how competitive of a residency is surgery?

[Guest justanotherpremed]

Where would you rate it in relation to internal medicine?

 

Also... how does CARMS work for surgery? What i want to know is --- does general surgery straight our of med school lead you to all of the surgery subspecialties? --- or do you enter neurosurgery separately , etc.?

 

Thanks :hat :smokin

[Guest aneliz]

There is no short answer here...it's kind of yes and no..

 

General surgery is its own residency program...you can apply to gen surg and be a general surgeon at the end...or you can do a fellowship afterwards and subspecialize in an area like vascular, thoracic or pediatric surgery.

 

However, if you want to do something like plastic surgery, orthopedic surgery or neurosurgery, these are separate residency programs that you apply to out of med school (not through gen surg).

 

General surgery hasn't traditionally been super competitive...unless you have your heart set on one particular program in one particular city... usually there are enough spots to go around and some left at the end of the first round. However, it is still more competitive than some other specialties (like family). I would say it is probably roughly equivalent to internal medicine in competitiveness...of course nobody knows what is going to happen now that the match is 1:1, grads:spots...

 

This is not the same fields like plastics or neurosurg...these are much more competitive to get into. (Given the much smaller number of spots).

[Guest Ian Wong]

Here's the list of statistics for matching into each specialty in CaRMS for 2003.

 

www.carms.ca/stats/stats2003.htm#first

 

As you can see, 85% of the applicants who wanted Internal Medicine as their first choice specialty got into it (50% of the applicants actually ended up also getting their first choice city as well).

 

For General Surgery, 100% of the applicants who wanted General Surgery as their first choice specialty got into it (80% of the applicants also got their first choice city).

 

Strictly looking at the numbers therefore, General Surgery residencies were easier to obtain this last year vs. Internal Medicine. These things have a way of changing from year to year, however, so it's tough to generalize. Things could be quite different 3-4 years from now when you'd be applying to residencies.

 

Ian

[Guest justanotherpremed]

thanks...

 

another question: which of these above mentioned surgeons would perform operations on the kidney/urinary system? :smokin :hat

[Guest mgupta]

Hi

 

Urologists perform operations on kidneys, male reproductive organs, adrenal glands, endocrine and male/female urinary system

 

Thoracic surgeons treat esophageal, lung cancers and surrounding areas (incl. pericardium)

 

ENT deal with ear, nose and throat (upper throat-oropharynx)

 

Vascular surgeons deal with aneurysms (aortic, peripheral)

 

General surgeons as mentioned deal with abdominal surgeries, and transplants

 

orthopedics deal with joints replacements (hip/knee)

 

Plastics deal with carpel tunnel syndrome, lacerations, reconstructive surgery and cosmetics - i believe this is the most diverse as a speciality now (when it comes to residency and Carms and stuff)

 

Cardiac perform bypass surgery and heart transplants

 

Neurosurgery deals with strokes, subdural hemorrhages and tumor resections....

 

Anesthesia and Emerg are seperate to enter for residency (like the above), but during clerkship are often grouped into surgery (at least they do that at UWO).

 

i hope this gives you a broad idea of what happens in each surgical speciality.

 

If i'm wrong about some of the specialities corrections are appreciated!

[Guest Kirsteen]

Hi there,

 

Typically, urologists would handle many surgical/structural issues concerning the kidneys and urinary tract. However, general surgeons and gynaecologists may also tackle related cases, e.g., kidney transplantation, or patients with issues of the reproductive tissues. There are probably other overlapping specialties which I haven't covered, too.

 

In fact, (bit of a mild, but humerous, segue here), I encountered a bunch of urologists at a recent scientific meeting. One of them was quite the woman. At this meeting, the majority of urologists present, (and the majority of meeting attendees in fact), were male. Someone had just delivered a presentation on reconstructive surgery for male patients with genital mutilation (most often due to botched circumcisions). This female physician stood up to ask a question about fistulae involving the foreskin, and prefaced it with: "The foreskin is an extremely important structure, although most of you wouldn't be privy to that since most of you probably don't have one." Well!

 

Cheers,

Kirsteen

[Guest justanotherpremed]

thanks to you both/...

 

what kind of transplants would a general surgeon perform? :hat :smokin

[Guest aneliz]

transplant surgery requires additional training beyond just general surgery...so the answer to what kind of transplants does a general surgeon do is none.

 

However, I believe the route to a transplant surgery fellowship is through general surgery...although I may be wrong. It is definitely a long road to doing transplants...and not something that you would be doing right out of residency!

 

To add to the earlier question about renal/urinary tract surgery... urogynecology is a subspecialty of OB/GYN..they tend to deal with most surgical bladder related issues in females...although they don't deal with the kidneys themselves.

[Guest 007]

Plastic surgeons also deal with burns (sort of part of their reconstructive duties I guess)......just one more thing to add to their diversity.

[Guest moo]

A general surgeon these days is pretty much limited to the abdominal area. Lots of gallbladder surgeries, that kind of stuff. They've pretty much fallen out of favor for the more specialized type of guys. They might do other things... not entirely sure cuz I really have no interest in surgery!

[Guest Kirsteen]

Hi there,

 

Actually, general surgeons can venture into the burns area, also. Our burn unit at Sunnybrook is staffed by three full-time surgeons: two completed a plastics residency and one completed a general surgery residency plus a one- or two-year burn fellowship (and neither were completed all that long ago). All three share the burn OR time equally and, as far as I know, perform the same types of burn surgeries, i.e., the general surgeon is not relegated to performing surgeries that are less plastics-oriented than those of the two plastics guys.

 

Cheers,

Kirsteen

[Guest moo]

actually once you complete a fellowship you're not really a general surgeon anymore. A general surgery residency can lead to many subspecialties, much like how a general internist can subspecialize into cardio, nephro, rheumatology, etc. If you just did a GS residency then you pretty much will only work in the abdomen, in the breast and some minor surgeries on the skin and neck

[Guest cracked30]

Mastectomy

Axillary node dissection

colectomy

cholecystectomy

hernias

small bowel resection

appedectomy

nissen fundoplication

amputations (anywhere)

gastrectomy

colonoscopy

gastroscopy

low anterior resection

ureter repair

tendon repairs of the hand

carpal tunnel, open and endoscopic

trauma laparotomy

-may include splenectomy, liver repair/resection

trigger finger release

phlebectomy

hip fracture repair

aortic anerysm repair (elective and emergent)

melanoma and other skin cancers

vascectomy

truncal vagotomy

thyroidectomy, hemithyroidectomy

parotidectomy

whipple procedure

tonsillectomy

excision dupuytrns contracture

excision coccyx

ganglia excision

chest tube insertion

trauma thoracotomy

miller shunt insertion

common bile duct exploration

skin grafts

ERCP

fasciotomy

PICC line inserion

pacemaker inserion

sentinel lymph node biopsy

 

 

I can back up this because I can name the general surgeons in southwestern Ontario who do these preocedures

[Guest cracked30]

nephrectomy

tracheostomy

zencker's diverticulectomy

Mitchell procedure

Open reduction, internal fixation of simple upper and lower limb fractures

[Guest cracked30]

cesarean section

[Guest justanotherpremed]

cracked30:

 

Since you are apparently a surgery expert, can you verify the previously posted idea that general surgery leads to further study in transplant surgery? If so, what is the route taken ( i.e. a big fellowship after general surgery or what?). Also, would this be a transplant of any organ system? In other words, I would expect the cardiovascular surgeons to do the heart transplants..... and the urologists to do the kidney transplants... am i wrong?

 

Thanks :hat :smokin

[Guest cracked30]

Transplant is a one year fellowship following general surgery, as it is following cardiac and urology.

 

Hearts-cardiac surgeons

 

Kidneys- usually urologists, general surgeons usually do the laparscopic donor nephrectomies though, since laparoscopic surgery is a general sugery specialty.

 

liver, pancreas, small bowel. General surgery

[Guest justanotherpremed]

allright:

so if you wanted to perform a heart transplant.... you would do five years of general surgery, three years of cardiovascular surgery fellowship, and one year of transplant fellowship... is that correct, approximately?

 

here's another question for you:

 

there have been recent breakthroughs in the use of stem cells to generate differentiated cells that may reverse functional defecits. In fact, researchers two years ago used stem cell transplant in a rat model of parkinson's disease.... my question is... who would perform the transplantation of differentiated cells into the patients? would it be a system-specific thing? in that case....

neural cells - neurosurgeon

myocardial cells - cardiovascular surgeon

pancreatic cells to reverse diabetes - general surgeon

liver cells for damaged liver - general

what do you think?

[Guest Ian Wong]

In Canada, Cardiac Surgery is a six year residency straight out of medical school. Here are the descriptions of each program as listed in the CaRMS Residency Program Directory. In the US, although there are a few such "integrated" cardiac surgery programs, most people still get there by completing a General Surgery residency (5 years) and a CVS fellowship is another 2 or 3 years. By then, I think you'd likely have done enough cardiac transplants that you'd be good to go.

 

Stem cells aren't in widespread use at the moment. Whoever is well-versed in that anatomic area, and has the appropriate training and referral patterns would be the ones to go to. For example, islet cell transplants can be done by both general surgeons, as well as interventional radiologists.

 

Ian

[Guest marbledust]

A general surgery resident told me that it is possible to do a 3-year cardiac surgery fellowship in Canada following a complete general surgery residency. I can't remember which programs he mentioned because it was some time ago.

 

So if you did your general surgery at UBC (which I believe is 6 years long), that route would take 9 years:eek Throw on the transplant year....wow.

[Guest UWOMED2005]

Yeah, novel therapies such as stem cell transplantation take YEARS to get to the point where you can offer that option to your run of the mill parkinsonian patients. I remember getting really excited in undergrad (studying biochem, immuno and micro) hearing about all these cool innovations only to get to medical school and realize how long it would be before any of this stuff became standard of practice, if ever! (lots of stuff never makes it beyond the theoretical stage)

 

cracked - you sure haven't missed anything? Nice list, great resource. If I was a jock rather than the nerd than I am (to borrow a stereotype from Scrubs - I'll probably be a meds kind of guys, Internal or 3 year emerg) I'd probably go for rural or small centre general surgeon. I think doing knee and hip arthroplasties day in day out for 35 years would drive me bonkers, but I think doing a Whipple's in the morning, a mastectomy in the afternoon, and an emergent appendectomy in the evening would be pretty exciting. Then again, my impression of gen surgery in London itself is not that far off what Moo described: as you stated, you can name THE surgeon who does each procedure. . . I'd rather not be the guy stuck doing nothing but elective cholecystectomies with the odd colonoscopy every day. Then again, I haven't yet done my surgery rotation in clerkship. . . I'm pretty eager to learn differently.

 

One question: Are you aiming for large or small centre?

[Guest justanotherpremed]

uwomed2005:

you should be spearheading the effort to get these therapies available!!!!

but yes, I agree with you that there are often many technical difficulties to such therapeutics. for example, there is the possibility that transplanted cells, although technically already differentiated, may not have full control of their cell cycle and proliferate, forming a tumor.

don't you think that substantia nigra cell-transplantation as a therapy for parkinsonism would be an interesting topic for an md/phd though? :hat :smokin

[Guest therealcrackers]

Most of the cardiac surgery programs are direct entry 6-year residency programs in Canada. I spent two weeks on the cardiac surgery service, and the 3rd year resident there spent most of his OR time doing the dissections of the internal mammary arteries, working on some of the anastomoses, and closing. From there, if you want to do transplant, it's a 1-2 year fellowship, so 7-8, not 9-10.

[Guest justanotherpremed]

so the first-year cardiovascular surgery residents would have very limited experience in surgical technique, mostly derived from their clerkship, correct? :hat :smokin

[Guest aneliz]

I imagine that most first year cardiac surgery residents would spend their PGY-1 year much like residents in most other specialties...a lot of it off-service.

 

They will likely spend a good chunk of their year in other disciplines like gen surg, medicine, etc. Don't know for sure because this is not a field that I am looking to enter...

 

They will not be surgical wizards from the beginning, nor will they be doing surgery on their own....