1)Very very low opportunity for private practice ownership, CT graduates are either hired by a hospital or working in academics. What about those who want to be their own boss? Make partner one day, answer to no one, make their own business decisions? If this is what you want, maybe CT isn't it.
2)The most recent job report on CT I've read stated that 30% of trainees still graduate without a job offer, after 8 years of training? You have to be kidding me! This field is still over saturated.
3)Interventional cardiologists, need I say more? It pains me to say, but that's the future of CT, they have and will continue to take over the field, valvular work will diminish.
4) Lifestyle is one of the worst if not the worst, which is not much of a deterrent for me, but I should at least get compensated well or if not then I should at least be working for myself, have some ownership over my practice, if I'm going to be putting in 90 to 100 hr weeks as an attending, I might a well be doing it for my business, but no read con #1.
5) salary is low, there are more graduates than there are jobs, it's a buyers market, this coupled with the length of training makes CT less attractive
6) integrated programs do not allow you to become board certified in general surgery. There is only one program integrated program I even considered applying to, and that was NYU. The only integrated program that allows you to be general surgery board certified. Why would that be important? If you revisit cons 1-6 you'll understand that having an outlet or a way to bail out is important. General surgeon do quite well and are in demand.
7) CABG will comprise about 90% of what you do, unless you are doing both thoracic and cardiac, or working at a major or top academic center, academia may take it down to 80%.
I will humbly disagree with some of your points...
(1) You may just be looking at big-market cities with powerful academic groups - lots of private practice groups out there who make a killing (1.5-2x the academic salary). And they do both cardiac and thoracic (something you can't really do in academics).
(2) Not sure where you got this data. My own experiences are limited to a big, cardiac-heavy residency program and my current fellowship program...but everyone that wanted a job, got one. In all the years I've been training, of all the fellows I've seen or known graduate, only 6 didn't immediately start a job after their CT fellowship. Two went into Peds CT, one went into an aortic superfellowship, one went into VADs/transplant, one went into a minimally invasive esophagectomy superfellowship and the last guy went into a program as a "junior attending" for 6 months before he became a regular attending there. All of those superfellowship folks kept training by choice, not because they couldn't find a job.
This doesn't, of course, include the non-ACGME fellows (the "international" fellows) who go back home.
(3) Interventional cardiologists are starting to get into the Medtronic CoreValve (still in trials) and Edwards Sapien transfemoral/transapical aortic valve stents. But these hybrid cases still need a cardiac surgeon in the room (you're not just "backing them up"). But that's it. That's really all that's on the horizon...percutaneous mitrals are a long way away. (Mini-mitrals and robotic mitrals are here, though, of course, and only done by cardiac surgeons.)
As more and more data comes out on the superiority of CABG vs. PCI in many patients (see the recent SYNTAX trial), cardiologists will be doing less stents and referring more patients. When insurance/Medicare eventually catch on, they'll stop reimbursing cardiologists for stents/PCIs that aren't indicated...a sure way to change practice behavior.
(4) Lifestyle can be bad. Lots of emergencies. But even the busiest guys don't work 90-100 hours a week. One of the busiest guys here operates four days a week, has clinic the fifth day. If you figure 7a-8p on the four operative days, 8a-4p on the clinic day...even if he rounded for 4 hours each day on Saturday and Sunday and came in for a 6-hour takeback for bleeding once a week, that's still only 74 hours a week. And that's a grossly overexaggerated, overly busy schedule.
As residents/fellows, we easily rack up the hours because we (1) come in very early to round, (2) often stay very, VERY late, and (3) take overnight call. That's how we easily get to 80, 90, 100, 110 hours a week.
(5) Again, not sure where you're getting your salary figures from. While the golden age of cardiac surgery (the 1980s) is over, and people aren't making a million a year anymore...they're not starving nowadays. And this is in academics. In private practice? Double it.
(6) Perhaps. I'm not big on the integrated programs, having gone the traditional route myself. I agree you shouldn't be board-eligible if you skip out on the critical senior/chief resident years of your training.
(7) Depends on the program - most academic cardiac surgeons don't just do CABGs though. Lots of valve work out there...and if you're at one of many centers who specialize in other aspects of cardiac, you may find you're buried in valves or aortas up the wazoo.
YMMV. What type of CT fellowship do you have at your residency program?
