Are you interested in pursuing a surgical specialty or subspecialty? There are 6 surgical residency paths, as well as dozens of further subspecializations to choose from.
If you’re interested in surgery, your list of career options is extensive. In this video, we cover colorectal surgery, vascular surgery, surgical oncology, minimally invasive surgery, surgical critical care, pediatric surgery, endocrine surgery, transplant surgery, HPB, and more.
Categorical Surgical Residency Options
First, let’s discuss the categorical surgical residency options, including some of the fellowship options you can choose to pursue afterward. These are specialties where you must match into the program directly, rather than completing a general surgery residency first.
General Surgery
And speaking of general surgery… This is the broadest of the surgical fields and a specialty you can pursue. It includes the surgical management of diseases and injuries from head to toe, such as head and neck, thoracic, and abdomen surgeries. Operations can range from traumatic injuries to repairing diseased tissue to removing cancer.
Since so many general surgeons choose to specialize, many who choose not to pursue a fellowship are relegated to procedures of the digestive and endocrine systems.
While not always considered a luxurious specialty, general surgeons still make $451K a year, and since they don’t need to complete a fellowship after residency, they’re able to start working and paying back debt sooner.
What’s interesting about general surgery is that it’s the pathway to many other subspecialties. We’ll cover the many general surgery subspecializations later in this video.
Plastic Surgery
Next, as you likely already know, is my personal favorite specialty—plastic surgery. Plastic surgeons focus primarily on a patient’s soft tissue, such as fat, skin, and muscle to reconstruct or reshape a patient’s function or appearance. Unlike other surgical specialties, plastic surgeons can work on any part of the body, from head to toe to hands to feet to eyelids to genitalia.
There are two different types of plastic surgery: aesthetic or cosmetic plastic surgery and reconstructive plastic surgery.
Aesthetic plastic surgery deals with procedures like liposuction, breast augmentation, and rhinoplasties, also known as nose jobs. Reconstructive plastic surgery involves procedures to correct body and facial abnormalities, such as a cleft palate. Plastic surgery regularly ranks as one of the top two most competitive specialties, as not only is it on the cutting edge of technology, it has one of the highest average annual compensations at over $600K, and a very high ceiling for those going into aesthetics.
There are two different paths to plastic surgery after medical school. First is the much more competitive Integrated Path, which means 6 years of plastic surgery residency. The other is the Independent Path, whereby you complete 5 years of general surgery residency before applying for an additional 3 years of independent plastic surgery residency, which brings the total to 8 years.
After completing a plastic surgery residency, you can choose to further specialize through fellowship options. Some of those fellowship options include:
Craniofacial surgery, which is the surgical correction of extreme facial deformities, facial clefts, and skull abnormalities.
Aesthetic Surgery, which focuses on improving a patient’s appearance through elective procedures such as face lifts, breast augmentation, and liposuction.
Breast Reconstruction Surgery, which is the surgical implanting, augmenting, and restructuring of the breast, most often due to cancer.
And microsurgery, which focuses on operating on and repairing nerves, small blood vessels, and tubes using microscopic technology. It’s a strenuous specialty with some of the most complex surgery in all of medicine. The most complicated surgeries can last more than 12 hours, involve multiple surgeons, and require very careful follow up to ensure the surgery remains successful.
For more information about these fellowship paths, as well as all of the categorical residency options, check out our So You Want to playlist, linked in the description.
Neurosurgery
Next, we have neurosurgery, which is much more than brain surgery. This specialty involves the surgical treatment of disorders that affect the central nervous system, which includes the brain and spinal cord, as well as the peripheral nervous system, which includes the neuromuscular junctions, peripheral nerves, cranial nerves, spinal nerves, and their roots and branches.
Neurosurgery can be broken down into two overarching categories: elective surgery and non-elective surgery, which is also known as emergent or trauma surgery.
Elective surgeries generally treat conditions that are not immediately life-threatening, such as **spine surgery, cranial surgery, and peripheral nerve surgery. Emergent/trauma surgery includes traumatic injuries to both the cranium and spine.
While neurosurgeons are extremely well-compensated, earning $788K a year, it’s a very challenging career path due to its long hours, poor work-life balance, and competitiveness. Plus, it’s going to take a long time to see that salary, as neurosurgery residency lasts a whopping 7 years, which is the longest residency from start to finish.
Neurosurgeons can further specialize with fellowship options, including:
Neurovascular surgery, which is notably technical, deals with aneurysms, hemorrhagic strokes, and bypassing blockages in the brain.
Peripheral neurosurgery deals with operations on the peripheral nervous system, which includes all nerves outside of the brain and spinal cord.
And skull-base surgery, which focuses on tumors that grow along the base of the skull.
Orthopedic Surgery
Orthopedic surgery deals with conditions involving the musculoskeletal system. Orthopedic surgeons utilize both surgical and nonsurgical treatments to manage musculoskeletal trauma, infections, tumors, degenerative diseases, congenital disorders, spine diseases, and sports injuries.
Where plastic surgeons focus on soft tissue, orthopedic surgeons focus on bones—though neither does so exclusively.
Orthopedic surgery residency lasts 5 years, and the specialty consistently ranks in the top 5 most competitive, in part due to its large annual salary of $624K a year.
After completing an orthopedic residency, you can choose to further specialize through several fellowship options, some of which are:
Hand surgery, which focuses on the diagnosis, treatment, and rehabilitation of hand injuries like carpal tunnel syndrome and degenerative and rheumatoid arthritis, as well as pathological disorders or trauma that affect the hand and wrist. Note that a hand surgery fellowship can also be pursued after a plastic surgery residency.
Orthopedic trauma, which focuses on fractures of the long bones of the extremities, such as the femur, tibia, forearm, and humerus, as well as fractures of the pelvis and hip socket.
Spine surgery, which includes surgical interventions to correct spinal deformity, trauma, degenerative disease, and nerve compression.
And sports surgery, which is by far the most common fellowship for orthopedic surgeons. It focuses on far more than treating athletes, as the name suggests. These surgeons treat ligamentous injuries, tendinous injuries, shoulder and elbow disease, as well as foot and ankle overuse.
Otorhinolaryngology (ENT)
Otorhinolaryngology, or ENT for short, is the surgical subspecialty that focuses on diseases of the head and neck region, which includes the vocal cords, nose, sinuses, ears, thyroid, and parathyroid, as well as head and neck cancers.
ENT is a 5-year residency and one of the most competitive specialties you can pursue, as the lifestyle is excellent. Not only can you make $489K a year, your work/life balance is more relaxed, so you can actually spend time with your family. You can also divide your time between the clinic and the OR, which is rare for surgical specialties. Clinical days will have regular 9 to 5 hours, and OR days can either be half days or full 12 hour days if you’re dealing with more complex cases.
After ENT residency, you can further specialize into a number of different fellowships, including:
Laryngology, which focuses on the voice, swallowing, and airway-related concerns, including taking care of trachs, esophageal dilations for swallowing, and vocal cord procedures such as injections, medialization, implants, reinnervations, or resections.
Rhinology, which is primarily focused on sinus surgery, dealing with everything from deviated septums to removing diseased segments with micro-debridement, addressing invasive and noninvasive fungal sinus infections, and helping neurosurgeons with skull base tumors and pituitary approaches.
And neurotology, which deals with incredibly small structures like the middle and inner ear, cholesteatomas, and tympanic membrane perforations. They also work alongside neurosurgeons for schwannomas and brain tumors.
Urology
Urologists are surgeons of the urogenital tract, which includes the kidneys, bladder, prostate, ureters, urethra, testes, and more. Urology can also cover sexual function, fertility, urinary continence, and gender identity.
Although some believe urologists simply cure STIs all day, urology residency involves demanding surgical training, making these surgeons experts at operating on a number of different structures within the pelvis.
Urology residency takes 5 or 6 years, depending on the program, and the residency has its own match, as opposed to the NRMP. After completing a urology residency, you can further subspecialize with a 1 or 2 year fellowship. Some of those options include:
Andrology, which focuses on infertility and sexual dysfunction disorders in men.
Endourology, which deals with some of the most complicated urology cases out there with minimally-invasive approaches using a surgical robot.
Uro-oncology, where you’ll be specializing in the minutiae of urological cancers.
The work-life balance of a urologist has much to offer, as you’ll only be working 40 to 60-hour weeks and still be clearing $506K a year.
Vascular Surgery
Vascular surgery is the surgical management of veins and arteries in every part of the body besides the heart and brain. The wide range of conditions they treat include aortic aneurysms, blood clots, carotid artery disease, thrombosis, varicose veins, and more.
Common procedures include a range of open surgeries and minimally invasive procedures, such as angioplasty and stenting, aortic aneurysm repair, or arterial or venous bypass surgery.
Vascular surgery residency typically lasts 5 years if you match directly into the specialty; however, you can also pursue vascular surgery after general surgery as a fellowship option, which brings training up to 6 to 7 years.
It’s another challenging surgical specialty, as vascular surgeons must be on-call and work both long and odd hours, including weekends. Although they make $558K a year, the work-life balance of vascular surgeons frequently has to take a backseat.
Subspecialties Following General Surgery
There are many other surgical medical paths that do not have a dedicated residency program. Instead, you must match into and complete a general surgery residency, which takes 5 years, and pursue the corresponding fellowship afterward. Let’s go over those career paths.
Colorectal Surgery
Colorectal surgery focuses on the surgical treatment of disorders of the lower digestive tract, including the anus, rectum, and colon. Colorectal surgeons perform a wide range of surgeries, operating on everything from hemorrhoids to diverticulitis to cancer.
The colorectal surgery fellowship lasts 1 year. These surgeons typically make $446K a year, enjoy a decent work-life balance, and are very comfortable working around poop.
Cardiothoracic/Thoracic Surgery
Cardiothoracic surgery is the surgical treatment of organs inside the thorax, also known as the chest cavity, such as the heart, lungs, aorta, esophagus, and diaphragm.
These surgeons perform valve replacements to replace impaired heart valves, coronary artery bypass grafts, also known as CABG, to reduce plaque buildup in heart vessels, and lung resections to remove lung cancer. They can also perform lung and heart transplants.
It should be noted that this specialty can be broken down into cardiac, thoracic, or cardiothoracic surgery. After completing their CT surgery training, physicians can choose to specialize in cardiac surgery, focusing on the heart and aorta, or thoracic surgery, focusing on the lung, esophagus, ribs, and other structures in the thorax.
However, physicians can also choose to remain generalized, operating in both cardiac and thoracic domains. This is more common at community centers, but if you work at a larger academic or urban hospital, you’ll likely specialize in cardiac or thoracic.
CT surgery is a specialty with a very difficult lifestyle. CABG operations can last anywhere from 4 to 8 hours. If complications arise, it could result in a procedure lasting up to 12 hours. While there’s not much of a work-life balance, these surgeons also make a whopping $707K a year.
HPB (Hepato-Pancreato-Biliary)
The hepato-pancreato-biliary surgery specialty, or HPB for short, focuses on the surgical treatment of benign and malignant diseases of the liver, biliary system, and pancreas. As the tongue-twisting name suggests, hepato stands for liver, pancreato stands for pancreas, and biliary stands for the biliary system.
The procedures performed by HPB surgeons involve removing tumors from the liver, pancreas, gallbladder, and bile duct, and these surgeries are some of the most complex in general surgery.
An HPB fellowship is typically 2 years in length, and that’s on top of 5 years of general surgery residency.
Endocrine Surgery
Endocrine surgery requires a a 1-year fellowship and focuses on the surgical treatment of the endocrine glands, including the adrenal glands, the parathyroid glands, the thyroid gland, glands of the endocrine pancreas, and some neuroendocrine glands.
Endocrine surgeons have a great lifestyle, as there aren’t many emergencies on-call, and you’ll have more reasonable working hours.
Trauma Surgery
Trauma primarily deals with patients who have undergone a physical injury, often in an acute setting. To become a trauma surgeon, you’ll need a 1 to 2 year fellowship in traumatology, surgical critical care, or emergency surgery.
This specialty combines the best of both worlds. While you’ll deal with high-intensity surgeries and traumas can occur at any time in the day, trauma surgery typically runs on a shift-type schedule. This means you’ll also be able to clock out when you’re not on shift, so you’ll have some control over your lifestyle and work-life balance.
Transplant Surgery
Transplant surgery has a 2-year fellowship and involves performing organ transplants from live or deceased donors, such as kidneys, livers, lungs, hearts, and more.
From an hours and technical standpoint, this is one of the most difficult and rigorous specialties. Not only are liver transplants extremely lengthy and challenging to perform, but you can also get called nearly 24/7, as harvesting is highly time-sensitive and donor availability is typically unplanned.
Minimally Invasive Surgery
Minimally invasive surgery, also known as MIS, requires a 1-year fellowship where you gain additional training in advanced laparoscopy and robotic skills.
Often, this translates to focusing on minimally invasive bariatric surgery, foregut surgery, and abdominal wall reconstruction. It’s on the more competitive side and has a good work-life balance after training.
Surgical Oncology
Surgical oncology requires a 2-year fellowship and focuses on the surgical management of tumors, especially cancerous tumors. The bread and butter cases include colon cancers, breast cancers, and soft tissue cancers, as well as abdominal cancers including the liver or pancreas.
It’s a competitive, sought-after fellowship, and the hours can be long and demanding, but those who are drawn to this line of work often find it extremely rewarding.
Breast Oncology
Breast oncology is a 1-year fellowship that focuses primarily on removing breast tumors, lymph nodes, or in some cases, entire breasts, also known as mastectomies.
The hours are considered less intense, so these surgeons enjoy a better work-life balance than other surgical specialties. You’ll also be working closely with plastic surgeons, who are responsible for reconstructing the breast, typically immediately after the surgery. Note that breast oncology exclusively deals with removal, not reconstruction.
Pediatric Surgery
Pediatric surgery is a 2-year fellowship and focuses on the surgery of fetuses, infants, children, adolescents, and young adults. Essentially, you’re a general surgeon for children. The bread and butter of this specialty will be treating emergencies, correcting congenital birth defects, and gastrointestinal surgeries.
Considering the fact neurosurgeons, orthopedic surgeons, and plastic surgeons can subspecialize in various pediatric-focused specialties, finding general pediatric surgeon job openings can be difficult. This means you may have to move to a part of the country you might not have chosen otherwise.
Other Specialties with Surgical Procedures
Additionally, there are a couple of specialties that sometimes perform surgical procedures. While they do not require general surgery residency practice, since surgery is performed, they are options available to those who are interested in surgery.
Ophthalmology
Ophthalmology deals with ocular and orbital diseases, which is anything relating to the eyes and immediate surrounding structures. While these doctors go to residency for ophthalmology, they are trained to perform some small, quick surgical procedures. However, some specializations require more involved procedures.
OB/GYN
OB/GYN combines obstetrics, the medical and surgical management of pregnancy and gynecology, and the medical and surgical management of the female reproductive tract. OB/GYN doctors see patients through puberty, adult life, pregnancy, menopause, and beyond. Because they deal with pregnancy, surgery is common, but these procedures are quick, messy, and typically require less precision than other surgical procedures.
There you have it. If you’re still undecided about the medical path you want to take, check out our So You Want to Be playlist, which takes a deep dive into many of the surgical specialties discussed in this video, and check out Every Medical Specialty Explained for a broader view of all medical career options.
