Old general surgery scope is my dream

[nassmomo]

Well, first of all, pardon me if I lack english skills, I'm from Quebec.

 

General surgery as it was back then was and is always the dream I want to fulfill... Being able to help the people around me by doing a great variety of procedures and to be a versatile surgeon is what I always wanted to do of my life. Unfortunately, with the subspecialities that grew so much, general surgery is no more than abdominal surgery... wich is disappointing... I wanted to know if there was a type of practice that could fit my expectations; I heard that in rural ares a general surgeon does exactly what I want to have as a scope of practice. If anyone could tell me if that statement is true or if there is any general surgery program or special fellowship/residency that could train me for that kind of practice ( I heard about global surgery), I would be very thankful!!!

 

Thank you in advance!

[Lactic Folly]

We still have general surgeons doing thyroid and breast surgery in the city, plus running lumps and bumps clinics and working as trauma team leader. What other types of procedures did you want to do?

[nassmomo]

I wanted to be able to do at least the basics of every surgical subspecialities, like a general surgeon of the past generation.

 

thank you for replying!

[Med0123]

Subspecialties grew so much because the amount of new knowledge available is exponentially growing.

 

In surgery, you learn to be a good technician if you have enough volume to master the skills required to be a surgeon. You can't do one or two or five adrenalectomies during residency and then claim you are equal to the endocrine surgeon. Even in rural areas, people will be willing to travel for hours to get the best care possible.

 

However, it is still true that in some remote areas, a general surgeon may be able to do some thoracic and vascular surgeries, cover Obstetric calls and perform emergent C/S, do thyroid, basic hand repairs (not too basic or it would be the ER physician). You need to have the right training tho. Surgical residents used to do more operations back then when there were no schedule limitations (present in Quebec since July 1st). You certainly don't want to repair that 6.9 cm abdominal aortic aneurysm if you don't feel adequately trained (unless it is already ruptured and no vascular surgeon is available). That is why I suggest you to choose wisely your residency program (not "too" academic so you will have a good volume of bread and butter cases and OR time to become technically efficient early in your residency).

 

I also suggest you to take a look at what's called Rural Surgery fellowship (http://www.facs.org/fellows_info/bulletin/2007/santry0707.pdf). Such programs exist in the US and UK. They do not here in Canada. I think that is what would be the closest to a surgeon who would be a jack of all trades like you.

[greengrassgrows]

You could do a fellowship in pediatric surgery. They typically do a greater variety of procedures than their adult counterparts... but then of course you would be limiting your population to <18 years.

[nassmomo]

My questions were all answered, now i got to work very hard to achieve my goals

 

Thank you very much!

[NLengr]

Subspecialties grew so much because the amount of new knowledge available is exponentially growing.

 

In surgery, you learn to be a good technician if you have enough volume to master the skills required to be a surgeon. You can't do one or two or five adrenalectomies during residency and then claim you are equal to the endocrine surgeon. Even in rural areas, people will be willing to travel for hours to get the best care possible.

 

However, it is still true that in some remote areas, a general surgeon may be able to do some thoracic and vascular surgeries, cover Obstetric calls and perform emergent C/S, do thyroid, basic hand repairs (not too basic or it would be the ER physician). You need to have the right training tho. Surgical residents used to do more operations back then when there were no schedule limitations (present in Quebec since July 1st). You certainly don't want to repair that 6.9 cm abdominal aortic aneurysm if you don't feel adequately trained (unless it is already ruptured and no vascular surgeon is available). That is why I suggest you to choose wisely your residency program (not "too" academic so you will have a good volume of bread and butter cases and OR time to become technically efficient early in your residency).

 

I also suggest you to take a look at what's called Rural Surgery fellowship (http://www.facs.org/fellows_info/bulletin/2007/santry0707.pdf). Such programs exist in the US and UK. They do not here in Canada. I think that is what would be the closest to a surgeon who would be a jack of all trades like you.

 

A general, non vascular surgeon shouldn't be doing open AAA repair anyway. It's much too high morbidity/mortality surgery to be handled by a non vascular surgeon.

 

Plus you need an ICU with dialysis capability for the patient post op (48 hour stay is standard practice at my center). That won't be available at a place a rural gen Surg would work.

[Med0123]

A general, non vascular surgeon shouldn't be doing open AAA repair anyway. It's much too high morbidity/mortality surgery to be handled by a non vascular surgeon.

 

Plus you need an ICU with dialysis capability for the patient post op (48 hour stay is standard practice at my center). That won't be available at a place a rural gen Surg would work.

 

That's what I was trying to say. A general surgeon can do SOME vascular surgeries (fem-pop bypasses, etc.), but can't be in any way comfortable enough to do AAA repairs unless he gets the exposure. And this amount of exposure is obtained with a fellowship.