Future of Cardiothoracic Surgery

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GAdoc

GAdoc

GAdoc
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First of all, I know there are many previous posts on this topic, so if this bores you, just keep browsing other threads and don't waste your time with this.

I start medical school this coming fall, so I'm at the start of the game. For those of you who are in clinical rotations, in residency, or practicing physicians your temptation will be to simply reply with "don't get your mind set on anything until you get to your third year of medical school". For the sake of argument, let's just assume I'm a fourth year with a 250+ Step 1 and am considering all residency options.

Realistically speaking, what is the future of cardiothoracic surgery? I've browsed all sorts of articles dealing with the subject. Most were written by older surgeons and I find the comments conflicting. Some suggest the field is all but dead, while others suggest it's only beginning to truly live. I'd love to get the opinions of some young doctors or medical students who are considering CT surgery as a career. Why pursue it? Why not interventional cardiology or electrophysiology? Where do you see the field in ten, twenty years? You get the idea. Thanks!
 
GAdoc said:
First of all, I know there are many previous posts on this topic, so if this bores you, just keep browsing other threads and don't waste your time with this.

I start medical school this coming fall, so I'm at the start of the game. For those of you who are in clinical rotations, in residency, or practicing physicians your temptation will be to simply reply with "don't get your mind set on anything until you get to your third year of medical school". For the sake of argument, let's just assume I'm a fourth year with a 250+ Step 1 and am considering all residency options.

Realistically speaking, what is the future of cardiothoracic surgery? I've browsed all sorts of articles dealing with the subject. Most were written by older surgeons and I find the comments conflicting. Some suggest the field is all but dead, while others suggest it's only beginning to truly live. I'd love to get the opinions of some young doctors or medical students who are considering CT surgery as a career. Why pursue it? Why not interventional cardiology or electrophysiology? Where do you see the field in ten, twenty years? You get the idea. Thanks!
Click to expand...


Hey buddy, i will be starting medical school next fall. I am infact quite interested in General surgery, more specifically in CT surgery. I have cousins and friends doing residencies in various fields and i hear that surgery itself is sort of a highly criticized residential field, it's hard to tell if any surgical field has a future considering the mixed opinions like you said you have gotten. But iam with you in pursuiting ct..infact i care less wat the heck this field is at this point. When i hit my rotations..i will know wat to do😉
 
i thought very seriously about doing a CT fellowship.
and ultimately decided no, after many conversations and much research on it...the chest is 'gods country' and so beautiful. but to me CT surgery didnt have the opportunites i wanted anymore.
just my opinion...
this is a pretty good editorial about the state of things...when it came out, it was pretty "talked about" at the STS conference. granted, its just another opinion.


http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-54.html
 
i too am interested/ was interested in CT surgery, as a MSIV here is what i have learned about the field

back in the day, CT surgeons did not protect their field and work hard to find new ways to do coronary bypasses, thus interventional cardiologist have developed and all but mastered non invasive techniques such as angioplasty and stents which have drastically decreased the need and number of open heart cases. for example, a center at my school was doing 17 open hearts a week, now they do 4 a week. the reality is, no one wants their chest opened. don't get me wrong, some centers are still getting great numbers, but those places are becoming a minority.
vascular surgeons with endovascular techniques have also somewhat decreased the case load for a CT surgeon. we had a traumatic aortic tear a couple of months ago, and the vascular surgeon did it, because their aortic repair was less risky than CT.
this surgical case volume has become such a problem that many cardiothoracic fellowship training programs have either not accepted applicants or not filled their positions. if you ask any surgeon right now about CT surgery, they will tell you about one of their CT friends who is doing trauma shifts or bread and butter general surgery cases to either pay the bills or just get in the OR. 2 different people i interviewd with said CT had no future, 1 told me of a CT surgeon who is now unemployed. damm

ON THE UP SIDE: i had the chance to interview with a young CT surgeon, and her reaction to the field is, many practicing CT surgeons are at the age of retirement so the field will be in demand once again.

i kinda think of the field as stage IV cancer, is it too far gone to survive, if it does survive, what is the quality of the work they will do.
i think the bottom line is, CT surgery will never be like it was. interventionalist have made certain of that, the entire theme of surgery is non-invasive, so be mindful of robotics as well.

i would still love to do it, but it just doesn't look good right now. lets re-evaluate in 3yrs and see what the buzz is.
i know you don't want to hear it, but going through some of the previous threads would be helpful. most of the opinions are from young surgeons.

as far as becoming an interventional cardiologist, i think its a totally different field than surgery, quite uneventful; its like coming to work to drive a wire through a maze which may take 40mins or 8hrs, booo. ok out to increase my BAL, happy new year all
good luck in school
 
So what are you considering for yourself?

I know I'm just starting out, but these days more than ever, I'd think one would be prudent to consider the future. The choices seem bleak and frustrating. Here's what I mean:

The absolute LAST area of medicine I can see myself in is Internal Medicine, while interventional cardiology seems like it would rock. However, three years of internal medicine are required before going into cards. What happens if you get stuck and don't match into a cards fellowship? Is your life basically over?

Or, say you go through the hell of a general surgery residency only to wind up being told there is no future in CT surgery and you can count on performing minor laproscopic procedures the rest of your career.

Sure there are other routes like ENT, Urology, Ortho, etc that still see a good number of cases in their respective fields...but what if you WANT the kind of fast paced life CT surgery would offer? What if you really are idealistic enough to want to spend your life in the service of others? Does that resign you to trauma surgery?
 
GAdoc said:
So what are you considering for yourself?

I know I'm just starting out, but these days more than ever, I'd think one would be prudent to consider the future. The choices seem bleak and frustrating. Here's what I mean:

The absolute LAST area of medicine I can see myself in is Internal Medicine, while interventional cardiology seems like it would rock. However, three years of internal medicine are required before going into cards. What happens if you get stuck and don't match into a cards fellowship? Is your life basically over?

Or, say you go through the hell of a general surgery residency only to wind up being told there is no future in CT surgery and you can count on performing minor laproscopic procedures the rest of your career.

Sure there are other routes like ENT, Urology, Ortho, etc that still see a good number of cases in their respective fields...but what if you WANT the kind of fast paced life CT surgery would offer? What if you really are idealistic enough to want to spend your life in the service of others? Does that resign you to trauma surgery?
Click to expand...

I always find it hilarious when people say they don't want to go through internal medicine to get to cardiology. Interventional cardiology involves more than just technical skills. The intellectual aspect is very important also. You need to have a strong background in internal medicine before cardiology as you will need to take care of medically complex patients in CCU, people with CHF, etc. People who are simply interested in doing procedures without a "medicine mind" will not thrive in cardiology.
 
Ok. So, surgical06 basically said most of everything that needs to be said, but I want to add a couple point in the debate that are commonly omitted. Nowadays you mostly hear stories about CT surgeons having to do crazy things to keep busy. I know a cardiac guy who is doing a 2nd fellowship after being let go after only a year as an attending because of low case volumes.

The only thing I want to point out regarding the cardiology vs. CT surgery debate is: CT surgeons have the best solution for lesions in the left anterior descending (LAD) in the internal thoracic artery (ITA). The ITA has documented 1-year patency rates at over 98% which no stent has been able to get close to (usually 90% at best). Not to mention that when you get out to 5 year patency rates, the ITA is clearly a superior solution. In fact stents in the LAD do the worst out of all of the coronary arteries. Now considering that patency of the LAD is the only vessel which has really been correlated with mortality, I would still personally have a ITA sewn to my LAD if I had a lesion to take care of. This fact has led to the increasing popularity of "hybrid" procedures, in which the LAD is grafted with the ITA through either a minimally invasive thoracotomy or robotic approach while the right and posterior heart are stented. I think thats just the best of both worlds.

So in short, I think the field is just changing. There will probably be less cases in the future that come to a CT surgeon because not every patient has a lesion in their LAD that needs attention. The old CT surgeons, who do 4x vein, sternotomy bypasses are definitely on their way out. Heck the top 25% of the field is over 65! The CT surgeon of the future is going to have to evolve into doing robotics and start to investigate training in more diverse procedures normally reserved for other specialities (e.g. thoracic aortic stenting). So, yes there will still be a future in CT. Will there be as many CT surgeons? Probably not. Is it still the best field in the world? Yes. *Sorry had to put the plug in* :laugh: Will you be making coin like the cardiologists and playing golf in your spare time? Ehh, probably not, but you've still got it good over peds! 🙂

Adios!
 
b16, that was great info! thanks


GAdoc, i admire your interest and early focus. don't be so quick to pigeon whole specialties wait to see what you like and don't like; i think internal medicine is a good field and it makes you a very solid clinician, and depending where you go for training, you can really enjoy it. if you are thinking of cardiology, you are going to need all the internal medicine you can get. the first patient you get in CCU on 3 drugs to maintain blood pressure (pressors), with arrythmias and kidney and respirator failure all at the same time, you'll love that internal medicine background!

to answer your question, my focus has expanded to CT, yes trauma (always will do it, whatever i do, love it), transplant and surg onc.. in that order. ortho, urology, and ENT are all specialties that aren't under general surgery. i didn't choose any of those fields because i felt they were limiting with respect to where anatomically i can and am trained to operate.



i'm not sure you can say CT surgery is/was fast paced, in fact i thinks its the opposite.
don't get worried about not getting into whatever you want to do, that process is futile, focus on your work and strive to be the best.
 
surgical06 said:
the first patient you get in CCU on 3 drugs to maintain blood pressure (pressors), with arrythmias and kidney and respirator failure all at the same time, you'll love that internal medicine background!
Click to expand...

Sounds like a lot of our SICU patients. 🙂
 
Surgical06,

Thanks for the good info. and encouragement. Let me also appologize to anyone who was offended by my remarks about Internal Medicine. I would never doubt it's importance to ANY doctor. What I was referring to was practicing as an internist. There is a huge difference between the medicine you learn as a med student and resident and what you end up spending 90% of your time practicing as an internist. I just don't want to end up pushing drugs and managing diabetes/hypertension my entire career. At the risk of continuing to insult the internists out there, let me move on.

I'm sad to hear everyone's opinions about CT surgery. But, it confirms what I have been hearing.

You mention that you are interested in transplant surgery...any particular organ?
 
One more question...

How does one become a transplant surgeon? I'd assume it would be five years general surgery, CT surgery fellowship, THEN a transplant fellowship. Is that correct, or would you go straight from general surgery to a transplant fellowship? How many fellowships exist and how competitive are they?

Also, I've seen a cardiac transplant fellowship offered at several places. They state that you would do IM, cards fellowship, then the transplantation fellowship. I assume, however, that these physicians only MANAGE transplant patients...they do not actually transplant the heart. Is this correct?
 
Gadoc, i'll have to defer some of those questions about transplant to more experienced here. i'm only aware of 5-7 yrs general surgery followed by 2yr transplant fellowship. i don't think you can do transplant surgery after IM then cards fellowship without surgical training.

with respect to my interest in transplant; i saw my first organ procurement 2 months ago (surgeons from all over come and take the organs they wanted) it was the best anatomy lesson i've ever had. pt was opened from the sternal notch to the pubic symphysis. heart, small bowel, liver, vessels all exposed. no particular organ; i like MAXIMMALY invasive surgery by the way. 😀


good luck with your future; i'm gonna hold you to that 250+
 
I assume you were talking about CT transplant because of the way you asked the question. Heart and lung transplants are performed by cardiac surgeons after they complete their CT fellowship. There is no additional transplant fellowship required for heart and lung transplant. Some CT surgeons do go on to complete fellowships in CT transplant at major transplant centers, but this is really only useful if one has the intention making thoracic transplant the focus of their clinical/research time or if they want to someday be chief of transplant at their hospital.
 
Quick clarification. When I say "CT fellowship" I should be saying CT residency. The general surgery residency is the first step followed by general surgery board certification. Then there is CT residency followed by CT board certification. The term "fellow" really refers to a level of education that is attained AFTER board certification in one field. So if one were to be board certified in CT and then did another couple of years in CT transplant that person would only then be considered a fellow. I get sloppy about this term all the time, and many people at the hospital do the same, so I just wanted to correct myself before I passed on my bad habit.
 
Obviously I'm no expert, but at many of the programs I've looked at, they only require fellowship applicants to be "board eligible". I guess this means, the resident has sucessfully completed an ACGME approved residency and is qualified to take the boards. Please correct me if I'm wrong however, because passing the boards is a big step and many people practice succesfully before becoming board certified (i.e. some plastic surgeons).
 
to answer your question:

to do cardiothoracic TRANSPLANTS (i.e. heart and lung) you do a cardiothoracic "residency" after general surgery "residency". in general, you are "board eligible" when you start and "board certified" in general surgery (supposing you pass the boards) while you are a CT resident.
if you choose to do heart and lung transplants, you do an extra year (or two) of training AFTER you do CT residency for 2-3 years (which is AFTER you do general surg residency for 5-7 years).

to be a "transplant surgeon" i.e "abdominal transplant" (interchangeable, in jargon) you can do liver, pancreas, and kidney transplants. you do 5-7 yrs of general surg residency, followed by 2 years of "transplant fellowship". currently, "transplant fellowship" is not ACGME certified. that being said, there is no "tranplant boards". so when you are done, you can get a job in transplant, but there is no "board exam" to take. since it is not (yet) ACGME certified...being a fellow in transplant also does not follow the 80 hr work week.

yes, the anatomy is beautiful.
yes, the exposure is beautiful.
yes, it is "maximally invasive".
yes, the impact on patients lives and quality of life is immeasureable.
 
lennox23 said:
yes, the anatomy is beautiful.
yes, the exposure is beautiful.
yes, it is "maximally invasive".
yes, the impact on patients lives and quality of life is immeasureable.
Click to expand...

I was kinda waiting for a catch. Is there a catch?

And btw, thanks a lot for the clarification, they were a bit too vague for me before.
A couple of questions:

Who does Kidney transplants? The Urosurgeon (a.k.a. urologist) or the General Surgeon (with fellowship in transplant)?

If the Urologist does Kidney transplants, and the CT surgeon does Heart transplants, what does that leave for the General Surgeon in the Transplant field?

Thanks.
 
TRANSPLANT surgeons do transplants; typically of kidneys and liver. Heart transplants are performed by cardiothoracic surgeons who have undergone an additional fellowship specifically in heart transplantation.

Neither urologists nor general surgeons typically transplant anything.
 
b16 said:
Ok. So, surgical06 basically said most of everything that needs to be said, but I want to add a couple point in the debate that are commonly omitted. Nowadays you mostly hear stories about CT surgeons having to do crazy things to keep busy. I know a cardiac guy who is doing a 2nd fellowship after being let go after only a year as an attending because of low case volumes.

The only thing I want to point out regarding the cardiology vs. CT surgery debate is: CT surgeons have the best solution for lesions in the left anterior descending (LAD) in the internal thoracic artery (ITA). The ITA has documented 1-year patency rates at over 98% which no stent has been able to get close to (usually 90% at best). Not to mention that when you get out to 5 year patency rates, the ITA is clearly a superior solution. In fact stents in the LAD do the worst out of all of the coronary arteries. Now considering that patency of the LAD is the only vessel which has really been correlated with mortality, I would still personally have a ITA sewn to my LAD if I had a lesion to take care of. This fact has led to the increasing popularity of "hybrid" procedures, in which the LAD is grafted with the ITA through either a minimally invasive thoracotomy or robotic approach while the right and posterior heart are stented. I think thats just the best of both worlds.

So in short, I think the field is just changing. There will probably be less cases in the future that come to a CT surgeon because not every patient has a lesion in their LAD that needs attention. The old CT surgeons, who do 4x vein, sternotomy bypasses are definitely on their way out. Heck the top 25% of the field is over 65! The CT surgeon of the future is going to have to evolve into doing robotics and start to investigate training in more diverse procedures normally reserved for other specialities (e.g. thoracic aortic stenting). So, yes there will still be a future in CT. Will there be as many CT surgeons? Probably not. Is it still the best field in the world? Yes. *Sorry had to put the plug in* :laugh: Will you be making coin like the cardiologists and playing golf in your spare time? Ehh, probably not, but you've still got it good over peds! 🙂

Adios!
Click to expand...

I really think that when you post a bunch of percentages that you should at least try to reference a study. As much as I believe that you are an expert, I'd rather see some proof.

A 90% (at best as you stated) 1-year patency rate is very low for current stents and unlikely to be accurate. If it is true, I want to read the study. Also, 5-year data supporting CABG would be more supportive of your argument, and 5-year morbidity and mortality (compared to a 1-year) would be more relevent to surgical intervention as well, as traditionally the less invasive procedures fare better in the immediate post-operative time period.

Old data shows CABG to have a significantly higher event free survival (lower number of reinterventions) at 5 years, but no statistically significant advantage on overall survival, and this is with bare metal stents. (ARTS II trial).

What is troubling to CT surgeons is that most of the data that they quote that is in favor of CABG over PCI is based on the use of bare-metal stents, which is outdated since most stenting is now done with drug-eluting stents. The new stents have decreased stenosis rates and therefore decreased number of reinterventions.

Now, don't get me wrong: I would love for CABG to remain as an important treatment for CAD, but to say that "surgery is the best solution for LAD disease" is near-sighted, as patient population, degree of stenosis, comorbidities, etc play a large role in determining which treatment is best.

Also, the vessel that we as surgeons are holding onto tightly is not the LAD, but the left main, as CABG is still the standard of care for left main disease.....of course, there are trials currently underway by cardiologists whose preliminary data shows left main stenting to be safe and effective.🙁

I'm personally torn emotionally by the issue. I love CT surgery and want there to be a strong future for the field, but it's unfair to the patient to be upset that less invasive procedures are being shown to be equally effective and, in some instances, superior.

The future of CT surgery is largely dependent on the creation of "hybrid procedures" as you mentioned, as well as the ability of CT surgeons to gain privileges to perform percutaneous interventions. And, of course, we always have the diabetics........

I do agree with you, however, that the IMA kicks @ss.

Some literature to read if interested:

1. The BARI trial. N Engl J Med 1996; 335: 217-224.
2. ARTS I and II trials. 1-N Eng J Med 2001; 344:1117-24. 2-J Am Coll Cardiol 2005; 46:575-81.
3. Argument against PCI: N Eng J Med 2005; 352:2174-83.
4. Drug eluting stents: 1. N Eng J Med 2003; 349:1315. 2. N Eng J Med 2004: 350: 221.
 
GAdoc said:
One more question...
Also, I've seen a cardiac transplant fellowship offered at several places. They state that you would do IM, cards fellowship, then the transplantation fellowship. I assume, however, that these physicians only MANAGE transplant patients...they do not actually transplant the heart. Is this correct?
Click to expand...

That is correct - often the transplant surgery patient will be transferred back to the cards service under the watch of someone who specializes in transplant once the peri-operative period is over (may be as soon as 48 hrs post-op if all is well). These IM guys do not do the surgery but play an extremely important role in managing the immunology, meds, etc.
 
GAdoc said:
Obviously I'm no expert, but at many of the programs I've looked at, they only require fellowship applicants to be "board eligible". I guess this means, the resident has sucessfully completed an ACGME approved residency and is qualified to take the boards. Please correct me if I'm wrong however, because passing the boards is a big step and many people practice succesfully before becoming board certified (i.e. some plastic surgeons).
Click to expand...

That is correct as well. You do not need to be BC to start a fellowship, as a matter of fact, most surgical fellows coming from a general surgery residency are not, since the board exams aren't given until after residency is completed.
 
SLUser11 said:
I really think that when you post a bunch of percentages that you should at least try to reference a study. As much as I believe that you are an expert, I'd rather see some proof.
Click to expand...

B16, I know my post was overly-argumentative. I guess I was just really annoyed by the "K. Here's the deal" title to your post. It's really funny what seemingly insignificant things drive me crazy.

Just so you don't think I'm a keyboard warrior, my real life persona is equally impatient and unfair....and somewhat misanthropic.....

I do want to read the study about low 1 year stent patencies if you have it, though......
 
Knight_MD said:
I was kinda waiting for a catch. Is there a catch?

And btw, thanks a lot for the clarification, they were a bit too vague for me before.
A couple of questions:

Who does Kidney transplants? The Urosurgeon (a.k.a. urologist) or the General Surgeon (with fellowship in transplant)?

If the Urologist does Kidney transplants, and the CT surgeon does Heart transplants, what does that leave for the General Surgeon in the Transplant field?

Thanks.
Click to expand...


The catch is the life of a transplant surgeon can be insane.... Take organs out at midnight and start transplanting first thing in the early morning... be on watch for postop disasters in the afternoon and the rest of the night..... their schedules are more insane than the average general surgeon. (My n=1 experience).
 
SLUser11 said:
B16, I know my post was overly-argumentative. I guess I was just really annoyed by the "K. Here's the deal" title to your post. It's really funny what seemingly insignificant things drive me crazy.

Just so you don't think I'm a keyboard warrior, my real life persona is equally impatient and unfair....and somewhat misanthropic.....

I do want to read the study about low 1 year stent patencies if you have it, though......
Click to expand...

I understand. As you can imagine, this isnt the first time that I've drawn some heat on this issue, actually this is the norm. I just felt that I need to counter, or at least add a fair defence among all of the anti-CT public opinion as of recent. Don't get me wrong, I think stents, especially DE stents, are great minimally invasive solutions in a lot of situations. Personally, one of the soul foucuses of my research is bypass graft patency. Between talks at national CT meetings and a couple of funded and co-authored R01's I've had to defend my position many times to many skeptical audiances. When I post on an internet fourm, I was speaking casually and not adressing my audiance as I would address a grant reviewer. To me its one of those things where, if you want to doubt me, you can; no hard feelings. I wouldn't reccomend basing clinical opinions on internet fourms, but in this e-information age, I guess I should start being less casual in my internet exchanges.

Back to the issue: I feel like the wave of public opinion has been so incredibly pro-stent, especially since the introduction of the DE stents. Cardiac surgeons are notorius for being bad salesmen. In many respects, cardiac surgeons are at fault for the down fall of the field becuase of their general lack of interest in defending the therapies they offer. I think its faily conclusive that when comparing a DE stent and a RA/SV graft in CABG, the DE stent almost always offers the best solution, especially since the RA/SV graft is going to require a sternotomy and a separate traumatic vein harvest; a simple LIMA-LAD anastomosis can be done as a MIDCAB or TECAB, which we do regularaly. On several occasions we've done MIDCABs on Jahovah's Witnesses and come out with an EBL of less than 30cc. Now, while I do really like DE stents, I don't feel that DE stents are the "magic bullet" for coronary disease in every situation (especially in the left main and LAD). As you've probably heard, recently a lot of cardiologists are going back to bare metal stents (especially in Europe) because of reports of incomplete reendothelialization and stent thrombosis when plavix is withdrawn (up to around 3 years post-stenting) because of the agressiveness of the antimotic agents in DE stents. When I say stent DE stent failure is around 90% at a year, I am including acute thrombosis (which is usually very low) and in-stent restenosis which usually makes up the majority of hemodynamically significant events within a year. I'm sorry that I'm not going to be able to cite you articles at the moment, as I'm on my laptop at home without my reference manager, but if you are genuninely interested, I'll make a point to pull some references up and post them here when I get back to my desktop. We collaborate with one of the world's most renown vascular pathologist named Dr. Virmani who seems to have a knack for predicting how a lot of these new therapies will fair in the long-run. I'll attach a quick link, which I do have at the moment, to an article on her opinion on DE stents. For some reason you can't directly link to the article but if you type "renu virmani" in google the first two results are the article I'm thinking of.

Cheers.
 
CT surgeons lack of defense of their therapies goes down to the same reason why vascular surgeons did not do a good job defending portacaval shunts vs TIPS done by IR.

It's who does the ER call and who answers.

If the ER calls CT surgeons and CT surgeons refuse to see the chest pains that might need stents or bypasses because the majority dont need intervention, then cardiology will benefit cause they answer the ER and they will likely do the stent even if we all know the bypass is better.

Same with someone coming to the ER for ascites with liver failure... who answers the consult? IR or General Surgeons? Well if general surgeons dont answer the consult cause they are too busy with everything else, then the IR will do their TIPS... until TIPS becomes an accepted solution and yet which is better remains questionable.

Therapies should be defended and improved. Aggressive clinical studies should be done to see which is better and in what situation but the problem is, people might not want to show that their therapy is inferior. (E.G are stents always worse than bypass? When are they better and when are they worse? Is it well defined... etc etc etc).

Of course I am not a CT surgeon and certainly some CT surgeon whose been around the block and confirm/negate my suspicions but it's what I observed.
 
Is there any way we can bump this to reflect any opinions more recent than 8 years ago?
 
Kelevra said:
Is there any way we can bump this to reflect any opinions more recent than 8 years ago?
Click to expand...

Came into medical school wanting to do CT and never changed my mind despite all the talk of a dying field
-Fellowship was hell...make sure you want to do it before you go into the field. You will work your ass off...there is NO 80 hour work week. not even close. I never thought about quiting in surgical residency. There were fellowship nights, and days, and evenings when I sat in the parking lot before going back into the hospital and thought "this is crap, I cant take it any more" but got through it.
-That said. When i finished had 3 solid job offers and at least 4 more prospects I didn't go after. All making a substantial amount more than I thought I would make. All the other fellows from my program had the same with the exception of one but he had some issues.
-Current practice has plenty of cases, blew away my RVU target.
-to the stent/cabg folks...all i have to say is syntax.
-the patients will get to you, you can only stent so long. You get the patients down the road long enough they are STILL going to die of cardiovascular disease or cancer. We just get them sicker and older, which is fine.
-There's a lot of aneurysm surgery out there.
-lot of lung cancer.
the field is fine, the job prospects are good. I wouldnt do anything else. If i couldnt do this anymore I'd leave surgery, maybe go into radiology (I'd have slapped myself 10 years ago for saying that) cause if I had to take out one more damn gallbladder I'd hang myself.
 
dynx said:
Came into medical school wanting to do CT and never changed my mind despite all the talk of a dying field
-Fellowship was hell...make sure you want to do it before you go into the field. You will work your ass off...there is NO 80 hour work week. not even close. I never thought about quiting in surgical residency. There were fellowship nights, and days, and evenings when I sat in the parking lot before going back into the hospital and thought "this is crap, I cant take it any more" but got through it.
-That said. When i finished had 3 solid job offers and at least 4 more prospects I didn't go after. All making a substantial amount more than I thought I would make. All the other fellows from my program had the same with the exception of one but he had some issues.
-Current practice has plenty of cases, blew away my RVU target.
-to the stent/cabg folks...all i have to say is syntax.
-the patients will get to you, you can only stent so long. You get the patients down the road long enough they are STILL going to die of cardiovascular disease or cancer. We just get them sicker and older, which is fine.
-There's a lot of aneurysm surgery out there.
-lot of lung cancer.
the field is fine, the job prospects are good. I wouldnt do anything else. If i couldnt do this anymore I'd leave surgery, maybe go into radiology (I'd have slapped myself 10 years ago for saying that) cause if I had to take out one more damn gallbladder I'd hang myself.
Click to expand...

Has life gotten much better after the fellowship?
 
dynx said:
Came into medical school wanting to do CT and never changed my mind despite all the talk of a dying field
-Fellowship was hell...make sure you want to do it before you go into the field. You will work your ass off...there is NO 80 hour work week. not even close. I never thought about quiting in surgical residency. There were fellowship nights, and days, and evenings when I sat in the parking lot before going back into the hospital and thought "this is crap, I cant take it any more" but got through it.
-That said. When i finished had 3 solid job offers and at least 4 more prospects I didn't go after. All making a substantial amount more than I thought I would make. All the other fellows from my program had the same with the exception of one but he had some issues.
-Current practice has plenty of cases, blew away my RVU target.
-to the stent/cabg folks...all i have to say is syntax.
-the patients will get to you, you can only stent so long. You get the patients down the road long enough they are STILL going to die of cardiovascular disease or cancer. We just get them sicker and older, which is fine.
-There's a lot of aneurysm surgery out there.
-lot of lung cancer.
the field is fine, the job prospects are good. I wouldnt do anything else. If i couldnt do this anymore I'd leave surgery, maybe go into radiology (I'd have slapped myself 10 years ago for saying that) cause if I had to take out one more damn gallbladder I'd hang myself.
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Your status still lists you as a fellow.
 
Ibn Alnafis MD said:
Has life gotten much better after the fellowship?
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Oh yeah. Have a great group of partners. Q5 except when someone's on vacation, that's almost mind boggling. I used to say to my junior residents "any day you get to go home is a good day" and now I, for the most part have good days. Still 10 to 12 hours but they end and I go home. I'm not all into the surgery lifestyle **** like I used to be, I don't take any pride in living in the hospital. I'd prefer to go home and see my kid, so I can do long hours but like when there's an end to the work day.
I Have a nice flow of patients so steady operating schedule, 1 day of office a week. In terms of emergencies you get called for "small" problems, bleeding is quick, cardiac emergencies these days are really aortic dissections in terms of operating in the middle of the night. The killer for fellowship was transplant. That and a lot more dissections because people would ship them from miles away. I specifically did not look at any institution with a transplant program. All in all, I can't complain (but I do). I'm doing exactly what I hoped I'd be doing...and some vascular crap but hey, nothing's perfect.
 
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What is your opinion on the 6 year integrated programs?
 
shishka32 said:
What is your opinion on the 6 year integrated programs?
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Can't really give one. When I started residency there were only 2 and I didn't want to take the risk of being one of the first to try it out. From what I can tell they're the future with talk of a complete transition for every program to an integrated format by 2020 (which I don't think will really happen). They seem to be strong programs I would have no hesitation if I was deciding now to go to one.
The single downside I see is if you change your mind. Which happens. I'd look carefully into what your options are for continuing as a GS resident, there may be issues in terms of number of approved spaces, room on rotations ect. That may preclude your continuing on as a categorical GS resident. That's just speculation, I don't know but it's something I'd be sure to figure out before hand.
 
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