How to Become a Surgeon

By: Andrew Colucci, MD

Last Updated: December 23, 2018

Surgeons use both their hands and specialized instruments to treat illnesses and injuries. To access body structures, they must cut through the patient’s skin and other body tissues. This is done while either the patient is unconscious (general anesthesia) or the area being treated is numbed (local anesthesia). Like all physicians, surgeons also examine and assess patients; order and interpret diagnostic tests; and educate patients about health and wellness.

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One especially rewarding aspect of surgery is that it produces fast, visible results. In a matter of hours, surgeons can remove deadly cancers, correct deformities, restore circulation, and close gaping wounds. Surgeons also enjoy considerable excitement and variety in their practice, with each day bringing new challenges. In addition, the team-based nature of the surgical practice breeds camaraderie and offers opportunities for leadership.

Workplace Details

About two-thirds of surgeons are employed by hospitals or physician groups. A significant number are self-employed, either as solo practitioners or partners within a group practice. About 3 percent work in educational settings such as universities and medical schools.

A general surgeon typically works 50 to 60 hours per week. Surgeons also must spend time “on call” during evenings, weekends, and holidays in case an emergency arises. Most surgeons divide their time between their offices, hospitals, and outpatient surgery centers.

Surgery is a very interactive specialty. In the operating room, surgeons lead a team that may include anesthesiologists, nurse anesthetists, surgical technicians, and surgical nurses. Some also supervise the medical assistants and administrative staff who work in their offices.

According to the US Bureau of Labor Statistics, surgeons earn a mean annual salary of $247,520. Among the most common job settings, salaries range from $140,180 (for those working for universities and medical schools) to $256,120 (for those in private practice).

Surgeon salaries also vary with experience, specialty, and reputation. Surgeons can often enhance their earnings by mastering new and in-demand procedures and by achieving good outcomes for patients. They may also be able to supplement their income by taking on leadership roles within their hospital or practice.

Job prospects for surgeons should be very good in coming years. The US Bureau of Labor Statistics estimates that employment of physicians and surgeons will grow by 14 percent between 2014 and 2024, which is a lot faster than the average for all occupations.

The aging or the American population and the expansion of healthcare coverage are increasing demand for all healthcare services. At the same time, there is currently a shortage of physicians in many areas.

Surgeons can improve their job prospects by choosing specialties such as cardiology and oncology that generally serve older patients. Willingness to relocate to rural or low-income areas is also helpful.

The American College of Surgeons posts surgical job openings on its website.

Hover over any state to explore local income and job growth data.

Students interested in a career in surgery should begin their preparation in high school. Taking advanced math and science courses is a good idea. Earning college credit through an AP, IB, and dual-option programs may allow you to advance more rapidly into higher-level science classes once you reach university.

Beginning in high school and continuing through college, it’s important to demonstrate your interest in and passion for a career in medicine. Look for opportunities to shadow a doctor, work in a lab, conduct research or volunteer at your local hospital. Many universities offer summer enrichment programs for high school students pursuing medical careers.

You don’t need a particular college major to apply to medical school after graduation, but you will need to take certain classes to fulfill the prerequisites:

• One year of biology
• One year of physics
• One year of English

• Two years of chemistry (including organic chemistry)

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Some medical schools have additional prerequisites. Links to schools’ admissions requirements can be found on the Association of American Medical Colleges (AAMC) website. Two detailed medical school guides are also available:

• Medical School Admissions Requirements (MSAR) by AAMC for Medical Doctorate (MD) programs
• Osteopathic Medical College Information Book by American Association of Colleges of Osteopathic Medicine (AACOM) for Doctor of Osteopathy (DO) programs

One year before you plan to enter medical school, you should take the Medical College Admissions Test (MCAT), a standardized assessment of problem solving ability, critical thinking, and knowledge of natural and social science concepts.

Medical school admissions are based on a number of factors, including grade point average, MCAT scores, recommendations, and an admissions interview. Both the AAMC and AACOM provide centralized application services that greatly simplify the process.

Medical school typically lasts four years. The first two years emphasize classroom- and lab-based learning. Coursework covers anatomy, physiology, biochemistry, and the various body systems.

Students spend the second two years practicing their new skills under supervision. They typically rotate through the departments of a teaching hospital, including obstetrics, family practice, internal medicine, pediatrics, neurology, and psychiatry.

Like all physicians, surgeons must be state-licensed in order to practice. State medical boards require physicians to pass one of the following exams:

• US Medical Licensing Examination (USMLE) for MDs
• Comprehensive Osteopathic Medical Licensing Exam (COMLEX-USA) for DOs

Both USMLE and COMLEX consist of three parts that are typically completed during years 2 and 4 of medical school and during residency.

Upon graduation from medical school, aspiring surgeons complete three to seven years of on-the-job training in the specialty of their choice. This period is called residency. A general surgery residency usually lasts about five years.

After completing residency, surgeons may opt to pursue an additional one to three years of training (called a fellowship) in a surgical subspecialty such as pediatric, cardiothoracic, or head-and-neck surgery. Most fellowships include a research component.

This final portion of the USMLE caps off your residency.

Surgeons may take an optional test to become board-certified in surgery and/or a surgical subspecialty. Board certification is administered by:

• American Board of Medical Specialties for MDs
• American Osteopathic Association for DOs

State boards of medicine each have their own requirements for licensure.

Experienced surgeons can pursue a variety of opportunities to increase their responsibilities and make their practice more rewarding:

• Specialists. Surgeons can enhance their reputation and earnings by becoming experts in a certain procedure and achieving excellent outcomes for patients.
• Clinical educators. Surgeons may opt to supervise residents and medical students who are completing their training.
• Professors. Medical schools hire surgeons to teach classes, supervise practical training, conduct research, and share administrative responsibilities.
• Researchers. Many surgeons participate in studies and clinical trials to find new treatments and improve the quality and safety of surgical care.
• Clinical leaders. Head surgeons work to enhance the surgical care delivered by their hospital or practice. They also supervise the performance and development of newer professionals.
• Healthcare administrators. Surgeons often transition into the leadership of medical groups, hospitals, and health systems.
• Policymakers. Some surgeons help to shape healthcare policy at the federal, state, or local level.

All surgeons must hold a medical degree (MD or DO). After graduating from medical school, they then complete five to seven years of supervised practice called residency. Since surgical education takes at least a decade, let’s break it down into bite-sized steps.

First things first: in order to get into medical school, you’ll need a bachelor’s degree. This typically takes about four years of full-time study to complete. Your degree can be in any subject, but you will need to make sure that you fulfill the medical school prerequisites. These almost always include English, biology, chemistry, and physics. Some medical schools have additional requirements.

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To help aspiring surgeons out, many colleges offer a pre-med track. This isn’t a major per se, but it does include the classes you’ll need to make a strong application to medical school, such as:

When it comes to getting into medical school, a good pre-med program can make a big difference. Ideally, it will offer academic advising, application assistance, and opportunities to volunteer and network with physicians. So when choosing a college, look for one with a strong track record of medical school acceptances.

A final thought on bachelor’s degrees: a few schools offer combined BA/MD or BS/MD programs. They’re pretty competitive, but getting into one usually carries a conditional acceptance to medical school. This is an option to explore if you’re a strong student who’s 100 percent set on becoming a surgeon.

After earning your bachelor’s degree, medical school is your next step. But consider that once you start, you’re going to be studying and working intensively for the next five to 11 years. More and more aspiring physicians are delaying their medical school applications to work, volunteer, conduct research, extend their undergraduate studies, or pursue personal interests. All of the above can actually strengthen your medical school application when the time comes.

So now let’s talk about medical school. This is where you gain the knowledge and the practical skills you’ll need to care for patients. It typically takes about four years to complete, after which you earn either your Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.

A lot of people wonder about the difference between an MD and a DO. Both degree programs cover the same subjects. However, MD training tends to focus on diagnosis and treatment (including surgical treatment), while DO programs emphasize health and prevention. While most surgeons hold MDs, DOs also can and do make great surgeons.

The first two years of medical school are dedicated to building up your medical knowledge and practical skills. Some courses you might find in your med school catalog:

Armed with this knowledge, you’ll complete your clinical rotations, or clerkships, in Years 3 and 4. This usually includes some exposure to generalist medicine (family practice, pediatrics) as well as some common specialties (psychiatry, emergency medicine, and yes, surgery).

So what does a clerkship look like? Let’s use surgery as an example. You’ll probably spend a lot of time in the OR assisting an experienced surgeon. Under close supervision, you’ll get to try your hand at using instruments to retract tissue or suturing the incision. You’ll also present real-life cases to the surgeon, residents, and your fellow med students during rounds.

During Year 4, you’ll have some elective clinical rotations built into your schedule. This is a great time to get more experience with a surgical specialty of your choice.

After medical school, surgeons complete a five-to-eight year training period called residency. This is where you really start strengthening your surgical skills and delving deeper into your chosen specialty.

When it comes to residency, there are four basic pathways you can take:

• General surgery residency (5 years)
• Specialty surgery residency (5-7 years). Common in plastic surgery, orthopaedic surgery, neurological surgery.
• General surgery residency followed by a second residency in a surgical specialty (6-8 years). Common in colon and rectal surgery, thoracic surgery.
• Integrated program (6 years). Combines general and specialty training. A handful of integrated residencies are now available in thoracic surgery.

Residents rotate through a variety of different clinical settings, including general and vascular surgery, surgical specialties, anesthesia, pediatric surgery, and the ICU. They also perform operations – starting as first assistant but with increasing independence as their skills improve. In addition, residents create individual care plans for patients before and after surgery. Some surgical residencies include a year or two dedicated to full-time research.

Some activities you might participate in as a surgical resident: