CT Endovascular

[Joel Fleischman]

Hey,
Do any CT surgery fellowship programs to any endovascular work...
i.e. attempt at the cardioVASCULAR aspect vs cardoTHORASIC?

I guess my question would be more of interms of Aortic arch, carotid etc.
thanks.

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[Tenesma]

it looks like a vascular surgeon would be far more likely to do aortic arch stents as well as carotid stents.... the CT surgeons unfortunately got screwed out of that big money game.

 

[USCTex]

When you get up that high pgy-7, 8, 9, etc. your options almost become like an apprenticeship. I don't know of any programs that specifically spend an extra year training for endo but there are oppurtunities...

I know our department here encouraged and helped set up a year of endovascular training for a recent residency grad...indeed I think he did a year at somewhere away from our home institution. I'm sure this isn't terribly uncommon nowadays (with the state of CT) and the impression I got is that it was something a little bit more informal than an actual residency application...just one department communicating with another and you get to spend another year in training.

As for the future, I heard some talk that the integrated CT programs will indeed come before I apply for residency (I know they've been talking about it for a while) and that some programs will probably be 3+4 (instead of 3+3) with an integrated year of endovascular. Not the level that vascular surgeons are getting...but CT is going to HAVE to move this way if it wants to survive. I really think the direct application/integrated residency model will be good for CT surgery; if they ever get it off the ground.

 

[CTS-PA]

Bruce Lytle, MD. Chairman of Cardiac Surgery at Cleavland Clinic discussed this topic at grand rounds at our hospital a few months ago. Cleavland Clinic, and Columbia have integrated vascular interventions (Thoracic Endo-Stents, etc.) into their their CT-Fellowships. You can also do an addition year beyond the standard CT-fellowship, as a Endovascular Fellow at a handful of programs throughout the country.

 

[Joel Fleischman]

I have heard rumors of several programs saying that the gears are starting to turn re. an integratedCT program, at the very least, making sure there is less repitition of the overlaping stuff between residencies.
Makes thus increasing the curriosity in getting the endovasc. training.
thanks for the 411 guys.

 

[droliver]

Carolina Medical Center in Charlotte,NC has had a 3 year combined CT-Vascular fellowship program for a number of years. Graduates were able to sit for their board exams in both specialties

 

[Chief Resident]

Check this out:
http://www.hsforum.com/forum/thread?table=Changing but still rewarding specialty

 

[USCTex]

Check this out:
http://www.hsforum.com/forum/thread?table=Changing but still rewarding specialty

Nice link. However, I'm scratching my head at the quote below...

"I went thru 5 years of general surgery and 2 years of research (including moonlighting) and a day does not go by that I do not rely on the tools (technical/judgement/maturity/experience) that I learned from every step. Cutting back is only going to turn out poorly trained individuals. Complex problem and no good issue - in part since no one understands what we do anymore - other than "bail-out" the sickest people in the hospitals. Yes we are old-fashion, but much the old-fashion calvary - society still needs us, they just dont appreciate (i.e. compensate/protect legally/etc) us.

michael"

This is very old school thinking, in my opinion. I know, despite opinions like this, a direct match, integrated, 3+3 program is inevitable. But this is very conservative thinking. The sort of conservative thinking which ceded stints to cardiologists. It is not an evidenced based opinion either. Neurosurgery deals with very similiar critical care situations and yet their integrated program seems to train very good caregivers.

As the link provided points out CT surgery is suffering from an identity crisis. An integrated program, i.e., being able to say right out of medical school, I'm a CV or thoracic surgery resident, is a superficial but very important step in redefining the role of cardiac surgery.

 

[Chief Resident]

Nice link. However, I'm scratching my head at the quote below...

"I went thru 5 years of general surgery and 2 years of research (including moonlighting) and a day does not go by that I do not rely on the tools (technical/judgement/maturity/experience) that I learned from every step. Cutting back is only going to turn out poorly trained individuals. Complex problem and no good issue - in part since no one understands what we do anymore - other than "bail-out" the sickest people in the hospitals. Yes we are old-fashion, but much the old-fashion calvary - society still needs us, they just dont appreciate (i.e. compensate/protect legally/etc) us.

michael"

This is very old school thinking, in my opinion. I know, despite opinions like this, a direct match, integrated, 3+3 program is inevitable. But this is very conservative thinking. The sort of conservative thinking which ceded stints to cardiologists. It is not an evidenced based opinion either. Neurosurgery deals with very similiar critical care situations and yet their integrated program seems to train very good caregivers.

As the link provided points out CT surgery is suffering from an identity crisis. An integrated program, i.e., being able to say right out of medical school, I'm a CV or thoracic surgery resident, is a superficial but very important step in redefining the role of cardiac surgery.

If the integrated programs do ever happen, I heard it is more likely going to be a 4+3 program, not a 3+3. That is, 4 years of GS + 3 years of CT surgery. If that is the case then it does not cut down on the minimum time to train as a CT surgeon since currently it is the same 7 years (5 years GS + 2 years CT). But the real issue is not give or take the year spent training, the real issue is finding a job after finishing training. Close to 30% of graduating CT surgeons are left without an attending-level job after they finish training according to the link. From what I have read elsewhere that is a conservative number (up to 50%). Call me pessimistic, but I don't think CT surgeons will be able to regain the turf on coronary artery disease that they have already lost to cardiologists. If anything they will continue to lose more turf to the point that CT surgeons will merely be there as back-up to 'bail out' the cardiologists if something goes wrong in the cath lab, as was mentioned in the link. They'll still have thoracic surgery, valve surgery, congenital surgery, transplant and LVAD surgery and some other miscellaneous procedures. But the main procedure--for coronary artery disease--will be done more and more by invasive cardiologists in the cath lab. Thus decreasing the need for as many CT surgeons.

 

[droliver]

Neurosurgery deals with very similiar critical care situations and yet their integrated program seems to train very good caregivers.

As the link provided points out CT surgery is suffering from an identity crisis. An integrated program, i.e., being able to say right out of medical school, I'm a CV or thoracic surgery resident, is a superficial but very important step in redefining the role of cardiac surgery.

1. First off, most Neurosurgeons are not trained in global delivery of critical care medicine. Most often they end up managing very focused issues of ICP or cerebral osmolarity while consulting out everything else (at least in the 5 level I centers and 16 community hospitals I've worked in various places over the last 12 years. I will assume this is a pretty good proxy for national patterns although I'm sure someone can find some exception where the NES residents manage everything from the vents to the TED hose)

2. CT doesn't suffer from an identity crisis. It suffers from the fact that the bread & butter of the field (CABG) has become both much less required and MUCH,MUCH less well compensated for. Calling yourself "an integrated CTVS" resident will do nothing to change the reality on the ground about why the best and brightest are avoiding the field in droves - lack of good jobs, relatively modest reimbursement, sicker patients, long hours, and an often humiliating relationship with the referring cardiologists.

Whats not to like?

 

[ggx12]

lack of good jobs, relatively modest reimbursement, sicker patients, long hours, and an often humiliating relationship with the referring cardiologists.

Whats not to like?

please define "often humiliating relationship with the referring cardiologists.". What do you mean?