General surgery

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

General surgery encompasses a broad range of surgery which includes:

• surgical conditions of the gastrointestinal tract from the oesophagus to the anus
• breast conditions
• kidney, pancreas and liver transplantation
• trauma to the abdomen and thorax
• certain skin conditions
• initial assessment of patients with peripheral vascular disease
• general surgery of childhood
• elective [1] surgery is also an important part of the work

General surgery is one of the two largest surgical specialties in the UK (the other being trauma and orthopaedics) employing 31% of the country’s consultant surgeons. This is a wide ranging surgical specialty with many sub-specialties.

General surgeons usually have their own subspecialty and also perform more general work.  Acute abdominal pain is the most common emergency presentation requiring surgery, since the abdomen has various organs which may be causing the pain. Common conditions requiring surgery include appendicitis, hernias and gallstones.

“The atmosphere in the operating theatre is great and you get to know your colleagues really well”. Bynvant Sandhu, higher specialty trainee, General surgery.

Read Bynvant’s story [2]

Common procedures/interventions

Laparoscopic or minimally invasive surgery (also known as “keyhole surgery”) is now widely used within general surgery. These techniques are also popular with patients as there is less scarring, a shorter recovery time and improved outcomes. Most abdominal operations including bowel tumour removal and hernia repair can now be carried out laparoscopically.  Some general surgeons choose to specialise in laparoscopic surgery.

Sub-specialties

Sub-specialties within general surgery include:

• breast surgery – assessment of breast symptoms, breast cancer surgery and breast reconstructive surgery where a plastic surgeon is not needed
• lower gastrointestinal surgery – for the diseases of the colon, rectum and anal canal, and particularly cancer of the bowel
• endocrine surgery – for thyroid and other endocrine glands
• upper gastrointestinal – this includes the oesophagus, stomach, liver and pancreas and also incorporates weight-loss surgery
• transplant surgery – renal (kidney), hepatic (liver) and pancreatic transplantations

Specialist training is also provided for advanced trauma surgery (for military surgery and trauma centres) and for remote and rural surgery.

Where do they work

General surgeons have an important role to play in A&E departments where emergency surgery is needed. In rural and remote areas general surgeons are in demand for their wide range of skills.

General surgeons also perform trauma surgery following accidents, although this has decreased because of improved car safety. This work requires close collaboration with other specialist colleagues and a holistic approach to treatment.

A small number of general surgeons are highly specialised and they only perform complex surgery within their own subspecialty, such as organ transplant surgery.

Within the Armed Forces military surgeons are general surgeons, where their work has an emphasis on trauma and emergency surgery.  General surgeons also carry out many simple childhood operations.

Specialist training is also provided for advanced trauma surgery (for military surgery and trauma centres) and for remote and rural surgery.

Want to learn more?

Find out more about:

• the working life [3] of someone in acute internal medicine
• the entry requirements [4] and training and development [5]
• a first-hand account of life in general surgery [2]

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.

  Find out more about the current pay scales for doctors [6], and there's more information on the BMA website [7]. 

  NHS employers [8]  provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in T&O surgery, flexible working and about wider opportunities.

  T&O surgery is a highly competitive specialty, with varied and interesting career opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training [9] (CCT [10]). You will receive your CCT [10] at the end of your general surgery training.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
  • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training [11] programme director. This role will be working within the Local Education and Training Board (LETB) [12]/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

  SAS doctor roles

  There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor.

  SAS surgeons (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for Specialty Doctor roles. Find out more about SAS doctors roles. [13]

  The role of an SAS surgeon can vary greatly. Depending on your experience, you might work on complex surgery or relatively minor diagnostic and outpatient work. SAS doctors will frequently participate in routine and elective [1] surgery rather than emergency work. They also train other staff.

  Some surgeons are attracted to the SAS role as the hours are more regular than those of the consultant, and any on-call work and overtime beyond 7am-7pm is paid.

  Other non-training grade roles

  These roles include:

  • Trust grade
  • Clinical fellows

  Other opportunities

  There are good opportunities for teaching undergraduate and postgraduate medical students and colleagues. Research opportunities are also good, where you will write papers, present work at conferences and have the opportunity to collaborate with national and international colleagues.

  General surgeons also undertake audit and committee work. With experience there are excellent opportunities to become involved in management and to actively participate in professional organisations.

  There may also be opportunities to work in the private sector and overseas.

  Academic pathways

  If you have trained on an academic general surgery pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in general surgery. Whilst not essential, some doctors start their career with an Academic Foundation post. Entry is highly competitive.  This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

  A PhD is often taken, either during core or specialty training.

  Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [14]

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine. [15]

  The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.

  The Integrated Academic Training Pathway

  If you are interested in research the integrated academic pathway may be for you. Trainees can apply for the two-year academic foundation programme [16] instead of a normal foundation programme. After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training).

  Trainees can then apply for academic specialty training.

  You will normally be appointed as an academic clinical fellow during ST1-2 and as a lecturer at ST3 and until the end of your training.

• Job market and vacancies

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  This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.

  Job market information

  In 2016, the competition ratio for CT1/ST1 Core Surgical Training  was 2.53, and for ST3 General Surgery it was 1.68 (NHS specialty training, 2016). [17]

  General Surgery had 2,237 consultants and 1,682 medical registrars in England ( [18]NHS Digital, 2016 [19]) [18].

  About 12 % of general surgeons are women.

  The rise of obesity and an increasingly ageing population means there will be a growing demand for general surgery.

  On this page we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland workforce information [20]
  NHS Wales workforce information [21]
  NHS Northern Ireland workforce information [22]

  Where to look for vacancies

  Applications for core surgery training are made via the Core Surgery National Recruitment Office [23]. Applicants with prior surgical experience are more likely to be offered ST3 posts than those applying from core training.

  London and the South East (LaSE) nationally coordinates the recruitment into Core Surgery Training round one (CT1) on behalf of England, Wales and Scotland. This training programme is open to those who may want to train flexibly on a less than full- [24]time [25] basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply.

  The competition ratios for core surgery training can be viewed on the Surgery Recruitment [26] website.

  Applications for core surgery training in Northern Ireland are dealt with by the Northern Ireland Medical and Dental Training Agency [27].

  Registration and application for core surgery and specialist training is online via Oriel. Further details person specifications and application deadlines are also available on the Oriel [28] site.

• Further information

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  Association of Trauma and Military Surgery [29]

  Association of Breast Surgery [30]

  Association for Cancer Surgery [31]

  Association of Coloproctology of Great Britain and Ireland [32]

  Association of Laparoscopic Surgeons of Great Britain and Ireland [33]

  Association of Surgeons of Great Britain and Ireland [34]

  Association of Upper Gastrointestinal Surgeons for Great Britain and Ireland [35]

  British Association of Endocrine and Thyroid Surgeons [36]

  British Medical Association [37]

  British Transplantation Society [38]

  Joint Committee on Intercollegiate Examinations [39]

  General Medical Council [40]

  Royal College of Surgeons [41]

  Royal College of Surgeons of Edinburgh [42]

  Royal College of Physicians and Surgeons of Glasgow [43]

  Vascular Society [44]