Surgeon: Expertise, Specialties, and Training

Surgical Expertise, Training, and Specialties

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.

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

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

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:

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 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.

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:

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.

General surgery is the term used for a broad spectrum of surgeries affecting almost any area of the body. 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.

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.

According to U.S. News and World Report, most successful medical school applicants need to have a cumulative grade point average (GPA) of 3.5 or higher.

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.

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.

According to Medscape's Residents Salary and Debt Report 2021, residents are paid roughly around $65,000 per year. They perform their duties under the direct supervision of experienced surgeons. The attrition rate among surgical residents is around 18%, 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.

Surgery is a respected and in-demand profession but one in which there remain ongoing shortages, particularly in rural areas. According to a 2017 report from 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 mean annual salary for a surgeon in most areas of medicine in 2021 was $297,800. Those involved in orthopedic and oral/maxillofacial surgery can earn more than $300,000 per year on average.

It can take at least 13 years after high school to become a surgeon. That includes four years for an undergraduate degree, four years for a medical degree, and five years for a residency.

The mean annual salary for surgeons equals about $120 per hour.

Orthopaedic surgeons help diagnose and treat conditions involving the joints, bones, ligaments, muscles, and tendons. They may recommend nonsurgical treatment, such as medication and rehabilitation, or repair your condition through surgery.

Vascular surgeons diagnose and treat conditions involving your blood vessels. A vascular surgeon may perform open surgery or minimally invasive surgery to restore blood flow. In other cases, they may prescribe nonsurgical treatment, such as medication or exercise.

Agency for Healthcare Research and Quality. Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012.

Yu J, Ji TA, Craig M, McKee D, Lalonde DH. Evidence-based sterility: the evolving role of field sterility in skin and minor hand surgery. Plastic and Reconstructive Surgery - Global Open. 2019;7(11):e2481. doi:10.1097/GOX.0000000000002481

Khoushhal Z, Hussain MA, Greco E, et al. Prevalence and causes of attrition among surgical residents: A systematic review and meta-analysis. JAMA Surg. 2017;152(3):265–272. doi:10.1001/jamasurg.2016.4086

New England Journal of Medicine. Physician Shortage Spikes Demand in Several Specialties.

Bureau of Labor Statistics. Occupational employment and wages, Surgeons.

Bureau of Labor Statistics. Occupational employment and wages.

American Academy of Orthopaedic Surgeons. Orthopaedic surgeons: Restoring mobility and keeping our nation in motion.

Society for Vascular Surgery. What is a vascular surgeon?

American Board of Surgery, American College of Surgeons, Association of Program Directors in Surgery, Association for Surgical Education. Statement on surgical preresidency preparatory courses. Amer J Surg. 2014 Nov;208(5):695-6. DOI: 10.1016/j.amjsurg.2014.06.030.

By Jennifer Whitlock, RN, MSN, FNJennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.