Busy CT Surg fellow here. Have any questions? Ask away!

[Buzz Me]

http://ats.ctsnetjournals.org/cgi/reprint/89/6/1853.pdf

http://bsurgmed.wordpress.com/2010/07/26/heart-surgeons-not-immune-to-private-practice-squeeze/

http://www.sciencedirect.com/science/article/pii/S0003497506008563

Found these with one quick google search, didn't put in the effort to find the original articles and research papers I've read.

As someone who has aspired to do cardiac surgery for a very long time, I'm sort of playing devil's advocate. I do hope your response is representative of the most up to date current CT market. But the most up to date research on the matter doesn't seem to be congruent with your experience.

From your posts on this thread. It seems you fall into the category of those who couldn't see themselves doing anything else and I admire that. The idealist in me believes that all the money and the best lifestyle in the world isn't worth surpassing doing what you love.

I can certainly ask around some more but what I reported is from my discussions with attendings in both my residency and fellowship programs (both big-name places).

It's true that I can't see myself doing anything else - I'm lucky that I love this field, because it would otherwise damn-near kill me with how hard it's kicking my butt!

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[Coffee Machine]

At what point in your training did you decide you wanted to do thoracic surgery? What factors influenced your decision?

 

[ToldYouSo]

Worst accident/mishap you've witnessed in the OR?

 

[jwhitebc22]

A year or so ago I ran across an article that mentioned an alternate route to CT surgery being: 5 year vascular integrated + 2 year CT fellowship. Here recently I searched for that pathway track, but I am coming up empty. Does such an option an exist? Is this a path that any take if it does exist? Is it feasible, frowned upon, etc...? Or am I mixing this up? I ask because I have read people talk about how it might be an advantage for a CT surgeon to have some wire skills in the future. With job market fluctuations, new procedures, PP patient base, etc... I don't think it is a bad idea for me to research the various options, especially as I am not in the position of having to choose my exact path at this exact moment. This question applies to not only Buzz Me but anyone who has the answer.

 

[Buzz Me]

At what point in your training did you decide you wanted to do thoracic surgery? What factors influenced your decision?

Early on...in college I did research in a cardiothoracic-related field and became fascinated by it. I don't want to give specifics for obvious reasons...but suffice to say I was one of the lucky people who liked many things in med school (and residency, for that matter) but in the end always loved CT most.

Pros? Working on the heart, lungs and esophagus is the best place to be in the body (IMHO). When we get called for thoracic trauma it's always a cool case. Going on bypass is amazing. You get huge variety in thoracic - foregut, lung cancer, esophageal cancer, transplant (if you so desire), peds (cystic fibrosis and pectus cases). I love the ICU, love sick patients, love cardiovascular physiology. Love Swans and drips. Love advanced vents (bilevel, oscillators and the like). Love ECMO.

 

[Buzz Me]

Worst accident/mishap you've witnessed in the OR?

Throughout all of my training, or just CT-related?

 

[Buzz Me]

A year or so ago I ran across an article that mentioned an alternate route to CT surgery being: 5 year vascular integrated + 2 year CT fellowship. Here recently I searched for that pathway track, but I am coming up empty. Does such an option an exist? Is this a path that any take if it does exist? Is it feasible, frowned upon, etc...? Or am I mixing this up? I ask because I have read people talk about how it might be an advantage for a CT surgeon to have some wire skills in the future. With job market fluctuations, new procedures, PP patient base, etc... I don't think it is a bad idea for me to research the various options, especially as I am not in the position of having to choose my exact path at this exact moment. This question applies to not only Buzz Me but anyone who has the answer.

I haven't heard much about this...for a while Stanford was talking about a combined Vasc/CT program but don't know if that actually panned out. Many people that truly want to do endovascular stuff (especially TEVARs) have to do a superfellowship to get the necessary wire skills - you just don't get enough volume of this during training (even in specialized integrated programs) by just doing a rotation in the cath lab and a rotation with the vascular guys.

 

[ToldYouSo]

throughout all of my training, or just ct-related?

ct

 

[Winged Scapula]

Worst accident/mishap you've witnessed in the OR?

Are you a malpractice attorney looking for work?

 

[droliver]

Worst accident/mishap you've witnessed in the OR?

True story. One of the CTVS guys where I trained about 15 years ago was upset with the perfusionist tech during a case, complaining about the pressure being too high through the circuit. Eventually, he gets so irritated that he takes the cannula tubing off and squirts her with the pressurized blood right in the face, saying something like "See, I told you the pressure was too high". He was "retired" within 48 hours and began a new career in non-operative consulting work.


Come to think of it, that was one of 4 department chiefs I watched go down in flames in front of me for absolutely insane behavior or outrageous non-PC comments.

 

[PennDippody]

True story. One of the CTVS guys where I trained about 15 years ago was upset with the perfusionist tech during a case, complaining about the pressure being too high through the circuit. Eventually, he gets so irritated that he takes the cannula tubing off and squirts her with the pressurized blood right in the face, saying something like "See, I told you the pressure was too high". He was "retired" within 48 hours and began a new career in non-operative consulting work.


Come to think of it, that was one of 4 department chiefs I watched go down in flames in front of me for absolutely insane behavior or outrageous non-PC comments.

What a malignant freak. It really scares me to think that I'm probably gonna have bosses like this some day.

 

[Non Pizza Lunch]

True story. One of the CTVS guys where I trained about 15 years ago was upset with the perfusionist tech during a case, complaining about the pressure being too high through the circuit. Eventually, he gets so irritated that he takes the cannula tubing off and squirts her with the pressurized blood right in the face, saying something like "See, I told you the pressure was too high". He was "retired" within 48 hours and began a new career in non-operative consulting work.


Come to think of it, that was one of 4 department chiefs I watched go down in flames in front of me for absolutely insane behavior or outrageous non-PC comments.

omg! I can imagine everyone in the OR just standing there with their jaws wide open under their mask, too stunned to even say a thing.

 

[Coffee Machine]

Come to think of it, that was one of 4 department chiefs I watched go down in flames in front of me for absolutely insane behavior or outrageous non-PC comments.

Care to share the stories of the other three?

 

[Winged Scapula]

What a malignant freak. It really scares me to think that I'm probably gonna have bosses like this some day.

You're not. That was a long time ago and while there is still some bad behavior it is almost been entirely eliminated in the operating room.

 

[Buzz Me]

The days of blatant malignancy as described above are pretty much over.

Having said that, I've seen some crazy behavior in the OR that wouldn't even be tolerated at most Gen Surg programs (I dealt with some pretty malignant attendings when I was a resident).

 

[ToldYouSo]

Are you a malpractice attorney looking for work?

XD

True story. One of the CTVS guys where I trained about 15 years ago was upset with the perfusionist tech during a case, complaining about the pressure being too high through the circuit. Eventually, he gets so irritated that he takes the cannula tubing off and squirts her with the pressurized blood right in the face, saying something like "See, I told you the pressure was too high". He was "retired" within 48 hours and began a new career in non-operative consulting work.


Come to think of it, that was one of 4 department chiefs I watched go down in flames in front of me for absolutely insane behavior or outrageous non-PC comments.

Thanks. I don't know what's worse, the story or the fact that its only 1 of 4!

 

[Pir8DeacDoc]

IIRC dr Oliver trained at one of the more malignant places. Old school.

 

[droliver]

XD
Thanks. I don't know what's worse, the story or the fact that its only 1 of 4!

Funny thing is that that CT surgeon was actually a relatively normal guy who just had a moment of insanity. The only other thing i can think of close to that story i can think of is an orthopedic surgeon who got frustrated with a nurse and stapled her in the forehead with a skin stapler during a case which happened here in town where I practice 5 Yeats ago.

Most of the people I saw get into trouble had to do with verbal abuse of nurses or decidedly non PC comments made in front of large groups of people about women or minorities. One of the orthopedic chiefs got into trouble for billing Medicare for staffing cases while he was in the state capital (where he was Lt. governor). They presented him with news videos compared with hospital record time stamps from surgery to prove he could not have been there.

 

[ToldYouSo]

Is this thread cross-listed in pre-allo? I feel like this should be getting a lot more traffic

 

[Buzz Me]

I don't believe it is.

 

[Winged Scapula]

Is this thread cross-listed in pre-allo? I feel like this should be getting a lot more traffic

Cross"listing" or posting is a TOS violation.

I had suggested moving it to Pre-Allo (where the other threads of its ilk are housed) but was waiting for permission from the OP.

 

[Buzz Me]

Cross"listing" or posting is a TOS violation.

I had suggested moving it to Pre-Allo (where the other threads of its ilk are housed) but was waiting for permission from the OP.

Oh! Well you always have my permission to do whatever you'd like. But you knew that.

 

[PennDippody]

1) Are you looking to work mostly in a community setting or academic setting, or some combination thereof and why?


2) What are your thoughts on the da vinci robot regarding future CT applications? (I noticed we tend to be significantly faster without it for most any type of surgeries at my hospital)

3) Could you compare the 2yr vs 3yr fellowships and why you chose your route?

 

[Coffee Machine]

7 years?! I thought GS was 5?

There are many programs that have two required years for research.

 

[roinom]

If a MS asked you which 3 or 5 scientific papers he/she should read prior to rotatingn at your department, which ones would that be?

 

[BioBeaver]

What's the most interested case you've had so far? And what's the average number of hours you're scrubbed in for a CT surgery?

 

[Winged Scapula]

7 years?! I thought GS was 5?

There are many programs that have two required years for research.

And others for which it is "highly suggested". Furthernore, there are competitive fellowships for which it is essential. 5 years is the minimum number of years to be board eligible in General Surgery.

 

[punkedoutriffs]

I heard on the news that they've recently successfully grown a human heart from stem cells. How far along is this technology from being clinically relevant?

 

[fishsticks2629]

1. When applying to fellowships for CT, what do program directors look for? Is there a Step 1 equivalent for applying to surgical fellowships?
Thanks!

 

[Cuongoff]

What kind of research do you do (if you do research)?

 

[mcloaf]

Is there a light at the end of the tunnel hours/workload wise, or do most attendings continue to push 80 hrs/wk once residency/fellowship is over? I realize that this is probably highly variable, but some surgical specialties (nsurg) seem to be more known for extreme hours even after training is finished.

 

[Fakhter]

What do you think of Emergency Medicine? Do you honestly believe ER docs are inferior compared to surgeons?

 

[mcloaf]

What do you think of Emergency Medicine? Do you honestly believe ER docs are inferior compared to surgeons?

This is the second surgical AMA thread in which you've posted this...

 

[487806]

This is the second surgical AMA thread in which you've posted this...

Fakhter wanted to get different perspectives in this matter.

 

[Winged Scapula]

What do you think of Emergency Medicine? Do you honestly believe ER docs are inferior compared to surgeons?

This sort of stuff is Pre-Med fantasy.

Just like MD vs DO arguments you guys constantly bring up, out in the "real world" inter-specialty rivalries are tongue in cheek. No one thinks the other "inferior". We are all here to do a job. Respect is based on the individual physician, not the degree and certainly not the chosen specialty.

 

[487806]

This sort of stuff is Pre-Med fantasy.

Just like MD vs DO arguments you guys constantly bring up, out in the "real world" inter-specialty rivalries are tongue in cheek. No one thinks the other "inferior". We are all here to do a job. Respect is based on the individual physician, not the degree and certainly not the chosen specialty.

I thought that response was implied in my sarcastic post... Guess not.

 

[Fakhter]

This sort of stuff is Pre-Med fantasy.

Just like MD vs DO arguments you guys constantly bring up, out in the "real world" inter-specialty rivalries are tongue in cheek. No one thinks the other "inferior". We are all here to do a job. Respect is based on the individual physician, not the degree and certainly not the chosen specialty.

I wouldn't ask this question if the general surgeon who is now in family practice didn't tell me what he told me. First of all he is a highly respected doctor and has the credentials to prove it. He asked me what I wan interested in and I told him Emergency Medicine. He bluntly stated, "they're not real doctors they just patch up a problem for a real doctor to fix". This statement shocked me at first because there is no way this could be true, right?


I'm not trying to to derail the thread I just wanted his opinion

 

[487806]

I wouldn't ask this question if the general surgeon who is now in family practice didn't tell me what he told me. First of all he is a highly respected doctor and has the credentials to prove it. He asked me what I wan interested in and I told him Emergency Medicine. He bluntly stated, "they're not real doctors they just patch up a problem for a real doctor to fix". This statement shocked me at first because there is no way this could be true, right?


I'm not trying to to derail the thread I just wanted his opinion

He's probably outdated. Today's world, doctors are too busy focusing on their work rather than having a superiority complex over their colleagues.

 

[Winged Scapula]

I wouldn't ask this question if the general surgeon who is now in family practice didn't tell me what he told me. First of all he is a highly respected doctor and has the credentials to prove it. He asked me what I wan interested in and I told him Emergency Medicine. He bluntly stated, "they're not real doctors they just patch up a problem for a real doctor to fix". This statement shocked me at first because there is no way this could be true, right?


I'm not trying to to derail the thread I just wanted his opinion

He also likely trained at a time when there was no official training in EM or board, when the ED was staffed with variable qualified physicians.

EM has come a long way. It sounds like he hasn't. His attitude is not a common one, at least outside of academia.

 

[Heday]

He also likely trained at a time when there was no official training in EM or board, when the ED was staffed with variable qualified physicians.

EM has come a long way. It sounds like he hasn't. His attitude is not a common one, at least outside of academia.

You know, I was shadowing a transplant surgery and the throughout the whole thing, the attendings constantly bashed (in a fun and light-hearted way) "clipboard" and pathologist. Do doctors, surgeons in particular, really dislike admins?

 

[mcloaf]

You know, I was shadowing a transplant surgery and the throughout the whole thing, the attendings constantly bashed (in a fun and light-hearted way) "clipboard" and pathologist. Do doctors, surgeons in particular, really dislike admins?

Does anybody like admins?

 

[Heday]

1] You know, I've always wanted to do surgery, in particular CT/transplant. Because of my life situation, I've had to delay med school... I've already wasted three years of my life, although I'm highly qualified. I want to have a family, and have been thinking IM might be something better for that... I come from humble beginnings (unfortunately, I'm still in my beginnings); money shouldn't play a role in choosing a specialty, but the older I get, the harder it seems that surgery is a possibility (other than gen). Do you have any words of advice? (Apart from the do what you love, because the older I get, the more sacrifices I have to make)

2] Any procedure that you hate? Feel like a drag?

3] Any specialties come close to CT?

4] Can you comment on your experiences with a transplant (heart and/or lung)? What you liked, what you didn't, that feeling when the lifeless organ flushes pink...

 

[Heday]

Does anybody like admins?

touche

 

[iforget2]

Sorry if this has already been answered, but when you say you work 100 hours a week does this include break times, time to do paperwork, or time to eat ? Or is it just pure work for 100 hours?

 

[Untraditional]

This sort of stuff is Pre-Med fantasy.

Just like MD vs DO arguments you guys constantly bring up, out in the "real world" inter-specialty rivalries are tongue in cheek. No one thinks the other "inferior". We are all here to do a job. Respect is based on the individual physician, not the degree and certainly not the chosen specialty.

I was just reading a CRNA forum where nurses declared MDs "lazy", "the enemy", and "the chief obstacle to that sweet paycheck" so I guess this applies only to interprofessional relationships among MDs and DOs?

 

[Winged Scapula]

You know, I was shadowing a transplant surgery and the throughout the whole thing, the attendings constantly bashed (in a fun and light-hearted way) "clipboard" and pathologist. Do doctors, surgeons in particular, really dislike admins?

Does anybody like admins?

Exactly.

Sorry if this has already been answered, but when you say you work 100 hours a week does this include break times, time to do paperwork, or time to eat ? Or is it just pure work for 100 hours?

Not the OP, but I worked in excess of 100 hrs/week during training and feel qualified to answer. Some days you will not have much time to eat or catch a breath but on others, you may find yourself waiting in the OR lounge for a case to go and you can check FB or SDN. There is clearly a lot more paperwork than ever; some of it you can delegate to junior residents or midlevel providers (if available) and some you simply have to do yourself. Some of my longest weeks during residency weren't filled with "doing stuff" but rather waiting for the Chief resident to come back in or get out of the OR so we could round. Then again, the longest straight "shift" (3 days in the hospital) was filled with one Vascular trauma after another and very little sitting around time.

is there a list?

No. Not a formal one that I am aware of.

I was just reading a CRNA forum where nurses declared MDs "lazy", "the enemy", and "the chief obstacle to that sweet paycheck" so I guess this applies only to interprofessional relationships among MDs and DOs?

Ugh. Thank goodness I am somewhat immune to that but really, the claims of "lazy" just chap my hide. After all, which one of those practitioners wants to have the same responsibility and salary as a physician but doesn't want to spend the time doing the same training? IMHO, nurses who call physicians lazy have never spent a day in an academic hospital and watched residents work excessive hours all the while they go home after their shift (and when they return we're still there).

 

[BioBeaver]

I was just reading a CRNA forum where nurses declared MDs "lazy", "the enemy", and "the chief obstacle to that sweet paycheck" so I guess this applies only to interprofessional relationships among MDs and DOs?

Nurses.... SHAKE MY HEAD

 

[mcloaf]

Nurses.... SHAKE MY HEAD

Premed in high school? Check.

Already bashing nurses? Check.

 

[Buzz Me]

1) Are you looking to work mostly in a community setting or academic setting, or some combination thereof and why?


2) What are your thoughts on the da vinci robot regarding future CT applications? (I noticed we tend to be significantly faster without it for most any type of surgeries at my hospital)

3) Could you compare the 2yr vs 3yr fellowships and why you chose your route?

(1) Academics - have always liked the intellectual atmosphere, conferences, M&M, etc. Like research (though clinical, not basic science). Love to teach and want to work with med students, residents and fellows.

(2) Unfortunately as the public becomes more aware of the da Vinci technology they're going to request it (or at least mention it) in the office. In cardiac it may help with mitral valve repairs though myocardial protection (cardioplegia) is not as good and you don't have to make that much bigger of an incision doing the "traditional" minimally invasive mitral valve repair via a R thoracotomy. For thoracic, it can develop limit incision size in mediastinal mass resections like for thymectomies in younger patients.

(3) To stay in academics, most people need a "niche" (I think I described this a little in an earlier post). After two years it's often hard to be ready to be a cardiac attending on your own, and you won't really have much of a selling point to distinguish yourself from other new graduates if you're looking into an academic career. Many people then go on to do another year-long "superfellowship," whether it be in advanced aortic surgery, endovascular techniques, transplant, VATS, robotics, etc. 3-year fellowships have this built it (we have lots of elective time). That's my humble opinion.

7 years?! I thought GS was 5?

I did two years of (optional) research.

If a MS asked you which 3 or 5 scientific papers he/she should read prior to rotatingn at your department, which ones would that be?

A medical student rotating through CT Surg? Not sure if papers are what you should be reading - more like one of the basic handbooks (Bojar) or brief textbooks (Hopkins). A big paper that we discuss now is the SYNTAX trial from NEJM looking at PCI vs. CABG. On the thoracic side, the CT screening trial is big. But there are so many out there, more for senior resident/fellow level folks.

 

[Buzz Me]

What's the most interested case you've had so far? And what's the average number of hours you're scrubbed in for a CT surgery?

Have done some huge cardiac cases (thoracoabdominal aneurysms, combined AVR/MVR/TVR/CABG [aortic/mitral/tricuspid valve replacement + coronary artery bypass]) and some very cool thoracic cases (robotic lobectomies and thymectomies). I really like the esophagus, though, and love the Ivor Lewis esophagectomies.

Most cases, skin to skin, in cardiac last around 3-4 hours, and more like 1.5-2.5 in thoracic.

I heard on the news that they've recently successfully grown a human heart from stem cells. How far along is this technology from being clinically relevant?

Pretty far away on the horizon. This technology (bioengineering) isn't clinically feasible yet, at least not on a large scale.

1. When applying to fellowships for CT, what do program directors look for? Is there a Step 1 equivalent for applying to surgical fellowships?

During your Gen Surg residency you'll take the yearly ABSITE, or the annual in-service that all Gen Surg residents across the country take. They look at your percentiles here...as well as any research you may have done. A big part of your app is your LORs.

What kind of research do you do (if you do research)?

At my program we're all required to do research. I do clinical research - looking at outcomes data, institutional experience in novel techniques, etc.