General and Vascular Surgery

[Castro Viejo]

Hello,

I'll be volunteering my time to discuss and answer questions regarding General Surgery and Vascular Surgery.

So if you've got questions about residency or fellowship training, lifestyle, reimbursement/income, career options post-training, or anything else, fire away!

Happy Holidays and Happy New Year!

---

Members don't see this ad.

 

[Castro Viejo]

What type of opportunities do you see GS's having in smaller towns (less than 25k or so)? I'm assuming it would depend specialist saturation, hospital proximity and affiliation, etc. What role would such a physician play in a smaller population setting?

Thanks!

It would very much depend on what are the available physician resources in the area as well as available hospital facility resources.

First and foremost the General Surgeon in such a community would likely be a true General Surgeon, operating not only in the abdominal cavity, but the thoracic cavity, head & neck, and some more common vascular operations.

This can be anything from hernias to Whipples to lung resections to infrainguinal vascular bypass operations.

Secondly, the General Surgeon in this kind of community would likely be the primary traumatologist for a particular hospital facility, responding to operative trauma when and if the need arises (so long as adequate facilities exist to take care of these types of patients postoperatively). At the very least the General Surgeon in this setting will stabilize the patient, operatively or non-operatively, and pack the patient up for transfer to a true trauma center if the facilities don't exist in his town.

Beyond being the true General Surgeon and the traumatologist, the General Surgeon may also be called upon for obstetric emergencies -- including C-sections, abdominal hysterectomies, etc., if an OB/GYN is not available.

There are many hats a General Surgeon in this kind of community can wear, and for some it's a daunting task, but for others it's a chance to be what he trained to be in the first place.

But as you point out, a lot of what you will do as a General Surgeon in that small of a community really depends on many of the factors you mentioned.

Hope this helps.

 

[Castro Viejo]

whats all this endograft i keep on hearing about?

"Endograft" is the term sometimes used to describe a self-expanding metal stent that's covered by a fabric used as a vascular conduit in various types of interventions.

As such, endografts have been employed in the treatment of aortic aneurysms, vascular injuries, and certain types of vascular occlusive diseases.

The first abdominal aortic aneurysm repaired with an endograft was by Dr. Juan Parodi in Argentina in 1990, and the first endograft repair in the United States was performed in 1992 by Dr. Parodi in New York, and since then, the "endovascular surgery" era was ushered into the mainstream. Today endografts are being developed that will make repairs of certain segments of the aorta possible without the need for a major operation.

You'll see us use the terms "endograft," "stent," or "graft" to all basically mean the same thing in terms of endovascular interventions. Endovascular and endoluminal are somewhat interchangeable in the vascular world as well. "Wall stent" is sometimes used to refer to a bare metal stent (i.e., without a fabric covering).

I hope this helps.

 

[turtleboard]

I'll be taking over Castro Viejo's duties as the SDN Mentor for General Surgery and Vascular Surgery for a while as he tends to other things in life.

I, too, am a General Surgery Chief Resident who will finish off in June 2008 and enter a fellowship in Vascular Surgery.

So ask away! I know Castro's always done a good job with this kind of thing, and I will be sure to live up to his standards!

 

[turtleboard]

turtleboard, can a osteopathic vascular surgeon graduating a DO program be board certified among the acgme?

If your question is for a DO who trained through a strictly osteopathic route, becoming board eligible by an osteopathic specialty board, then no. If your question is for a DO who trained through ACGME-accredited programs, and is board eligible by the American Board of Surgery, then yes.

Let me explain a little more clearly.

First, only the specialty boards recognized by the American Board of Medical Specialties (ABMS), which does not include the osteopathic specialty boards, can board certify a physician or surgeon. The ACGME has nothing to do with board certification, but going through its programs generally will lead to board eligibility with an ABMS specialty board.

Currently the allopathic board, the American Board of Surgery (ABS), grants board certification in General Surgery and awards a "primary certificate" (i.e., similar to board certification) in Vascular Surgery. Additionally the ABS awards a Certificate of Added Qualifications (CAQ) for Trauma/Surgical Critical Care. This applies to MDs or DOs who train through ACGME-accredited ("allopathic") programs. To obtain a primary certificate in Vascular Surgery, you can go through one of several approved routes of training.

1. Successfully complete an ACGME-accredited ("allopathic") 5 year residency in General Surgery followed by an ACGME-accredited 2 year fellowship in Vascular Surgery. Some call this the "Traditional Route" or "5+2" training. This leads to board certification in both General Surgery and Vascular Surgery.

2. Successfully complete 4 years of an ACGME-accredited residency in General Surgery followed by an ACGME-accredited 2 year fellowship in Vascular Surgery. Some call this "Early Specialization" or "4+2" training. This leads to board certification in both General Surgery and Vascular Surgery.

3. Successfully complete 3 years of an ACGME-accredited residency in General Surgery followed by a 3 year residency in Vascular Surgery. Some call this "Early specialization" as well or "3+3" training. This leads to board certification in Vascular Surgery only.

4. Successfully complete an ACGME-accredited 5 year residency in Vascular Surgery. Some call this an "integrated" residency or "0+5." This leads to board certification in Vascular Surgery only.

Osteopathic Vascular Surgeons who trained in osteopathic residency programs can only obtain a CAQ from the American Osteopathic Board of Surgery (AOBS), which requires prior board certification from the AOBS in General Surgery.

Current training requirements for Vascular Surgery through an osteopathic program are:

Completion of an AOA-accredited osteopathic rotating internship, 4 years in an AOA-accredited osteopathic General Surgery residency, followed by 1 year of an AOA-accredited osteopathic Vascular Surgery fellowship.

I hope this helps.

 

[turtleboard]

I'm a little confused about option 2 in the above post. Would you just quit after your 4th year of a regular GS residency and move on to a vascular fellowship? Or are there specialized 4 year GS residencies that are designed for you to move on to a subspecialty more quickly?

The 4+2 programs are self-contained programs, where a General Surgery residency "fast-tracks" you into the associated Vascular Surgery fellowship. Completion of four years of General Surgery makes you eligible to sit for the ABS examinations, provided you complete the 2 year Vascular Surgery sequence.

 

[turtleboard]

Would I be accurate in saying that surgeons tend to work more hours and have a more demanding schedule than doctors in other specialties? How much flexibility do surgeons have in determining their work schedule?

I suppose it's a matter of opinion, but surgeons can have very demanding work schedules.

One's work schedule after residency training is determined by a number of things such as practice locality (urban vs. rural), practice type (academic vs. private solo practice vs. private group practice), what your scope of practice is going to be (full General Surgery or concentration in certain things), how much trauma coverage is involved, and finally, just how much you're willing to work yourself.

Solo practice has more flexibility as you determine your schedule, however, the financial demands on today's surgeon makes this a difficult undertaking. If you wanted to take off for a week, though, you could very well do that and basically answer to no one.

In group practice, your group's dynamic is going to partly determine how much you work. Some groups work well together and they work to get each other home as early as possible. It's actually quite a refreshing thing to see.

In academic practice, one must figure in teaching/research responsibilities in addition to clinical responsibilities within the medical school.

This is just a quickie superficial examination of a surgeon's lifestyle after residency training, though. If you have more specific questions, please let me know.

I hope this helps.

 

[vascular2007]

Hi there! I'll be starting a thread for vascular surgery under the surgical subspecialty section...please keep posting so we can all benefit from shared advice. I am currently one of the intergrated vascular surgery residents...

Thanks!
Vascular 2007 Mentor

 

[turtleboard]

Hi, i'm a MS3 interested in g-surg, and was wondering about the lifestyle of a resident and after you're done. I would like to join a group and do private practice. Some people say that a surgeon's lifestyle is hard out in private practice because u'll have to take trauma call, come in and get called in the middle of the nigh for appendectomy, etc. I think i'm leaning towards something in MIS or colorectal surgery. Also, how many letters of recs should you get when applying to g-surg residency? I am also wondering about scrambling after match. Lets say u don't match, what are the chances that u will scramble and get a residency in g-surg somewhere? because i heard that g-surg is getting more and more competitive. Also, how do they screen the boards score, is it by computer or if they see u have a low score, they just throw or application out? thanks!

The lifestyle for practically any physician is difficult nowadays, whether in private solo practice, private group practice, or academic practice. Everyone is working harder to earn a dollar and it would seem that will be the continuing trend for the foreseeable future. A General Surgeon's lifestyle is a little more difficult than most, however. General Surgeons often will have to respond to middle of the night issues if and when they are on call, even in private practice. Most hospitals will want you to take a certain number of General Surgery calls per month when granting you privileges. This ensures their EDs are covered by a surgeon and, to be honest, it helps you develop another way to get patients.

Trauma is still within the scope of a General Surgeon's practice, especially at the private practice level. As noted above, you will often be required to take call for a hospital when you're the new kid in town and cover the hospital's ED. This means caring for not only urgent General Surgery issues, but running a trauma service. This can be both painful and lucrative at the same time.

Doing a fellowship in MIS or Colorectal Surgery (CRS) will certainly give you an edge in trying to go for a job without ED or Trauma coverage. CRS has few emergencies. MIS guys are still General Surgeons at heart and often will take General Surgery call in most private practice settings.

All residencies require at least three letters of recommendation (LORs), with one usually from the Chairman of Surgery at your medical school.

With regard to not matching and scrambling into General Surgery, it's great if you find a categorical position that way, but chances are you'll only find preliminary spots. Preliminary spots are like purgatory. You'll never know when and if you'll ever get out and become a board certified surgeon. The American Board of Surgery made this even less attractive, as they now cap at THREE, the number of different programs you could have trained through prior to applying for their board certification examinations.

Different programs will look at the board scores differently. At my program, our PD uses it as a screening tool, with a set cutoff. LORs are alsmo immensely important. Your essay and a lot of the other extracurricular stuff is usually not looked at much, unless you've published papers.

And, yes, General Surgery is becoming more competitive again.

 

[turtleboard]

I heard that the competition for GS residencies is decreasing, although applicants who match still have above average board scores. Mainly due to lifestyle, many surgical residents are specializing, creating a shortage of GSs. Is this correct? Also, I heard that the demand for GSs is increasing, especially in rural and inner-city areas. If this is true, how can the competition be increasing. According to this website, the demand will exceed the supply of GSs in the near future.
I heard most of this from this website: http://cut-to-cure.blogspot.com/2007/11/future-of-surgery-xii.html

I am not familiar with the blog you're talking about, but reviewing it quickly just now, it's the musings of one community General Surgeon. His opinions are not necessarily fact based.

The fact is competition for General Surgery residencies is increasing as are board scores for those admitted. There are now more applicants for each categorical General Surgery position in this country. And most years after the match, there are fewer than 3 positions open nationwide. The preliminary positions continue to suffer, but this should not at all, be construed as a decrease in competition. Perhaps Dr. Parker is looking at these numbers to draw his conclusions. That's only speculation on my part, of course.

There's a variety of reasons for why there is a relative increase in the number of General Surgery graduates today pursuing subspecialty training. One of them is, in fact, lifestyle. There is already a shortage of General Surgeons today, however. This will be exacerbated by the estimated 60-70% of General Surgery graduates pursuing fellowship/subspecialty training.

The demand for General Surgeons is projected to increase and mainly in non-urban areas. The issues primarily relate to trauma coverage and emergency/acute care surgery coverage issues. The lag time between competition for residency positions and competition in the job market is several years.

 

[turtleboard]

Does anyone know how "competitive" they are? Compared to urology? Seeing as there are only a few of them, I imagine they are extremely competitive. Any idea of Step 1 scores, AOA type numbers and/or #publications they look for? Just curious..

There haven't been any data released for the integrated Vascular Surgery match as the first time these programs ever participated in the NRMP was in 2007.

The general consensus is, however, that the integrated Vascular Surgery prorgams are quite competitive compared to General Surgery but I can't give you a clear and accurate comparison to Urology, Neurosurgery, Plastics, Ophthalmology, Otorhinolaryngology, or any other surgical subspecialty.

I would wait for the Charting Outcomes publication to be released by the NRMP/AAMC for 2008 and review the data before making any sweeping predictions regarding the competitiveness of these programs.

 

[turtleboard]

I wanted to know how difficult it would be for a carribean graduate to get a general surgery residency. I understand that GS is becoming increasingly competitive, so I am worried that if I go to Ross/St George University in the carribean, I wouldn't have a fighting chance of getting a GS residency.

The reason I ask is because, as a nontraditional student I have to make a decision to either call it a day and go to dental school, or continue to pursue my dreams by going to medical school in the carribean b/c my stats are not competitive for US medical school (3.7cum GPA, 3.2 science.) I am 27, so I am not getting any younger so I am not comsidering a SMP. But if I am pretty much set in the road of doing FP or IM by going to school in the carribean, then I guess dentistry might be better.
I guess, bottom line, is a GS residency next to impossible for a FMG?Thanks in advance.

It's certainly not "next to impossible." There are non-US graduates in general surgery residencies, though according to ACGME data, they make up fewer than 20% of all General Surgery residents. Compare this to about 40% of all Internal Medicine residents being FMGs. Given this data it would suggest that FMGs either are not as interested in pursuing General Surgery as a career or they'e not as competitive in the application process.

Then again, who knows until you try? The pool of competitiveness may drop by the time you apply or the number of positions in General Surgery may expand (to presumably address the predicted shortage of General Surgeons in the US).

 

[turtleboard]

So with the advent of these 5 year vascular programs I have a question:


If I were to do one of these 5 year vascular programs and got my cert in vascular surgery, do you think I could get considered at a CT fellowship? Common sense would dictate a vascular surgeon would be at least as qualified to start the residency as a General Surgeon, but who knows with turf wars...

Currently the American Board of Thoracic Surgery allows certification for cardiothoracic surgeons who completes one of three pathways:

1) completion of a five year General Surgery residency followed by the completion of a Cardiothoracic program.

2) completion of a six year integrated Cardiothoracic residency.

3) completion of a Vascular Surgery program (presumably of either the traditional 5+2 or the integrated 0+5) followed by a Cardiothoracic residency.

So it's conceivable that current Cardiothoracic programs WILL consider your application if you're a trained Vascular Surgeon.

 

[wakawakawaka]

Hi there, I'm a 4th yr gen surg resident, wanted to pick your brain on what you consider the top 10 vascular programs in the country?

 

[cweb]

What makes one competitive enough for a vascular surgery fellowship? Is prior research a requirement? What about ABSITE scores? Im starting General Surgery residency in July and would like to start preparing as much as I can for fellowship (even though it's 5-7 years away=)).

 

[Doc Ivy]

bumping this thread