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 with “call” for urgent medical conditions
is going to result in a more challenging lifestyle.
Not all “call” is 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.
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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.