breast fellowship

[PAgirl]

How competitive is a breast fellowship right now? Do you need to do a gen surg residency at a university program? Do you need research during residency?

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[Winged Scapula]

The match rate has hovered around 65% for the last few years. The number of positions is low compared to the number applying. The SSO has put a moratorium on new programs opening up (after a flurry of new programs in 2007) for 3 years. I have not heard if they are formally lifting it next year or not (I am not on the Education Committee any longer).

Some programs will take an Ob trained resident, but general surgery is the preferred pathway.

It is not necessary to train at a university program or to have research except in the most academic programs (Memorial, MD Anderson, etc.). These are great programs but not appropriate, IMHO, for someone who wants to do a private or community practice as you will not learn the skills you need to be successful in that arena.

The breast fellowship community is small and making connections is probably just as important as anything as there is an expectation, especially at programs that might be more likely to train you for private practice, that you will be personable. The patients are fairly high maintenance, there are lots of follow-ups and you have to be comfortable working in a multidisciplinary environment with lots of other physicians. So many programs put an emphasis on your interpersonal skills, more so than many surgical specialties. In addition, my program (and others I've seen) also include "appearance/comportment" as a factor in your interview. Research doesn't hurt and certainly presenting something at the annual meeting would get your name out there.

There are a few threads in here about this topic which you can find if you do a search.

 

[JackADeli]

...Some programs will take an Ob trained resident, but general surgery is the preferred pathway.

...university program ...IMHO, for someone who wants to do a private or community practice as you will not learn the skills you need to be successful in that arena...

I am not a breast surgeon per se. However, I will add, numerous communities are starving for specialists and have fairly lucrative recruitment packages.... But, the caveat is this..... CEOs try to obtain the "swiss army knife" specialists. They love an OB/Gyn/Breast surgeon or General/Vasc/MIS surgeon or Thor/Vasc/Gen surgeon..... Unfortunately, residencies often fail miserably in preparing you for the reality of what the community hospitals are recruiting.... Not to even mention the dreaded TRAUMA!!!

 

[Winged Scapula]

Yes, I've seen those ads and they do tend to get a bit ridiculous with the breadth of things they want their physicians to do.

One of the issues SSO breast fellowships have with Ob residents is that they start from scratch. All GS residents have done the basic procedures (mastectomy, axillary staging, wire localized lumpectomies, port placements) in breast surgery during residency. OB have not. In addition, some of the fellowships require Surg Onc or GS call, which of course, an OB fellow cannot take.

The point I was making about the university programs is that most do not teach image guided surgery and biopsy which is the key to success in private/community breast surgery practice. It has been suggested that programs that do not teach such tools should not be accredited, but that would mean removing accreditation from some of our countries most prestigious medical centers.

The compartimentalization that happens in academics is not so prevalent in the community...I like "Swiss Army Knife" surgeon. I will have to use that phrase (with your permission).

 

[JackADeli]

...One of the issues SSO breast fellowships have with Ob residents is that they start from scratch. All GS residents have done the basic procedures ...in breast surgery during residency. OB have not...

...The compartimentalization that happens in academics is not so prevalent in the community...I like "Swiss Army Knife" surgeon. I will have to use that phrase (with your permission).

I believe we are on the same sheet of music. I agree. I am definately NOT advocating OB/Gyn route to breast surgical oncology. I am just noting the surprising "reality" one finds when getting out into the community. Academics definately does have a great deal of "compartmentalization".... it's like the old joke about being an academic superspecialist that only specializes in disorders of the LEFT testicle and thus refusing the consult for the right in the middle of the night! I actually saw an "Academic" GSurgery attending that fancied themself an "MIS" specialist. Did bowel resections, gall bladders, apendectomies, hernias, took trauma call, etc.... But, made very clear could not safely care for a patient's hemorrhoids.

Feel free to use the "SAK" surgeon reference at your discretion

 

[cncrsrgry]

Winged Scapula,

How much of your practise is office based, image guided procedures (biopsies, FNAs, brachytherapy catheter placement, etc), port removal etc?

Anything else of significance done in the office?

How many of these procedures do you do versus OR cases per week?

Are your numbers typical?

Thanks

 

[Winged Scapula]

Winged Scapula,

How much of your practise is office based, image guided procedures (biopsies, FNAs, brachytherapy catheter placement, etc), port removal etc?

Anything else of significance done in the office?

How many of these procedures do you do versus OR cases per week?

Are your numbers typical?

Thanks

I don't know the numbers (and they vary week to week) so don't know if they are typical or not. I do not do Port Removal in the office but average about 10 cases per week. Remember I am just starting out in practice and I see a lot of non-op stuff (unfortunately) so expect those numbers to increase.

I alternate spending 2 days in the office with 3 OR days and the reverse the next week. I will have some weeks where I do no in office procedures and other where I am seemingly doing 4 or 5 a day.