Session 96 Today, Dr. Brian Smith, a general surgery program director at UC Irvine, talks about his journey to becoming a surgeon and what he expects from applicants to be competitive in his program. Find out what you can do to be more competitive as an applicant and as a medical student. Please take a listen to all our other podcasts and get the resources you need. For medical students, we have the Board Rounds (with BoardVitals). For the premed students, come check out The Premed Years, OldPreMeds Podcast, and The MCAT Podcast. [01:30] Interest in General Surgery Brian's interest in general surgery started in his first year of medical school. When he started medical school, he wanted to be a family practitioner. He liked the idea of continuity and being able to take care of the whole patient. Very quickly after starting his rotations in the anatomy lab, he realized he had a tremendous love and passion for human anatomy. It was the first time he ever considered surgery. He knew that if he wanted to spend most of his career involved with human anatomy, then surgery would be a excellent way to do so. [03:00] Traits that Lead to Being a Good General Surgeon One of the basic traits of being a good proceduralist is that you like working with your hands as well as diagnosing or treating things. Do you like working with your hands or do you like working with your brain? Once you've answered that question and you've moved down to "working with hands" halfway, then you begin to figure out you're probably down the proceduralist path. Brian's inherent tendency is to enjoy fixing things. He used to enjoy working with his car. He likes tinkering with things. He has always had this inherent joy in taking a problem and giving it a definitive fix. Surgery initially became the clear choice for Brian. But general surgery became his choice when he was sure he needed the variety. He enjoyed the variety that comes with general surgery. [04:50] Risk of Running Out of Patients As Brian puts it, one of the beauties of general surgery is they take care of the whole patient. They take pride in the fact that they're really an internal medicine physician that operates. They're able to manage the entire patient and at the same time be able to operate and fix their derangements. There's a tremendous kinship with either family medicine or internal medicine who serves as the contractor for all of the patient's ailments and really manage them all. That being said, there's a drive or movement in the direction of increasing subspecialization of current trainees. This is a trend that's not going to dramatically change over the near future. But for those people with broad interests and really like to take care of the whole patient, general surgery has that to offer. Brian was concerned that subspecialization would narrow down his knowledge base. And he didn't want to give that up, hence, he chose general surgery. [07:00] The Bread and Butter for General Surgeons The bread and butter in 2019 is dictated by the community in which you serve. If you're a general surgeon in the midwest and there's not a lot of specialists in town, you're more likely to do more than the general surgeon in downtown Los Angeles. By and large, in the urban and suburban environments, the bread and butter for general surgeons is going to consist of gastrointestinal surgery, colons, gall bladders, hernias, endocrine surgery including thyroids, parathyroids, and adrenals. Occasionally, they deal with the liver, spleen, skin (melanoma and skin cancers), and extremity work (soft tissue tumors). [08:20] The Most and Least Liked Things About Being a General Surgeon Brian loves being able to take care of all the patient's needs. He's able to handle almost everything. From an operative perspective, he loves being able to travel all over the body. He rarely does two of the same operation in one day. He's constantly doing something different. And this forces him to keep up with the literature or cur