Next up in the MSH Specialty Review Series is general surgery. I’m now going to begin each review with a summary that can be easily scanned for important information.

Summary Review

Residency Training Information

• 5 year residency
• 80+ hour work weeks
• Expect around q4 call

General Surgery Trends

• Overall interest declining
• Lifestyle cited as top reason
• Despite this, above-average board scores needed to secure spot

Post Residency Careers

• Job market looks good
• Demand for surgeons is up as fewer enter the marketplace

Salaries

• Salaries average at around $261,000 annually

Lifestyle

• Overall considered “poor”
• General surgeons reportedly worked an average of 60 hours per week

Rating

• 3.5/10

Introduction

Surgery is without a doubt one of the most demanding specialties that a medical student can choose. Interest in surgery has decreased to a low of 5.3 percent in 2002. Television shows such as Grey’s Anatomy, which frequently glamorize the surgical lifestyle, has the potential to pique interest in the surgical specialties once again. Some state that the 80 hour weekly work week implemented in 2003 has increased interest in surgery again.

Residency Training Information

Preparation for a practice in general surgery is 5 years. Expect an additional 2-3 years if you want to sub-specialize with a surgical fellowship. Average residency salaries start in the high $30,000 per year range, but given the number of hours you’ll be working, your average hourly wage will be lower than specialties that aren’t as demanding. General surgery participates in the regular NRMP match.

Residency work hours are grueling. Expect no less than 80 hours per week. In fact, it’s pretty safe to say that you’ll work over 80 hours and be expected to “fudge” the numbers if necessary. This is quite common from surgical residents that I have spoken to, and while not something that will be exposed except on rare occasions, is probably more common than not.

Call while in residency will obviously vary by program, but q4 call would probably be a safe bet for programs across the board.

According to this study, an average of 2753 hours or 14.3% of 19,200 hours (5 years of 80-hour work weeks) were spent as a chief surgeon, 272 hours as an assistant, and another 938 hours for immediate preoperative and postoperative attendance. The average total time for operative training was 3963 hours or 20.6% of 5 years of 80-hour weeks (16.5 h/wk).

Keep in mind that working residents past the 80 hour work week will certainly vary by program. I hope you’re reading this review for the real deal. I won’t lie and say that you won’t work over 80 hours. I honestly believe that as a surgery resident, you will.

General Surgery Trends

Based on my experiences and research overall interest in surgery is declining, and lifestyle is the top reason cited. Today’s medical student is a smarter medical student - looking towards a healthy life and reasonable work hours. This is a very good change, and is something that surgical residency program directors need to take into consideration.

However, those students genuinely interested in surgery throw lifestyle out of the window. The fact is that somebody has to do it - I’m just glad it’s not me. Despite the overall decline in interest, general surgery is still considered a competitive field, and above-average board scores and grades are generally required to secure a spot for residency.

It’s important to consider the opportunity cost that is given up when choosing surgery. Most residents won’t be ready to hit practice until 7-8 years down the road, as more and more physicians are choosing to go the fellowship route. Compare this with some of the less demanding specialties that require 3 years’ worth of post-graduate training.

Post Residency Careers

The job availability for a general surgeon appears to currently look good. For example, a general surgery job search at Locum Tenens shows over 1500 results from all over the country.

Residents do report getting several job offers throughout their residency career. Be wary of promises of guaranteed income, however. Most income guarantees are only until you get on your feet, and typically for a year or two at most.

The post-residency job availability is probably due to the overall decrease in demand for careers in general surgery altogether. With fewer surgeons being trained each year, there will be a natural increase in available jobs as demand for surgical procedures remains unchanged.

“There is a concern,” said Brundage. “Surgery is a highly valuable commodity and as the numbers of surgeons are on the decline, access to surgical care will be more difficult. Even at this time in the United States, there are waiting lists of six to eight months for some non-emergency surgical procedures. Rural communities and inner cities are particularly underserved. As the numbers of surgeons decline, there is bound to be an even more pronounced shortage of surgeons.”

Nevertheless, the promise of increased jobs is certainly a trade off for lifestyle should you choose a career path down the surgical road.

Salaries

Salaries for general surgeons are above average for medical specialties. Using salary data from 2 different sources, we see salaries ranging from a low of $150,000 annually to a high of $520,000 annually reported. The averages are more in line of what we need to be looking at, and across the two data sources I have a calculated average of $261,000.

As far as salary trends go, the low-end salaries actually decreased from 2002 to 2006, while average salaries increased during the same time period. This is probably due to the reporting of higher salaries on the high end of the spectrum, bringing the average back into line.

If the shortage of general surgeons continues, expect increases in salaries as practices attempt to recruit more surgeons. It’s unclear at this point whether salary increases will be enough to entice medical students to pursue general surgery, but given comparable salaries in other medical specialties with less demands, some more drastic changes may be required.

Lifestyle

The lifestyle of a surgeon is considered poor by today’s medical students. In fact, the number three reported reason for dissatisfaction with general surgery was cited as “lifestyle issues” by practicing general surgeons today. This was behind reimbursement and medical liability issues, respectively.

In general, practicing general surgeons work unpredictable hours and average 60 hours per week in actual practice. These average work hours were close to the top of the list, exceeded only by OB/GYN Anesthesiology, and Urology. Expect rounding on your patients both pre- and post-op, as well as a rigorous schedule in the OR. Call will depend upon your employment situation.

Interestingly, spouses of general surgeons were found to be the major decision makers at home as well less likely to work outside of the home. Further, they were less likely to give credit to the general surgeon for contributing to household duties and childcare. Probably a result of less family time on the part of the general surgeon, but these results are interesting and something I ran across during my research.

Final Thoughts

To be a surgeon for the remainder of your working life will take many sacrifices, many involving your personal and family life. The salary of a general surgeon is above average for medical specialties, but certainly involves trading a great deal of time for that money.

Post-op patients are frequently very sick, and changing wound dressings or swabbing wound discharge might not be as appealing to you after 20 years of practice. Of course, there’s always the question “have you passed gas or stool today, Mr. Smith?”

You will be at an increased risk for infectious disease exposure, and operating on patients who cannot pay for services rendered will be somewhat common depending upon your practice situation.

On the other hand, if the only place you feel at home is the OR, then a career in surgery may be for you. Surgeons typically enjoy working with their hands, and it is often considered a more “procedural” versus “cerebral” specialty. If you enjoy doing procedures, suturing, and generally seeing patients improve after a case, then you just might be cut out to be a surgeon.

The job market looks promising for residents that are finishing up training in general surgery, and I expect for that to continue as fewer general surgeons enter the job marketplace.

At the end of each review, I’m going to break it down into two factors: Lifestyle and Salary. The idea is to find the best combination of these two factors. In my opinion, that is the perfect specialty.

Final Rating:

Lifestyle: 0/10
Salary: 7/10
Average: 3.5/10

Resources

• Locum Tenens 2006 General Surgery Salary Survey
• Surgery career lifestyle unappealing to medical students, research reveals
• Student Doctor Surgery Forums
• How much time do surgical residents need to learn operative surgery?
• Locum Tenens
• Physician Salaries
• 2006 Review of Physician Recruitment Incentives
• Average Hours Worked By Specialty
• Gender differences among spouses of surgeons
• American College of Surgeons
• Successfully Navigating the First Year of Surgical Residency: Essentials for Medical Students and PGY-1 Residents

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• Pediatrics

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