CT surgery questions

[miler]

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Last year I read some people's opinions on here that were quite negative as far as CT surgery is concerned, mainly that CABG procedures are losing out to stents so there isn't as many cases, and people saying that it is a horrible lifestyle.

My question is: what is the future of this field really going to be like? It is easy to say that it is a dying field but there are still CABG's for multi-vessel disease, bad valves that need replacing, trauma, congenital heart defects, plus lung tumors, esophageal problems, etc. Plus, with the 80 hour week being in effect, is it really that much worse that other surgery fields?

Basically, I'm trying to open up the discussion about this field again because I find it incredibly fascinating and want to hear some more opinions on it...

Thanks

 

[Blade28]

I've been struggling with this myself. I've been interested in CT surgery ever since I was a freshman in college - now that I'm in G Surg, I hear more and more residents/attendings tell me it's a "dying field," and that I should "get out" and look elsewhere for a fellowship. I'm really torn - I don't know what else I would do, though I am interested in laparoscopy and surg onc right now.

I do think it's tough to predict what's going to happen to any given field in medicine over the next decade - is it silly to make decisions now based on guesses about the future, or foolish to ignore your colleagues' warnings?

 

[Pilot Doc]

Last year I read some people's opinions on here that were quite negative as far as CT surgery is concerned, mainly that CABG procedures are losing out to stents so there isn't as many cases, and people saying that it is a horrible lifestyle.

My question is: what is the future of this field really going to be like? It is easy to say that it is a dying field but there are still CABG's for multi-vessel disease, bad valves that need replacing, trauma, congenital heart defects, plus lung tumors, esophageal problems, etc. Plus, with the 80 hour week being in effect, is it really that much worse that other surgery fields?

Basically, I'm trying to open up the discussion about this field again because I find it incredibly fascinating and want to hear some more opinions on it...

Thanks

This thread recurs q3-6 months. Do a search.

That having been said, cardiac surgery is not a dying but a shrinking field. Yes, there will always be operations in the chest. Extrapolating that fact to "Cardiac surgery is a good career choice" is a HUGE logical fallacy.

With the rise of PCI, supply of CT surgeons greatly exceeds demand. That will continue for decades until the oversupply of trained CT surgeons retires or leaves the field. It's a bit like the airline industry - there's going to be some very painful capacity reductions until supply and demand reequilibrate.

 

[AJ2000]

What about those people who want to do general thoracic (ie non cardiac)? Do you feel that the decreasing competitiveness of the fellowship as a whole has oddly worked in their favor? Also, I know that a few years ago the ABTS approved that ABS board certification was no longer a requirement, and somebody mentioned WashU and UTSW as the two programs that were trying out the 3+3...but whatever happened with this?

 

[Misterioso]

 

[mysophobe]

What about those people who want to do general thoracic (ie non cardiac)? Do you feel that the decreasing competitiveness of the fellowship as a whole has oddly worked in their favor? Also, I know that a few years ago the ABTS approved that ABS board certification was no longer a requirement, and somebody mentioned WashU and UTSW as the two programs that were trying out the 3+3...but whatever happened with this?

There are a bunch of surgeons here that are only general surgeons that do a lot of chest work--they just stay away from the heart.

 

[miler]

Thanks for the input, I know this thread recurrs quite often, I was just hoping to open up the discussion on it again....I agree with Blade 28 that it is a tough balance of taking in people's opinions on something with wondering if it is foolish to make guesses about the future.

Also, if there is a oversupply of CT surgeons, why exactly is their rep so bad as far as lifestyle is concerned? It seems like their then should be enough sugeons to go around to make their lives a little more tolerable.

I was in yesterday on a couple CT surgeries, and it is such a fantastic and complicated mix of pathology, surgery and physiology (perfusion, bypass, etc.) I just haven't seen such a good mix of all of the above in other surgeries....(Just my bias obviously...) Any others that compare in your opinions?

 

[mysophobe]

Thanks for the input, I know this thread recurrs quite often, I was just hoping to open up the discussion on it again....I agree with Blade 28 that it is a tough balance of taking in people's opinions on something with wondering if it is foolish to make guesses about the future.

Also, if there is a oversupply of CT surgeons, why exactly is their rep so bad as far as lifestyle is concerned? It seems like their then should be enough sugeons to go around to make their lives a little more tolerable.

I was in yesterday on a couple CT surgeries, and it is such a fantastic and complicated mix of pathology, surgery and physiology (perfusion, bypass, etc.) I just haven't seen such a good mix of all of the above in other surgeries....(Just my bias obviously...) Any others that compare in your opinions?

It depends on your interests I think. I do enjoy CT, but for me, vascular surgery has the technology that is continually advancing, as well as the other factors you mentioned above. There's nothing I'd rather be doing for 4 hours on a Friday morning than AAA stents or an aorta-bifem.

 

[miler]

It depends on your interests I think. I do enjoy CT, but for me, vascular surgery has the technology that is continually advancing, as well as the other factors you mentioned above. There's nothing I'd rather be doing for 4 hours on a Friday morning than AAA stents or an aorta-bifem.

Good point, maybe I should start going to more vasc. stuff.... 🙂

Keep the discussion coming!!

 

[mysophobe]

Good point, maybe I should start going to more vasc. stuff.... 🙂

Keep the discussion coming!!

Well, three of the vascular surgeons at this hospital do a lot of chest work as well as general and vascular--they are workaholics. Doing a lap chole, a pneumectomy, and a declot all in the same day is definitely a cool experience.

 

[miler]

Well, three of the vascular surgeons at this hospital do a lot of chest work as well as general and vascular--they are workaholics. Doing a lap chole, a pneumectomy, and a declot all in the same day is definitely a cool experience.

Very interesting, you're painting a pretty good picture for vascular..

 

[mysophobe]

Very interesting, you're painting a pretty good picture for vascular..

Haha. Come over to the dark side of the force! I was very interested in doing CT surgery, but it was mostly the general thoracic stuff that I enjoyed. After working with those guys, coupled with my love for vascular, it seems like a perfect match. You should definitely think about it.

Plus, vascular is only 2 years instead of 3. 😛

 

[Blade28]

Damn, I've actually considered vascular and surg onc but I didn't realize vascular surgeons still do lap choles too! That's awsome.

 

[mysophobe]

Damn, I've actually considered vascular and surg onc but I didn't realize vascular surgeons still do lap choles too! That's awsome.

Actually, I've found that to be a common misconception: that once you do a fellowship, you're stuck doing only that kind of work. But, I've never met a surgeon in the private setting, even a fellowship trained one, that didn't do some type of general work as well. I'm sure you could narrow yourself to only that area, and in academia, I'm sure it's pretty common. In private practice, though, it's pretty common, from what I've seen, for them to do a pretty good mix of both. And it's still possible to get the new technology. At the private hospital I'm at, the vascular guys do AAA stents, carotid stenting, etc. We just got the Angiojet thrombectomy doohickey this week. I haven't used it yet, but it looks pretty cool.

 

[Blade28]

Haha. Come over to the dark side of the force!

Funny you should call it that - I used to call General Surgery the "dark side of the force" when trying to convince fellow med students to switch from IM, peds, etc.

 

[mysophobe]

Funny you should call it that - I used to call General Surgery the "dark side of the force" when trying to convince fellow med students to switch from IM, peds, etc.

Haha. It has multiple uses I guess.

 

[johnny_blaze]

It depends on your interests I think. I do enjoy CT, but for me, vascular surgery has the technology that is continually advancing, as well as the other factors you mentioned above. There's nothing I'd rather be doing for 4 hours on a Friday morning than AAA stents or an aorta-bifem.

I’m really interested in vascular as well, I’ve spent most of my medical training with this in mind as a career. However, recently I’ve been looking into CT. Don’t sell it short… it’s an expanding field with technology change as well, robotics are becoming more and more popular.

Just for a bit of discussion… these “future of CT” threads do frequently come up on this forum and I always enjoy reading them. I understand that the reason why CT is so unpopular now is because of the unstable job market following qualification training. I am under the impression that in the US there are too many fellowships and not enough consultant posts (I hope I’m correct in assuming this, I’m pretty sure I read about this in a similar forum). I find this interesting because in England (where I live) we don’t really have this problem. CT training here is its own specialty (not part of GS) and the government, general medical council, and postgraduate deanery closely control the number of training spots. And yes, there are also less cardiac procedures done now in the U.K and this does reflect the number of consultant spots but this also results in a decrease in the number of specialist training spots. This all means that if you do manage to get a training spot in CT, there’s still a good chance that there will be a good job waiting for you when you finish as the “bottleneck” is before you start your training, not after you finish.. Private work for CT is really good here in the U.K. It costs 12-15k pounds (around 30k dollars) to get a CABG done… not too bad for a few hours work. I don’t think I’d ever make as much money doing vascular… but I guess it’s best to just do what you love. 🙄

 

[johnny_blaze]

Damn, I've actually considered vascular and surg onc but I didn't realize vascular surgeons still do lap choles too! That's awsome.

This depends on the surgeon and where you work. Most vascular surgeons I know only do vascular, simply because of the demand. In a busy vascular service, there really isn’t much time to be taking on general cases as well. However, I do know that some vascular surgeons still do general surgery in smaller centres but I suspect all the really complicated vascular stuff gets sent to a major unit. I’d personally rather do complex vascular surgery than a GB or an appendix.

 

[mysophobe]

Yeah, I'm not selling CT short; on the contrary, I think it's a great field, and I have great respect for the people in it. When I said "for me", I meant for me. I wasn't speaking generally, just in my opinion. I'm more interested in the vascular stuff than that CT stuff, so it naturally appeals to me more.

Are you at a teaching hospital? I've met a few vascular surgeons in academia that do nothing but vascular work, but I currently work with a bunch of private practice docs that do just as much general as they do vascular, including complex cases. We aren't just doing declots and angiograms, but we also frequently do AAA stenting, carotid stents, angiojet now that we have it. Two of the vascular docs do tons of bariatric work, and they are definitely two of the best in the country, so it is definitely possible to keep a busy vascular practice while doing general.

 

[johnny_blaze]

I’m at a university teaching hospital and all the vascular surgeons do nothing but vascular here and in the other teaching hospitals in my area. I also worked in an academic hospital in Ontario and it was the same thing. The “complex” stuff I was referring to usually involves complex aortic repair or other some-what rare conditions/scenarios that might require intensive care management post-op or close collaboration with other specialties. A lot of this stuff gets shipped off to major units who can accommodate this.

The emergency commitment in busy centres is quite demanding and I don’t really see how one could also keep up a general surgical workload along with it. The vascular surgeons I’ve met only do vascular on-call and don’t bother with general. However, I have see advertisements for posts wanting vascular surgeons with an interest in trauma surgery or renal transplant in academic centres, so I assume they handle a double-work load.

When I’ve been on vascular services I’ve assisted in things like spleenectomies and nephrectomies, and bowel resections, however, these were all due to vascular pathology. I guess the vascular surgeon can find him/herself doing a variety of different things even in an academic setting. 👍

 

[mysophobe]

Yeah, I figured you were in an academic setting. Like I said, in that setting, the vascular guys I've met only do that stuff.

 

[saki0005]

www.sts.org

There's a direct link to a lecture that Dr. David Taggert gave during the 2006 STS meeting in Chicago last month. It's a fantastic presentation on stents v. CAB's.

 

[automaton]

www.sts.org

There's a direct link to a lecture that Dr. David Taggert gave during the 2006 STS meeting in Chicago last month. It's a fantastic presentation on stents v. CAB's.

good talk, thanks for the heads up. although he is a bit childish towards the end towards cardiologists. i guess it's his way of fighting back... kinda sad.