Yo.
So… when I started med school I really thought I wanted to go into peds. I love kids. They re-energize me. They are fun, and adorable, and I just love them. The parents I could do without most of the time, but give me the kiddos all day every day. And I was 100% ready to be committed to going into peds.
And then my gen surg rotation happened. I thought I would hate it. Despise it. Have a terrible time.
However the complete opposite happened and I ended up having a mid-life crisis of sorts. I was at a fork in the road; a fork that wasn’t supposed to be there but somehow appeared, and now I had to make a choice. Turn left, and continue down the path to peds. It would be a comfortable option for me. Or turn right and go down surgery. It would be more challenging in many aspects. Many people kept telling me to think of the lifestyle that I would have (or lack there of) as a surgeon.
So I decided to use my two electives in third year to help me decide. NICU rotation (I thought I wanted to be a neonatologist) and general surgery again. Welp… turns out the OR is much more my speed.
Rural Vs City
Hmm… so I didn’t actually get to be in the OR when I was a scribe in Michigan. But the surgeons who I worked for in the office had a very narrow subset of things they would see and do surgery on. I’m assuming when you get to cities, since that is where most of the sub-specialties are at, your window of what you see is very small. You’ll be the best at it, but it’s still a small window.
Even in Springfield, MO where I do most of my rotations are similar to this. Which, is crazy to me because Springfield isn’t big enough to be a city in my eyes. More like a suburb. But out here it is considered a city. And with that, there are way more subspecialties for surgery. The general surgeon I was with mainly did gallbladders, appendectomies, hernia repairs, and peritoneal dialysis catheters. Occasionally lipoma removals and I think he removed one adrenal tumor. But overall, not a ton of variation. Sure, each case had small differences which made them interesting, but the same none the less.
In rural, the general surgeon does just about everything. There is no subspecialty. So I got to also see port placements, colonoscopies, EGD’s, bowel resections/surgeries regarding the bowels, examinations under anesthesia, hemorrhoidectomies, and a whole bunch of other cool stuff. Oh, and there isn’t an age cutoff. Got a 3 year old with appendicitis? No pediatric surgeon available- you do it. Anything that my preceptor couldn’t handle got shipped off to the nearest city.
Not to mention all the excisions and biopsies you get to do in clinic in a rural area!
Community vs Academic
I think when most people think of medicine they think of Gray’s Anatomy. It’s a big teaching hospital. Lots of shit happens.
Academic medicine tends to be more like that (but obviously different because Hollywood doesn’t work with patients). You have large hospitals. Many floors/units and patients you are in charge of. You have several subspecialties and sometimes the lines get blurred but mostly not. Several different attending have studies going on so you can do some experimental shit. But mostly, everything is taken care of by residents. It can be crazy or it could be dull. So far in my fourth year most residents sign up for a case or are assigned cases via the chiefs in charge of that team. If they need help another resident is called in. For some locations, there weren’t a ton of students so despite being “academic” you had your choice of surgeries you could assist in. At another place there were several students and you did have to communicate with other students to get surgeries to see. Being a 4th year means you get to basically pick and choose where you go (even though there are some very annoying third years who don’t understand that their shit DOES STINK and they are not in charge but whatever, not my time or place to put humble them).
Community still has a strong teaching aspect; but since there are less residents and specialties, that means you do it all as the resident or student. Since I was in a community hospital, it meant that either I did it or the PA did it. There was no resident. And if the PA wasn’t there, the attending themselves did it. I know a lot of people who are from larger populated areas dislike community places. However this is where you will likely get the most hands on. You don’t have to share. You are taught literally everything. And you’ll have way more one-on-one time with your preceptor or their PA/NP and they will teach you all sorts of shit.
Other important shit
I talked about sterile fields in the last one. That is still important and should never be forgotten. But there are other things to learn about.
- pre op evaluations
- suturing and removal (same with stapling)
- CT scans/tests and how to read them or when to get them
- wound vacs
- dressing wounds
- ileus and how long to wait/when to push to start trialing oral intake
- post-op complications
- knowing when something isn’t surgical or shouldn’t be operated on
The list goes on and on here.
But really I just wanted to point out some differences that I’ve seen in surgery. I will say the more medical heavy specialties don’t necessarily change a ton based on rural vs city and academic vs community. It seems to me that your patient load changes not matter where you are, how big your hospital is, and how many residents you have on your team to follow. For surgical specialties, there is the added OR time that changes how things are and how many sub-specialties are present to divvy up the work.
Obviously, no matter what the specialty if you are in a program/place with less people and resources you will be doing more yourself. End of story.
Anywho, hope this was eye opening. I’ve been adding to old posts that I’ve started in my third year quite a bit and cannot for the life of me remember what else I wanted in this post so I’m just going to end it here. Cheers!
