Dimitar [not his real name] writes [edited for length]: I am a medical student who has already applied to the field of general surgery and finished the interview process. I hope to become a pediatric surgeon because it is one of the last fields that allows for one to operate all over the human body and to be a true general surgeon.
However
I have been struggling with something that I hope you can help me with. I love
the technical aspect of surgery. I enjoy becoming better at tying knots, suturing,
and various surgical skills, and above all I love traditional open procedures. I
like to feel with my hands and not with those laparoscopic instruments, I like
to see with my own eyes and not through a tiny little camera all through a tiny
little port. My biggest fear is that everything will become robotic, and that
an open procedure will be a rarity in the future. And pediatric surgery most of
all is basically an advanced laparoscopic fellowship. I want to make clear that
I do not hate laparoscopy, I just enjoy the open procedures much more. I
understand that this is probably a very selfish thought as laparoscopy has
better recovery times, less pain, shorter hospital stay etc., but I guess that
is why we have websites like this where I can ask anonymously what I am to
ashamed to asked in public with hopes of getting a non-judgmental response.
To
sum it up, I feel like I was born to do surgery back in 1950 or something when
everything was open. I would like to find a field that would allow me to
operate all over the body and do it the traditional way. Other than trauma, and
transplant, what are my options? Would general surgery ever get back to what is
was before? If I don't learn to love this laparoscopic and robotic thing am I
screwed?
Those are very good questions. Let's start with your worry
that pediatric surgery "is basically an advanced laparoscopic
fellowship." I'm not so sure about that. If you look at the statistics for
residents who finished pediatric surgery fellowships in 2013, you will find
that many open cases are being done. This link gives you all the information
you need. By my estimation, more than half of all pediatric surgery cases done
by fellows were open. That's the good news.
For some bad news, you need to get the full text of this
American Journal of Surgery paper that appeared online in November 2013.
Written by some senior pediatric surgeons, it gives some worrying information
about the specialty of pediatric surgery. The number of complex cases being
done by attending pediatric surgeons has remained static while the number of
pediatric surgeons has increased. It looks like many pediatric surgeons, even
in university hospitals, aren't doing enough complex surgery.
The other bit of bad news is that competition for pediatric
surgery fellowship positions remains intense. Here are some data from the last
five matches.
As you can see the number of applicants for each position
ranges from 1.5 to 2, and the number of unmatched applicants is rather high.
Trauma surgery is not the answer. There are so few open
trauma cases being done that in order for trauma surgeons to maintain their
skills, the specialty has morphed into "trauma, critical care, and acute
care surgery."
I may be wrong, but I don't see general surgery ever
returning to the old days where open surgery ruled. Not only that, I think in
the future more and more cases will be done with minimally invasive techniques,
even if the robot turns out to be a bust.
So in answer to your final question, I think you will have a
problem if you do not learn to love the laparoscopic approach.
I wish you the best of luck.
I also had the wish to be a classic general surgeon. My 5-year experience as a rural surgeon and stints abroad as volunteer surgeon are the closest I've found. Very satisfying!
ReplyDeleteBe careful making assumptions about what you will or won't like. I started residency thinking about peds surgery or Hepatobiliary. In my 3rd year I found I loved (and was good at) laparoscopy. I did a MIS fellowship and now do 90% lap foregut and hernia. As long as you like fixing things, you will do fine.
ReplyDeleteChris and Andrew, thanks for the relevant comments. Good points.
ReplyDeleteIt is interesting to wish to be a surgeon from the 1950's. It skips and ignores all of the great discoveries that have truly benefited man, at the expense of open surgery. Take the advent of H2 blockers and PPIs. This has made gastric surgery all but extinct. I feel that I came from the last generation if residents that had to know how to do ulcer surgery but never did. Surgery, be it in 1950 or 2014, is a field that is always moving forward, transforming. As a result, those best suited for a career in surgery are those, not necessarily interested in open technique, but those interested in a career of evolving techniques that lead to better outcomes and less morbidity. @dreskim
ReplyDelete@dreskim, thanks for the very pertinent comment. Surgery is evolving and one cannot fixate on a single aspect of it, especially when it is never going to be as it was.
DeleteWho knows where the technology will evolve next? I wonder if soon enough there'll be a tactile Da Vinci that lets us transform our own arms into tiny hands inside the body, allowing for robotic mini-scale surgery that's a cross between open and lap. I don't think the field will be the same by the time Dimitar and I finish residency and it will most certainly be very different in 20-30 years down the line. I think @dreskim is right, keep the mind open to new techniques and the heart open to doing what's best for the patient.
ReplyDeleteAsya, nice amplification of the previous point. You may be right about the eventual addition of haptics to the robot. That would eliminate one of the major drawbacks of the device.
ReplyDeleteTo be honest, the robot surgery thing seems like a scam for the present time. Correct me if I'm wrong, but I haven't seen a single study that seems to show a significant advantage of utilizing the Da Vinci or any other such devices.
ReplyDeleteMaybe 20, 30, 50 years from now things will be different, but until they can make a robot with superior precision to a human surgeon and the ability to work at least semi-autonomously (neither of which current robotics can achieve to my knowledge) the original poster here shouldn't have much to worry about.
And hey, if it turns out that robots can do a better job, think about all the currently difficult/high risk surgeries that may become commonplace and safe in the future, and the experience that will provide you with/genuine benefit to your patients.
Good points. We do have to move on. Surgery certainly has changed a lot since I started.
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