General Thoracic Surgery Questions

[SociableJimmy]

Hi everyone. I'm a graduating 4th year about to start GS residency with an interest in CT fellowship. Cardiac has been discussed ad nauseam here; and I feel well-informed in that regard. However, information on general thoracic practice, here and elsewhere online, seems rather scarce. I've seen it touted as a more lifestyle-friendly specialty within GS, but I'm still unfamiliar with general practice settings.

My understanding is that the majority of cases are elective: lung CA, gooses (geese?), thymecotmies, etc. What, if any, call responsibilities do attending thoracic surgeons have? I would imagine that most chest & mediastinum trauma can be handled perfectly well by trauma surg and cardiac, respectively. Could thoracic be expected to cover cardiac emergencies if necessary? Are there any other emergent cases they may frequently deal with? Boerhaave's is the only situation that immediately comes to mind that would specifically require thoracic. Salary info has also been difficult to find. All of the numbers I've seen thus far seem to lump cardiac and thoracic under the umbrella of "cardiothoracic," which I'm sure is more heavily skewed towards pure cardiac salary. Can I expect salary to be more in line with other GS subspecialties, i.e. CRS, surg onc etc.?

---

Members don't see this ad.

 

[ThoracicGuy]

Hi everyone. I'm a graduating 4th year about to start GS residency with an interest in CT fellowship. Cardiac has been discussed ad nauseam here; and I feel well-informed in that regard. However, information on general thoracic practice, here and elsewhere online, seems rather scarce. I've seen it touted as a more lifestyle-friendly specialty within GS, but I'm still unfamiliar with general practice settings.

My understanding is that the majority of cases are elective: lung CA, gooses (geese?), thymecotmies, etc. What, if any, call responsibilities do attending thoracic surgeons have? I would imagine that most chest & mediastinum trauma can be handled perfectly well by trauma surg and cardiac, respectively. Could thoracic be expected to cover cardiac emergencies if necessary? Are there any other emergent cases they may frequently deal with? Boerhaave's is the only situation that immediately comes to mind that would specifically require thoracic. Salary info has also been difficult to find. All of the numbers I've seen thus far seem to lump cardiac and thoracic under the umbrella of "cardiothoracic," which I'm sure is more heavily skewed towards pure cardiac salary. Can I expect salary to be more in line with other GS subspecialties, i.e. CRS, surg onc etc.?

Most general thoracic issues are elective. Things that could bring you in on call include perforated esophagus, need for chest tubes, and if you are at a trauma center, there's always a chance of being needed to help on a case.

Coverage with cardiac surgery depends on the job. If you are in a mixed cardiac and thoracic job, you would cover. If there is a separate cardiac and thoracic team, I would not expect you would need to cover.

Salary is variable by location and type of job, academic vs pp mainly. I don't know how it compares to other fields.

 

[SociableJimmy]

Most general thoracic issues are elective. Things that could bring you in on call include perforated esophagus, need for chest tubes, and if you are at a trauma center, there's always a chance of being needed to help on a case.

Coverage with cardiac surgery depends on the job. If you are in a mixed cardiac and thoracic job, you would cover. If there is a separate cardiac and thoracic team, I would not expect you would need to cover.

Salary is variable by location and type of job, academic vs pp mainly. I don't know how it compares to other fields.

Thanks for your input. Do you have any thoughts on how some of the recent studies comparing SBRT vs. lobectomy for early-stage CA might impact surgical practice/volume in the coming years?

 

[ThoracicGuy]

Thanks for your input. Do you have any thoughts on how some of the recent studies comparing SBRT vs. lobectomy for early-stage CA might impact surgical practice/volume in the coming years?

It may chance surgical volumes some, I don't expect it to make surgery obsolete. I primarily use for people who can't tolerate surgery.

 

[idiot07]

Thanks for your input. Do you have any thoughts on how some of the recent studies comparing SBRT vs. lobectomy for early-stage CA might impact surgical practice/volume in the coming years?

SBRT is worse than lobectomy (40-50% 5 year survival vs 70-85% 5 year survival for stage I NSCLC, depending on the path). It's probably comparable to wedge resection for tumors < 3 cm in patients with poor lung function, but a randomized trial has been difficult to do for a variety of reasons. Difficult to know whether segmentectomy is better than wedge resection or sbrt for similar circumstances, but it probably is. Surgery is here to stay for lung cancer.

For what it's worth, I get along great with the rad onc guys here, and it's nice to have a place to send inoperable patients for an effective and safe treatment, rather than rolling the dice on an operation and dealing with them in the ICU for a week. In the same vein, we have a great working relationship with heme/onc, GI, and interventional pulm, as compared to constant battle between cardiology and cardiac surgery.

The other kicker with your lifestyle is if you do lung transplant, ecmo, or airway surgery. Depending on coverage and volumes of this, your lifestyle can take a big hit. There's also enough inpatient garbage cases, i.e., skanky decortications, infected sternoclavicular joints, that your lifestyle is never going to be as good as a pure surgical oncologist, but it's almost certainly going to better than cardiac or general surgery.

Agree with everything Thoracic Guy said. I would also add that it's a bit of a niche field, and you're probably going to have to be in a academics or a larger community hospital system to support a pure Thoracic practice. I also think it's a lot easier to be a Cardiac guy and do a little general thoracic on the side rather than vice/versa. A lot of the difficulty in thoracic is either in the intellectual side of things or doing an operation minimally invasively. The cardiac guys I know would have no trouble doing a decort or open lobe still. If I had to do an emergency 3 vessel CABG, we got trouble.

 

[TypeADissection]

From a credentialing standpoint, will thoracic only fellowships allow one to sit for boards and be able to get privileges to do lung/esophageal work? My understanding was that the only way to do thoracic was through a formal STS approved fellowship and then sitting for those boards, whereas thoracic only doesn't allow for that. Just attempting to clarify before people start dreaming of career that may not necessarily exist unless they go through the proper channels. Cheers.

 

[idiot07]

You are correct. The only way to sit for boards in the United States is to do a full cardiothoracic fellowship (technically it's a residency since it leads to board certification). If you know you want to do thoracic when you get out and not cardiac, there are "thoracic track" cardiothoracic fellowships where you do more thoracic and less cardiac than the traditional cardiac heavy programs. These are acgme approved and you go through the official match process. However, you're still doing around a year of cardiac training total. Most other countries have made thoracic and cardiac separate.

The one year "thoracic only" fellowships are geared mainly towards people trying to kill a year before their official Ct fellowship/residency or those that already did an old school traditional Ct fellowship and want more thoracic training. You can't sit for thoracic boards if this is all you do.

Hospital privileges are a different matter. Depending on your facility, you may not need any extra training beyond general surgery to do lung an esophageal surgery, particularly if it's in a rural area. I could be wrong, but I think a surprisingly large percentage if not the majority of lung cancer resections are done by general surgeons. I think this will change in the future, but change usually happens slow.

From a credentialing standpoint, will thoracic only fellowships allow one to sit for boards and be able to get privileges to do lung/esophageal work? My understanding was that the only way to do thoracic was through a formal STS approved fellowship and then sitting for those boards, whereas thoracic only doesn't allow for that. Just attempting to clarify before people start dreaming of career that may not necessarily exist unless they go through the proper channels. Cheers.

ir

 

[mntrzl]

How does pay compare to cardiac surgery? I understand that a majority of general thoracic will be in academia which will skew the average, but let's say a cardiac surgeon vs general thoracic in the same practice setting. And versus surg onc or general surgery as well.

 

[CTFellowMD]

Hospital privileges are a different matter. Depending on your facility, you may not need any extra training beyond general surgery to do lung an esophageal surgery, particularly if it's in a rural area. I could be wrong, but I think a surprisingly large percentage if not the majority of lung cancer resections are done by general surgeons. I think this will change in the future, but change usually happens slow.

This is not the case anymore. Unless you are in a (very) rural area, the vast majority of thoracic surgery procedures are being done by thoracic trained surgeons. There still may be some old school general surgeons that have adequate training to do lobectomies via thoracotomy, but this is becoming more and more rare. Current general surgery residents are not coming out with the expertise to do any lung surgery, especially VATS.

How does pay compare to cardiac surgery? I understand that a majority of general thoracic will be in academia which will skew the average, but let's say a cardiac surgeon vs general thoracic in the same practice setting. And versus surg onc or general surgery as well.

Cardiac vs Thoracic: From my experience the last few years, both job markets are currently pretty good. There are more general thoracic jobs out there at the moment. It all depends on the practice model for overall compensation, but in the long run, cardiac usually gets paid more because they pull in higher RVUs. The procedures, patient base, and lifestyle for cardiac vs thoracic are drastically different, so I would not suggest choosing one over the other based on salary....

Compared to my friends that have done general surgery, average starting salary for general thoracic is about 20-25% higher and escalates pretty quickly in first 5 years.

 

[idiot07]

This is not the case anymore. Unless you are in a (very) rural area, the vast majority of thoracic surgery procedures are being done by thoracic trained surgeons. There still may be some old school general surgeons that have adequate training to do lobectomies via thoracotomy, but this is becoming more and more rare. Current general surgery residents are not coming out with the expertise to do any lung surgery, especially VATS..

Look up: Schipper, P.H., Diggs, B.S., Ungerleider, R.M., and Welke, K.F. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg. 2009; 88: 1566–1573

General surgeons did over 50% of lung resections during the time period which admittedly was 22 to 13 years ago. I'm sure the percentage has dropped since and will continue to decline further. I used to think it was going to go away quick. However, after a couple years of practice, I think these things change slower than we think in academia, particularly where you get to communities with less than 100,000 people, which is a large fraction of the country.

I have two co-residents for instance who are recently graduated general surgeons in communities about that size, that are doing easy lung cancer resections now. They're both good surgeons. They both have a senior general surgery partner, who has done a lot of thoracic work to help them with the cases. They do apparently do vats. The patients don't want to drive 2-3 hours to a major thoracic surgical center and deal with "big city" traffic. I think this is nuts btw, but their short-term outcomes are fine. I do worry about the oncologic quality of the resections done by non fellowship trained surgeons, and I always wonder about people getting wedges when they should be getting lobes or segmentectomies, and availability of sbrt if surgery is not available, etc. That being said I have no problem with general surgeons doing vats pleurodesis and decortications.

 

[ThoracicGuy]

Look up: Schipper, P.H., Diggs, B.S., Ungerleider, R.M., and Welke, K.F. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg. 2009; 88: 1566–1573

General surgeons did over 50% of lung resections during the time period which admittedly was 22 to 13 years ago. I'm sure the percentage has dropped since and will continue to decline further. I used to think it was going to go away quick. However, after a couple years of practice, I think these things change slower than we think in academia, particularly where you get to communities with less than 100,000 people, which is a large fraction of the country.

I have two co-residents for instance who are recently graduated general surgeons in communities about that size, that are doing easy lung cancer resections now. They're both good surgeons. They both have a senior general surgery partner, who has done a lot of thoracic work to help them with the cases. They do apparently do vats. The patients don't want to drive 2-3 hours to a major thoracic surgical center and deal with "big city" traffic. I think this is nuts btw, but their short-term outcomes are fine. I do worry about the oncologic quality of the resections done by non fellowship trained surgeons, and I always wonder about people getting wedges when they should be getting lobes or segmentectomies, and availability of sbrt if surgery is not available, etc. That being said I have no problem with general surgeons doing vats pleurodesis and decortications.

People getting a wedge resection are at a four fold increased incidence of recurrence compared to lobectomy. If they are doing wedge resection in place of indicated lobectomy in a patient that could tolerate it, they are not following acceptable standards.

 

[CTFellowMD]

Look up: Schipper, P.H., Diggs, B.S., Ungerleider, R.M., and Welke, K.F. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg. 2009; 88: 1566–1573

General surgeons did over 50% of lung resections during the time period which admittedly was 22 to 13 years ago.

Can't compare that time period to the current era. Thoracic Surgery from 1996-2005 was in the Pre to VERY early VATS days. Things have changed quite a bit since then. This was also prior to the differentiation of cardiac and thoracic tracks in CT fellowship.

I have two co-residents for instance who are recently graduated general surgeons in communities about that size, that are doing easy lung cancer resections now. They're both good surgeons.

That being said I have no problem with general surgeons doing vats pleurodesis and decortications.

If they can do a quality operation, then that's fantastic and I applaud them. I just know that from my experience, along with friends who trained at other general surgery programs, there is definitely not enough thoracic training in most general surgery programs.

People getting a wedge resection are at a four fold increased incidence of recurrence compared to lobectomy. If they are doing wedge resection in place of indicated lobectomy in a patient that could tolerate it, they are not following acceptable standards.

Agree with this 100%. That is the biggest issue we are facing in our field. Inadequately trained general surgeons (and cardiac surgeons...) who are performing non-oncologic operations. The second issue which will take longer to settle out is inexperienced surgeons performing lobectomies through a large thoracotomy for early stage lung cancer. Also not acceptable in this day and age.

 

[TypeADissection]

If they can do a quality operation, then that's fantastic and I applaud them. I just know that from my experience, along with friends who trained at other general surgery programs, there is definitely not enough thoracic training in most general surgery programs.

Gonna echo this sentiment. I'm very happy with my general surgery experience and know where my strengths and weaknesses are if I was going to go straight into a community in a few short months, however, there really isn't a single thing within the realm of thoracic surgery outside of placing chest tubes that I would even want to be responsible for because my thoracic training was very very cursory and minimal. My chief a few years back really sought out thoracic stuff and probably would've been pretty good at it had he stayed in general surgery but he went into CTS anyway.

 

[LebronManning]

Do cardiothoracic surgeons ever take general surgery call or do GS elective cases in order to keep up business if there isn't enough? Jw with the whole interventional cards and cardiac surgery thing.

 

[ThoracicGuy]

Do cardiothoracic surgeons ever take general surgery call or do GS elective cases in order to keep up business if there isn't enough? Jw with the whole interventional cards and cardiac surgery thing.

Cardiac surgeons wouldn't take general surgery call. You might find a few jobs out there that combine general thoracic and general surgery. That won't be very common.

 

[TypeADissection]

Do cardiothoracic surgeons ever take general surgery call or do GS elective cases in order to keep up business if there isn't enough? Jw with the whole interventional cards and cardiac surgery thing.

Let's ask a different question: If you're a fellowship trained CTS, why on earth would you want to take GS call? Do you want to get woken up for Fournier's, or free air, or an appy? I'm sure there are some out there who may do this, but I don't know why anyone would. They're really two different fields and patient populations.

 

[LebronManning]

Let's ask a different question: If you're a fellowship trained CTS, why on earth would you want to take GS call? Do you want to get woken up for Fournier's, or free air, or an appy? I'm sure there are some out there who may do this, but I don't know why anyone would. They're really two different fields and patient populations.

Cardiac surgeons wouldn't take general surgery call. You might find a few jobs out there that combine general thoracic and general surgery. That won't be very common.

Yeah I’m sure this is less than ideal but just wondering if this would serve as an insurance policy for going into cardiac surgery at an unsure time. Although it seems the Cardiothoracic market has bounced back, I wonder if it’s here to stay.

 

[LucidSplash]

Yeah I’m sure this is less than ideal but just wondering if this would serve as an insurance policy for going into cardiac surgery at an unsure time. Although it seems the Cardiothoracic market has bounced back, I wonder if it’s here to stay.

I don’t know why you would put yourself through a 3-year CTS fellowship and then take call for both cardiac emergencies and gen surg. It’s an unnecessary insurance policy.

 

[ThoracicGuy]

Yeah I’m sure this is less than ideal but just wondering if this would serve as an insurance policy for going into cardiac surgery at an unsure time. Although it seems the Cardiothoracic market has bounced back, I wonder if it’s here to stay.

Cardiac guys just won't have the want to do general surgery. If they don't have enough business to support cardiac, I expect they would find another hospital to add to their work or move to a new location. With general thoracic, if you don't have enough volume to support thoracic only you can add something else. Some of this will depend on call schedules though. You can't cross cover patients with general surgeons because they won't/can't deal with thoracic patients.

 

[Buzz Me]

Do cardiothoracic surgeons ever take general surgery call or do GS elective cases in order to keep up business if there isn't enough? Jw with the whole interventional cards and cardiac surgery thing.

No, I have never heard of that. The most overlap I've seen is covering Vascular Surgery or some wire-skill-based procedures (overlaps with Cardiology).

 

[LebronManning]

No, I have never heard of that. The most overlap I've seen is covering Vascular Surgery or some wire-skill-based procedures (overlaps with Cardiology).

I was wondering if they did this during the apparent CT Surgery doomsday that was from 2000-2010 in order to support their incomes. Also wondered if this would be a reasonable fall back if CT Surgery continues to see further decreasing volumes. Maybe there will always be enough volume per surgeon now that there won't be an excess of CT Surgeons?

 

[Buzz Me]

Also wondered if this would be a reasonable fall back if CT Surgery continues to see further decreasing volumes.

That's a common misconception among the non-CTS crowd.

 

[LebronManning]

That's a common misconception among the non-CTS crowd.

That volumes are decreasing?

 

[CTFellowMD]

That volumes are decreasing?

Cardiac volume at our center and 2 neighboring hospitals is highest that it’s been in quite some time.

 

[LebronManning]

Cardiac volume at our center and 2 neighboring hospitals is highest that it’s been in quite some time.

Do you think this volume has rebounded as a backlash against low efficacy of PCI or because there are simply more sick patients than 10 years ago?

 

[CTFellowMD]

Do you think this volume has rebounded as a backlash against low efficacy of PCI or because there are simply more sick patients than 10 years ago?

Hard to say. Our patients are certainly much more complicated than they used to be (multiple valves, cabg/valve combos, low EF, etc etc), but we still are operating on a fair amount of straight forward CABGs and single valves as well.

 

[Buzz Me]

That volumes are decreasing?

Yes.

Do you think this volume has rebounded as a backlash against low efficacy of PCI or because there are simply more sick patients than 10 years ago?

For some reason everything thinks that the advent of coronary stenting killed the cardiac surgeon's practice volume. Then you take a look at any major hospital and look at the number of hearts done per year. Business is still booming.

 

[LebronManning]

How is cardiac surgery lifestyle in attending-hood? I imagine your patients would be very sick but that's why they go to an ICU where an intensivist can manage them right? Seems like most coronary emergencies will be handled by IC and most CABGs would only be when patient is stable. What other emergencies would require emergent OR other than dissection or thoracic aneurysm? Both of which are pretty rare right"

 

[doc05]

How is cardiac surgery lifestyle in attending-hood? I imagine your patients would be very sick but that's why they go to an ICU where an intensivist can manage them right? Seems like most coronary emergencies will be handled by IC and most CABGs would only be when patient is stable. What other emergencies would require emergent OR other than dissection or thoracic aneurysm? Both of which are pretty rare right"

They work all the time. Frequently manage their post ops as well.

Keep in mind that whatever specialty, if you do a big case, you're following very closely afterwards. You don't just hand them over to an "intensivist" and walk away.

 

[SociableJimmy]

Des anyone have any insight as to how long it may remain viable to practice both cardiac and thoracic in a community setting? Is community practice moving in the same direction as academics, with separate thoracic and CV departments?

 

[dynx]

Des anyone have any insight as to how long it may remain viable to practice both cardiac and thoracic in a community setting? Is community practice moving in the same direction as academics, with separate thoracic and CV departments?

I practice in a community setting:
A couple of points stand out.
1. As above volume is going up. CABG is growing...I figured this would be the case but I also figure it will fall again in 10-15 years. I thing the tail wind we are getting is an aging population and a lot of people that were stented and “put off” years ago that now need CABG. Great for us/me. Volume is growing 15-20% a year with no effort. AVRs are falling though.

2. To your question: I do cardiac. I have partners that do robotic lobectomy (I don’t) I do VATS. I don’t think there is a difference in patient outcome BUT pulmonologists can be convinced otherwise. I’d do whatever thoracic was sent my way but the referrals tend to be sent towards “the guy” that does X.
I think the specialties are separating just like the training even in the community at least in a large city setting. Probably not out in the rural areas but that’s just a matter of time. Just my experience....it’s not worth my time to fight for the thoracic cases if I don’t do robotic. They pay less anyway.

I would guess (and it’s a guess): In a desirable location probably you can do both as an established surgeon for 20 more years. As a new surgeon....10?.

 

[Apollyon]

Just 'cause there are thoracic guys in here, question for y'all: had a pt last week with a TAA, with suggestion of plaque ulceration. Call the ivory tower, to the transfer line. I tell them where/what I need, and they help get the right doc. The coordinator says that, where I am going to send the pt, if it's below the diaphragm, it goes to vascular, and, above, to thoracic. So, she pages thoracic. I don't talk to the doc, but the coordinator said that the thoracic surgeon called back, and said she doesn't do TAA. The coordinator was somewhat taken aback by this, saying that, in all her years, that never happened before. Fortunately, the next person, covering cardiac, is also vascular, and he took the patient.

So, that's my question: how common is it for someone to be a thoracic surgeon, and not do aortic aneurysms?

 

[LucidSplash]

Just 'cause there are thoracic guys in here, question for y'all: had a pt last week with a TAA, with suggestion of plaque ulceration. Call the ivory tower, to the transfer line. I tell them where/what I need, and they help get the right doc. The coordinator says that, where I am going to send the pt, if it's below the diaphragm, it goes to vascular, and, above, to thoracic. So, she pages thoracic. I don't talk to the doc, but the coordinator said that the thoracic surgeon called back, and said she doesn't do TAA. The coordinator was somewhat taken aback by this, saying that, in all her years, that never happened before. Fortunately, the next person, covering cardiac, is also vascular, and he took the patient.

So, that's my question: how common is it for someone to be a thoracic surgeon, and not do aortic aneurysms?

I’m vascular not thoracic and can only speak anecdotally on the 2 institutions I’ve been at for residency and fellowship - thoracic does lungs and foregut mostly, doesn’t touch the aorta. Ascending thoracic aortic aneurysms is cardiac, descending and abdominal is vascular. For Type A dissections, they get a combo of cardiac for the ascending +\- debranching and then either staged or retrograde simultaneous TEVAR by vascular. Open descending thoracic would also be vascular. Will be interested to see what the patterns are elsewhere.

 

[Apollyon]

Thank you! As you know, I'm just a dumb ER doc!

 

[Psai]

I’m vascular not thoracic and can only speak anecdotally on the 2 institutions I’ve been at for residency and fellowship - thoracic does lungs and foregut mostly, doesn’t touch the aorta. Ascending thoracic aortic aneurysms is cardiac, descending and abdominal is vascular. For Type A dissections, they get a combo of cardiac for the ascending +\- debranching and then either staged or retrograde simultaneous TEVAR by vascular. Open descending thoracic would also be vascular. Will be interested to see what the patterns are elsewhere.

Same

 

[ThoracicGuy]

Just 'cause there are thoracic guys in here, question for y'all: had a pt last week with a TAA, with suggestion of plaque ulceration. Call the ivory tower, to the transfer line. I tell them where/what I need, and they help get the right doc. The coordinator says that, where I am going to send the pt, if it's below the diaphragm, it goes to vascular, and, above, to thoracic. So, she pages thoracic. I don't talk to the doc, but the coordinator said that the thoracic surgeon called back, and said she doesn't do TAA. The coordinator was somewhat taken aback by this, saying that, in all her years, that never happened before. Fortunately, the next person, covering cardiac, is also vascular, and he took the patient.

So, that's my question: how common is it for someone to be a thoracic surgeon, and not do aortic aneurysms?

I do general thoracic and I wouldn't do a descending thoracic aneurysm. I'll do abdominal ones, but we don't have any pump support at our hospital and haven't tried to get into the thoracic aneurysms. Our volume would be relatively small if we were interested. We send them to cardiac guys locally.

 

[CTFellowMD]

I’m vascular not thoracic and can only speak anecdotally on the 2 institutions I’ve been at for residency and fellowship - thoracic does lungs and foregut mostly, doesn’t touch the aorta. Ascending thoracic aortic aneurysms is cardiac, descending and abdominal is vascular. For Type A dissections, they get a combo of cardiac for the ascending +\- debranching and then either staged or retrograde simultaneous TEVAR by vascular. Open descending thoracic would also be vascular. Will be interested to see what the patterns are elsewhere.

Pretty much exactly the same for everywhere I've been (all large university setting.)

At the tertiary referral centers I've been at:

General Thoracic: Lungs, Esophagus, Mediastinum, Chest wall, Other random foregut
Cardiac: Heart, ascending aorta
Vascular: Descending thoracic and abdominal aorta

 

[Apollyon]

Yeah, there's the "regional variabilty". As I said above, where I call, they subdivide at the diaphragm (or, theoretically, as, again, I stated above). After my kerfuffle, all I know for certain is that vascular takes AAAs. And, if I get in such a jam again, I would be grateful to get "Dr. Smith" again on the phone; mondo helpful!

 

[mimelim]

Just 'cause there are thoracic guys in here, question for y'all: had a pt last week with a TAA, with suggestion of plaque ulceration. Call the ivory tower, to the transfer line. I tell them where/what I need, and they help get the right doc. The coordinator says that, where I am going to send the pt, if it's below the diaphragm, it goes to vascular, and, above, to thoracic. So, she pages thoracic. I don't talk to the doc, but the coordinator said that the thoracic surgeon called back, and said she doesn't do TAA. The coordinator was somewhat taken aback by this, saying that, in all her years, that never happened before. Fortunately, the next person, covering cardiac, is also vascular, and he took the patient.

So, that's my question: how common is it for someone to be a thoracic surgeon, and not do aortic aneurysms?

We made it simple. The answer is always yes. If for some reason the transfer call ends up in the hands of the intern, the answer is, "We will be happy to take the patient (assuming they are stable enough to transfer), make sure you send the CDs" Then we deal with it on our end. But, we have an aortic center, so it makes things a heck of a lot easier... In general all descending/abdominal is vascular and ascending is cardiac. But, we have so many hybrid faculty that there really isn't a rule.