

 

I know that family doctors can do additional training to be surgical assistants, but I couldn't do that. I am only a med student and already I get antsy watching surgeries and not being able to be the one in control doing the procedure and making the decisions.

 

Any insight would be greatly appreciated. Cheers

[pheochromocytoma]

Thanks for the answer Alastriss, that's encouraging to know. Community is more my cup of tea

 

Any others out there that can speak from their experience? Maybe more to cardiac??

Thanks!

[moo]

The docs that I've worked with are pretty chill, but then again when they're on call they're hit hard. I remember I was on call one weekend with a community surgeon in residency. We worked literally from Friday early morning, went home Friday night/Sat morning at around 2am, came back to round at 6am, was in the OR again until early Sunday morning/Sat night at around 1-2, and again up at 6 am to round, and finally things slowed down around 6pm that Sunday night. Then she had clinic again Monday morning at 8am. This happens probably about 1 in 6 weekends for her, and about 1 weeknight a week or so she'd also be on call.

 

The rest of the time you have scheduled OR cases and so your day runs from probably around 5:30-6am to 5-6pm, depending on how fast (or slow) you are. Clinic days are pretty straight forward but again you have to round in the morning, probably a bit later given clinic starts later than ORs (which usually start at 730-8am at most places). In Canada though, you probably only get 1-2 OR days per week for your scheduled cases and so it's probably amenable to more of a lifestyle than in the US.

 

Cardiac surgery is probably pretty similar to gen surgery in terms of hours. There probably are less emergent cases but sometimes you do get called to do CABGs in the middle of the night (I have stayed away from cardiac surg so anyone correct me if I'm wrong).

 

It's hard to control your life completely as a general surgeon. You have obligations to the hospital, your call group, and your patients.

[pheochromocytoma]

Thanks Moo!

At least for cardiac when you get called in the middle of the night it's do CABGs(!!!), I think they are a very fun procedure (though I imagine that the novelty wears off when you can do a CABG in your sleep and you have to perform it at a time when sleep is something you really want to do, haha).

[Prion]

Do surgeons who retire from the OR have other means of practising medicine when their "shelf-life" is up?

 

I know for ENT, you can keep yourself busy with just clinic but what about say Gen surg where most of your clincs are for pre-op/post-op purposes?

[moo]

Again, you can't really practice gen surg without an OR. That's one of the issues here. You can make a medical practice out of ENT if you wanted to (and this is the case with older docs who want to turn it down). You can't do that with gen surg really. Another reason why it's not as competitve.

 

I'm curious as to what private procedures you can do with gen surg. I think stuff like bariatrics can be private, but I don't know if it's feasible to turn this surgical career into something less strenuous as you get older.

 

Not really, unless you work in a private surgical center. If you're at an academic center or community hosp with privileges, you are expected to participate in the call schedule.

 

You can tone things down though. When I was in med school in Chicago, one of our anatomy tutors was a retired surgeon in his 70s. Funny guy too.

[NLengr]

Thanks Moo!

At least for cardiac when you get called in the middle of the night it's do CABGs(!!!), I think they are a very fun procedure (though I imagine that the novelty wears off when you can do a CABG in your sleep and you have to perform it at a time when sleep is something you really want to do, haha).

 

It's probably also less fun when you are exhausted and the patient's life is literally in your hands during a procedure that's outcome is highly influenced by technical skill.

[jerkstore]

The docs that I've worked with are pretty chill, but then again when they're on call they're hit hard. I remember I was on call one weekend with a community surgeon in residency. We worked literally from Friday early morning, went home Friday night/Sat morning at around 2am, came back to round at 6am, was in the OR again until early Sunday morning/Sat night at around 1-2, and again up at 6 am to round, and finally things slowed down around 6pm that Sunday night. Then she had clinic again Monday morning at 8am. This happens probably about 1 in 6 weekends for her, and about 1 weeknight a week or so she'd also be on call.

 

The rest of the time you have scheduled OR cases and so your day runs from probably around 5:30-6am to 5-6pm, depending on how fast (or slow) you are. Clinic days are pretty straight forward but again you have to round in the morning, probably a bit later given clinic starts later than ORs (which usually start at 730-8am at most places). In Canada though, you probably only get 1-2 OR days per week for your scheduled cases and so it's probably amenable to more of a lifestyle than in the US.

 

Cardiac surgery is probably pretty similar to gen surgery in terms of hours. There probably are less emergent cases but sometimes you do get called to do CABGs in the middle of the night (I have stayed away from cardiac surg so anyone correct me if I'm wrong).

 

It's hard to control your life completely as a general surgeon. You have obligations to the hospital, your call group, and your patients.

 

 

What kind of procedures is a gen surgeon rated to do? I heard something about speciality training in the second half of the residency (or maybe the speciality training is after) so please include those.

[jerkstore]

Doing things like Lap bands, bypasses and such privately can be tough but is doable. I think it's just tougher because you need a full-out OR, not like plastics/ENT where you can do a lot of cosmetic procedures out of office.

 

I've heard of gen surg guys doing plastics fellowships in the states. I'm not sure if you can bring any of that back for the minor stuff.

 

Interesting, what procedures can you take on with a plastics fellowship?

 

Another thing that interests me, how do you get "tested" whether or not you can do said procedures? I assume doing a fellowship is just following a doctor around, but who's to say at the end if you can actually do these procedures half way decently, do you undergo some practical surgical test?

[pheochromocytoma]

It's probably also less fun when you are exhausted and the patient's life is literally in your hands during a procedure that's outcome is highly influenced by technical skill.

 

I see you are trying to shoot down my optimism about this surgery. I mentioned the exhausted part, and to be honest the part you mentioned about the patient's life being in my hands and the technical skill involved are components that actually attract me to cardiac and general surgery. I want to be the one that patients entrust their lives to on the operating table. So actually that component won't make it less enjoyable/fulfilling

[moo]

Interesting, what procedures can you take on with a plastics fellowship?

 

Another thing that interests me, how do you get "tested" whether or not you can do said procedures? I assume doing a fellowship is just following a doctor around, but who's to say at the end if you can actually do these procedures half way decently, do you undergo some practical surgical test?

 

Through residency. There's also a principles of surgery exam after 1st year that you take. You are expected to be competent to do those skills by the end of residency. You will be observed by your attendings as a resident so you'll have plenty of feedback. If you aren't comfortable doing it, you do more training (fellowship).

[jerkstore]

Do you ever get to work autonomously during residency?

 

I mean you'd think by the 4th of 5th year of surgical residency you'd be doing it all on your own with a doctor simply "accessible".

[rmorelan]

Do you ever get to work autonomously during residency?

 

I mean you'd think by the 4th of 5th year of surgical residency you'd be doing it all on your own with a doctor simply "accessible".

 

I have seen that a bit on call, but even during the day last year surgical residents I have been have the surgeon in the room (well excluding prep and closing etc). Part of it could be billing as well - can't imagine you can charge for a procedure taking place when you aren't ever even in the room

[jerkstore]

I have seen that a bit on call, but even during the day last year surgical residents I have been have the surgeon in the room (well excluding prep and closing etc). Part of it could be billing as well - can't imagine you can charge for a procedure taking place when you aren't ever even in the room

 

Why not they do it with PA's.

[jerkstore]

You could always do a small FP residency when you're all washed up!

[preppy038]

You could always do a small FP residency when you're all washed up!

 

what's a 'small' FP residency?

[NLengr]

I see you are trying to shoot down my optimism about this surgery. I mentioned the exhausted part, and to be honest the part you mentioned about the patient's life being in my hands and the technical skill involved are components that actually attract me to cardiac and general surgery. I want to be the one that patients entrust their lives to on the operating table. So actually that component won't make it less enjoyable/fulfilling

 

Get over yourself.....

 

I don't really care if you like CABGs. Or what your career plans are. Or if you are enthusiastic about a procedure. I merely pointed out that when you are the person making decisions or performing surgeries in the middle of the night it's not as fun as you think. Statistically, it's well proven emergent surgeries do worse than planned surgeries. Add to that middle of the night mental fog and physical fatigue. Now add on the fact that you have minimal back-up, no other staff around, limited services like radiology and ICU (both of which are run by residents overnight) and you have a recipe that makes it easy for things to go poorly. Its all well and good as a med student to be working at night because you don't have any real responsibility for patient care, but it's different as a resident and staff. Mistakes are easier to make and the consequences magnified. I don't know a single resident, myself included, or staff who enjoy operating or making serious decisions overnight. It increases the risk of poor outcome, and you shoulder the burden of that outcome.

 

CABGs are great. Cool procedure, I'm glad you enjoy them, but I am telling you now, you wont look forward to the emergent cases overnight.

[NLengr]

Through residency. There's also a principles of surgery exam after 1st year that you take. You are expected to be competent to do those skills by the end of residency. You will be observed by your attendings as a resident so you'll have plenty of feedback. If you aren't comfortable doing it, you do more training (fellowship).

 

The principles of surgery exam is written in the latter months of PGY2. Just for the record.

[jerkstore]

what's a 'small' FP residency?

 

[rmorelan]

You could always do a small FP residency when you're all washed up!

 

I wonder how often that really happens! The stereotypical surgeon personality I don't think would handle that well

[Blake]

I wonder how often that really happens! The stereotypical surgeon personality I don't think would handle that well

Yea, that wouldn't go well. I'm pretty chill myself compared to most of my surgical co-residents, but I couldn't do FP, IM, path, derm, anesthesia, etc even if my life depended on it. As the saying goes, often wrong but never in doubt, haha.

[1234]

The principles of surgery exam is written in the latter months of PGY2. Just for the record.

 

Actually, that is more of a recommendation. The requirement is that POS is successfully passed prior to your Royal College examinations. Many people do write it at a later date.

[NLengr]

Actually, that is more of a recommendation. The requirement is that POS is successfully passed prior to your Royal College examinations. Many people do write it at a later date.

 

Yeah, now that I think about it you are correct. I know someone writing it in PGY3 for the first time. At my center almost everyone writes in PGY2. My program, everyone writes second year.

 

I guess you could push it later, like if you just had a kid in March pgy2.

[coastalslacker]

Get over yourself.....

 

I don't really care if you like CABGs. Or what your career plans are. Or if you are enthusiastic about a procedure. I merely pointed out that when you are the person making decisions or performing surgeries in the middle of the night it's not as fun as you think. Statistically, it's well proven emergent surgeries do worse than planned surgeries. Add to that middle of the night mental fog and physical fatigue. Now add on the fact that you have minimal back-up, no other staff around, limited services like radiology and ICU (both of which are run by residents overnight) and you have a recipe that makes it easy for things to go poorly. Its all well and good as a med student to be working at night because you don't have any real responsibility for patient care, but it's different as a resident and staff. Mistakes are easier to make and the consequences magnified. I don't know a single resident, myself included, or staff who enjoy operating or making serious decisions overnight. It increases the risk of poor outcome, and you shoulder the burden of that outcome.

 

CABGs are great. Cool procedure, I'm glad you enjoy them, but I am telling you now, you wont look forward to the emergent cases overnight.

 

lol, I love the first line, and absolutely agree with the rest of the post. I like working at night less every year.

[cheech10]

There are extremely few emergency CABGs anyway. Almost all get PCI if they're actively infarcting or in cardiogenic shock. Don't let workload issues dissuade you from surgery (or any surgical subspecialty); the workload is much lighter after residency.