Cardiology VS CT Surgery

[LGMD]

Hi I'm a med student and I have always been fascinated with the heart, and like pretty much everything about it, and like it way above any other organ system. Entering Med School I was always attracted to CT surgery, and I thought of it as the ultimate challenge in which you had to have a strong knowledge base and skill. However after seeing what cardiologists do I really enjoyed it too. I know both are different specialties with different training, etc, and I began to drift away from CT because I find the idea of being a clinician mentally stimulating while at the same time being able to do procedures (Interventional Cards) if eventually I decide to go into cards. Also I've heard a lot of people say that CT is a dead field, with not such a great future. So I would like you guys to comment on your impression on what the future holds for both fields. Thanks in advance.

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[H_Caulfield]

I spoke to a surgeon who assured me that people are generally misinformed, and that I should try my best to ignore them and pursue what interests me. According to him, THORACIC (note: no "cardio") surgery is in no danger whatsoever; you've still got the esophagus and lungs. Plus, valve replacements, congenital stuff, and complex bypasses are still well within the heart surgeon's realm. If you do a CT fellowship you'll be able to do both cardiac and everything else in the thorax, so I doubt you would run out of work.

ALSO, you'll be a licensed general surgeon. So if your thoracic work is dwindling on any given month you can just work in the abdomen. The idea really appeals to me because you're covering the entire trunk. Think about it: could you run out of work with procedures for the whole trunk in your arsenal?

Now if you're one of those people who just wants to do bypasses and nothing else...well...you should worry a bit then.

 

[TxMed]

i would take what the above poster says w/a grain of salt. here are some threads found in this very forum discussing ct surgery.

http://forums.studentdoctor.net/showthread.php?t=384787&highlight=surgery

http://forums.studentdoctor.net/showthread.php?t=44459&highlight=surgery

http://forums.studentdoctor.net/showthread.php?t=364777&highlight=surgery

http://forums.studentdoctor.net/showthread.php?t=360607&highlight=surgery

http://forums.studentdoctor.net/showthread.php?t=51631&highlight=surgery

http://forums.studentdoctor.net/showthread.php?t=354218&highlight=surgery

after reading through these you should have a good basis for what is going on currently. many (most) of these posters are residents or ms3/ms4s. unlike HC who is a college student. nothin' but love.


-tm

 

[Pilot Doc]

The "people will always need valve replacements" theory for entering CT surg drives me nuts. The demand for CT surgery, barring some dramatic new operation, has permanently and fundamentally decreased. Unfortunately, we have 1.5 generations of CT surgeons still in practice looking for their next CABG. Once all the old surgeons retire and the fellowships stop turning out too many surgeons, life will be good again and being a CT surgeon will probably be a lot like being a neurosurgeon.

But for the meantime, there are way too many CT surgeons chasing too few patients and it's going to be an unpleasant next 10-30 years.

As for cardiology vs. CT surgery, figure out if you like medicine or surgery better then do whichever suits you.

 

[Winged Scapula]

I spoke to a surgeon who assured me that people are generally misinformed, and that I should try my best to ignore them and pursue what interests me. According to him, THORACIC (note: no "cardio") surgery is in no danger whatsoever; you've still got the esophagus and lungs. Plus, valve replacements, congenital stuff, and complex bypasses are still well within the heart surgeon's realm. If you do a CT fellowship you'll be able to do both cardiac and everything else in the thorax, so I doubt you would run out of work.

Your surgeon friend was right and I agreed with him/you, until you reached the last sentence. The fact is that, currently, there are too many CT fellows without adequate jobs and not enough work for all of them. Many of the most recently graduated are working for little more than a PA would make; "pity" jobs given them by their former fellowship programs. As for straight thoracic, the same is true...too many trained surgeons without enough cases to go around. As PilotDoc notes, when the old farts retire and the fellowships stop churning out grads at a far faster pace than we need them, the situation will be better.

ALSO, you'll be a licensed general surgeon.

Pedantics here but being licensed has nothing to do with being a surgeon. You are licensed as a physician, not as your specialty. If the OP completes a general surgery residency he will most likely be Board Eligible and hopefully licensed, but the two are separate entities. You can be licensed but not BE; to be BC you have to have a license unless you take the exam within 6 months of completing your fellowship.

So if your thoracic work is dwindling on any given month you can just work in the abdomen.

The hospital credentialing doesn't necessarily work that way. A thoracic surgeon may not be given privileges to operate in the abdomen or to do general surgery cases if he is hired as a thoracic surgeon. You will have a defined set of procedures which are you allowed to do; of course, if you feel prepared to handle the abdomen (and many fellowship trained surgeons do not feel comfortable doing many general surgery cases, cases they haven't done since residency and have never done alone), you can always apply for privileges to do so.

I don't think the OP needs to choose between CT surg and Cards to be "mentally stimulated clinician". There is plenty of mental stimulation in surgery, especially a field like CT where there are plenty of emergencies and you have to think fast on your feet. Please do not accept the old saw that surgeons aren't good clinicians, diagnosticians or thinkers. You DO have to decide whether or not you prefer surgical management or medical.

Anyway, just my thoughts...

 

[Arch Guillotti]

A while back I was chatting with a CT fellow. He is job-hunting and said that there are about fifty applicants per spot at some of the places that he is looking. Pretty dismal.

 

[H_Caulfield]

Dr. Cox, thanks for your input. This exemplifies the differences between a med student and a surgeon, I suppose: med students merely THINK they know what they're talking about. I had spoken to a urologist, so...hardly a relevant surgical field for the purposes of our discussion; probably should have mentioned that. It DOES annoy me that I get nothing but encouragement when I ask physicians around school; I'll have to make a decision soon and all the input I get from faculty is dressed up in horse crap. I'm sure the justification would be that I should care less about compensation, job securty, etc., but it's hard not to consider those things when you're under two tons of debt.

In any case...I love the idea of general surgery but have heard such horror stories about every path. Dr. Cox...better prospects for transplant than for CT? To the OP, let's hope ortho isn't the only way to go...everytime they talk about the musculoskeletal system I suddenly find myself waking up, groggy, when it's all over.

 

[Winged Scapula]

Dr. Cox, thanks for your input. This exemplifies the differences between a med student and a surgeon, I suppose: med students merely THINK they know what they're talking about. I had spoken to a urologist, so...hardly a relevant surgical field for the purposes of our discussion; probably should have mentioned that. It DOES annoy me that I get nothing but encouragement when I ask physicians around school; I'll have to make a decision soon and all the input I get from faculty is dressed up in horse crap. I'm sure the justification would be that I should care less about compensation, job securty, etc., but it's hard not to consider those things when you're under two tons of debt.

In any case...I love the idea of general surgery but have heard such horror stories about every path. Dr. Cox...better prospects for transplant than for CT? To the OP, let's hope ortho isn't the only way to go...everytime they talk about the musculoskeletal system I suddenly find myself waking up, groggy, when it's all over.

Does your school have a CT fellowship? If not, your faculty may be out of touch with what is happening to CT grads out there, which Arch Guilliotti has accurately described.

At any rate, if you are interested in surgery, taking the general surgery route gives you plenty of options. Not sure what you mean by "horror stories". Transplant is probably not as dire as CT in regards to current job prospects but you need to be aware that it can limit you geographically. That is, most small community hospitals do not have a transplant surgeon on staff - a good transplant program needs a large core of people to run it, not just a surgeon. This can be costly and larger medical centers are able to fund it in a way that smaller places cannot. However, if you would be happy doing only kidneys, these can be done at smaller places - pancs, small bowel, livers tend to be at larger centers, with greater volume. Hearts are done by CT surgeons, not transplant surgeons, FYI.

It is tough when you are encouraged yet realize that there are some roadblocks in the way to your dreams. I do wholly believe the adage that "if you are good, you'll find a job" - there are enough good CT surgeons who will attest to the falseness of that statement. However, you are at least a good 5-7 years from CT fellowship, or fellowship of any kind, and job prospects may radically change in that span of time. You may also find that other areas of surgery which you have yet to fully experience are also interesting to you.