When the much anticipated “We are pleased to confirm your acceptance…” letter arrives, many medical school applicants already know what branch of medicine appeals to them. I did not. However, after completing the third-year surgical rotation, surgery seemed a real possibility, where my spatial recognition skills and good manual dexterity would be advantageous. Direct “hands-on” patient care associated with surgery was appealing; and, furthermore, at that time, when we only had rather simple diagnostic tools, one advantage of surgery was the certainty of a tissue-based diagnosis.
This was not always the case with other branches of medicine. Another appealing aspect was the broad scope of surgical training and surgical practice. Our resident training program included experience in orthopedics, pediatric surgery, chest surgery, plastic surgery, vascular surgery, and neurosurgery. Some of us even performed cardiac catheterization—then a nascent procedure. One drawback of surgery is that becoming a competent general surgeon requires a longer, more arduous training period than other specialties such as medicine or pediatrics. In the “bad old days” as surgical residents, we routinely worked every other night and alternate weekends. Yet, in what other specialty was there an opportunity to perform dramatic, life-saving procedures such as an urgent splenectomy for a ruptured spleen?
After completion of residency, the diversified training proved useful during the years I worked as a general surgeon in a community hospital. It was also helpful when I eventually moved to a nearby academic medical center, where I could participate in the training of surgical residents. Shortage and Burnout of General Surgeons Over the past several decades, the field of general surgery has gradually narrowed. Now a steadily increasing proportion of general surgical residents obtain additional training in one of the many subspecialties. This trend is leading to a rapid and alarming shortage of general surgeons. Dr Michael Ellis DeBakey (1908-2008), who worked until he was 99 years old, most surgeons retire in their 60s, some even earlier. However, with increasing longevity and better health, the retired surgeon can anticipate a couple of decades of life expectancy after retirement. Travel, golf, or other recreational activities can fill the remaining years, but are there other choices that might be attractive and have the additional advantage of generating income?
Either before or after retirement, some surgeons do opt for additional training in administration, law, or public health. In planning ahead, Denis Parsons Burkitt was one of my role models because he combined a surgical career with a productive additional career in cancer research. That’s the reason why, during my surgical career, I obtained additional training in epidemiology at the International Agency for Research on Cancer, a unit of the World Health Organization. It gave me the tools to investigate the causes of several different types of digestive tract cancer. Then, when young, enthusiastic surgeons at our center became available to provide emergency surgical care, I was happy to have the extra time to enjoy a second career with different rewards and satisfactions.
Surgery affords the opportunity to discover the cause of a variety of complex, disabling, or life-threatening problems; fix them; and enable the patient to carry on with their life. Doctors are often asked, “Would you choose this career again?” For some surgeons, the immediate response is “No!” This reaction is understandable, especially considering the many aggravations and frustrations associated with our current healthcare delivery system. My response would be, “Yes, I would certainly do it again.” Why? Because surgery affords the opportunity to discover the cause of a variety of complex, disabling, or life-threatening problems; fix them; and enable the patient to carry on with their life. Can there be a more satisfying career choice? Unlikely.