Future Surgical Specialities

[HariSeldon]

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Hi All,

I've been doing quite a bit of reading into the history of surgery, and it raised the question "are there any more surgical specialities to create?" . In the near future or ever at all do you think there are more surgical specialities to create as Harold Gillies did with modern plastic surgery, Harvey Cushing for modern neurosurgery and Jones with orthopaedics. My thinking is that we have all body parts and ages covered so there isn't really any space for new surgical specialities, but am I wrong in this.

Thanks for thoughts,
Hari

 

[TypeADissection]

Probably not so much the creation of new specialties but rather further subdivision of subspecialties as the trend towards "centers of excellence" continues. That and human nature to do the things we are good at and steer away from things we aren't so good at to our colleagues who do them more often (and hopefully better).

 

[HariSeldon]

Probably not so much the creation of new specialties but rather further subdivision of subspecialties as the trend towards "centers of excellence" continues. That and human nature to do the things we are good at and steer away from things we aren't so good at to our colleagues who do them more often (and hopefully better).

"Centers of excellence"? What is this phrase in reference to?

 

[DoctwoB]

Probably not so much the creation of new specialties but rather further subdivision of subspecialties as the trend towards "centers of excellence" continues. That and human nature to do the things we are good at and steer away from things we aren't so good at to our colleagues who do them more often (and hopefully better).

I could see cardiac and thoracic going separate ways at some point. I could see the trend of integrated residencies of former Gen Surg fellowships continuing like a peds surg residency. Can’t really think of any others.

 

[WedgeDawg]

I could see cardiac and thoracic going separate ways at some point. I could see the trend of integrated residencies of former Gen Surg fellowships continuing like a peds surg residency. Can’t really think of any others.

Cardiac and thoracic are already totally separated at my institution.

 

[DoctwoB]

Cardiac and thoracic are already totally separated at my institution.

Mine as well. I was just saying that at some point there will likely be separate cardiac and thoracic surgery residencies.

 

[LucidSplash]

"Centers of excellence"? What is this phrase in reference to?

LMGTFY

 

[TypeADissection]

LMGTFY

I saw the alert in the upper right hand corner, read the question, was going to LMGTFY that question, saw that you already did it, laughed, passed flatus, wrote this response.

 

[mmmcdowe]

Spine surgeons have discussed becoming their own specialty. Seems unlikely at the moment.

 

[Psai]

Spine surgeons have discussed becoming their own specialty. Seems unlikely at the moment.

Seems very risky.

 

[droliver]

Cardiac and thoracic aren't going to split, and anyone thinking that has probably never worked outside a teaching hospital. In community practice, almost all CT surgeons do both, and quite often they do vascular surgery as well.

 

[ConfusedChemist]

Cardiac and thoracic aren't going to split, and anyone thinking that has probably never worked outside a teaching hospital. In community practice, almost all CT surgeons do both, and quite often they do vascular surgery as well.

They've been split in Canada for a number of years now...

 

[droliver]

They've been split in Canada for a number of years now...

I just looked at what are generally considered the top training programs in Canada, and their curriculum is very traditional in scope between cardiac and thoracic training on the half a dozen I looked at. While there may be individuals who narrow their practice, most private practice CTVS surgeons do a mix of cases (cardiac, vascular, thoracic) as there is rarely the volume in most settings to have such narrow practices, and that's only become more true. Especially on the cardiac side, a lot of those cases that used to turn the wheel are now endovascular or non-operative management.

 

[idiot07]

I just looked at what are generally considered the top training programs in Canada, and their curriculum is very traditional in scope between cardiac and thoracic training on the half a dozen I looked at. While there may be individuals who narrow their practice, most private practice CTVS surgeons do a mix of cases (cardiac, vascular, thoracic) as there is rarely the volume in most settings to have such narrow practices, and that's only become more true. Especially on the cardiac side, a lot of those cases that used to turn the wheel are now endovascular or non-operative management.

They're definitely more separate in Canada than in the United States. Cardiac is its own 6 year integrated residency up there, wile thoracic is a 2 year fellowship after general surgery or cardiac. There is cross training, of course, but from what I remember, the thoracic residents would do about 4 months of Cardiac surgery out of two years of training, which is significantly less than those in "thoracic track" fellowships here do, about 12 months during a 2 year fellowship. That's how most of Europe and Asia do it too. More importantly, the Boards are separate. Agree that most of the community jobs in the US have you doing a mix, but I think this will change over the next 15 years as the thoracic and cardiac technical and intellectual skill sets continue to diverge. It was one thing two do both when most of your operations consisted of CABG, open AVR, decortications, and open lobes. As you noted, cardiac surgery continues to go down the endovascular route and the remaining open cases get more and more complicated. Thoracic at the same time has gotten significantly more difficult with the rise of VATS, endoscopic interventions, and more complex oncologic decisions. It's going to be hard to practice both. I live in a mid sized city, and none of the "community" surgeons I know regularly do both, albeit everyone works for a big hospital system with referral bases that allow this. If you go out in the state, or look a ctsnet, what you describe is correct, the most typical job description is to do everything, I just don't think this is tenable long term.

 

[droliver]

Skeptical. There just aren’t the cases around for most to not do both (vascular and thoracic) particularly on the thoracic side, to be pumping out a significant number of thoracic only surgeons. That practice model really only can work at tertiary hospitals within a feeder system. I work at 6 community hospitals with about 15-20 CTVS surgeons scattered in a 1.2M metro area that also has a large University hospital with something like another 15 ctvs surgeons in it. Out of that group outside the University, only one is thoracic only, a guy who’d been thoracic only at the University hospital for a decade prior to leaving, and he’s at the feeder cardiac hospital of a 5 hospital system locally.. The rest all do cardiac, peripheral vascular, and chest cases. The University is a different story, with 1-2 dedicated adult thoracic oncology only guys, a few that do both, and the rest pure CABG/valve jockeys, and a few peds surgeons that did both. That was the same pattern I saw in the other 3 large metro areas I went to school and trained in.