Tuesday 4 October 2016

Becoming a trauma surgeon

I swear I wrote this same damned post a few months or years ago, but my chronically aging brain couldn't seem to find it despite hours (read: 75 seconds) of exhaustive (read: cursory) searching.  Unfortunately because I couldn't initially find it that means either A) I'm losing my mind, B) I've lost my mind, C) I'm losing my mind, or D) I never wrote it AND I'm losing my mind.  Therefore I am forced to write it again.  Grumble grumble etc etc.

The fact that I did find it means that it's probably A.  Or B.  Or possibly C.

Write what again, you may ask?  This.  No, not the word "this", I mean this blog post.  The one I'm about to write.  I mean the one I wrote.  No, not the other one, I mean the one I've just written and and that you're currently reading.  That is, in your temporal point of view, the one you're about to read or are currently reading . . .

GOD DAMN IT I have got to learn not to drink 2 coffees and a latte before sitting down to write.  I usually limit myself to one damned coffee a day, so clearly that is a good policy, one that I need to adhere to more strictly.

[intermission for caffeine washout]

Ok now that my mind is no longer buzzing and is instead running along at a somewhat normal pace, I'll continue.

I've had numerous people tell me over email during the past few years that they wish to pursue a career in trauma surgery, and they invariably ask the same thing: advice on how to get to where I am, if trauma surgery can mesh with their desired lifestyle, how to cope with long hours, losing patients, etc.  I touched on the subject a bit here and here, but not in enough detail.  Trauma surgery is a noble profession (if I do say so myself), so I feel it is my duty and privilege to guide people along that path if that is their particular flavour of torture that they've chosen.  However, instead of emailing people the same advice over and over, I am writing this so I can lazily point them to this post in the future rather than writing everything out again.

My first advice is always "RUN AWAY!  GO BE AN ACCOUNTANT OR A BANKER OR A ARCHITECT OR ANYTHING ELSE YOU FOOL!"  This may sound like I am actively trying to veer people away from medicine, but the only reason it sounds like that is because I AM trying to steer you away, because going into medicine is hard, going into surgery is even harder, and going into trauma surgery is a fucking bitch.  My apologies to all the actual fucking bitches out there for comparing you to trauma surgery, because in all honesty it isn't a fair comparison.  Trauma surgery is much worse than you, you fucking bitches.

I say that with my tongue firmly implanted in my cheek, because as difficult as trauma surgery is, it is also the most rewarding profession I know (other than toll booth collector).  However, before you embark on the journey that begins in college and concludes with you cutting open someone's chest and squeezing his heart in a desperate attempt to keep him out of the morgue, you need to know exactly what enemies stand in your way and will try to defeat you at every turn along the way.

I will preface any and all (real) advice by saying that I am not and have never been on an admissions committee.  It has been many moons since I applied to medical school, and requirements and expectations may have changed.  They also vary from country to country.  Medical school training is also in flux, so take everything I say with a very large grain of salt.

With that nonsense out of the way, there are many obstacles to surmount, and I covered some of them in that prior post that I mentioned previously.  As I said, medical school requirements are different from country to country.  For example, in all American and most Canadian medical schools you must first complete a 4-year undergraduate degree prior to starting your 4-5 year journey through medical school.  In most European countries and Australia you go directly from high school to a 6-8 year medical school.  In India medical school is 6 years.  If you happen not to live in one of those areas, I'm not your mother - go look it up, damn it.

The major roadblocks in undergraduate university are the dreaded science prerequisites - some combination of biology, chemistry, organic chemistry, and physics.  These also will vary from country to country and school to school (for example, some medical schools also require biochemistry).  Regarding courses to take (and/or avoid), I cover that topic in great detail here.  The bottom line is this: kill the prerequisites, and then (and only then) take courses that interest you and make you a well-rounded individual.  Are you interested in advanced maths?  Study that.  Do you like ancient Chinese literature?  Study that.  Art history, music, philosophy . . . the choices are nearly endless.  It's college, for chrissakes, and you only get this opportunity once.  But don't be that guy who takes all science courses and loses out on studying subjects that interest you because you think medical schools want that.  THEY DON'T.  Quite the opposite - they want people who aren't science robots.  I think.  Maybe.  Probably.

Assuming you do well in college (especially on those core science courses), depending on where you live (again) you then need to destroy the Medical College Admission Test (which is used in the US, and Canada) or GAMSAT (used in Australia and UK).  Other countries have their own tests, which all have the same purpose - to defeat you and destroy your dreams and beat you into submission and force you to do something else with your life.  It is incredibly easy to fail these tests and choose another profession, and that is exactly what they are designed to do.  They weed out the weak links.

Medical school is similar everywhere - learn, learn, learn, learn, and then just when you think your brain can't possibly accept any new facts without jettisoning some actual useful information, you have to learn some more.  I can't give you any advice here except to learn stuff.  Lots of stuff.  If you say you aren't good at rote memorisation, then med school is not for you.  You can try to have "a life" during medical school, but don't count on it.

You'll have to get through all the other rotations (paediatrics, internal medicine, obstetrics, etc).  If you're truly a surgeon at heart, these will bore the life out of you.  I felt like I'd rather stick hot pokers in my eye than sit through another 6-hour rounding marathon where we stand and talk and talk and stand. 

When you finally get to your surgery clerkship, learn as much as you can.  Try to suck up to the surgeons without it being obvious that you're sucking up (trust me, we can tell).  Be interested, be enthusiastic, but don't fake it.  We can detect false enthusiasm a mile away.  Get there early and be the last to leave.  Read your books the night before, and know the operation better than I do.  Know the anatomy and be prepared to be quizzed mercilessly (aka "pimped").  If you don't know your shit, it will be obvious  Make it clear that you want to learn surgery, not because you're faking it, but because you do.

When it comes to becoming a surgeon, in the UK it takes about 10 years (2 years of foundation training, 2 years of core surgery training, and 6 years of specialty training).  In the US you go through The Match where you apply for residencies, which last for 5-7 years.  In Australia surgery training is 5-6 years after medical school.  After all that, training in trauma is an additional 1-2 years.  If that seems like an interminable torturous lifetime of training, just wait until you're in the middle of it.  It seems even worse. 

Until you finish.

The biggest hurdle to get over, at least in my opinion, is meeting someone.  I got damned lucky and met Mrs. Bastard before I started medical school, and I was even luckier that she stayed with me during the entire ordeal and afterwards.  

Seriously, what the hell was she thinking?

If you're wondering if it's possible to have and/or start a family during surgery training, I am living proof that it is.  I got married a few weeks before starting mine, and my daughter was born towards the end.  My wife says that all that means is that we managed to see each other for five minutes nine months earlier, but I'm pretty sure she's exaggerating.  I don't really remember though.  My brain has mercifully blocked out that entire section of my life.

I think I'll stop there.  I could go into much more detail, but I think this has been boring enough for everyone NOT interested in becoming a trauma surgeon (which is approximately 99.99582% of you, according to my calculations).  Perhaps the remaining 0.00418% of you gained a little insight into how I became the curmudgeonly pessimist you've all come to love to despise. 

Perhaps not. 


  1. shameless plug:
    if you find you don't have the calling to be a trauma surgeon, or you already have a fulfilling career; look into volunteering for your local emergency services agencies.

    the training necessary varies depending on what you end up doing, and how much you have available to commit - and sometimes you can get your foot in the door for a career in emergency services.

    1. Thanks for the PSA, Ken :p

  2. Chrissakes doc?

    1. Yeah, I decided to try it on for size. I'm not sure it fits.

  3. In Canada you have the added dilemma of choosing between a Fracophone or Anglophone school.. in my experience (for pharmacy; comparable in length to becoming a trauma surgeon if your goal is to work in a hospital and specialize ex: oncology drugs & therapeutics), getting into the french schools is easier than the english ones, but the program is more difficult.

    You're absolutely right Doc, training is long and arduous, but it's worth it in the end (hopefully, haha, I'm not there yet). In any case, you never stop learning :)

  4. Hi, Doc! I have a question. I'd like a career in the medical field. But not a doctor/surgeon/nurse. What would you recommend?

    1. Radiologic Technologist, Respiratory Therapist, Physician's Assistant, Perfusionist, X-ray Technician, Nurse Practitioner.

    2. Physical Therapist!!

    3. I hear undeath care is a rapidly growing field.

    4. Great suggestion, Ken!

      - No need to worry about communicating with the patient, since s/he is already unconscious and unresponsive.

      - No need to have concerns about the patient's pain or discomfort level.

      - No need to think about what might actually improve the patient's quality of life, since that isn't possible.

      - And, most importantly, no need to feel responsible for trying to *save* a life, if it's already gone.

    5. I should probably clarify, I'd prefer to do my schooling online only. I was in college once before and my professors were all ding dogs! I was in an English class and the professor couldn't spell common words!

    6. ding dongs. Not dogs. lol!

    7. you're not going to get ANY type of working medical field education online. the best you could get online is some sort of clerical job. and your chance of finding out after submitting all your credit card information that the courses you took were a waste of money is pretty high.

      unfortunately, it is getting harder to differentiate between the legitimate colleges and universities and the for-profit diploma mills.

    8. I'm actually a graduate of Trump University but no one in my family attended my graduation.

    9. Well, THERE'S your problem.

  5. You can bypass all that and enter medical school directly from high school. Combined BS/MD or BA/MD programs.

  6. Actually your first piece of advice is very good. I took it to heart 35 years ago and became an accountant instead of an MD. I have never regretted that decision.

  7. 1. Um, toll booth collector? Is there some background missing here?
    2. Did you forget to tweet again?

    1. 1) The toll booth collector comment was supposed to be tongue-in-cheek.

      2) I didn't forget to tweet this one - I omitted it on purpose. I didn't think this would get a great response, since it wasn't really intended to. It is definitely a niche post, so I didn't think many of my Twitter followers would need to hear about it. Perhaps I was wrong?

    2. I dunno. I think if you wrote a post with a random word generator, a fair number of us would read it eagerly, trying to see if we could figure out where it's going!

  8. Wait.. Did I understand this correctly?

    You do 6-8 years medical school, 5-7 years residency, and then 1-2 years of niche training? So it takes about 20 years to become a trauma surgeon?

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