Can you be a general surgeon and an internal medicine physician at the same time?

Question

I am trying to choose a career and I was wondering whether or not I can do both.

Answer 1

You can be one at the same time but not become one at the same time.

The training differs.

Answer 2

Strictly speaking, no, you cannot be both an internist and a surgeon.  There are a couple of reasons why.  However, you can do a few things that might help you satisfy more than one interest if you do decide to become a doctor and you're looking at how to design your career.

To become a surgeon requires that you compete for, and obtain a slot in a surgical residency program which requires a minimum of 5 years of extremely intensive training after medical school.  Doing this is incompatible with having any other types of regularly scheduled activities during those years.  In particular, one could not do internal medicine training at the same time.  Following surgical training, one has to become board certified in surgery.  The process of board certification typically needs to follow directly on training or else too much is forgotten to pass the test.  

To become an internist requires 3 years of training.  Although not as intensive as surgical training, it still requires 100% of the doctor's attention.  There is no extra time to do other regularly scheduled activities.  Internists also have to be board certified following training.

To actually set up a surgical career requires having hospital privileges.  One applies for these at any hospital that they might want to work in.  The hospital looks to see that the doctor has actually been doing the things that they're applying for privileges to do.

If one did a medicine training program followed by certification and then a surgical training program afterward, there would be too much time elapsed for a hospital to consider granting privileges for doing internal medicine.  If one did it the other way around, there would be too much elapsed time for them to consider granting privileges for surgery.

So, you can't do these training programs at the same time, and if you did one and then the other, you'd only be able to use the more recent one.  You'd waste a tremendous amount of time!

Even if you COULD get privileges to do both, you'd be ineffective in trying to do both.

Internists need to manage patients both in the hospital and in outpatient clinics.  They have to see a lot of patients to make ends meet.  They need to spend a lot of time at a lot of different bedsides to earn their money and maintain their skills.

Surgeons need to do a lot of surgery to make ends meet.  There are a lot of costs involved in doing surgery.  The insurance is more expensive and the types of support staff that a surgeon needs to employ are very specific.  A surgeon needs to do quite a lot of surgery just to keep all these people paid.  Additionally, a surgeon's work is periodically re-evaluated and if they're not doing enough of some types of operation, they lose their privileges to do it in the future.  Skills have to be maintained.

With all that time in the operating room, a surgeon has little time to do the kinds of things that the internist does.  With all the time the internist spends at hospital bedsides and in the clinic, they have little time to the kinds of things that the surgeon does.

That being said, surgeons do a lot of bedside medical decision making, and they see lots of patients in clinic, but most of the issues are surgical ones.  The other types of medical problems that patients have need to be managed, but as added issues.  Surgeons don't tend to see patients long term like internists do, but the "detective work" aspect and the broad attention to detail is still there, in a lesser degree.

Also, many internists specialize, and some of the subspecialties of medicine are VERY "procedural".  Gastroenterology, for example, involves the medical management of people with problems of the digestive system, but they do a tremendous amount of endoscopy.  Endoscopy is a highly skilled procedure that has similiarities to surgery.  Cardiologists can become specialized in interventions, too.  The interventional cardiologist not only manages patients with heart problems but they do sophisticated procedures involving fishing wires and tubes from the artery in the leg all the way up to the heart, and opening blood vessels that were otherwise clogged.  

People who choose to work as doctors in rural areas are given tremendous amounts of lattitude in how they define what they do.  Surgeons do less surgery and more medicine.  Internists do some minor procedures.  Everyone tries to work together to provide needed services.  There are now people who are trying to define a new medical specialty of "rural medicine" to try to meet this type of need.

The bottom line is that you cannot be both a surgeon and an internist in the strict definition of these terms.  However, there are ways to shape a medical career to satisfy a lot of different interests.  Step one is to get into medical school.  From there, find out what your strengths are, work to improve your weaknesses, and figure out what sort of career choices will continue to satisfy your interests over the long arc of your career.