From what I've heard, the 10-year Duke program is an "in house" program, in that they usually (not always) take the CT fellows from their own pool of general surgery residents. The Hopkins programs is much the same from what I've heard, only that you decide on a cardiac or general thoracic surgery track early on in your general surgery residency and then pursue that track. Although both these programs span 10-years, they are still extremely competetive.
They've been talking about these "6-year integrated CT programs" that can be matched into from med school for some years now without much development. The 80-hour rule is a major road block since it would be pretty difficult to train a competent CT surgeon in only 6 years if they were limited to 80 hours per week. Canada has 6-year cardiac programs straight out of med school (2 years general surgery+ 1 year research + 3 years cardiac surgery), but those guys are still pulling 120-130 hours per week.
One thing that has changed though is that you no longer need to be board certified in general surgery in order to be board certified in CT surgery in the US. This opens the door for CT programs to take residents who have not finished their general surgery program (i.e you can apply for a CT residency after 3 or 4 years of general surgery and not have to sit and pass the general surgery boards, only having to pass the CT board exam at the end of CT training). But yet again CT programs are reluctant to take a resident who has not completed a full general surgery residency when they have applicants who have indeed finished general surgery and even become board certified in general surgery. My personal opinion is that it's going to be at least 2-3 more years until we see 6-year integrated programs popping up around the country.
WashU was the first pilot program that started experimenting with a handful of its own general surgery residents. I believe they started the program last year, so it's too early to tell how it's going.
There's a bunch of info on the ABTS website about the the changes in CT residency and integrated programs.
