Exploring The Different Subspecialties Within Surgery: Part Two

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Which Surgical Sub-Specialty Should You Choose?

The nine recognised specialties within surgery include:

– Trauma and Orthopaedic Surgery

– Cardiothoracic Surgery

– Paediatric Surgery

– Oral and Maxillofacial Surgery

– Neurosurgery

– Urology

– Otolaryngology (ENT)

– Plastic Surgery

– General Surgery

While there are some aspects that are common to all specialties, there are also marked differences between the specialties. It is important to take time to choose your subspecialty only after careful consideration.

Take a look at the salient characteristics of each of the nine sub specialties with regards to the job description and the working conditions.

Trauma and Orthopaedic Surgery

Trauma and Orthopaedic surgeons work on bones, joints and associated soft tissues, including nerves, muscles and ligaments. Trauma work involves fractures and other injuries. Specialist areas in trauma and orthopaedic surgery include; lower limb joint reconstruction and surgery of the spine, upper limb, hip, knee, ankle and foot. Paediatric orthopaedics, rheumatoid surgery, bone tumours and sports and exercise surgery are also included in this specialty.

Orthopaedic doctors spend around 40% of the time performing surgeries, with the rest divided between ward work, clinics and on-call commitments. Most surgeries are performed during regular working hours. However, trauma work can extend way beyond that and there is a considerably demanding on-call commitment. There are a lot of opportunities for research and sub-specialisation.

Cardiothoracic Surgery

Observing Orthopaedic Surgery Cardiothoracic surgeons deal with illnesses of the heart, lungs, chest and oesophagus. Their areas of specialty include cardiac surgery (heart and great vessels), thoracic surgery (organs within the thorax but excluding the heart), oesophageal surgery, transplantation and heart failure surgery, and congenital surgery in adults and children. Most of the procedures involved are major and often complex. Within cardiac surgery, the most common operations are valve operations and coronary artery bypass grafting. Common operations in thoracic surgery include lobectomy or pneumonectomy for carcinoma of the lung.

A cardiothoracic surgeon’s clinical time is split equally between performing operations, outpatient work, administration and time spent with patients and their families. A lot of time is spent in intensive care and high dependency units. Most procedures are elective (non-emergency, pre-booked) but there could sometimes be emergency work that will need to be done out of hours. Heart transplant surgery involves lengthy, extensive surgery that can often extend into the night. While the volume of patients is relatively low you will continue to see your patients for a long period of time. There is less emergency work in cardiothoracic surgery compared to general or orthopaedic surgery.

Paediatric Surgery

Paediatric surgeons specialise in the surgical treatment of diseases, malformations and trauma during childhood years – from the foetal period to the teenage years. Specialist areas include neonatal, oncological, GI, hepatobiliary and urological surgeries. About 10% of all operations on children are performed by paediatric surgeons. The remaining operations are performed by surgeons from other sub specialties who have an interest in paediatric conditions.

Paediatric surgery does not have a high level of emergency work and is well suited to flexible working. A larger proportion of the clinical workload comprises day-time surgery. However, emergency workload cannot be ruled out completely although the nature of its delivery will vary between different units.

Click here to read part three of ‘Exploring The Different Subspecialties Within Surgery’

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