Choosing General Surgery residencies...???...

[BeeGee]

As the end of my 3rd year comes to a close, I am entirely stressed out about what to do first in order to match well. I'm interested in General Surgery, and am narrowing the list of programs down to University-based programs. I plan to go on to a Cardiothoracic fellowship after Gen training. Is it necessary to do 1 -2 research years in order to get this fellowship? I really need help in further narrowing my list which is now about 70 programs long. I'd prefer to be in a large metropolitan city rather than out in the middle of nowhere. Any helpful suggestions will be appreciated.

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[droliver]

Beegee,

its a pretty good time if you want to be a surgery resident @ some of the traditional powers in the field, as the # of applicants has troughed for a # of reasons. A lot of people who would have had no chance a few years ago ended up with great positions @ top programs. If you like I can give you some of the better programs by reputation in any part of the country.

Also, cardiothoracic surgery is in the boat only worse. For several years now there have been more spots than applicants. If you want to do hearts these days you will be able to get a spot somewhere.

 

[dr.evil]

I concur with droliver. Matching into General Surgery as well as a fellowship in CT is pretty nice right now (i.e. low stress).

I'm not trying to make your life difficult, but I would go interview at some of the better community based and community based-university affiliated programs. You will definitely be surprised by their training and especially some of the fellowships their graduates obtain. I think I needed to see all types of programs considering all I knew was a pretty academic program.

I just finished the interview trail for Gen Surg and can honestly say that some of the programs known to be powerhouses were placed very low on my rank list (if at all) due to the impressive nature of some of the other programs I interviewed.

Is 1 to 2 years research necessary for CT? Right now, I would say no but you will still need to do some research throughout your 5 years of training. I would clarify my statement by saying that the biggest/best CT programs will still want 1 to 2 years of research.

The best way to go about narrowing your list is to figure out LOCATION first. West Coast/Midwest/South/East Coast. Then narrow it with the large metropolitan cities that you like. This will give you a list of programs to pick from. Then ask residents and 4th year med students/interns to help narrow your list a little further (although remember the source).

 

[surg]

I agree here. Getting from 70 to about 30 can be done fairly simply via a geography or city size test, because outside of the top 5-10 programs, there is a huge cluster of excellent programs that most people would generally consider to be largely equivalent. Some things that you might help you distinguish:

1) Does that program has a CT fellowship associated with the program?

Having one will certainly lower the number of thoracic cases you do (don't worry about the cardiac cases, no residency has their residents doing full CABGs by themselves, although sewing some of the anastamoses is another matter). The upside is you will get exposure to someone who can write you a strong recommendation, and if the current dearth of CT fellows continues (which is no guarantee considering that you are looking 6-8 years down the road! Heck, if 6-8 years we may be treating heart disease with angiogenesis therapy instead of bypasses!), will almost certainly offer you a spot if you show that you are worthy.

2) A solid track record of placing graduates in their desired career tracks. This is important to note, since some University programs actually appear to get a predominantly private general surgery practice population of residents. Not passing judgment, but if someone has done what you want to do recently, it provides a recent graduate to lean on for advice if need be.

3) A solid education: virtually any program can give this to you.

4) Fit. Both academically and personality. This is where you take your list of 20-40 to an attending that knows you well (if you don't have someone like that, start working on that!), and ask them, "which of these would be a good fit for me?" They will give you amazing insights into what is going on at programs sometimes (esp. who is leaving or retiring)

Hope this gets you on your way.

 

[Oche]

Hey BeeGee, I would take a look at this speech made by Tomas Salerno, MD Professor of Surgery at the University of Miami, and Chief of the Division of CT Surgery at Jackson Memorial Hospital, Miami, Florida on "A Realistic View of the Cardiothoracic Surgery Specialty"
Here is the link
<a href="http://www.ctsnet.org/doc/6529" target="_blank">http://www.ctsnet.org/doc/6529</a>

 

[tonem]

Peustow would you mind listing some of the programs you were impressed with and the reasons you liked them so much.

 

[dr.evil]

I'm from the middle of America so I kept my interviews mostly in the Southeast, Midwest, and West. So the only interviews I did out east were mostly academic programs (i.e. Hopkins, Vanderbilt, Wake Forest, Tenessee schools). I did interview at Mayo in Jacksonville, FL and definitely recommend you check that place out. I ranked it low because they only took 2 categoricals which was a little smaller program than what I wanted.

If you are going to venture west at all, the best university affiliated/community programs (in my opinion) were in some strange locations. Texas A&M/Scott&White program is excellent but in Temple, TX (wherever that is). Great facilities, great faculty, early operative experience, no Level 1 Trauma though, weak on peds.

Baylor in Dallas (you can tell I liked Texas) is probably one of the best community programs in the nation and is better than the majority of the academic programs. It really has an academic feel except for the early operative experience and livable residency. The problem with it was the travel between the 2 hospitals (one in Ft. Worth & one in Dallas which is about 45 minutes of driving). Awesome transplant, trauma, vascular cases. Residents get great fellowships.

2 surprises to me were in Kansas & Colorado. The University of Kansas-Wichita was extremely impressive with superb operative experience, two Level 1 Trauma centers, great faculty, good call schedule, and residents who match into great fellowships if they want. The bad thing about it was it was in Wichita, KS!

In Colorado, I took the Exempla St. Joseph interview in Denver and was equally impressed. The program is a little small for me and did not have enough of an academic feel compared to the previously listed programs. But, these guys operate a lot and early on.

I just really felt like a lot of the community programs provided early operative experience that was unmatched by the big time academic places. You really have to balance the goods and bads. It would be difficult to obtain a pediatric fellowship out of these places but that seems to difficult no matter where you go.

I also had a friend interview at Carraway in Alabama who raved about its nice combination of academic feel with community operative experience.

I interviewed at entirely too many places (mostly middle of the country) so if you want to know anything about the middle of America, let me know. I just really wanted to get a good feel of all types of places so I would make a wise decision for me when I filled out my rank list.

 

[tonem]

Thanks, I'm actually mostly interested in going back to the western half of the USA, anywhere in New Mexico, Arizona, Colorado, Nevada, California, Oregon, or Washington. I'd certainly appreciate any other input you might have.

 

[LaCirujana]

Tonem--

I sent you a PM.

 

[Juice]

BeeGee,
No need to worry. If you are a decent american grad with simply better than average boards, you will match into a solid university based program. Applications to gen surg continue to decline, and so too do the applications to fellowship, especially CT. Across the country CT surgical based cases are down 25% compared to 5 years ago. As well, research trials are now being done on coated stents with agents such as Taxol, and other antiproliferative chemo agents with amazing results. Left Main dz stenting is in clinical trials in 2 european countries with results that I think will pass any bypass results.
This being said, CT is a great subspecialty. There will always be valves, and the thoracic side i find much more interesting. i am at oneof the larger university based programs in the country, but friends of mine at community programs have attained very solid university fellowships with little to no research. The applicant pool is so low, many foreign grads are getting university spots as well.
I would not worry at all about fellowship. I personally would recommend a university program for gen surg. I believe you will find commrades to be of a higher caliber, and i think you will learn more. However, there are some very good university affiliated community programs out there. Virginia Mason in Seattle would be my pick as the best community program in the country. Good luck.