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Hi everyone, i'm a 3rd yr med student in Canada and I have to make my specialty decision asap.
So far i'm in between cardiac surgery and general surgery. In Canada, cardiac surgery is a direct entry 6 year stream and general surgery is 5 years. Cardiac in Canada is not highly competitive like the I-6 programs in the states. Cardiac and thoracic are separate specialties in Canada. Thoracic is normally entered after general surgery but can still be entered after cardiac (although not typical and you may find it difficult to get community jobs).
My resume is more geared towards a cardiac application, I have electives, research etc in it and my interest has been in it as well as interventional cardiology for quite a while. I have always had an interest in general surgery as well but it has always kind of been a 3rd choice for me until now.
I'm now at the point where I've had experience in medicine, cardiology, CCU, ICU, cardiac surgery and general surgery and I know I want to do surgery over medicine. The trouble is cardiac vs general.
The reason I like general surgery, is that I like the diversity of the cases. I definitely like the idea of being able to operate almost anywhere in a pinch and I like that there are some cases that are simple and short and some that are longer and more complex. I also like the idea of putting off a specialty decision until later. I like that in general surgery, you are very involved in the entire hospital, you go to the emergency while on call for consults, so you get your medicine as well. As staff, I do like the diversity in careers, so there are options for a less hectic work schedule as well as more hectic ones. I do like the idea of one day being able to do international surgery and the idea that if needed, you could be a very useful physician in low resource settings.
What I don't like is that while I do like the GI tract, I don't like it as much as the heart and lungs. I like that with the heart and lungs, there isn't as much poop and gas to deal with, less odd smells. I like emergencies and gen surg provides that but I do find that cardiac and thoracic emergencies excite me the most. I get excited at the idea of ECMO, chest tubes, pneumothorax, TAVI, TEVAR and thoracic trauma more so than abdominal emergencies. The side effects of some general surgery procedures don't interest me as much, like the idea of giving people an ostomy bag. I believe I would be most interested in thoracic, upper GI, trauma, hpb or mis if I were to do gen as opposed to colorectal.
The reason I like cardiac surgery, is first that I always liked the heart and vascular system. Bleeding/blood excites me and the great vessels excite me as well. I like the cardiac patient and the fact that the post-op care is almost like a assembly line and simple and often part-managed by other specialties. Most patients go home post op day 5-7, NPs manage the wards and cardiac anesthesia/ICU manages the CVICU. In the end as a cardiac resident or staff you round symbolically and pull chest tubes, this is nice. I like how cardiac surgery research is booming and how there is real funding in cv research and I like all the advancements in the field and want to participate in that.
I do appreciate that this often means later starts to the day since less rounding and ward work is required. As mentioned above, I like that cardiac patients are nice patients to have, they are typically cooperative with their care and they often very appreciate your help. I also like that the outcomes are good on cardiac surgery, there aren't very many complications that leave patients alive but permanently disabled (true, stroke but this happens less often than an inoperable tumor or mets in general surgery).
What I am most worried about is the future of cardiac surgery. TAVIs are predicted to be at least 50% of all AVR cases in the next 5 years and eventually will likely be 80%+. I don't see cardiac surgery being able to perform most TAVI cases in the future, I believe some surgeons may do them, but the majority will be done by interventional cardiology. Mitraclip is an interventional procedure now and while I see TEVAR and TMVI leaning more cv surgery. The current job market for both general and cardiac is bad, but worse for cardiac in Canada. I'm worried that if most aortic valves leave cardiac surgery, 15-20% of the case load will disappear and I will not be able to find a job in 10 years.
Like I mentioned above, I also dislike the fact that cardiac doesn't deal with much medicine at all. The workup and consults are almost entirely done by cardiology, to the point that most of a cardiac surgeon's non-surgical work is simply reading an angiogram and determining where to place grafts. As a cardiac surgery resident, it is nice that you will get sleep while on call, but I do feel like I would miss going to the emerg for consults and cases (aortic dissection seems to be the only reason for emerg to consult cardiac). I also dislike the fact that in the future if caseload doesn't change, it is very possible that 70% of cardiac cases will be CABG only and I feel like that might not be enough diversity in cases for me.
I could feasibly do general surgery and then apply for a CT fellowship in the states but the issue with that again is that if there are limited jobs in Canada i'm pretty sure that most jobs would go to someone who was dedicated trained in Cardiac and then pursued fellowships over someone who was a 5+3. In addition, another issue is that I know people in cardiac surgery much better and also have a better chance of matching in cardiac than general at this point. In terms of my knowledge, I know cardiac better than general. I know this shouldn't play a role, but in some sense it feels like I've gone so far into the heart and know so much that it would be a shame to turn back.
Any advice or opinions?
So far i'm in between cardiac surgery and general surgery. In Canada, cardiac surgery is a direct entry 6 year stream and general surgery is 5 years. Cardiac in Canada is not highly competitive like the I-6 programs in the states. Cardiac and thoracic are separate specialties in Canada. Thoracic is normally entered after general surgery but can still be entered after cardiac (although not typical and you may find it difficult to get community jobs).
My resume is more geared towards a cardiac application, I have electives, research etc in it and my interest has been in it as well as interventional cardiology for quite a while. I have always had an interest in general surgery as well but it has always kind of been a 3rd choice for me until now.
I'm now at the point where I've had experience in medicine, cardiology, CCU, ICU, cardiac surgery and general surgery and I know I want to do surgery over medicine. The trouble is cardiac vs general.
The reason I like general surgery, is that I like the diversity of the cases. I definitely like the idea of being able to operate almost anywhere in a pinch and I like that there are some cases that are simple and short and some that are longer and more complex. I also like the idea of putting off a specialty decision until later. I like that in general surgery, you are very involved in the entire hospital, you go to the emergency while on call for consults, so you get your medicine as well. As staff, I do like the diversity in careers, so there are options for a less hectic work schedule as well as more hectic ones. I do like the idea of one day being able to do international surgery and the idea that if needed, you could be a very useful physician in low resource settings.
What I don't like is that while I do like the GI tract, I don't like it as much as the heart and lungs. I like that with the heart and lungs, there isn't as much poop and gas to deal with, less odd smells. I like emergencies and gen surg provides that but I do find that cardiac and thoracic emergencies excite me the most. I get excited at the idea of ECMO, chest tubes, pneumothorax, TAVI, TEVAR and thoracic trauma more so than abdominal emergencies. The side effects of some general surgery procedures don't interest me as much, like the idea of giving people an ostomy bag. I believe I would be most interested in thoracic, upper GI, trauma, hpb or mis if I were to do gen as opposed to colorectal.
The reason I like cardiac surgery, is first that I always liked the heart and vascular system. Bleeding/blood excites me and the great vessels excite me as well. I like the cardiac patient and the fact that the post-op care is almost like a assembly line and simple and often part-managed by other specialties. Most patients go home post op day 5-7, NPs manage the wards and cardiac anesthesia/ICU manages the CVICU. In the end as a cardiac resident or staff you round symbolically and pull chest tubes, this is nice. I like how cardiac surgery research is booming and how there is real funding in cv research and I like all the advancements in the field and want to participate in that.
I do appreciate that this often means later starts to the day since less rounding and ward work is required. As mentioned above, I like that cardiac patients are nice patients to have, they are typically cooperative with their care and they often very appreciate your help. I also like that the outcomes are good on cardiac surgery, there aren't very many complications that leave patients alive but permanently disabled (true, stroke but this happens less often than an inoperable tumor or mets in general surgery).
What I am most worried about is the future of cardiac surgery. TAVIs are predicted to be at least 50% of all AVR cases in the next 5 years and eventually will likely be 80%+. I don't see cardiac surgery being able to perform most TAVI cases in the future, I believe some surgeons may do them, but the majority will be done by interventional cardiology. Mitraclip is an interventional procedure now and while I see TEVAR and TMVI leaning more cv surgery. The current job market for both general and cardiac is bad, but worse for cardiac in Canada. I'm worried that if most aortic valves leave cardiac surgery, 15-20% of the case load will disappear and I will not be able to find a job in 10 years.
Like I mentioned above, I also dislike the fact that cardiac doesn't deal with much medicine at all. The workup and consults are almost entirely done by cardiology, to the point that most of a cardiac surgeon's non-surgical work is simply reading an angiogram and determining where to place grafts. As a cardiac surgery resident, it is nice that you will get sleep while on call, but I do feel like I would miss going to the emerg for consults and cases (aortic dissection seems to be the only reason for emerg to consult cardiac). I also dislike the fact that in the future if caseload doesn't change, it is very possible that 70% of cardiac cases will be CABG only and I feel like that might not be enough diversity in cases for me.
I could feasibly do general surgery and then apply for a CT fellowship in the states but the issue with that again is that if there are limited jobs in Canada i'm pretty sure that most jobs would go to someone who was dedicated trained in Cardiac and then pursued fellowships over someone who was a 5+3. In addition, another issue is that I know people in cardiac surgery much better and also have a better chance of matching in cardiac than general at this point. In terms of my knowledge, I know cardiac better than general. I know this shouldn't play a role, but in some sense it feels like I've gone so far into the heart and know so much that it would be a shame to turn back.
Any advice or opinions?
