The match is complete and now the 4th year
medical students are preparing to make their move to residency and chief residents
are preparing to start their new career as an attending. The next phase of their
lives are about to begin.
The match got me thinking about a comment I read recently
from a doctor who decided to not become a general surgeon, which she had always
wanted to be, and switched instead to a specialty that had a “better home
It is a misconception that general surgery doesn’t have a
good home life. There is no specialty that has or does not have a good home
life. The home life you have is determined by you and how you organize your
life, not by the specialty you choose. Yes, some specialties have more call,
but that alone will not ruin your home life.
I was a general surgeon in private practice for 20 years.
Then I became a locums surgeon for three years. Both afforded me a good home
life because I wanted to have a good home life and made it so.
When I first came to town, my partners made rounds and took
care of their own patients on the weekends if they were in town, and they expected
me to do the same. That was not what I wanted. I wanted to have the weekends
off if I was not on call. I knew this was a battle I could not win. So I took a
different tact. I bought a motor home.
With the motor home, I was able to check out to whoever was
on call and take my family away for the weekend. When I bought the rig my kids
were nearly three and one. We often went camping at a campground just outside
of town. We purchased an inexpensive, used motor home, with 47,000 miles. But
it gave me my weekends off with my family, which was my goal. Four years later,
after hiring another surgeon, we changed the weekend coverage. Whoever was on
call for the weekend would cover for all surgical patients.
When my kids needed a soccer coach on the U-8 soccer league,
I volunteered. Games were on weekends and I could set the weekday practice
days. Tuesday was my day out of the office and on Thursday, my operating day, I
was done by three. So practices were Tuesday and Thursday at 4pm. I asked to
not be on call on Thursdays during soccer season. I had a parent who could be
my backup if there was ever an emergency that kept me away. I really enjoyed
being a youth soccer coach.
We chose to buy a house that was close to my office and
close to the kids’ school. It was a choice we made for a better home life. When
my kids had a school event, I could duck out of the office, see their part of
the program, and get back to the office before anyone missed me. Many doctors
choose to buy their house out in the country, which meant their kids went to the
county schools which are a long way from their offices in town. Having my house
close to work also gave me a short commute, enabling me to spend more time with
my family. I was even able to make it home for lunch several times a week.
Weekend call was Friday at 7am to Monday at 7am. After my 72
hour call weekends I was usually very tired and had lots of clean up to do on
Monday. Other doctors with the same schedule had their Monday fully booked and
had to work their weekend add on cases into an already full day. I took that Monday
off, which cost me some income, but it gave me some breathing room. If the
weekend was light, I spent the day off with my family. If it was a tough
weekend, I could finish the work from the weekend and go home to sleep.
We chose to pay off all our debt and become debt free. Which
meant I could take a lot more time off, as I didn’t need money to make payments
on the house, cars, credit cards, etc. Others chose to run up debt by
purchasing toys they just had to have. Without the debt I was able to take 12
weeks of vacation a year. I chose a lower income for a better home life.
I had always wanted to be in a play. I auditioned and was
cast in On Golden Pond at our local theater. I made a deal with one of my
partners to trade call. He took all of my call for 12 weeks so I could be at
all rehearsals and every performance. After the show closed, I took all his
call for 12 weeks. I came up with a way to do both my job and something I
really wanted to do for fun.
As you can see, I could have missed out on many things and
claimed that general surgery was bad for my home life. But I found ways that
made my profession work well with my home life. You can too.
When you become an attending it is you who chooses where you
will live. You can live close to the hospital, or the office, and have more
time with your family, or you can live out in the country and not see them as
much. If you have a long commute, is that the specialty’s fault or yours? You
can’t believe how many times someone has told me they “had to” buy a house out
in the suburbs and have a one hour commute because of some special circumstance.
Then they complain about their work hours keeping them from their family.
You choose the size and expense of your house, how much you
spend and how often you buy a car, and which toys you acquire. Your debt burden
is completely within your control. Now is the time to decide what kind of life
you want. A big house, expensive cars, and lots of toys equal many hours
working to finance these luxuries. A modest home, reliable cars and toy
purchases, only after becoming debt free, will grant you more time with your
family and a less stressful life.
I have seen many doctors who have made poor choices blame their
lack of family time on their job. They spend their free time working extra
shifts to earn more money to spend on new toys, a bigger house, or a special
vacation. While their family is at home wishing they could spend more time with
them. It’s time we took control of our lives and do the right thing. Create a
working environment in which we and our families can thrive.
In the recent Medscape burnout report, general surgery had a
burnout rate of 46%. Pathology had a burnout rate of 33%. If it was the specialty driving the issue,
pathology should have a very low burnout rate. Pathologists have little to no
call, they never deal with dying patients, and they have extremely low stress.
Yet 1 in 3 pathologists are burning out.
It is not the specialty that is the biggest detriment to
becoming burnt out or to a poor home life. Make your family a priority. Make
your home life a priority. If you make them important, and not just say they
are important, then you will have a great life as a physician no matter what
specialty you choose.
So choose the specialty that you like the best, with no
regard to its perceived home life or income. Make your home life what you want
and take control. Even employed physicians can have a very nice home life with
a little negotiating.
Take control of your
don’t let your job
If debt is causing you to work extra hours, then get a copy of The Doctors Guide to Eliminating Debt and take control today. You deserve it.
How about you? What have you done to take control of
something in your life or practice?
16 thoughts on “Choosing to be a general surgeon is not choosing a bad lifestyle”
The key to reduce burn out is to keep the number of anastomotic leaks close to zero. surgical complications more than long hours cause stress. I still take 10 calls a month but never feel tired. Surgery is actually much less demanding than training for Boston marathon or a full Ironman distance as long you do not need to deal with a major catastrophe. taking call is probably less stressful than doing major elective cases. Aloha g maldini
Gregorio, You are spot on about the stress of complications. If I was worried about a case, it would eat at me for days, until the patient was out of harm’s way. If I did get a complication, it would eat at me for weeks. Then that patient who sues you eats at you for years.
I too chose the road less traveled in the General Surgery world. I too have enjoyed a life style and a surgery career. My family flourished….I am happy. I applaud your decisions to choose your priorities. Yet, by doing so…..many of our General Surgery colleagues often look down on our choices. We will be vilified as the renegades and General Surgeons who turned to the “dark side”. They will not celebrate in our new found freedoms. It is sad that our colleagues who complain the most about their lack of freedoms and lifestyle are the very ones who will not celebrate the surgeons who make it work…. make it work for themselves, their families and ultimately for their patients.
Dr. White thanks for your comments. Yes some look down on the ones who choose to have a good home life by working a little less. I remember hearing, “You’re always on vacation.” “Are you leaving again, you were just gone for two weeks.” “How could you possibly have time to coach soccer?” “I don’t have any apartments like you so I have to work.” “Good doctors don’t write books that are not about medical care.” I’m glad you found your happy place.
Your family also participates in those financial decisions. and if they don’t work with you it becomes a crummy lifestyle ‘n
Kent Kossoy, yes your family must participate in your lifestyle choices. But this is true no matter what you choose to do for a living. But if your family sees you are making a good effort to put them on the top of your priority list, they can put up with a few bad days now and then.
Wisdom beyond quantification.
Thanks for your kind words.
I think your timing was right to be able to do the things you report here. And you have already written about the tremendous support your wife gave you. I think it is much harder to accomplish the things you did in today’s world. Medical student debt level, corporate medicine, lack of smaller hospital support services are but a few things that are obstacles to getting where you were. I think its great to think outside the box and try to live a life in medicine such as you had. I just think the table is set differently these days.
Everything I talked about can be done today. Even when I was doing it people would tell me it just can’t be done in “their situation.” That was rarely the case. Medical student debt level doesn’t eliminate these options. You need to pay student debt off just the same as paying off your house, your car and anything else you borrow. If debt is an issue, read my book The Doctors Guide to Eliminating Debt. Income is also much higher now than when I started. I was $500,000 in debt three years into starting my practice before I decided to get out of debt for good. How you are employed should not effect prioritizing your home life. Nothing I did required any hospital support. There are many aspects of your practice that you can alter to your benefit. Some aspects you cannot alter. For example, I could not remove taking call from my schedule. I still had to do my share. But I could manipulate when I took call. When I was on call, I would not schedule anything else to do. Being on call was my task of the day. When I was not on call, I scheduled family time. You mentioned you thought it was “much harder to accomplish…in today’s world.” But you didn’t say you can’t do it in today’s world. Harder you can handle. You have been doing hard things all your life if you are a doctor. Put your family on the top of the priority list and your family will notice the difference. Think outside the box and find ways to do the things you really want in life. You can do them as a general surgeon or as any other specialty, if they are a priority.
Best of luck to you and thanks for the comment.
I have designed my practice this way. I’m also a woman with a husband who works full time as an attorney. I’ve given up income and live below my means so I have time to be a good parent and spouse. It can be done.
M.A. I’m glad to hear from another doc who realizes that you have choices to make that can improve your life. Make good life choices and you can have a good life. Sometimes we don’t think we have a choice, but there are always things we can do differently.
Good advice as always Dr Fawcett!!
Thanks Ramin R
It is great to see an actual example of how having your finances in order and making decisions to promote family time can be put into practice.
General surgery is often perceived as one of the harder specialties to maintain a good lifestyle (the late night emergency surgeries, etc) but as you pointed out you can design a practice to make it more manageable.
I switched from surgery after 2 years of residency to radiology because the lifestyle just wasn’t for me. But even in my “lifestyle specialty” there is burnout and I have still felt it despite choosing a practice that gives me no call and no weekend. Having your financial affairs in order does do wonders in reducing it and should be a main point for every doc in any specialty.
Xrayvsn, Thanks for your comments. Lot’s of people switch specialties based on their perception of the lifestyle, as if they can’t control it. Glad you found a good fit.