Cardiac Surgery is BACK...and competitive again (2016 update)

[Mr Cookie Pants]

It seems like every thread on CT is about a decade old. Which makes sense as Cardiac Surgery interest has been waning ever since 1987 or so. Well it's back, for a few reasons. I'll finish with yesterday match statistics.


THE DECLINE (2003-2013)
coincided with general surgery, lagged a few years. PCI (overusage) led to fewer cases, fewer jobs as the old guys were staying in the field. Pre 80HWW, general surgery life was bad but Cardiac training was even worse. Q2/Q3 in house CTICU + vad/txp/dissection call, all with the possibility of not getting a job, or making 275 to do 35 CABG a year and a bunch of decorts. Naturally, as the general surgery pool declined in number, cardiac declined. Especially with the appearance of MIS and vascular (endo). People of that time wanted to do CABG, CABG, CABG. The field was getting left behind and the mindset was singular. As a result, applications dwindled. Spots didnt fill, programs closed and even academic places operated mostly with PAs as trainees were scarce.

THE COMPETITOR (200😎
Integrated residency was the answer. Pluck the 'best and brightest' from med school, dont bother with the pancreas and perineum, churn out cardiac physicians. I'm not here to debate/discuss I-6. I'm sure they'll be fine. This got ~30 trainees. The first few are just going into practice currently. In doing this, what was ~130 spots for the traditional (2 or 3) has now dropped to 84! 30 spots have gone to I6, and another 10-20 programs have shut their doors. There is a supply and demand to this.

THE FIELD (2010)
Like I said, CT surgeons in the 80s wanted to do ONE thing. CABG. $5000 a pop in 1987 money, Coooley and his group of 7 did FIVE THOUSAND in 1982 alone. Money, quick recovery, a slick operation, its awesome. But as we know PCI happened. Crazy that patients didnt want a sternotomy if they could have a wrist poke. But the field evolved (TAAA, TAVR, actually being Thoracic (CT, not just C) surgeons) and current trainees have a different approach, more than a vessel technician. And on top of that, the average CT surgeon age is 55 or 57. Theres a group of 62-68 year old that have had the great jobs and they're retiring. Current graduates are getting 4-6 job offers. They're starting TAVR programs. Theyre actually good jobs and the pay is KILLER. most private practice guys are getting bought out and are employed so theres no overhead, you get RVUs for mediciad/uninsured patients. AKA, getting paid for work. Its a good field. And theres a dedicated thoracic track too, which has brought a subset of people who arent interested in doing dissections at 2am on thanksgiving when theyre 50. Much more controlled life, transitions to general surgery as well.

THE RESULT (2014-)
Traditional thoracic surgery was at an all time low in interest in 2011-12. Training has changed in terms of call coverage and treating you like a human. IN 2011, all US grads got a spot and then either filled foreign or didnt go filled. One place I interviewed at this cycle got NINE applications and it was decent spot. This year they got 67 for that one spot. Literally 4 years later. In 2014 it was about even, 2015 was the first year with more applicants than spots in a long while. 2016....well

2016 Match statistics
Spots: 84
Applicants: 120
Applicants who submitted a rank list: 115
Filled: 84/84
Unmatched: 31/115 (75%)
US grads unmatched: 20 (craziest stat of all)

So while its not Peds surg crazy, its definitely way harder than in the past 8+ years. I went on 16 interviews and received 20 (of 31 I applied to). 15-20 interviews seems to be about the norm. I matched at one of my top choices. But I was sweating. The interview trail is small and I probably am on a first name basis with 75 of the 120 on that list. When you see who didnt match, its unreal.

THE LONG AND SHORT
CT is back. The fellowship is more humane and the job market is better. As a result it is competitive. I thought 10 interviews would be enough, it's not. Go on 15-20. Have some cardiac experience prior. I can only imagine that the number of spots available (84) will go down as some are doing integrated (WashU, USC, thats 3 right there). It definitely isn't going up.

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[Winged Scapula]

Fair analysis except the GS INCREASED in popularity with number of apps up and post match open positions down due to the implementation of work hour rules in 2003.



Sent from my iPhone using SDN mobile

 

[SLUser11]

I went on 16 interviews and received 20 (of 31 I applied to). 15-20 interviews seems to be about the norm. I matched at one of my top choices. But I was sweating. The interview trail is small and I probably am on a first name basis with 75 of the 120 on that list. When you see who didnt match, its unreal.

Congrats on the match!

Where are you getting the match info? I can't find much specific to thoracic surgery on NRMP website.

Also, what percentage of the positions were filled by US allopathics vs DOs and IMGs? That always seems to be the most accurate measurement of competitiveness.

One thought, similar to what was seen with plastics, is that the applicant pool has been watered down since some of the most competitive applicants matched in the I-6 programs. What are your thoughts?

Congrats again. Weight off your shoulders.

 

[adenocard]

Applying for I6 this year and am super nervous. I'll be applying to gen surg also, but there's no doubt the limited number of spots and the number of applicants make this a tough match.

That said there was one unmatched program in the Midwest this year.
US Seniors: 65 applied
US Seniors Matched: 31 out of 38 positions = 81.6% US match rate. The majority of unmatched are either FMG/IMG or DO students.

http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf
Page 4

Congrats on matching!

 

[ARAV_Rocky]

Congrats on matching! Just curious, from what you know of the graduating residents with job offers, do you have an estimation of how many are going into academics?

 

[metalmd06]

Congrats on matching! I did too!

 

[OUMED2K16]

MS1 here interested in the field. Any advice on how to make myself a competitive applicant?

 

[ThoracicGuy]

MS1 here interested in the field. Any advice on how to make myself a competitive applicant?

Do well on Step 1.

 

[OUMED2K16]

Do well on Step 1.

haha yeah kind of figured that one. Anything else besides grades and step 1 at this point? Seems to be such a competitive field, I imagine they'll want to see a little more than that right?

 

[pacman2018]

haha yeah kind of figured that one. Anything else besides grades and step 1 at this point? Seems to be such a competitive field, I imagine they'll want to see a little more than that right?

not planning on going into CT surgery myself, but for pretty much any competitive specialty this is all you need to do during preclinical. Try to do research and get published summer after first year. even if you change your mind and go into something else, being productive and getting published is positive for residency apps (although obviously field specific research is best)

 

[ThoracicGuy]

haha yeah kind of figured that one. Anything else besides grades and step 1 at this point? Seems to be such a competitive field, I imagine they'll want to see a little more than that right?

Research is helpful, particularly if you can find a project in the CT field. Publications are what helps to show that. It also helps to have a CT training program where you are in med school as you can get in with that group and get known to them. They would be one of your best resources.

Show dedication to the field and that goes a long way. Networking is very beneficial. And of course grades/steps are important as well.

 

[CTFellowMD]

2016 Match statistics
Spots: 84
Applicants: 120
Applicants who submitted a rank list: 115
Filled: 84/84
Unmatched: 31/115 (75%)
US grads unmatched: 20 (craziest stat of all)

Thanks for this years stats. Compared to 2011 when there were 99 applicants for 113 spots, things have changed dramatically. The applicants this year were VERY strong, and I'm shocked at some of the people that didn't match.

For comparison, I had posted the last 2 year stats previously:

2014 app cycle (2015 appointment year):
114 applicants for 87 spots.
4 unfilled spots (in reality, only 2 - Kansas and Nebraska), and 31 unmatched applicants
Overall 73% match rate
US grads: 87 applicants, 65 who matched (75% match rate)

2015 app cycle (2016 appointment year):
127 applicants for 90 spots
0 unfilled programs
Overall match rate: 71%
US grads: 86 applicants, 69 matched (80% match rate)

Also, what percentage of the positions were filled by US allopathics vs DOs and IMGs? That always seems to be the most accurate measurement of competitiveness.

I don't have the data for this years cycle, but for the 2015 app cycle:
Of the 90 matched applicants -- 69 MD, 3 DO, 2 Canadian, 5 US International, 11 Non-US international


Interested to see the full analysis of the 2016 app cycle when NRMP releases it.

 

[Danbo1957]

Those CT surgeons aged 55 to 57 are busy, on older Boomers. Six to ten years from now when current MS1's-PGY1's enter the market, those hard-living, chicken-fried steak eating, boozed-out, recreational drug riddled 1945-1960 born Boomers will be dead or hitting 70-80 years old (and out of the target patient population). Current ~90 CT program slots may fill, but don't expect many mothballed programs to reopen...

Water doused.

 

[ThoracicGuy]

Those CT surgeons aged 55 to 57 are busy, on older Boomers. Six to ten years from now when current MS1's-PGY1's enter the market, those hard-living, chicken-fried steak eating, boozed-out, recreational drug riddled 1945-1960 born Boomers will be dead or hitting 70-80 years old (and out of the target patient population). Current ~90 CT program slots may fill, but don't expect many mothballed programs to reopen...

Water doused.

70-80 years old is pretty common for bypass and valve surgery...

 

[OUMED2K16]

Those CT surgeons aged 55 to 57 are busy, on older Boomers. Six to ten years from now when current MS1's-PGY1's enter the market, those hard-living, chicken-fried steak eating, boozed-out, recreational drug riddled 1945-1960 born Boomers will be dead or hitting 70-80 years old (and out of the target patient population). Current ~90 CT program slots may fill, but don't expect many mothballed programs to reopen...

Water doused.

Cardiac surgery is most common in the 7th decade of life so the patient population is only going to expand for the next decade or so and peak around 2025-2030...

 

[Danbo1957]

Ok. You have the next 10-15 years... then what? Ain't going to need ~1000 CT surgeons under the age of 50 after 2030.

 

[Brahnold Bloodaxe]

Those CT surgeons aged 55 to 57 are busy, on older Boomers. Six to ten years from now when current MS1's-PGY1's enter the market, those hard-living, chicken-fried steak eating, boozed-out, recreational drug riddled 1945-1960 born Boomers will be dead or hitting 70-80 years old (and out of the target patient population). Current ~90 CT program slots may fill, but don't expect many mothballed programs to reopen...

Water doused.

If you look at the population pyramid, it seems the hexagenarian population will keep getting bigger until it reaches a peak roughly 10 years from now as today's 50 year olds enter their 7th decade. Even beyond that peak 10 years from now, subsequent cohorts will still be far larger than today's geriatric population simply because the US population has continued to grow at a rapid clip well past the baby boom. So true, we will hit a peak in less than 15 years, but the post-peak hexagenarian population will still be far larger than where we're at today and will hit a new peak by the time today's M1s are in late career.

 

[Danbo1957]

I'm going to figure that in 40 years time CT medical procedures will be far different than that of now; anyway, no future American population will require 1000+ CT surgeons (if ~90 slots were to fill per year over the next ten/twelve years).

 

[Mr Cookie Pants]

Congrats on the match!

Where are you getting the match info? I can't find much specific to thoracic surgery on NRMP website.

Also, what percentage of the positions were filled by US allopathics vs DOs and IMGs? That always seems to be the most accurate measurement of competitiveness.

One thought, similar to what was seen with plastics, is that the applicant pool has been watered down since some of the most competitive applicants matched in the I-6 programs. What are your thoughts?

Congrats again. Weight off your shoulders.

The match info is actually on the NRMP website where I log in to see status, rank list, etc. I dont think they've officially released it yet. I will reprint some of it but theres staunch legal warnings.

I dont think that my class (2010-12 medical school depending on research) was watered down. There were only ~15 spots or so in the I-6 back then, really wasnt a viable option unless you had been tracking into it as a M1 (which was 08, the first year of the I-6)

US MD grads 59/79 (75%) 20 unmatched, 3 not certified, withdrawn
US DO 6/7 (83%)
Canada 2/2 (100%)
US Foreign (US citizens who obtained med degree elsewhere) 8/12 (66%)
Foreign 9/15 (66%)


---------------------------

One thing I don't have is cardiac vs thoracic as that data is not available. Of the people I know who didnt match, most were trying Thoracic, which has fewer spots and is more academic.

 

[OUMED2K16]

You're really going out on a limb saying medical procedures will be different in 40 years. Every medical profession will rapidly change and most, if not all, of those CT surgeons will have a need based on that age chart Brahnold posted.

 

[SLUser11]

The match info is actually on the NRMP website where I log in to see status, rank list, etc. I dont think they've officially released it yet. I will reprint some of it but theres staunch legal warnings.

I dont think that my class (2010-12 medical school depending on research) was watered down. There were only ~15 spots or so in the I-6 back then, really wasnt a viable option unless you had been tracking into it as a M1 (which was 08, the first year of the I-6)

US MD grads 59/79 (75%) 20 unmatched, 3 not certified, withdrawn
US DO 6/7 (83%)
Canada 2/2 (100%)
US Foreign (US citizens who obtained med degree elsewhere) 8/12 (66%)
Foreign 9/15 (66%)

Thanks for the stats! I've always found match statistics (as they relate to competitiveness) to be very interesting. We consider supply/demand along with the quality of the residents trying for the spots (schools, scores, AOA, research, etc), but really there's much more to it. For example, the resident's LOR and the relationship between the resident's mentor and the fellowship of choice have a huge impact on match rates, but this can't be effectively tracked.

A quote from the NRMP based on the 2015 data (http://www.nrmp.org/wp-content/uploads/2015/02/Results-and-Data-SMS-2015.pdf): Gynecologic Oncology had the highest proportion filled by U.S. allopathic medical school graduates
(92.2%) and Nephrology had the lowest (31.1%). The top five specialties in the percentage of positions filled by graduates of U.S. allopathic medical schools are Gynecologic Oncology (92.2%), Pediatric Surgery (89.6%), Hand Surgery (89.3%), Interventional Radiology (85.2%), and Neuroradiology (84.3%).

Table 6 from that document (page 31) probably best demonstrates the increased competitiveness of CTS over the last 5 years.

 

[Thanatos]

It seems like every thread on CT is about a decade old. Which makes sense as Cardiac Surgery interest has been waning ever since 1987 or so. Well it's back, for a few reasons. I'll finish with yesterday match statistics.


THE DECLINE (2003-2013)
coincided with general surgery, lagged a few years. PCI (overusage) led to fewer cases, fewer jobs as the old guys were staying in the field. Pre 80HWW, general surgery life was bad but Cardiac training was even worse. Q2/Q3 in house CTICU + vad/txp/dissection call, all with the possibility of not getting a job, or making 275 to do 35 CABG a year and a bunch of decorts. Naturally, as the general surgery pool declined in number, cardiac declined. Especially with the appearance of MIS and vascular (endo). People of that time wanted to do CABG, CABG, CABG. The field was getting left behind and the mindset was singular. As a result, applications dwindled. Spots didnt fill, programs closed and even academic places operated mostly with PAs as trainees were scarce.

THE COMPETITOR (200😎
Integrated residency was the answer. Pluck the 'best and brightest' from med school, dont bother with the pancreas and perineum, churn out cardiac physicians. I'm not here to debate/discuss I-6. I'm sure they'll be fine. This got ~30 trainees. The first few are just going into practice currently. In doing this, what was ~130 spots for the traditional (2 or 3) has now dropped to 84! 30 spots have gone to I6, and another 10-20 programs have shut their doors. There is a supply and demand to this.

THE FIELD (2010)
Like I said, CT surgeons in the 80s wanted to do ONE thing. CABG. $5000 a pop in 1987 money, Coooley and his group of 7 did FIVE THOUSAND in 1982 alone. Money, quick recovery, a slick operation, its awesome. But as we know PCI happened. Crazy that patients didnt want a sternotomy if they could have a wrist poke. But the field evolved (TAAA, TAVR, actually being Thoracic (CT, not just C) surgeons) and current trainees have a different approach, more than a vessel technician. And on top of that, the average CT surgeon age is 55 or 57. Theres a group of 62-68 year old that have had the great jobs and they're retiring. Current graduates are getting 4-6 job offers. They're starting TAVR programs. Theyre actually good jobs and the pay is KILLER. most private practice guys are getting bought out and are employed so theres no overhead, you get RVUs for mediciad/uninsured patients. AKA, getting paid for work. Its a good field. And theres a dedicated thoracic track too, which has brought a subset of people who arent interested in doing dissections at 2am on thanksgiving when theyre 50. Much more controlled life, transitions to general surgery as well.

THE RESULT (2014-)
Traditional thoracic surgery was at an all time low in interest in 2011-12. Training has changed in terms of call coverage and treating you like a human. IN 2011, all US grads got a spot and then either filled foreign or didnt go filled. One place I interviewed at this cycle got NINE applications and it was decent spot. This year they got 67 for that one spot. Literally 4 years later. In 2014 it was about even, 2015 was the first year with more applicants than spots in a long while. 2016....well

2016 Match statistics
Spots: 84
Applicants: 120
Applicants who submitted a rank list: 115
Filled: 84/84
Unmatched: 31/115 (75%)
US grads unmatched: 20 (craziest stat of all)

So while its not Peds surg crazy, its definitely way harder than in the past 8+ years. I went on 16 interviews and received 20 (of 31 I applied to). 15-20 interviews seems to be about the norm. I matched at one of my top choices. But I was sweating. The interview trail is small and I probably am on a first name basis with 75 of the 120 on that list. When you see who didnt match, its unreal.

THE LONG AND SHORT
CT is back. The fellowship is more humane and the job market is better. As a result it is competitive. I thought 10 interviews would be enough, it's not. Go on 15-20. Have some cardiac experience prior. I can only imagine that the number of spots available (84) will go down as some are doing integrated (WashU, USC, thats 3 right there). It definitely isn't going up.

Congrats on matching! The match stats are certainly reflecting a lot of our experiences, I was interested in cardiac back when I applied to general surgery (because the I6 didn't really exist then, at least not in more than 2 programs I think) and the only real way was the 10 year path. It was interesting to watch my chief and senior residents easily get interviews and all match at their #1 spots 5 years ago....some of them had never published a paper, a few of them failed the absite every year and etc etc.....a lot of them were poor applicants on paper but didn't care because the field was so wide open. They went on to interview and match at big name places and came back to report "hey buddy you're gonna be fine, when you apply they're just gonna ask if u have hands and speak english and if you do you're set!" But when I applied and matched two years ago (2014 cycle) my competition was legit....I met a lot of really cool people on the interview trail and made some friends, but I was impressed by a lot of my co-applicants who had done 2 years of research with important people and came from fancy places. I did 13 interviews back then and my advisors thought I was absolutely over doing it but looks like that would be on the low side now, I predict in a few years it will be 20 plus. Now I have junior gen surg residents telling me they're working their asses off trying to get more competitive for the CT match......so in 6-7 years we've gone from wide open to sweating bullets. Probably a combination of more interest and decreased spots because of the I6.

I work at a big fancy place that will not be named and our applicants are certainly impressive, but no one can catch these I6 people who are some of the best applicants coming out of medical school for any field. I'll be interested to see how all of that works out of course, they're still coming straight out of medical school and we are all going to have to adjust our curriculums to accommodate them.....a lot of my attendings haven't taught at the "a 6-0 is smaller than a 5-0 prolene" for a good long time so we'll see.

Those CT surgeons aged 55 to 57 are busy, on older Boomers. Six to ten years from now when current MS1's-PGY1's enter the market, those hard-living, chicken-fried steak eating, boozed-out, recreational drug riddled 1945-1960 born Boomers will be dead or hitting 70-80 years old (and out of the target patient population). Current ~90 CT program slots may fill, but don't expect many mothballed programs to reopen...

Water doused.

I was patiently waiting for this series of posts (didn't quote them all) because a large part of the medical community is still convinced that cardiac surgery is just going to roll over and die any minute, and everyone heard from someone who heard from someone 10 years ago that was true and so it must be so. That no matter what there's going to be a bunch of cardiac surgeons sitting around with no work to do because over training + less volume or whatever. The most common things I heard throughout residency about my interest in cardiac was that 1) cardiac surgeons were a dying breed in a dead field who will have no surgery to do and 2) the lifestyle is going to be so horrible you're going to hate it. I always found those two things constantly spewed around like common knowledge, despite the fact that they somehow can't both be true when you think about it, and like Duke lacrosse players if you hear something enough it must be true even if you lack any evidence.

What I can tell you from my experience in one shop is that our CABG referrals have gone slightly up in the past year....it turns out that despite all the statins, drug eluting stents and aggressive non-referring cardiologists studies keep coming out showing just how good CABG outcomes are. Despite all the bad rumors I heard over the years, now that I'm in fellowship I get a fair number of legit consults every day, with a significantly higher needs surgery : doesn't need surgery ratio than I ever got in general surgery I might add, even on people I would much rather let cardiology keep! Hell we go to high risk conference every week with cards and try to pass around some of these like hot potatoes....NOT IT NOT IT!!

A lot of my experience is what common knowledge led me to expect, we do CABG, AVR, mitral valve repair and replacement daily and are booked out weeks ahead of time. What I didn't even know before was everything else:

1. most centers are seeing their LVAD volume go up, in the next few years most of us are predicting the HVAD and HeartMate 3 outcomes to be better than previous devices. The development of smaller pumps without drivelines will be an explosion in volume, and its hard to say if we will find more clever ways to preserve donor organs. So many hearts and lungs get thrown in the trash now, if we can find a way to increase the donor pool thats going to lead to some work to do given our enormous heart failure population.

2. TAVR is certainly not going anywhere, with the Partner III trial now enrolling for low risk patients. There is concern this will dip into surgical volume of course, unless we stay involved doing TAVR and make that part of our scope of practice. There are plenty of old frail people who are poor surgical candidates, and even if we get more aggressive with TAVR there's this: http://www.medpagetoday.com/meetingcoverage/europcr/57983 which means there may be a fair number of people who will need surgical AVR to come save the day. What remains to be seen is how we're going to do that....complex root surgery is not for the faint of heart, and the way some of these TAVR valves may grow into surrounding tissue we may have to invent new procedures to get out of this mess, unless you think sewing a dacron graft to the actual ventricle is easy.

3. We do a fair number of pacemakers in people EP turns away because of weird anatomy or previous infection or whatever....we do VATS epicardial leads at least a few times a week and it lets me feel that all my time doing minimally invasive surgery in thoracic wasn't wasted completely. At the end of the day its the same old thing....when I was in general surgery we always had that one IR guy who never could find that window to drain that abscess (especially on Fridays and weekends) or who didn't think he could embolize that bleeding spleen or stent that SFA......same with cardiology and EP, we get a fair number of referrals to do things I don't think most people are even aware we do that often.

So food for thought, I'm not a market economist but most of us are very busy in cardiac and develop a great relationship with cardiologists who regularly find us plenty of work to do. I think the field got a bad rap in the 80's when PCI really took off and since then the reputation has been hard to shake. What I find amusing is that a lot of us aren't experiencing the doomsday so many people outside the field have predicted for us. More amusing is that I wonder about the doomsday reckoning of other surgical fields no one talks about because lets face it.....all of us in surgery are one magic pill away from being extinct right? What if GI comes out with a pill that reliably dissolves gallstones? Antibiotics for appendicitis (there is already literature)?? Trauma is already mostly non operative, and the diet industry is working damn hard for medication that can kick bariatric surgery back to hell where it clearly belongs. Half my residency program went into breast surgery, a field where early detection is prioritized/publicized and very well funded, and the chemotherapy is getting better and better for those tiny little DCIS things they find.....would it be crazy to say we should worry most about them? I'm not pointing fingers, just saying that you can predict the demise of any field and make it sound scary. But in reality you're all going to go back to work on Monday and find plenty to do, because everything evolves.

 

[Medstart108]

Great news, i've noticed the sea change as well. Canada's had its 6 year Cardiac Surgery training programs since the 70s and its interesting to see how the I-6 is getting more and more popular in the states as well.

Cardiac has gotten more competitive in Canada as well, 3-4 years ago spots were being left unfilled, there were 5 applicants for about 10 spots across country in 2010-11, 2016 there were 12 applicants who ranked cardiac surgery as their first choice for 9 spots.

 

[Neurosurgeon26]

Do well on Step 1.

Sorry - how well are we talking here? Is a 239 an okay score to apply to integrated CT?

 

[ThoracicGuy]

Sorry - how well are we talking here? Is a 239 an okay score to apply to integrated CT?

Probably.

 

[Psai]

Sorry - how well are we talking here? Is a 239 an okay score to apply to integrated CT?

239 is an okay score for pretty much anything

 

[Shorin-Ryu]

It seems like every thread on CT is about a decade old. Which makes sense as Cardiac Surgery interest has been waning ever since 1987 or so. Well it's back, for a few reasons. I'll finish with yesterday match statistics.


THE DECLINE (2003-2013)
coincided with general surgery, lagged a few years. PCI (overusage) led to fewer cases, fewer jobs as the old guys were staying in the field. Pre 80HWW, general surgery life was bad but Cardiac training was even worse. Q2/Q3 in house CTICU + vad/txp/dissection call, all with the possibility of not getting a job, or making 275 to do 35 CABG a year and a bunch of decorts. Naturally, as the general surgery pool declined in number, cardiac declined. Especially with the appearance of MIS and vascular (endo). People of that time wanted to do CABG, CABG, CABG. The field was getting left behind and the mindset was singular. As a result, applications dwindled. Spots didnt fill, programs closed and even academic places operated mostly with PAs as trainees were scarce.

THE COMPETITOR (200😎
Integrated residency was the answer. Pluck the 'best and brightest' from med school, dont bother with the pancreas and perineum, churn out cardiac physicians. I'm not here to debate/discuss I-6. I'm sure they'll be fine. This got ~30 trainees. The first few are just going into practice currently. In doing this, what was ~130 spots for the traditional (2 or 3) has now dropped to 84! 30 spots have gone to I6, and another 10-20 programs have shut their doors. There is a supply and demand to this.

THE FIELD (2010)
Like I said, CT surgeons in the 80s wanted to do ONE thing. CABG. $5000 a pop in 1987 money, Coooley and his group of 7 did FIVE THOUSAND in 1982 alone. Money, quick recovery, a slick operation, its awesome. But as we know PCI happened. Crazy that patients didnt want a sternotomy if they could have a wrist poke. But the field evolved (TAAA, TAVR, actually being Thoracic (CT, not just C) surgeons) and current trainees have a different approach, more than a vessel technician. And on top of that, the average CT surgeon age is 55 or 57. Theres a group of 62-68 year old that have had the great jobs and they're retiring. Current graduates are getting 4-6 job offers. They're starting TAVR programs. Theyre actually good jobs and the pay is KILLER. most private practice guys are getting bought out and are employed so theres no overhead, you get RVUs for mediciad/uninsured patients. AKA, getting paid for work. Its a good field. And theres a dedicated thoracic track too, which has brought a subset of people who arent interested in doing dissections at 2am on thanksgiving when theyre 50. Much more controlled life, transitions to general surgery as well.

THE RESULT (2014-)
Traditional thoracic surgery was at an all time low in interest in 2011-12. Training has changed in terms of call coverage and treating you like a human. IN 2011, all US grads got a spot and then either filled foreign or didnt go filled. One place I interviewed at this cycle got NINE applications and it was decent spot. This year they got 67 for that one spot. Literally 4 years later. In 2014 it was about even, 2015 was the first year with more applicants than spots in a long while. 2016....well

2016 Match statistics
Spots: 84
Applicants: 120
Applicants who submitted a rank list: 115
Filled: 84/84
Unmatched: 31/115 (75%)
US grads unmatched: 20 (craziest stat of all)

So while its not Peds surg crazy, its definitely way harder than in the past 8+ years. I went on 16 interviews and received 20 (of 31 I applied to). 15-20 interviews seems to be about the norm. I matched at one of my top choices. But I was sweating. The interview trail is small and I probably am on a first name basis with 75 of the 120 on that list. When you see who didnt match, its unreal.

THE LONG AND SHORT
CT is back. The fellowship is more humane and the job market is better. As a result it is competitive. I thought 10 interviews would be enough, it's not. Go on 15-20. Have some cardiac experience prior. I can only imagine that the number of spots available (84) will go down as some are doing integrated (WashU, USC, thats 3 right there). It definitely isn't going up.

🙂

 

[Shorin-Ryu]

Congrats on the match!

Where are you getting the match info? I can't find much specific to thoracic surgery on NRMP website.

Also, what percentage of the positions were filled by US allopathics vs DOs and IMGs? That always seems to be the most accurate measurement of competitiveness.

One thought, similar to what was seen with plastics, is that the applicant pool has been watered down since some of the most competitive applicants matched in the I-6 programs. What are your thoughts?

Congrats again. Weight off your shoulders.

For reference: Statistics on the CT I6 2016 Match:

Results and Data 2016 Main Residency Match
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

2016 NRMP Main Residency Match: Match Rates by Specialty and State
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-by-State-and-Specialty-2016.pdf

NRMP Program Results 2012-2016 Main Residency Match
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Program-Results-2012-2016.pdf

Hope this will help.

 

[Shorin-Ryu]

239 is an okay score for pretty much anything

In 2015, I found the info on SDN that the Step 1 median for CT I6 was 242.

 

[SpikesnSpookes]

For reference: Statistics on the CT I6 2016 Match:

Results and Data 2016 Main Residency Match
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

2016 NRMP Main Residency Match: Match Rates by Specialty and State
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-by-State-and-Specialty-2016.pdf

NRMP Program Results 2012-2016 Main Residency Match
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Program-Results-2012-2016.pdf

Hope this will help.

When looking at the main residency match, why is it listed under "thoracic" surgery rather than CT?

 

[Shorin-Ryu]

When looking at the main residency match, why is it listed under "thoracic" surgery rather than CT?

Just the way it goes. If you look under Brigham & Women's Hospital, they offer 2 positions: Thoracic Surgery / Non-cardiac (1) and Thoracic Surgery/Cardiac (1); UPMC Medical Education also offers 2 positions: Cardiothoracic Surgery (1) and Thoracic Surgery (1), etc.

NRMP Program Results 2012-2016 Main Residency Match:
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Program-Results-2012-2016.pdf

 

[Shorin-Ryu]

Sorry - how well are we talking here? Is a 239 an okay score to apply to integrated CT?

Sorry, pressed on the wrong button. 🙂

 

[SpikesnSpookes]

Just the way it goes. If you look under Brigham & Women's Hospital, they offer 2 positions: Thoracic Surgery / Non-cardiac (1) and Thoracic Surgery/Cardiac (1); UPMC Medical Education also offers 2 positions: Cardiothoracic Surgery (1) and Thoracic Surgery (1), etc.

NRMP Program Results 2012-2016 Main Residency Match:
http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Program-Results-2012-2016.pdf

If you apply and get accepted to a thoracic program, do you not have the chance to do cardiac then? Or is it still considered "cardiothoracic"?

 

[Buzz Me]

There are now two different "tracks" during training, a cardiac one and a thoracic one. You have to do rotations in cardiac, thoracic and congenital (peds) in order to sit for your boards - but depending on where you're training, you'll have more rotations in either thoracic or cardiac based on your interests. There are different case numbers that you have to log in order to sit for your boards (e.g. a minimum number of CABGs, or lobectomies, etc.) and these vary based on whether you're in the cardiac track or thoracic track.

 

[Shorin-Ryu]

If you apply and get accepted to a thoracic program, do you not have the chance to do cardiac then? Or is it still considered "cardiothoracic"?

All programs are cardiothoracic. Some of them are more cardiac oriented, other ones more thoracic. Some have officially two tracks: a cardiac and a thoracic one and you apply via ERAS to both tracks and see where you would end up matching. Researched all the programs before I applied.

@Buzz Me posted an excellent answer to your question.

Best of Luck.

 

[SpikesnSpookes]

All programs are cardiothoracic. Some of them are more cardiac oriented, other ones more thoracic. Some have officially two tracks: a cardiac and a thoracic one and you apply via ERAS to both tracks and see where you would end up matching. Researched all the programs before I applied.

@Buzz Me posted an excellent answer to your question.

Best of Luck.

Great - thank you both! So if you go through an official thoracic tract, can you still end up doing cardiac surgery after the training? Sorry for the annoying questions - this is all new language to me.

 

[Shorin-Ryu]

Great - thank you both! So if you go through an official thoracic tract, can you still end up doing cardiac surgery after the training? Sorry for the annoying questions - this is all new language to me.

Asking questions is a great learning tool. Saves time too. 🙂 Now, if you graduate the official thoracic track, you can only do thoracic surgery. However, if you work at a community hospital, there might be a possibility to do cardiac as well. However, I believe, this option is disappearing as I type this post.

In case you are not sure whether you are interested to pursue the track that you have matched to, it seems that at the beginning of your cardiothoracic residency, you might be able to declare an 'undecided status' (for a short while) until you figure out which track you would like to pursue but I am not 100% sure how it works. @Buzz Me might have some great points on that.

 

[jackofalltrades7707]

There's only one board certification for both; therefore, I would assume that you would be able to do both when you become an attending. I'm sure that many don't do this, especially in academia, simply because people just become more specialized. I know of one attending at a major institution that does both regularly but this is obviously an outlier. Nevertheless, it's an anecdote which speaks to the fact that it's possible.

Moreover, not all places have this dichotomous route and some programs boast about having a more balanced program. This would imply that one could do both after training rather than having to choose one or the other.

Sent from my iPhone using SDN mobile app

 

[CTFellowMD]

Now, if you graduate the official thoracic track, you can only do thoracic surgery. However, if you work at a community hospital, there might be a possibility to do cardiac as well.

This is not true.

There is only one board certification despite which track you choose. You are still qualified and certified to practice both aspects of cardiothoracic surgery.

Now where it comes into play is applying for academic jobs. Most major university centers are looking for people to fill specific niches, and want people who trained in one track or the other. It doesnt matter as much for community practices, although it's definitely region based.

 

[Shorin-Ryu]

This is not true.

There is only one board certification despite which track you choose. You are still qualified and certified to practice both aspects of cardiothoracic surgery.

Now where it comes into play is applying for academic jobs. Most major university centers are looking for people to fill specific niches, and want people who trained in one track or the other. It doesnt matter as much for community practices, although it's definitely region based.

Thank you, @CTFellowMD. I should have been more specific. Basically, I was trying to say the same thing. 🙂

 

[Kahreek]

Is not this the classical case of buy low sell high?

 

[Medstart108]

Is not this the classical case of buy low sell high?

Its always buy low sell high, always go into things when people are running for the hills. Especially when it comes to cyclical things.