ortho v gen surg

Do your ortho rotation and if you like try to match in it. You can always find Gen surg spots

I had the same problem, until I actually did my gsurg rotation during my 3rd year. Prior to my 3rd year I was drawn to the trauma side of gsurg because it truly is cool, but when I did my 3rd year surgery clerkship i realized that I hated dealing witht he other aspects of gsurg like rectal abscesses/fistulas, bowel...any part of it, colostomies...dear god colostomies, and lap choles. I actually liked lap appys for some reason. Trauma seems to have more glory, but I realzed that I couldn't avoid the other stuff.

If you like all of the aspects of gsurg and not just the trauma, and you equally love ortho then I guess you have to look at other aspects like the overall personalities of the attendings and residents, and whether your personality gels with theirs. Or the lifestyle difference between the two. Or the overall pay in the end. But I honestly haven't met anyone that has experience ortho and gsurg and loves both of them equally.

Every surgery (sub)specialty has its perks and its share of $hit-shovelling. For instance, I really enjoyed the "clean" gen surg cases... I mean, I did a 20 minute chole on a sick kid earlier this year and it was very rewarding... on the other hand, dealing with the chronic ostomies, all the post-op Whipples that die, and the general fact that a whole bunch of gen surg patients are SICK, makes it a tough field in which to stay happy.

On the other hand, most of our patients are broken---not sick---and the satisfaction of "fixing" someone keeps many coming back. Yet, you can't tell me y'all don't occasionally get tired of seeing the late-night inpatient consults for "____ pain" with negative XRs and no trauma.

Most of the Surgery attds I've worked with are of the previous generation when they were the ones at the sharp end of their med classes and, frankly, if I got shot on the way to work (you know, those "two guys who jumped me while I was mindin' my own business"), I'd damn sure hope one of them was tending to my belly vs. someone trained in GS b/c he didn't get the match s/he wanted...

The ability of ortho to turf to medicine is grossly undervalued. It is great to be able to transfer anyone with a moderately serious post-op medical problem off of your service. General surgery definitely does not do this, and as a result you will end up having to manage people on the verge of severe sepsis, horrible acute renal failure, post-op MIs, 90+ year old folks who have terrible nutritional and mental status but still need surgery for perforated bowel, etc. These people will languish on your service forever. Many will never get better, and some will die. On the flip side, all of the 80 year old ladies with hip fractures get admitted to medicine, and any serious trauma will be admitted to the general surgery trauma service. Ortho comes in, does their operation, and leaves the medical managment to the primary team. It is a beautiful thing.

The general surgery residents will tell you that they like this stuff because they are "real doctors" who can operate but still manage the medical issues. They are lying to you and/or themselves. Few (if any) people go into general surgery because they "like" managing this stuff, but they all end up doing it because they have to. I have no problem admitting that I have no interest in doing that, and that I probably will never learn it as well as the gen surg folks. I want to operate, and for people who actually want to operate without moonlighting as internal medicine docs, ortho is the way to go.

I think there's a sense of pride among gen surg residents that they manage everything and they see consulting things out as a sign of weakness.

*nod* I obviously want to do ortho, but I don't agree with the posting 2 above. I am not comfortable becoming 'dumb' to medical problems. If that means that I have to wade in crap to stay sharp, I'd rather do that. I can't tell you how many residents I saw on interviews were saying that was a plus that they didn't have to manage medical problems, etc. etc. That was a turn off to me. I'd rather suffer the extra work for a few years to have a good solid understanding of managing patients. Like, I want to take ACLS/ATLS. Maybe that's just me, or maybe I'm an idiot.. I dunno
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Agree with Iliizarovian, I'm not doing ortho because I hate medicine. I'm doing ortho because I love ortho!

well....when you are up to your ankles in open femur fractures, acetabular fxs, and a finger amputation comes into the ER all at 3 am on friday night....you will be happy that you are not getting floor pages about chest pain and acu checks, while you are covered in blood and plaster in the ER.......

Can I manage all that crap sure!!!! But medicine is like any other indusrty...specialization of labor and efficiency are king.....

I can just see you in your deposition now...SO Dr. Ilizarovian....when was the last time you read JAMA and New England journal on management of diabetic ketoacidosis in the octagenerian.......

You neophytes will see.. this not a matter of pride...its a matter of us getting our work done....sure I can roof my own house...but a company can do it faster, better, and more efficiently that me....

Sometimes its is simply better patient care to hire a consultant....do you want the general trauma surgeons putting on ex-fix and nailing femurs....I am sure they could figure out how to do it....But we do it like a craftsman that is a specialist in a trade.....

Well, like anything in life, it's about knowing your own limits. The same crap we complain about for bad EM consults, we turn around and do to IM.

The easiest way to solve this? Let residents bill for their consults!
"It's not that we're lazy, we just don't care. See, it's a lack of motivation."

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I read NEJM weekly. I don't like JAMA.

Yes, when you're overburdeoned with work, you don't want to be bothered with doing 'extra' stuff and others may do a better job.. but that's not the point.

The point is you should be halfway knowledgable about what's best for your patient, even if you send for a consult. Ultimately, the decision is yours whether or not to follow the advice or the consult.

In the realm of today's healthcare industry, everything is getting specialized for the sake of patient care and resource management, true, but at the end of the day, the more you know about everything medical, the better doctor you will be, regardless of speciality.

As training physicians in the US we are very lucky to have a big support structure usually at academic institutions..but at places where they don't exist or in underserved areas, the more knowledge you have, the better.

and good for you that you can handle that stuff.. judging by what you've said, you have obviously had sufficient exposure..which is what I'm getting at.

PP hears where I'm coming from here. Believe me, when I was a med student, I also thought it was lame when the ortho residents tried to get 90 year old women with hip fractures admitted to medicine. Many of my fellow residents felt the same when they were in med school.

But when you guys become interns, you will quickly realize that ortho is different from other specialties in that our patients are pretty healthy, and being a "good intern" isn't so much about how smart you are or how much you know, but rather being super-efficient. Dealing with simple medical problems is fine, easy enough. High glucose? Ok, increase the sliding scale. Low blood pressure? Ok, give a bolus and hold the BP meds. I actually hate calling consults, especially for something so simple, because it often ends up being more trouble than it's worth, and it's more work to check charts for alll the consult recs when you can easily manage the problem yourself. But in ortho, you won't have to take care of any truly sick patients, which are the ones that really take up a lot of your time and effort that could be better spent doing other work.

Obviously, ortho residents know HOW to manage medical complications. In general, we are among the more intelligent interns because ortho is so competitive. Additionally, we all have to do general surgery and ICU and vascular in our intern years, and you have to take care of very sick people on those rotations. The difference is that after intern year, you simply are not expected to manage any complicated medical issues, and it makes it a lot easier.

I really do think that you can only get this perspective after you start your intern year. I certainly did.

I will also add -

As much as I hate calling consults for BS reasons, I LOOOOOOVE transferring to medicine for anything serious!

I bow down to my wise elders and the almighty medicine transfer!
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