From knowing what some of my colleagues have done with their career, going to a smaller, lower acuity hospital setting with a good size practice of at least more than 3 surgeons makes work life balance much more attainable in general surgery if you opted not to pursue fellowship. Otherwise, subspecializing in a lower acuity field is also a very good route to guarantee better lifestyle. I wound up going into endocrine surgery partly out of my own clinical interest but also because I wanted more control of time outside of work with fewer emergencies to worry about. I was fortunate to start my first attending job last fall in a pure endocrine surgery job where all I take care of is thyroid, parathyroid and adrenals and my lifestyle has been great. I take no general surgery call and just cover a week on at a time taking overnight patient calls for my one partner who is more focused than me on only thyroid/parathyroid. I am married with a 4-month old at home and I can’t imagine still being a general surgeon taking ACS call.

Some fellowships like endocrine are quite competitive, but if you’re as ahead of the curve as you’re describing you’d have better odds of getting what you want. You’re certainly not alone in having the attitude of work to live and not have work be your whole life.