Monday, September 9, 2013

MiM Mail: Pathology vs General Surgery (long-term goal: breast surgery)

I have been following this blog for the last 3 years. I am currently a fourth year medical student who is about to apply to residencies … and I am a confused fourth year student. I am also a 33 years old mother of a 3 year-old boy. 

I applied to medical school thinking about becoming a pathologist. It was my mother’s dream and had some exposure to pathology when I had worked at a clinical laboratory as a phlebotomist and a lab assistant during pre-med years. During the third year clinical clerkships, I fell in love with general surgery and scheduled all my sub-I’s having surgery in mind. Now finishing up my first sub-internship and having taken a couple of 30 hour trauma calls, I start to doubt my decision for the first time.  I am now torn between pathology and general surgery for the first time since the middle of the 3rd year. Feeling physically tired contributes to it but what I have recently realized is that I do not know much about neither residency schedules in either specialty nor about lifestyle of neither general surgeons nor pathologists. I am worried that if I choose pathology I will work just as hard during residency but would be thinking about how would my life be if I chose surgery. I heard that it is best to choose what you love the most and the schedule will work out at the end. Would you agree with this statement? I also heard statements about applying to general surgery only if one can not imagine doing anything else but surgery, but I also find it hard to believe that the general surgeons, especially mothers,  never doubted their career choices.

Here are my questions, and I would appreciate input from Cutter and Gizabeth.
-       What are the approximate work hours in residency (pathology and general surgery)?
-       Do the hours in residency depend more on a specialty or more on a type of a program?
-       How will my schedule look like when I become a breast surgeon vs a pathologist?
-       What is an attitude towards family in pathology and a general surgery residency?
-       My husband would really like us to have another baby.  Would it be feasible to combine internship, 2nd or a 3rd year residency with a pregnancy / new baby?
-       If my marriage does not work out, would it be possible to continue residency and take care of my kid as a single parent?
-       I am shy about asking my current residents and attendings about their schedules since I am on an audition rotation. Do you have any ideas whom I should ask and what else I can do to try to figure it out within the next few weeks? (Ideally, I should be submitting my ERAS application between September 15 and October 15).

14 comments:

  1. Don't be shy about asking residents/attendings about their schedules. It shows that you're interested in the program and that you want to understand what you're getting into before committing to it. As long as you phrase it as "I want to know what the training entails" rather than "I'm not sure I want/can handle a demanding residency", I can't see anyone viewing your questions as a negative.

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  2. I second Solitary above---it would actually be weird NOT to talk to someone in your institution prior to applying, about the details of the training program and it would also be silly to not take advantage of the experience of attendings at the school to get a first-hand sense of what life entails outside of training. I think its fine to talk to residents whenever the opportunity pops up (waiting for a case to start, waiting for someone to start rounds), but maybe give a heads up that you'd love to pick their brains, and they can then try to find a free moment to give you. For attendings, try to set up a meeting so you can talk about it outside of the chaos of rounding/working---you can meet with anyone in the department, and most people take it as part of their job to mentor and speak with medical students. Of course, don't phrase it as "so what are the hours?" but more "describe to me your day to day life on the job". If you happen to meet with someone who you know has children I also don't find it unreasonable to ask her "so how have you found balancing career with family". I've had a medical student ask me that before and didn't think poorly of it. Its smart to be proactive and find out all the details before you commit.

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  3. Breast surgery = 5-7 years residency + 2(?) year fellowship
    Path = 4 year residency

    Based on what you've said, I'd choose path. The only happy surgeons I know are the ones who love surgery more than they love anything else (including sleep).

    You can also ask about # weeks on-service time. Even men care about things like that so it probably won't come off as lazy.

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  4. Here are a couple of my thoughts. The patient factor in both of these is quite different. Are you drawn to either because of the type of patient care. I also don't think to do surgery you have to love it more than sleep and food and everything else in life (sorry OMGD, however I still have much love for you!). Surgery is like motherhood and many other things in life worth a struggle - its hard as crap, it turns your entire life around, and there is no way you can really know what you're getting into before you're there. I loved surgery. I wasn't die hard kicked out of my moms womb would punch my grandma to be a surgeon in love with it, but I loved it for many reasons. I loved the technical aspect, the surgical diseases, the large fund of knowledge it required, etc. etc.

    But to answer the questions you posed.

    Can you do it with a 3 year old - Yes. There are two women in my program that started residency with 3 year olds and 2 that started this year with infants. Is it east to do this - NO, of course not, but some way you figure it out. But, let me be clear, it is really hard, and you will cry and you will question yourself as a mom, but kids are remarkably resilient and smart. Yesterday I kept apologizing repeatedly to my two and a half year old for not being home on Saturday, then finally she says to me "mommy, its okay when you go to the doctor house, don't worry, just go help people." Even at two she is proud of me in her own way, and that is pretty awesome.

    What are the hours - 80 hours a week, some may be 75, but pretty much 80!

    Is it dependent on specialty - don't know, all interns will prob work 80 no matter what specialty. The difference with surgery is that its 80 hours for 5-7 years, not 3 or 4

    Attitude towards family is completely program depended, you will have to glean that during interviews, mine wasn't particularly family friendly or unfriendly when I started, but we are a fertile crew and as more women become surgeons, more residents are going to have a babys, its just a fact.

    Can you have a second - a few of our residents have had their second while in the lab, its doable but also really hard, very dependent on your support network, the more support the better. It sucks bing pregnant in the OR, also this could put quite the strain on your relationship.

    What if you get divorced? Why do you ask? I have a husband and a child and a busy life, so believe me, I know why you could ask, but I would really think about why you're worried about this and factor that into your decision. You could do it single, but would really need other family around.

    Also, feel free to ask me more stuff personally. Just send the questions to the same e-mail account and I'll try and make sure I get them.

    Good luck. Oh, and I'm also planning to do breast. 5-7 yr residency + 1 year fellowship

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    1. Cutter, I fell in love with surgery because of my love for anatomy and for opportunities to fix things with my hands. If there was an opportunity to be only at the OR and do surgeries all day every day, I would have signed up. Unfortunately, in most places surgery is combination of medicine, social work, etc. As a sub-I on surgery I feel like I am doing internal medicine all over again. It makes me depressed. Then I go to an OR, and get energetic and happy again. The reason why I considered path is because of this opportunity to cut and stay at the lab instead of the clinic or an inpatient floor most of the time.

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    2. Surgery is not just about the cutting. If that is your only reason, if you don't like patient care but only get hyped up to be in the operating room then I don't think that is a good reason to do surgery. The patient care part of it is important, you have to know when to operate and when not to. Everyone who goes into surgery loves the operating part, but the love of surgery has to be deeper than operating.

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  5. Very program specific answers to your questions. Pathology friend worked 8am-4pm and moonlighted all the time. General surgery what we are doing...at hospital between 5-6am depending on rotation just to round, check out at 6pm unless cases run late then once or so a week home around 10pm. on call every 5/6 nights in exchange for two guaranteed weekends off a month. When on call (can go up to 40 days without a day off with switch days for various rotations, other people's vacation schedules, etc) work about 100 hours that week. Hour restrictions are an average NOT a weekly set minimum.
    Hours in residency depend on program and specialty. Do your homework. Ask question and be observant. Any mom's preggo's in surgery programs you're looking at? If not assume it's because they can't do it.
    You won't become a breast surgeon without having stellar absite scores (which requires about 20-30 hours a week of extra reading outside of your "working hours) plus research that is published (another 10-30 hours a week of non 80 hour work week stuff) plus you have to impress your attendings so they don't think you're a lazy idiot which means no time for the kid you have, the husband you have plus the fetus you want to grow in your belly.
    Attitude towards family in our program, women should not have kids because being pregnant is serious business and it just can't be done scrubbing a 10 hour case and being 9 months pregnant on call. Men can have as many kids as they want but the moment their wives have the second or third or fourth the wife loses her mind (literally) there is talk of divorce sometimes separation and everyone at work pulls together to give that resident some extra time to save his marriage. Half the time it works and the other half get divorced. If your marriage does not work out as a path you can continue on. If you are GS you will have to switch to something else unless you have very supportive family in town who are almost willing to raise your child for you. Dont' let anyone tell you different. 2nd and 3rd year here are the hardest. You could not have a baby as a female surgeon here. Attending lifestyle of a breast surgeon is fantastic. Pay not so great but hours great. Never emergency cases. Pathology lifestyle fantastic as well. Good money, good hours not too stressful depending on the track you take or fellowships you do. Do ask what lifestyles are like and how long it took to get that life. Could they have family and kids in residency. Ask questions. If the program looks down on you for asking questions then they are not the right place. REsidents will be honest. Attendings will be honest too. We asked at interviews can we have more kids if we go here. Programs were honest. Good luck. And if you want specific examples of why I said what I said email me anonymousdocma at gmail dot com.

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  6. My approximate work hours in residency: 50-60. Yes, I had a few rotations that were 8-4ish, but they were few and far between. Surgical pathology rotations are pretty intense - depending on the staffing to specimen ratio I have heard of some residents grossing pretty late hours. I think hours depend more on a specialty, but I am sure there are variations within and I agree it helps to check it out beforehand. I loved Ana's open ended question scenarios designed to get info without looking like you are trying to get out of work (which you probably aren't, you just need info to make an informed decision about what you are getting yourself into). I'll never forget the resident applicant who started the lunch asking about how much sick leave and vacation we got. Not good.

    It is doable in pathology to have a child during residency (I had two - that was a little rough) but family friendly is definitely program, not specialty dependent. I have heard of some pretty malignant attitudes toward child-bearing across all specialties. Again, do your homework. Don't assume less hours = tolerance toward mothering. There are always bad attitudes toward child-bearing to be found, but depending on the power of who holds them it can really get rough and all-pervasive.

    I am a little concerned (as a divorced MiM!) that you say your husband (no mention of you!), wants a child, and that divorce is a possibility. If there is a possibility of splitting in your future, I would strongly advise counseling before deciding to get pregnant again.

    My schedule is pretty good - 40-50 hours a week when not on call - closer to 55-60 when on call. Works well for me as a single parent (who's ex and kid's stepmom are very involved and help a lot, also dad and mom in town to pitch in and boyfriend who is a big help). I can't imagine it without all that back-up. And I do love what I do. That helps a lot. Good luck to you! Feel free to e-mail me, too, with any more specific questions.

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    1. Gizabeth, I would really like to have another baby and a sibling for my toddler. I am 33, soon to be 34, and with my schedule and potentially over 5 year residency training the time will fly. If I want to get pregnant, I have the best chance of having another child with my husband, no matter how happy our relationship is.

      Thank you for sharing your story and advice. I would like to know more about your everyday routine as a pathologist.

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  7. Thank you everybody for the useful responses. I do love being in the OR but I realize that general surgery is not all about surgery but also about medicine and rounding and paperwork besides the long hours. Is there a surgical sub-specialty in general surgery that is mostly OR?

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  8. I was in the same position at the end of med school (minus kids, still none yet). I couldn't decide between path and surgery. I really loved surgery and felt like I would have been an excellent technical surgeon, but I really hated the lifestyle, the culture, and the medicine aspects of it. I ended up interviewing for both path and surgery and that actually helped me make my decision. After a couple of interviews for both path and surgery I could tell that my personality really didn't fit in surgery. It was a gut feeling but it was also an easy decision at that point. I also have lots of interests outside of medicine and I realized that I would have to give them up to do surgery. I think it really is true that you have to love surgery to the exclusion of pretty much everything else in your life to be happy in it. 5 years later I'm a fellow in pathology and I definitely made the right decision. As a first year resident I worked about 50-60 hours a week. As a fellow I'm doing about 40 hours a week with no call. I think you just have to make a decision about what's important to you. You can also try surgery, do an intern year and if you hate it, transfer to path. It happens all the time.

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  9. I do agree with all the posts. I am being devil's advocate in saying that for someone that has a clear goal and a good idea about work-life balance, the means to an end is still the heart of the issue. Going into a field that it turns out doesn't interest you as much as you thought can be so frutrating. Whether or not it is path or general surgery or even internal medicine, you have to understand that along that path... there may be bumps. There may not be a breast fellowship at the end of the general surgery route. And how many bowel resections and appendectomies. And what is to say on the path front that to get "the job" you want you have to do a path fellowship (or two) to get what you want in path.

    Enjoy the ride and remember that your family does come first. Not sure if your husband is also a physician. I know for me, even though both of us are in medicine and went right along, when my daughter needed major surgery in my second year of fellowship, I was the one that took a leave of absence without any hesitation at all. Eventually I did return and was delayed in finishing with pushed back another fellowship I desperately wanted but I just kept going because it was what I wanted.

    The hours at the end, same thing. As a mom, you may be passed over because you can't take all the night calls in a week or you may do all the calls and regret missing your daughter growing up frustrated you didn't have time and when you did you were too tired.

    Hard choice and balancing act. In the end, do what feels right to you but DO NOT hesitate to ask attendings about their life/balance. We are more than interested in sharing.

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