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 “MIS,” 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
connection with patients. The joke that surgeons just put patients under anesthesia and don't
interact with them couldn't be further from the truth.
Huge shout out to my friend Dr. David Hindin for helping me with this video. He’s a YouTuber,
general surgeon, and current surgical critical care fellow at Stanford. He has an awesome
YouTube channel and is an expert on innovation in medicine. Go show him some love, link to
his channel in the description. Are you hoping to become a general surgeon?
To get into medical school and match into general surgery residency, you’ll need to
score well on your class tests and standardized exams. As you look at resources and companies
to work with, seek out those who are actual MD physicians, not PhD or other types of doctors
that didn't go to medical school. Look for those who have achieved stellar results themselves,
a track record of success with positive ratings from customers, and a systematic approach
so you know you'll always receive high quality service. If you decide on Med School Insiders,
we'd love to be a part of your journey in becoming a future physician. Visit us on MedSchoolInsiders.com.
Thank you all so much for watching! If you enjoyed this video, check out our So You Want
to Be an Internist video, or another specialty on our So You Want to Be playlist. And go
show Dr. Hindin some love. See you all soon.