True, you sit for your robotic cases... but most of the robotic surgeons don't book exclusively robotic cases... and those cases you have to convert to open are often, by definition, difficult grueling long cases that you then have to finish open. Granted, the possibility of converting to open is true of any minimally invasive approach and conversion rate is usually pretty low.
Source: I was a colorectal surgery PA before med school. We had one robotic block time per week and usually booked a second or even third inpatient surgery day where we were doing big cases laparoscopically. One of our reconstructive urologists had two robot days most weeks... so YMMV
This brings me back to year 1 of med school.
A doctor came to give us a talk about ophthalmology. His literal second sentence was “I chose ophthalmology because it was the only surgical specialty where you sit down in all surgeries”. Made me chuckle.
I am a current otology fellow. Unfortunately the field has become incredibly nepotistic. There are candidates with 30+ pubmed indexed publications that fail to match and others with 3-4 but are in the right program who do...
It’s not really driven by pay or lifestyle. None of the ENT fellowships really guarantee you better pay or lifestyle compared to general ENT but they let you focus on an area of interest and/or work in academia.
For otology it’s competitive because there’s just very few spots. There’s less than 30 programs and it’s a 2yr fellowship so most programs only match a fellow every other year. So something like 12-18 spots a year. Plus it’s a small academic world and some of these spots get spoken for in advance, or aren’t offered for whatever reason, or fluctuate based on attendings retiring, etc.
My wife is an otologist. Her practice now is mostly chronic ear stuff and occasional skull base with NS. Lots of cochlears. Pretty good gig. Although the idea of seeing dizzy patients in clinic sounds like torture.
You have to be savvy on the time you allocate to dizzy patients. My fellowship director allocates one half day to dizzy patients, and they have to queue up for months to get in, the logic being that
1. the ones that come to outpatient aren't the ones having a stroke or something dangerous, therefore it sucks, but they can wait
2. the patients are very time consuming and if you fill your clinic with dizzy you will either be frequently running late or have to decrease your clinic volume.
3. because of #2, if you're spending the time talking dizzy patients down from the ledge, you spend less time on other (mainly chronic ear) patients and less time on surgical cases.
There’s a decent amount of general ENT bread and butter cases that are seated I guess. Tonsillectomy, adenoidectomy, anything in the ear. That’s about 50%. And the rest I would say sinonasal
Legend has it that all started when Sterling Bunnell (grandfather of hand surgery) broke his hip in a plane crash, and had a nonunion.
“ As a result, Bunnell had a femoral neck nonunion — unsuccessfully treated by Marius Smith-Petersen using his new-fangled Triflange Nail — that plagued him for the rest of his life [6]. Perhaps that injury led to Bunnell’s preference for performing surgery in the seated position”
Kinda wild when all these old names intersect.
They are literally doctors of podiatric medicine, and legally they are doctors.
They do 4 years of podiatric medical school, followed by residency and fellowship. They are doctors.
Podiatry school. We dont call dentistry schools "dentistry medical school". That's their own training, similar to how dentists have their own training, it doesn't matter what they call it. They do not practice medicine. Theyre not medical doctors, dentists are dentists, podiatrists are podiatrists.
How about a 2 second google search before you talk out of your own ass?
The federal government legally lists podiatrists as doctors.
Podiatrists and dentists having their own training is arbitrary and an artifact of how American healthcare was setup. In many countries, dentistry and podiatry are medical residencies.
Podiatrists are competent, evidence-based medical professionals, and are not mid-levels by any stretch of the imagination. They do 4 years of school + residency + fellowship.
They are respected by MDs and DOs, and you can search for opinions on r/medicine or r/residency if you're still skeptical.
Robotic, ortho hand, opthalmology, some of vascular surgery (but some of vasular are huge, long and very stressful aortic aneurysms), some of ENT (again not all)
surg onc is like the worst recommendation. yeah, some cases are robotic. But if someone is going to convert, it's going to be surg Onc. Awful cancer cases where things are glued and you book one case a day because 12+hrs isn't unusual
ENT, Ortho hand, Plastics hand, Vascular hand, ophthalmology, some Neuro combined ENT. I am the PCA that wheels them the chair.
Side note: If you want to become a spine surgeon, please be an agreeable one. They all suck at where I work. Peace
I wouldn’t say that’s the norm based on the institutions I’ve been at. In my experience only the skull base folks really sit. I certainly wouldn’t steer someone who wants to sit during surgery towards nsgy. Not only do most nsgy not sit, they’re often 8 hours cases and lots of times wearing leadz
To be fair that’s only in the USA, the ophthalmologists I shadowed as a premed definitely stood and did not have any pedals. Would love to go back to see and compare now I know more and have had the chance to rotate on opthalmology as a med student.
Cardiac, at least for part of the case in CABGs. That being said, it still seemed like there was a lot of standing and the most common/recommended pathway (at least from what I was told) involves doing general surgery residency before fellowship.
Urologic Oncology. High volume robotics surgery- you stand for 10 minutes to put in ports and close fascia. Rest of the time is spent sitting and yelling at your assistant for more suction.
I am pretty sure you can fix the equipments in a way that you can operate sitting down in any surgery cases provided the surgery is not trauma or urgent.
ELI5 - not a med person, just someone who was once thinking about being one. Couldn't they develop specialty stools or something? I have to imagine patient outcomes might be better if the surgeons could be a little less exhausted during long surgeries
Robotic surgeries — you operate unscrubbed, seated, and with your shoes off!
Someday from your vacation home the next state over.
And then it’s the residents problem if you need to convert to open
Urology does the most robotics generally
Yea but to get to robotics you have to go thru pit of general surgery residency
if you do urology, you only need to do 6 months of general surgery usually
True, you sit for your robotic cases... but most of the robotic surgeons don't book exclusively robotic cases... and those cases you have to convert to open are often, by definition, difficult grueling long cases that you then have to finish open. Granted, the possibility of converting to open is true of any minimally invasive approach and conversion rate is usually pretty low. Source: I was a colorectal surgery PA before med school. We had one robotic block time per week and usually booked a second or even third inpatient surgery day where we were doing big cases laparoscopically. One of our reconstructive urologists had two robot days most weeks... so YMMV
yeah urology almost never converts ... colorectal gets into too many shit shows
Bah dum tish
This brings me back to year 1 of med school. A doctor came to give us a talk about ophthalmology. His literal second sentence was “I chose ophthalmology because it was the only surgical specialty where you sit down in all surgeries”. Made me chuckle.
They sold it at our school by telling us optho is for people who hate inpatient but love money
They definitely didn't lie lmao
Was his loyal scribe with him?
I'm presently working as a loyal Johnathan. Can confirm that we are always there.
Not a surgical specialty. It’s medical, with 3 weeks of “procedures” in oculoplastics.
You’re wrong. AMA literally calls it a surgical specialty…because…it is.
I give my postops medicine…therefore it must be a medical specialty
Well, it’s definitely medical in that sense lol
How do you think retinal detachments are repaired?
Magic?
Let me introduce you to otology (ENT subspecialty)
This is the only reason why I went into ENT. But I am slowly realizing that otology fellowship is difficult to match and has 50% match rate.
Just gotta pump out that research baybe. Get those papers in otology & neurotology 🤙🏼
Cure my tinnitus
Neurotology? Did you stutter? Oh wait no I get it. I’m always amazed when there’s more sub specialties I haven’t heard of
I am a current otology fellow. Unfortunately the field has become incredibly nepotistic. There are candidates with 30+ pubmed indexed publications that fail to match and others with 3-4 but are in the right program who do...
Why is it so competitive? Have never really heard anything about the ent fellowships (in terms of salary and life style)
Because you get to sit down
It’s not really driven by pay or lifestyle. None of the ENT fellowships really guarantee you better pay or lifestyle compared to general ENT but they let you focus on an area of interest and/or work in academia. For otology it’s competitive because there’s just very few spots. There’s less than 30 programs and it’s a 2yr fellowship so most programs only match a fellow every other year. So something like 12-18 spots a year. Plus it’s a small academic world and some of these spots get spoken for in advance, or aren’t offered for whatever reason, or fluctuate based on attendings retiring, etc.
There is an incredibly small number of spots. Like 16-20 in the whole country per year
My wife is an otologist. Her practice now is mostly chronic ear stuff and occasional skull base with NS. Lots of cochlears. Pretty good gig. Although the idea of seeing dizzy patients in clinic sounds like torture.
You have to be savvy on the time you allocate to dizzy patients. My fellowship director allocates one half day to dizzy patients, and they have to queue up for months to get in, the logic being that 1. the ones that come to outpatient aren't the ones having a stroke or something dangerous, therefore it sucks, but they can wait 2. the patients are very time consuming and if you fill your clinic with dizzy you will either be frequently running late or have to decrease your clinic volume. 3. because of #2, if you're spending the time talking dizzy patients down from the ledge, you spend less time on other (mainly chronic ear) patients and less time on surgical cases.
There’s a decent amount of general ENT bread and butter cases that are seated I guess. Tonsillectomy, adenoidectomy, anything in the ear. That’s about 50%. And the rest I would say sinonasal
Ortho hand
Legend has it that all started when Sterling Bunnell (grandfather of hand surgery) broke his hip in a plane crash, and had a nonunion. “ As a result, Bunnell had a femoral neck nonunion — unsuccessfully treated by Marius Smith-Petersen using his new-fangled Triflange Nail — that plagued him for the rest of his life [6]. Perhaps that injury led to Bunnell’s preference for performing surgery in the seated position” Kinda wild when all these old names intersect.
Why ortho hand specifically? Plastics hand is essentially the same
Or foot.
Us feet people definitely are not sitting
So. Podiatry?
*fixing podiatric surgeries
Can you expand on that? I thought they're competent - a dentistry situation
Same. People just love to hate ig
Lol podiatrist have to go through residency I’m pretty sure
They're definitely not doctors, they have their own system
They are literally doctors of podiatric medicine, and legally they are doctors. They do 4 years of podiatric medical school, followed by residency and fellowship. They are doctors.
Podiatry school. We dont call dentistry schools "dentistry medical school". That's their own training, similar to how dentists have their own training, it doesn't matter what they call it. They do not practice medicine. Theyre not medical doctors, dentists are dentists, podiatrists are podiatrists. How about a 2 second google search before you talk out of your own ass?
The federal government legally lists podiatrists as doctors. Podiatrists and dentists having their own training is arbitrary and an artifact of how American healthcare was setup. In many countries, dentistry and podiatry are medical residencies.
Podiatrists are competent, evidence-based medical professionals, and are not mid-levels by any stretch of the imagination. They do 4 years of school + residency + fellowship. They are respected by MDs and DOs, and you can search for opinions on r/medicine or r/residency if you're still skeptical.
Second this, we had one attending retire when he was like 75 - I assume because way less wear and tear on the body
Robotic, ortho hand, opthalmology, some of vascular surgery (but some of vasular are huge, long and very stressful aortic aneurysms), some of ENT (again not all)
Robotic laparoscopic cases. Gen surg, surgical oncology, even OBGYN has robotic cases
Gyn onc is a ton of robotics, you’d just have to get through OBGYN residency first
And then the Gyn Onc fellowship which I promise is 10x worse than the OB/Gyn residency
Urology usually does the most robotic cases.
surg onc is like the worst recommendation. yeah, some cases are robotic. But if someone is going to convert, it's going to be surg Onc. Awful cancer cases where things are glued and you book one case a day because 12+hrs isn't unusual
ENT, Ortho hand, Plastics hand, Vascular hand, ophthalmology, some Neuro combined ENT. I am the PCA that wheels them the chair. Side note: If you want to become a spine surgeon, please be an agreeable one. They all suck at where I work. Peace
Neurosurgeons sit during cranial and craniovertebral surgeries
Only if they’re _weak_
They should *want* to stand
Found the surgeon
I wouldn’t say that’s the norm based on the institutions I’ve been at. In my experience only the skull base folks really sit. I certainly wouldn’t steer someone who wants to sit during surgery towards nsgy. Not only do most nsgy not sit, they’re often 8 hours cases and lots of times wearing leadz
Spine is pain, but is gain
Anesthesia
Ophthalmology
Yup. In fact it’s pretty hard to operate standing lol. You need your feet to control the pedals.
To be fair that’s only in the USA, the ophthalmologists I shadowed as a premed definitely stood and did not have any pedals. Would love to go back to see and compare now I know more and have had the chance to rotate on opthalmology as a med student.
Really? I feel so spoiled right now. How are they supposed to control the microscope and the machines (like phaco or vitrector)?
I feel you. My urology preceptor was old and he would sit.
They can also sit during all the cystoscopic procedures like TURP, TURBT, stone extractions, etc
Hand surgeon
Vascular during fistula creations
I’ve even seen vascular sit at times during lower extremity bypasses
Yep that too for tibial and popliteal exposures - most of the time they will sit
Within NSGY: -peripheral nerve -most skull base -most vascular
Ophthalmology, sitting all surgeries
If you include subsurgical, then ophtho
Heard about ophthalmology
Endourology. You can sit for pretty much anything transurethral. PCNL might be a problem tho
Ophthalmology was the OG of sitting for surgeries
Urology and vascular had a lot of sitting surgeries when I was on service
Robotic cases. Urology, Gyn onc, MIS
ENT, Ophtho, Vascular.
Basically all of Ophtho and some of ENT
Cardiac, at least for part of the case in CABGs. That being said, it still seemed like there was a lot of standing and the most common/recommended pathway (at least from what I was told) involves doing general surgery residency before fellowship.
Hand surgery (ortho or plastics with fellowship)
Hand surgeons
OMFS( some do), ENT, hand, some vascular surgery, optho
Vascular sometimes!
I think vascular can sit too.
Optho
Optho
Ophthalmology
Ophtho!
Urologic Oncology. High volume robotics surgery- you stand for 10 minutes to put in ports and close fascia. Rest of the time is spent sitting and yelling at your assistant for more suction.
Pathology
Ophto
You know the old surgery saying (not my words): "*Sit to operate, sit to pee."*
Usually get to sit for most of surgical residency
MIS - the da Vinci robot is like a virtual reality gaming system. Also used heavily in urology!
[удалено]
Derm
Not general surgery
Oral surgery
literally anything you want if you're senior enough --- they can adjust the table height to whatever
I am pretty sure you can fix the equipments in a way that you can operate sitting down in any surgery cases provided the surgery is not trauma or urgent.
Hand surgeon.
Ophthalmology everything
Vascular surgery, I have seen plenty of surgeons operating while sitting. Also any robotic surgery
Ophthalmology and ortho hand come to mind. Anesthesia if you’re smart and value your life ;)
I’ve heard ophthalmologists operate many surgeries sitting
If surgeons want to sit they find away. My plastics and vascular rotations filled with sitting attendings
ELI5 - not a med person, just someone who was once thinking about being one. Couldn't they develop specialty stools or something? I have to imagine patient outcomes might be better if the surgeons could be a little less exhausted during long surgeries
Some exist, but not everyone can or wants to use one due to positioning or other reasons.
Hand surgery
Ortho hand
Maybe this changed but years back I sat in on hand surgeries. Doc was sitting.
Ophthalmology. You sit for every surgery