Surgeon

Surgeons are medically qualified doctors who operate on patients in order to treat disease or injury

As a surgeon, you will treat injuries or diseases by performing operations on the body to repair, remove or replace the damaged part. As well as operating, you'll carry out ward rounds and outpatients clinics and will take on a range of administrative duties and teaching responsibilities.

Becoming a surgeon can take many years and you'll need a high level of commitment to succeed. Competition for places can be fierce, particularly in the later stages of training. New surgery techniques are continually evolving so you'll learn new skills throughout your career.

Types of surgeon

Surgeons usually specialise in one of the following ten main areas:

• cardiothoracic - dealing with surgical treatments inside the chest, generally addressing conditions of the heart and lungs
• general - a range of knowledge and skills is required to deal with all kinds of surgical emergencies, with an emphasis on acute abdominal problems including the stomach, small bowel, colon, liver and pancreas
• neurosurgery - performing surgery on elements of the nervous system including the brain, spinal cord and extra-cranial cerebrovascular system
• oral and maxillofacial - deals with the diagnosis and surgical treatment of patients with diseases affecting the mouth, jaw, face and neck
• otorhinolaryngology - also known as ear, nose and throat (ENT) surgery. ENTs specialise in a range of diseases of the head and neck
• paediatric - dealing with surgery of premature and unborn babies, children and young adults up to the age of 19
• plastic - plastic surgeons deal with surgical restoration, reconstruction or alteration of the human body. This includes cosmetic or aesthetic surgery and the treatment of burns
• trauma and orthopaedic - these surgeons use surgical treatments to treat a range of conditions of the musculoskeletal system and supporting structures such as ligaments, tendons, muscles and nerves
• urology - urologists fix problems of the female urinary system and the male genitourinary tract. They diagnose and treat disorders of the kidneys, ureters and bladder using surgical techniques
• vascular - vascular surgeons concentrate on the diagnosis and surgical treatment of conditions affecting the circulation, including disease of the arteries, veins and lymphatic vessels.

There are further options for sub-specialisation within some of these main specialisms.

For more information, see the Royal College of Surgeons of England Surgical Specialties Overview.

Responsibilities

Activities will vary depending on your area of specialisation. However, as a surgeon, you'll typically need to:

• assess and examine patients to establish if an operation is necessary
• manage and monitor preoperative and postoperative treatments and procedures, such as use of sedatives and antibiotics
• speak to patients and their families before surgery to go through the procedures that will be carried out with them to provide reassurance
• operate on patients to improve or restore functions, such as repair injuries or treat diseases
• follow established surgical techniques during the operation
• direct and coordinate the activities of other health staff within the multidisciplinary team, including junior doctors, nurses and operating department practitioners
• undertake ward rounds on a regular basis and take outpatients clinics - the amount of time you spend on these activities will depend on your specialism
• refer patients to other medical specialists or other practitioners when necessary
• undertake associated administrative work.

You'll also be expected to:

• conduct research to help develop and test surgical techniques and equipment that can improve operating procedures and outcomes
• help teach and train other junior doctors and medical students and other members of the multidisciplinary team.

Salary

• Junior doctors undertaking foundation training earn a basic salary of £32,398 to £37,303.
• As a doctor undertaking your specialist training, your basic salary ranges from £43,923 to £63,152.
• The basic salary for specialty doctors ranges from £52,530 to £82,400. If you are a specialist grade doctor you'll earn a basic salary of £83,945 to £92,275.
• Consultants earn a basic salary of £93,666 rising to £126,281, depending on length of service.

As well as a basic salary, doctors in training earn extra for any hours over 40 per week, a 37% enhancement for working nights, a weekend allowance for any work at the weekend and an availability allowance if they are required to be available on-call.

Consultants may also apply for local and national Clinical Impact Award (NCIA). They can also supplement their income by working in private practice.

Figures relate to the pay and conditions of medical doctors within the NHS, which is the largest employer of surgeons in the UK. Consultants working in the private sector can expect to be paid more.

Income data from Health Careers - Pay for doctors. Figures are intended as a guide only.

Working hours

You'll work long hours, including nights and weekends, being on call out-of-hours on a rota basis.

In some cases, less than full-time training for doctors is possible.

What to expect

• You'll have contact with patients and will also take part in ward rounds.
• Jobs are available throughout the UK, mainly in acute hospitals. You'll typically work in operating theatres, outpatient clinics and specialist units such as accident and emergency (A&E).
• You'll work within a multidisciplinary team, which includes nurses, operating department practitioners, radiologists, anaesthetists and other medical and healthcare staff.
• The work is challenging and requires a great deal of commitment and determination but can also be very rewarding.
• You may be expected to travel to other surrounding hospitals or clinics.

Qualifications

To become a surgeon, you'll need to start by taking a degree in medicine recognised by the General Medical Council (GMC). This usually takes five to six years to complete.

If you've already got a degree in a subject other than medicine (usually a 2:1 or above in a science-related subject) you can apply for a four-year accelerated graduate entry medicine programme (also known as a graduate entry programme). The British Medical Association has further information about applying to medical school as a graduate.

You'll then go on to complete the two-year UK Foundation Programme, a paid training job in a clinical setting. During this time, you'll work in hospitals as a junior doctor on a rotational basis in different departments, including surgery. After the first year of training, you'll be recommended for full registration as a doctor with the GMC. On successful completion of the foundation training, you're awarded the Foundation Programme Certificate of Completion (FPCC) and will start your surgery training.

The route you'll follow depends on which of the ten main specialisms you decide to take. Training for many specialisms is split into two years of core surgical training (CT1 and CT2), followed by approximately six years of specialty training (ST3 to ST8). However, run-through training is available for some of the specialities, such as neurosurgery. This typically takes eight years to complete.

Core surgical training provides a basic grounding in surgery that develops the required skills and knowledge needed to progress on to specialty training or it may be tailored to a particular specialty. Before moving on to surgical training at specialty level, you must pass the Intercollegiate Membership of the Royal College of Surgeons (MRCS) Examination.

Specialty training is highly competitive and each specialty has its own curriculum. GMC-approved curricula for the ten surgical specialties are provided by the Intercollegiate Surgical Curriculum Programme (ISCP).

At the end of this training you must obtain the Certificate of Completion of Training (CCT), which allows you to join the GMC Specialist Register and to apply for surgery consultant positions. In order to obtain the CCT, you'll need to pass the RCS Intercollegiate Specialty Fellowship Examination, which leads to specialty fellowship of the Royal College of Surgeons (FRCS).

A number of surgeons are neither consultants nor trainees and take up posts as specialty doctors or associate specialists (SAS). To do this, you'll need to be registered with the GMC and have completed four years of postgraduate training, including two years of specialty training.

The RCS and Health Education England are in the process of introducing new standards that will make postgraduate training more flexible for all doctors, including surgeons. See the Improving Surgical Training (IST) pilot programme for information on how surgical trainees will be offered a better training-service balance that includes working alongside professionals from other specialties to improve patient care.

For more information on becoming a surgeon, see RCS Careers in Surgery.

Skills

You'll need:

• technical knowledge and clinical expertise in order to elicit the necessary information from patients and identify key issues and the appropriate options
• good hand-eye coordination to perform operations
• communication skills, with the ability to adapt your communication style to suit the situation
• leadership and team involvement skills to positively deal with problems in a non-confrontational away
• negotiation skills in order to reach solutions to complex, and often competing, needs
• the ability to remain calm and in control under pressure
• the self-knowledge to know your limitations and use your judgement to compromise and seek help if required
• the confidence to justify your decisions in high-pressure situations
• the ability to prioritise your workload and delegate work to others
• problem-solving skills to think ahead and plan for different contingencies, anticipating different situations that might occur
• situational awareness, including how to deal with subtle changes in clinical conditions
• the ability to manage your time and resources effectively
• a flexible approach to work and the ability to consider all factors before reaching a decision
• professional integrity and honesty, respecting both patients and colleagues
• emotional stability and empathy
• commitment, drive and focus
• the ability to reflect and learn from your own work and a commitment to continuing professional development (CPD).

Work experience

As getting into surgery training is competitive, you'll need to improve your chances of success while at medical school. You can do this by developing a portfolio to show your interest and passion for surgery and by doing your elective in a surgical area.

A good first step is to become a member of your university's surgical society and attend their events and skills sessions. Try and speak to as many surgeons as you can to get a feel for their specialty. See the Royal College of Surgeons' advice on improving your chances of entering surgical training.

If you're a woman entering the world of surgery, find out more about Women in Surgery, a national initiative set up to encourage more women into the profession.

During your two-year Foundation Training as a junior doctor, you'll take at least one surgery rotation that will give you a good insight into the work. Use this time to get involved in other activities that can show your interest in surgery.

Find out more about the different kinds of work experience and internships that are available.

Employers

The NHS is the largest employer of surgeons in the UK. There are also opportunities to work in the private sector as well as setting up a private practice.

Look for job vacancies at:

• BMJ Careers
• NHS Jobs - for England and Wales
• NHSScotland Jobs
• Northern Ireland Health and Social Care (HSC) Jobs
• private healthcare websites.

Specialist recruitment agencies advertise jobs.

Individual trusts and hospitals advertise vacancies on their websites and sometimes in printed bulletins.

Professional development

As a surgeon you'll be expected to continue learning throughout your career. Continuing professional development (CPD) is essential for remaining on the GMC register. CPD activities can include attending courses, conferences, meetings and workshops, as well as pursuing research and peer-reviewing journal papers. Guidance on how much and what kind of CPD you'll need to undertake is available from the Royal College of Surgeons.

For an academic research career, you'll need to study for a PhD in an area of original research.

Additional postgraduate qualifications will be looked upon positively. If you wish to integrate more formal study into your work, you can take certificate, diploma and Masters courses in medical education. Search postgraduate courses in medical education.

Career prospects

You'll gradually gain more experience in your clinical duties and take on more responsibilities over time. You'll have the opportunity to move into managerial roles, initially as a medical lead (a lead consultant for a team), then as a clinical director (a lead consultant for a department), and possibly on to a medical director (a lead consultant for a hospital trust).

If you're working as a specialty doctor, you'll spend most of your working day on patient care and be responsible to a named consultant surgeon. There is some scope for leadership and management roles and you may also have the opportunity for teaching, research, committee work and more.

If you wish to take up scientific research and an academic career, you'll need to start early at medical school or during your Foundation Training as this field is highly competitive.

Surgeons interested in teaching future doctors may become a director of medical education, training programme director or associate dean in charge of the entire training programme.

The vast majority of doctors practising privately also work in NHS consultant posts conducting their private work outside of their NHS commitments.