A list of questions about Cardiothoracic Surgery

[The Angriest Bird]

My childhood dream is to be a heart (cardiothoracic) surgeon. I'm a 3rd year now and I'm 95% determined about going into cardiothoracic surgery.

The following is a list of questions which have been haunting me for a very long time. If some of you guys can take a look and answer them, I can't tell you how much I appreciate it. You are more than welcome to use yourself as example, but try to provide answers that are as unbiased as possible.

Q1: Because the residency is a two-step course, general surgery followed by CT surgery, which one weighs more in terms of preparing myself to be a competent CT surgeon?

Q2: If my goal is to be a pure clinical practitioner (no research), does getting into a prestigious residency program matter, in terms of clinical competency and future financial revenue?

Q3: After I finish my General Surgery residency, how competitive is it to get into CT surgery program? What are the selection criteria? Do I have to ace my General Surgery residency to get into a good CT Surgery program?

Q4: Is "4+3" (4yr G. Surgery + 3yr CT Surgery) better than "5+2"? Are there any combined programs?

Q5: Why do CT surgeons have the worst lifestyle? If I do solo private practice, can I just see less patients a week so I work 45 hours instead of 70 hours (making less $$ of course)?

Q6: I really hate working at night and on weekends. Is there anyway to avoid it as a CT Surgeon (night calls as a resident is perfectly expected)?

Q7: As a solo-private-practice CT surgeon, is it possible to secure 2 months of vacation every year (making less $$ of course)?

Q8: Is CT Surgery a specialty that is fading out, partially due to competition from catherization?

Q9: At what age is an average CT Surgeon too old to operate? At that point, what do you do?

Q10: Why do some CT Surgeons choose to work in hospitals? Do they make less or more money? What are the advantages of working in a hospital as opposed to private practice?

Q11: As a pure practioner with zero research, what exactly generates "fame"? A word of mouth?

Extra Question: Is the a website or book that lists all General Surgery and CT Surgery residency programs in US, with brief profiles? Is there by any chance a ranking for them (I do NOT endorse rankings)?

---

Members don't see this ad.

 

[ESU_MD]

Most of your questions are in the Blade FAQ's at the top of this forum.

BUt to touch on a few topics-

it doesnt really matter where you do general surgery. general surgery has almost nothing to do with your cardiac training.
CT residency is pretty much wide open

The job market is beginning to open wide- just a look into any of the trade journals/web sites will tell the tale if you dubt me. further more- go to any hospital website and look at the pictures/resumes of the CT guys on staff- they are all OLD and ready to retire. meaning more jobs

Caths will never take over. for every superaggressive cardiologist, there are 20 lazy, timid ones who wont stent anything (even when you want them to do so)

the most important thing when choosing a CT fellowship is one where the staff will let you sew distals and do valves. name/prestige doesnt mean jack if you cant sew a distal. ---its all about the prolene

 

[Blade28]

PLEASE read through my FAQ.

Additionally, FREIDA lists all residency and fellowship programs.

 

[Winged Scapula]

Q1: Because the residency is a two-step course, general surgery followed by CT surgery, which one weighs more in terms of preparing myself to be a competent CT surgeon?

I will disagree with my esteemed colleague ESU; without good basic training in general surgery you will be a horrible CT surgeon.

Do you need to know the specifics of how to do a Whipple? Obviously not. But learning the surgical techniques as well as caring for critically ill patients is a skill that will carry you through to your fellowship and beyond. A CT fellowship is honing those skills, building new ones and learning more complex procedures and managing those patients than you would have in residency. I can say no more because as a general surgery resident I never saw the inside of the CT ORs, but I spent a lot of time in the CT ICU (and I did [really] stay at a Holiday Inn Express last night).

Q2: If my goal is to be a pure clinical practitioner (no research), does getting into a prestigious residency program matter, in terms of clinical competency and future financial revenue?

Probably not. Training at a prestigious program is nice and it will get you some referrals initially but it will come down to your clinical competence which prestigious programs don't necessarily have a lock on.

Q5: Why do CT surgeons have the worst lifestyle? If I do solo private practice, can I just see less patients a week so I work 45 hours instead of 70 hours (making less $$ of course)?

Short answer and a few questions...

because their patients are sick and their problems often happen emergently - ie, the patient crashing in the Cath lab, the trauma patient with the aortic near-transection, the post MI patient with a ruptured ventricle, the heart that becomes available for transplant. You can't package these problems, as well as any peri-operative issues into a nice schedule.

whom do you plan on having to take care of your patients outside of those cushy hours, especially if you are in a non-academic practice?

have you informed your patients that they will be expected not to have any post-operative complications and if they do, please to do so only between the hours of 8 and 5 pm?

C'mon. You're a third year medical student. You know the answer to this. CT patients can be sick, very sick - before and after you operate on them. CT Surgeons have a crappy lifestyle because emergent procedures don't fit nicely into your schedule any more than they do for a Vascular surgeon. The way to have a nice lifestyle is to operate on low risk patients and do low risk surgery. I have chosen that, but I still work more than 45 hours per week. I think it a bit naive to think that a *solo* practitioner could work that few hours, especially in the beginning and build a practice. You have to be available for your referring doctors (when someone's crashing in the cath lab, they don't wanna hear that you've already worked 44 hours this week and were planning on taking the rest of the day off), you have to be available for your patients and you have to be able to pay your bills. A solo practice is a very expensive proposition.

But yes, in the abstract you could work only 45 hours per week but CT is notoriously unpredictable with regard to hours, so if you don't want to go over that, you'd better pick some low risk patients and stick to some low risk thoracic procedures.

Q6: I really hate working at night and on weekends. Is there anyway to avoid it as a CT Surgeon (night calls as a resident is perfectly expected)?

Probably not if you want hospital privileges. Most CT surgery patients do better if they are admitted post-operatively after an operation in a hospital.

My hunch is that as the new guy in town, you are not only not going to be able to get out of the CT Surgery call schedule but it will be MANY years before that will be the case (ie, once you become a big powerful guy in the community for whom the hospitals are tripping over themselves to get).

When you open a practice, join a practice, get a job at a hospital, you will need to become a member of the medical staff (at one or more places) and get admitting and operating privileges. This will involve that you take call. How often depends on the number of surgeons they have in the pool for CT. Expect as the new guy, your name will show up on the weekends and holidays more often than John. Q. Bigwig CT Surgeon, MD does.

You might want to rethink this idea of CT Surgery as it appears that your lifestyle needs are incompatible with this career choice at least in the beginning.

Q7: As a solo-private-practice CT surgeon, is it possible to secure 2 months of vacation every year (making less $$ of course)?

You can do whatever the heck you want, but you have to have someone cover your practice. Whom is taking call for you at the hospital and for your own private patients? Hospital privileges also generally require that you have someone already on staff cover for you, so that if your patient comes in, that there is someone available to take care of him/her. Good luck getting someone to take call for you for two months out of the year as well as cover the phone calls, etc. from the office.

In addition, your privileges will also probably require that you do X number of procedures during your first couple of years. This shoots a hole in the plan to only work 45 hours a week, if you have to do all those cases in 10 months.

But sure, if you can figure out the above, you can take as much time off as you want. Be forewarned that referring physicians don't like to send patients to someone they cannot rely on being available, at least most of the time.

Q8: Is CT Surgery a specialty that is fading out, partially due to competition from catherization?

No. As noted above, there is plenty of work, and plenty of lesions that catheterization has NOTHING to do with. CT Surgery is not all atherosclerotic bypasses (and besides, there is good evidence that stents aren't all they were cracked up to be...especially for the sicker patients).

Q9: At what age is an average CT Surgeon too old to operate? At that point, what do you do?

Whatever age you want. There are no mandatory retirement clauses across the board. The average surgeon retires in their early 60s; I've known people go for many years beyond that and do well.

After you retire you can sail around the world, get a mistress and a red Porsche or be the old guy who comes to Grand Rounds once every few months and rambles on about some procedure he did back in the 20s. Retired CT surgeons do the same things as other people do when they retire.

Q10: Why do some CT Surgeons choose to work in hospitals? Do they make less or more money? What are the advantages of working in a hospital as opposed to private practice?

Some people prefer a large support staff, multidisciplinary approach and the resources that a hospital employed position can offer. If it is also an academic medical center, you can have residents and students as well - for better or worse. Hospital based positions can allow you to walk into an infrastructure that you don't have to create. There are more opportunities for research, to work closely with other colleagues and to participate in building a Center of Excellence or teaching students and residents.

In short, the same reasons anyone else chooses an employed position with a hospital rather than a private practice.

Q11: As a pure practioner with zero research, what exactly generates "fame"? A word of mouth?

Treating your referring physicians well. Being available when people need you. Doing lots of talks locally during Heart Disease Awareness Month. Treating the hospital employees, especially the nurses right (they will tell people who the best surgeon is). Inventing some tool or procedure that everyone starts to use.

Look, I don't mean to be harsh but you seem to have a skewed vision of what surgery, CT surgery and medicine in general is like. And its not just surgery, private practice is a tough gig, that requires a lot of work and dedication. You might want to reconsider either your professional or lifestyle goals as they appear incompatible. There are plenty of other fields which can be adapted to a 45 hour/week, no weekends and 10 months per year schedule...CT Surgery is extremely unlikely to be one of them.

 

[smq123]

Q6: I really hate working at night and on weekends. Is there anyway to avoid it as a CT Surgeon (night calls as a resident is perfectly expected)?

a) You will have to work at night and on weekends for FIVE years as a surgical resident, and then an additional THREE years as a CT fellow. You're okay with that?

b) Have you considered the scintillating fields of emergency medicine, dermatology, pathology, anesthesia, ophtho, and radiology? They seem more in line with your lifestyle goals.

Look, there's nothing wrong with wanting to have a good lifestyle. But at some point you kind of have to accept the fact that you can't have it all. Either you're a CT surgeon who will need to work until 11 PM on many nights, or you're a pathologist with a 8-5 job.

For your own sake - when you hit your surgery rotation, please do it at the most rigorous, demanding rotation site available. The one where they make students take q3 or q4 overnight call, and have to follow several patients at a time. That's the only way you can judge whether you love a field or a lifestyle more.

After you retire you can sail around the world, get a mistress and a red Porsche or be the old guy who comes to Grand Rounds once every few months and rambles on about some procedure he did back in the 20s.

Aww, I like those old guys. They usually have one or two fun, crazy stories up their sleeves. (Granted, you may have to hear these fun, crazy stories multiple times, but that's okay.)

Isn't that what med students are for anyway? To act as a captive audience for those veteran surgeons? "Elderly Dr. Smith is going to give a med student lecture this afternoon....titled 'Life before MRIs.'"

 

[Winged Scapula]

Aww, I like those old guys. They usually have one or two fun, crazy stories up their sleeves. (Granted, you may have to hear these fun, crazy stories multiple times, but that's okay.)

I do too, usually. But I just came back from a conference and during one of the sessions, while hoping to learn something, this old geezer told the same damn stories he told during the conference last year.

And then there was the time, the geezer who came to Grand Rounds had an arrythmia and as the intern sitting closest to him, I got to escort him to the ED, make sure he was treated as a VIP, call his wife, etc. Not that I necessarily minded all of that (he was nice and it got me out of all my regular work otherwise) but I was terrified he was gonna conk out on me in the elevator.

 

[The Angriest Bird]

One thing to clarify.

I don't want you guys to get the false impression that I want to go into a field that's working 9-5 while making a lot of money. I don't mind harsh lifestyle. I simply want my decision of going into CT to be an "informed decision."

 

[Winged Scapula]

One thing to clarify.

I don't want you guys to get the false impression that I want to go into a field that's working 9-5 while making a lot of money. I don't mind harsh lifestyle. I simply want my decision of going into CT to be an "informed decision."

That's a suprising clarification.

I don't think any of us assumed anything about wanting to go into a field like CT Surgery for the money. Although it will probably change as the number of CT surgeons retiring increases, the reimbursement, especially for a hospital CT surgeon these days is pretty pitiful. I know a few who are only making $10K more than the CT PA. I am making twice what a friend of mine who is doing CT is - and with fewer years of residency, no call, no emergencies that drag me out of bed, etc.

So, I doubt any of us were thinking you were going into CT for the money. If you were, please let me disabuse you of the notion that CT Surgeons are bringing home bucketfulls. Not anymore. If you want a lot of money and few hours, think Rad Onc, Derm, etc.

But you say that's not what interests you. Fine.

But in MULTIPLE places in your OP, you DO state that you mind a HARSH LIFESTYLE. Or at the very least you imply it, when you ask about:

- 45 hour work weeks
- call is ok during residency
- no nights or weekends
- two months of vacation per year
- no research
- how can I become well known


I'm all for being informed but honestly your post had MUCH more focus on lifestyle than simply asking questions about being a CT surgeon. If you had said "I've always wanted to be a CT surgeon but I'm concerned about my ability to coordinate such a career and still have time for a family. Do you have any suggestions?, then that would have seemed more reasonable than asking about a CT Surgery practice with an easy lifestyle. There is nothing wrong with being concerned about these things so my comments aren't meant as a dig at you.

 

[dienekes88]

No. As noted above, there is plenty of work, and plenty of lesions that catheterization has NOTHING to do with. CT Surgery is not all atherosclerotic bypasses (and besides, there is good evidence that stents aren't all they were cracked up to be...especially for the sicker patients).

I read a couple articles about this in the New England Journal of Medicine


Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease
Conclusion:

For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization

Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden
Conclusion:

Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents.

Analysis of 14 Trials Comparing Sirolimus-Eluting Stents with Bare-Metal Stents

The use of sirolimus-eluting stents does not have a significant effect on overall long-term survival and survival free of myocardial infarction, as compared with bare-metal stents

Long story short... It looks these stents (including the drug eluting stent) aren't the panacea for coronary artery disease. However, I ain't a doctor nor am I a researcher, so I'll defer to the surgeons for a discussion of these articles.

 

[Winged Scapula]

I read a couple articles about this in the New England Journal of Medicine


Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease
Conclusion:


Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden
Conclusion:


Analysis of 14 Trials Comparing Sirolimus-Eluting Stents with Bare-Metal Stents


Long story short... It looks these stents (including the drug eluting stent) aren't the panacea for coronary artery disease. However, I ain't a doctor nor am I a researcher, so I'll defer to the surgeons for a discussion of these articles.

Others may choose to discuss these articles if they wish, but as I stated above, I think it pretty clear that the "board answer" is that stents are not the right choice for many patients and that the indications for CABG (left main disease, LAD > 70%, 3 vessel dz or 2 vessel dz with LAD stenosis or low EF or 1 vessel disease but high risk by testing or symptoms) stand, leaving very few indications for stenting over CABG.

 

[The Angriest Bird]

@ Winged Scapula

There are simply two ways to ask a question. I can either ask "can thoracic doctors secure 45 hr/week" or "do thoracic doctors work 60+ hrs/wk." I apologize for any misunderstanding.

Let me reiterate what best describes me:

1. I will be willing to tolerate any suffering during residency. No problem

2. If CT surgery has a harsh lifestyle, I think I can handle it. But I really want to know it before I start my career instead of letting reality surprise me.

3. I want to do CT because 1) it interests me 2) it's still one of the best-paying job in medicine. I hate derm and rad-onc. You can always find a pediatrician who makes way more than a sports surgeon. I'm simply talking about the statistics that circulate around us.

4. According to me, choosing the right specialty is about finding a harmonious balance between income, lifestyle, and personal interest/passion about the field. One very very rarely gets all of them, at least that's my case.

 

[Winged Scapula]

@ Winged Scapula

There are simply two ways to ask a question. I can either ask "can thoracic doctors secure 45 hr/week" or "do thoracic doctors work 60+ hrs/wk." I apologize for any misunderstanding.

Apologies aren't necessary, but fair enough, it is easy to misunderstand on a BB.

Let me reiterate what best describes me:

1. I will be willing to tolerate any suffering during residency. No problem

2. If CT surgery has a harsh lifestyle, I think I can handle it. But I really want to know it before I start my career instead of letting reality surprise me.

Good idea. Suprises like that are generally not well received (by anyone involved).

3. I want to do CT because 1) it interests me 2) it's still one of the best-paying job in medicine. I hate derm and rad-onc. You can always find a pediatrician who makes way more than a sports surgeon. I'm simply talking about the statistics that circulate around us.

Ok. My question to you is "where are you getting these statistics?"

It is true that in the heyday of CT Surgery (15 years or more ago) that they were making in the high 6 figures. However, as reimbursement has declined significantly (ie, CABGs are paying 1/5 or less now than they paid 15 years ago), so have the salaries. CTSNet reports a recent (2005) survey which showed the average salary of new CT surgeons to be $202,500. This also includes those who are making half that.

I am aware that you can "always find a pediatrician who makes way more than a sports surgeon", but I honestly think you need to do some more research into the field, if you are basing your ideas about CT surgery salary on old data. Medical school professors aren't exactly the best resources for these kinds of things...they simply spout data that was true the last time they checked (circa 1994). It is NO LONGER one of the "best paying jobs in medicine"; besides Derm and Rad Onc, those jobs would also include Anesthesiology Rads (especially IR), Neurosurgery is still high (although falling as are all surgical specialties), PM&R, etc.

Are CT Surgeons starving? No. But if you would be happy, after all those years of training and knowing the lifestyle, to perhaps make less than your FM buddy who finished residency 5 years before you, then CT may be the right choice. I am not being disingenueous when I tell you there are CT surgeons, out of fellowship who could not find jobs paying more than $100K per year. There are obviously others who are making more if the $200K figure is still accurate, but really, in this day, even $200K is not one of the "best paying jobs in medicine" by far.

4. According to me, choosing the right specialty is about finding a harmonious balance between income, lifestyle, and personal interest/passion about the field. One very very rarely gets all of them, at least that's my case.

And I would agree with you. Therefore, I think you need to hear the good, bad and the ugly about CT. I don't agree that CTS is a dying field and I do think there will be plenty of jobs available in the upcoming years. There will also be a lot of competition for those jobs, because 15%-21% of general surgery residents seeking fellowships (according to CTS) are still going into CTS (which is about right - 700 or so each year doing fellowships, 100 of them doing CT, not counting those who didn't go through a match).

It looks like CT will meet your personal interests, but I encourage you to learn more about the lifestyle and the income as it appears that you may have some skewed ideas about both. If you can live with the rigorous lifestyle and low(ish) pay, then I'll stop harping on the subject.

People will do a lot of things for a good salary, but when you add up the rigorous CT surgery training as well as the lifestyle of an attending with the pay, for many people it doesn't make sense.

 

[SLUser11]

@ Winged Scapula

There are simply two ways to ask a question. I can either ask "can thoracic doctors secure 45 hr/week" or "do thoracic doctors work 60+ hrs/wk." I apologize for any misunderstanding.

Let me reiterate what best describes me:

1. I will be willing to tolerate any suffering during residency. No problem

2. If CT surgery has a harsh lifestyle, I think I can handle it. But I really want to know it before I start my career instead of letting reality surprise me.

3. I want to do CT because 1) it interests me 2) it's still one of the best-paying job in medicine. I hate derm and rad-onc. You can always find a pediatrician who makes way more than a sports surgeon. I'm simply talking about the statistics that circulate around us.

4. According to me, choosing the right specialty is about finding a harmonious balance between income, lifestyle, and personal interest/passion about the field. One very very rarely gets all of them, at least that's my case.

Just a few quick remarks:

1. You will likely find that you really don't want to do CT surgery that bad. These guys work harder and longer hours than most, and there's no way around it. Also, it's nowhere near the best paying job in medicine. That's why a lot of your CT surgeons are working even more hours to make ends meet.

2. You should seriously consider Emergency Medicine. Do a rotation as soon as you can and see what you think. If you train in the right program, and practice in the right area, you can have an excellent lifestyle with reasonable work hours, do lots of procedures, see interesting cases everyday, and make lots of money.

3. The reason you're meeting contempt with your line of questioning is that surgeons pride themselves on working longer and harder than most, and see your plans as inherently contradictory.

4. Asking a CT surgeon not to work nights and weekends is like asking him not to breathe. The joke goes, "How do you hide $100 from a CT surgeon?"


You tape it to his kid's forehead...........his forehead, Good Yeast.

 

[dienekes88]

Others may choose to discuss these articles if they wish, but as I stated above, I think it pretty clear that the "board answer" is that stents are not the right choice for many patients and that the indications for CABG (left main disease, LAD > 70%, 3 vessel dz or 2 vessel dz with LAD stenosis or low EF or 1 vessel disease but high risk by testing or symptoms) stand, leaving very few indications for stenting over CABG.

Ah thanks, WS.

Building on that, the first article suggests that CABG is associated with lower mortality than DES even in the case of 2 vessel disease without proximal LAD artery: Adjusted Hazard Ratio for death = 0.69 (95% confidence interval: 0.48-0.98), p= 0.04.

 

[The Angriest Bird]

My statistics:

"Iserson's Getting into a Residency" (2006) Figure 5.1: Cardiothoracic Surgery $560,000 (higher than all other specialties)

Yahoo! HotJobs: CT Surgeon in Dallas TX: $434,172

My point is, ON AVERAGE, CT surgeon is probably the highest-paid specialty.

Common sense also tells me, for 7 years of gruesome residency, if CT paid something like 250K, very few people would ever consider it. People around me, i.e. my classmates, are people who seem to be ridiculously realistic. Maybe my school is unique.

P.S. I'm not trying to argue with any of you guys. This is a free discussion thread after all. I'm simply expressing my opinions. Correct me if I'm wrong!

 

[The Angriest Bird]

To simplify the discussion, I'd do something for 500K a year for 65 hrs a week, including some nights and weekends. And I like operating on the heart/lungs/esophagus. This is the "balance" between money, lifestyle, and interested I mentioned above.
To keep me from CT (which is a valid goal of this thread), you have to convince me either of these:

1. CT surgeons don't make, on average, 500K a year (all my sources tell me they do)

2. The lifestyle is worse than 65hr/week + night calls and weekend duties

3. I actually hate CT (which you won't change anyway)

 

[Winged Scapula]

Iserson. Woot!

He's been out of touch, out of date and frankly, just wrong on many fronts. I wouldn't use him for medical advice any more than I would use my own mother.

And I'm sorry, but ON AVERAGE, CT Surgery is NOT the highest paid specialty. Far from it. That would be Spine (ortho or neuro), with PRS (purely aesthetic guys), Derm, RE, Rad Onc, and Interventional Rads farther down the line. And yes, there are plenty of people here who will still pursue the career, regardless of the number of years of training, knowing that they will not make $500K

Is is possible to make $450K as a CT Surgeon? Sure. But then again, I can show you a job listing for a general surgeon for $600K. Those kind of jobs are listed everywhere.

These job listings with salaries attached are often "too good to be true." Believe me, I spent a year looking at those jobs and the salaries in the "real world" often have little to bear in comparison to what people really get offered. And the same was true for my friends...people who were told that the average general surgery salary was $250; yet the offers right out of residency were closer to $150K. I know some people who do make fantastic money doing these things but they almost always come with some strings attached. Maybe they really will pay you that, but I'll bet that is a first year guarantee which is required to be paid back, has you taking ED call at 4 hospitals or has some other onerous attachment (the general surgery job paying $600K required q1 call, middle of nowhere - only surgeon in town. Fun!)

I'd rather believe the salary statements of CT Surgery fellowship grads as to what they make than some illusory ad or Iserson. And again, remember when looking at these salary surveys, you can discount that average because YOU aren't going to be making anywhere near those salaries right out of the box. So the $560K from Iserson includes some hot shot Department Chair who is making $700K as well as the junior attending who is making $125K.

Common sense has very little place in medicine. For example, common sense would tell you that you should make more money in expensive places, because the COL is higher, right? Guess what? I was getting offers for jobs in California $100K LESS per year than what I'm making here...and the length of training does not correlate to the salary, in many cases.

 

[Winged Scapula]

To simplify the discussion, I'd do something for 500K a year for 65 hrs a week, including some nights and weekends. And I like operating on the heart/lungs/esophagus. This is the "balance" between money, lifestyle, and interested I mentioned above.
To keep me from CT (which is a valid goal of this thread), you have to convince me either of these:

1. CT surgeons don't make, on average, 500K a year (all my sources tell me they do)

I think your sources are skewed as I've noted above. However, will you eventually make $500K? Probably, but it will take you many years to get there unless there is a fantastic change in reimbursement for your procedures.

Current Medicare reimbursement for a 3 vessel CABG? Around $2100. LESS than it was in 1992. Much less. And guess what? Many times you don't even collect that, or at least not all of it. Too bad your mortage, malpractice, student loans, car, etc. aren't less too.

2. The lifestyle is worse than 65hr/week + night calls and weekend duties

What happened to 45 hrs/week?

65 is more reasonable as long as you include night and weekend calls. But remember, as the attending you can't go home post-call, nor can you cancel an office full of patients who've waited weeks to see you. But I'm willing to say that 65 is more doable.

3. I actually hate CT (which you won't change anyway)

Honestly. I have bigger fish to fry than convince you you hate CT. Nor would I care to. I am competely and totally in favor of people doing what they want to do. But you need to be informed about it, which, as I recall, was what you came here for. So far you have me and a senior surgery resident disagreeing with you. Obviously we are not the final word, but the fact that SLUser doesn't see me as going off the deep end with my comments, tells me that the picture of CT Surgery that I've painted is probably more accurate that the one you are getting from Iserson, Yahoo and your classmates.

Others are free to chime in and agree or disagree.

 

[dienekes88]

To simplify the discussion, I'd do something for 500K a year for 65 hrs a week, including some nights and weekends. And I like operating on the heart/lungs/esophagus. This is the "balance" between money, lifestyle, and interested I mentioned above.
To keep me from CT (which is a valid goal of this thread), you have to convince me either of these:

1. CT surgeons don't make, on average, 500K a year (all my sources tell me they do)

2. The lifestyle is worse than 65hr/week + night calls and weekend duties

3. I actually hate CT (which you won't change anyway)

I believe this is the study that WS is quoting:
Cardiothoracic Surgery Resident Education: Update on Resident Recruitment and Job Placement

Graduates initially seeking jobs reported the salary they accepted or would accept was between $150,000 and $250,000 in 70% of the cases, with the average salary being approximately $194,000. The average salary actually obtained by those residents gaining a job was $202,500. A slight majority (51%) reported this salary as being adequate.

 

[eclcell]

If there is a listing for CT surgeon on yahoo jobs, please post the link. If it is paying that much I know several that would want to apply.

 

[dienekes88]

My statistics:

"Iserson's Getting into a Residency" (2006) Figure 5.1: Cardiothoracic Surgery $560,000 (higher than all other specialties)

Yahoo! HotJobs: CT Surgeon in Dallas TX: $434,172

My point is, ON AVERAGE, CT surgeon is probably the highest-paid specialty.

Common sense also tells me, for 7 years of gruesome residency, if CT paid something like 250K, very few people would ever consider it. People around me, i.e. my classmates, are people who seem to be ridiculously realistic. Maybe my school is unique.

P.S. I'm not trying to argue with any of you guys. This is a free discussion thread after all. I'm simply expressing my opinions. Correct me if I'm wrong!

Only 108 people applied for the 2009 Appointment Year... 118 positions.

24 positions went unfilled (only 94 matched).

It's not like people are tripping over one another trying to get into CT surgery.

 

[ESU_MD]

Interesting thread...

I am someone who is keenly interested in this subject for personal reasons (current CV fellow)

It is very true that the job market had hit some tough times.
However, things are opening up now somewhat.

I know of the placements and rough salaries of several recent grads.
If you are going to work in academics or at a VA, plan on making a lower salary- ~200k, maybe less. Some people actually WANT to work in academics for a strange reason. Others NEED to work in "underserved" situations like VA's for visa/immigration issues. These jobs dont pay well.

On the other hand, I know of several recent grads who signed for ~375k. This is what they tell me, so take it with a grain of salt. Some of these jobs were in places I wouldnt put on my top choice list. I am sure the 375 figure included other stuff and wasnt true takehome pay, but it is encouraging enough to keep me going.

To go into private practice from a top CV program as a proficient
"grand slam" (cardiac, thoracic, endo + periph vascular) you are looking at getting AT LEAST 325-350. BUT- you will be working your butt off to earn it, probably living somewhere you dont want to live, and not having alot of partners to share call with- ie you, the junior guy will be doing weekends.holidays + all the garbage cases.

If you think you are going to come out and make 400k only doing 3 cabg's/wk, you are delusional

Senior private CT guys do make ~400-500, Top guns, chairs are hitting 7 digits. but these are far and few between. the million/yr days are long over.

My best advice- if you dont REALLY LOVE CT, then DONT DO IT!!! the residency really sucks, the lifestyle sucks and its stressful.

If you want money and lifestyle- try er (if you can live with yourself)
or rads.
-hell, even general surgery is low stress compared to CT and probably pays better relative to lifestyle.

 

[The Angriest Bird]

Good discussion!

First, @ Winged Scapula. Thanks for all your inputs. You are truly omnipresent on these forums $500K and $450K don't make that much of a difference for me. I say I'd go as low as $400K.

Second, the goal is definitely not to make the most money. If that were the goal I wouldn't even go into medicine. Being able to to open the chest and stop the heart means a lot to me.

Being in a city I like also means huge to me. I will not go to New York City or California, period. Don't judge, it's just me.

My bottom line is very objective:

1. I love CT surgery.

2. I hate many specialties that are supposed to make more money than CT surgery, e.g. any radiology, derm, and ortho.

3. If CT pays less than $400K (after 5 years in practice) or requires more than 65 hours a week, I'm not gonna do it.

 

[The Angriest Bird]

Some extra information. I have a Gift from God: my parents have some decent saving in their bank.

I know I know. I'm one of the "lucky bastards" who won't be in any debt. My parents also promised to invest a good chunk of their saving to help me open a private practice right off the bat.

I'm not showing off for Christ sake. So please don't judge. I'm simply adding this piece of information to let you know better about me. For example, if one has to work his/her ass off in the first 5 years after graduation to start a private practice, I'm fortunate enough to pass that phase.

 

[Winged Scapula]

What's with all this "judging" bizness?

I don't think anyone here, at least not me, was judging you. Hell, if anyone should be judging someone for wanting good pay with a good lifestyle, it certainly isn't me (having taken the non-ED call road to my surgical practice). And since my grandmother paid for half of my medical school education, I think its great that your family is willing and able to assist you in obtaining your dreams.

Whether you want to live in fly over country rather than NY or California is of no concern to me; I understand several people enjoy doing so. I cannot claim to understand but then again, my friends do not know how I stand the heat here.

So look, no one's judging...we just want you to realize that you have to understand where your sources are coming from, and fully arm yourself with all the available information. I think it is probably perfectly reasonable to expect $400K/year as a CT surgeon in several years but realize that for being paid top end dollar, you will sacrifice - whether its location, call schedule, other perks, etc. Only you can decide what your walk away points are in contract negotiation.

Finally, unless you decide to go the integrated CT route, you have MANY years ahead of you to look at the market, decide whether or not the field is for you.

best of luck to you...

 

[teddybear]

First, @ Winged Scapula. Thanks for all your inputs. You are truly omnipresent on these forums

Well she should be, cause she's not only a real life surgeon, but also a SDN admin,***.

 

[...to_the_OR!]

My statistics:

"Iserson's Getting into a Residency" (2006) Figure 5.1: Cardiothoracic Surgery $560,000 (higher than all other specialties)

Yahoo! HotJobs: CT Surgeon in Dallas TX: $434,172

My point is, ON AVERAGE, CT surgeon is probably the highest-paid specialty.

Common sense also tells me, for 7 years of gruesome residency, if CT paid something like 250K, very few people would ever consider it. People around me, i.e. my classmates, are people who seem to be ridiculously realistic. Maybe my school is unique.

P.S. I'm not trying to argue with any of you guys. This is a free discussion thread after all. I'm simply expressing my opinions. Correct me if I'm wrong!

Actually PRS is probably the highest paying surgical specialty (for those doing some aesthetics).

And Cards, Derm, and Reproductive Endo the highest paid medical specialties.

 

[smq123]

Being in a city I like also means huge to me. I will not go to New York City or California, period. Don't judge, it's just me.

3. If CT pays less than $400K (after 5 years in practice) or requires more than 65 hours a week, I'm not gonna do it.

If you're already laying down these many conditions, at such an early stage in your medical career, then I really don't think that CT surgery is for you.

You can't know what CT surgery will pay 10 years from now (when you'll actually finally be a CT attending). You can't know if it's going to require more than 65 hours a week. No one, especially not people posting on this thread, can promise you that. 65 hours may be doable....but who knows? Maybe it won't be.

I think one of the hardest lessons to learn in third year, as you make a career choice, is that you have to accept that there are always going to be certain trade-offs. (Particularly if you never had a job in the "real world" before.)

"Iserson's Getting into a Residency" (2006) Figure 5.1: Cardiothoracic Surgery $560,000 (higher than all other specialties)

Yahoo! HotJobs: CT Surgeon in Dallas TX: $434,172

My point is, ON AVERAGE, CT surgeon is probably the highest-paid specialty.

And you'll definitely be fielding those kinds of job offers fresh out of fellowship, as a junior attending. Uh-huh. RIGHT.

Please don't fool yourself.

Good Yeast: I think that the glamour of CT surgery is clouding your ability to think clearly, and I want to congratulate you for at least trying to really investigate it before you jump in. (Although you should also wait and see if you even like your surgery rotation.)

The PRS guys at my hospital seem to really have it all. They have a good practice, they make great money, they seem happy and on top of the world. A few of them make frequent appearances in the "society pages" of the local newspaper.

And, unfortunately, that's all that most med students and junior residents see...the lifestyle, the money, the famous clients, etc.

The stories, though, of how they got to be where they are now, are truly hair raising. As junior attendings (i.e. right out of fellowship) they were often shuttling between three different hospitals. Getting up at 2-3 AM, getting home at 10:30 PM. Doing this, day in and day out, 6 days a week...in some cases for 10 years. Being the "go-to" attending for any burn cases, all the horrible reconstructive work on trauma victims. They were the ones who were called in for the stat hematoma I&D at 11 PM. The only reason why they could stop was when the practice hired another young surgeon out of fellowship....and they were no longer the "bottom guy" on the totem pole.

So don't think that the hard work ends when your fellowship ends. It doesn't. And don't let observations of other physicians making huge amounts of $$$ with loads of free time sway your decision. You don't know how hard they had to work to get to the point where they could demand those kinds of salaries with those kinds of cushy work hours.

 

[maxheadroom]

Actually PRS is probably the highest paying surgical specialty (for those doing some aesthetics).

And Cards, Derm, and Reproductive Endo the highest paid medical specialties.

Guess again. The super-high-end cosmetic guys make big money, but most Plastic surgeons do a mix of Aesthetic and Reconstructive surgery and they don't make the super big money that the Ortho Spine guys make. If you're looking for big money in surgery right now, it's all about Spine.

Big cosmetic practices have a huge overhead, also. Your cosmetic Concierge service that you have to keep going to make the high-dollar patients happy doesn't come cheap.

Listen to WS and SLUser -- they're giving good advice. While you might have your parents' money to fund you starting a practice, no one is going to refer to you if you're the new guy in town who just finished fellowship, but doesn't feel the need to totally bust your ***** to get patients. That's how you establish a referral pattern. Other doctors send you patients because you take good care of their patients, you see them quickly, the patients like you, and you keep them in the loop about what's going on with their patients. If you don't do that when you first get out, you're not going to capture their referrals.

65 hours/week for a new CT guy isn't very realistic (from what I've seen). Maybe you'll get lucky, but most guys that I've seen out seem to work MORE in their early years of practice than they did during residency/fellowship.

 

[dynx]

To simplify the discussion, I'd do something for 500K a year for 65 hrs a week, including some nights and weekends. And I like operating on the heart/lungs/esophagus. This is the "balance" between money, lifestyle, and interested I mentioned above.
To keep me from CT (which is a valid goal of this thread), you have to convince me either of these:

1. CT surgeons don't make, on average, 500K a year (all my sources tell me they do)

2. The lifestyle is worse than 65hr/week + night calls and weekend duties

3. I actually hate CT (which you won't change anyway)

Well we can all spew different statistics. The thing is, the way you are phrasing your posts makes it seem you are looking for a lifestyle speciatly in terms of time off and a reliable schedule. Number 2 is ABSOLUTELY NOT TRUE. you will not work those hours in private CT practice. Thats not to say the lifestyle isn't great....you're operating on the heart, thats a lifestyle, and its awsome. What better things are you going to be doing on those free weekends?

 

[filter07]

Hmm

A cardiothoracic surgeon who does no research, works 45 hours a week without nights or weekends, and yet is famous and makes 400-650k a year...

reality check...

 

[The Angriest Bird]

Let's face it: I'm not a guy who can live happily with less than 400K. Truth be told, there are only a selected number of specialties that will likely delivery that amount of salary per year. And I hate most of them. I absolutely WILL NOT do any radiology because I want patient interaction. Rad-Onc involves patient interaction, but I hate dealing with cancers.

Cosmetic surgery is a "never" for me. I'm not going to spend my life to make people look better while they are already prettier than 90% of the population. Reconstruction plastic surgery is okay according to my "political views," but just being frank, I hate it anyway. I hate Derm too, and I don't really know why.

In some sense, I chose CT surgery by exclusion, if you wish.

Am I stuck with these ideas? Nope. That's why I'm 95% about CT but not 100%.

Am I "clouded" by the glamour of CT? You are somewhat right. But I think it's such a pessimistic way to say it. I'd put it like I'm very excited by the theme of CT surgery. Am I doing CT just for the saking of bragging about it? Not really. But being a CT surgeon is surely some big bragging right in the current society. Status and respect can mean huge for guys.

You can't know what CT surgery will pay 10 years from now (when you'll actually finally be a CT attending). You can't know if it's going to require more than 65 hours a week.

Nobody can predict anything accurately about any specialty in 10 years. The medical fields are changing so fast that it's almost ridiculous. I was told the old days when you had to work your ass off to be a pathologist and when 75% Ob-Gyn docs were male. But making bold predictions about the future is still better than letting life work its ways out for ya.

 

[The Angriest Bird]

Hmm. A cardiothoracic surgeon who does no research, works 45 hours a week without nights or weekends, and yet is famous and makes 400-650k a year...reality check...

Fame brings cash faster than anything else combined. My college roommate's uncle, a famous CT surgery chair in Philadelphia, makes 5 mils a year.

 

[maxheadroom]

Fame brings cash faster than anything else combined. My college roommate's uncle, a famous CT surgery chair in Philadelphia, makes 5 mils a year.

OK, so it's money that you're after. You're totally in the wrong field. Go into business or law if you just want to clear $400K. And while I believe that your college roommate's uncle might be a famous CT chair in Phillie, I would be pretty surprised if he clears $5 million. I know of no way that he can operate enough to bill (let alone collect) that much and he must be siphoning off of the department and his junior attendings something fierce.

You just don't seem to get it. You want to make lots of money, but not work as hard as most of the other people in the field. You want to be famous, but don't want to do research.

Fame and fortune come to people who work hard and put out either lots of patients with great results or lots of papers with high impact. In order to achieve either of those goals, you're going to have to spend lots of time at the hospital or in the lab. And you know what? With the way that surgical compensation is headed, I wouldn't bet the farm on any particular salary. You have to do something like CT surgery because you love it and it's the only thing that you want to do. Choosing it by exclusion just seems to be total folly.

 

[Blade28]

For your own sake - when you hit your surgery rotation, please do it at the most rigorous, demanding rotation site available. The one where they make students take q3 or q4 overnight call, and have to follow several patients at a time. That's the only way you can judge whether you love a field or a lifestyle more.

Sage advice, and that's what I tell all the MS-Is and MS-IIs here.

dienekes88, nice lit search!

As WS correctly points out, CT Surg is far from the best-compensated field. Maybe in the golden age of medicine, 20-30 years ago, but certainly not anymore with the decline in reimbursements.

How do you know you like operating on the heart and lungs that much? Research? Shadowing? Volunteering? Previous job (scrub tech/first assist)?

65 hours/week for a new CT guy isn't very realistic (from what I've seen). Maybe you'll get lucky, but most guys that I've seen out seem to work MORE in their early years of practice than they did during residency/fellowship.

Agreed. The new/junior CT attendings here all work well over 65 hours a week, every week.

 

[Winged Scapula]

Let's face it: I'm not a guy who can live happily with less than 400K.

Fame brings cash faster than anything else combined. My college roommate's uncle, a famous CT surgery chair in Philadelphia, makes 5 mils a year.

You aren't helping your case here. It clearly IS about the money. And if you think you can't be happy on any less than 400K per year (which is somewhat of a moot point since you haven't apparently worked a day in your life so have no idea about whether or not you would be happy making less), then CT Surgery is the WRONG choice, especially when coupled with your statement that you won't work more than 65 hours per week, will not take night or weekend call and won't publish.

Truth be told, there are only a selected number of specialties that will likely delivery that amount of salary per year. And I hate most of them. I absolutely WILL NOT do any radiology because I want patient interaction.

Now I'm starting to suspect that you aren't a medical student. Even a junior student knows that radiologists DO have patient contact - image guided biopsies, drain placement, venous access placement, arteriography, etc. Perhaps a good choice for you is interventional radiology - surgical procedures, average salary higher than CT Surgery, more vacation, fewer hours, less rigorous training, etc.

While I know that academic chairs of surgery can make more than they bill (since they typically do not operate much), I find it hard to believe that your friend's uncle makes 5 million a year as a Chair of CT Surgery; that is so far out of the realm of realistic as to be almost laughable, regardless of how "famous" he is. Joe Pa makes only $500K (which is a crime given his record and what other coaches make, but that's a topic for another day).

Since its pretty easy to list the departments in Philly and such salaries would be a matter of public record, which of the following is he:

Satoshi Furukawa, MD
Section Chief, Cardiothoracic Surgery
Surgical Director, Cardiopulmonary Transplantation
(not a Chair)
Temple

James B. McClurken, MD, F.A.C.S.
Professor and Vice-Chair of Surgery, Surgical Subspecialties
Director of Perioperative Services, Cardiothoracic Surgery
Temple

James T. Diehl ,MD
Thomas Jefferson University
Jefferson Medical College
Department of Surgery
Director and Clinical Professor, Division of Cardiothoracic Surgery
Thomas Jefferson

(Diehl is not a Chair; the Chair at Jeff is a HPB Surgeon, not CT)

Michael A. Acker, M.D.
Chief, Cardiovascular Surgery Division
University of Pennsylvania Medical Center
Professor of Surgery
University of Pennsylvania School of Medicine
(not a Chair; James Mullen the Chair, is not a CT Surgeon)

Joel D. Cooper, MD
Division Chief, Thoracic Surgery
University of Pennsylvania Medical Center
(also not Chair)

Hahnemann doesn't employ physicians, so there is not an academic CT Surgery department there

N. Scott Adzick, MD, MMM, FAAP, FACS
Surgeon-in-chief, Department of Surgery
Chief, General, Thoracic and Fetal Surgery
Director, Center for Fetal Diagnosis and Treatment
CHOP
(he's a pediatric surgeon, not a CT Surgeon officially and again, not Chair)

Feh...I'm tired of looking these guys up. Anyway, you get the point. These are the big name hospitals in Philly, the only ones that could or would possibly pay someone big bucks (ie, you aren't going to see that at Mercy, St. Joes, etc.). Which one is he?

 

[smq123]

Anyway, you get the point. These are the big name hospitals in Philly, the only ones that could or would possibly pay someone big bucks (ie, you aren't going to see that at Mercy, St. Joes, etc.). Which one is he?

Maybe he's referring to Larry Kaiser - he was (until last May) chair of Surgery at Penn, and was a thoracic surgeon specializing in lung cancer.

In any case, Good Yeast - Kaiser was no slouch either. He trained at Sloan Kettering, had numerous pubs, and undoubtedly worked his butt off to get where he was. (And I doubt that he made $5 million.)

 

[Winged Scapula]

Maybe he's referring to Larry Kaiser - he was (until last May) chair of Surgery at Penn, and was a thoracic surgeon specializing in lung cancer.

True...he would be the only famous CT Surgeon I know (outside of the great Debakey and Cooley, ad a few others who are no longer living). I still don't see him making $5 mil in salary...grants to the hospital, endowments, etc. perhaps.

And you are right...this guy works hard. So much so that he hasn't had time to shave his moustache since the 80s! (or at least, the last time I saw him). I think if he saw this - $400K, working 65 hours a week, being famous but without publications he would laugh his arse off. Even he admits in an interview to the Wharton SOB that reimbursements to CT surgeons are WAY down.

 

[smq123]

Let's face it: I'm not a guy who can live happily with less than 400K.

Why not? Expensive hobbies? Do you have a drug habit to support? (Good luck getting that surgery residency, in that case!) A gold-digging mistress? Like to play the horses? What?

I mean...honestly.

Rad-Onc involves patient interaction, but I hate dealing with cancers.

I guess Thoracic is out for you, then, since much of what many CT surgeons are starting to specialize in are new treatments for esophageal CA and lung CA. (See Larry Kaiser as an example.)

In CT, a lot of the "hot tickets" nowadays are thoracic cancers and lung transplants. And if you hate dealing with cancers, I can't imagine that you'll like transplants any more....

I hate Derm too, and I don't really know why.

Don't want to be mean, but that's really not an intelligent answer.

Before you rule something out, you should have some concrete reason for why you hate it, especially when it offers you the life style and reimbursement that you like so darn much.

But being a CT surgeon is surely some big bragging right in the current society. Status and respect can mean huge for guys.

So you want money...free time...AND bragging rights, but you don't want to do the hard work required to get them?

If you're not a troll, then you're just plain delusional. Work for an actual chair of surgery at an academic center. If you're lucky and he operates frequently (as Dr. Yeo does here at Jefferson), you will be blown away at how hard he works on the research side, the administrative side, and the clinical side.

Your posts are reminding me increasingly of the kids that I used to coach when I coached a high school debate team. There was always one or two who REALLY wanted to be state champion...but never worked on their arguments, routinely goofed off at practice, and sort of trudged their way through the year. If you want the results, you need to put the work in.

How do you know you like operating on the heart and lungs that much? Research? Shadowing? Volunteering? Previous job (scrub tech/first assist)?

Ummm...not to be mean, but somehow I doubt that Good Yeast has ever held a real job before.

 

[smq123]

Good Yeast - the only way to get the fame and money that you want is to be a really good surgeon. Really good. That takes time and dedication. As someone wrote in another thread, What makes a surgeon excellent:

The ones who impress me most are the ones who give a damn about their patients, who do the right thing even if its late, they are tired or whatever it is, is inconvenient and they do it anyway. They read and know their field in-depth and have an idea about what others do. They constantly refine their skills, do not accept mediocrity, treat others with respect and communicate with families and patients.

Do you think that you can do that? For as long as it takes until you really establish a reputation? For years after you finish fellowship?

If you can't, you'll forever be piddling along in some backwoods community hospital, making less than a pediatrician could make.

 

[PeepshowJohnny]

So you want money...free time...AND bragging rights, but you don't want to do the hard work required to get them?

Porn star?

 

[SLUser11]

Let's face it: I'm not a guy who can live happily with less than 400K. Truth be told, there are only a selected number of specialties that will likely delivery that amount of salary per year. And I hate most of them. I absolutely WILL NOT do any radiology because I want patient interaction. Rad-Onc involves patient interaction, but I hate dealing with cancers...

OH MY GOD! I have no idea how you could have gotten through 2 years of med school with such a superficial understanding of medicine. You need to take a much bigger step back, and start thinking about what medicine is all about, and if you'll be happy doing it.

That being said, I highlighted first your unrealistic monetary expectation. The money is just not there. I'm glad that you have a "gee whizz" story about your friend's uncle, but IMGs from the caribbean also have stories about their classmates matching NS and Ortho.


The next bolded statement is another of the multiple reasons you shouldn't do CT surgery, since a large portion of the thoracic practice is taking out lung cancer, and your patients are generally not going to do well.

Cosmetic surgery is a "never" for me. I'm not going to spend my life to make people look better while they are already prettier than 90% of the population. Reconstruction plastic surgery is okay according to my "political views," but just being frank, I hate it anyway. I hate Derm too, and I don't really know why...

You're so noble.

In some sense, I chose CT surgery by exclusion, if you wish.

Am I stuck with these ideas? Nope. That's why I'm 95% about CT but not 100%.

Am I "clouded" by the glamour of CT? You are somewhat right. But I think it's such a pessimistic way to say it. I'd put it like I'm very excited by the theme of CT surgery. Am I doing CT just for the saking of bragging about it? Not really. But being a CT surgeon is surely some big bragging right in the current society. Status and respect can mean huge for guys..

I'm near speechless.

Please take all of these things we are saying to heart. You need an advisor, and should set it up immediately, so you can get some perspective.

You are living in fantasy world. Perhaps when you are a famous CT surgeon, you can ride your unicorn to work.

Nobody can predict anything accurately about any specialty in 10 years. The medical fields are changing so fast that it's almost ridiculous. I was told the old days when you had to work your ass off to be a pathologist and when 75% Ob-Gyn docs were male. But making bold predictions about the future is still better than letting life work its ways out for ya.

Nice worthless superficial observation. Please explain how this will lead to your fantasy career.

Now I'm starting to suspect that you aren't a medical student.

I disagree. I think he's just not in touch with reality.

If you peruse his previous posts, he is either truly a third year medical student, which is very scary, or an extremely dedicated troll.

 

[The Angriest Bird]

Why is "money" such a hard topic to talk about when it comes to residency consultation? Either you don't mention it at all, i.e., I do whatever only to help people, which is rarely true among the medical student population. On the other hand, as soon as you throw out a number, like I did, the crowd goes like "so all you want is money, ok."

 

[The Angriest Bird]

WOW.

I can't believe I'm getting, flamed.

I'm not sure I will keep trying to "turn the tide" of the discussion, because you guys 1) put words in my mouths for what I do not really mean 2) label me so quickly for what I am not 3) call me "delusional" without knowing how little junior med students actually know about the real medical world

First, let me clarify that "my roommate's uncle makes 5 mils." I was simply saying occassionally you can find a doctor who makes a ridiculously amount of money by fame. Therefore, my goal is NOT to become famous intentionally, because fame is such a subjective and random thing. I want to keep my feet on the ground. Be competent and hardworking, and let fame come naturally.

Putting words into my mouth
I chanllenge you to find anywhere in this thread where I said "I do not want to work hard." And where did I say "all I want is money." I said the minimal incoming I'm looking for is 400K. And what's wrong with that? Isn't that what EVERYONE in our society is doing anyway, setting a dream income and trying to achieve it?

Labeling me so quickly
I get the impression that you guys have such a low "index of suspicion" to call a junior med student who asks for advice as someone who WANTS A LOT OF MONEY, THE BRAGGING RIGHT, and $$$. I'm wondering if I were ever able to convince you guys that I'm not one of those people, because there are plenty of them around me in my school.

So am I delusional and live in a fantasy world?
Delusional? Do you know how much my school actually teaches us about the how post-grad medical world works? Almost none. Instead, we get all the ethic/professionalism crap. How can I be not delusional while I actually DO NOT know what's the reality on in residency and beyond? That is the very reason why I come here.

In a nutshell
I'm not pissed and hope you are not pissed either. This is a thread in some Internet forum for Christ sake. We are all very tired already, aren't we.

We have 2 options: you guys rethink about who I really am, or we just stop the discussion before someone really gets pissed (not me) and call it a day.

 

[Winged Scapula]

Why is "money" such a hard topic to talk about when it comes to residency consultation? Either you don't mention it at all, i.e., I do whatever only to help people, which is rarely true among the medical student population. On the other hand, as soon as you throw out a number, like I did, the crowd goes like "so all you want is money, ok."

There is nothing wrong with being interested in money. Frankly, the med and pre-med students who say things like, "I'd do this job even if it meant I was paid only $45K a year" annoy me more.

But money is a hard topic here for a few reasons:

1) you originally claimed that your interest in CT surgery had nothing to do with money but was based on your passion for the field

2) you claim to have been raised without want for anything, yet you seem to have been raised without an appreciation for what work goes into having that money or perhaps more importantly, for the fact that happiness in life is not based on money.

Now obviously the above is a discussion for another forum and thread. And I will admit that a certain amount of money makes things better; I make more money than I know what to do with but I am not happier than I was when I was making less than $40K/year.

So I am not sure having this discussion with you is even possible; it sounds like you don't know what its like to live from paycheck to paycheck, to wonder how long you can "float" your rent check or have to pay a deposit to have your utilities turned back on. These things aren't necessary to appreciate making good money, but they sure help and in addition, make you realize that money makes things easier but it doesn't make you happier.

3) finally, it is not the issue of money itself that we object to. Its your continued quest for money, fame, glory without the work it takes to get there. For those of us who slaved away through medical school and residency (working over 100 hrs per week) for a good salary, having someone claim to want what we have and more, but without putting in the time is insulting.

So, we don't care whether you want to work for free or for some actual number, artificial or not. Please reread your posts and see its not the $400K figure that bothers us but all the statements around that comment.

 

[The Angriest Bird]

@ Winged Scapula

You made good points. When you said "I am not happier than I was when I was making less than $40K/year," I totally believe you. However, happiness is such a subjective concept. A rule-of-thumb for everyone that draws the correlation between income and happiness simply does not exist. Some homeless people are very happy. Some billionaires are depressed as hell. Some people, like myself, are happy as long as they reach a threshold of income.

I would dare to say I'm a person with good self-awareness. I'm not perfect but I know who I am. Based on 25 years of experience with myself, I know I won't be a person who will be happy, under any circumstance, with $40K. The average income of an internist is unlikely to satisfy me, either. The 400K comes from somewhere. Am I deadly sure about this? No. We all change. Our situations changes. We meet new people, significant ones, and their world views can differ from ours. But what can we do other than predicting the future based on what we know about ourselves right now? That is exactly what I'm doing now in this thread.

And I'm going to work hard to get that 400K. I've gone through everything as a typical med student. 100hr/week if you wish. If I want to be a CT surgeon, I may just have to go through every step a CT surgeon went through. So I can say "I deserve 400K" and it's not insulting to you guys.

About fame: I hate this damned word. That's why I'm not seeking it. I will work hard and do the right things for my patients. If fame comes, cheers. If not, who cares.

 

[GettingSeptic]

Seriously...which one is "your roomates uncle"...either your roomate is lying or you are lying...it is simple as that

 

[Winged Scapula]

Yeasty,

I appreciate your mature response to the comments here. We have perhaps forgotten how little is taught in medical school about residency and beyond and presume more knowledge was the norm.

Are we cynical? Yes. This is the nature of most surgeons. Even if it weren't an inherent trait, the teachings of a surgical residency are such that you learn to never take things at face value (don't trust someone else's abdominal exam; if they say they did a rectal exam, they probably didn't; patients lie and if they don't they are out to get you; get up and go see the patient rather than relying on someone else's report that they are "doing fine"; and when your sign out is, "they're all rocks, you should get some good sleep tonight", count on at least one patient going into new onset AFib and another to have a PE). You can count only on yourself and maybe a few others (only after you've known them for awhile). As one of my Vascular Attendings used to say, "assumptions kill" (as in "Was the Angio done?", "I assume so, we ordered it 5 hours ago.")

So I am sorry that we seem so mistrusting. Anyone here who has spent day one in a surgical residency knows what its like to be told A and find out its B, and the disaster of relying on that information without verifying. Verify, verify, verify. Its not you - we treat everyone this way; as a matter of fact, I noted that in the Announcement at the top of the forum because many wander in here and get attacked.

And we have gotten off track in responding to your comments and focused on a very small part of your lengthy OP. I admit I was amused by the visual of you riding to your fancy CT Surgery practice on a unicorn (thanks SLUser) but the point made was valid; you can't claim the rewards without having done the time and that your impression of what was required to reach that goal was unrealistic.

So I don't think anyone here is pissed...after all, as you note, its a freakin' internet forum. I will personally admit that I am not used to students arguing with me about something I'm fairly sure I know more about. There was something in your original response which rubbed me the wrong way; I guess I expected a response more along the lines of, "how come I see ads for CT Surgeons like this one for $450K" or "a friend's uncle is Larry Kaiser and he says that he makes $5mil/year - is that really possible?" rather than a reply which interpreted as saying I was wrong and you were right.

Self-awareness is a wonderful attribute; one that most of us don't possess in spades. I forget sometimes, especially here on SDN, that as an Admin or an attending surgeon that I can be intimidating, even when I'm saying the same thing someone else might. I try and be cognizant of that just as I try to do so in my office and OR. I'm not always successful.

Therefore, I'd suggest that since I and apparently others had the same reaction to your initial response (and those that followed), that WE ALL take a better look at that and try and understand. You - to try and understand why what you were typing came off in a manner that got our hackles up and us - to try and understand why we let this become more emotional than it should have. It would have been sufficient to say, "you're wrong and here's why" without all the assumptions about each other.

Best of luck to you...

NB: Yeah, who's the uncle? We wanna know!!!

 

[The Angriest Bird]

Aww, that's a nice post Scapula.

We as medical students get so frustrated on how little you know about the future. The school doesn't teach us anything. The admins have this attitude that "just work hard and everything will be fine," which we know is not true at all. Medicine is business. You may have the mind of a Nobel Prize winner, but if you run your practice like an academic nerd, you will bankrupt, get sued and lose, and perish. We know there's light at the end of the tunnel, but we don't know what's really outside the tunnel. It's a very disturbing thought.

What makes this thing worse is that there's really no good means to talk about it. Our peers know very little anyway. The residents in our hospital refrain from telling us the truth, we can tell that, because they are in the system already. Asking someone who's already in the specialty will invariably give you biased data, because they are 10x likely to tell you that speciality is good than bad. Every pediatrician wants you to be a pediatrician. It just doesn't help anyone.

I'm fully aware of the "unique personality" of surgeons. Actually, one of my classmates told me "the biggest obstacle for becoming a surgeon is getting used to the Surgery Culture." I think it can't be a truer statement. But I think I'm ready for it. I'm assertive. And to be honest, I don't trust a lot of people either. To put it in a very pessimistic way, I think I'm "mean" enough to be a surgeon, while I'm sane enough to be a caring doctor.

As for my roommate's uncle, well my roommate has a very troubled life. It's highly possible that he was lying. I don't even remember whether he told me that or his mother did. I don't know the surgeon's name. I could've told you my roommate's last name, but I don't think that's an appropriate thing to do.

 

[Winged Scapula]

The residents in our hospital refrain from telling us the truth, we can tell that, because they are in the system already. Asking someone who's already in the specialty will invariably give you biased data, because they are 10x likely to tell you that speciality is good than bad. Every pediatrician wants you to be a pediatrician. It just doesn't help anyone.

Very interesting statement.

IMHO while surgeons might think that we have the best job, we actually try and talk people out of doing it. Maybe its because the training can be so miserable in comparison that you really have to want to be a surgeon to endure the training. So while all pediatricians may want all students to be pediatricians, most surgeons realize that not everyone is cut out to be one and that there is nothing worse than a miserable resident.

I'm not sure why the residents at your program would lie to you, after all, there is no benefit in spouting rainbows and unicorns about surgery only to be working with a new intern in a few years who believed the fairy tales. It hurts everyone if you're content on riding into work on your unicorn (sorry, can't get that imagery out of my head) and then find out that Rainbow Bright is a real bitch to work with.

I'm fully aware of the "unique personality" of surgeons. Actually, one of my classmates told me "the biggest obstacle for becoming a surgeon is getting used to the Surgery Culture." I think it can't be a truer statement. But I think I'm ready for it. I'm assertive. And to be honest, I don't trust a lot of people either. To put it in a very pessimistic way, I think I'm "mean" enough to be a surgeon, while I'm sane enough to be a caring doctor.

Eh, you don't have to be mean - I'm frequently told I'm "too nice" to be a surgeon - but you do have to be assertive and be unwilling to accept excuses when it comes to caring for your patients. OTOH, one of my former interns probably thought I was mean when I read him the riot act for being over an hour late for rounds twice in two weeks.

As for my roommate's uncle, well my roommate has a very troubled life. It's highly possible that he was lying. I don't even remember whether he told me that or his mother did. I don't know the surgeon's name. I could've told you my roommate's last name, but I don't think that's an appropriate thing to do.

He may very well have been lying because as we noted, it really seems out of the realm of the norm. A Chair I know makes $700K and he's at a pretty prestigious program, so its hard to figure that someone could be making THAT much more. At any rate, it WOULD be inappropriate to tell us because your friend is not a public figure, so doesn't deserve us discussing him here.