Wednesday, September 11, 2013

Is it possible to live a full life as a surgeon‏?

Neymar (not his real name) writes

Dear (Dr.) Skeptical Scalpel:

I'm writing this evening as a fourth year medical student wholly committed to pursuing a long and fulfilling life as a general surgeon. It's what I got into medicine for, and my love for the profession has only heightened in the arduous years of preparation and (nascent) training I've undergone thus far. I have had the fortune of living a very full life—travel, adventure, and a broad milieu of individuals have all shaped the form of the man I am now, and greatly influence the man—and surgeon—I hope to be in time.

Like many people in and outside of medicine, I reflect on what has been lost or what might have been lost along the path. At present, the balance sheet reflects a clear net gain. The opportunity cost, however, can be measured in the loss of time in wilderness, love and relationships and socializing that adds richness to my life. How do you advise young physicians pursuing such an ambitious and all encompassing professional course to maintain richness and fullness in their lives? How do you reconcile the personal forfeitures with the professional gains? And, most importantly, if one hopes to be a surgeon, are these questions worth considering or best left in the recesses of the mind?

Thanks for being a mentor to an entire generation of aspiring surgeons.

Thank you for writing and for the kind words.

The questions are definitely worth considering. I am not sure that my response will be applicable to your situation or anyone else's.

I chose surgery because it appealed to me more than any other specialty. Like most others of my era, I was young and had gone the traditional route—four years of college followed immediately by med school. I had experienced few adventures [in fact, none] and had not yet met my wife-to-be.

I never even considered what impact my choice would have on my personal life. The subject simply did not come up. I worked hard in medical school but had a great time. I think I had more fun in med school than I did in college.

My residency prepared me well for the rigors of a surgical career. I spent the first four years of my training taking call about half every other night and half every third night. As a chief resident, I was in call every night. Somehow I found the time to have a relationship and got married at the end of my third year.

My wife of 39 years is a saint. I have wonderful children and now grandchildren too.

I was fortunate in my career to have had the opportunity to supervise the training a number of surgeons who are helping people every day.

Although I'll never climb Everest, go an African safari, ski the Swiss Alps or do many other things that might be important to others, I've had an interesting and fulfilling life. Wilderness? Not so much. But love and relationships? I got 'em.

But it is different for the millennial generation. What I consider interesting and fulfilling might not be to you.

Surgery continues to evolve. I think it may be possible in the near future to have a career as a general surgeon and also have a manageable lifestyle. By the time you finish training, everyone will be in group or hospital-based practices. Or you could be an acute care surgeon with fixed hours.

You will have to decide what compromises to make such as deciding if leaving work at 5 pm is more important than staying late to operate on your patient who has a complication you created.

No one talks about this part—you will have to find partners you can trust with the lives of your patients. The roadside is littered with the corpses of group practices that didn't last because of productivity issues, attitudinal and/or philosophical differences among the surgeons.

For many surgeons, fulfillment is measured by the satisfaction of knowing you made a difference in someone's life.

Can you be a surgeon and have a rich and fulfilling life? You can, but it depends on how you define rich and fulfilling.

If you haven't read this post, you should.


  1. I read this question with interest. I am a general surgeon in my fourth year of attendinghood. I am female, have two children, trail run, take call 10 days a month, and run an elective practice. My life is full and rich. The trade off? I'm in a rural area and will probably not make the median salary for surgeons.

    There are many ways to build a balanced rich fulfilling life, as an attending. I use that as a caveat because as a resident, my life was hectic, stressful over scheduled (I had a baby my fourth year of residency which was the best, stupidest decision I ever made). You cannot realistically expect to have multiple extracurricular interests as a resident. This is one downside to the push for well rounded medical students -- many well rounded students arrive in residency and are shocked that they won't be able to maintain their penchant for international travel, their love of rockclimbing, fulfill their desire to write a screenplay AND find a spouse. Maybe one of these is accomplishable in residency, but not all. Even as an attending, I can't do all of these things. I've had to pick and choose, ensure that I continue to give the best care possible to my patients, and fall in to bed pretty spent each night. It's a good life, but it's not a glamorous one.

  2. I am a general surgeon of age 54. I finished a university-based residency in 1990 and have been in a 4-5 person group for 22 years doing broad-based general surgery. I am jaded. I have seen the carnage of divorces, suicides, depression, and isolation brought on by the carreer of surgery. Of the 50 graduates of my residency over 10 years, a good many of them have had divorces and at least 3 have committed suicide. Some have quit medicine.

    The medical/industrial complex is a huge impersonal machine that takes in eager, naive, doctors and uses them up, to spit them out years later. IT doesn't care and churns on, feeding on us all.
    You will get a job, and you will like it and do good things, but gradually the call, demands, paperwork, restrictions, regulations, personalities will weigh on you. You will have your hands deep in blood and have people shout at you, then have to help your 8 year old do math while your pager goes off. The things that were important to you fade away and you find yourself treading water, trying to be afloat. There is no respite.

    It takes very strong will and convictions to fight this and come out whole at the other end. It is possible, but like passing a camel through the eye of the needle, it is very, very, difficult.
    I wish you well.

  3. E, I enjoyed your comments. I hope Neymar reads this and sees your point of view.

    Anon, thanks for your sobering reality check. It's not all fun and games out there. Again, Neymar and others contemplating surgery careers should take heed.

  4. I would like to reply to Anonymous -- I was personally heading down that same road of burnout as a general surgeon. After several years of practice, I decided to take a significant pay cut; I went to work for a critical access hospital. Yes, my hours are unpredictable, but overall they are better. I have seen my children more during the last few years, and my marriage survived. I had to wrestle with my priorities and choose what was most important to me.

  5. Anon, thank you for telling us about what worked for you. I am glad that you found a way to get through it all. The bonus is that you are doing a lot of good too.