Becoming a Surgeon: Who, What, Why, and How

The following post is courtesy of Survivor D.O, a real-life surgical resident. He created a great site: Surviving Gray's that you should definitely check out. If anyone knows something about becoming a surgeon, it is him. Enjoy. 

General surgery. From the Halstedian gods of past we are left with a rapidly evolving field. Most are intrigued by it, many are scared of it and some are even disgusted by it. It is perhaps the most divisive medical specialty out there, but let’s shed some light on it.

Why I chose general surgery

When I tell people I am training to become a general surgeon I consistently get one of two responses. Many people have the “that is really cool” response. They genuinely think it is neat that I cut people open for a living (I do too!). However, the most common response I get is a look of surprise/disgust/disdain all mixed into a comedic facial expression. “But you don’t seem like an asshole, I thought all surgeons were assholes?”. Truth is, we have developed a bit of a reputation. At times it has been well deserved. I think where some of that reputation comes from, and what drew me to the field, is that we like to get things done. TCBing (taking care of business…ing) as I like to call it. It comes down to this:

The defining intervention in a patient’s hospital course is often made by a surgeon.

Need emergency dialysis access? Call the surgeon. Need that hemorrhaging colon taken out? We’ll put it in the bucket. Don’t get me wrong, I have great respect for the medicine doctors and they play an integral role in a patient’s care but their entire day is what composes the worst hour of my day. Continuously rounding and writing notes on patients without sticking at least one of them with a pointy object is my own personal hell. I am, to put it simply, a doer.

Who chooses a career in general surgery?

General surgery, like most of medicine, is an evolving field. What used to be a group of old white guys in suits without a sense of humor has morphed into an increasingly diverse population inclusive of all races, sexes and creeds. As an upper middle class white guy I didn’t exactly break the mold, however, my colleagues have. Women now make up one-third of physicians (and that number is increasing) and are filling a whopping 40% of the general surgery spots. There is no longer a “typical” student that goes into surgery; interest and ability are defining the field. Follow the guide in the Choosing a Medical Specialty posts and if you still are interested in surgery then go for it!

women in general surgery

What is a career in general surgery like?

If you have read any of my other posts you have probably figured out that at this point I am still a lowly intern so I am clearly not fully equipped to give a complete answer to this question. However, I do have a better idea than most of the knuckleheads out there. Surgery, and general surgery in particular, is typically thought of as a poor lifestyle choice. Check this out:

work hours by surgical specialty

Now this is old data and I would ignore the salary figures. Draw your attention instead to the number of hours worked. They are all pretty similar across the spectrum. The difference is your ability to choose WHEN you work those hours.

Surgeons by their very nature deal with acute problems. Unfortunately one cannot decide when these problems present themselves. With the traditional call model this leads to an admittedly crappy lifestyle (although I still contend that if you love what you are doing it doesn’t matter). However, there are options out there. There are plenty of surgeons working 8 AM to 3 PM four days a week in wound care or breast centers. The development of the surgical hospitalist model will likely relieve some of the pressure from the traditional general surgeon.

As for me, I can only comment on my life as a surgical intern. I love my job. Hours are long, there is plenty of scutwork and I often want to throw my pager at the wall but overall it is rewarding. Everyday I go into the hospital I know I am going to learn how to better treat a medical condition, push my boundaries in a new way and continue to hone my technical skills.

surgical intern pagers

How do I decide if general surgery is right for me?

I often get asked the “is general surgery right for me” question. The best answer I have come up with is this. Lay out every single medical specialty before you. If you can see yourself doing anything other than general surgery then don’t do it. It is simple! You have to love every aspect of surgical patients. Liking the OR is not enough.  You have to love working them up in the office, taking care of them after their operation and dealing with the inevitable complications. In case you haven’t noticed there are a lot of grumpy surgeons out there. You better be sure this is what you want to dedicate your life to before you head down this track.

I choose surgery because it allows me the chance to make an immediate and lasting intervention with my own two hands. The buck stops with us. I truly believe we are the most well-rounded physicians in the hospital (Mrs. Survivor DO’s “bullshit-meter” is literally going to explode when she reads this). I don’t say this out of jest but just ponder this:

If you were stranded on a deserted island what type of physician would you rather have with you than a general surgeon?