Any suggestions for quality general (noncardiac) thoracic surgery programs? My goal for training would be to learn both open and minimally invasive pulmonary as well as foregut surgery. I have heard of programs that are heavier in noncardiac thoracic than cardiac, which would be ideal for me because I have no interest in cardiac. Geography is not important to me, I am looking for the best training I can find regardless of location. Thanks!
general (noncardiac) thoracic surgery fellowships
- Thread starter bsbush
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There are no thoracic-only (non-cardiac) fellowships that allow you to sit for the thoracic boards. There ARE non-cardiac fellowships (typically 1 year in length) but you can't sit for thoracic boards. Many fellowships (?most) have 'thoracic heavy' and 'cardiac heavy' tracts (with a few more months on the thoracic services in the thoracic tract). Memorial Sloan Kettering comes to mind, however the 'thoracic tract' there still does 9 month of cardiac surgery during the 2 year fellowship.
The American Board of Thoracic Surgery website has all the info regarding operative case requirements needed to sit for thoracic boards.
http://www.abts.org/sections/Certification/Operative_Requiremen/index.html
The American Board of Thoracic Surgery website has all the info regarding operative case requirements needed to sit for thoracic boards.
http://www.abts.org/sections/Certification/Operative_Requiremen/index.html
Out of curiosity, if my career objective is a noncardiac thoracic surgery practice, possibly with some general surgery added in, how important would it be to be board certified? What are the advantages/disadvantages of sitting for the thoracic boards vs. not sitting for them? I would imagine that an academic position would require board certification, and I may or may not want to be an academic surgeon, i.e., I don't want to rule out that option just yet. So if anyone has any info/knowledge on any of the nonaccredited thoracic only programs, or on any of the accredited "thoracic heavy" combined cardiothoracic programs, or even on any cardiothoracic programs where you get an above average general thoracic training, I'd greatly appreciate it.
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Do not assume that only academic positions want you to be BC.
We are entering a phrase of increasing requirements and insurance companies and hospitals are starting to require it as part of the credentialing process. A friend told me last week that she was denied privileges at a local hospital because she is no longer BE (she never took her gen surg boards, for reasons I don't know). All I have privileges at require BE and BC within a certain period of time.
Some employers are requiring it as part of the contractural agreement as well.
The advantage of sitting for, and becoming BC in thoracic surgery is to get you out of the general surgery call pool. Some hospitals are also requiring anyone who is not BC in another specialty to take Gen Surg call/ED call. I can see no disadvantages. It is much easier to limit yourself to thoracic cases if you are BC.
Finally, I wouldn't train in a non-accredited program, for the same reasons. You never know who might not accept your training if it is not ACGME accredited.
We are entering a phrase of increasing requirements and insurance companies and hospitals are starting to require it as part of the credentialing process. A friend told me last week that she was denied privileges at a local hospital because she is no longer BE (she never took her gen surg boards, for reasons I don't know). All I have privileges at require BE and BC within a certain period of time.
Some employers are requiring it as part of the contractural agreement as well.
The advantage of sitting for, and becoming BC in thoracic surgery is to get you out of the general surgery call pool. Some hospitals are also requiring anyone who is not BC in another specialty to take Gen Surg call/ED call. I can see no disadvantages. It is much easier to limit yourself to thoracic cases if you are BC.
Finally, I wouldn't train in a non-accredited program, for the same reasons. You never know who might not accept your training if it is not ACGME accredited.
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To do throacic cases without board certification, you would be limited to working in a small town. I have talked to a handful of rural surgeons that do a decent amount of non-cardiac thoracic in their practice. These were guys were just general surgery trained.
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i'm also interested in this and was wondering for BC thoracic surgeons who aren't doing much cardiac, whats the lifestyle like for these individuals? i imagine a lot of cases or scheduled and so it might diminish some of the brutality associated with the typical CT surgeon or is that incorrect?
thx
thx
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if you can be a board certified thoracic surgeon in 2 yrs, why do a one year non-accredit fellowship?
there exists a few places around the country that have a thoracic-track program, where you only have to do a minimal number of cardiac cases. most of these places are competitive and aim to train academic thoracic oncologists. not someone who just wants to go into the community and do VATS lobes and esophagectomies.
although there may be a market for this type of surgeon developing. the pure thoracic surgeon is a rare breed that doesnt quite fit into the general surgery category and is blackballed by the cardiac guys.
i would say in the real world, most easy lungs are done by old school general surgeons, the rare surg onc guy and the poor junior cardiac guy who has to do these "nuisance" cases to pay the bills. the rest are sent to tertiary centers.
i bet not many general surgery residents graduating today get enough training to do anything more complex than a wedge resection in the chest, let alone get privledges to do so.
there exists a few places around the country that have a thoracic-track program, where you only have to do a minimal number of cardiac cases. most of these places are competitive and aim to train academic thoracic oncologists. not someone who just wants to go into the community and do VATS lobes and esophagectomies.
although there may be a market for this type of surgeon developing. the pure thoracic surgeon is a rare breed that doesnt quite fit into the general surgery category and is blackballed by the cardiac guys.
i would say in the real world, most easy lungs are done by old school general surgeons, the rare surg onc guy and the poor junior cardiac guy who has to do these "nuisance" cases to pay the bills. the rest are sent to tertiary centers.
i bet not many general surgery residents graduating today get enough training to do anything more complex than a wedge resection in the chest, let alone get privledges to do so.
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The UK, Canada, NZ, etc have separate thoracic and cardiac training tracks. You could probably find a thoracic only spot there. I suspect that would qualify you - potentially with some fighting - for thoracic privileges in most places. But the question raised above about market share is a reasonable one - where are you going to go that has a bunch of thoracic and foregut cases lying around with no one to take them?
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So, the Board (i.e. ABTS) is currently looking at this question and putting together a position statement AGAINST non-BE/BC practicing Thoracic surgery. They have some good research data to back their position.
Specifically, non-BE/BC surgeons have a dramatically larger number of incomplete pulmonary resections for cancer with inadequate pre-op staging and actual operative staging. Obviously, there may be some excellent gensurgeons doing some excellent true "cancer operations" on the lung. However, the group of individuals failing to perform complete resections will cause a wash-out of privileges for all non-BE/BC. Medcare/Medcaid is also looking to minimize and/or prevent payment for services from non-BE/BC. Surgical oncology advances also lead to more dedicated cancer centers.... requiring BE/BC surgeons. I would say, if you want to be a true thoracic surgical oncology surgeon... do accredited training.
JD
also, as far as a "few of this and a few of that", esophagectomies and the like are showing outcomes are proportional to volume (similar to whipple argument). The ABTS I believe is proposing one should perform at a minimum 12 esophagectomies per year after accredited training to maintain a minimum of standards in outcomes. It also means you need a good hospital based team able to care for the patients post-op. This will almost necessitate tertiary level of care. This is not a dabble arena.
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I'm glad to hear that an organization with no potential bias or reason to favor boarded CT surgeons is making such a statement.
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That is generally my impression as well.... being a board certified general surgeon myself.
I appreciate your point/perspective. However, the ABTS position is not an isolated/ivory tower stance. Rather, it is going to be more in line with medical organizations accross the country, dedicated multidisciplinary cancer treatment providers, as well as insurance/medicare/medicaid. Namely, cancer patients deserve the best chance at cure. Often it is their first operation that has the best if any chance of durable cure/disease free interval. Increasing evidence (I believe accross all cancer types) seems to indicate that individuals not "fully trained" are failing to stage fully pre-operatively, failing to perform complete "cancer operations" and/or resections, and at time of operation failing to perform complete resection to include staging components of the operation.
Again, I appreciate your perspective. I will not get into a turf argument or debate about how sufficient general surgery training is ect.... I am simply trying to respond to the original post and reasonability of unaccredited training leading to a complete and satisfying career....
JD
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I didn't say you were wrong. Your explanation above is quite compelling, in fact. I just pointed out that the ABTS really doesn't have any credibility to make that statement. It's like GM issuing a position paper saying no one should buy Ford.
That said, your argument doesn't address the op's question. He is not suggesting GS training is adequate for thoracic surgery. He is inquiring into non-cardiac thoracic fellowships which don't lead to ABTS certification. There are very few of these in the US. You can make all sorts of pragmatic arguments about why non-BE training might be a poor choice, but I don't see the basis for stating that these surgeons are clinically inferior to someone with an ABTS lapel pin. Most of the world trains thoracic and CT surgeons separately.
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interesting arguments- these fights go on in alot of area- the colon-rectal surgeons argue that general surgeons shouldnt do colon operations, etc..
I dont think that necessarily getting board certified automatically "qualifies" someone to do a particular operation. Take for instance alot of ABTS guys just want to focus on cardiac.
If a person has an interest in thoracic oncology- spend some extra time focusing on it. you probably only need 1 solid year for noncardiac thoracic oncology. this could be gained as an un-accredited fellowship, but it just isnt worth it in my opinion. there are a few 2yr thoracic track programs now that are 12-18 months thoracic, with the rest cardiac. even 6 months of cardiac training is valuable, you may never do a CABG, but you learn good vascular skills. In some places, the thoracic surgeons can act as vascular surgeons too (oncology surgery involving reconstruction, misadventure, etc)
I dont think that necessarily getting board certified automatically "qualifies" someone to do a particular operation. Take for instance alot of ABTS guys just want to focus on cardiac.
If a person has an interest in thoracic oncology- spend some extra time focusing on it. you probably only need 1 solid year for noncardiac thoracic oncology. this could be gained as an un-accredited fellowship, but it just isnt worth it in my opinion. there are a few 2yr thoracic track programs now that are 12-18 months thoracic, with the rest cardiac. even 6 months of cardiac training is valuable, you may never do a CABG, but you learn good vascular skills. In some places, the thoracic surgeons can act as vascular surgeons too (oncology surgery involving reconstruction, misadventure, etc)
