Do you have to be top of the class to be a surgeon??

[Spencer Wells]

Thank you geezer for that fantastic post.

[geezer6]

No worries. It has been a while, eh?

Funny how some things change, and yet some do not.

I was up at 4:30am getting ready for an Orthopaedics elective blitz list. Saturday working (boo)...but at £75 an hour, I say yes, I do. Plus, you get paid to get more operative experience as well - much recommended if you can wangle it in the future.

[James]

I agree with above. Most of the high flyers from my year at med school have either burnt out or gone into GP. The people who have excelled as doctors and got into competitive specialities tend to be the 'middle of the road' B-students. The 'nice' guys who got on well with people, were easy to talk to and had outside (non-medical) interests to keep them well grounded.

Only 10% of being a doctor is being intelligent, 90% is just hard work and being a good communicator.

[Baki]

You don't need to be top of the class to become a surgeon. Quite the opposite actually. I know what you're saying, but it's almost an insinuation that surgeons are the most intelligent in the medical profession, which would make some chuckle. How can you be clever when your job involves cutting holes in things every day and not having many friends??

I think you need to forget that "top of the class" bullshit and realise that if you want to become a surgeon (any type), you've got to graft your balls off and neglect yourself for the rest of your life - a) because there will never be enough of you to go around and b) because the workload is relentless. Oh, and c) because everyone else wants your job. Not necessarily because you need to be clever to do it.

When you start being a house officer, you will notice about 5 people in your cohort crack and not be able to deal with the workload and stress, mainly because they're spending 2/3 of their life in work and not having an adequate social life. For whatever reasons, that cohort will differentiate out and decide what they want to do - predominantly on account of how much of a (kind of) real life that career choice permits them. Surgeons want to become surgeons as pretty much from day one; it is required to become blinkered and consider nothing else.

You made a comment about being a one-dimensional social retard? It's almost par for the course if you want to do surgery. I've not met many surgeons that don't have some sort of significant personality defect. You've got to be completely single minded, focused, driven, and be willing to realise that you will make huge life sacrifices to become a surgeon - even if it means telling your girlfriend you're off to Fife next year because that's where the surgery is. She won't come. When all of your mates are going out after a hard 12 hours in work, you will be opening your MRCS core text to revise for an exam in 4 months' time, while practicing how to open an artery clip left handed at the same time, and practicing hand-ties on a stool as a "break". With your feet. Friends are just this "thing" that "other people" have. After this, you will read a few pages of a surgical journal because "you're expected to".

I came out of medical school roughly approaching the top of the class with a couple of hiccups along the way, which were more valuable to me than any A grade or intercalation or "mature background". I enthusiastically worked a very busy 2a rotation in a very busy London hospital (and decided I wanted to do surgery at that point) and then did a whole year of Surgery in one of the best surgical centres in the country. The workload was ridiculous. 12 hour days were the norm rather than the exception; on-calls pushed this to something similar to old-school hours. We worked out the SHOs were working a 2a and getting paid a 1a, and the SpRs were working a Band 3 and being paid a 1a. When one of the SpRs complained about this, they threatened his career progression. I think the exact quote from a previously quite nice consultant was "if you persist with this, it could have serious implications for your career". When the SpR said, "is that a threat?", he said, "yes."

Whenever you felt like you were making progress and developing in confidence as a Surgical SHO (even one who wanted to do it, and not one on a GPVTS), someone started asking why you hadn't done this that or the other - why you still hadn't took MRCS (erm, I'll just find that £475 under my mattress), why ATLS wasn't on the cards (erm, I'll just find that £675 under my mattress), why you hadn't done any teaching yet, etc. Coming from a medical school that seemed set up entirely to train GPs in communication skills to the detriment of anatomy and surgical teaching exclusively, it was a little bit of a disadvantage.

I hit the end of that surgical rotation broken, and considering quitting the rotation/medicine at some points due to the sheer bullying at points I had to suffer. I found it a surprise when the director of surgery gave a top reference, because I honestly thought he hated me. One particular time when he rang me at 830pm at night just as I was leaving the hospital to tell me to rejig the theatre list and tell 4 patients their operations would be cancelled does spring to mind.

I then moved to Orthopaedics and got bullied and completely humiliated twice as much for four months every morning in front of a projector, 5 consultants, 5 nurses, 7 SHOs and 7 Regs for an hour, which included choice put downs as, "boy (generic reference for any SHO), you're like the Times of India. Far too many words at 17 sections - even on a Thursday" and "Q: boy, you've decided that this shoulder replacement is a good one. Why is this? A: Because you put it in boss. Retort: See, the twit is learning. Next SHO to the front please..." I considered General Surgery "a good rotation" at this point.

When December came of that year, people were asking what deaneries you wanted to apply to, and how well your logbook was coming on. I never felt particularly well prepared for this, thinking my only career guide had no faith in me until about a week earlier and told me to "piss off, I'm busy" when I asked him for an MMC-style "induction meeting and career guidance". I had no careers advice or induction prior to working that year - it was literally about daily survival and getting all of the jobs done, picking up the sickies and not killing anyone. Unsurprisingly, when the applications for ST came up, I felt woefully underprepared and inadequate for interview, and thus decided it wouldn't be a good idea to apply. I went for a Surgical MSc which was funded entirely by myself doing locum work for the whole year when I should really be studying (fees £6k - ouch), and applied for GP as a lifeboat. My intention was to do MRCS in that year as well.

I got the MSc after being completely lambasted for a "light CV and lack of interest in surgical journals" - to which I replied I was a house officer plus 5 months. I turned up to GP interviews having not revised at all, cockily sat the tests and did the interviews and smashed it. Then I spent about two whole months trying to work out what I really wanted to do.

I still haven't completely decided, although I have, in fact.

Unfortunately, the MSc was completely financially non-viable with a 16k car still to pay off, and after sending various letters to and from the University, they offered me a defer and begged me to take the job this year with the promise of lucrative work in the private sector which has yet to materialise, and probably never will. Meanwhile, a 3 year GP StR rotation in Surrey landed in my e-mails. Apparently my lack of regard for the MTAS style applications for GP seemed to take the stress off so significantly that I performed well on zero revision.

I accepted the Surrey GP rotation in a very very nice area, citing career and locational security in a financial depression versus repeat applications every 12 months and nil guarantee of career progression, excellent pay for less work, better organisation and support as a trainee, and the opportunity to drive my own career and choose what [i]I[i/] wanted to do, and less stress as the major reasons. While at the same time, Surgery decide to opt out of the EWTD as faculties around the country fall apart while trying to implement a "compliant" rota, meaning half the workforce are at home, asleep at any one time. The director of surgery recently abused the most senior SHO for wanting to take a week off, telling her she was "unreliable as you're always off, and I would rather employ a nurse practitioner than you".

Taking GP does feel like I'm making a right choice in review of a particularly shitty year, but I wasn't prepared to commit to a career which had such scant regard for its juniors, irrespective of my abilities. I still wake up every morning asking myself if I have made the right decision, and cursing myself for my lack of ambition, but I'm sure, somehow, that will manifest itself in some other way that won't be to my neglect along the way. Plus, I might actually get a girlfriend after two years of being a complete hermit. "I'm on nights next week and I have a resus course the week after" isn't the best chat-up line when a girl asks when they can see you next.

I think the net point in all of this, is that Surgery, from my perspective, isn't all that peachy. If one of the major things in life for you is being able to tell someone at a dinner party that you're a surgeon and then bore them about surgical chat for an hour because you can't talk about anything else (or in fact going round hoping people ask if you are because no-one really wants to talk to you because you're odd), then yeah, do surgery. If you like the practical aspects of surgery, the basic and clear cut of diagnosis and case management, and the "challenge" that surgery presents to you as an individual and a career, then yeah, definitely go for it.

But you do have to put your balls on someone else's mantlepiece for your entire life. It was a commitment I couldn't bring myself to make, but in the long term, I will be much much happier, on better pay, with a life of my own too. And before anyone says, I will be just as intelligent too.

Does the same apply for all F1 doctors? I mean, do Internal Medicine (Physicians) juniors get treated the same way

[James]

In medicine they don't tend to have the big personalities and culture of workplace bullying in some surgical specialities. But it is still very hard work, the MRCP exams are just as hard as MRCS, just as expensive and you are under immense pressure to take and pass them ASAP. The working hours are very dependant on the particular hospital and specialty but tend to be a bit lighter than the surgeons.

To be warned being a medical registrar on-call is perhaps the busiest job in the hospital, you just don't stop and always have an ever growing list of sick patients to see. The referrals from other specialities come thick and fast, you are expected to be in A&E resus for all the bad medical sickies, they now expect you to review every patient your juniors have admitted (post-MMC medical SHOs can't take a shit without supervision from the registrar) and you need to do all the procedures (central lines, LPs, chest drains) as the SHO's are just not up to it any more.

[Donny Oddlegs]

Must say, I've read this thread with great interest. But all I can think now is: "Crikey! What on earth am I trying to get myself into?" My brother and sister always told me stories of when they were PRHO/SHOs; though just thought they were playing around or embellishing for effect. Sounds like at times, the treatment juniors are subjected to is terrifying.

Despite all of the nonsense, being berated, lack of sleep etc.: has it all been worth it — the years of med school and the house jobs/training?

[alex MD]

Yeah, thanks for the post geezer, it's a hell of a lot of food for thought. Although I have to admit it's nice to know that I'll be able to (occasionally ) relax and enjoy med school rather than go at 100mph all the time. It's also quite reassuring to know that you don't have to be top of the class to become a surgeon, fantastic academics and pure intelligence have never been my strength; I've got by, and I believe got into med school, by my personality, hard work and the fact I'm a personable guy. Geezer, what you say about becoming a one dimensional social retard would be the main reason I didn't go into surgery; I don't aspire to become a boring, cynical, angry old bastard. Plenty of time yet before I have to begin to make choices about my specialty

[Clarkey]

Welcome back Geezer, memorable as ever!

[The Fantastic Dr. Fox]

food for thought indeed for this boy sitting in the library

[Gizmo says -]

and a bag 'o chips.

thank u, geezer-macca.