about cardiac surgery

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peace zealot

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well i want to get enlightened about cardiac surgery...what is the scope of this field in future...and also the most important question what score in usmle would be sufficient for an IMG to get a residency in this field......does the repute and grades of my school will matter in future in getting any residency in USA in any field......
will anybody enlighten me...........???

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well i want to get enlightened about cardiac surgery...what is the scope of this field in future...and also the most important question what score in usmle would be sufficient for an IMG to get a residency in this field......does the repute and grades of my school will matter in future in getting any residency in USA in any field......
will anybody enlighten me...........???

I'm not sure asking what score is sufficient is the right way to approach this. It's not like your will change your study method based on whether we tell you 220 or 250. Always shoot for the top score you can get.
I believe there is an active thread in the step 1 forum linking to info on residency scores by specialty. But notwithstanding that, some specialties are reportedly going to be more friendly to IMGs than others. Surgery is a field that has gone up and down in popularity, due to the lifestyle issues, so it is somewhat hard to predict the trends.
Yes, the reputation and grades you get in med school will matter in terms of US residencies -- decisions are not purely driven by Step 1 scores, and things like clinical evaluations, deans letters, research count.
 
CT surgery isn't as dead as people make it out to be. Interventional cardiology has creeped into coronary bypass but there's still plenty of work for the surgeons. And there's going to be a HUGE demand for cardiac surgeons in the future as baby boomers get older (my advisor whose a CT surgeon gave me the numbers the other day, I can't remember the specifics, but it puts CT surgery as the most underrepresented/underserved surgical specialty in 10 years). Something around 65% of all CT surgeons out there are over the age of 50 (this is based on an estimate from a reliable source, not on hard numbers). That being said, the training is not going to get any shorter. It's still a long road to get there, and its still a lot of hours when you do get there. It's getting better though, and should continue to do so.

The area I'm interested in that's going to be evolving quite a bit is congenital cardiac surgery (it's about to become its own recognized specialty). No longer is it dealing solely in peds, as surgeons these days are reaping the successes of their predecessors and the average age of patients grows older (since those newborns are growing up). As a result a lot more congenital cardiac surgeries are becoming elective in nature (since, for example, a valve replacement is something that can be taken care of during a certain period of time instead of being an emergency procedure).
 
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There was an article about CT Surgery published in the New Physician, a few months ago. What I took away from the article was that its gradually getting easier to get into. The workload is decreasing, as preventative and invasive cardiology is advancing. CT Surgery is becoming more of a last resort.
 
Something around 65% of all CT surgeons out there are over the age of 50 (this is based on an estimate from a reliable source, not on hard numbers).

I heard a talk from a CT surgeon who indicated it was "literally" a dying field, regardless of the demand, because the average age of a CT surgeon is well in his/her 60s. He predicted that if a lot of new young blood was not brought in and fast, the subspecialty would cease to exist in the not too distant future, and the turf would be taken over by other (younger) specialties.
 
I heard a talk from a CT surgeon who indicated it was "literally" a dying field, regardless of the demand, because the average age of a CT surgeon is well in his/her 60s. He predicted that if a lot of new young blood was not brought in and fast, the subspecialty would cease to exist in the not too distant future, and the turf would be taken over by other (younger) specialties.

Doesn't surprise me. The CT department at my school has been pushing hard lately to get medical students interested. I don't want to say they sounded desperate... but they sounded desperate. Can't blame them, because there's a lot of negative preconceptions of the field these days (high level of arrogance and difficult colleagues, quickly being enveloped by interventional cardiology, lots of call and long hours in practice, having to do the full general surgery residency plus fellowship, etc)

Hard to believe from a specialty that was one of the most competitive to go into 10 years ago!
 
Hard to believe from a specialty that was one of the most competitive to go into 10 years ago!

Might have been a little longer ago than that - more like 15, perhaps?

Plastics has been popular since at least the late '90s.
 
So for cardiac surgery, you do 5 years of GS, and then how long is the fellowship 1 or 2 years?
 
Moving to Surgery and Surgical Subspecialties as this is a question about residency.
 
My main quesiton is if the CT guys are so worried about Interventional cards, why cant they just start doing heart caths, etc, and pick up on business as usual? Is it just hospital politics-IE patient comes in, gets referred to the IC guys and they just take the procedures rather than giving them up to the CT guys?
 
My main quesiton is if the CT guys are so worried about Interventional cards, why cant they just start doing heart caths, etc, and pick up on business as usual? Is it just hospital politics-IE patient comes in, gets referred to the IC guys and they just take the procedures rather than giving them up to the CT guys?

Cardiology controls the referrals… they wouldn’t refer a procedure they can do themselves and get the money for. Simple as that.
 
The area I'm interested in that's going to be evolving quite a bit is congenital cardiac surgery (it's about to become its own recognized specialty). No longer is it dealing solely in peds, as surgeons these days are reaping the successes of their predecessors and the average age of patients grows older (since those newborns are growing up). As a result a lot more congenital cardiac surgeries are becoming elective in nature (since, for example, a valve replacement is something that can be taken care of during a certain period of time instead of being an emergency procedure).

I don’t really understand what you mean with this statement. How is paed cardiac surgery becoming it’s own specialty? Are you suggesting that training in this very very subspecialised field is going to separate from CT surgery? If so then I would like to know what you are basing this on? This is a very complex and very difficult subspecialty. I don’t see how anyone can be a paediatric cardiac surgeon without foundation training in the adult sector.

And by the way, a procedure being planned as an elective case doesn’t make it much easier then if it was done as an emergency. The demand for a high success rate is much greater if you have time to plan the procedures vs. during an emergency.
 
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so its a total of 7 to 8 years to be a ct surgeon
 
CT surgery isn't as dead as people make it out to be. Interventional cardiology has creeped into coronary bypass but there's still plenty of work for the surgeons. And there's going to be a HUGE demand for cardiac surgeons in the future as baby boomers get older (my advisor whose a CT surgeon gave me the numbers the other day, I can't remember the specifics, but it puts CT surgery as the most underrepresented/underserved surgical specialty in 10 years).

I'd be careful about totally buying the current recruiting pitch from the CT Surgery guys. They are desperate to fill their fellowship spots, and are currently heavily selling the line about how the glory days will return in 10 years once all the current old CT guys retire.

Maybe it's true, but things might just as easily get worse. Catheter-based intervention is continually getting better, medical management of coronary disease is constantly improving, and percutaneous cardiac valve replacement is already a reality. Combine that with a decreasing lung CA rate, and you may not see that much of an upturn in the demand for CT surgeons.

Luckily, as a medical student you have a few years to watch what happens to the specialty before you commit.
 
Or you could be like me and just plunge in headfirst. :) The (bleak) future be damned!
 
Well, since the CT surgeon of the house is busy doing a 3 vessel case, I'll be the one to comment.

Last year ie June 07, hubby finished fellowship. We sent CVs to about 25 openings. Had offers for 11 interviews, mostly in SE and some in West. Went on 7 interviews. Withdrew from 1 because it was a crappy job. Offered 3 jobs. Took 1.

Most of the jobs, including the one we took, had a similar profile:

40% cardiac, 20-ish thoracic and 20-ish vascular. Mr Iron maiden had some awesome vascular experience, and that went a long way on the job trail.

Financially the offers were great for us. 325k 1st yr, 350 2nd year and 450-650 for 3rd year as partner average. All the places we interviewed had a 2 year partnership track with a modest buy in (30-60k) at some.

The call ranged from q3-q6. Four places covered one hospital, while one covered two and a third covered three.

We looked on CT Net, Practicelink, and had several jobs passed on to us from the surgeons and cardiac anesthesia people. My husband has a great reputation as a competent surgeon and a decent human being, so we had a lot of folks willing to go to bat for us.

This time last year we were really nervous, but I have to say when they started putting contracts under our noses I became a believer.
 
Well, since the CT surgeon of the house is busy doing a 3 vessel case, I'll be the one to comment.

Last year ie June 07, hubby finished fellowship. We sent CVs to about 25 openings. Had offers for 11 interviews, mostly in SE and some in West. Went on 7 interviews. Withdrew from 1 because it was a crappy job. Offered 3 jobs. Took 1.

Most of the jobs, including the one we took, had a similar profile:

40% cardiac, 20-ish thoracic and 20-ish vascular. Mr Iron maiden had some awesome vascular experience, and that went a long way on the job trail.

Financially the offers were great for us. 325k 1st yr, 350 2nd year and 450-650 for 3rd year as partner average. All the places we interviewed had a 2 year partnership track with a modest buy in (30-60k) at some.

The call ranged from q3-q6. Four places covered one hospital, while one covered two and a third covered three.

We looked on CT Net, Practicelink, and had several jobs passed on to us from the surgeons and cardiac anesthesia people. My husband has a great reputation as a competent surgeon and a decent human being, so we had a lot of folks willing to go to bat for us.

This time last year we were really nervous, but I have to say when they started putting contracts under our noses I became a believer.

ahh... real world experience.

thanks for posting.
 
and one more thing.... the jobs and offers were pretty much at a standstill until the spring, and things suddenly started opening up. It was right after one of the big meetings (STS I think) and we saw things start to move.

By spring every other stinking resident in the hospital had a contract. It totally sucked going to work and being asked where we were moving. I mean, what resident doesn't have a job 3 months before finishing. (The interventional cards guys signed a year ahead, some with absurd signing bonuses.)

We saw our first offer in March and signed the one we wanted in April- complete with 25k signing bonus, so it was worth the wait. Up until then I was preparing to move back in with my parents and do radiology to support our family:)

We did encounter some real winners out there who were trying to get a new grad to come to work for the 125K (or so) range. One of our friends actually took a job like that for a year, but bagged 6 months in when he got a better offer.

The only applicants (2 jobs) who were chosen over us had 1-3 years experience.

1-3 years exp + good endovascular experience+ thoracic + strong rep of training program + recs is probably the formula that is most desirable

I think the moral is be patient. Also if the 1st job is not the dream job, keep building the CV and it will happen.

ps and I have to brag that his work schedule is ***AWESOME*** compared to fellowship!!!
 
and one more thing.... the jobs and offers were pretty much at a standstill until the spring, and things suddenly started opening up. It was right after one of the big meetings (STS I think) and we saw things start to move.

By spring every other stinking resident in the hospital had a contract. It totally sucked going to work and being asked where we were moving. I mean, what resident doesn't have a job 3 months before finishing. (The interventional cards guys signed a year ahead, some with absurd signing bonuses.)

We saw our first offer in March and signed the one we wanted in April- complete with 25k signing bonus, so it was worth the wait. Up until then I was preparing to move back in with my parents and do radiology to support our family:)

We did encounter some real winners out there who were trying to get a new grad to come to work for the 125K (or so) range. One of our friends actually took a job like that for a year, but bagged 6 months in when he got a better offer.

The only applicants (2 jobs) who were chosen over us had 1-3 years experience.

1-3 years exp + good endovascular experience+ thoracic + strong rep of training program + recs is probably the formula that is most desirable

I think the moral is be patient. Also if the 1st job is not the dream job, keep building the CV and it will happen.

ps and I have to brag that his work schedule is ***AWESOME*** compared to fellowship!!!


Thanks again for posting.

I have 2 questions:

1) How do you get good endovascular training in CT fellowship? Is this just a matter of getting into the right program?

2) How 'awesome' is his schedule... could you elaborate a little?


Thanks!
 
Yeah, please elaborate. From the types of practices you mention (40% cardiac, 20% thoracic, 20% vascular) sounds like they're either looking for CT and vascular fellowship trained surgeons or else a residency with an uncommonly good vascular component. Is that fair to say, that you'd essentially need to have 2 fellowships for the current job market?
 
Me: What were your vascular numbers and endovascular numbers and where did you get them?
(edit out grumbling about why I am asking this at 9pm)

CT: Our GS program- everyone who graduated had at least 2-3 times the required vascular cases and towards the end there were a lot more endovascular. I did at least 12 AAAs endovascularly for example.

Me: was that enough to get privileges?

CT:yes

Me: So how is your schedule?

CT: You know what my schedule is... Are we going to watch Grey's on tivo or what?

Me: Ok I'll finish this later.....
 
The call schedule is q4, which is great.

On avg he leaves the house at 7am. 8am on clinic day which starts at 9, after rounding on pts. (For years it was 5 or 6a when he left) M-Th home around 6:30 pm, earlier on Friday (5) unless it is his call weekend.

Probably once a week one of the following happens:
1. A case goes long or an emergent case comes in
or
2. Gets called in for perf esoph, emergent CABG, AAA- the fun stuff- while on call.

During fellowship there were many nights when both he and the other fellow were there 2 nights straight and had 2 rooms running the entire time. Craziness!!! It was "home call" which was a total joke. He was rarely home before 8, and often came in at 12 am only to leave again at 5 for unit rounds.

Also, lots of the cases were people that the outside folks didn't want to touch and dumped on the academics. Now he is getting people with great anatomy and healthy (relatively) ventricles so things seem to go a lot smoother overall. I think he is beginning to realize that not everyone has COPD and is on dialysis.

TIME OFF: 5 wks vacation incluging 1 CME week, 6 weeks as partner with all kinds of awesome benefits that come with the territory of being a partner.

if anyone is seriously looking, CTS Net, Practicelink, and the people you work with are the best bets for finding a job in CT right now.
 
All of the CT guys who went to his GS program have had no problem whatsoever getting credentialing at their CT hospitals as attendings. A fellowship is not required. ALl they did during interviews was ask numbers, and by then they had already called his references and checked on his reputation.

A friend of ours had very weak training in vascular and his chair at his program let him go hang with the rads and vascular and cards people for two months during the days during the last few months of his CT fellowship. His was a different situation, and you have to have people willing to help.

*****When interviewing for CT fellowships it is very very wise to ask the senior fellows if they have found jobs and if they have had the support of their chairman/attendings. In this job market a pro-active and well-connected chair is priceless.*****
 
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