CT Surgery Future's So Bright I Gotta Wear Shades

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drtx

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Hey guys,

Just wondering people's thoughts.

My best friend is trying to make up his match list right now. He has interviewed at all the big name places, he's fretting over the possibility of a dismal future in something he really loves and this is my take on the whole " Oh my god, the future of CT surgery is over..... should I go to a big name place to ensure my future career options"

NONSENSE! Go where you will be happy!
And this is why I say this.

There are about half of the applicants this year for the available spots. What that means is that in a couple of decades, there is going to be a shortage.

Just purely from a supply and demand point of view- Things are going to swing back to a much better position for CT surgeons. There won't be enough of them. The demand will go up and the tragic stories you hear about CT surgeons eating ramen noodles to stay alive will be a thing of the past.

Accompanied by the fact that I think that things will get so damn good in terms of minimally invasiveness (proper term?--I am drinking wine right now) the future is really promising.

What do y'all think? Do you agree?
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drtx said:
HJust purely from a supply and demand point of view- Things are going to swing back to a much better position for CT surgeons. There won't be enough of them. The demand will go up and the tragic stories you hear about CT surgeons eating ramen noodles to stay alive will be a thing of the past.
Click to expand...

Preaching to the choir. :)

I'm crossing my fingers for all those attendings in their 60s and 70s to retire in the next 5-10 years, so when I get out into practice I'll be able to find a job. And I'm hoping that recent NEJM studies showing that stents are NOT superior to CABGs (in select situations) will help...along with the fact that the aging, obese baby boomer generation will always need valves, lobectomies, and the like. Knowing how to deploy TAGs is critical as well.

Plus I'm pretty sure I'm going to pursue lung transplant as well.
 
This is actually a great time to go into this specialty. In 10 years, the shortage is going to start being felt and the people going into it right now will have just enough experience to get into the higher chair positions with ease because there will be so few of them energetic, fairly young and experienced enough. Prime time is now, I wish I had interest in it from a purely business point of view- but I'm a belly lover.
 
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drtx said:
This is actually a great time to go into this specialty. In 10 years, the shortage is going to start being felt and the people going into it right now will have just enough experience to get into the higher chair positions with ease because there will be so few of them energetic, fairly young and experienced enough. Prime time is now, I wish I had interest in it from a purely business point of view- but I'm a belly lover.
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2015! That's when I'll be looking for a job...here's hoping the market will be better by then! :thumbup:
 
If it were stock, I'd be all over it.
 
I think it will pick up as the technology advances and we get some of these ventricular assist devices approved.
 
There seems to be a lot less cardiac surgery being done now, even at major 'heart hospitals'. In the end you should go into what you think you will be happy doing, but I wouldn't count on any kind of medical field being lucrative. Just because a field is underrepresented doesn't mean the pay is going to be any better. Insurance companies and medicare have a stranglehold now. They know that if you are in practice in CT surgery they can pay you whatever they like because you are providing a service that people need and don't want to pay for.

Unfortunately in the U.S. healthcare is considered a right by most people. If they have the bill for the plasma TV, the new Escalade and your bill sitting in front of them, which do you think will be payed last, if at all? After all, you're a rich doctor, you don't need the money, and the plasma TV will help them recover better. Also they will need the plasma for when they go on disability in a couple months.

So in 15 years, when you are working for 47 grand a year and you are getting called in at 3 in the morning to put in a chest tube after the intern dropped a lung, don't say you weren't warned. Just be sure you're ready to make peanuts and work your arse into the ground.
 
GSresident said:
So in 15 years, when you are working for 47 grand a year and you are getting called in at 3 in the morning to put in a chest tube after the intern dropped a lung, don't say you weren't warned. Just be sure you're ready to make peanuts and work your arse into the ground.
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Killjoy.
 
GSresident said:
In the end you should go into what you think you will be happy doing, but I wouldn't count on any kind of medical field being lucrative. Just because a field is underrepresented doesn't mean the pay is going to be any better.
Click to expand...


I agree, your salary in real dollars will continue to dwindle versus inflation in CTVS (or any surgery really) even if there is some kind of turn around in job prospects. Any increase in productivity or volume is getting lapped in spades by Medicare payment cuts (which privates index for their rates as well) and there is never going to be some new infusion of capital back to surgeons with pending universal healthcare systems looming.

The # of traditional CABG's is going to fall even more as the endovascular tech. advances presumably. There is nothing poised to ever replace the traditional bread & butter of the field (CABG) compensation wise. I'd be surprise if we didn't see more and more consolidation of smaller open heart programs to fewer higher-volume centers
 
Castro Viejo said:
Killjoy.
Click to expand...

I'm really sorry. I'm just trying to prevent unrealistic expectations. People need to know they will get paid peanuts to work 3 times as hard as everyone else before choosing a field. You'd better be sure.
 
Blade28 said:
Plus I'm pretty sure I'm going to pursue lung transplant as well.
Click to expand...

yeah that will help your chances in finding a job. You can only work at like 10 places in the whole country. You increase your chances of finding a job by being broad.. The more specialized you get the more boxed in you get. There are 42 year old cardiac surgeons who are doing av grafts for a living because they cant make a living doing cardiac. Pretty sad.
 
I have been through the CT surgery interview trail last yr. i agree that now is a great time to get into CT if you like it.

Even the big places can't attract residents. There are a significant amount of foreign grads in these programs who will NEVER be eligible for a job in the US due to visa issues- this sort of negates the argument that there are all these superfellows out there to compete with someday once the job market opens up.

People will always need CT surgeons. CABG is not going away. Valve disease will not be treated percutaneously for quite some time. (Did anyone see the ACS newspaper article about the sapien valve?) and most of all- the cardiologists will continue to screw up people in those cath labs and perforate vessels, so CT surgeons will always need to exist to babysit the cath lab. stents are getting ready to be made obsolete, and the lawsuits will be coming soon for all those off-label stents placed without true informed consent.

great times lay ahead.
 
maceo said:
yeah that will help your chances in finding a job. You can only work at like 10 places in the whole country. You increase your chances of finding a job by being broad.. The more specialized you get the more boxed in you get. There are 42 year old cardiac surgeons who are doing av grafts for a living because they cant make a living doing cardiac. Pretty sad.
Click to expand...

I think that what Blade28 meant was that by doing some lung transplant work, he broadens the number of skills that he has. By having a wider range of skills, he can market himself more effectively when he looks for a job as an attending.

It seemed to make sense to me - not only would he be able to do CT stuff (CABGs, valve replacements, esophagectomies, etc.), but he'd also be able to claim wider experience with lung transplants.

In any case, aren't there more than 10 places in the country where they do lung transplants? :confused:
 
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GSresident said:
I'm really sorry. I'm just trying to prevent unrealistic expectations. People need to know they will get paid peanuts to work 3 times as hard as everyone else before choosing a field. You'd better be sure.
Click to expand...

(I'm in total agreement with you and happen to pretty much feel the same way...)
 
droliver said:
I agree, your salary in real dollars will continue to dwindle versus inflation in CTVS (or any surgery really) even if there is some kind of turn around in job prospects. Any increase in productivity or volume is getting lapped in spades by Medicare payment cuts (which privates index for their rates as well) and there is never going to be some new infusion of capital back to surgeons with pending universal healthcare systems looming.

The # of traditional CABG's is going to fall even more as the endovascular tech. advances presumably. There is nothing poised to ever replace the traditional bread & butter of the field (CABG) compensation wise. I'd be surprise if we didn't see more and more consolidation of smaller open heart programs to fewer higher-volume centers
Click to expand...

True. Part of why I decided to go into plastics.
 
Obviously, people who are interested in making ALOT of cash are going to slip and slide on their own drool into plastics. Comparing CT surgery and plastics is like trying to decide between driving a Bentley or a Sonata.

I'm was just pointing out that I think the future of CT Surg is not as bad as people think.
 
smq123 said:
I think that what Blade28 meant was that by doing some lung transplant work, he broadens the number of skills that he has. By having a wider range of skills, he can market himself more effectively when he looks for a job as an attending.

It seemed to make sense to me - not only would he be able to do CT stuff (CABGs, valve replacements, esophagectomies, etc.), but he'd also be able to claim wider experience with lung transplants.
Click to expand...

Exactly! :thumbup:

Basically at this moment I'm equally open to taking on a broad range of Cardiac and/or Thoracic cases to help survive. I do realize that it's all about finding your "niche," and I've got a few years to work on that.

In any case, aren't there more than 10 places in the country where they do lung transplants? :confused:
Click to expand...

Indeed there are!

http://www.cms.hhs.gov/approvedtransplantcenters/downloads/lung_heart_list.pdf

There are 47 adult heart/lung transplant centers in the country.
 
drtx said:
Obviously, people who are interested in making ALOT of cash are going to slip and slide on their own drool into plastics. Comparing CT surgery and plastics is like trying to decide between driving a Bentley or a Sonata.
Click to expand...
 
drtx said:
Obviously, people who are interested in making ALOT of cash are going to slip and slide on their own drool into plastics. Comparing CT surgery and plastics is like trying to decide between driving a Bentley or a Sonata.

I'm was just pointing out that I think the future of CT Surg is not as bad as people think.
Click to expand...

What I was getting at was that plastic surgeons are less subject to the whims of the good people who run Medicare than other physicians, and that was the "part of why I went into plastics." I'm not just talking about the money, I'm talking about being less beholden to some bureaucrat with a political agenda.

Make no mistake, I would still have gone into plastic surgery if money were not as good because it's the right field for me. It is something that uniquely suits me. In the words of Moravian, plastic surgery is what "turns me on." The possibility of having a straight fee-for-service aspect to my practice (in the face of declining reimbursements for almost every field) allows me more independence and thus only sweetens the deal.

Although future earning potential was something I thought about when I made my decision, it was pretty far down the list. Like many plastic surgeons, I vastly prefer reconstructive work to cosmetics.

If I were picking a field based solely on salary, I would have become a Mohs surgeon or an orthopedic spine surgeon. And if you familiarize yourself with plastic surgery at all, you'll realize that it is impossible to "slip and slide" into the field--it's actually very, very difficult to become a plastic surgeon.

Don't hate because you're jealous. And most of the time I wipe my drool before I slip on it.
 
Alright, just relax...it was a joke. Let's keep this upbeat. This is not worth drama.
 
drtx said:
Alright, just relax...it was a joke. Let's keep this upbeat. This is not worth drama.
Click to expand...

Sorry, it gets a little knee-jerk sometimes. I've spent a lot of time trying to educate people about plastic surgery NOT being like "Dr. 90210" or "Nip/Tuck" or whatever. It gets so old having medical people intimate that I'm doing it for the money, and having friends/family/people you just met saying "Oho, plastic surgeon eh? Well how bout you give me [cosmetic procedure x]?" I'm sure I'll appreciate that more when I'm finished with residency, but now I sort of reflexively get defensive about it.
 
You just hit is squarely on the head. The single best thing about plastic surgery is the single worst thing about every other field. In plastics you can truly be your own boss. You can start your own practice if you want to, build a cosmetics practice and stop taking insurance and medicare. If you run your own show no one can tell you what to do.

Hospital administrator: "Yeah, I'm gonna need you to come in and work on Saturday, and I'm gonna have to ask you to take call on Sunday as well. Oh and did you get that memo on the new forms we need you to fill out on every patient? I'll have Bill in accounting send you another copy. Oh and by the way, you're not seeing as many patients a day as we would like you to. You're seeing 42 patients, and I'm gonna have to ask you to see 60. So if you'd just go ahead and come in 3 hours earlier and stay 3 hours later that would be great."

Only if you are your own boss can you tell the hospital administrator what he should be told - GO FLY A KITE.

DrDre311 said:
What I was getting at was that plastic surgeons are less subject to the whims of the good people who run Medicare than other physicians, and that was the "part of why I went into plastics." I'm not just talking about the money, I'm talking about being less beholden to some bureaucrat with a political agenda.

Make no mistake, I would still have gone into plastic surgery if money were not as good because it's the right field for me. It is something that uniquely suits me. In the words of Moravian, plastic surgery is what "turns me on." The possibility of having a straight fee-for-service aspect to my practice (in the face of declining reimbursements for almost every field) allows me more independence and thus only sweetens the deal.

Although future earning potential was something I thought about when I made my decision, it was pretty far down the list. Like many plastic surgeons, I vastly prefer reconstructive work to cosmetics.

If I were picking a field based solely on salary, I would have become a Mohs surgeon or an orthopedic spine surgeon. And if you familiarize yourself with plastic surgery at all, you'll realize that it is impossible to "slip and slide" into the field--it's actually very, very difficult to become a plastic surgeon.

Don't hate because you're jealous. And most of the time I wipe my drool before I slip on it.
Click to expand...
 
DrDre311 said:
Sorry, it gets a little knee-jerk sometimes. I've spent a lot of time trying to educate people about plastic surgery NOT being like "Dr. 90210" or "Nip/Tuck" or whatever. It gets so old having medical people intimate that I'm doing it for the money, and having friends/family/people you just met saying "Oho, plastic surgeon eh? Well how bout you give me [cosmetic procedure x]?" I'm sure I'll appreciate that more when I'm finished with residency, but now I sort of reflexively get defensive about it.
Click to expand...

Its natural - I found the same thing when I was interested in Hand or Craniofacial. And even now when people assume I work 8-5, I get a little cranky when I'm still doing charts at 11 pm.
 
I heard a rumor that there were more candidates for CT surgery this year compared to years past. Anyone know any #'s?
 
DrDawg said:
I heard a rumor that there were more candidates for CT surgery this year compared to years past. Anyone know any #'s?
Click to expand...

Yeah, 2 more this year than the last.
 
Should know better than to trust the rumor mill
 
the rumor mill wasnt wrong. 2 more than last year is still 2 more.
 
Isn't that within the error of the measurement, though? Taking repeated samples from the same pool will result in slightly different match rates... and that might be what we're seeing here. That would mean the change in match rate wasn't really a change in gen surg resident interest in CT surgery. In other words, 2 more can't necessarily be considered an actual change.
 
mosfet said:
Yeah, 2 more this year than the last.
Click to expand...

guys, I was JUST kidding!! I just made up that number.....there is no need to analyze it any further. It was a failed attempt of sarcasm targeted towards the field of CT surgery. I was trying to imply that even if there were an increase in the number of applicants, it couldn't have been by a lot (in other words, as dienekes88 mentioned in an earlier post, it's probably within the error of measurement).
 
mosfet said:
guys, I was JUST kidding!! I just made up that number.....there is no need to analyze it any further. It was a failed attempt of sarcasm targeted towards the field of CT surgery. I was trying to imply that even if there were an increase in the number of applicants, it couldn't have been by a lot (in other words, as dienekes88 mentioned in an earlier post, it's probably within the error of measurement).
Click to expand...

Hahaha. I looked it up and 3 more matched CT this year than last year (87 vs. 84) and there were only 5 more applicants (96 vs. 91). Not a bad guess on your part!

Meanwhile each year from 2004-2007 there was a significant change (decrease) in both the number applying and the number matching. The 2008 data may suggest that interest in CT isn't declining any further...
 
dienekes88 said:
Hahaha. I looked it up and 3 more matched CT this year than last year (87 vs. 84) and there were only 5 more applicants (96 vs. 91). Not a bad guess on your part!

Meanwhile each year from 2004-2007 there was a significant change (decrease) in both the number applying and the number matching. The 2008 data may suggest that interest in CT isn't declining any further...
Click to expand...

How did you get this years match stats? I thought the match was June 11.
 
With the new primary certificate in vascular surgery an option now, anyone considering going into CT after a vascular residency? Seems like it'd be a good idea (from an MS3 perspective), if you know you want to do CT or even vascular for that matter. I think the training in vascular might be more useful than the training in general for a chest surgeon. Seems like where I'm at, the cardiothoracic guys do a lot of vascular procedures, like CEAs, and not any general surgery procedures.
 
Job Bluth said:
Seems like where I'm at, the cardiothoracic guys do a lot of vascular procedures, like CEAs, and not any general surgery procedures.
Click to expand...

Because they probably don't want to do general surgery procedures and can't get privileges for them (which often requires ER call for gen surg). Most fellowship trained surgeons do not do general surgery, even though they've done the residency.
 
Job Bluth said:
With the new primary certificate in vascular surgery an option now, anyone considering going into CT after a vascular residency? Seems like it'd be a good idea (from an MS3 perspective), if you know you want to do CT or even vascular for that matter. I think the training in vascular might be more useful than the training in general for a chest surgeon. Seems like where I'm at, the cardiothoracic guys do a lot of vascular procedures, like CEAs, and not any general surgery procedures.
Click to expand...

One of my medical school classmates was married to a vascular attending who took a CT fellowship at the program where she matched (derm).
 
Yeah, I'm a MS3 and have also looked at/considered doing a Vascular Residency (but am pretty much limited to trying to get into the Mt Sinai for geographical reasons, so unless i blow them away in interview or more NYC places start up...) then CT fellow, thinking that'd be a great pathway for it and more complete. I did read that CT fellowships will take the vascular residents...

Does anyone think the future of CT surgery will boil down to getting rid of the division between people doing Cardiac and people doing Pulmonary/Thoracic? I know Cardiac is struggling, but is the pulmonary end doing that bad? I mean, don't they remove lung masses, and isn't lung cancer at all time highs, and better chemo means masses that used to be non-resectable are becoming operable? Again, this goes back to people being more marketable, but also means no one will be as skilled at CABG or valve replacement...

Also, what about the idea of hybrid invasive cardiology/cardiac surgery fellowship/OR's. I believe Columbia was working on or has a fellowship now where they do a year in the cath lab then do CT surgery, and they have new OR suite designed to do catheter's but also be to OR standards so if needed to open up don't have to go from the cath suite to the OR. Can't CT steal cath from Cardiology? Most other surgical fields involved in vessels (so basically vascular surgeons and neurosurgeons) do catheterizations, so why can't CT surgeons! I'm sure a surgeon will be much better at cath than a internist, and especially if you go the Vascular Residency - CT fellowship route, you will be a skilled cath user, so why not go into the coronary vessels?
 
Winged Scapula said:
That data is for a 2008 APPOINTMENT - meaning they matched last year in June 2007 for a start date in July 2008.

Match Day for Thoracic Surgery this year is June 11, 2008 for a 2009 APPOINTMENT.
Click to expand...

Thanks for clarifying, Winged Scapula.

2009 Appointment:
108 applicants (6 didn't submit ROLs, 1 withdrew)
94 matched (84 for 2007 appointment, 87 for 2008 appointment)
7 unmatched

Looks like it's trending upwards...
 
7 unmatched? How in THE WORLD did that happen?
 
Assuming you aren't "just anyone", Blade. ;)
 
Blade28 said:
Well hopefully my residency program, output from research and letters from faculty here will count for something! :thumbup:
Click to expand...

One of the keys in my program to getting good letters for fellowship was never to have a manuever named after you.

Like you wouldn't want to have it known that the "Blade Procedure" was stapling across the NG tube while making the pouch for a R en Y (wasn't me). Or breaking the specially ordered Pediatric Chemo Infusion port which happened to be the only one in the hospital on insertion (also not me). :laugh:
 
Winged Scapula said:
One of the keys in my program to getting good letters for fellowship was never to have a manuever named after you.

Like you wouldn't want to have it known that the "Blade Procedure" was stapling across the NG tube while making the pouch for a R en Y (wasn't me). Or breaking the specially ordered Pediatric Chemo Infusion port which happened to be the only one in the hospital on insertion (also not me). :laugh:
Click to expand...

:laugh: Good, sage advice.
 
Blade28 said:
Well hopefully my residency program, output from research and letters from faculty here will count for something! :thumbup:
Click to expand...

I hate to break it to you Blade, but the word on the street is that all of that stuff is about as important as being able to do a good 6-braid on a loaf of Challah. I know. I wish it were important too. I just made 4kg of Challah.

:laugh:
 
dienekes88 said:
I hate to break it to you Blade, but the word on the street is that all of that stuff is about as important as being able to do a good 6-braid on a loaf of Challah. I know. I wish it were important too. I just made 4kg of Challah.

:laugh:
Click to expand...

I have no idea what Challah is, but OK, I believe you.

;)
 
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