Are you interested in a 0+5 vascular program?

Blue Rover · May 19, 2006

If the 0+5 option (matching directly into Vascular Surgery from medical school - eventually being Board Eligible/Certified for only VS, and not GS) opened up in time for the 2007 Match, how many of you would want to apply?

Vascular surgery isn't the most popular fellowship these days (some posts in the past seem to indicate that people don't like the work/procedures), and I'm wondering if the SDN community would find the shorter training enough of an inducement to consider specializing early.

Blade28 · May 19, 2006

No, I'd want to get boarded in G Surg first.

drpectin · May 19, 2006

Blade28 said:
No, I'd want to get boarded in G Surg first.

Definitely want to be boarded in Gsurg first. As a med student you aren't exposed to the full breadth of practice. And who knows what kind of mentors you might find as a resident, that might inspire you into trauma, plastics, Cardiothoracic, Surgonc etc...

Blue Rover · Jun 13, 2006

Thought I'd bump this up to see if there was anyone else who might want to vote before it got lost on the back pages.

tlew12778 · Jun 13, 2006

My husband is doing this bc we live in Italy and you sub-specialise immediately here. He hates it. He thinks the upcoming US option of 3+2 (or is it 3+3?) would be ideal. He actually gets bored of doing aneurysms, carotids and amputations all the time. Plus, with the whole issue of rads taking over more and more vascular cases, he is concerned with the future of vascular. Obviously there will always be vascular surgeons, but the number of them may well decrease = bad for post-residency job placement...

So now he is considering doing a GS residency AFTER his vascular one is done. Which sucks bc that means being poor for another 5 years.

Winged Scapula · Jun 13, 2006

I have a feeling there's a behind the scenes lobby for the accelerated Vascular residency since this question seems to get posted about once a month!

mysophobe · Jun 13, 2006

tlew12778 said:
My husband is doing this bc we live in Italy and you sub-specialise immediately here. He hates it. He thinks the upcoming US option of 3+2 (or is it 3+3?) would be ideal. He actually gets bored of doing aneurysms, carotids and amputations all the time. Plus, with the whole issue of rads taking over more and more vascular cases, he is concerned with the future of vascular. Obviously there will always be vascular surgeons, but the number of them may well decrease = bad for post-residency job placement...

So now he is considering doing a GS residency AFTER his vascular one is done. Which sucks bc that means being poor for another 5 years.

Why did your husband go into vascular if he doesn't like it? The UK has subspecialties separate from gen surg too, but you can still just go into general surgery. Were there no spots?

pratik7 · Jun 14, 2006

Quick question.... if you complete a 3+3 program, are you able to do general surgery procudures such as appys and cholys

Pilot Doc · Jun 14, 2006

pratik7 said:
Quick question.... if you complete a 3+3 program, are you able to do general surgery procudures such as appys and cholys

You would not be board certified in general surgery. Since no one has done this, it remains to be seen how it would affect operative privileges.

tlew12778 · Jun 15, 2006

mysophobe said:
Why did your husband go into vascular if he doesn't like it? The UK has subspecialties separate from gen surg too, but you can still just go into general surgery. Were there no spots?

Well he used to like it. That just changed the more he did it. It probably has a lot to do with his particular hospital as well, in that it is private but affiliated with the national healthcare system here. They have a more money-minded approach to patient care (like scheduling surgeries at 5PM that could normally be day surguries but bc they are done so late, the govt now has to pay for a bed). He did consider taking the test for general but it was on the same day as vascular and he ran the risk of being late for his vascular test. Since the spot was more or less guaranteed in vascular (but not in general... 50+ apps for 16 spots that year vs 6 apps for 5 spots in vascular that year) he chose vascular. He wanted to take the general surgery exam this year and switch but they scheduled boards one the same day, at the same time, to prevent residents from doing that.

mysophobe · Jun 16, 2006

Those bast'ids.

Celiac Plexus · Jun 17, 2006

i think integrated is the way to go. there is simply too much to learn these days to stick to the traditional 5 years general plus 2-3 years of fellowship. why does a vascular surgeon need to know how to do a lap nissen? he or she is never going to do them in practice.

the fact is that 70% of general surgery residents pursue fellowship training. and most of these future specialists will never even get privileges for a lot of the stuff that they were required to learn in general surgery residency.

as an extreme example, take the future cosmetic plastic surgeon... how is having to learn how to do an apr, or a trauma splenectomy, helpful to his/her future practice?

and what about those who want to be straight general surgeons? the advanced laparoscopy, oncological, endovascular, thoracic, advanced bariatric, and even (gasp) breast cases are going to go to fellowship trained individuals in medium and large markets.

general surgery has not changed its training paradigm in decades, while the field itself no longer resembles general surgery of yesteryear.

integrated pathways are a reasonable approach to the future education of surgeons. additionally, general surgery training must also change significantly to reflect the state of the art today (but that's another rant for another day).

mysophobe · Jun 17, 2006

When I was a scrub nurse, all 7 out of the 7 vascular surgeons I worked with did general surgery in addition to vascular; however, 1 of them did less general than the other surgeons. But, even he said that eliminating the gs residency would be stupid, as it pays to be well-rounded, and a gs residency really teaches you how to be a surgeon. That said, I would have gone into a 5-year vascular program if I had the opportunity. In 5 years, I don't see how you wouldn't be properly trained to do anything you'd have to do in a pure vascular practice (I've been given conflicting opinions on whether or not it is possible to maintain a private practice on vascular alone).

footcramp · Jun 18, 2006

it is possible to have a vascular-only private practice. there are a few out there. but i would guess that most require general surgery. if you go into academics then there probably won't be a great need for your general surgery skills. i like to think of the integrated vascular programs as a fast-track for academic minded research-surgeons.

mysophobe · Jun 18, 2006

Yeah, that's what I was thinking. Not a bad gig. I'm not sure how many applicants there would be, though. In my experience, people going into surgery have no idea whether or not they want to subspecialize after residency, let alone right away.

Reading the APDVS website (http://apdvs.vascularweb.org), I don't think they'll be having any 0+5 programs anytime soon. It seems like in all their surveys, a large portion of respondents want to do some type of general surgery, and they are taking this into account when redesigning training paradigms. I think the 4+2--aka, ESP--programs might be the closest thing to an integrated program we get.

johnny_blaze · Jun 21, 2006

mysophobe said:
The UK has subspecialties separate from gen surg too, but you can still just go into general surgery.

not true. In the U.K subspecialty training (for gen surg specialties) is included in your general surgery training as a registrar. The only subspecialty that is seperate from gen surg in the U.K (compaired to the US) is CTS.

mysophobe · Jun 21, 2006

Hmmm...where was I thinking of then? I believe you (I mean, you practice there, so I better!

), but I swear somewhere over there vascular is its own specialty.

johnny_blaze · Jun 27, 2006

mysophobe said:
Hmmm...where was I thinking of then? I believe you (I mean, you practice there, so I better! ), but I swear somewhere over there vascular is its own specialty.

In order to practice as a vascular surgeon here you have to train in general surgery. The final two years of your training are usually spent on a vascular service. When you sit the FRCS exam you can request that your viva be in vascular surgery.

Your choices are then as follows...
be a general surgeon with an interest in vascular surgery
be a pure vascular surgeon (may need a bit more experience if you haven't trained at a major hospital with a busy vascular unit)
go into renal transplantation (more training needed, but some vascular surgeons do this)

As far as I know, this is the only way to do it. You might have confused it with CTS, which is completely separate from GS over here.

surgwannabe · Jul 3, 2006

Celiac Plexus said:
i think integrated is the way to go. there is simply too much to learn these days to stick to the traditional 5 years general plus 2-3 years of fellowship. why does a vascular surgeon need to know how to do a lap nissen? he or she is never going to do them in practice.

the fact is that 70% of general surgery residents pursue fellowship training. and most of these future specialists will never even get privileges for a lot of the stuff that they were required to learn in general surgery residency.

as an extreme example, take the future cosmetic plastic surgeon... how is having to learn how to do an apr, or a trauma splenectomy, helpful to his/her future practice?

and what about those who want to be straight general surgeons? the advanced laparoscopy, oncological, endovascular, thoracic, advanced bariatric, and even (gasp) breast cases are going to go to fellowship trained individuals in medium and large markets.

general surgery has not changed its training paradigm in decades, while the field itself no longer resembles general surgery of yesteryear.

integrated pathways are a reasonable approach to the future education of surgeons. additionally, general surgery training must also change significantly to reflect the state of the art today (but that's another rant for another day).

Although true, I think your argument applies to the academic setting more appropriately. In a private practice, you will be forced to take calls by yourself. Since I don't think your partners want to come in to do an emergent lap chole while you are on call, it makes more sense for the private practitioners to be certified in both GS and VS.

Are you interested in a 0+5 vascular program?

Are you interested in a 0+5 (directly out of med school) Vascular Surgery program?

Yes, I love vascular surgery and know it's for me!

No, I want to keep my options open or VS is just unappealing to me.

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