No Iove surgery. I would probably quit medicine if I couldn't be a surgeon. Intern year was horrible, but each year gets a bit better.
That being said, when I started medical school I was pretty sure I would hate surgery. I'm not a morning person and I was always kinda of a klutz. But I totally fell in love with it during third year rotation. I think it's a great field and it's pretty secure compared to other fields in medicine right now. You really don't have to worry about being outsourced or replaced by an NP or a PA. (The people who think that a mid level can do a "simple" operation like a lap chole, lap appy, or hernia have never done one or don't understand that here's no such thing as a simple case. (I'm a 4th year resident and have done hundreds and I still regularly get tough cases where I struggle and am thankful I have an attending to bail me out.)
Agree. Fortunately, cardiac surgery is not simple.
In terms of CT, I absolutely love it, but the future of that field is not great. If you want to go into a field like that, CT attendings have told me that you better be willing to go anywhere in the country and be happy making as much as the average general surgeon. Don't expect your subspecialty training and extra years of training to earn you any more income.
Disagree. CABG is starting to turn around, and PCIs are declining nationally. Check out the FREEDOM trial and 5y follow up on the SYNTAX trial. The referring cardiologists are listening. People keep coming up with better technology, but it never seems to beat the operation that just turned 50 years old (Dr. Kolessov in the USSR performed the first LIMA-LAD in
1964).
Cardiac surgeons missed the boat on PCI, and that was a grave error. However, the ability to do a good coronary is still in demand and will be for the foreseeable future. Read the COURAGE trial. Stenting chronic stable angina doesn't improve survival, because it isn't the 90% concentric lesion that ruptures and kills you. It's the 40% eccentric lesion with a thin fibrous cap. Also, a significant proportion of coronary disease is a diffuse vasculopathy (e.g. diabetics, NSTEMI patients) rather than a single stentable lesion. This is more suited to a new conduit than stenting.
Is the future cardiac surgeon going to need wire skills? Absolutely. TEVAR and TAVR will need to be in the armamentarium of the future heart surgeon. These days with the S3 valve, TAVR no longer even requires a cutdown, so wire skills will be important. Having said that, TEVAR for anything other than symptomatic aneurysmal disease in a patient not eligible for an open operation, complicated type B dissection, and traumatic aortic injury (typically Vancouver III and IV) is unproven. Additionally, TAVR for anything other than high risk operable AVR and inoperable due to technical reasons (e.g. porcelain aorta) is of questionable benefit. High risk inoperable patients have many medical comorbidities. Will technology improve? Absolutely. Betting against science/technology is typically a losing game. Today's heart surgeons are adopting these technologies early.
On the one hand, the future cardiac surgeon may need to be an all-around utility player (horizontal integration): TEVAR, LVADs, port access mitrals, CABG. On the other hand, the future cardiac surgeon may need to be capable of crossing specialties to some extent(vertical integration): i.e. the aortic surgeon who is able to do the standard open AVR in addition to TAVR, valve-sparing aortic root replacements, TEVARs, total arches, descending thoracic aortic aneurysms, type A dissections, and TAAAs.
Well that sucks. If I were to go into cardiac surgery my plan was to go for integrated CT residency then do a one year transplant fellowship. Most of the hospitals that do transplants are academic (they're mainly in metropolitan areas) so chances for a job are slim like you said. Well, hopefully things change in the future.
As a 4th year resident do you still get to rotate through different services?
More and more programs are integrating. It allows for more time to incorporate the other fields (CT radiology, Interventional cards, Vascular, IR, etc.) into the training and further allows the trainee to become a true cardiovascular specialist.
Transplant is no longer just a transplant fellowship. It's Mechanical Circulatory Support too. LVADs, paracorporeal/extracorporeal VADs, ECMO, etc. in addition to transplant (both heart and lung). The role of the LVAD is evolving as outcomes improve and $/QALY improves. The evidence is that Bridge-to-Transplant LVAD patients survive better than medically treated Status 1B patients on the waitlist.
I'm really interested in this as I've gotten several different answers depending on who I talk to. Of course the interventional cards guys think this is likely to happen (and has already started to happen), but one of our newer CT faculty is fellowship trained in wire skills and does all the TAVR's with the cards guys. The 6 or 7 CT surgeons I've talked to at my institution don't think there will be an extreme downturn and there will always be a need for open cases. Your point about working in a major metro area is well taken, though. I've always loved CT and spent a large chunk of time on their service, but I'm scared about the future as well. One of the fellows told me he wished he did something else, but he was post-call that morning
Cardiac surgery can be painful: the patients are often sick, and the operations are tricky. However, there will always be a need for a surgeon.
.Ortho and Plastics can and many do have very good lifestyles as an attending.
