Hepatobiliary fellowships

[Scrubbed In]

Does anyone know the best programs for Hepato-Pancreato-Biliary fellowship?

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[karatekid]

John Hopkins, work for the "god" himself in the field, Dr. John Cameron.

 

[SocialistMD]

Look on the fellowship council's website. It lists the faculty, the cases done, the publications generated and % clinical/research activity.

 

[imtiaz]

ive decided that i want to be an HPB surgeon, whatever that means. however, the more i investigate, the more i realize that there really arent a whole lot of options available. according to www.fellowshipcouncil.org theres only 12 programs in the united states for this field (accredited, at least). ive even heard that in order to land one of those spots, you essentially need to do a "super-fellowship" meaning do a surg-onc fellowship then try to get HPB surgery.

i know theres probably people out there that know a lot more about this than me, and id love to hear some of their comments. im hearing mixed information. some of my attendings havent been in the fellowship scene in a while and things are changing somewhat. anybody here recently try for HPB?

from what im seeing on the fellowship council website, there were 50 applicants for about 12-16 spots? that doesnt sound THAT bad.

 

[blue2000]

ive decided that i want to be an HPB surgeon, whatever that means. however, the more i investigate, the more i realize that there really arent a whole lot of options available. according to www.fellowshipcouncil.org theres only 12 programs in the united states for this field (accredited, at least). ive even heard that in order to land one of those spots, you essentially need to do a "super-fellowship" meaning do a surg-onc fellowship then try to get HPB surgery.

i know theres probably people out there that know a lot more about this than me, and id love to hear some of their comments. im hearing mixed information. some of my attendings havent been in the fellowship scene in a while and things are changing somewhat. anybody here recently try for HPB?

from what im seeing on the fellowship council website, there were 50 applicants for about 12-16 spots? that doesnt sound THAT bad.

Two of our new faculty are HPB guys who did surg onc at MSK and landed jobs at a big academic program. One is really just doing liver/cholangio and the other is just doing pancreas. They didn' t do the super fellowship, just did surg onc in the right place with the right people.

 

[OFwhipple]

edited

 

[imtiaz]

Indiana University

Dr. Lillemoe, Dr. Pitt, Dr. Schmidt, Dr. Nakeeb, and etc..

i dunno, maybe im not being clear in what im asking. so ill try to rephrase. is there anyone who has recently applied for HPB surgery that can comment on the process and what it was like? im already familiar with the field, ive actually met dr lillemoe.

 

[Amgen1]

There have traditionally been about 3 ways to get into HPB:
1. Transplant
2. Surg onc
3. HPB fellowship

The opinion of which is the best route will depend on who you talk to. Transplant surgeons will argue that they are more comfortable with the anatomy than the other surgeons. The surg onc surgeons will argue that they more completely understand the multidisciplinary approach and know more about he med onc therapies. The HPB trained doc will argue that the in surg onc training you do 18 months of clinical of which prob only 3-4 are HPB. They argue that all of the training in breast, melanoma, etc distracts you from your training as an HPB surgeon

This year the HPB application process was combined with the surgical oncology application process. You could interview at both surg onc and HPB programs, and then rank both types of programs.
ie
1. MD Anderson
2. Wash U HPB
3. MSKCC, etc

Now all of that being said, many of the surg onc programs now recognize that people want to focus on a specific organ system. Several of the programs such as UPitt, Johns Hopkins, etc are starting to "track" their surg onc fellows. Such that if you match to the UPitt or JHU surg onc/ HPB track you do one full year of general surg onc and the second full year of HPB.

These tracks have become very popular b/c you get the benefit of surg onc training but you are guaranteed a full year of high volume HPB cases. This has several benefits:
1. you are able to take a general surg onc job if there are not HPB jobs available
2. you have an HPB area of focus that you can take as a bargaining chip to your next job

Keep in mind that there are a limited number of HPB job openings each year. You may have to be flexible and be open to doing general surg onc or even general surgery depending on where you go to practice

 

[Smoke This]

IMHO Toronto is by far the best HPB fellowship, and also the most competitive (~250 applicants, 4 interviewed, 1 fellow/year). The fellows get autonomy in the OR like you'd never find in the US and see an immense volume. I didn't personally apply there but one of our chiefs this year landed the spot and that's what he has to say.

 

[imtiaz]

awesome. thats more of what i was looking for.

ive heard similar things. the problem is surgical oncology is a very competitive fellowship. in contrast, transplant isnt very competitive. i originally started out intern year wanting to do transplant, but then realized that i was more interested in the HPB side of things.

it puts one in a weird dilemma. on the one hand, you have an option to apply for a very competitive fellowship end up possibly not matching and be screwed. or apply for a not so competitive fellowship, train hard for 2 yrs in an area that you probably wont end up practicing in, only to train for another 2 yrs in the real field you want.

ideally, (and i know someone in my program whos done this) id like to just go straight HPB out of residency. well see what happens though.

 

[droliver]

Gary Vitale at the University of Louisville has a kind of unique HPB fellowship among surgery programs in that it's very heavy on endoscopic management (ERCP) and treats a lot of patients with chronic pancreatic disease. He gets a lot of tertiary referrals for pancreatitis (and related sequella) and CBD injuries. If you're infatuated with commando surgical procedures for adenoCA or hepatocellualr CA and nothing else, it may not be your bag, but in practice there are a lot more people needing that kind of HPB work then needing whipples & liver trisegmentectomies.


From UofL's website (http://louisvillesurgery.com/ResidencyFellow.html)
Interventional Endoscopy and Therapeutic ERCP Fellowship - This one-year fellowship allows the fellow to gain extensive experience in ERCP-related procedures involving both the biliary and pancreatic ductal systems. Flexible endoscopy including EGD and colonoscopy is included in the fellowship. Fellows also gain experience in complex pancreatic and biliary tract surgery under the direction of the surgical faculty. Research related to the clinical activities is ongoing and the fellow is expected to participate.

For additional information or for assistance with applications please contact:
Judy Slaughter, Interventional Endoscopy and Therapeutic ERCP Fellowship Coordinator
University of Louisville
Department of Surgery
550 S. Jackson St.
Louisville, Kentucky 40202
502-629-2278
Judy.Slaughter@nortonhealthcare. org

Or faculty coordinator:
Dr. Gary Vitale
University of Louisville
Department of Surgery
550 S. Jackson St.
Louisville, Kentucky 40202
502- 629-2278
[email protected]

 

[SLUser11]

IMHO Toronto is by far the best HPB fellowship, and also the most competitive (~250 applicants, 4 interviewed, 1 fellow/year). The fellows get autonomy in the OR like you'd never find in the US and see an immense volume. I didn't personally apply there but one of our chiefs this year landed the spot and that's what he has to say.

Nice to hear from you. I feel like you haven't posted for 1-2 years, and I thought you changed specialties.

On a similar note, I haven't seen any posts from Blade in a really long time....

 

[DO_Surgeon]

On a similar note, I haven't seen any posts from Blade in a really long time....[/QUOTE]

Been wondering that myself....

 

[Winged Scapula]

On a similar note, I haven't seen any posts from Blade in a really long time....

Been wondering that myself....

Unfortunately, he received some flak from his faculty about his involvement here and had to retire his account.

 

[IndianPrince]

Hello Dear Friends. I am starting to apply for fellowships this year. Kindly advice me how many programmes are there apart from the 12 listed which can give me experience in HPB.........i mean there is no guarentee we can get a fellowship in first attemp rite ?

 

[toxic-megacolon]

Anyone know a link to where next year's HPB fellows matched?

 

[amini23]

How competitive are hepatobiliary fellowships? There are only 15 fellowships in US and Canada on Fellowshipcouncil.org? How many applicants apply?

 

[HPBsurg]

Tough question and depends on what you are looking for. If I had to rank some of the best programs I would do the following:

MSK (HPB not surg onc) - 1 spot
Mayo Clinic - 1 spot
Washington Univ St. Louis - 1 spot
MD Anderson (HPB not surg onc) - 1 spot
Toronto - 1 spot

All of these programs are extremely competitive. In years past most of the people who got these spots were doing a superfellowship (i.e. already did Surg onc, MIS, transplant etc).

 

[Sarr]

I really would like some input on the HPB fellowship matching process.

Surg-onc is known to be a very competitive field, and in the pastt HPB fellowships were regarded as fairly easy to get accepted to. There were less spots (12 programs, now it is more, 19) and even one user as far as I can remember (WS I think) commented that "if you can breathe, you can get in (or something like that) ".

I know that HPB is harder than Transplant, but has it really gotten so hard to get into ?

Hopkins requires the applicants to be Halsted grads or MSK gives preference to residents who have completed 1 year of surg-onc, but many programs acept IMG's w/o us training (foreign surgery boarded). If it was so competitive would this be the case ? and what are the thoughts of people who recently applied or know someone who has....

Thank you

 

[ajlmd]

Would echo what HPBsurg said... a friend of mine who is an extremely strong candidate applied during residency a year ago and did not match (fortunately, he ended up getting a surg onc spot.) His impression was also that most people that matched were those who were already doing surg onc, so essentially it is like a super fellowship.

 

[coldsteel77]

Does anyone know where to find out where the 'nonaccredited' (i.e. not in the fellowship council match) HPB fellowships are? Thanks.

 

[jacksonphonic]

I matched this year into HPB and can shed some light into this. I chose HPB because I wanted to do liver and pancreas surgery first and foremost. I was turned off by transplant because they do not do much pancreas work. I did not like surg onc because I did not want to do melanoma, breast, endocrine, etc. Also, surg onc did not do any benign, i.e. chronic pancreatitis or acute pancreatitis surgery which I want to have as an HPB surgeon. I interviewed from general surgery residency, and did HPB research during my program's research year. HPB is very competitive, but I think it is the best training now if you want to do true HPB surgery.

 

[droliver]

jacksonphonic,

how much ERCP are you going to be doing?

 

[jacksonphonic]

jacksonphonic,

how much ERCP are you going to be doing?

There is no definite ERCP rotation, but I can rotate with the GI service for ERCP and EUS if I want to. I dont have a strong desire to do so, so I probably wont.

 

[thedrjojo]

I matched this year into HPB and can shed some light into this. I chose HPB because I wanted to do liver and pancreas surgery first and foremost. I was turned off by transplant because they do not do much pancreas work. I did not like surg onc because I did not want to do melanoma, breast, endocrine, etc. Also, surg onc did not do any benign, i.e. chronic pancreatitis or acute pancreatitis surgery which I want to have as an HPB surgeon. I interviewed from general surgery residency, and did HPB research during my program's research year. HPB is very competitive, but I think it is the best training now if you want to do true HPB surgery.

thanks for the insight. My goal is liver and pancreas surgery first and foremost as well, but am leaning towards transplant because the penultimate liver surgery is the transplant, and by doing HPB, you exclude a major limb of liver surgery, but agree that the pancreatic surgery is primarily limited to whipples/total pancs and less of the the benign stuff. I haven't ruled out HPB, and my research, while transplant, is liver based, and I'm working with our surg onc guy as well and going to have some pure HPB stuff as well, so i won't have burned my surg onc/hpb bridge by putting all my eggs in the transplant basket. Another reason i might be leaning more towards transplant is competitive level... i know it sounds like a cop out, but realistically speaking, while I think i could be competitive (getting mid 80's on my absites, going to have several first author pubs, got an MPH during residency, etc etc), the fact that i'm geographically limited means if I want to stay in the NE, i have like 3-4 onc programs, 3-4 HPB programs, or like 15 transplant programs legitimately to pursue... we shall see what I think closer to app time (2.5 years from now)

 

[Apollyon]

thanks for the insight. My goal is liver and pancreas surgery first and foremost as well, but am leaning towards transplant because the penultimate liver surgery is the transplant,

Then what is the ultimate? If OLT is penultimate, what is antepenultimate? What is preantepenultimate?

(I am just teasing with you about your word choice.)

 

[thedrjojo]

Then what is the ultimate? If OLT is penultimate, what is antepenultimate? What is preantepenultimate?

(I am just teasing with you about your word choice.)

lol... yeah, that was a poor word choice... meant it to be ultimate... although a tri-sectorectomy is also a major wack, and the patient might be just as jacked up post-op as they are post-op of an OLT... and require as much if not more technical skill (cept no hepatic artery anastomosis to worry about i suppose, which seems to the the most critical portion of the whole damn case... the reason that the attendings double scrub at my place (no fellows, so PGY4 is doing the rest of the case with an attending)...

 

[droliver]

There is no definite ERCP rotation, but I can rotate with the GI service for ERCP and EUS if I want to. I dont have a strong desire to do so, so I probably wont.

Really? That's like a breast surgeon saying that don't want to learn image guided biopsies and is an obsolete model for training for those organ systems. It will REALLY,REALLY limit the kind of practice you can develop and the places you can work. I would find it hard to believe a program could be accredited in HPB without heavy ERCP #'s being required. I suspect some of these fellowships at University programs run into some of the problems the breast fellowships have run into in that the management of the disease is split up traditionally among departments (surgery, radiology, GI) and there are political issues they run into about trying to stay current with where the field is heading (image guided and endoscopic treatment).

You really can't be a bile duct or pancreas specialist without doing ERCP as there just aren't that many cases requiring formal surgery and there are a lot of chronic benign disease patients floating around. While you may dread those patients as a resident, the benign disease treatment and endoscopy/ERCP is what actually churns the wheel for your business model.

There are only a very few places in academics with the volume where you can sit back and let these kinds of traditional surgical cases come to you with no interventional endoscopy skills. OTOH, if you become skilled at ERCP with HPB surgical training you can build a pretty busy community practice in many locations which might otherwise be saturated with surgeons as you can handle the things they typically have to refer out (CBD injury, strictures, pancreatitis issues, etc...). If you let it be known you will treat those patients, you will have patients falling out of trees from outlying areas as there are a lot of them around.

 

[ThoracicGuy]

The HBP program at my gen surg training location didn't teach ERCP at all. As a surgeon, we wouldn't even be able to do an ERCP - it was all done by the GI guys. I wonder how easy it would be to get ERCP privileges when there are GI docs at the same hospital.

 

[Winged Scapula]

The HBP program at my gen surg training location didn't teach ERCP at all. As a surgeon, we wouldn't even be able to do an ERCP - it was all done by the GI guys. I wonder how easy it would be to get ERCP privileges when there are GI docs at the same hospital.

Ours didn't either, but there ARE opportunities out there which is what droliver is highlighting.

I've worked with General Surgeons who were trained in ERCP and there was plenty of business for them. That isn't to say that there aren't political landmines about but if the opportunity to train presents itself, the fellow should take it because it can only serve to broaden one's skills and marketability.

In particular, I and many others have found it difficult to find a gastroenterologist who will perform ERCP on patients with reconfigured GI systems - most notably RNYGBP. Even in the very large city in which I live, when I was asked to help with a colleague who needed one, it was very difficult to find someone willing to do so. This would seem to be the perfect opportunity: a surgeon who is familiar with the anatomy, doing the ERCPs, where GI isn't willing to do so.

 

[ThoracicGuy]

Ours didn't either, but there ARE opportunities out there which is what droliver is highlighting.

I've worked with General Surgeons who were trained in ERCP and there was plenty of business for them. That isn't to say that there aren't political landmines about but if the opportunity to train presents itself, the fellow should take it because it can only serve to broaden one's skills and marketability.

In particular, I and many others have found it difficult to find a gastroenterologist who will perform ERCP on patients with reconfigured GI systems - most notably RNYGBP. Even in the very large city in which I live, when I was asked to help with a colleague who needed one, it was very difficult to find someone willing to do so. This would seem to be the perfect opportunity: a surgeon who is familiar with the anatomy, doing the ERCPs, where GI isn't willing to do so.

I do agree. As many skills as you can have, the better it is. In my job I'll likely be doing alot of interventional bronchoscopy as there are no pulmonologists that are doing it and all those patients get sent to the big hospitals nearby. For me, the political landmines are small. For my GS training program, the political landmines there would be huge... but then they were a big center for ERCP as it was.

 

[Gentle]

Anyone applying for HPB this year?

 

[ram006]

Yes

Brilliant response.

 

[Njsurgres]

I'm interviewing soon for hpb fellowships. Anyone out there on any advice on interviews?