Thursday, January 19, 2012

A med student asks, “Is surgery the right career for me?”

A third-year medical student emailed me with some interesting questions asking how one can confirm whether surgery is the right career choice. She said she had just completed a two-week rotation of nights and felt that she handled it well.

How does a student know if surgery is right for her? That's a tough one. I'm afraid that working only 2 weeks of nights, while certainly hard, is a little misleading. Anyone can do 2 weeks of nights. Surgery training is 5 years with a lot of nights, weekends and long days. I think that one of the reasons there is a 25% attrition rate among general surgery residents is that their medical school experience is nothing like what residency really is. [See my blog about this.] Don't forget that it continues when you become an attending. The attending surgeons in private practice where I now work are putting in a lot of hours, sometimes more than 80/week. I'd suggest you take an elective of at least 6 weeks in general surgery as your first 4th year course. Find a good elective in a busy trauma center. If you still like surgery after 6 weeks of doing that, it might be right for you.

Here is an interesting website. It features the “Medical Specialty Aptitude Test.” I took it and here were the top 10 specialties it suggested for me.

And here are the bottom 10.

In my case, the test was pretty accurate with two exceptions. One is listing neurology and nuclear medicine in the top 10 and the other is colon and rectal surgery in the bottom 10.

What about other fourth-year electives? [I blogged about this also.] Note that my suggestions were only my suggestions. I don't know if all, some or no program directors agree with me. I'm a little out of the loop and don't know if “audition” electives [The student takes an elective at a hospital where she wants to train so that she may be seen performing well.] are still mandated by some programs.

How can I tell if I will be competitive for some of the big name surgical training programs? If you are above the 90th percentile of USMLE Parts I and II, you should be OK for all but say, the Mass Generals and Stanfords of the world. I'll tell you a secret. USMLE scores are second only to AOA in importance for surgery program directors.

By the way, most general surgeons I know like what they are doing but are discouraged about declining reimbursements, lawsuits, paperwork and more.

There is a predicted shortage of us though. [See my blog about this.] One will always be able to find work.


Brian Sabb said...


Another nice blog...thanks!

The online test is very cool. It was pretty accurate for me too.

I am not familiar with all programs and all specialties. However, I know that audition rotations are very helpful. Many students would not have a chance at certain programs without these rotations.


Dr. Brian Sabb

Skeptical Scalpel said...

Dr. Sabb,

Thanks for commenting. Interesting to see that the audition elective is alive and well.

Anonymous said...

I gotta confess i took that aptitude test to back up my decision to become a surgeon a few years ago...& i do belive in trying it out during electives to make sure ;)

Skeptical Scalpel said...

I'm a little skeptical about aptitude tests. I hope your electives go well.

Anonymous said...

USMLE score second to AOA? I really don't get that... is that not variable by what med school you are at / who your class is composed of?

I enjoy your blog posts and your attention to the comments - thanks for all your work.

Skeptical Scalpel said...

You raise a good question. I can't explain it. I think AOA only applies to less than 10% of each class.

Also, there have been papers pointing out that USMLE scores don't correlate with resident performance. I'm not sure if there are similar ones regarding AOA status.

Survivor D.O. said...

As someone who completed the applications process to general surgery programs last year I can confirm that audition rotations are still of utmost importance. Some programs I came across will not even offer interviews to students who have not rotated there, regardless of scores.

Having now seen the process from behind the scenes I can tell you my program's two main considerations are boards scores and how well we think you would get along with the rest of the team.

Survivor D.O.

Skeptical Scalpel said...

I am amazed that audition rotations are still considered important. I was burned more than a few times by a student who was a star on a 4-week elective rotation but who burned out when it came to doing it for a year of residency.

Skyhigh said...

Surgical carrier is long and at times boring. You feel frustrated at not getting enough cutting, spending days (and nights) in wards. The true rewards come at.least after 10 years of giving your life to this profession. Once you learn your art, its a different feeling to work and operate.

Skeptical Scalpel said...

Skyhigh, interesting way to look at it. Like many occupations, it can become routine. I'm not sure it takes 10 years to learn your art. I think you never stop learning.

Anonymous said...

As a trauma/critical care surgeon, I took the test and it gave me ENT, pulmonology, orthopedic surgery, general surgery, and thoracic surgery as my top 5, so I guess it's pretty accurate...haha!

Skeptical Scalpel said...

Accurate for you, maybe. Interesting that pulmonology and orthopedics are in the same group. I certainly would not base my career choice for the next 40 years on that.

Anonymous said...

I am a recently matched med student in general surgery. I interviewed all over the country at mostly academic institutions which I did NOT do audition rotations in. I've actually been told more than once audition rotations "can hurt you more than help you" in addition to costing big bucks. I think this only applies to General Surgery. Surgical sub-specialties are more demanding of it.

Skeptical Scalpel said...

Anon, thanks. I agree that audition rotations probably don't help much in general surgery. I too have heard that some specialties use them more.

Paula Lewis said...

Hi guys, I really enjoyed your blog it was quite inspirational, keep posting! Dr Heekin

Espoir said...

wonderful blog! And very good article!We actually wonder whether we are in the right for the job or not!

Marko said...

I keep always asking myself that question! But finally we know what's best.
Thanks for this inspiring article! wonderful!

Skeptical Scalpel said...

Mario, I appreciate your comment, but tell me, is surgery the right career for you?

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