Want to go for surgery after your MBBS degree? Here's what you need to know

Yup, a couple of weeks back I wrote about what you should do if you don’t want to practice clinically after you’re done with your MBBS. You can read about it here, (I went on about the not-so-ideal conditions and the insane commitment required to achieve those lofty ambitions such as the most demanding specialties like Neuro, Plastics, etc.). But let’s be honest. Most people who came into Medicine (at least the ones who came with their own will) came into it with a passion will not let that stop them from going after their dreams with everything they’ve got.

This article is a brief introduction to the world of surgical residencies and has been written as a comparison between the 3 most common countries Pakistani graduates specialize in USA, UK, and obviously Pakistan itself.

WHAT ARE MY OPTIONS?

Everybody with the slightest inclination for this route probably has a fair idea of what options they have and might even have decided one for themselves but it’s worth reviewing the list to make sure we don’t miss anything. Here are the 10 subspecialties offered by the Royal College of Surgeons in the UK :

• CARDIOTHORACIC

• GENERAL SURGERY

• NEUROSURGERY

• PLASTIC SURGERY

• ORAL AND MAXILLOFACIAL SURGERY

• OTOLARYNGOLOGY

• PEDIATRIC

• PLASTIC

• TRAUMA AND ORTHOPEDIC

• UROLOGY

• VASCULAR

The American College of Surgeons, however, offers 14 subspecialties. Apart from the ones offered by the UK, they also recognize:

• COLON AND RECTAL SURGERY

• GYNECOLOGY AND OBSTETRICS

• GYNECOLOGIC ONCOLOGY

• OPHTHALMIC SURGERY

The College of Physicians and Surgeons in Pakistan, rather strangely, doesn’t seem to make an official distinction between the fields of Surgery and Medicine. It just mentions all the specialties together. I speak in more detail about the workings of the CPSP here.

As you can probably identify though, there are about 9 options in the first Fellowship and they’re pretty similar to the ones offered by the other 2 Colleges. Interestingly, the CPSP offers at least 3 more surgical subspecialties in their 2nd specialty. Again for more detail on how the FCPS system works, read this. The specialties are:

• BREAST SURGERY

• VASCULAR SURGERY

• SURGICAL ONCOLOGY

WHAT ARE THE MOST COMPETITIVE SPECIALTIES?

Considering you're already aiming to be in one of the most competitive fields in the world wherever you go, it becomes particularly important to notice the differences between even the different subspecialties. This is important since that will again significantly alter your competition and hence the level of competency required of you to stand out from the crowd.

The American Medical Association (AMA) reported that the five most competitive specialties in 2019 were:

• Otolaryngology

• Integrated plastic surgery

• Thoracic surgery

• Neurosurgery

• Orthopedic surgery

The University of Michigan also includes these in the list (apart from the above)

• Dermatology

• General Surgery

• Ophthalmology

• Plastic Surgery

• Urology

• Radiation Oncology

The trend is roughly similar across all countries. However, Neurosurgery, Cardiothoracic Surgery and Trauma, and Orthopedic surgery were the 3 fields that had the highest competition ratios in the UK.

What this means is that anyone who wants in on these specialties will have to make sure they go that extra yard ahead to have a shot.

COMPENSATION /PAYMENT

After all the blood, sweat, and tears, everyone wants to know how sweet the pie is and of course, where its at:

The US pays the most, well over anyone else; just how much? Well here you go:

• Neurosurgery — $746,544

• Thoracic surgery — $668,350

• Orthopedic surgery — $605,330

• Plastic surgery — $539,208

• Oral and maxillofacial — $538,590

• Vascular surgery — $534,508

• Cardiology — $527,231

• Radiation oncology — $516,016

• Gastroenterology — $485,817

• Radiology — $485,460

Just by the way, the list is well over $350k/year even down to the 20th specialty. Not too shabby. Certainly not compared to the UK which with its National Health System (NHS) where even consultants in surgical fields can only expect to earn a basic salary of £77,913 rising to £105,042 depending on the length of service. That’s less than $150,000 at maximum. Definitely can’t be into medicine for the money in the UK.

WHAT’S THE ROUTE AND HOW LONG DOES IT TAKE?

In the UK

To become a surgeon you'll need to complete:

• a two-year foundation program of general training

• two years of core surgical training in a hospital

• up to six years of specialist training

It goes without saying that this comes after you've completed your MBBS degree, given your PLAB, and have been registered as a doctor in the UK by the GMC.

In the US

Surgical residencies generally last for 5-7 years. Most residencies require you to spend at least a few years in General Surgery before specializing in the specific field you want. For example:

• Thoracic surgery would require: 5 years General Surgery + 2 additional years

• Neurosurgery would require: 1 year of General Surgery + 5 years of Neurosurgery training

In Pakistan

There’s not a lot of clarity about how the Pakistani system works. However, the General Surgery program at AKU for example (approved by the Royal Colleges of Edinburgh and Glasgow as well as the CPSP) is a 5-year training program.

Other specialties usually span 4-6 years. Similar to the US and UK most specialties require a combination of a few years in General Surgery and a few additional years in the specialization itself:

• Cardiac surgery: 6 years. This includes 2 years of General Surgery + 4 years of Cardiac Surgery solely.

• Orthopedic surgery: 6 years. Again this has 2 years in various surgical disciplines before the specialization.

• Plastic surgery is a 4-year program.