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  • So you want to be a general surgeon. You like the idea of being the generalist of the operating

  • room, having the knowledge and skills for a wide range of surgical interventions. Or

  • maybe it's just a stepping stone for you to get to the subspecialization you're after.

  • Let's debunk the public perception myths, and give it to you straight. This is the reality

  • of general surgery. Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want to Be. In this series, we highlight a

  • specific specialty within medicine, such as general surgery, and help you decide if it's

  • a good fit for you. You can find the other specialties on our So You Want to Be playlist.

  • If you want to vote in upcoming polls to decide what future specialties we cover, make sure

  • you're subscribed. If you'd like to see what being a general

  • surgeon looks like, check out my second channel, Kevin Jubbal, M.D., where we'll be covering

  • a day in the life of a general surgeon in the future.

  • General surgery is the broadest of surgical fields, covering the surgical management of

  • diseases from head to toe. This may include head and neck surgeries to thoracic to interventions

  • inside the abdomen. Operations can range from removing cancer, to treating traumatic injuries,

  • to restoring function to diseased tissue. We think of surgeons most commonly in the

  • act of performing surgery, but a big part of the work surgeons do is taking care of

  • surgical patients. This includes diagnosing a patient's illness, assessing various interventions,

  • and caring for the patient before and after surgery. Examples include staging a cancer

  • patient prior to surgical intervention or managing ICU patients who are postoperative

  • yet remain very sick. Even the busiest surgeons are in the operating

  • room only a couple days per week. The rest of their time is spent seeing new patients

  • or postoperative patients in clinic. If the surgeon is part of an academic center, they'll

  • also have to divide their time between academic responsibilities, including teaching and research.

  • This brings us to an important method of differentiating a general surgeon's practice.

  • In academia, general surgeons tend to be more specialized, meaning they've done a fellowship

  • after residency and are managing patients within a specific niche. At these larger academic

  • institutions, you're also more likely to see complex and rare pathologies that are infrequently

  • managed at smaller community practices. In community or private practice settings,

  • general surgeons are more likely to operate without fellowship training, although several

  • are still fellowship-trained. Compared to an academic practice, community and private

  • practice general surgeons have higher average compensation.

  • Let's clear up some of the misconceptions about general surgery.

  • First, some think that general surgery is the specialty for medical students who want

  • to be surgeons but aren't competitive enough to match into a more desirable surgical subspecialty,

  • like plastic surgery, neurosurgery, orthopedic surgery, and so on. The truth is that general

  • surgery has a great deal to offer that is unique from other surgical fields, and for

  • that reason attracts a large number of candidates. Second, the challenging lifestyle aspects

  • are often overstated, at least for when you're a fully trained attending physician. Ultimately,

  • your work-life balance comes down to the type of specialization within general surgery you

  • pursue, in addition to the type of job you seek out. You have the ability to negotiate

  • toward a true lifestyle specialty to something more stereotypically intense.

  • After medical school, general surgery residency is 5 years, although some programs have 2

  • mandatory research years built in for a total of 7 years. The 7 year residencies are usually

  • at academic residency programs and are preferred by medical students who are either seeking

  • an academic career or want to apply into a more competitive fellowship.

  • As a PGY1, also known as your intern year, you're usually not operating much, and are

  • instead focused on managing surgical patients on the wards, meaning those staying in the

  • hospital, usually requiring post-operative care. You ensure floor work is taken care

  • of and act as the eyes and ears for the rest of the team who are usually scrubbed into

  • cases or handling clinic. Once you finish your work, you're generally welcome to join

  • your team in the operating room and scrub into cases.

  • As a junior resident, meaning your PGY2 and PGY3 years, you'll have one intern below you

  • and one senior above you on any service. If new consults come in, you'll be seeing them.

  • If you're in the operating room, you're likely doing smaller or more straightforward cases,

  • while the more complex cases are handled by the senior resident.

  • As a senior resident, meaning your PGY4 and PGY5 years, you handle the most complicated

  • cases and have the most autonomy, both inside and outside of the operating room. That translates

  • to making treatment decisions and putting plans into place, and operating with less

  • supervision. In your chief year, meaning as a 5, when you are most senior, you will also

  • have the added responsibility of handling light administrative work for the residency

  • program, such as schedules and responsibilities for the residents below you.

  • Research years, if required by the program, are typically done after either PGY2 or PGY3.

  • Residents typically maintain some level of clinical involvement during this time to keep

  • their clinical acumen sharp, such as by taking call occasionally or covering overnight shifts.

  • In terms of competitiveness, general surgery is middle of the pack with 70 points in our

  • MSI Competitive Index, ranking below vascular surgery and above med/peds. Of the surgical

  • specialties, general surgery is the most attainable. The match rate is 84%, average USMLE Step

  • 1 is 235, and average Step 2CK is 247. After completing general surgery residency,

  • you can further subspecialize with fellowship. Historically, any form of surgical specialization

  • through fellowship always followed a general surgery residency. This is termed the independent

  • pathway. If you wanted to become a plastic surgeon, you would first complete 5 years

  • of general surgery residency, followed by 3 years of plastic surgery, for a total of

  • 8 years. As medicine has moved further toward specialization,

  • combined pathway programs cropped up, whereby you would complete 3 years of general surgery

  • residency followed by a few years of specialty training. For example, combined plastic surgery

  • programs combined 3 years of general surgery residency with 3 years of plastic surgery,

  • for a total of 6 years. And finally, the integrated pathway is now

  • gaining momentum, whereby you match and complete training in your surgical specialization from

  • day 1 of residency. Neurosurgery and orthopedic surgery have done the integrated pathway for

  • some time now, and there are no independent or combined options. Plastic surgery has followed

  • suit, but there are still some independent and combined programs available, although

  • they are declining in number. More recently, cardiothoracic surgery integrated programs

  • have been cropping up around the nation. Integrated pathway programs are shorter and more focused

  • on your ultimate specialization. However, they are usually substantially more competitive

  • than going the independent pathway, and some are concerned about weaker training in the

  • fundamentals of surgery. To specialize in critical care you'll complete

  • a 1 year fellowship, although a 2nd year is usually completed for those who ultimately

  • want to work at busy trauma centers. Trauma and critical care combine the best of both

  • worlds – you get both high-intensity surgeries but also clock out when you're not on shift.

  • As a result, you get decent control over your lifestyle.

  • Typically these surgeons also have a component of their month for elective general surgery

  • and emergency general surgery call, which can be flexible depending on the surgeon's

  • preferences. We have a full episode on trauma surgery linked below.

  • Colorectal surgery is a 1 year fellowship for the general surgeons who appreciate a

  • decent lifestyle and a wide variety of procedures, from colonoscopies to small outpatient procedures

  • to bigger cancer operations, including both minimally invasive and open cases.

  • Pediatric surgery is a 2 year fellowship whereby you essentially become a general surgeon for

  • children. Compared to adults, your patients will bounce back faster from surgeries. Your

  • bread and butter will include a large amount of gastrointestinal surgeries, treating emergencies,

  • and correcting congenital birth defects. Within pediatric surgery, there is a high

  • degree of specialization. For example, a neurosurgeon or orthopedic surgeon or plastic surgeon can

  • subspecialize in various pediatric-focused specialties. As a result of this specialization,

  • it is often difficult to find general pediatric surgeon job openings. You might have to take

  • a job in a part of the country you might not otherwise have chosen.

  • Breast is a 1 year fellowship, focusing primarily on resecting cancer from the breast. The hours

  • are considered less intense compared to other surgical fields and its more conducive to

  • a balanced lifestyle. You'll be working in close conjunction with plastic surgeons who

  • will be reconstructing the breast usually immediately after.

  • Vascular is a 2 year fellowship. With technological advances, many of your cases are endovascular,

  • whereby you use wires and stents to fix issues within blood vessels, from the aorta on down.

  • You'll also be involved in reconstructing vascular supply to the body's organs while

  • working in tandem with other surgeons, such as during massive tumor resections, repairs

  • after trauma, and so on. Endocrine is a 1 year fellowship whereby you'll

  • specialize primarily in surgeries of the thyroid, adrenal gland, and to a lesser extent pancreatic

  • lesions, which are more often handled by hepatobiliary or surg onc teams. Endocrine has a great lifestyle,

  • as there are typically few emergencies on-call and working hours are considered favorable.

  • Transplant is a 2 year fellowship primarily focusing on kidney and liver transplants from

  • deceased donors to live recipients. Less commonly, you'll be performing pancreatic transplants

  • or live donor liver transplants, whereby part of the liver is transplanted given the unique

  • regenerative properties of the liver. This is one of the most rigorous and challenging

  • specialties from an hours and technical standpoint. Not only are liver transplants extremely lengthy

  • and difficult to perform, but you can also get called nearly 24/7, as donor availability

  • is usually unplanned and harvesting is highly time sensitive.

  • Surgical oncology is a 2 year fellowship focusing on surgical management of cancer throughout

  • the body. Bread and butter includes breast cancers, colon cancers, soft tissue cancers,

  • such as sarcomas, and other abdominal cancers including the liver or pancreas.

  • It's a competitive fellowship, the hours can be long and demanding, but those who are

  • drawn to this line of work find it highly rewarding.

  • Minimally invasive surgery, aka β€œMIS,” is a 1 year fellowship where you gain additional

  • training in advanced laparoscopy and robotic skills. This often, but not always, translates

  • to focusing on minimally invasive foregut surgery, bariatric surgery, and abdominal

  • wall reconstruction. It's more on the competitive side and is considered to have a good lifestyle

  • after training. You can also pursue fellowships in cardiothoracic

  • and plastic surgery, both of which we've done dedicated So You Want to Be episodes on. Link

  • in the description. There's a lot to love about general surgery.

  • General surgeons are the ultimate physician, or the "doctor's doctor." They can broadly

  • diagnose, stabilize, and treat nearly any acute life threatening condition and then

  • take it up a notch by fixing the problem with their hands. If you could pick only one type

  • of doctor to be stranded on a boat with, you'd want a general surgeon.

  • General surgery is immensely satisfying. You're intervening to save someone's life on the

  • brink of death, curing cancer, transplanting organs, and more. These are some of the most

  • exciting and deeply meaningful things you could ever ask for in a job.

  • Compensation is in the upper half of specialties, with general surgeons pulling in approximately

  • $373,000 per year. And there will always be a need for general

  • surgeons. While general surgery is awesome, it's not

  • for everyone. Training is lengthy, much more so than non-surgical

  • fields. While your non-surgical medical school classmates are finished with residency and

  • living their attending lives, you'll still have another few years to complete.

  • The hours in training are also long. There will be plenty of early mornings, late nights,

  • busy overnight call, and surgeries lasting several hours. And while there is some flexibility

  • in your work-life balance after you finish training, know that the average surgeon still

  • works 60 hours per week. And finally, compared to other surgical specialties,

  • general surgeons have the lowest compensation. How can you decide if general surgery is right

  • for you? They say that if you can find happiness in another specialty of medicine, then do

  • that. Only do general surgery if you couldn't imagine yourself doing anything else.

  • If you're passionate about medicine broadly and like the idea of being a doctor's doctor,

  • general surgery might be for you. You should love working with your hands, thrive in having

  • a serious level of responsibility for your patients, and crave and enjoy deep, meaningful