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The pros and cons of specializing in surgery
Q: I will be starting at Wayne State University School of Medicine this August. I have invested about 500 hours shadowing physicians in dozens of specialties (and primary care fields) in order to find a niche that will provide the best match for my personality and goals. Although I found several specialties I think I could enjoy, by far my favorite has been orthopedic surgery. This seems to combine the satisfaction of immediate impact (which you can no doubt appreciate as an ER doc) with reasonable monetary compensation. I would go on with my myriad reasons for favoring this particular match, but I understand you are a very busy man, unlikely to be interested in hearing me wax eloquent about my newly kindled romance with the knife. I was wondering though if you would mind sharing a bit of your wisdom on the merits (and demerits) of such a surgical subspecialty.
Answer by Kevin Pezzi, MD:
The cons:
- The length of training.
- The specialization. Specialization can be a huge plus, but it can also be restricting, too. Henry Ford had a difficult time understanding why his well-paid workers (he doubled their salaries to $5 per day in 1914, which was a princely sum for factory workers) often didn't like the routine of doing the same thing over and over again. It's not that bad in orthopedic surgery, but the range of what they do is necessarily limited. However, that is true for most specialties, with family practice and emergency medicine being notable exceptions. More about Ford and the drawbacks of repetitive work at the end of this article.
The pros:
- The joy of doing surgery. I love using my hands, seeing immediate results, and helping people. Most surgeons feel the same.
- An excellent income. The government has slashed surgical reimbursement (relative to inflation), but as an ortho doc, you'll still enjoy a superb income.
- Relative immunity from medical outsourcing. I discussed this in these articles:
1. Doctor competition: Medical outsourcing and fringe practitioners (I had fun creating the mock magazine cover :-)
2. Long-term job prospects for ER doctors/Medical specialties in jeopardy - The opportunity to shine. I am generally competitive only with myself, but I must admit that I derive immense satisfaction from doing a better job than other doctors. That's very difficult to do if we're prescribing a drug for high blood pressure or a sore throat, for example. However, surgery really separates the men from the boys. The zillion variables in surgical judgment and performance add up to a world of difference between average and topnotch surgeons, which often amounts to a world of difference in outcome: life and death, or an excellent surgical result or one necessitating a second operation, or one that leaves patients with hideous scars instead of ones barely visible. You will make many patients very happy if you close skin with the meticulousness of a plastic surgeon, which any doc can learn to do.
Henry Ford and the secret of making boring things fun
While doubling worker pay to twice the industry average generally “lit a halo above Ford's head,” his generosity also triggered sharp criticism from people who said he was “a traitor to his class.” That is yet another illustration of how some people can find justification for criticizing almost anyone.
While Ford was far from perfect, he was a remarkably talented and fascinating man, as I discussed in a long blog posting about one of the most evil men in history (Adolf Hitler), whose wickedness overshadowed the one big thing he did right: take a bankrupt economy in total collapse and make it roar to life. Wouldn't you just love it if our leaders could do the same thing? Had they achieved even half of what Hitler did, we'd now be singing “happy days are here again.” BTW, my article is off the Richter scale in terms of intensity, so don't read it if you've recently eaten. That article is certain to anger people who are too close-minded to consider that the history we've been taught is hardly the full story, but others will likely revel in some of the amazing tidbits of history I present.
Ford correctly thought that paying his workers more would heighten their motivation to do better work, but more money was not the panacea for the noxiousness of repetitive factory work. Variety is the spice of life, and monotonous factory work doesn't inherently offer enough variety to provide the pleasure that humans voraciously seek. While it doesn't inherently offer that variety, there's a secret to making almost anything enjoyable. Had Ford and other automakers discovered that, they could have averted many of the problems that plagued (and ultimately contributed to the bankruptcy of) American automobile companies, such as absenteeism, drug and alcohol abuse, and an aversion to work that made many employees focus more on escapism than on devotion to doing a good job.
One of my beefs with teachers and professors is that they don't teach some essential life skills, such as how to make almost anything fun. During 12 years in school and often four or more years in college, there is surely an hour to spare that could give people the secrets to combating boredom, which will affect virtually everyone—if not at work, then likely in one's marriage. I discuss these secrets in my books and websites, but even though I am addicted to reading and have pored over a mountain of books, magazines, and articles, I've never seen another author discuss this topic.
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