Re: vascular surgery -
@Cyberdyne 101 ,
@RJGOP
Lifestyle in Vascular surgery has a big range like most specialties. It is not unheard of for a full time surgeon working 45-50 hours a week. Most of the private practice guys can get down to that level if, #1 its what they want, #2 they are in a large group, #3 they are established (5+ years into practice). For various reasons they tend not to. (no judgement, just my observation). The biggest reason is obviously money. The more active you are, the more you get compensated. The second big reason though is simply the nature of the pathology. We don't really 'cure' many people. There is a reason I can be away for 3 months at another hospital and come back and know 2/3rds of the patients on the list. Your access patients and your limb salvage patients are going to keep coming back over and over. There is a lot of business to go around if you stay in one place to get established.
Yes, the field has changed in the last 10 years dramatically and it is still rapidly evolving. And yes, our interventions are tending toward the less invasive and shorter in terms of average procedure length. But, overall, endovascular procedures are LESS durable than their open counterparts. Which means patients return sooner. At the same time, our medicine colleagues are keeping the vasculopaths alive longer and longer and so we are operating on older and older and sicker and sicker patients.
None of our surgeons at the main hospital (6) work less than 60 hours a week. At least one works 80-100. He also does ~20-25 access cases plus an additional 6-10 other cases per week and has correspondingly large clinics. Not everyone is as operatively busy, but between research, administrative, educational and clinical duties, they all work pretty damn hard. Our outlying hospitals that have 1 or 2 vascular surgeons are much more 'community' based and are less busy. I don't really have a great feel for how much they work. The biggest problem with the endovascular revolution is that a lot of different people are getting in on the action because reimbursement is good. (or better than non-procedural stuff at least). Interventional radiology, interventional cardiology, interventional nephrology etc. They also (IC and IN) control the referral networks, so you have to play really nice most of the time. But, for the most part, none of them work weekends or take care of their own complications. The reimbursement for managing those complications is usually lower than what they got paid for the index operation (given the amount of work that is required to deal with it).
It is next to impossible to be a "solo practitioner". I don't think its even possible these days. There aren't THAT many emergencies, even at a quaternary referral center like we are. But, when they hit, they hit. Everyone gets ruptured AAA and cold legs. But, we also get the large DVT/PE for catheter directed thrombolysis and aortic dissections that will go at night, no matter when they show up. A given week of night call for me would be 1 night off, 3 completely quiet nights, 2 nights with a single case or a complex management and then 1 night of pedal to the metal, gogogogogogo all night long. Mine last week was 4 aortic dissections, 2 PEs and a cold leg. Between those 7, we went to the OR with 3 patients and at one point were running 2 rooms between the attending, fellow and myself. Not everyone gets that (or would ever want that), but somebody has to do it.
Bunch of quick thoughts, just sorta rambled
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