Non-surgeon Surgical Careers

Being a surgeon is not for everyone.  It takes 30+ years of education, lots of debt, aching shoulders, and lost sleep. It is often an emotional and spiritual roller-coaster.  That said, I can't imagine doing anything else with my life.

But for those of you who can, here's a few other career ideas that get you into the operative world.

OR aide - entry level position, does everything from running specimens to pathology to helping us position anesthetized patients for surgery. Invaluable man power to keep the OR running.

Certified scrub tech - Simply put, the CST handles the many instruments on the field and provides assistance to the surgeon during the operation.  But any surgeon knows a good CST is worth his or her weight in gold-- a good CST can make an even the most complex operation go smoothly. If you want a team oriented, face-paced, on-your-feet job, check out CST training programs.

Circulating RN - During each surgery, a nurse is present to assist with patients going to sleep, waking up, and also to help track down supplies for the team. These RNs aren't usually scrubbed in, but instead are present in the room to trouble-shoot and support the operative team. They also generally are tasked with some of the double-checks and safety protocols.

Preop RN - Nurses who get patients ready for surgery. A great preop RN is adept at reassuring anxious patients and their families, while efficiently completing a pre-op to-do list (IVs, EKGs, medication reconcillation, ensuring the surgeon has marked the operative side, etc).

PACU RN - Postoperative Anesthesia Care Unit nurses are often experienced RNs who come from surgical wards or ICUs.  These RNs take care of patients who have just come out of surgery.  For most patients, that means monitoring them as they wake up from anesthesia and move them onwards to home or to their hospital bed. Patients in the PACU have potential to decompensate - requiring intubation or return to the OR - so the RNs are responsible for noting these changes and alerting the anesthesia and surgery teams.

CRNA - Certified nurse anesthetists are RNs with graduate level training in administering anesthesia.  If you have had surgery, chances are that a CRNA was the one who intubated you, stayed at the head of the bed, and extubated you. Anesthesia is jokingly known for "periods of boredom punctuated by moments of terror."  CRNAs are supervised by a physician anesthesiologist, but have quite a bit of independence and responsibility.  The relationship of anesthesia and surgery is a time honored one of teamwork, lively banter, and tongue-in-cheek mutual respect. If you choose a career in anesthesia, I recommend a sense of humor and broad shoulders.

Perfusionist - I had never heard of this before my clinical training.  This health care professional is in charge of heart-lung bypass machines and other similar devices such as our blood auto-transfusion machines.  For cardiopulmonary bypass, the surgeon sews huge canulas into the blood vessels and the blood is re-routed through the machine allowing the surgeon to operate without massive blood loss or cardioplegia. Since a perfusionist is in charge of the machine that acts as the patient's heart and lungs, their ability to anticipate and quickly troubleshoot any problems is paramount.

Physician assistant - Yes, PAs and NPs can be in the OR where they assist surgeons both with perioperative management of patients and during cases in the OR. Often PAs do defined parts of a case such as saphenous vein harvest in a CABG while the surgeon works on the sternotomy or closing the incisions. Surgeons may hire a PA (or a very experienced CST) as their assistant if they commonly do surgeries that require a second pair of trained hands (and a surgery resident is not available, as is common in the community!).


See you in the OR!
Petite Surgeon

The Medical Marriage

My last post was for women who are constantly told to avoid a life in surgery if they want a family. (Long story short: Do what you love, have the family you love, and never look back) 

Stumbled upon an awesome blog with great advice for those embarking on a relationship through residency.  It's aimed at married surgeons, but honestly, the advice is great for everyone with a partner in a busy residency or training program. (And it has specific advice for both residents and their partners).

Check it out:

Balancing My Marriage and a Scalpel: Lessons Learned as a General Surgery Resident that Kept My Medical Marriage from Exsanguinating

So you want to be a female surgeon

One of my pet peeves as a medical student when I mentioned in conversation thatI wanted to be surgeon was eternally getting the response:  "Oh, my [daughter/fiance/wife/mother/sister/someone I met on the internet] thought about doing that. But then she decided she wanted a family. So she became a [family doctor/PA/NP/insert something that has nothing to do with surgery here]."

I'm here to tell you that it is hard work but not impossible to be a female surgeon.

You can be a single female surgeon.

Or you can be married without kids.

Or you can be married with kids.

And no matter which you choose, you can still run a practice, have hobbies, and/or be an academic.

The training is hard (okay, really hard), and yes, being on call and pregnant may be a special type of torture.  You will be called "nurse" a lot along the way, and you'll either feel guilty about leaving the kids or guilty for not having them at all.

But at the end of the day, surgeons have amazing careers that take every form from subspecialist to generalists, shift work to private practice.  Even with the extra potential burden of motherhood, being a female surgeon is a completely reasonable and rewarding career choice.  I couldn't imagine doing anything else with my life.  I look forward to passing that passion for health and healing on to my future kids.  Don't worry about the folks who said they didn't want to do surgery.  If you truly do, you and your ninja time management skills will find a way.

Don't believe me?  Check out Dr. Mary Edwards Walker, one of the original American civil war surgeons who carved a path for women and the only female recipient of the medal of honor.  There are a number of great resources online, but just trust in yourself.  If you want to be a surgeon, then go be one. 


Til next time,
Petite Surgeon

The best way to prepare for case

Imagine you're a third year medical student.  It's dark 'o thirty on week one of your surgery rotation.  Your team has just finished rounds, and your notes and tasks have been diligently completed.  It's off to the operating room!

Hot lights, blue drapes, everyone moving briskly and efficiently, making jokes and slapping metal instruments into palms, a square of human flesh draped out on a table -- it's all a little unreal.  The attending surgeon turns to you and asks you some tidbit of anatomy that has been covered in a thick layer of dust. Your life flashes before your eyes as you struggle to picture your coffee stained Netter's atlas from MS1.  It's your time to shine...or sink.

So, how do you prepare for the OR?

 First of all, preparation is key.  Ask the junior-most resident on the team to help get you a copy of the cases for the week; gently remind them when they forget-- or at least find some way to know what to prepare for.  Sometimes you'll be assigned to cases; other times you'll have more freedom to choose.  If you've been following a patient preoperatively, make an effect to be involved in their operation. 

 Once you have the schedule, review these things:
 

1. Know the patient
Read the H&P!
- Why is this person having an operation?
- Why *this* operation? (For example, a person with inflammatory breast cancer gets a modified radical mastectomy.  A person with less invasive cancer may get a lumpectomy or simple mastectomy.)
- What comorbidites / past surgeries have they had?  (No meds, no past surgical histories, or did they have to delay getting their 18th surgery because of the latest myocardial infarction?)
Hint: Attendings often put their favorite pimp questions in the H&P; enjoy those freebies.  "What's the risk of X complication, med student?"  "It's 2%, sir!" 

*BONUS* The first words out of an attending's mouth at the scrub sink to the resident will un-doubtedly be: "So did you look at their films?" You want to be able to say "Yes, sir/ma'am. [And insert description of relevant pathology or abnormality]"

2. Know the operation
   Okay, if you're a resident, you should shrive to know the operation well enough that if your attendings vanished mid-case, you could muster on without them.
If you're a medical student, you need to know enough to know what the heck is going on.
- Read a broad description of the operation in any surgical text.  Break it down into bite size steps and write them out.  (Cholecystectomy: Access abdomen, insuflate with gas. Place 4 ports. Dissect out a critical view of safety. Ligate cystic artery and cystic duct. Remove gallbladder from hepatic fossa.  Pull gallbladder out. Close.)
- Now look up those relevant structures!  Know your anatomy first and foremost.  95% of your average MS3 pimp questions will be anatomy.  The rest will be either basic physiology or common postop complications.
- Surgical Recall somehow magically has all the good pimp questions. I highly recommend it earn a place in your white coat or ipad.




The Rapid Review
"I'm working with a different team today and found out that we're doing a Whipple today.  I have 10 minutes before the case starts.  What do I study??" 
- 1 min: Skim the H&P.  (46 yo W with Pancreatic cancer. No nodes. HTN. Hysterectomy in the past. Former smoker. Got it.)
- 3 min: Know the indications for the operation.  (UpToDate or Surgical Recall in a pinch).  (Ask yourself: Why is this patient getting an operation?  In this case, because a Whipple can extend life or even cure patients with pancreatic adenocarcinoma with a 25% 5 yr survival)
-7 min: Anatomy! (Go back to basics.  What's the blood supply to the pancreas? What are the branches of the celiac and SMA? etc.)


If you're prepared for the OR, it'll be easier to understand what's going on, ask intelligent questions, and actually learn something.  You might find yourself enjoy the cases more as you become more involved, and studying becomes much easier when you directly apply it in the operating room. 

Hope this helps -- Good luck!

Til next time,
Petite Surgeon

Match Day!

This past week thousands of medical students across the medical students opened an envelope that told them where they would complete their residency in various specialties.

Most physicians remember that day like it was yesterday.

And for a few medical students of a particular persuasion, that envelope can be a dream come true: You're going to be a surgeon.

Surgeons: physicians who combine critical thinking, precision tactile skills and techniques, and care for a range of patients and diseases - everyone from the 21 year old who wrecks their dirt bike to your grandpa who was just diagnosed with colon cancer.   It is a grueling, awesome career choice, and to those lucky (crazy) folks who matched this past week, Congratulations!

And to the future surgeons out there in high school, college, medical school, and even still in residency (like me), the goal of being a surgeon is worth the time, effort, lost weekends in the library, and perpetual caffeine addiction - if it's the profession that truly calls you.

In this blog, I'm going to try to share my best advice, experiences, and words of wisdom.  So you want to be a surgeon?  If you're crazy enough to try, you just might make it.

For all those medical students out there, here is some complied, extensive advice from myself and two colleagues at the University of Washington who matched happily into surgery a several years ago.

Til next time!
Petite Surgeon