Cardio-thoracic surgery... how do i match? Help needed

[The wise one]

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Currently an MS2... I currently have no paper (publication) but I do have 2 abstracts at top 10. I go to a P/F school but my class rank shouldn't be a problem. I will be taking step 1 this summer.
I was stuck on Uro vs Neuro vs Cardiosurg. However, I couldnt help it but noticed the surge in our overweight population (i.e. more heart issue down the line). Based on my personal research, I fear that Uro and neurosurg, especially neurosurg might end up like rad onc down the line.

Anyways, to keep it simple. I am interested in Neuro, Uro and Cardio-surg. So, how do I make myself competitive?

Thanks

 

[ThoracicGuy]

First thing you need to answer is what kind of career do you want as all three of those fields have vastly different experiences out in practice. This is something you'll be doing for the rest of your life, so it should be something you truly like, not just something that you think might have a good market x years down the road.

 

[The wise one]

Surgery and helping people. Not to downplay Uro, but it is more of a lifestyle choice to me. But it something that I could enjoy down the line especially w/ our increasing STDs rate.
In short, I am interested in surgery. Cardio surgery makes the most sense to me followed by neuro. Also, I have neuro second because I fear we'd have less strokes, trauma cases, in the near future.
But I am open to anything. Remember, I am typing this as a MS2 so my perspective can indeed be wrong.

First thing you need to answer is what kind of career do you want as all three of those fields have vastly different experiences out in practice. This is something you'll be doing for the rest of your life, so it should be something you truly like, not just something that you think might have a good market x years down the road.

 

[ThoracicGuy]

Surgery and helping people. Not to downplay Uro, but it is more of a lifestyle choice to me. But it something that I could enjoy down the line especially w/ our increasing STDs rate.
In short, I am interested in surgery. Cardio surgery makes the most sense to me followed by neuro. Also, I have neuro second because I fear we'd have less strokes, trauma cases, in the near future.
But I am open to anything. Remember, I am typing this as a MS2 so my perspective can indeed be wrong.

Going into something because of what you think of how much of X disease is out there really isn't the way to think of it. You need to be looking at what types of surgeries you might enjoy doing. What type of patients do you like treating. What sort of hospital/clinic ratio. What sort of lifestyle do you want. These questions are far more important than the incidence of certain diseases.

 

[TypeADissection]

Going into something because of what you think of how much of X disease is out there really isn't the way to think of it. You need to be looking at what types of surgeries you might enjoy doing. What type of patients do you like treating. What sort of hospital/clinic ratio. What sort of lifestyle do you want. These questions are far more important than the incidence of certain diseases.

I can't second this enough. You need to choose a specialty based upon where your interests are. I was on track for Urology as a med student and realized very quickly that I just couldn't do the clinics and endless cystoscopies (more power to those who can). I ended up doing what I'm doing now because of the types of procedures and work I get to do on a daily basis. In a given week I'll sew a patch, or primarily close, or do an end-to-end bypass. I'll do fens or debranch and TEVAR someone. I tossed around the idea of doing CTS but realized that I personally didn't enjoy thoracic or foregut work and cancer just wasn't my jam. These are the things you need to be asking, otherwise you may end up doing something you don't really enjoy and that's tragic. Cheers.

 

[The wise one]

Sure, I apologize for not making clear. But out of all fields, those 3 are the ones that I would enjoy doing for free. Cardio > neuro >>> Uro.

I can't second this enough. You need to choose a specialty based upon where your interests are. I was on track for Urology as a med student and realized very quickly that I just couldn't do the clinics and endless cystoscopies (more power to those who can). I ended up doing what I'm doing now because of the types of procedures and work I get to do on a daily basis. In a given week I'll sew a patch, or primarily close, or do an end-to-end bypass. I'll do fens or debranch and TEVAR someone. I tossed around the idea of doing CTS but realized that I personally didn't enjoy thoracic or foregut work and cancer just wasn't my jam. These are the things you need to be asking, otherwise you may end up doing something you don't really enjoy and that's tragic. Cheers.

 

[ThoracicGuy]

Sure, I apologize for not making clear. But out of all fields, those 3 are the ones that I would enjoy doing for free. Cardio > neuro >>> Uro.

Though you haven't started clinical rotations, so you will need a bunch more experience to really have an idea of what you might like.

 

[The wise one]

And I agree but life made me realize that what "I might like" isn't as important as what my app (step score, research networking) looks like.

If I may, let me ask; if you were an MS2 in 2020, how would you prepared your app for I6. Based on your experience, is there anything that you would have done differently?

Though you haven't started clinical rotations, so you will need a bunch more experience to really have an idea of what you might like.

 

[ThoracicGuy]

And I agree but life made me realize that what "I might like" isn't as important as what my app (step score, research networking) looks like.

If I may, let me ask; if you were an MS2 in 2020, how would you prepared your app for I6. Based on your experience, is there anything that you would have done differently?

I didn't have I6 as an option when I was going through it. For I6 apps, you need a good Step 1 score. It helps to have research and a letter from a Dept Chair or PD for a CT training program. Even better, if they are part of an I6 program.

 

[Circ Arrest]

The answer to this is and always will be to do the best you can do.

Doing well on Step 1 is not going to hurt you regardless of what field you want to go into. Doing research is not going to hurt no matter what field you want to go into. Applying for scholarships through professional societies, presenting at meetings, etc, is not going to hurt you regardless of what you are going into.

Do the best you can to keep your options open. For all you know, you might end up wanting to do rural primary care medicine after your clinical rotations, and having good scores, research, connections are not going to hurt you should you decide you want to do that.

These fields are different. I would recommend approaching your clinical rotations with an open mind and really be honest with yourself about what you enjoy. Surgery training is difficult enough as is and is even more so if you have regrets with your decision or do not truly enjoy the procedures.

 

[dodolol21]

Unless you are 100% committed to Cardiac Surgery, the I6 programs are probably not a great idea. They are absolutely one of the most difficult sets of programs to match, just due to the number of spots. The USMD match rate is abysmal, like less than half. With a few exceptions, they are designed for those students who know very early on that they want to be a heart surgeon, and are aggressive in their pursuit for all of medical school. Even if you are one of the top applicants in a year, matching at an I6 is not guaranteed, and many amazing candidates land at great GS programs.

 

[SurgeDO]

STDs? Obesity? I wish neurosurgery would become more like radonc so that I could get some sleep every so often.

I think you need to spend some more time researching these fields.

 

[akuko2]

Its basically the same for any competitive field, get great STEP scores, great clinical grades, figure out what you want to do early by doing some shadowing and then start getting connected to your home dept and doing research. Apply for away rotations strategically and work hard to secure good LORs. You can also get a tattoo to show your devotion to a particular field but its difficult to show it off on interview day with a suit on so I suggest taking a picture of it with your phone.

 

[Dave1980]

If you're already an MS2 you are way behind the 8-ball for NSG or an integrated CT surgery program. You need to start making connections and getting published.

 

[The wise one]

Focus on Step, do some kind of research, explore these fields on rotations and figure out what kinds of things you want to be doing in your career.

Thanks for the feedback!

The fact that you are bringing in STDs makes me think that you don't have too much experience checking these fields out. Uro will have some patients with orchitis/prostatitis/urethritis and you have some not-too-common HPV related pathology, but you wouldn't be working with STDs much at all. That's primary care. Urology is a surgical field. It is a lifestyle specialty because call is better than other surgical fields.

Point was, having STDs (multiple sexual partners) increase the risk of orchitis/prostatis, etc...

I also don't understand what you mean about uro/neurosurg becoming like rad-onc. You shouldn't focus on which pathology you believe will increase (especially if it's obesity which increases the incidence of diseases for all specialties....and stroke and cardiac risk factors have a lot of overlap). If anything, think about how the management of conditions are changing? ie. how is volume being effected by interventional cardiology/radiology/neurology or by improvements in medical management (which are things impacting all three fields to different degrees)?

That was refreshing.

 

[The wise one]

How?? Mind elaborating? I will publish a 2 article on wikijournal this summer (after step); something on Corona and CVD.
Also, I am planning on attending the general session in Austin (TSDA General Session | TSDA).
What else should I work on?

If you're already an MS2 you are way behind the 8-ball for NSG or an integrated CT surgery program. You need to start making connections and getting published.

 

[daenschl]

I disagree somewhat that you’re way behind as an M2.
I guess I know only one guy who matched I6 at a prestigious California program, and he had been preparing for cardiac surgery well prior to medical school with a metric ton worth of research. So I guess you may be behind for I6.
But you should still be fine for NSG. Maybe you’re behind for top programs, but there should be plenty in your reach with the time you have left. You just need to do the things mentioned above (great Step, great grades, strategic away rotations, good LOR’s). Research will definitely be quite important. Doesn’t matter quite as much what field you do research in.
when others say you’re behind the ball, I might just mean you won’t have as much time to accumulate quality pubs In decent journals

 

[Dave1980]

How?? Mind elaborating? I will publish a 2 article on wikijournal this summer (after step); something on Corona and CVD.
Also, I am planning on attending the general session in Austin (TSDA General Session | TSDA).
What else should I work on?

If you are finishing up your second year that means you have about 18 months before it's time to apply and interview. Applicants to those specialties usually have multiple publications in real peer-reviewed journals and have formed long-term meaningful relationships with Attendings in their field to ensure stellar LORs.

I don't know anything about wikijournals but it doesn't sound like they will "count". Good luck.

 

[deleted50541]

On the extreme end of things, I knew a med student who was already scrubbing cases with the cardiac guys as an MS1 when they weren't in class. And could apparently read echos better than some of the fellows. This person had already made research connections with one attending as an undergrad and continued to work closely with them during med school.

These are the kind of people you're going up against for one of the few integrated spots.

 

[bobjonesbob]

I disagree somewhat that you’re way behind as an M2.
I guess I know only one guy who matched I6 at a prestigious California program, and he had been preparing for cardiac surgery well prior to medical school with a metric ton worth of research. So I guess you may be behind for I6.
But you should still be fine for NSG. Maybe you’re behind for top programs, but there should be plenty in your reach with the time you have left. You just need to do the things mentioned above (great Step, great grades, strategic away rotations, good LOR’s). Research will definitely be quite important. Doesn’t matter quite as much what field you do research in.
when others say you’re behind the ball, I might just mean you won’t have as much time to accumulate quality pubs In decent journals

I'll second this. Had one person match neurosurgery and one CT this year out my class. Both were relatively late deciders and didn't start research until spring of 3rd year. They both matched fine albeit not at top tier places. And just for reference I am at a mid tier medical school.

Otherwise agree with the others. You need to get more clinical experience and see what the lives of the residents are like before you make a decision.

 

[The wise one]

Wow! That's insane.

On the extreme end of things, I knew a med student who was already scrubbing cases with the cardiac guys as an MS1 when they weren't in class. And could apparently read echos better than some of the fellows. This person had already made research connections with one attending as an undergrad and continued to work closely with them during med school.

These are the kind of people you're going up against for one of the few integrated spots.

 

[SpliceOfLife]

CT surgery residency is not easy and is often not fun, but the work can be very rewarding. My own 2 cents is that you should try to apply if you have a sincere interest in the field but not be discouraged if you don't get in. Apply to general surgery as well.

There are always going to be very strong applicants in any surgical field, and in a lot of non-surgical ones as well.

 

[The wise one]

**** up on step 1 236 - I should have done more questions. I am hoping to do better on step 2. Based on internal ranking, I am top 3 in my class. Any advice on what I should do next?

Considering the GS route, and hoping to do better on Step 2. Joined the Trauma team at my home program, working on a pub;
Do I even have a shot at upper mid tier w/ a 236? I would hate to go a low tier or mid tier?

Step 1 - 236
3 Research project
2 pubs
Currently working on a Trauma project
Scholarships
Tutor
Leaderships positions at school.

For third and 4th year:
- Hoping to do better on Step 2 (This wouldn't be problem, I know why step 1 went wrong; as matter of fact, I improved my score by 20 point in a week)
- Hoping to get AoA ranking (shouldnt be hard due to my current ranking)

@ThoracicGuy

 

[ThoracicGuy]

**** up on step 1 236 - I should have done more questions. I am hoping to do better on step 2. Based on internal ranking, I am top 3 in my class. Any advice on what I should do next?

Considering the GS route, and hoping to do better on Step 2. Joined the Trauma team at my home program, working on a pub;
Do I even have a shot at upper mid tier w/ a 236? I would hate to go a low tier or mid tier?

Step 1 - 236
3 Research project
2 pubs
Currently working on a Trauma project
Scholarships
Tutor
Leaderships positions at school.

For third and 4th year:
- Hoping to do better on Step 2 (This wouldn't be problem, I know why step 1 went wrong; as matter of fact, I improved my score by 20 point in a week)
- Hoping to get AoA ranking (shouldnt be hard due to my current ranking)

@ThoracicGuy

From those I've talked to that are faculty in i6 programs, their minimum step 1 scores are in the 220-230 range, so 236 should still be ok. For general surgery, I would think you're still good to go for applying, though I suppose it always matters what your fellow applicants are scoring.

 

[The wise one]

Sure.. faculty at Yale is willing to write me a letter. He is IM though. I asked for a sub with their gen surgery. He said he will talk to someone. So, that's one away from 4th year. I will do the rest at home and focus on getting publish.

Thanks again for your input.

 

[ThoracicGuy]

Sure.. faculty at Yale is willing to write me a letter. He is IM though. I asked for a sub with their gen surgery. He said he will talk to someone. So, that's one away from 4th year. I will do the rest at home and focus on getting publish.

Thanks again for your input.

A letter from IM isn't going to add a whole lot. You really need surgery letters primarily.

 

[BovieToMe]

Using predictions on how busy a field might be, or based off your perceived demand in the future is really an act of futility. You are looking at a 30+ year career here, you really think that demand is not going to change during that time? In almost any of these fields, a miracle drug, or device or anything for that matter could come around and make you obsolete for that pathology.

You just have to figure out what you like to do. Most of the people who wanted to do surgery back when I was a medical student ended up switching once 3rd year came along. Surgery can be very difficult sometimes, and its not just long hours or physically demanding work that is the issue; but the type of work that you sometimes do can feel like you're on a constant roller coaster.

I don't want to sound overzealous or anything, but in all honesty, learn about these fields and think about what you would enjoy. A lot of people who go into cardiac surgery would have a very hard time enjoying urology. Urology might be a lifestyle field, but cardiac surgeons tend not to be "lifestyle" types.