gen -> CT surg vs IM -> cardio

[bluelamin]

hi everyone
so im debating doing surgery and IM for the following:
1. ideally I'd like to pursue CT surgery but theres no guarantee that i'll match into fellowship from gen surg...per nrmp data 50-60% of people match into this fellowship...ands that not just US MD alone (could include DO, IMG, etc.).
2. i really like cardio as a system and thus would want a career centered around that. hence the IM -> cardio route. i realize this is not surgery and again theres a fellowship component to it but its def less competitive and plenty of US MD grads match....

so i really like surgery and have hopes of doing CT but would be risking my future to do only general surgery if things didnt work out.....
so im having trouble deciding...advice?

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[deleted50541]

hi everyone
so im debating doing surgery and IM for the following:
1. ideally I'd like to pursue CT surgery but theres no guarantee that i'll match into fellowship from gen surg...per nrmp data 50-60% of people match into this fellowship...ands that not just US MD alone (could include DO, IMG, etc.).
2. i really like cardio as a system and thus would want a career centered around that. hence the IM -> cardio route. i realize this is not surgery and again theres a fellowship component to it but its def less competitive and plenty of US MD grads match....

so i really like surgery and have hopes of doing CT but would be risking my future to do only general surgery if things didnt work out.....
so im having trouble deciding...advice?

Not sure where you got those numbers, but I reviewed the 2021 NRMP fellowship match data. 79% of U.S. MD grads (77/98) who applied matched into a CT surgery fellowship, which is mostly consistent with previous years data. 71% (99/140) of all applicants matched. While cardiology matching from IM is slightly better at 83% for U.S. grads, it's no guarantee either.

I've said this before on this forum and in real life to many students, "what do you want to do, medicine or surgery?". That's your starting point. If you can't see yourself doing general surgery if things don't work out with matching in CT, then why go down that route? I was fortunate enough to match my first go around, but I also enjoyed general surgery and was ok doing that if CT surgery wasn't meant to be.

If you're surgery inclined, then I'm guessing if you went the cardiology route that you would prefer to be an interventionist. That is another year of training typically after 3 years of cardiology fellowship. I don't have the stats for that match, but I'm aware that it's also a very competitive sub-specialty.

Some things to think about.

 

[bluelamin]

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2021/05/Thoracic-Surgery-and-Vascular-Surgery_AY2022.pdf

^i used that document...the 2nd page is specific for thoracic surgery. 154 applicants preferred the specialty and of those 91 matched and of those only 65 were US MD grads so basically 65/154 = 42% was the match rate.

 

[bluelamin]

yes you are correct that i would like to do further training after cardiology (either IC or EP who knows..). also the number of programs for IC are way more...altho might be proportional to # of applicants but not sure.

cardio is objectively an easier goal to obtain (even if for some reason i just stick with noninvasive cardio).

but i really loved my CT surgery rotation....and thats the main issue...my feelings for pursuing it vs practicality

 

[deleted50541]

Ok, that's the data for this year's match, which I hadn't seen. I would still go by the U.S. MD grad stats with 71% matching as a relative barometer of your chances. A little bit tougher this year then, especially with more integrated programs coming on. Last year there were 101 positions, 91 this year...yikes. Who knows what it'll look like in 5+ years.

I get that "feelings... vs practicality". I am a surgeon first and foremost though. I knew I would be a surgeon no matter if I sub-specialized or not. Go with your passion. If you want to do CT surgery, don't get hung up on the numbers too much and pursue that goal. You can always change your mind if you feel like a surgery residency isn't working for you.

Lastly, loving a rotation is one thing, living the life is another. Do you truly understand what it takes and means to be a CT surgeon? While incredibly rewarding, it's not an easy path or an easy life. Granted, it's hard to realize that until you're in the thick of it and committed.

 

[mikeGR]

90% of students who (think that they) want to do a specific subspecialty end up changing their mind (anecdotal data). Take it one step at a time, as noted above, and think about surgical vs medical specialties first. Once you have several medical and surgical rotations you'll have a better chance of answering this first question right.

If you then decide you prefer surgery, you have a few years to confirm whether CT surgery really is for you.

I liked almost everything as a med student. I thought I'd fit better in a surgical specialty, and I only "knew" I do NOT want to do cancer or liver/pancreas. Guess what I'm (perfectly happy) doing now...








(Spoiler: Yes, it's Surg Onc/HPB)

 

[bluelamin]

90% of students who (think that they) want to do a specific subspecialty end up changing their mind (anecdotal data). Take it one step at a time, as noted above, and think about surgical vs medical specialties first. Once you have several medical and surgical rotations you'll have a better chance of answering this first question right.

If you then decide you prefer surgery, you have a few years to confirm whether CT surgery really is for you.

I liked almost everything as a med student. I thought I'd fit better in a surgical specialty, and I only "knew" I do NOT want to do cancer or liver/pancreas. Guess what I'm (perfectly happy) doing now...








(Spoiler: Yes, it's Surg Onc/HPB)

yea i kinda need to decide cuz im in my last year and need to apply in a few months haha

 

[daenschl]

These are always such tough questions. The farther along in training I go, the more I realize how difficult this question of specialty choice really is. As @the negative 1 noted, it is very difficult (impossible?) to really know how much you like/not like a given field until you are in the middle of it and committed to it. Changing then, while still very much possible, comes at a much higher cost. In my anecdotal experience, students sometimes overestimate how much they'll like surgery and later discover that the difficulties, which were truly only abstractly observed concepts as a medical student, are actually quite bothersome. i have no good advice regarding the matter, it's a tough call to make. My general sense is that if you feel like you might be happy not doing surgery, you probably shouldn't do it. I was 100% gung ho set on only surgery but still find myself on some days wistfully wondering about other careers. But then again, the grass is always greener, and I am quite happy doing what I do.

 

[dienekes88]

Simple. Do you want to be a surgeon. Or do you want to do medicine. This is the fundamental question that you need to answer.

 

[TypeADissection]

Simple. Do you want to be a surgeon. Or do you want to do medicine. This is the fundamental question that you need to answer.

This is as simple as it gets. I remember when I was an MS-3 on surgery. For 8 weeks, I worked >80 hours a week with rather malignant residents and did so much scut, but they still taught in their own ways. And even though it was midnight and I was running to the trauma bay for another level 1 activation, or scrubbing into a Whipple where I knew damn well I would be retracting for hours; there was absolutely nothing else I would rather be doing. I knew that I had to do this. I wanted to do this and no matter how long and arduous the training, this is what I was going to do. I transitioned from my surgery block to IM for 8 weeks, then FM, then OBGYN and Peds. And despite the markedly better hours and personalities, I never wished for a quicker and sweeter death than when I was on hour 6 of IM rounds or realizing it's only 0900 and there are 20 more patients in outpatient FM clinic. It all comes down to how you want to spend your days and nights. As a resident, surgery is 16 hours of work crammed into a 12 hour day; IM is 3 hours of work crammed into a 12 hour day. Good luck. Cheers.

 

[bluelamin]

This is as simple as it gets. I remember when I was an MS-3 on surgery. For 8 weeks, I worked >80 hours a week with rather malignant residents and did so much scut, but they still taught in their own ways. And even though it was midnight and I was running to the trauma bay for another level 1 activation, or scrubbing into a Whipple where I knew damn well I would be retracting for hours; there was absolutely nothing else I would rather be doing. I knew that I had to do this. I wanted to do this and no matter how long and arduous the training, this is what I was going to do. I transitioned from my surgery block to IM for 8 weeks, then FM, then OBGYN and Peds. And despite the markedly better hours and personalities, I never wished for a quicker and sweeter death than when I was on hour 6 of IM rounds or realizing it's only 0900 and there are 20 more patients in outpatient FM clinic. It all comes down to how you want to spend your days and nights. As a resident, surgery is 16 hours of work crammed into a 12 hour day; IM is 3 hours of work crammed into a 12 hour day. Good luck. Cheers.

i've actually had a very similar thought process and decided im gonna go ahead with my passion for ct surgery! thanks for the advice y'all!

 

[Medstart108]

Don't worry, it is very common for CT residents to have thought about cardiology. I did the same as a med student and chose surgery. I don't have any regrets so far.