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  • So you want to become a surgeon. You've come to the right place.

  • In this new series, we'll cover various specialties and types of doctors and help you decide which type of

  • doctor, surgeon or other healthcare professional would be the best fit for you.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our second installment of the So You Want to Be series. You can find the entire list on our

  • on our So You Want To Be playlist.

  • In this series, we highlight a specific specialty or type of professional within healthcare,

  • explaining not only what it means to be that type of provider, but also how to become one.

  • If you want to help us decide which specialty or healthcare professional to cover next,

  • drop a comment down below with your request.

  • If you like to see what it's like to be a surgeon check out my second channel Kevin Jubbal, M.D.

  • where I do another series in parallel titled A Day In the Life.

  • So far we've followed orthopedic surgeons, hospitalists, a pulmonary critical care doctor, and more.

  • Link in the description below.

  • There are several stereotypes of surgeons, one of them being that they love history.

  • So pay attention.

  • The history of surgery is a fascinating story, and my medical school actually provided us with a copy of

  • An Anatomy of Addiction to read prior to starting our first year.

  • It's one of my favorite medical books, covering Dr. William Halsted and the birth of modern surgery,

  • and if you're interested in any surgical specialty, definitely check it out.

  • Link below.

  • Until the 19th century, surgeons were trained simply by apprenticeships.

  • There weren't formal residency programs as there are today.

  • The length of training could vary,

  • usually lasting anywhere from 5 to 7 years and starting around the age of 12 or 13.

  • That's right, imagine a tweenie cutting you open and be then grateful that you live in the 21st century.

  • In the 1890s, Dr. William Osler of Johns Hopkins introduced the concept of clinical clerkships

  • and bedside rounds to teach his medical students, which are now the norm today.

  • In the early 1900s, Dr. William Halsted moved to Baltimore and was appointed the first chief of

  • the department of surgery at Johns Hopkins.

  • The modern practice and training of surgery can be largely attributed to the anal-retentive,

  • cocaine-addicted, and incredibly badass Dr. Halsted.

  • He not only created the first formal surgical residency program in the U.S. at Johns Hopkins,

  • but also pioneered many other aspects of modern surgery that we take for granted today.

  • His advances resulted in new techniques and instruments to

  • reduce damage to tissues and blood vessels, such as different types of forceps, suture, and ligatures.

  • He was also the first to introduce rubber gloves to the operating room

  • and was the father of modern sanitization in surgery.

  • We call many of his lasting impressions Halsted's Principles,

  • including modern techniques for hemostasis - meaning the controlling of bleeding,

  • accurate anatomical dissection, complete sterility, and gentle handling of tissues.

  • If you've ever had surgery, or even a small procedure using local anesthetic,

  • you can thank Dr. Halsted for it not being a barbaric mess.

  • There's a wide spectrum of surgical subspecialties, and it isn't fully agreed upon what

  • being a surgeon entails. Let's start with the most traditional forms of surgery.

  • The core is of course General Surgery, originally being the broadest category of surgery.

  • However, over the decades, it has mostly been relegated to procedures of the

  • gastrointestinal, meaning digestive, and endocrine systems.

  • In medical school and residency, we joke that general surgeons are the true masochists,

  • as their lifestyle is nothing to be envious of,

  • they don't make as high of salaries as other specialties,

  • and they handle some of the less desirable and odorous pathologies dealing

  • with abdominal contents and fecal matter.

  • But in all seriousness, it's a pretty awesome specialty and I know some great general surgeons,

  • like Dr. David Hindin who provided me some insights about general surgery when making this video.

  • Be sure to check out his channel.

  • General Surgery residency is five years, after which you can specialize further.

  • Colorectal surgery is a one-year fellowship,

  • dealing with pathologies such as colon cancer or inflammatory bowel disease.

  • Minimally invasive surgery is also a one-year fellowship,

  • and focuses on techniques like laparoscopic surgery that are less invasive than

  • the traditional open abdominal procedures.

  • Transplant surgery is one to two years, and focuses on kidney and liver transplants most commonly,

  • but also pancreas transplants and access procedures such as

  • dialysis fistulas and peritoneal dialysis catheters.

  • Surgical critical care is one year, focusing on patients who are more medically unstable

  • and requiring acute surgical interventions.

  • Pediatric surgery is one to two years, obviously focusing on surgery in babies and children.

  • Vascular surgery is also a one to two year fellowship, dealing with procedures of the aorta,

  • carotid arteries, varicose veins, dialysis access, or other procedures dealing with arteries and veins.

  • Surgical oncology is one year, dealing with cancer pathologies,

  • meaning the resection, or removal, of the tumor.

  • Breast surgery is one year, focusing on breast cancer and other breast pathologies.

  • Surgical oncologists and breast surgeons remove the tumor but they don't cover the defect themselves.

  • They turn to plastic surgeons for complex coverage and reconstruction.

  • Plastic surgery is moving toward an integrated residency,

  • meaning six years of dedicated plastic surgery training after medical school.

  • However, there are some more traditional independent pathways,

  • meaning three years of plastic surgery fellowship after completing five years of general surgery.

  • Cardiothoracic surgery is two to three years, focusing on surgery of the heart and thoracic cavity,

  • although there is also a six-year integrated pathway, similar to the plastic surgery route.

  • Hand surgery is a one-year fellowship, although only a few percent of practicing hand surgeons

  • take this route after general surgery.

  • Over 95% of hand surgeons have completed an orthopedic surgery or plastic surgery residency first,

  • and then take a 1-year hand fellowship.

  • This was the path I was intending to take after completing my plastic surgery residency,

  • but I said YOLO and resigned in 2018.

  • There are other fields that perform surgical procedures, but some surgeons wouldn't call it

  • surgery in the traditional sense.

  • OB-GYN doctors perform procedures like Cesarean sections,

  • which is less refined, way more crude, and far less complex than regular surgery.

  • That being said, OB-GYN doctors also do hysterectomies,

  • meaning surgical removal of the uterus, and other gynecology oncology resections that

  • certainly count as surgery.

  • The other surgical specialty that isn't really surgery is Ophthalmology.

  • We generally consider ophtho to be more of a procedural specialty than a surgical subspecialty.

  • Entering medical school, surgery really wasn't on my radar.

  • I was enamored with the idea of being a gastroenterologist and helping pediatric patients

  • that have inflammatory bowel disease and other similar pathologies.

  • I've always known that I wanted to work with my hands,

  • as it's something that comes naturally to me and I greatly enjoy it,

  • but I soon realized that the procedures of gastroenterology aren't as complex,

  • nuanced, or varied as I would like.

  • I could not imagine myself doing scopes for the rest of my career.

  • The procedural complexity and excitement in surgery, on the other hand, is second to none.

  • After seeing my first case, a joint neurosurgery and plastic surgery case

  • where we created a makeshift bicep out of someone's latissimus dorsi, I was hooked.

  • I couldn't believe this was real life and not science fiction.

  • If you want to hear the full story, I talk about why I chose plastic surgery,

  • including that amazing first case I saw, on my Kevin Jubbal, M.D. channel.

  • I'll have you linked to that specific video in the description.

  • If you enjoy working with your hands and enjoy complexity, challenge, and nuance,

  • surgery may be a good fit for you.

  • Other non-surgical specialties may include procedures, like endoscopies in gastroenterology

  • or skin excisions in dermatology, but they are certainly not anything like surgery.

  • Comparing these simple procedures to surgery is like comparing driving automatic with paddle shifters

  • to a true manual transmission car. Not that one is better than the other. It's just not really a comparison.

  • Another point that comes up is one's dexterity.

  • After all, surgeons need to be incredibly dextrous to perform at the highest level.

  • There are two things to say about this.

  • First, having terrible dexterity and being incredibly clumsy has been

  • a limiting factor in some people being able to complete residency,

  • but this is quite rare.

  • For most, they are able to learn how to be more efficient and effective with their hands and surgical instruments.

  • That being said, being dextrous and working at it deliberately years before you first enter

  • the operating room will serve you well.

  • I credit much of my own dexterity to building small model cars as a kid,

  • pursuing artistic endeavors, and even playing video games.

  • In medical school, I was highly disciplined about reading proper techniques for suturing,

  • knot tying, and other basic procedures, and practiced religiously at home or even while listening in lecture.

  • I would brush my teeth and open doors with my left hand, a habit I still practice to this day.

  • This sort of dedication served me well,

  • as attendings noticed I was operating several years past my training level.

  • In fact, the chair at a highly prestigious plastic surgery residency even said

  • I was operating at a second or third-year resident level while I was a fourth-year medical student.

  • By demonstrating competence, attendings will trust you and allow you to do more.

  • Many medical students or interns complain about not being able to do much in the operating room.

  • I tell them it's probably because they haven't developed the skills

  • to warrant being able to do much beyond retracting.

  • By working at my skills, just a few months into residency I was able to do my own half of a blepharoplasty.

  • Blepharoplasties are challenging procedure usually reserved for higher-level residents,

  • as they involve highly precise operating on the eyelids, which is the thinnest skin in the human body.

  • Surgery is awesome, but being a surgeon is not without major costs.

  • The main factor holding people back from choosing a surgical specialty is the lifestyle,

  • meaning your work-life balance, or rather lack thereof.

  • You'll work harder than non-surgical physicians, which only makes sense.

  • Not only do you have to round on your patients and handle them medically,

  • but also handle them surgically which can take several hours for each case.

  • Within surgery, some subspecialties have more challenging and demanding lifestyles than others.

  • Residency for just about any of the traditional surgical specialties is going to be very challenging.

  • As an attending, however, the lifestyles are more variable.

  • As a general rule, any surgical specialty withcallfor urgent medical conditions

  • is going to result in a more challenging lifestyle.

  • Not allcallis created equal, as sometimes when you're paged you need to come in immediately,

  • and other times you can just wait until you come later in the morning.

  • When I was rotating on a sub-internship on a burn service in plastic surgery,

  • we paged the dermatologist at 3 AM for ruling out a life-threatening condition, but she only showed up at 6 AM.

  • Dermatologists simply aren't used to life or death situations.

  • On the other hand, trauma surgeons and neurosurgeons have the most challenging lifestyles,

  • as their call includes emergency situations requiring a rapid response.

  • Other surgical specialties with more demanding call schedules include general surgery,

  • cardiothoracic surgery, and vascular surgery. Orthopedic surgery call isn't that bad,

  • unless you specialize in orthopedic trauma.

  • Plastic surgery call isn't that bad either, unless you specialize in microsurgery.

  • We'll be covering these subspecialties in greater detail in future So You Want to Be videos.

  • If you'd like to watch those, make sure you are subscribed and have the notification bell enabled.

  • This may not be all that intimidating to you right now.

  • When I was in college, I actively despised sleep, since it felt like a waste of time,

  • and I wouldn't think twice about having any issues with a challenging lifestyle.

  • Truth is, the demanding lifestyle of surgery impacts everyone,

  • no matter how efficient or dedicated or high energy you are.

  • Pushing yourself to the limit day after day, year after year, is not the healthiest or most sustainable way to live.

  • If you ever decide to have a family or want to travel and pursue other time-consuming hobbies,

  • there's obviously an impact there as well.

  • For that reason, most surgeons say only choose surgery if you cannot see yourself doing anything else.

  • The cost of being a surgeon is simply so high.

  • If you enjoyed this video, you'll love my weekly newsletter.

  • It gets sent out once a week and is super short.

  • In it I share actual lessons that I've learned, tools, tips and resources available only if you sign up

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  • Check it out at MedSchoolInsiders.com/Newsletter.

  • If you ever change your mind, It's one to click unsubscribe and I promise I will never spam you.

  • Are you interested in becoming a surgeon?

  • If so, let us know down below what's driving your and what type of surgeon do you want to be.

  • As always, thank you all so much for watching,

  • much love to you all and I will see you guys in that next one.

So you want to become a surgeon. You've come to the right place.

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