To fully understand the difference between general surgeons and surgicalists, you have to step outside of the operating room and meet our Surgicalists.
A General Surgeon’s Rite of Passage
Imagine designing your ideal career in healthcare as a physician. A career providing equal doses of engaging work along with a life lived in balance with adequate parts of sleep, exercise, family time, and personal time. Does this sound far-fetched, especially if you are a general surgeon whose work is never ending? General surgeons typically work 24 hours a day, seven days a week to address their core practice of elective surgery, clinic days, and taking on emergency call for the emergency department. Those physicians who choose a surgical career, begin with competition as a driver. It starts with competing for limited surgical residency positions, which are coveted. Inevitably, some are not selected for a surgical residency on Match Day and must wait it out by going to graduate school or taking a position doing research as they wait for the next opportunity at a surgical residency. Eventually, those who make it into a surgical residency continue to compete. They compete with other residents to get assigned to the most interesting cases, or working with the best attendings, or being selected for the role of Chief Resident.
Once residency training is completed, a newly minted general surgeon typically joins a practice or becomes employed by a hospital. Either way, they take their position as low-surgeon-on-the-totem pole. They pay their dues as a rite of passage. Taking ER call and working the least desirable surgical schedules is part of the deal. It takes years to reduce call responsibilities and carving out a niche and priority on the hospital’s surgical schedule. General surgeons agree to take ER call for the hospital. There are perceived rewards associated with taking call: earning added income and growing a private practice with downstream referrals. Most general surgeons see ER call as part of the ‘cost of doing business.’
Balancing Surgeries
Emergencies cannot be scheduled, and this interrupt-drive life is simply part of the job description. General surgeons find their career taxes both personal health and happiness. Many find themselves in difficult relationships with their spouses and family. Surgery comes first and family second. Divorce and burnout are real side effects of a general surgery career. However, general surgeons are finding it does not have to be that way. They can opt for a subspecialty as a surgicalist; a general surgeon limiting their practice to emergent, urgent, and trauma surgery. One benefit is there is no clinic practice to manage. Another benefit is working every other week – 26 weeks a year.
Unveiling the Surgicalist Model
Mit Desai, MD, FACS, (pictured left in the University of Michigan scrubs), founded The Surgicalist Group practice to address the lifestyle of the general surgeon in 2007 in Tampa, Florida. The practice has grown over the years and is now in several states with many general surgeons who have taken up the mantel of the subspecialty and seeing it grow in scope and popularity with hospital leaders. Surgicalists can help community surgeons by taking on emergent and urgent cases, allowing their peers to have more time to focus on their practice and have more time for their personal lives. The model also helps hospitals focus on improving performance at the intersection of the emergency department and the surgical suite. Areas where hospitals benefit from incorporating surgicalists includes improving efficiency and throughput in the ER and OR, patient satisfaction associated with getting the right care at the right time and place, improved quality with evidence-based protocols incorporated, and cost-savings with standardization on supplies and processes. Surgicalists are change agents within hospital EDs and ORs.
Meet Our Surgicalists | Dr. Daniel Rizzo
One of our surgicalists, Dr. Daniel Rizzo, who practices with our group in the Dallas Fort-Worth area, is a shining example of the life that is working as a surgicalist. After completing medical school in Arizona in 2009, he matched for a surgical residency in Toledo, Ohio at St. Vincent’s Medical Center, where he was also Chief Resident and joined the Navy during residency. After residency he completed four years of military duty and spent time on the USS Wasp, USS Harry S. Truman, and the USS Abraham Lincoln as an attending physician, and worked as an attending surgeon primarily at the Naval Medical Center Portsmouth in Virginia.
While at the Naval Medical Center Portsmouth, Virginia and Naval Hospital Camp Lejeune in North Carolina, Dr. Rizzo realized that there was a significant difference between the life he had as a resident in the civilian world and that of an attending physician with the Navy. He wondered if it would be possible to strike a career with more balance but decided he did not want to be a career military physician. Unexpectedly one day, he received an email solicitation from a recruiter for a position with The Surgicalist Group asking him if he wanted to talk about taking a position as a surgicalist in the Dallas Fort-Worth area which piqued his interest. At the time, he and his wife Morgan had six children with their seventh on the way. He wanted a career where he did not have to miss the school field trips, Daddy-Daughter Dances, or help teach kids on important lessons about life and family. Like most physicians, he had not responded to random recruiter solicitations, but this seemed like an opportunity that was “too good to be true.” In parallel, he was considering an offer to join an established general surgery practice also in Texas. When he compared the two jobs, he realized that the amount of time off with The Surgicalist Group was better than any private practice could offer him, and the compensation was comparable. So, he opted to move his growing family to the Dallas Fort Worth area to join The Surgicalist Group. And, the rest, as they say, is history. Dr. Rizzo joined a group of three other general surgeons in 2018 with The Surgicalist Group, which was the organization’s first Texas practice.
Behind the Scenes
Dr. Rizzo feels fortunate to have joined a group with like-minded surgeons and gets to do the work he loves – which is doing surgery – and he works a schedule that gives him every other week off. On the weeks he works, he is on 24 hours a day, 7 days a week like all general surgeons. However, he enjoys the camaraderie with his partner surgeons and never feels like he is out there alone. If he needs help, he can always call on one of his colleagues for advice or even to come in and “double scrub” for cases that would benefit from another set of eyes and hands. He and his partners enjoy times when they can work together. It is very collegial, and everyone is respectful of each other’s time off, too. The surgeons have autonomy to manage their practice, including what time of day they like to start. Some are early birds, like Dr. Rizzo who likes to get up early before his family and get in a run or do some reading before heading to the hospital at 7:30 am to do rounds on his patients who have been admitted, conduct consultations on inpatients, and catch up with hospitalists who are caring for his surgical patients who have multiple comorbidities that need more medical oversight. Other partners like to start their day late morning and stay at the hospital through the early evening. It is all a matter of person preference, unless, of course there is an emergency case which requires a quick response to the hospital and showing up right away. Since they have no clinic or office to manage, they can drop everything to tend to the emergent or urgent case. Living close by allows him to go home after his morning duties are complete and wait for the phone to ring in the case of an emergency. Somehow, the days get filled and he is often called in to perform an emergent or urgent case during the day or night but the rest of the time he is free to spend with his family, on personal interests, or just resting up.
The work of the surgicalist days is not just filled with simple appendectomies or cholecystectomies. Like other surgicalists, Dr. Rizzo enjoys the variety of cases he is called on to perform, like dealing with a perforated gastric cancer, removing large bowel obstructions, or addressing gastric outlet obstructions. It is all in a week’s work (or 26 weeks of work in a year) for surgicalists like Dr. Rizzo. He even had the time during his weeks off to do some teaching with a colleague, Dr. Devine, a thought leader in osteopathic manipulative medicine (OMM), on incorporating osteopathic manipulative medicine into a hospital based surgical practice.
A Rewarding Balance
His life is full. The time he has off every other week is perfect to help around the house and 
share in parenting activities, co-parenting with his wife, Morgan. With seven kids, ranging in age from teens to toddlers: 18, 16, 13, 9, 5, 4, 2, you could argue they are busier than most families!
One trip Dr. Rizzo looks forward to is attending the ACA Annual Meeting American College of Osteopathic Surgeons. The conference is going to be in San Diego this October. Hopefully, if the COVID-pandemic is under control, he may be able to attend and take time to visit his undergraduate alma mater, the University of California San Diego, where he studied biology.
