To Specialize or Not?

In surgery there are many different specialties. Some of these include cardiovascular, orthopedics, neurology and more. Depending on the size of the hospital you decide to work at you may end up on a specialized team or you may do a little bit of everything. Some places specialize in groups of specialties, like combining neuro and urology specialties. There isn’t always a rhyme or reason to what gets paired. It is often based off of call volumes per specialty so certain teams do not end up getting overloaded with cases when they are taking call. Which makes sense, that’s an easy way to cause burnout. I think there are pros and cons to both specialized and non-specialized teams. It really comes down to the individual and their future goals.

When interviewing at hospitals for positions it is always a good idea how to ask how they structure their “teams”. Also, ask how it’s determined what team you will be on. Sometimes when you accept a position you accept it for a position on the “x’ team. Some hospitals where you accept a position you may through orientation and get placed where the best fit is. Then there is always getting placed where the biggest need is- and sometimes that isn’t where you want to be. Sometimes there is a reason why there is a need for that team.

Make sure you clarify this, always. For example, when I graduated nursing school, I was offered an RN position in the OR where I worked as a surgical tech on the general team. I did not accept immediately and not long after my boss reached out asking “would it make a difference if the offer was for the general team instead of the hand team?” Absolutely it would. I would not be accepting a position on the hand team, so I was honest, and I told her that I wouldn’t accept if it was for the hand team. She told me I could stay on the general team, so I accepted.

Now let’s talk a little about the pros and cons of specialty teams. Here is a list of most of the specialties

-General (hernias, laparoscopic procedures, etc.)

-Neurology

-Ortho; sometimes divided into upper extremity and lower extremity

-Ophthalmology (my least favorite)

-Urology

-Gynecology

-ENT (my personal favorite!)

-Robotics

-Pediatrics

-Cardiovascular

-Plastics

-Bariatrics

I am sure that I am missing a specialty or two, but this shows there are a lot of different options! Not every facility actually performs procedures from all of these specialties, especially surgery centers, but that’s always a question you should ask when interviewing at a new place. When I first started as a surgical tech I was on the ”general” team. However, this was not just general- this also included plastics, gynecology, ENT, urology, trauma and robotics. So, “specialized” but a very broadly specialized team. I think being on this team really helped me learn a variety of procedures and get to work with a lot of good surgeons, nurses, surgical techs, CRNAs, anesthesiologists, and a few other disciplines. Working on this team I found the specialty that I love, which is ENT. No, not like tubes and tonsils. I mean like the hemimandibular resection with a fibular graft, free flaps, radical neck dissections, thyroidectomies- THAT kind of ENT. Bu also, you can’t go wrong with an open belly of any sort. Once this hospital began functioning as a level II trauma center, I gained a lot of great experience- especially since this was in a town with a pretty high crime rate. You could pretty much guarantee you’d be getting called in for a gunshot wound (GSW) during your call weekend when the weather was nice- sometimes even when the weather was bad, in the middle of the week in broad daylight. Obviously, it’s never a good situation, but it did provide me with a lot of opportunities to learn. I could talk for days just about the things I’ve been called in for over the years. Maybe I’ll do that in a future post.

I think that this mix of “specialized” worked out pretty well for me. So, here are some of the pros about being on a specialty team. I was able to learn a smaller group of procedures and everything that goes along with it and become proficient at a much faster pace than if I was doing all specialties and taking considerably longer to rotate through. I was able to form better (working) relationships with the surgeons- I knew what their preferences were, how to effectively communicate with them, and most of the time what to put in their hand before they even asked. Due to all of this I was confident in my ability to scrub any case including the ones I was not familiar with, because I knew how to anticipate these surgeons. This did not happen overnight, but if I wouldn’t have been on a specialized team it would have taken a lot longer- probably years. At this time in my career, I didn’t want it any other way. Ortho? Ew.

Fast forward to a new facility where there are only two teams. A CV team and a “general” team, which was all other specialties, so it really is not specialized. Where you’re expected to scrub anything from a D&C (gyne) to a TKA or THA (total hip/knee arthroplasty) to a brain tumor resection. To some, learning all the additional specialties may not sound like much, but when each of the ortho doctors you work with use a different vendor- it’s a lot. For example, on Monday you may scrub 5-6 total joints with the Mako robot, which is a Stryker robot. Then on Tuesday you’re doing all of your totals using Zimmer’s instrumentation and implants. Thank goodness for the reps, sometimes. I’ll talk a little more about reps in a later post as well. So, as you can imagine, becoming proficient and confident on a non-specialized team is going to take a much longer time, so that confidence is also going to be lacking for quite a while. But imagine the feeling of being able to eventually be assigned to any room and not feel like you don’t know what you’re doing. Being able to do anything also makes you more versatile and more of an asset to your department. But then also when you look for your next job you won’t be limited by what you can’t do, you’ll be able to choose by what you WANT to do. Now, that is a good feeling. Working on a non-specialized team will also allow you to find your favorite specialty, you just may not be able to be in those rooms as much.

The general recommendation for anything medical has usually been- don’t specialize first. Learn the “basics” and get a good understanding of all specialties before you decide to focus on one or two. However, I don’t think there is really a big push for that as much anymore. So, even if you are dead set on only wanting a certain specialty, keep in mind these things! If you do choose to go somewhere on a specialized team, never turn down an opportunity to learn more- it will only make you a more well-rounded scrub or nurse. There are so many options out there right now- surgery centers, private practice, hospitals- there is bound to be one that is the right fit. Always keep in mind that you will most likely never be at the same place you begin your career for your entire career, you could, but it just doesn’t seem like the norm anymore.