ZBL Posted March 23, 2018 Report Share Posted March 23, 2018 I was chatting with a surgeon the other day on what their opinions were on which surgeons spend the most time operating. Thought this might be useful discussion to those early in med school, so perhaps we could list off all specialties from most to least procedural oriented - note this is not specifically taking a knife to skin, but rather any physical intervention or invasive diagnostic approach. Also excluded are subspecialties within each discipline, as that can change things quite a bit. This is meant as more of a general guide by royal college discipline assuming someone in general community practice. Feel free to correct as needed, as I’ve not rotated through all of them. Procedure Heavy CT Surgery = NeuroSx Ortho = Gen sx Plastics Vascular Urology ENT = ob/gyn Ophtho = Derm Anesthesia Rad onc EM Rads (Diagnostic) PMR FM IM Neuro Peds Psych Public health Few procedures Link to comment Share on other sites More sharing options...
GrouchoMarx Posted March 23, 2018 Report Share Posted March 23, 2018 27 minutes ago, ZBL said: I was chatting with a surgeon the other day on what their opinions were on which surgeons spend the most time operating. Thought this might be useful discussion to those early in med school, so perhaps we could list off all specialties from most to least procedural oriented - note this is not specifically taking a knife to skin, but rather any physical intervention or invasive diagnostic approach. Also excluded are subspecialties within each discipline, as that can change things quite a bit. This is meant as more of a general guide by royal college discipline assuming someone in general community practice. Feel free to correct as needed, as I’ve not rotated through all of them. Procedure Heavy CT Surgery = NeuroSx Ortho = Gen sx Plastics Vascular Urology ENT = ob/gyn Ophtho = Derm Anesthesia Rad onc EM Rads (Diagnostic) PMR FM IM Neuro Peds Psych Public health ?????????????????? Few procedures Link to comment Share on other sites More sharing options...
ZBL Posted March 23, 2018 Author Report Share Posted March 23, 2018 Was something not clear? Use your words. Link to comment Share on other sites More sharing options...
JohnGrisham Posted March 23, 2018 Report Share Posted March 23, 2018 Path didnt make your list ha. Link to comment Share on other sites More sharing options...
Lactic Folly Posted March 23, 2018 Report Share Posted March 23, 2018 Link to comment Share on other sites More sharing options...
zizoupanda Posted March 23, 2018 Report Share Posted March 23, 2018 Procedure Heavy Ortho=Plastics CT Surgery NeuroSx Vascular Urology Gen sx ENT Ob/gyn Ophtho Gastroenterology Anesthesia Intensive Care Derm Respirology EM FM Rads (Diagnostic) Cardiology (General) RadOnc PMR Rest of IM Neuro Peds Psych Public health Plastics and Ortho are purely surgical; there's no medical component to their care. Gen Surg and Neurosurg take care of a lot of issues which do not always go to OR (SBO, pancreatitis, high ICP,...) and are medically managed on the ward. It's also kind of unfair to package all of IM. GI is very procedure heavy for example and there's plenty of procedures in ICU and resp. FM can be procedure heavy depending on how you practice. RadOnc outside of brachytherapy which a few do is not at all procedure heavy from my experience. Link to comment Share on other sites More sharing options...
indefatigable Posted March 23, 2018 Report Share Posted March 23, 2018 46 minutes ago, zizoupanda said: Procedure Heavy Ortho=Plastics CT Surgery NeuroSx Vascular Urology Gen sx ENT Ob/gyn Ophtho Gastroenterology Anesthesia Intensive Care Derm Respirology EM FM Rads (Diagnostic) Cardiology (General) RadOnc PMR Rest of IM Neuro Peds Psych Public health Plastics and Ortho are purely surgical; there's no medical component to their care. Gen Surg and Neurosurg take care of a lot of issues which do not always go to OR (SBO, pancreatitis, high ICP,...) and are medically managed on the ward. It's also kind of unfair to package all of IM. GI is very procedure heavy for example and there's plenty of procedures in ICU and resp. FM can be procedure heavy depending on how you practice. RadOnc outside of brachytherapy which a few do is not at all procedure heavy from my experience. Unless the dermatologist has a subspecialization in Mohs surgery (which plastics surgeons can also do), it's not going to be any more procedure intense than FM. I agree there's a lot of variance in IM. Link to comment Share on other sites More sharing options...
ZBL Posted March 23, 2018 Author Report Share Posted March 23, 2018 I don’t know if I’d put GI that high - sure they do scopes, but to me they’d be no more procedure intensive than anesthesia, maybe even less so. I agree with bumping ortho/plastics up. Disagree about derm = fm for procedures. In a given day, a derm will do tons of cryo, and certainly more biopsies and excisions (and On average more cosmetics) than FM. FM can do IUD, and joint injections, but I doubt that outpaces the average derms procedure rate in the community setting. For Mohs, that would definitely bump derm up. FYI I have heard plastics is technically no longer allowed to do American College of Mohs Surgery fellowships, so this will likely increasingly become exclusively derm. Also so agree with ICU and resp being more procedure oriented if we are going IM subspecialties too. I have no no idea about rad onc, so thanks for the correction. And yes, I forgot path. I’d call their procedures more science experiments than a human procedure though Link to comment Share on other sites More sharing options...
rmorelan Posted March 23, 2018 Report Share Posted March 23, 2018 Minor point - but diagnostic radiology is actually the field that does all the biopsies (prostate, lung, abdominal, breast, thyroid...., thoracentesis, paracentesis, LP drains/aspirate/chemotherapy, nephro/biliary/abscess tubes. GI tube placement, RF ablations, spine injections, joint injections and aspirations........... NOT IR radiology. It is a part of the job I actually really enjoy and I get to routinely stab people ha. IR radiology does all of the angio-interventional work - anything that has to access a blood vessel. Now because a IR rad is also a general rad they can do the above as well and it may be structured that way but often it is well any rad. 20-30% of the job is often doing procedures. People often don't realize that. We have been doing procedures a lot longer than IR even existed. Link to comment Share on other sites More sharing options...
shikimate Posted March 23, 2018 Report Share Posted March 23, 2018 I would put forensic pathology on the top. As a staff you can do 300 evisceration of all the organs in the body per year. Doesn't get more invasive and procedural than that. Link to comment Share on other sites More sharing options...
shikimate Posted March 23, 2018 Report Share Posted March 23, 2018 If you're a surgeon or endoscopist in Canada GOOD LUCK getting OR time or scope time these days. If you like procedures go do GI in US, I am sure there are scope clinics that are happy if you scope 6 days a week and do a Sunday clinic. Link to comment Share on other sites More sharing options...
goleafsgochris Posted March 23, 2018 Report Share Posted March 23, 2018 3 hours ago, zizoupanda said: Procedure Heavy Ortho=Plastics CT Surgery NeuroSx Vascular Urology Gen sx ENT Ob/gyn Ophtho Gastroenterology Anesthesia Intensive Care Derm Respirology EM FM Rads (Diagnostic) Cardiology (General) RadOnc PMR Rest of IM Neuro Peds Psych Public health Plastics and Ortho are purely surgical; there's no medical component to their care. Gen Surg and Neurosurg take care of a lot of issues which do not always go to OR (SBO, pancreatitis, high ICP,...) and are medically managed on the ward. It's also kind of unfair to package all of IM. GI is very procedure heavy for example and there's plenty of procedures in ICU and resp. FM can be procedure heavy depending on how you practice. RadOnc outside of brachytherapy which a few do is not at all procedure heavy from my experience. I don't see how ortho tops the list. Have you been to a fracture clinic? They typically will just say hi to the patient and look at XRs, and someone from allied health will do the castings--its basically a procedure free day. Or an ortho sports clinic? They may do an occasional injection but again its almost a completely non-procedural day. As a resident you cast and do reductions but in the community the ER docs will do it. They maybe get 1-2 OR days per week and otherwise its fairly non-procedural. I agree path is probably the most procedural. Although I guess it depends on your definition of procedure. Link to comment Share on other sites More sharing options...
Aconitase Posted March 23, 2018 Report Share Posted March 23, 2018 11 hours ago, ZBL said: I was chatting with a surgeon the other day on what their opinions were on which surgeons spend the most time operating. Thought this might be useful discussion to those early in med school, so perhaps we could list off all specialties from most to least procedural oriented - note this is not specifically taking a knife to skin, but rather any physical intervention or invasive diagnostic approach. Also excluded are subspecialties within each discipline, as that can change things quite a bit. This is meant as more of a general guide by royal college discipline assuming someone in general community practice. Feel free to correct as needed, as I’ve not rotated through all of them. Procedure Heavy CT Surgery = NeuroSx Ortho = Gen sx Plastics Vascular Urology ENT = ob/gyn Ophtho = Derm Anesthesia Rad onc EM Rads (Diagnostic) PMR FM IM Neuro Peds Psych Public health Few procedures What about ICU? Link to comment Share on other sites More sharing options...
Snowmen Posted March 23, 2018 Report Share Posted March 23, 2018 Wouldn't PM&R do quite a bit of procedures like Botox, joint injections, nerve blocks, EMGs and what not? Even more so for sports medicine or chronic pain specialised physiatrists. Link to comment Share on other sites More sharing options...
indefatigable Posted March 23, 2018 Report Share Posted March 23, 2018 4 hours ago, ZBL said: Disagree about derm = fm for procedures. In a given day, a derm will do tons of cryo, and certainly more biopsies and excisions (and On average more cosmetics) than FM. FM can do IUD, and joint injections, but I doubt that outpaces the average derms procedure rate in the community setting. For Mohs, that would definitely bump derm up. FYI I have heard plastics is technically no longer allowed to do American College of Mohs Surgery fellowships, so this will likely increasingly become exclusively derm. True - I guess I associated procedures with major procedures. Cryo is relatively simple and so are the biopsies compared to anything else almost. Didn’t know that about Mohs. Link to comment Share on other sites More sharing options...
MarsRover Posted March 23, 2018 Report Share Posted March 23, 2018 6 hours ago, rmorelan said: Minor point - but diagnostic radiology is actually the field that does all the biopsies (prostate, lung, abdominal, breast, thyroid...., thoracentesis, paracentesis, LP drains/aspirate/chemotherapy, nephro/biliary/abscess tubes. GI tube placement, RF ablations, spine injections, joint injections and aspirations........... NOT IR radiology. It is a part of the job I actually really enjoy and I get to routinely stab people ha. IR radiology does all of the angio-interventional work - anything that has to access a blood vessel. Now because a IR rad is also a general rad they can do the above as well and it may be structured that way but often it is well any rad. 20-30% of the job is often doing procedures. People often don't realize that. We have been doing procedures a lot longer than IR even existed. Can you tell me if procedures are something that the residents tend to end up doing more, or is it up to the individual radiologist how much they do? I have shadowed a few times because I did hope to see that procedure side. On ultrasound there weren't any that day, then x-ray stuff, mri day, another ultrasound day, and fluoro day. Didn't end up seeing many procedures although definitely a couple with fluoro. Is it day dependent and i was just there on a bad day - or can a radiologist sort of try to gear themselves into have more or less procedures? Link to comment Share on other sites More sharing options...
rmorelan Posted March 23, 2018 Report Share Posted March 23, 2018 58 minutes ago, MarsRover said: Can you tell me if procedures are something that the residents tend to end up doing more, or is it up to the individual radiologist how much they do? I have shadowed a few times because I did hope to see that procedure side. On ultrasound there weren't any that day, then x-ray stuff, mri day, another ultrasound day, and fluoro day. Didn't end up seeing many procedures although definitely a couple with fluoro. Is it day dependent and i was just there on a bad day - or can a radiologist sort of try to gear themselves into have more or less procedures? Yeah that is a bit trickier than just a normal day at an academic centre - first off the the fellows/residents are doing most of the work because it is important training and the stuff already know everything. Next trainees are often tricky as we already have one, you don't have radiation clearance/badges etc, and in an academic hospital often just a subset does the majority of the procedures (faster, more efficient, some really like/hate them.....). At our centre for instance 6 staff do US biopsies in the abdomen and they do one full week at a time. Link to comment Share on other sites More sharing options...
brady23 Posted March 23, 2018 Report Share Posted March 23, 2018 This is amazing, thank you! Make sense that my narrowed specialities are the bottom 5/6 of the list Link to comment Share on other sites More sharing options...
brady23 Posted March 23, 2018 Report Share Posted March 23, 2018 Out of curiosity, what kinds of procedures do typical family physicians do? I was surprised to see it higher than IM on the list! Link to comment Share on other sites More sharing options...
ZBL Posted March 23, 2018 Author Report Share Posted March 23, 2018 13 minutes ago, brady23 said: Out of curiosity, what kinds of procedures do typical family physicians do? I was surprised to see it higher than IM on the list! Very dependent on the type of practice you want, but in an urban semi-large city for a typical FM this would normally range from some cryotherapy, IUD insertions, PAPs, joint injections, and the occasional small non-facial skin biopsy/excision. Some others will do lipomas and cysts, though usually not and send them to derm or plastics especially if on the face. In rural areas this list expands to have more low risk OBGYN, and more EM procedures. Also dependent on some of the +1 options available like OB, anesthesia, EM etc. Link to comment Share on other sites More sharing options...
Edict Posted March 24, 2018 Report Share Posted March 24, 2018 CT surgery is probably the first for procedures. Specifically, cardiac surgery does a lot of OR and does very little clinic or ward work. A cardiac resident is typically in OR 4 days a week and 1 day a week for clinic. Same with thoracics, both specialties typically rely on NPs for ward management. Neurosurgery does a lot of consults for patients that do not turn into operations. Ortho does a lot of surgery but they also have a significant amount of clinic because of lack of OR time but also because they tend to follow up patients before surgery as well. General and Vascular do a decent amount of OR, but typically General does 2 days-3 days of OR a week and they do a bit less OR because their patients are sick and they need to manage the wards. Also, not sure if you want to include IC and IR. Both do a lot of procedures, but they are subspecialties. How I would rank them: CT Surgery Orthopedic surgery Neurosurgery = General surgery = Vascular surgery Plastics Urology ENT = ob/gyn Ophtho = Derm Anesthesia Rad onc EM Rads (Diagnostic) PMR IM - (IM will do procedures on ICU/CCU) FM - (FM will do procedures but only really small ones that often aren't considered procedures) Neuro Peds Psych Public health Link to comment Share on other sites More sharing options...
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