What Is a Surgeon?

Surgical Expertise, Training, and Specialties

Doctors with a patient
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Introduction

A surgeon is a physician who is trained to perform surgical procedures. It is a profession that demands exceptional manual dexterity and fine motor skills to carry out the techniques needed to investigate disease, repair or remove damaged tissues, or improve the function or appearance of an organ or body part.

It takes no less than 13 years of training and education to become a general surgeon. Those wanting to specialize can expect to add another one to two years to the training. Although physicians can be practiced in other medical specialties (such as ophthalmology, gynecology, podiatry, and dentistry), surgery is its own specialty and a professional dedicated solely to surgical procedures.

Concentrations

Surgical procedures are broadly categorized by their urgency, location, purpose, degree of invasiveness, and types of instruments and techniques involved:

  • Based on urgency, an operation may be considered elective, semi-elective, or an emergency.
  • Based on location, operations can be described by the body part (breast, colon, appendix) or broadly classified as gastrointestinal (digestive tract), genitourinary (reproductive and urinary organs), hepatic (liver), nephrotic (kidneys), neurologic (nervous system), orthopedic (bones and joints), and others.
  • Based on purpose, an operation may be exploratory (diagnostic), therapeutic, cosmetic, corrective, or reconstructive. It may also involve amputation or transplantation
  • Based on the degree of invasiveness, an operation may be minimally invasive or require open surgery.
  • Based on instrumentation, you may undergo laser surgery, microsurgery, laparoscopic surgery ("keyhole surgery"), angioplasty (using a catheter to perform surgery via a blood vessel), or robotic surgery.

Procedure Types

A surgical procedure can be identified by the suffixes used to classify the aims of the operation, such as:

  • -ectomy refers to the removal of an organ or structure, such as an appendectomy or hysterectomy.
  • -otomy describes the cutting into an organ or tissue, such as with a laparotomy.
  • -oscopy refers to the use of a scope in a minimally invasive operation, such as laparoscopy or arthroscopy.
  • -ostomy is used to describe the permanent or semi-permanent opening in the body, such as a colostomy.
  • -oplasty is used to describe reconstructive or reparative surgery, such as rhinoplasty or arthroplasty.

Common Surgeries

The list of surgeries performed is encyclopedic. According to a 2014 study from the U.S. Department of Health and Human Services, the 15 most common surgeries performed in the United States are:

Procedural Expertise

Surgeons perform surgery on either an inpatient or outpatient basis. The surgeon leads a surgical team which typically includes an anesthesiologist and registered nurse but may also involve a surgical assistant, surgical technologist, circulating nurse, and cardiac perfusionist.

The surgeon is involved in all stages of surgery, including preoperative, intraoperative, and postoperative care.

Preoperative

Preoperative care is primarily used to verify that a person is fit and ready for surgery. This phase may be extremely brief or require extended preparation during which a person may need to lose weight, undergo preoperative evaluations, or await the receipt of an organ for transplant.

The assessment may be done by the surgeon but, in hospitals, is most often performed by a nurse. The surgeon is ultimately responsible for reviewing the findings and giving the go-ahead to proceed. Prior to the surgery, the surgeon would be expected to meet with the patient, answer any questions, and help mitigate any anxieties the patient may have.

Intraoperative

The intraoperative phase is the surgery itself, spanning the time in which a patient is wheeled into surgery and wheeled out to the recovery room.

The surgery will ultimately involve some sort of incision. An angiography, for example, would involve a small incision in the arm or leg, while laparoscopy would require several keyhole incisions to insert the scope and surgical instruments. Open surgery is the traditional form of surgery in which a larger incision is made with a scalpel.

Prior to the surgery, the surgeon's hands, wrists, and forearms would be thoroughly washed for at least four minutes, after which sterile gloves are placed onto both hands. Sterile drapes are placed around the operating site, while surgical masks are worn to prevent contamination from droplets or aerosolized pathogens.

One or several procedures may be performed during the operation, such as:

  • Ablation (the targeted destruction of tissue or tumors using electricity, chemicals, microwaves, or freezing)
  • Anastomosis (the reconnection or bypass of structures that carry fluid, such as blood vessels or intestines)
  • Angioplasty (the opening of a narrowed blood vessel)
  • Arthrodesis (the surgical connection of bones so that they can grow together)
  • Centesis (the drawing out of fluid with a needle or tube for the purpose of diagnosis or treatment)
  • Debridement (the removal of dead tissue)
  • Decompression (including the decompression of intracranial pressure or spinal vertebra)
  • Excision (the cutting out of an organ, tumor, or tissue)
  • Grafts (the placement of tissue from one part of the body to another)
  • Implants (the permanent or semi-permanent implantation of mechanic devices like pacemakers, heart valves, and cochlear implants)
  • Ligation (the tying off tubes, blood vessels, or ducts)
  • Prostheses (manmade devices use to replace body structure, like the knee, hip, or breasts)
  • Reduction (the realignment of a body part, such as bone or cartilage, to correct its position)
  • Resection (the partial removal of an organ or structure)
  • Stent placement (the insertion of an artificial tube-like implant into narrowed or blocked vessels or ducts)
  • Transplantation (the transfer of a donated organ or tissue from a human or animal)

Postoperative

The main responsibility of the surgeon during the postoperative phase is to manage any complications of surgery. The surgeon would also review the outcomes with the patient, disclosing any findings whether adverse or favorable.

In addition, the surgeon will be responsible for ensuring the appropriate long-term follow-up in the event of an ongoing postsurgical problem.

Subspecialties

General surgery is the term used to surgeries that primarily involve the abdomen but can extend to any body part or medical condition when appropriate. Because the field of surgery is so vast, many surgeons will embark on additional training to specialize in a certain condition, group, or technique. Some of the more common subspecialties include:

Some types of surgeons are not trained in general surgery but rather become surgeons within their specific field of practice. For example, obstetrics and gynecology is its own field of medicine under which gynecological surgery is a part of the training. The same applies to podiatry or otolaryngology.

Training and Certification

Becoming a surgeon is a long and challenging process. The educational pathway takes an average of 13 years to complete upon graduations from high school. This can be broken down into undergraduate school, medical school, residency, and fellowships.

You would typically start by enrolling in a university or college with a pre-medical program which would include biology, physics, and chemistry. After earning a bachelor's degree, you would need to pass the Medical College Admission Test (MCAT) in order to apply to medical school.

Most successful medical school applicants to have a grade point average (GPA) of 3.3 or higher.

Medical School

After college graduation, you can either pursue a Doctor of Medicine (MD) degree or a doctor of osteopathic medicine (DO). There are currently 141 medical schools in the United States offering an MD degree and 35 offering a DO degree. The programs are similar, but you will receive extra training in bones and joint in a DO program.

During the first two years of medical school, you will expand upon your undergraduate studies in the classroom (including anatomy, physiology, microbiology, biochemistry, organic chemistry, pathology, psychology, ethics, and medical law). The second half of medical school will be devoted to clinical rotations in different facilities to gain exposure to different fields of medicine.

In your fourth year in medical school, you will begin interviewing with the different surgical residency programs you are interested in. If accepted, you would enter the program in June of the year you complete medical school.

Residency and Licensure

Some surgical residencies can last for as long as eight or nine years, but most are comprised of five. The first year of residency is called the intern year. Thereafter, the next three to four years would be focused on general surgery under the tutelage of academic surgeons. If you decide to pursue a subspecialty, such as thoracic or vascular surgery, you might expect to add another two to three years to your training.

Residents are paid roughly in $55,000 per year and perform their duties under the direct supervision of experienced surgeons. The attrition rate among surgical residents is around 18 percent, according to a 2017 study in JAMA Surgery.

Upon the completion of residency, you would obtain licensing in the state in which you intend to practice. This typically requires passing a national and, in some cases, a state exam. Surgeons with an MD degree will sit for the U.S. Medical Licensing Exam (USMLE), while DO surgeons have the choice of taking the Comprehensive Osteopathic Medical Licensing Exam (COMLEX).

Although it is not yet required, it is highly recommended that surgeons become board certified through the American Board of Surgery (ABS). Doing so significantly increases your employment potential as well as your standing in the surgical community.

Appointment Tips

Regardless of whether an operation is major or minor, surgery can be extremely stressful. It often helps to discuss your fears with the surgeon in advance of the procedure. Doing so can help you understand what is involved as well as the benefits and risks of treatment.

Start by scheduling an office appointment and writing down any questions you have so you don't forget any details. The questions may include:

  • Why is this procedure needed?
  • Are there any alternatives that haven't been explored?
  • What might happen if I don't have the surgery?
  • What are the benefits, and how long will they last?
  • What are the risks and possible complications?
  • Is there anything I can do to reduce the risk?
  • How often have you performed this procedure?
  • What type of anesthesia will be used?
  • What can I expect during recovery?
  • What kind of care might I need during recovery?
  • What is the cost of the surgery?

It is important to understand that the surgeon's fee does not include the hospital facility fee or the anesthesiologist's fee. Contact your insurance provider to find out which costs are covered and if the providers are in-network.

You should also take the time to check the surgeon's credentials. A good place to start is with the DocInfo website managed by the Federation of State Medical Boards. The site can provide you details about the surgeon's education, board certifications, states with active licenses, and any actions filed against the surgeon.

A Word From Surgery

Surgery is a respected and in-demand profession but one in which there remain ongoing shortages, particularly in rural areas. According to the New England Journal of Medicine, shortages in all non-primary care specialties are expected to increase by 2025, most especially surgical ones. It is for this reason that surgeons remain among the highest earners in the medical profession.

According to the Bureau of Labor Statistics, the median annual salary for a surgeon in 2018 was $255,110. Those involve in orthopedic and oral/maxillofacial surgery can earn well in excess of $300,000 per year.

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