09-26-2002, 12:34 PM
I was just curious. as far as getting a residency in the above mentioned field these days, how competitive is it? I'm assuming you can just be on the bottom of your class or anything. However, relative to the spectrum of competitiveness how hard would it be?
09-26-2002, 03:51 PM
Cardiothoracic Surgery is in a bit of a trough right now. There are many reasons why it has gone down in competitiveness but that's another thread. Competitiveness is way down and if you finish a 5 year general surgery residency, you are almost guaranteed a CT fellowship. As in everything, the top places are still pretty competitive.
There are a few programs you can enter directly out of medical school and I have no idea how competitive these positions are as they are few and far between.
CT rocks and gets a bad rap. You will be taking on a lot of extremely sick patients in the future with surgery for LVADs, CABG after 10 freakin' stents, transplants, VATS, etc but it still rocks.
09-26-2002, 04:12 PM
There have been more spots then applicants for CTS over the last few years. However, the top programs are still very competative with most of the fellows having come from the better surgery programs with many having done a year of lab time. The least desirable programs are having a hard time filling their spots with US trained surgeons. Duke & Hopkins used to have a system where you matched out of medical school for a decade's worth of training & lab time, but these really weren't integrated programs like has sprung up with Plastic Surgery and did not shorten your training period (Duke no longer does this I believe, & it may have also been abandoned @ JH by now). Abbreviating the training to an integrated model has been discussed but is only in the prelim phases of planning here. A similar process was tried & abandoned in the UK after more than 1/3 of the graduates were estimated to need re-training to be deemed competent. The pending 2003 ACGME work hours rules (which also applies to fellows) will make it even more diffucult to consider shortening the training length
09-27-2002, 12:18 AM
What do you guys think the solution will be to the progressively decreasing popularity of CT surgery among surgical residents and med students? I've read that it is estimated that by around 2010, almost half of the current CT surgeons in the U.S. will have retired. This, compounded by the fact that less and less people are deciding to go into CT surgery (including IMG applicants), will ultimately result in a shortage of qualified CT surgeons. Right now the proposed integrated General/CT surgery residency programs would include 3 years of general surgery plus 3 years of CT surgery, instead of the currently required 5 years of general surgery plus 2-3 years of CT training. Do you guys think shaving about 2 years off the training time is enough to significantly increase interest in CT surgery, despite the fact that compensation for CT operations seems to continue to decrease?
Or will the only way to get interest back into CT surgery will be to increase compensation to what it was before (or close to it)? The way I see it, potential CT surgeons are unwilling to go through arguably the most demanding specialty training, and in the end be working many hours but making about one-half the income CT surgeons before them were making.
09-27-2002, 10:54 AM
There are lots of potential variables in the work-force estimates for future cardiac surgeons, namely how the advances of endovascular delivered stents & even valves will decrease the number of traditional bypasses required. The shrinking pool of training surgeons may end up in fact being appropraiate for the residual CAD patients requiring bypass.
The experience overseas with the integrated CTVS training has really tempered alot of enthusiasm for attempting to abbreviate the training. On top of that, federally-mandated work hours which go into effect in 8 months will decrease the experience of the fellows by 20-30% in some places. As a chief resident, I don't see how you could compress so many of the fundamental skills you need to acquire BEFORE you start during cardiac surgery into 3 years time. The vascular skills to do a CABG are very specialized & before you can tackle something like that safely, you need the experience of 100's of other vascular cases to develop your technique. This is in addition to all of the routine patient care, critical care, general surgical knowledge, and thoracic surgery skills that must be integrated