Does it seem like less people are interested in surgery now?

[jlkhhylyiluh6]

Trying to gauge what its like at other schools- at my school it really seems that now that people are 1/2way through clerkship,experiencing both 1st hand the surgery rotations as well as all the residents/fellows talking about how the match is getting increasingly more competitive with no jobs in many specialties, i have had several people who were heavily intersted in surgery at the start of 3rd year now want to do family or internal. A LOT of interest in internal in my class, and looking at the CARMS stats from last year showed a big uptick in interest nationwide as well. So anyone else get the feeling that the zeitgeist is moving from surgery to internal/family in canada?

[ralk]

Interest in surgery has been steadily dropping for the last decade or so, and the CaRMS stats reflect that. The drop in interest has been partially if not fully matched by a drop in availability of surgical residency spots though, so competitiveness continues to be high in many surgical specialties. Interest in FM has grown steadily over that same decade, though has leveled off in the past couple year. And, as FM started to see a plateau in interest, IM started to see a rather sharp increase in interest in the last two years or so, after being rather flat for numerous years.

Much of these trends are, as you say, driven by the job market, as well as lifestyle and slow changes in compensation. FM has a good job market, decent hours and pay that, while still being towards the bottom end of things for physicians, is better than it used to be in relative terms. Surgery has a tight job market and fairly rough hours, though maintains good pay. IM falls in the middle, with some specialties trending more towards the FM side of things (better hours, better job market, worse pay) and others towards the surgical side of things (worse hours, worse job market, better pay).

[rmorelan]

27 minutes ago, ralk said:

Interest in surgery has been steadily dropping for the last decade or so, and the CaRMS stats reflect that. The drop in interest has been partially if not fully matched by a drop in availability of surgical residency spots though, so competitiveness continues to be high in many surgical specialties. Interest in FM has grown steadily over that same decade, though has leveled off in the past couple year. And, as FM started to see a plateau in interest, IM started to see a rather sharp increase in interest in the last two years or so, after being rather flat for numerous years.

Much of these trends are, as you say, driven by the job market, as well as lifestyle and slow changes in compensation. FM has a good job market, decent hours and pay that, while still being towards the bottom end of things for physicians, is better than it used to be in relative terms. Surgery has a tight job market and fairly rough hours, though maintains good pay. IM falls in the middle, with some specialties trending more towards the FM side of things (better hours, better job market, worse pay) and others towards the surgical side of things (worse hours, worse job market, better pay).

also some adjustments were to government actions - restricting potentially new family doctors in Ontario I suspect in part resulted in the surge in internal interest recently. Ha, never a dull moment

[ralk]

7 minutes ago, rmorelan said:

also some adjustments were to government actions - restricting potentially new family doctors in Ontario I suspect in part resulted in the surge in internal interest recently. Ha, never a dull moment

That definitely played into it, especially since the perception of the changes in Ontario got blown well beyond the on-the-ground effects. Heard a lot more warnings about the changes for FM doctors from non-FM preceptors than I have from the FPs I've worked with.

[rmorelan]

2 minutes ago, ralk said:

That definitely played into it, especially since the perception of the changes in Ontario got blown well beyond the on-the-ground effects. Heard a lot more warnings about the changes for FM doctors from non-FM preceptors than I have from the FPs I've worked with.

things like that are so annoying - I mean you prepare for X all through out residency and then something out of your control makes a mess out of things during CARMS.

It is similar in the sub fields of internal it seems - this year Gastro was as I understand it (just from talking to my fellow residents) extremely popular and a lot of people went unmatched if they were going for it. Last year it was Hematology if I recall. Go unmatched and you are put into the 4 year IM stream which for some is simply not what they want.

At least further back in the med school match things are a bit more stable in terms of what is popular and what isn't etc.

 

[ralk]

1 minute ago, rmorelan said:

things like that are so annoying - I mean you prepare for X all through out residency and then something out of your control makes a mess out of things during CARMS.

It is similar in the sub fields of internal it seems - this year Gastro was as I understand it (just from talking to my fellow residents) extremely popular and a lot of people went unmatched if they were going for it. Last year it was Hematology if I recall. Go unmatched and you are put into the 4 year IM stream which for some is simply not what they want.

 

Well, considering it happened the year I went into FM, I guess I can't really complain that it drove others away from what I wanted 

[rmorelan]

Just now, ralk said:

Well, considering it happened the year I went into FM, I guess I can't really complain that it drove others away from what I wanted 

Ha, I guess not - it does work both ways

[Birdy]

I think it’s a lot easier to be interested in surgery until you’ve been waking up at 4:30am to round at 5:15 for a month and a half. 

[bearded frog]

A better question would be "Why is anyone interested in surgery?"

[rmorelan]

11 hours ago, bearded frog said:

A better question would be "Why is anyone interested in surgery?"

most common answer I heard is they just love fixing the problem Issue is X, they go in and remove/repair/replace X, and the problem goes away. You are happy, the patient is happy and life goes on.

A lot or maybe even most of medicine is about managing problems - take these pills and your symptoms will be less. See you next month sort of thing. I think a lot of surgery types would go a bit nuts in that environment.

Or worse, ha, something like radiology where we need to know the same amount of anatomy but all we do all day is figure out what the problem is and do thing about it. The classic radiologist has no interest beyond that - fixing it or managing it is boring to them. Only the puzzle matters.

 

[rmorelan]

13 hours ago, Birdy said:

I think it’s a lot easier to be interested in surgery until you’ve been waking up at 4:30am to round at 5:15 for a month and a half. 

...and don't leave until 6 (if you are lucky) on all of those days as well  

[goleafsgochris]

13 minutes ago, rmorelan said:

...and don't leave until 6 (if you are lucky) on all of those days as well  

It really is hard to comprehend what a nightmare the lifestyle is until you do it.  I always think people with an interest in surgery should tag along with a surgical team from start to finish of a day (or even better, of a call shift or a full week) VERY EARLY ON. (Like pre-clerkship before they get too invested)  So much of the average day is out of the OR!!  Theres a ton of ward work, plus a solid amount of clinic work.  To want to do surgery IMO you need to not only love the OR, but love it so much that its worth spending 20-25hours of a (generously) 80 hour draining, painful work week in the OR.

[rmorelan]

1 minute ago, goleafsgochris said:

It really is hard to comprehend what a nightmare the lifestyle is until you do it.  I always think people with an interest in surgery should tag along with a surgical team from start to finish of a day (or even better, of a call shift or a full week.)  So much of the average day is out of the OR!!  Theres a ton of ward work, plus a solid amount of clinic work.  To want to do surgery IMO you need to not only love the OR, but love it so much that its worth spending 20-25hours of a (generously) 80 hour draining, painful work week in the OR.

True - which is why so many people do it in clerkship and just go "nope" after. 

Which is fine because in the beginning we have way too many people interested in surgery than we need in surgery. It would be a CARMS blood bath if everyone in year one that wanted to do surgery actually applied for it. Plus that lifestyle is exactly why some surgical fields are so popular - remove the lifestyle constraints surgery is pretty good!

[Birdy]

16 hours ago, bearded frog said:

A better question would be "Why is anyone interested in surgery?"

Surgery is amazing. I love the OR. I really enjoy the process of it, and the amazing things that can be done to fix problems. I also really like the OR environment and how everyone works together and the almost theatrical nature of everything that goes on. There is something immensely satisfying about wheeling the patient into PACU after you’ve helped fix something. It’s amazing. I particularly enjoy gynae surgeries.

But you have to love all of that enough to be willing to put up with the lifestyle. And that turned out to be a big “nope” for me.  I like my kids too much.  

 

[Edict]

21 hours ago, beeboop said:

Trying to gauge what its like at other schools- at my school it really seems that now that people are 1/2way through clerkship,experiencing both 1st hand the surgery rotations as well as all the residents/fellows talking about how the match is getting increasingly more competitive with no jobs in many specialties, i have had several people who were heavily intersted in surgery at the start of 3rd year now want to do family or internal. A LOT of interest in internal in my class, and looking at the CARMS stats from last year showed a big uptick in interest nationwide as well. So anyone else get the feeling that the zeitgeist is moving from surgery to internal/family in canada?

Surgery across the world in general becoming slowly less competitive. For a number of reasons.

One, compensation has dropped in comparison with many other specialties.

Two, jobs aren't as plentiful.

Three, increasing training times for all specialties means that surgery is just too much of a sacrifice now.

Four, hours are long and the younger generations value lifestyle more.

Five, medical school selection and pre-clerkship training has moved towards valuing empathy, nuturing traits (except Quebec where surgery interest is still very high) and medical students are less interested in surgery as a result. 

Six, we are no longer in the "heydey of surgery", the 1900s-1980s brought about massive increases in technology and improvements in surgery. Many new procedures were developed, whole new fields were developed during this time. Since the 80s, mortality rates have dropped, safety has improved, but much of this are due to improvements in peri-operative medicine and improvements in consistency with greater regulation and oversight of surgical outcomes. It remains to be seen if there will be a new renaissance in surgery, but the big mortality challenges have been taken down in multiple fields of surgery. Many surgical specialties rarely deal with intra-operative death anymore. 

 

With all this being said, surgery is really only exhibiting a slow decline in interest. Plastics, ENT, ophtho are still highly competitive and no surgical specialty can truly be considered not very competitive. 

 

 

 

[#YOLO]

1 hour ago, Edict said:

Surgery across the world in general becoming slowly less competitive. For a number of reasons.

One, compensation has dropped in comparison with many other specialties.

Two, jobs aren't as plentiful.

Three, increasing training times for all specialties means that surgery is just too much of a sacrifice now.

Four, hours are long and the younger generations value lifestyle more.

Five, medical school selection and pre-clerkship training has moved towards valuing empathy, nuturing traits (except Quebec where surgery interest is still very high) and medical students are less interested in surgery as a result. 

Six, we are no longer in the "heydey of surgery", the 1900s-1980s brought about massive increases in technology and improvements in surgery. Many new procedures were developed, whole new fields were developed during this time. Since the 80s, mortality rates have dropped, safety has improved, but much of this are due to improvements in peri-operative medicine and improvements in consistency with greater regulation and oversight of surgical outcomes. It remains to be seen if there will be a new renaissance in surgery, but the big mortality challenges have been taken down in multiple fields of surgery. Many surgical specialties rarely deal with intra-operative death anymore. 

 

With all this being said, surgery is really only exhibiting a slow decline in interest. Plastics, ENT, ophtho are still highly competitive and no surgical specialty can truly be considered not very competitive. 

 

 

 

facts. f surg

[NLengr]

Surgery is amazing. At least my specialty is. Problems are well defined and when I go to work I know I am going to be fixing problems. 

The hours suck in residency, especially in gen surg, but improve a ton once you are staff. For example, I rarely start before 8 am now. I can usually get home by 5. Sometimes earlier. 

[MarsRover]

3 hours ago, NLengr said:

Surgery is amazing. At least my specialty is. Problems are well defined and when I go to work I know I am going to be fixing problems. 

The hours suck in residency, especially in gen surg, but improve a ton once you are staff. For example, I rarely start before 8 am now. I can usually get home by 5. Sometimes earlier. 

My fear with residency has been people that I shadow seem to not have a huge variety of cases. In Uro they spent a very sizeable portion of their week removing stones, ENT it was tons of thyroid. Is this just an issue of smaller fields of surgery? I tend to like variety, so I thought it got kind of boring quick shadowing the same one again and again. Do you find variety to be an issue? Perhaps I felt that way because I tend to be more actually hands on as opposed to watching people do stuff where I feel less engaged. 

[NLengr]

1 hour ago, MarsRover said:

My fear with residency has been people that I shadow seem to not have a huge variety of cases. In Uro they spent a very sizeable portion of their week removing stones, ENT it was tons of thyroid. Is this just an issue of smaller fields of surgery? I tend to like variety, so I thought it got kind of boring quick shadowing the same one again and again. Do you find variety to be an issue? Perhaps I felt that way because I tend to be more actually hands on as opposed to watching people do stuff where I feel less engaged. 

Don't feel that way at all. Every type of surgery has routine stuff they do all the time. The key is to find the area where you enjoy the routine cases.

 

Even big surgery becomes routine after a while because you do it so many times. 

 

Truth be told, if it's not routine you probably aren't doing enough of that type of case to be offering it. 

[goleafsgochris]

1 hour ago, MarsRover said:

My fear with residency has been people that I shadow seem to not have a huge variety of cases. In Uro they spent a very sizeable portion of their week removing stones, ENT it was tons of thyroid. Is this just an issue of smaller fields of surgery? I tend to like variety, so I thought it got kind of boring quick shadowing the same one again and again. Do you find variety to be an issue? Perhaps I felt that way because I tend to be more actually hands on as opposed to watching people do stuff where I feel less engaged. 

This is really true in any specialty.  You have to at least enjoy the routine a reasonable amount.  Even specialties with the MOST variety (I dunno, GIM? Family?) are mostly routine.  

[brady23]

On 2/11/2018 at 0:08 PM, goleafsgochris said:

It really is hard to comprehend what a nightmare the lifestyle is until you do it.  I always think people with an interest in surgery should tag along with a surgical team from start to finish of a day (or even better, of a call shift or a full week) VERY EARLY ON. (Like pre-clerkship before they get too invested)  So much of the average day is out of the OR!!  Theres a ton of ward work, plus a solid amount of clinic work.  To want to do surgery IMO you need to not only love the OR, but love it so much that its worth spending 20-25hours of a (generously) 80 hour draining, painful work week in the OR.

This. Hopefully clerkship gives me a flavor of what these intense specialties can be like (ex: 26 hour call for IM, surgery)

[jlkhhylyiluh6]

2 hours ago, MarsRover said:

My fear with residency has been people that I shadow seem to not have a huge variety of cases. In Uro they spent a very sizeable portion of their week removing stones, ENT it was tons of thyroid. Is this just an issue of smaller fields of surgery? I tend to like variety, so I thought it got kind of boring quick shadowing the same one again and again. Do you find variety to be an issue? Perhaps I felt that way because I tend to be more actually hands on as opposed to watching people do stuff where I feel less engaged. 

One, every speciality has "bread and butter" cases that make up the vast majority of patients you see.

Two, the problem is worse in surgery because of the skill/technical aspect of it; you NEED repetition to get good at performing the surgeries, so spreading yourself out too thin to have a big variety of cases sounds pretty counterproductive. You need to be the master of the surgeries you do, not pretty good at lots of different types.

[Edict]

On 2/12/2018 at 5:56 PM, MarsRover said:

My fear with residency has been people that I shadow seem to not have a huge variety of cases. In Uro they spent a very sizeable portion of their week removing stones, ENT it was tons of thyroid. Is this just an issue of smaller fields of surgery? I tend to like variety, so I thought it got kind of boring quick shadowing the same one again and again. Do you find variety to be an issue? Perhaps I felt that way because I tend to be more actually hands on as opposed to watching people do stuff where I feel less engaged. 

You get the most variety in residency but as staff there is less variety. The reason is because you want to be really good at what you do and if all you do is thyroids, you can be the thyroid expert, thus reducing mortality and improving outcomes. So ultimately, surgery (in any specialty, even general surgery) isn't for those who like a variety. These days, a community general surgeon will do mostly endoscopy, choles, appys, lysis of adhesions and a few emergencies, but they certainly won't go anywhere near complex colorectal cases, HPB cases or thoracic cases. 

 

Honestly though, i feel like eventually you realize that you'll never know everything, and that you'd rather just do one thing really well or know a little bit about everything. When you get older you aren't going to be as proficient in learning new things anyways. 

 

 

 

[NLengr]

15 hours ago, Edict said:

You get the most variety in residency but as staff there is less variety. The reason is because you want to be really good at what you do and if all you do is thyroids, you can be the thyroid expert, thus reducing mortality and improving outcomes. So ultimately, surgery (in any specialty, even general surgery) isn't for those who like a variety. These days, a community general surgeon will do mostly endoscopy, choles, appys, lysis of adhesions and a few emergencies, but they certainly won't go anywhere near complex colorectal cases, HPB cases or thoracic cases. 

 

Honestly though, i feel like eventually you realize that you'll never know anything, and that you'd rather just do one thing really well. When you get older you aren't going to be as proficient in learning new things anyways. 

 

 

 

How much you do in the community depends on where you are too. I'm 4 hours from the closest tertiary center. Catchment is about 100k. Huge geographic area. I do cases that would never be done in most Ontario community practices because they would be referred to the academic center which is close by. When I was a resident and a fellow the community guys close to our center literally did nothing beyond the most simple cases.