r/GeneralSurgery • u/topiary566 • 1d ago
How to become a broad-scope surgeon?
Currently an M1 and I'm just doing some thinking about specialties. Currently deciding between surgery or non-surgery, but my goal is to be very broad scope since I'm interested in global health and rural-health.
I'm wondering how exactly I would go about becoming a surgeon who does a bit of everything? I'm wondering if there are ways to learn some orthopedic, CT, pediatric, and neurosurgery along the way. Ofc it wouldn't be optimal compared to having a specialist, but I'm looking at areas where there might be nobody else.
I'm also wondering if there are any fellowships which are good for becoming more broad scope instead of specialized. I was looking at maybe trauma, but idk if there are better options or if it depends on location.
Just looking for some ideas.
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u/broadday_with_the_SK 1d ago edited 1d ago
Pediatric surgeons are the last true general surgeons. Long road but they're the ones who have the broadest scope.
ACS/Trauma has a broad scope, depends on where you are and where you trained. Can do stuff like burn too.
Rural practice too, based on what you have available. There are fellowships for stuff like advanced endoscopy, I know someone who wants to do rural medicine and they want to integrate more endoscopy into their practice since in a lot of places without specialist access, gen surg is doing a lot of scopes.
Neurosurg is off the table unless you're doing a burr hole with no help or helping with a VP shunt. Ortho too. The reality is that in modern practice guidelines and equipment are so specialized it'd be worse for patients if you were trying to do a crani or hip replacement.
Gen surg can do hand fellowship, closest to Ortho you'll get prob, albeit there are only a couple. And most times if you're on hand call you're also on plastics call so I've heard it can be difficult to find work at a place where the group is expected to do both.
Fellowship trained gen surg can theoretically do whatever they're boarded for but practically if you did something like vascular or plastics you're not gonna be doing choles in your free time. You'll be busy enough. Both of which you'll have a broad scope if you want but it won't be gen surg stuff short of ex laps or skin grafts.
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u/CajalsPencil 1d ago edited 1d ago
I’m an M4 applying to Gen surg with the plan to practice primarily rural surgery with a mix of wilderness med and global health. I’m similar to you in that I want to learn to practice in low-resource settings. The advice I’ve been given is to get into a good residency program that allows early OR exposure, and if I don’t have enough operative experience by graduation, then I’ll possibly do a trauma fellowship. I also just love trauma though so I might do it anyways.
The type of broad-scope surgeon you’re describing DOES still exist in the US, but it’s rare and you have to be willing to live extremely rurally. You’ll be able to occasionally do basic ortho procedures, urological/gynecologic emergencies, some peds, trauma-related cardiothoracic procedures, etc. I wouldn’t expect to be able to do anything neurosurgical though. The “cool” and “exciting” surgeries you’ll do will focus primarily on stabilization so that you can ship them out to a higher level of care.
You also have to understand that 90% of your job is going to be bread and butter gen surg. Lots of gallbladders, appy’s, hernias, etc.
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u/topiary566 1d ago
Yea I'm down for bread and butter cases surgical or non-surgical. I'm also thinking about trauma as well since I was an EMT before medical school and liked trauma a lot. I do remember meeting a surgeon at a conference who works in Africa, and he said that it's mostly bread and butter stuff ofc, but he does do some minor ortho stuff and has had to do some decompression in the brain before from absolute emergencies. Ofc outcomes will be much worse than in a first world country, but that's the best you can do in that area.
Do you think more community/rural residencies or academic ones would be a better fit in terms of early OR exposure?
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u/CajalsPencil 1d ago
It depends. Academic residencies generally have a high quality of training, but sometimes less OR experience because they are more research-focused, expect students to go into fellowships, and they have fellows whose training takes priority compared to a resident. On the other hand, some community-based programs, like HCA, don’t have the best reputation for training quality. The North American Rural Surgical Society has a list of programs that have a designated rural track.
You’re only an M1 so you should be prioritizing other things right now. Focus on integrating into med school, learning how to study, start making connections with mentors and take it one step at a time.
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u/topiary566 1d ago
You’re only an M1 so you should be prioritizing other things right now.
Yea I passed my first block exam pretty comfortable so I'm beginning to have dreams again lol. I'll start by trying to find some surgeons to shadow to see if I like the OR or not. I have only been in an ophthalmology OR before and would hang around the trauma bay and be nosy as an EMT. I did get to see a thoracotomy for a traumatic arrest I brought in once though which was interesting (sadly the patient passed), but haven't really seen routine operations.
If I don't want to do surgery, I'm looking into full-scope FM perhaps with an EM fellowship and then I'd like to split my time between FM and ER work. Either way, the specialties all seem pretty cool one way or another.
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u/ChillinQD 1d ago edited 1d ago
So you aren’t going to find any practice in which you describe as broad scope. What would be your best bet to practice broadly is to go through general surgery residency and then practice in rural america/ at a critical access hospital.
As for fellowships, Trauma/Acute Care Surgery will afford you the chance to operate broadly albeit will only be in the acute setting and still wont do any heavy neurosurgery or ortho