have not seen anyone post about this, perhaps because there are only a few of us. was wondering if any of you were out there. maybe we can start a discussion. difficult times, since we are the banner year for the growing pains of this transition.
I'm in the integrated residency applicant pool with you.
The novelty of these programs is part of what I like though -- they are newly planned and likely not set in stone. I think this gives us the opportunity to make these malleable programs better based on our input. Could be fun...
-BTD
For the two of you who are applying, did you do away rotations at any of the program sites? I was considering contacting them after the interview season is over to set something up. Also, the charting outcomes document does not really contain any statistics except number of applicants last year. Do you have any idea what average USMLE scores are or whether they put heavy emphasis on AOA or publications?
Question to anyone with an answer:
Do these integrated thoracic programs offer a cardiac/cardio-vascular track? or do they all intensify their training towards thoracic surgery?
most of these integrated programs are actually unofficially cardiovascular track, as opposed to thoracic track. there is plenty of contention about whether or not this training paradigm is appropriate for cardiovascular surgery as is, and even more controversy that they are appropriate for those interested in general thoracic surgery. the thinking being that general surgery is more directly applicable to thoracic surgery, given the increasing MIS component of general surgery and its direct relation to several of the thorascopic procedures in general thoracic.
be very very cautious about these integrated programs.
Most trainees want to get a job doing mostly cardiac, however the reality is that almost nobody gets such a dream job right away. (unless you take a crappy academic job with poor working conditions and low pay)
with most decent jobs in private practice avail today, you can expect to do all the crap thoracic cases and you better be able to do peripheral vascular.
Hell, I even know of jobs that require trauma/general surgery call. But the good thing is you get to stop doing those cases and move up the totem pole as time goes on.
doing an integrated program will really put you at a disadvantage in the job market trying to compete with a traditional general-CV surgery candidate who can "do it all" and there are plenty of unemployed and underemployed candidates out there
Current practitioners double boarded are actually allowing ABS certification to "lapse" and just maintaining ABTS certification.
I think I read somewhere that the population of CT surgeons is currently predominantly over age 65.... Again, a significant shortfall of available Cardiac or Thor surgeons is easily anticipated. The marked drop in applicant numbers, those that apply and quit, and the rev up integrated system (which takes 6 years to graduate someone) all will have an impact. There will be a transition... But, community folks are more and more moving to formally trained subspecialists including vascular surgeons, etc... The leapfrog and other such measures pushing for minimum numbers in procedures, average GSurge residents "doing" less then 3 lobectomies during training, limited ABS GSurge requirements for GenThor/Card experience, liability issues, etc.... ALL will change the landscape and scopes of practice over the next decade, IMHO.Although I admit my experience is limited and as ESU_MD stated, the cardiac surgeons I've met who fall in this category are academic physicians doing CABGs and valve repairs day in, day out. I'd be surprised if this was the case for a number non-academic surgeons; As I know a couple ex-academic, private practice thoracic guys who do general surgery cases on a regular basis.
Ok, so here is what I found:Average age of CT surgeons is somewhere in late 50's (57 to be exact, if i am not mistaken), not 65. So the shortage is coming, but not as soon as one would hope. As far as shortages are concerned, the purported shortage of general surgeons, that everyone talks about, was apparently there ten-twelve years ago as well, according to some of our attendings, who were hearing the same thing back then.
I think, in general, the situation with jobs in CTS is somewhat better now then 3-4 years ago, but you are still not likely to be picking the job - rather the job would pick you, for few years.
This is always an interesting, though IMHO, hollow perspective.... What if at the end of GSurgery you decide you don't like it after 5 yrs, how about OB/Gyn, NeuroSurge, Ortho, ENT... integrated plastics, etc.... 7yrs Neurosurgery, 6yrs CT, 5yrs GSurge, 4yrs OB/Gyn, 4yrs Uro, etc.... That's life.... I guess really unfair for neuro...the issue here is - how many of people here at the beginning of their med school knew exactly what they wanted to do?...If you spent six years as a CT surgeon, only to decide thats not what you want...
that being said, this is how the rest of the world trains their CT surgeons.
This is always an interesting, though IMHO, hollow perspective.... What if at the end of GSurgery you decide you don't like it after 5 yrs, how about OB/Gyn, NeuroSurge, Ortho, ENT... integrated plastics, etc.... 7yrs Neurosurgery, 6yrs CT, 5yrs GSurge, 4yrs OB/Gyn, 4yrs Uro, etc.... That's life.... I guess really unfair for neuro...
Ok, but you can have that in Neurosurgery. You can have that in traditional 5+2 paths.... I just don't see that as a rational to mandate 5 years GSurgery. As noted numerous other countries run it integrated. Obviously, we aren't numerous other countries, we are USA. But, there seems some magic fear in the CT world that seems there is less attrition and better program by beeting someone for 5yrs in GSurgery... to finally reach the heart. Every program has attrition. There are plenty of "traditional" programs that have a "1st yr" fellow with no "senior/2ndyr" because of attrition.....The real issue though is attrition. Most of these integrated programs have what, 1 resident per year? What happens if 4 years down the line your senior CT resident decides it's not for him/her? Then you have a big hole to fill in your residency...
When i am done with my training, i want to do hearts, chest and maybe some carotids and aortas (abdominal).
General thoracic surgery nowadays pays better, and has a better lifestyle for the most part. as far as people doing chest cases to pay bills - i don't think you can speak so categorically. Some do, i am sure, but there are others who do, because, that's what they are trained at, and some simply enjoy it.
My GSurgery training program provided almost NO cardiac surgery experience.... Those classes after my year actually had no cardiac rotation, just GenThor rotations... I have heard from others that this lack of cardiac surgery in GSurgery training was a growing trend....general surgery residency...still provides a significant cardiac surgery experience...
Agreed. The fall of interest in CT has been an issue resulting from CT attendings being unwilling to actually train their GSurgery fully trained fellows. The reality is, some retirements are in order, new, young attendings will have to take a large role in the training process....I think that the real issue lies with the training programs themselves. Are these CT attendings who are used to having fully trained general surgeons...going to be willing to train residents from the ground up? ...is going to be a painful transition for those CT attendings...
My GSurgery training program provided almost NO cardiac surgery experience.... Those classes after my year actually had no cardiac rotation, just GenThor rotations... I have heard from others that this lack of cardiac surgery in GSurgery training was a growing trend.
agreed....I actually think that a cardiac experience is useful if only for the valuable ct-icu experience that it provides...
Sorry you didn't get much cardiac exposure in your residency. I think it is valuable and would rather be doing that than more months of trauma.
My I have heard from others that this lack of cardiac surgery in GSurgery training was a growing trend.
I think this is true. In most places- cardiac service is pretty segregated. their own OR's, instruments, nurses, etc.. add in a 4th yr general surgery resident to the mix: as a 4, you start to feel pretty comfortable with doing OR stuff, then you go to CT where you dont understand any anatomy at first, and you can even have attendings telling you to step aside so their PA can assist them while you 2nd, or even 3rd assist!! It is a setup for disaster, and sure to make all but the most determined complain to their PD about the bad experience on the cardiac service. alas- no more cardiac rotations.
probably the best spot for a 4th yr experience is with a dedicated thoracic service- if your place has one. Not necessarily with the junior cardiac garbage man stuck with doing the lungs (doesnt make for a good teaching experience)
Another thing is I wish I was able to spend time as a pgy-2 taking care of cardiac postops. you havent seen a sick patient until you have have sat bedside with an unstable postop heart.
IMHO......I think in some ways integrating CT surgery is an attempt to attract candidates who haven't had to face the reality of what it means to be a CT surgeon...
I think this is true. In most places- cardiac service is pretty segregated. their own OR's, instruments, nurses, etc.. add in a 4th yr general surgery resident to the mix: as a 4, you start to feel pretty comfortable with doing OR stuff, then you go to CT where you dont understand any anatomy at first, and you can even have attendings telling you to step aside so their PA can assist them while you 2nd, or even 3rd assist!! It is a setup for disaster, and sure to make all but the most determined complain to their PD about the bad experience on the cardiac service. alas- no more cardiac rotations.
probably the best spot for a 4th yr experience is with a dedicated thoracic service- if your place has one. Not necessarily with the junior cardiac garbage man stuck with doing the lungs (doesnt make for a good teaching experience)
Another thing is I wish I was able to spend time as a pgy-2 taking care of cardiac postops. you havent seen a sick patient until you have have sat bedside with an unstable postop heart.
Any word on the match? Anyone rank these programs or hear of anyone matching into them? Godspeed.