Are you serious? It’s 2 a.m., and you take a patient to the OR for what you believe is a bowel obstruction or appendicitis — only to find metastatic cancer, necrotic bowel, or something equally catastrophic. The patient is unstable, anesthesia is struggling to maintain blood pressure, and you can’t simply apply a wound vac and leave the patient in the ICU. This is when your training must take over.
Since 2003, I’ve observed a significant decline in the quality of surgical training. I’ve seen general surgeons who were undecided between primary care, internal medicine, or surgery, and ultimately chose surgery for financial reasons. The result? Many of these surgeons are poorly prepared and deeply dissatisfied with their careers.
When I was a resident, I faced dozens of critical moments in my first three years — and I learned from every one of them. General surgery is incredibly demanding, especially in unpredictable situations. I wouldn’t be surprised if we’re seeing an increase in burnout, career changes, or even suicides among surgeons who trained in the modern era. There’s a reason surgical residencies were once so rigorous: Patients’ lives depend on our readiness and resilience.
Work-life balance? If that’s your top priority, consider fields like radiology, pathology, or primary care. When you tell an admissions committee you want to save lives, understand that it comes with sacrifices. Misleading prospective surgeons with unrealistic promises is both harmful and unfair.
General surgery is akin to the special forces of medicine. Not everyone is suited for it — in fact, very few are. Lowering standards weakens the profession and puts patients at risk. When a surgeon is called to the bedside, they must set aside personal struggles — relationship challenges, financial stress, dissatisfaction among senior partners, fatigue — and focus entirely on the patient. Where does a surgeon learn that critical skill? Through rigorous, demanding training — not through slogans about work-life balance or well-being coaches.
Philip Alford is a surgeon.
