17
GENERAL SURGERY
SURGERY DISSECTED
Surgery, the treatment of disease by operation, is often definitive therapy—many times curative—for a broad range of conditions affecting all organ systems. The general surgeon treats diseases of the entire body, from the skin, to the blood vessels, to the liver, and beyond. The surgical subspecialties focus on specific body regions, that is, cardiothoracic surgeons address problems of the heart, lungs, and other organs within the thorax (chest), whereas other specialties focus on certain body systems or patient populations, that is, vascular surgeons operate on arteries and veins and pediatric surgeons operate primarily on infants and children. No matter the subspecialty, surgeons are knowledgeable in critical care, and often care for their own critically ill patients in the ICU.
For most new medical students and nonmedical professionals, surgery remains somewhat of a mythical realm characterized by scalpels, blood, and constant action. This mystery may be partly why surgery-based television shows and movies remain so popular in society today. What most people do not see or understand is that surgery is, indeed, structured, organized, thoughtful, and meticulously planned. Even during times of apparent chaos, surgeons have a definitive plan of action to reestablish control, to treat complications, and to make a difference in the lives of their patients. This art requires a great deal of time and experience. Surgical residency aims to provide the broad foundation necessary for a successful career.
General surgery remains one of the few fields in medicine that brings together many disciplines in order to treat patients. As a surgeon, you will master several aspects of the medical field in order to be successful. You need to work up and evaluate a patient with the efficiency of a medical internist. Surgeons must order and analyze radiological investigations with the acuity of a radiologist. After making the final decision for surgery, you will prepare patients with their cardiac and pulmonary status in mind in order to assess the relative risk of the procedure. Finally, after the operation, surgeons care for any severe complications with the intelligence of a critical care specialist. Being a surgeon means much more than just operating as a technician or automaton. In fact, the perioperative care often alters the course of life and death in high-risk surgical patients. In this regard, general surgeons are indeed the few remaining renaissance individuals in a new medical landscape where superspecialization is becoming the way of life.
THE ART OF SURGERY
Surgery is as much art as it is science. The surgeon has the privilege of experiencing the delicate beauty of the human body, both internally and externally. Though all physicians have a knowledge of anatomy from their gross anatomy class in medical school, it is only in the surgical disciplines that one can feel these structures pulsating with life. It is exhilarating and awe-inspiring to hold the small bowel in your hand and feel the peristaltic waves, or to touch the breathing, spongy lung of a living being. It is even more exciting to watch these structures tolerate the procedures we perform on them. For example, there is nothing more invigorating than spending time concentrating on making an anastomosis (connection) between an artery and vein to form a fistula and then feeling the “thrill” of the blood rushing through it. The surgeon has the manual dexterity and sense of spatial relationships necessary to make the correct incision, perform the appropriate operation, and bring the tissues together for a functional and cosmetically appealing result. All the while, the surgeon is prepared for the unexpected; there is no such thing as routine surgery. Complications can occur at any time, even in the “simplest” of all procedures. In becoming a surgeon, you will develop patience, manual dexterity, and the ability to remain calm and composed under intense pressure.
✓ Has excellent hand–eye coordination and manual dexterity.
✓ Can think quickly, act decisively, and remain flexible.
✓ Enjoys mastering new technology.
✓ Demands the highest level of perfection.
✓ Is an energetic, dedicated, and compassionate physician.
Surgeons thrive on the immediate gratification of operating. When choosing a specialty, medical students who want to see the results of their treatment on a moment-to-moment basis will gravitate toward the fast-paced surgical specialties. The general surgeon relieves a patient’s unbearable abdominal pain by resecting an inflamed appendix or by performing a lysis of adhesions to relieve a small bowel obstruction. The vascular surgeon performs a femoral popliteal bypass and restores blood flow to a patient’s ischemic, painful limb, saving him from amputation. Trauma surgeons repair organs damaged in the path of a bullet, and surgical oncologists perform definitive cancer operations, giving their patients the chance of a cure. As a surgeon, there are never-ending opportunities to use your knowledge, your skill, and your hands to make a difference in the lives of your patients.
Few people are born with the innate technical skills to perform surgery well. For the majority of us, learning how to operate requires repetition, self-awareness, dedication, and intraoperative teaching—all of which take place in the setting of an “apprenticeship” during residency. From the first day of internship, new surgeons are taught the proper technique for performing procedures appropriate to their level. Usually this begins with closing an incision or placing a “central line” (a catheter inserted into large veins and threaded to the heart in order to obtain central venous access for administering fluids and drugs). For all procedures, residents can learn certain aspects from textbooks: landmarks, patient positioning, indications, and risks. But the art of the procedure must be learned as an apprentice. To ensure the development of good technique with minimal risks to the patient, senior residents and attendings teach junior residents how to hold instruments properly, take a stitch, tie knots, and use the “bovie” (electrocautery device). They teach them how to avoid the common technical errors which can result in a bad outcome. There are some “tricks of the trade” that no textbook can illustrate. These subtleties are taught by observation and experience over 5 years of clinical training. Over time, every resident cultivates his or her own style, within the limits of being a safe and skilled surgeon.
Residency in general surgery requires 5 years of postgraduate training. There are currently 267 accredited programs. Some programs offer (or require) an additional 1 to 3 years of basic science or clinical research. There is no argument that surgery is a tough residency. Residents arrive at the hospital very early to round on their patients before heading to the operating room. Because patient care and consultations continue after finishing the scheduled operations, the days are long and physically demanding. To comply with the 80-hour work week requirements, surgical residents have “night float” systems and shift work. In the first year, interns spend little time in the operating room. They see patients in the hospital requiring consultation and master the essentials of postoperative care on the wards and in the ICU.
Operating-room time increases throughout the year, and cases are usually allocated based upon complexity. Residents spend the first 2 years primarily in general surgery but also rotating through surgical subspecialties which may include neurosurgery, urology, and orthopedics. The remaining 3 years are dedicated to rotations in general, vascular, cardiothoracic, pediatric, and transplant surgery. Additional months of training include surgical intensive care and endoscopy. Residency in general surgery provides the gateway to a number of subspecialties that require fellowship training.
THE SURGICAL FIELD IN TRANSITION
With the advent of resident hour restrictions in medicine limiting hours within the hospital to an average of 80 hours a week, the surgical landscape and specialty as a whole have undergone dramatic changes. Resident duty hour requirements were started in July 2003 by the Accreditation Council for Graduate Medical Education (ACGME).1 Gone are the days of relatively living within the hospital and 120-hour weeks. This change may be partly responsible for the rising interest and increased applications for general surgery positions around the country. Individuals who would give up surgery due to the previous time dedication are reconsidering their options and pursuing surgical careers.
A survey of residents in surgical programs in New England revealed that their “practice desires” and “lifestyle choices” varied significantly from surgeons already in practice. The majority of them wished to work 60 hours a week or less as attendings.1 Whether the change in the residency hours is responsible for this outlook is not yet clear.
The shift work associated with these restrictions and possible lack of continuity in care may reveal new problems to be addressed. For example, serial abdominal examinations on a patient with a questionable abdominal process and pain in prior years could be performed by one surgical resident. Any changes would be apparent because that one resident knew the examinations based upon his own assessment earlier in the day. Now, however, within a 24-hour shift, there may be as many as three different residents assessing the patient at successive intervals without exact knowledge of the previous examination’s impression. Therefore, “sign-out” rounds in surgical residencies are becoming critical in establishing continuity of care and patient safety.
As technology in the medical field continues to grow, so do surgical techniques and options. What was previously done through large incisions is now being performed through small holes and with cameras. Laparoscopic surgery has revolutionized the surgical field. Old “bread and butter” appendectomies and cholecystectomies, which were done with open incisions followed by a couple of days in the hospital, are now being done laparoscopically. Patients recover faster and are discharged days earlier. A modern surgeon needs to be apprised of new surgical techniques and discoveries in order to provide his or her patient the best care possible. Therefore, residencies are beginning to incorporate this training with new equipment into the curriculum. Surgery is no longer merely scalpels and lap sponges. It is now dominated by trocars, angled cameras, and robotic machines. As a surgical resident and attending, you will need to stay on the cutting edge of new technology and treatments.
THE “SURGICAL PERSONALITY”
The surgical rotation for many medical students is often viewed as scary and overwhelming. You are expected to arrive early in the morning and often leave late at night. You follow the lifestyle of the residents characterized by hunger and exhaustion. Yet, you share the thrill of being in the operating room, being part of a team, and helping take care of patients. However, attending surgeons are sometimes known to be ruthless during morbidity and mortality rounds by interrogating residents. Some in medical school were told that surgery was a frightening place where you were advised to tread carefully. It is fair to say that much has changed in recent years in the surgical personality.
Most surgeons do not fit the description of being insensitive, overbearing, and arrogant. They are diligent, caring, lively, and driven. They are team players and take personal pride in their work. They are decisive, compulsive, and seek success in all their endeavors. These qualities reflect the level of dedication and personal responsibility surgeons take in the care of their patients. After all, surgeons need the confidence and ability to be assertive when necessary. They have to control their environment when carrying out plans. Remarkably, these characteristics have been extensively studied and well represented in the surgical literature. A study examined the traits that are more common in surgeons than in the general population. The authors found that surgeons are less neurotic, more extroverted, more open, and more conscientious.1 They also concluded that surgeons are more likely to be aggressive, to prefer competition, and to express their anger when necessary. It is easy to see how these traits are adaptive in this field.
No matter the stereotype, surgeons are team players. It is ironic that the “typical surgeon” perceived by young doctors-in-training is a lone wolf, self-directed, and independent, where, in reality, the success of the individual surgeon depends on working well as a member of the team. The surgeon is called upon to consult on surgical issues and perform basic procedures for other services. (The placement of chest tubes and difficult central lines are two of the most common such procedures.) This highlights the constant interaction between surgeons and other physicians and the need for a collegial relationship. The surgeon must communicate effectively with referring physicians, whether they are in internal medicine, gastroenterology, pulmonology, or other services. The efficient and accurate transfer of information is essential for the care of the surgical patient, and this requires excellent skills of communication.
Most attendings are no longer unapproachable and feared. The old mentality is being replaced by a supportive and understanding one. Surgeons are demanding and meticulous because they want the best care for their patients. This often requires them to be unyielding and uncompromising in the management of their patients. That is why they are often viewed in such light by peers and outsiders. Make no mistake—surgeons are indeed dedicated, compassionate, and unwavering in their responsibilities to their patients.
SURGICAL PROWESS
Details—it’s all about the details! This is what makes a great surgeon. Attending physicians and senior residents remind you of this quintessential point every day of your surgical residency. The correct way sutures are placed, the extra attention paid to a critically ill patient, and knowing when to operate are a few key qualities that distinguishes an awesome surgeon from an average one.
As a surgeon, you must think on your feet and keep your composure in stressful situations. You cannot always predict what you will encounter during an operation, and therefore you must remain levelheaded and ready for anything. This requires a mastery of anatomy and common anatomic abnormalities, physiology and pathophysiology of disease, as well as of proper surgical technique and options for treatment. For example, to safely perform a laparoscopic cholecystectomy, surgeons must know the common anatomic variations of cystic arteries, hepatic arteries, and the ductal system. They have to understand unusual disorders of the biliary tract like Mirizzi’s syndrome and parasitic diseases like Clonorchis sinensis infection to accurately interpret the clinical, radiographic, and intraoperative findings. Surgeons must know when it is appropriate to perform cholecystectomy rather than simply placing a cholecystostomy tube. This question often arises with the elderly and debilitated or those who refuse surgical intervention.
As a surgical resident, you will be tired, sleepy, and hungry. You will stand on your feet for consecutive hours and be asked to stand for many more. You need to know that the road is not easy and is quite long compared to other specialties. However, the impact that surgery can have in the face of illness is great. This is what makes surgery worthwhile for so many residents and students. Moreover, education as a surgery resident occurs constantly. Unlike other medical specialties, surgery demands that you learn in many different ways. In the operating room, your mentors will teach you how to cut, bovie, suture, and tie. Outside the operating room, surgical trainees learn how to manage their patients postoperatively. There will be a great deal of responsibility placed upon you as a resident to identify your strengths, weakness, and areas of improvement.
Like all physicians, surgeons begin with a focused history and physical examination before making the diagnosis and the decision to operate. In a typical day, surgeons may receive a page from the emergency department regarding an elderly patient with abdominal pain, emesis, and increased white blood cell count, and simultaneously receive a request for consultation on an incarcerated inguinal hernia from the medicine clinic. The surgeon must ask focused questions to determine the acuity of the consult and prioritize the order in which patients will be seen. Proper clinical judgment determines what tests must be ordered, if further radiographic studies are appropriate, or if the patient should proceed directly to the operating room. What differentiates surgical disciplines from other fields is the limited time available to integrate reams of information from the history, physical examination, laboratory results, and radiographic studies to come to the correct diagnosis and pursue the proper course of action. This requires a sense of urgency and self-motivation on the part of the surgeon.
THE DOCTOR–PATIENT RELATIONSHIP
As a surgeon, you meet patients along various points in their medical course. You may be called in consult regarding a gastrointestinal bleed in a patient who is in the ICU setting. Another patient may be on an operating room table, and during a routine hysterectomy, an inadvertent enterotomy (hole in bowel) was created requiring your attention. Outside the hospital in your office, a family physician may refer a patient to you because of a breast lump noted on routine physical examination. The most important aspect of being a surgeon is not knowing just how to operate, but also when to operate. Therefore, it is paramount that you educate the patient about his or her illness, assess the risks and benefits, and provide information regarding complications so that they can make an informed decision.
The amount of trust that patients place in doctors, especially surgeons, remains unparalleled in all other professions. Patients who are sick and in pain meet doctors for the first time and immediately reveal the most personal information regarding their lives, habits, activities, and desires. Therefore, it is required that surgeons be understanding and open regarding the wishes of patients and their families. After all, patients have to give up control of their medical care and entrust their welfare to your skill and judgment. They may be frightened about undergoing even relatively simple operations such as hernia repair or setting of a fracture. The surgeon must provide comfort during this time of stress and anxiety. A good surgeon–patient relationship requires sensitivity, compassion, and a gentle hand. Despite all the technology involved in an operation, some of the greatest tools of the surgeon are the physical examination and the history. In the time spent taking a history and performing a physical examination, the physician builds a rapport and trust. During the history, the surgeon learns about the patient’s belief system and his or her wishes. Many procedures, such as mastectomy (the removal of a breast), have long-term emotional impact, and so you must be prepared to address these concerns. The surgeon–patient relationship does not end at the close of the case. Patients return to the office with questions regarding postoperative pain and changes in their physiology or physical appearance.
After establishing the relationship between the surgeon and the patient, it is the duty of the surgeon to follow that patient until surgical issues have been addressed and resolved. Surgeons do not operate and then send patients back to their primary physician. Instead, they typically have close, often long-term relationships with their patients. For example, in the case of a patient who comes into the emergency room with right lower quadrant pain and undergoes an appendectomy, this means following the patient in the hospital until discharge, instructing the patient in wound care, answering all questions, setting them up for follow-up visit, seeing them in the office postoperatively, and addressing any other concerns. In this instance, it may be a relationship that lasts a few weeks. In other situations, such as treating patients with Crohn’s disease or colon cancer, it requires patience, compassion, and dedication. These illnesses may require several operations, dealing with complications, and supporting the patients and family members through very difficult times. The end point is hopefully resolution of their illness, but sometimes it requires compassion until the last breath.
LIFESTYLE CONSIDERATIONS AND PRACTICE OPTIONS
It is true that surgery requires intense dedication and residency is a minimum of 5 years in length, but what happens after that? Although there is little control over work hours during residency, afterward surgeons can choose from a multitude of practice settings and decide how much or how little they want to work. Needless to say, if you enjoy what you do, the hours will be less of an issue. While it is ideal to have control over your time and where you spend it, if you are tethered to something you love, it is hardly a punishment. Most medical students are exposed only to the highly specialized practice of academic surgery, but the field of general surgery is practiced in a multitude of ways. As an academic surgeon, you can divide your time between research, clinical duties, and teaching. Academic surgeons are often experts in a certain field, for example, parathyroid surgery or inflammatory bowel disease and give lectures at other institutions in their chosen subspecialty. You will have residents to buffer you from the minutiae, but you ultimately are in control of the care of the patients. Moreover, teaching in the operating room and in formal lectures is an enjoyable and fulfilling experience.
Alternatively, you could become one of many surgeons in a group practice. Surgical attendings usually divide up their hospital week with operating days and office days. They have some days where they operate in the morning and see patients in the afternoon. The size of the practice and volume will dictate how often they operate. In this private arrangement, there is a set on-call schedule and a wealth of patients from established referral patterns. Although private practice surgeons may have less control over when they work, the hours are usually predictable and predetermined. Some of these surgeons also serve as clinical attendings and have resident coverage. Some go into solo private practice where there is maximal control over the work hours, but you are responsible for practice management, reimbursement, and referral patterns, which administrators take care of in the academic and mega-medical-group settings. A rare few leave the clinical arena and dedicate their time to industry or research. Whatever practice you choose, your lifestyle will no longer be that of a surgical resident.
• Cardiothoracic surgery |
$645,112 |
• Colon and rectal surgery |
$431,865 |
• General surgery |
$413,824 |
• Oncology |
$387,400 |
• Pediatric surgery |
$524,030 |
• Transplant surgery (kidney) |
$401,555 |
• Transplant surgery (liver) |
$503,493 |
• Trauma surgery |
$463,494 |
• Vascular surgery |
$481,127 |
Source: American Medical Group Association.
Attending surgeons that are a part of a university hospital may share call responsibilities and rounding on surgical inpatients. The advantages of being part of a university practice includes the ability to teach residents and medical students, engage in research studies, and avoid some of the financial issues and overhead costs associated with private practice. The disadvantages include less income or personal freedom with regard to managing the practice. Many surgeons love teaching and shaping the education of residents and students over the years. For them, they desire an academic position over private practice benefits.
FELLOWSHIPS AND SUBSPECIALTY TRAINING
After the completion of general surgery training, there are several options available for subspecialization. Some individuals decide to forgo further training and dive right into practice as general surgery attendings. For others, the difficulty is often choosing one specific area. Most of the application process takes place during the fourth year of clinical training. By then, the surgical resident has been exposed to a wide range of the available specialties.
There has been a trend toward early surgical subspecialization. Instead of completing 5 full years of general surgery and then pursuing a fellowship, there have been various permutations resulting in earlier entry into specialized fields including vascular surgery, cardiothoracic surgery, and plastic surgery. The pros and cons of this movement continue to be debated. Proponents argue that it attracts a higher-quality candidate, decreases the length of training, and is more focused on what the surgeon will be doing in daily practice. Detractors argue that a strong general surgery experience is fundamental to being a safe surgeon. The debate will continue for years, but more and more integrated programs are being established.
• Number of positions available: 1281
• 1384 US seniors and 1005 independent applicants ranked at least one surgery program
• 99.8% of all positions were filled in the initial Match
• The successful applicants: 78.7% US seniors, 10.4% foreign-trained physicians, and 2.5% osteopathic graduates
• Mean USMLE Step I score: 235
• Unmatched rate for US seniors applying only to general surgery: 9.6%
Source: National Resident Matching Program.
Cardiothoracic Surgery
As the name implies, surgery is on the heart and in the chest cavity. It also includes operations on the lungs, esophagus, and major blood vessels in the chest. Heart surgery includes coronary artery bypass grafting, valve replacements, heart transplants, thoracic aneurysm repairs, septal defect repairs, and trauma to the heart. Thoracic surgery includes lung resections, esophageal resections/reconstructions, video-assisted thoracic surgery (VATS), pleurodesis, and similar procedures. The fellowship may be 2 or 3 years depending on the program. There are also fellowships that emphasize cardiac operations. Others focus more on thoracic and lung surgery. It is therefore important to know which interests you more and apply to programs accordingly. Now there are also direct programs which accept medical student graduates. They are usually 6 years in length and the 5-year general surgery training is not a prerequisite. If you enjoy cardiac and pulmonary physiology, love meticulous procedures, and become excited with the idea of operating within the chest, CT surgery may be your calling.
Colorectal Surgery
Colon and rectal surgery is growing with the increased screening for colon cancer and other disorders of the lower gastrointestinal tract. Patients will come to you with a variety of pathology, including colorectal cancer, motility disorders, inflammatory bowel disease, diverticulitis, anal fissures and fistulas, constipation, and fecal incontinence. These subspecialists perform colon resections, low anterior resections, abdominal perineal resections, hemorrhoidectomies, operations for Crohn’s disease, anal fissures, and colonoscopies. Fellowship training ranges from 1 to 2 years. Many of these surgeons have working relationships with gastroenterologists so that they have a strong referral base for their practice. Colorectal surgeons take the cases of patients within a wide range of ages, from a young male with ulcerative colitis to an elderly woman with a colonic mass.
Pediatric Surgery
Pediatric surgeons work in all aspects of the care of children from prematurity to adolescence, such as the repair of congenital defects and treating traumatic injuries and burns. Like true general surgeons, they perform operations on the entire body: abdomen, chest, extremities, and more. Common pathology encountered includes disorders of development such as pyloric stenosis, congenital anomalies such as Hirschsprung’s disease, and childhood cancers. Known for its delicate precision, pediatric surgery is challenging. These surgeons work with pediatricians, pediatric intensivists, and other surgical subspecialties such as otolaryngology to provide the best comprehensive care for their young patients. As one of the most competitive subspecialties, pediatric surgery is usually 2 years in length following general surgery training. Since there are so few spots throughout the country, many applicants supplant their resume with additional time of surgical research and experience prior to applying for this specialty.
Surgical Oncology
For some patients with cancer, surgery offers the possibility of a cure, while for others, operation means palliation, allowing them to live comfortably with an incurable cancer. Surgical oncology offers additional training in the most complex operations. Like their colleagues in medical and radiation oncology, surgical oncologists deal with strong emotions, particularly when their patients’ cancer is unresectable, recurs, or has metastasized. Many surgical oncologists work in academic medical centers and conduct cancer research. Fellowships in this subspecialty require 1 to 3 years of additional training.
Transplantation Surgery
With a particular emphasis on complex medical management, this subspecialty encompasses kidney, liver, pancreas, and small bowel transplantation. Transplant surgery is a very exciting field that relies on many medical disciplines for its success. With immunology as one of its scientific bases, it calls upon knowledge of anatomy, physiology, infectious disease, and basic sciences. Fellows usually train in 2-year programs that focus on performing organ transplants for patients with end-stage organ failure, caring for them perioperatively, and treating any complications that may arise following transplantation. The transplant surgeon works as a part of an integrated team of professionals, including nurses, social workers, and medical subspecialists (nephrologists, endocrinologists, and hepatologists).
Trauma Surgery and Critical Care
Traumatic injuries range from gunshot and stab wounds, crush injuries, motor vehicle accidents, electrical injuries, and more. Scenarios requiring operative intervention will call upon you to operate efficiently and quickly in order to save lives. Trauma surgeons are general surgeons who operate throughout the entire body in order to resuscitate their injured patients. In the emergency department, they usually lead the “trauma team” to stabilize and resuscitate critically ill patients before taking them to the operating room. Trauma surgeons also coordinate care with various consultants including neurosurgery, orthopedics, vascular surgery, plastic surgery, and oral–maxillofacial surgery. Trauma fellowships are usually 1 year in length. In addition to acute management of emergency situations, you will receive extensive training in the intensive care management of critically ill patients.
Vascular Surgery
Vascular surgery involves the arteries and veins of the entire body, from the neck to the distal extremities. Surgical procedures include carotid endarterectomies, arteriovenous fistulas, abdominal aortic aneurysm (AAA) repairs, bypass procedures to revascularize threatened extremities, angiographic procedures, amputations for ischemia, repair of pseudoaneurysms, and repair of any type of disruption of blood vessels. Vascular surgery is currently experiencing exciting changes with new procedures including endovascular AAA repairs, carotid stent grafting, angiogenesis, and similar advances in vascular technology and research. There is an increasing demand for vascular surgeons given the aging population with vascular diseases. Due to the fact that the vascular disease process is not limited to specific parts of the body, patients often have heart, pulmonary, and comorbid conditions such as diabetes, hypertension, and increased cholesterol. Therefore, these patients are very sick and high-risk operative candidates. Vascular surgeons are skilled operators who operate despite dangerous conditions in hopes of improving the lives of their debilitated patients. The fellowship is typically 1 or 2 years in length. There are also direct vascular surgery programs from medical school which are usually 5 years in length.
WHY CONSIDER A CAREER IN GENERAL SURGERY?
As a field of medicine, surgery is never stagnant. Since it is constantly evolving, surgeons must learn to change and adapt as well. From day one as a lowly intern, there will always be perpetual training, teaching, and learning. It continues into your subspecialty, practice, and eventual livelihood as a surgeon. Those who choose general surgery understand that this is a lifestyle decision. You cannot change the lives of patients without giving some of your own in the process. Surgeons come to terms with this sacrifice and find great satisfaction in positively and immediately impacting the lives of their patients.
Surgery is an intellectually, physically, and emotionally challenging specialty that surgeons love to be a part of. Nothing is greater than the unbelievable surge of adrenaline that occurs while scrubbing in, stepping into the operating room, and gowning up. Within the hospital or private practice, being a surgeon means being the master conductor in the care of surgical patients. It calls upon an individual who enjoys working with and at times directing various other specialties toward the common goal of curing illness. Surgeons combine the knowledge of a scientist, precision of a technician, passion of an artist, and empathy of a physician. They demand nothing but the best for the patients, and they give nothing but the best in all of their efforts. Though challenging and demanding, surgery will amply reward all the effort you put into it.
ABOUT THE CONTRIBUTOR
Dr. Ashish Raju completed a 6-year accelerated BA/MD program through Lehigh University and Drexel University College of Medicine. Dr. Raju then completed general surgery residency at the University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School. He then went onto to complete a 2-year vascular/endovascular fellowship at Montefiore Medical Center in New York City. He enjoys following sports, writing, traveling, and spending time with family. He can be reached by e-mail at ashish.raju@gmail.com.
REFERENCE
1. McGreevy J, Wiebe D. A preliminary measurement of the surgical personality. Am J Surg. 2002;184:121–125.
SOURCES
1. Breen E, Irani JL, Whang EE, Zinner MJ, Ashley SW. The future of surgery: Today’s residents speak. Current Surgery. 2005;62(5):543–546.
2. Johansen KH, David M. So, You Want To Be a Surgeon. American College of Surgeons. 2001–2003.