Specialty Profiles

What it’s like in colon and rectal surgery: Shadowing Dr. Simianu


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What it’s like in colon and rectal surgery: Shadowing Dr. Simianu

Apr 2, 2024

As a medical student, do you ever wonder what it’s like to specialize in colon and rectal surgery? Meet Vlad (Val) Simianu, MD, MPH, a colon and rectal surgeon and a featured physician in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in colon and rectal surgery might be a good fit for you.

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Vlad (Val) Simianu, MD, MPH

“Shadowing” Dr. Simianu

Specialty: Colon and rectal surgery.

Practice setting: Medical center.

Employment type: Employed by a Seattle hospital that is part of the Virginia Mason Franciscan Health, which is a member of the AMA Health System Program. The program provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Years in practice: Six.

A typical day and week in my practice: A typical workweek for me includes two days for surgical operations and one and a half days in clinic and conducting screening colonoscopies. The remaining one and a half days are spent doing research or administrative duties, depending on the week.

The most challenging and rewarding aspects of colon and rectal surgery: While awareness of colorectal disorders has become more common in recent years, patients may still feel embarrassed about dealing with, or discussing, a colorectal problem. This often leads to delays in their seeking care. The greatest challenge I experience is ensuring that my patients feel comfortable and safe discussing their problems so that we can work together to explore treatment options. It is also one of the most satisfying things I do.

The most rewarding aspect of my work is that I get to be both a specialist and a generalist. Colorectal surgeons do big, complex operations, such as procedures to remove rectal cancers that invade multiple organs. We also do relatively simple procedures, such as injecting Botox to treat an anal fissure. This also supports our approach to research, where we are able to use our firsthand experiences to boost research concepts and work on studies that can have positive impacts on the whole field. Patients are thankful in their own ways for treatment of both malignant and benign conditions.

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The impact burnout has on colon and rectal surgery: Burnout has been pervasive in health care, even prior to the pandemic. As physicians, we are passionate about caring for all our patients, but we may not take the time to take care of ourselves too. I’m seeing surgeons in my specialty retiring early because rapid advances in technology and techniques can be difficult to keep up with. However, a surgeon’s experience and wisdom can be captured in other ways, such as in clinician-driven research projects.

Additionally, I’d love to explore how we can continue to provide supportive and flexible options to retain their expertise, such as mentoring programs for the next generation of surgeons and rebalancing caseloads to create teaching and support opportunities.

How Virginia Mason Franciscan Health is reducing physician burnout: At Virginia Mason Franciscan Health, patient safety is our top priority. As we, like all health care organizations, grapple with ongoing staffing shortages and high patient volumes, we have a robust recruitment and workforce development strategy to attract and retain talent. Workforce development is important—if you invest in your team, develop them, they are more likely to stay with you. And we prioritize that.

One of the biggest reasons that surgeons like me stay at Virginia Mason Franciscan Health is to support our colleagues and the high-level medical care we get to deliver to our patients. In the contemporary era, colorectal care is truly multidisciplinary—I work closely with gastroenterologists, medical and radiation oncologists, radiologists, pathologists, gynecologists and urologists. We all have the same focus: outstanding care for our patients. That enables us to innovate, educate and deliver high-quality health care, and it also reduces burnout, because we feel stimulated and supported by each other.

How my lifestyle matches, or differs from, what I had envisioned: I’m not sure I really had an idea of the lifestyle of a surgeon in medical school. My wife, who I met in medical school, is also a physician, so we've worked to build our lives together as a two-physician household. In practice, our shared calendars help us organize our lives from calls to cases to child care.

Our careers, while super rewarding, also put many of life’s challenges into perspective, highlighting what is most important. For many years, before we had our daughter, we capitalized on opportunities to be outdoors and travel, sometimes even post-call as residents! Now, we still do many of those things, just a little differently with our 3-year-old. I got her up on skis and pedaling her bike this year, and I feel like that’s pretty awesome.

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Medical student sitting on a stack of textbooks

Skills every physician in training should have for colon and rectal surgery but won’t be tested for on the board exam: The main skills every physician in training interested in colorectal surgery should have but may not be tested for in a board exam, include these below.

Team management—specifically, how to lead, listen and resolve conflicts. As a surgeon, you’re a leader in and out of the operating room. There are many things you have agency over, and you can leverage those things to elevate your team members, which, in turn, makes for a stronger team.

Health care economics. It’s valuable to understand what makes your hospital and health system work, particularly as health systems across the country are facing multiple financial pressures. Having an understanding of how you can support the organization’s goals beyond your daily duties enables you to be more informed while advocating for your program and patients. For example, consistently working with colleagues in other disciplines to identify opportunities to provide a comprehensive, multidisciplinary approach to care that achieves the best outcomes for your patient.

Asking for help. The best part about a career in any field, including medicine, is that you have the opportunity to continuously learn and grow. Post-residency and well into your career, it’s critical to acknowledge when you need help and to seek out support that can ultimately make you a better physician.

One question physicians in training should ask themselves before pursuing colon and rectal surgery: What am I hoping to accomplish as a physician, and can I do that as a colorectal surgeon?

Books, podcasts or other resources every medical student interested in colon and rectal surgery should be reading:

Additional advice I would give to students who are considering colon and rectal surgery: To quote a mentor and friend, “Why would you do anything else?” I really believe that. This is an exciting time to be a colorectal surgeon.

Our practice allows us to care for patients across malignant, inflammatory and benign conditions. We bring mastery of unique pathology and technically complex procedures to multidisciplinary collaborations. We are privy to high-quality research done by our predecessors and get the chance to build on it through local and national partnerships, trials and innovations. We’re attracting driven young surgeons. The future is bright.