Graduating Cardiothoracic Surgery Fellow available for questions

[celling]

I'm completing my CT surgery fellowship at THI/BCM in 6 weeks and finally have a little free time. Wanted to see if there are any questions from the current crop of med students about the present or future of this fascinating field of medicine.

I'll try to be prompt and honest with responses, but I'm still in fellowship and working crazy hours, so be patient and I'll try to respond to everyone.

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[phuynh94]

Was CT something you had imagined doing? What got you into the field?

 

[673441]

Can you give your stats?


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[dataDyne2]

Do you see this field as sustainable, or will it begin to take a backseat to interventional cardiology?

 

[midwestm2]

Do you foresee a continued increase in the number of integrated thoracic surgery residency slots? And what in your opinion are the major differences in the two tracks (integrated thoracic vs. gen surg --> CT fellow) ? Thanks for reaching out!

Edit: I feel like an early congratulations is in order! Well done for your hard work thus far

 

[celling]

Was CT something you had imagined doing? What got you into the field?

I was a surgical tech before med school and loved the cardiac surgeries. From there, I enjoyed my med school rotation and gen surgery residency rotations. It just seemed to work that I go into the field.

 

[celling]

Can you give your stats?


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I'm guessing you're referring to med school stats.
Step 1 226
Step 2 CK 248
Step 2 CS pass
Step 3 235
Top 10 of my med school class

 

[celling]

Do you see this field as sustainable, or will it begin to take a backseat to interventional cardiology?

This is usually the most common question I get from med students. I think the field is just starting its second golden age. Cardiology is good for stenting single and double vessel disease but cabg is better for left main disease, proximal lad lesions, triple vessel disease, low ef pts, diabetics, in stent thrombosis, and pts with high syntax scores. As for valves, I don't think tavr will replace surgical avr for low risk pts and moderate risk pts is still up in the air. Transcatheter mistrals and tricuspids are still in their infancy.

There still is a role for aortic surgery, heart failure, atrial fibrillation, etc. plus you can do, lung cancer, benign lung, esophageal, chest wall, foregut surgeries.

Not to mention that cardiology has a nack for messing things up (femoral rupture, dissections, coronary rupture, coronary thrombosis, etc) that they are unable to fix and will need ct surgery to bail them out.

 

[celling]

Do you foresee a continued increase in the number of integrated thoracic surgery residency slots? And what in your opinion are the major differences in the two tracks (integrated thoracic vs. gen surg --> CT fellow) ? Thanks for reaching out!

Edit: I feel like an early congratulations is in order! Well done for your hard work thus far

Thanks.

I think that there is actually going to be drop in the number of integrated positions. In discussions with other attending a, I'm hearing that a lot of people haven't been thrilled with the quality of the graduates. They are good at the surgeries when things go well but they don't have the general surgery/vascular surgery experience. For example, if you were to rupture the hepatic vein placing a venous cannula, most of us would be able to mobilize the liver, identify the rupture and repair it. If you only 3-4 years of gen surg (with a high concentration of cardiac and thoracic in those years) it would be highly unlikely they could fix it.

In summary, as painful as doing 5-7 years of general surgery residency is (and it is painful), there is a knowledge base that one obtains, that cannot be replicated. It allows cardiac surgeons to be in control at all times and able to fix pretty much anything that gets thrown at you.

 

[235009]

As for valves, I don't think tavr will replace surgical avr for low risk pts and moderate risk pts is still up in the air.

This is by far the minority opinion and is a product of your bias as a CT surgeon. TAVR continues to be equivalent or superior to surgery in lower risk patients. I have no doubt that TAVR will replace surgery as the standard of care in the next 5-10 years. Here's the article from 3 wks ago about tavr in intermediate risk pts which I'm sure you've seen but assuming many on this board haven't http://www.nejm.org/doi/full/10.1056/NEJMoa1514616

With regards to stents: in America we are far more conservative with stents than in Europe so I wouldn't be surprised if the indications for stents also get expanded over the next decade.

You're right that CT surgeons will always be needed as backup for when complications happen during percutaneous procedures.


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[SSnows123]

I'm completing my CT surgery fellowship at THI/BCM in 6 weeks and finally have a little free time. Wanted to see if there are any questions from the current crop of med students about the present or future of this fascinating field of medicine

Since no one else has, I'll start with the requisite "lifestyle" questions. Could you give us a typical day in your life? On a different note, what's your favorite procedure? And is there anything you've discovered about the training or about your future career that you wish you had known before you started? That's a very broad question but anything you've noticed, positive or negative, that you didn't know before and feel others should.
Thank you much!

 

[akwho]

Bigger god complex CT Surgeons or Neurosurgeons?

 

[Merely]

Bigger god complex CT Surgeons or Neurosurgeons?

No one should have a God complex, certainly not surgeons lol..they're just people like any of us who decided to dedicate their entire lives to training for one thing over and over again. Some would say they wasted their lives away from loved ones while being used as profit machines for admins and CEOs exploiting them for their labor. Others would argue that that is their passion and they followed it. Regardless, they're not Obama or someone with any real power so they def should not have a God complex. Just random thoughts.

 

[witzelsucht]

As a fellow, do you get excited when an interventional cardiologist pokes a hole in something and you go to clean up emergently? or is it more like "oh crap now i have to go do this...". Is there anything on a technical level that vascular surgeons do that you can't? or is the only difference geography? it seems like if you can anastamose a little coronary artery you could probably figure out a fem pop or CEA. do you think CT attracted rock stars in the past and now you get more community trained types? like the reverse-derm effect? or is everyone still so high quality it makes no difference? is it common for CT surgeons to do gen surg at all, or is a lot of the skill/interest/ability gone after two years? do you ever act like "gen surg attending" in fellowship like how some obgyn fellowships have L&D attending time? are there rotations in ctsurg fellowship like onco, cabg, trauma or is it all just "ct service?"

 

[PL198]

No one should have a God complex, certainly not surgeons lol..they're just people like any of us who decided to dedicate their entire lives to training for one thing over and over again. Some would say they wasted their lives away from loved ones while being used as profit machines for admins and CEOs exploiting them for their labor. Others would argue that that is their passion and they followed it. Regardless, they're not Obama or someone with any real power so they def should not have a God complex. Just random thoughts.

lol wut

 

[witzelsucht]

No one should have a God complex, certainly not surgeons lol..they're just people like any of us who decided to dedicate their entire lives to training for one thing over and over again. Some would say they wasted their lives away from loved ones while being used as profit machines for admins and CEOs exploiting them for their labor. Others would argue that that is their passion and they followed it. Regardless, they're not Obama or someone with any real power so they def should not have a God complex. Just random thoughts.

The question is, 'Do I have a 'God Complex'? Mr. Merely says yes, which makes me wonder if this internet poster has any idea as to the kind of grades one has to receive in college to be accepted at a top medical school. Or if you have the vaguest clue as to how talented someone has to be to lead a surgical team. I have an M.D. from Harvard. I am board certified in cardio-thoracic medicine and trauma surgery. I have been awarded citations from seven different medical boards in New England. And I am never, ever sick at sea. So I ask you, when someone goes into that chapel and they fall on their knees and they pray to God that their wife doesn't miscarry, or that their daughter doesn't bleed to death, or that their mother doesn't suffer acute neural trauma from post-operative shock, who do you think they're praying to? Now, go ahead and read your Bible, Merely, and you go to your church - and with any luck you might win the annual raffle. But if you're looking for God, he was in operating room number two on November 17th, and he doesn't like to be second-guessed. You ask me if I have a God complex? Let me tell you something: I Am God - and this side show is over.

 

[celling]

Since no one else has, I'll start with the requisite "lifestyle" questions. Could you give us a typical day in your life? On a different note, what's your favorite procedure? And is there anything you've discovered about the training or about your future career that you wish you had known before you started? That's a very broad question but anything you've noticed, positive or negative, that you didn't know before and feel others should.
Thank you much!

Lifestyle is tough for a CT surgeon. No doubt. When you get called for an emergency consult in the middle if the night it usually means you're up all night. If you aren't married yet you need to have a wife that understands that. On the positive, the money is pretty good right now and getting better by the year. Last years graduating class from my program was getting 275-350k. I was offered 500-625k when I was applying.

My favorite procedure is an aortic valve. Simple, beautiful when done right, and makes a substantial impact on the patient.

I wish I had understood the level of sacrifice it takes to get to this level. It takes so much dedication to get here. My friends all have houses and children. I'm 39 years old and still borrowing money from my family. I just got married last year and have never owned a house and have no kids.

 

[celling]

Bigger god complex CT Surgeons or Neurosurgeons?

We all get a level of arrogance. It comes with the years of training and experience. Many can call it a god complex. I find with the more experienced CT surgeons that they realize that it is A very humbling field. **** can go wrong in cardiac surgery really fast and pts can die in dramatic fashion. Sometimes it's unavoidable and sometimes it's by making a minor mistake.

The surgeons that develop a god complex are the ones who don't truly understand their fallibility.

 

[Brahnold Bloodaxe]

Thanks for the thread, CT surgery was definitely one of the "underserved" areas for AMA.

What is the geographical flexibility like? Mostly limited to large academic centers in big cities or more flexible? Also, do CT surgeons have the ability to work full time locums if they so desire?

 

[themoonman2]

Did you go through an integrated residency program or gen surg -> fellowship? Would you do that pathway again if you could choose between the two again? What do you think sets cardiothoracic surgery apart from other surgical specialties?

 

[cushingtriad]

A couple questions (from someone who is currently strongly considering CT):
1. Could you please elaborate a bit further on lifestyle as an attending? How does lifestyle differ between private and academic practice, and what can you reasonably hope for if you're willing to sacrifice income to a degree? An attending I know works 6a-6p weekdays and has q4 call, is this about the best you can do?
2. An attending CT surgeon I've been shadowing had the same perspective regarding the I6 programs–he thinks that the 4/3 programs may be a fair compromise, do you agree?
3. Is it possible to still have a fairly general practice with both cardiac and thoracic work, or do you pretty much need to choose one if not specializing further?

I greatly appreciate your time, it's difficult to find good information on CT surgery and it's helpful to get different perspectives.

 

[celling]

Thanks for the thread, CT surgery was definitely one of the "underserved" areas for AMA.

What is the geographical flexibility like? Mostly limited to large academic centers in big cities or more flexible? Also, do CT surgeons have the ability to work full time locums if they so desire?

The job market is getting a whole lot better. It's been even more noticeable in the last2-3 years. I'd say I see about 60-70% private practice and 30-40% academic. There are plenty of jobs in small to medium sized cities and those jobs usually pay more.

As for locum jobs, there is a lot of opportunity. I get 3-4 offers for locum work per week.

 

[celling]

A couple questions (from someone who is currently strongly considering CT):
1. Could you please elaborate a bit further on lifestyle as an attending? How does lifestyle differ between private and academic practice, and what can you reasonably hope for if you're willing to sacrifice income to a degree? An attending I know works 6a-6p weekdays and has q4 call, is this about the best you can do?

That's a pretty good deal. Some places you will have to work a little more. Just depends on what size group you join. if it's only 2 of you then you'll be on q2. Private practice usually requires you to work a bit more but the average private practice guy makes almost double an academic guy.

2. An attending CT surgeon I've been shadowing had the same perspective regarding the I6 programs–he thinks that the 4/3 programs may be a fair compromise, do you agree?

I think it's probably better but I don't have any personal experience in seeing students or graduates of these programs.

3. Is it possible to still have a fairly general practice with both cardiac and thoracic work, or do you pretty much need to choose one if not specializing further?

In private practice you probably will need to do both. A lot of practices also want you to do vascular. As for academics, most choose one or the other.

I greatly appreciate your time, it's difficult to find good information on CT surgery and it's helpful to get different perspectives.

 

[HelpPleaseMD]

much props. congrats on closing in to the finish line.

 

[cushingtriad]

Are you planning on going into academic or private practice, and why?

Furthermore, what do you envision your future practice consisting of (in terms of cardiac vs. thoracic, specialization, etc) and are you okay with that?

 

[celling]

Are you planning on going into academic or private practice, and why?

I've signed with a private practice group. I've never had a lot of interest in research or teaching residents. I just want to get really good at the operations. I think that most of the great academic positions are in very malignant hospitals and Im sick of all that by this point in my life. Plus private practice pays way more than academics.

Furthermore, what do you envision your future practice consisting of (in terms of cardiac vs. thoracic, specialization, etc) and are you okay with that?

My initial job will be 90% cardiac and 10% thoracic. It'll be heavy on aortic work. I'll probably focus more on thoracic later in my career. It's a lot less stressful.

 

[Brahnold Bloodaxe]

The job market is getting a whole lot better. It's been even more noticeable in the last2-3 years. I'd say I see about 60-70% private practice and 30-40% academic. There are plenty of jobs in small to medium sized cities and those jobs usually pay more.

As for locum jobs, there is a lot of opportunity. I get 3-4 offers for locum work per week.

Cool. Is there a strong trend towards hospital buyouts of PP like in other fields, or have you not noticed that in CT surgery?

 

[MarioKart]

@celling Congratulations on almost finishing, Okay so my main questions are...how many hours did you work a day on average in residency, and how many do you expect to do once finished?? I was talking with some neurosurgeons halfway through their residency a few days ago and they seemed pretty relaxed and for the most part only did surgeries that were scheduled out days in advance. This is at a big hospital in metro New York so I don't know if you're nearby or not but in your experience were most of yours surgeries also planned or did you wake up a lot at night for emergencies???? Thanks!!!!!

 

[celling]

Cool. Is there a strong trend towards hospital buyouts of PP like in other fields, or have you not noticed that in CT surgery?

I've noticed that most groups have been bought out by hospitals

 

[celling]

@celling Congratulations on almost finishing, Okay so my main questions are...how many hours did you work a day on average in residency, and how many do you expect to do once finished?? I was talking with some neurosurgeons halfway through their residency a few days ago and they seemed pretty relaxed and for the most part only did surgeries that were scheduled out days in advance. This is at a big hospital in metro New York so I don't know if you're nearby or not but in your experience were most of yours surgeries also planned or did you wake up a lot at night for emergencies???? Thanks!!!!!

My work hours were very variable through training depending on the rotation I was on. General thoracic was usually less hours. On average I would say I worked 10-12 hours per day on non-call days and I was on in house call q4. I'd expect to work around 10-12 hrs/day when I'm done.

As for planned vs emergency surgeries, we do more emergencies than neuro but I wouldn't say that most of our surgeries aren't elective. I'd say 90% of procedures are elective. But we do have our emergencies (type a dissections, acute AI, cath lab mess ups).

 

[BphysDoc]

How do you feel working 10-12 hr per day for all your adult life in a stressful career? How did you handle the stress? Now looking back, can you comment on general surgery residency? How hard was it?

 

[NontradCA]

I'm guessing you're referring to med school stats.
Step 1 226
Step 2 CK 248
Step 2 CS pass
Step 3 235
Top 10 of my med school class

He meant Bench/Deadlift/Squat

 

[Merely]

He meant Bench/Deadlift/Squat

He's not ortho so prolly very low numbers

 

[tiedyeddog]

No one should have a God complex, certainly not surgeons lol..they're just people like any of us who decided to dedicate their entire lives to training for one thing over and over again. Some would say they wasted their lives away from loved ones while being used as profit machines for admins and CEOs exploiting them for their labor. Others would argue that that is their passion and they followed it. Regardless, they're not Obama or someone with any real power so they def should not have a God complex. Just random thoughts.

You, my friend, have not met enough neurosurgeons or CT surgeons (and I say that as someone who is a resident in one of those fields).

 

[Merely]

You, my friend, have not met enough neurosurgeons or CT surgeons (and I say that as someone who is a resident in one of those fields).

What I said has nothing to do with the people in the field. I made an ought claim, not saying that they don't. Who cares what they think they prolly do think they're God...no one cares. Everyone thinks they're god in some way, especially people with real power (unlike surgeons).

 

[tiedyeddog]

What I said has nothing to do with the people in the field. I made an ought claim, not saying that they don't. Who cares what they think they prolly do think they're God...no one cares. Everyone thinks they're god in some way, especially people with real power (unlike surgeons).

"Power" is difficult to define but in a medical context plenty of Surgeons see themselves as having God-like healing powers.


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[Merely]

"Power" is difficult to define but in a medical context plenty of Surgeons see themselves as having God-like healing powers.


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Money and influence = power, surgeons dont have that so they're not that powerful. Every doctor has the power you're talking about if you speak broadly enough.

 

[tiedyeddog]

Money and influence = power, surgeons dont have that so they're not that powerful. Every doctor has the power you're talking about if you speak broadly enough.

Surgical departments keep plenty of medical centers profitable across the country. The staff in my department have plenty of weight to throw around at my hospital and I know it is like that plenty of other places. They have plenty of power within the medical community.

Do they have power like Obama? No... but I am not sure what that has to do with this conversation.

 

[Merely]

Surgical departments keep plenty of medical centers profitable across the country. The staff in my department have plenty of weight to throw around at my hospital and I know it is like that plenty of other places. They have plenty of power within the medical community.

Do they have power like Obama? No... but I am not sure what that has to do with this conversation.

Thats the point of this conversation...surgeons should not have a God complex because they do not have any real power. They are labor for the hospital. They can be hired and fired on a whim. Your administrator is your master. Contrast this with billionares, owners of multinational corporations, senators, governors, etc. who have power in the sense of either lots of money or lots of influence. Does anyone know or care about the local neurosurgeon? Not really. The state governor? You bet your ass.

 

[tymont12]

Thats the point of this conversation...surgeons should not have a God complex because they do not have any real power. They are labor for the hospital. They can be hired and fired on a whim. Your administrator is your master. Contrast this with billionares, owners of multinational corporations, senators, governors, etc. who have power in the sense of either lots of money or lots of influence. Does anyone know or care about the local neurosurgeon? Not really. The state governor? You bet your ass.

People's 'God Complex' isn't usually based in rational thought...I've met parking attendants who think the world spins around them. Similarly, people with any real power shouldn't have a God Complex. I certainly don't think Obama has one.

 

[celling]

How do you feel working 10-12 hr per day for all your adult life in a stressful career? How did you handle the stress? Now looking back, can you comment on general surgery residency? How hard was it?

10-12 hrs on average isn't that bad. Especially if it's something you enjoy.

Stress management is something you learn as you go. My best advice is find a constructive way to vent your frustrations and don't let them build up.

General surgery residency is very hard. ITll be the hardest thing you probably will ever do. That being said, CT surgery fellowship is harder.

 

[Bacchus]

From a graduating PGY3 in FM, what are your thoughts about your primary care colleagues?

 

[celling]

He's not ortho so prolly very low numbers

Well, I benched 400 and squatted 500 lb before I started med school. Not as much since I started training.

 

[celling]

From a graduating PGY3 in FM, what are your thoughts about your primary care colleagues?

I'm looking for referrals starting August 1.

 

[Fengxian_Tech]

Hey Celling,

First off, thanks for making yourself available. I am a ST looking to become a CT Surgeon in the future so it is awesome to see a former surgical tech go the distance. How did you like being a surgical tech and do you think it helped for med school? Also would you go the ST route again to get to where you are at?

Fengxian

 

[deleted123544]

Hey guys! this is an awesome thread! thanks to Ceiling for sticking around and contributing. I am currently an MS-3 in the Midwest and next year I will be applying for residency. Before coming to medical school, I knew I wanted to a CT Surgeon. Nonetheless, it wasn't until the summer after my MS-1 year where I was awarded the AATS Summer Intern Scholarship and worked in Congenital CT Surge, the field that I want to go into as well as AVRs, those are definitely neat. My current question is in regards to training. I know the number of I6 programs keep growing and some traditional fellowships have closed, like it occurred in North Carolina. Right now, I am split between applying to I6 or go the traditional Route or maybe a 4+3.

From my experience working with residents and fellows in both pathways, I have noticed that a lot of the traditional fellows and those who did 4+3 have better surgical skills, SICU knowledge, and are more confident in the OR and when it comes to pre-op and post-op patient management. I have also met some I6 residents who are great, but by far those who had the general surgery training seem superior. I also heard from one of the fellows that some programs are reluctant to interview I6 residents for Peds CT Surgery sub fellowship. This kind of has made me lean more towards to 4+3 programs or the 5 yr general surgery + 2-3 CT fellowship. So for Ceiling, what is your view/opinion? And for everyone else in the field, what is the current word "in the street" about the training? I just really want to have the best medical training, as well as surgical skills and knowledge possible so that I can be the best! Thanks guys

 

[celling]

Hey Celling,

First off, thanks for making yourself available. I am a ST looking to become a CT Surgeon in the future so it is awesome to see a former surgical tech go the distance. How did you like being a surgical tech and do you think it helped for med school? Also would you go the ST route again to get to where you are at?

Fengxian

I enjoyed being a surg tech and felt that it helped me a lot in med school. I was more comfortable with procedures, anatomy, etc. I would definitely do it again. The only problem is that it does delay getting through med school and residency.

 

[celling]

Hey guys! this is an awesome thread! thanks to Ceiling for sticking around and contributing. I am currently an MS-3 in the Midwest and next year I will be applying for residency. Before coming to medical school, I knew I wanted to a CT Surgeon. Nonetheless, it wasn't until the summer after my MS-1 year where I was awarded the AATS Summer Intern Scholarship and worked in Congenital CT Surge, the field that I want to go into as well as AVRs, those are definitely neat. My current question is in regards to training. I know the number of I6 programs keep growing and some traditional fellowships have closed, like it occurred in North Carolina. Right now, I am split between applying to I6 or go the traditional Route or maybe a 4+3.

From my experience working with residents and fellows in both pathways, I have noticed that a lot of the traditional fellows and those who did 4+3 have better surgical skills, SICU knowledge, and are more confident in the OR and when it comes to pre-op and post-op patient management. I have also met some I6 residents who are great, but by far those who had the general surgery training seem superior. I also heard from one of the fellows that some programs are reluctant to interview I6 residents for Peds CT Surgery sub fellowship. This kind of has made me lean more towards to 4+3 programs or the 5 yr general surgery + 2-3 CT fellowship. So for Ceiling, what is your view/opinion? And for everyone else in the field, what is the current word "in the street" about the training? I just really want to have the best medical training, as well as surgical skills and knowledge possible so that I can be the best! Thanks guys

If I had to choose between I-6 and the traditional training program it would be difficult. Both have pluses and negatives. I-6 is shorter and is more CT surgery oriented. However, you will not get the knowledge that comes from general surgery training. If I had to choose which training program produces the best CT surgeons I would lean towards the traditional approach. However, the I-6 training programs are still in the infancy.

 

[deleted123544]

If I had to choose between I-6 and the traditional training program it would be difficult. Both have pluses and negatives. I-6 is shorter and is more CT surgery oriented. However, you will not get the knowledge that comes from general surgery training. If I had to choose which training program produces the best CT surgeons I would lean towards the traditional approach. However, the I-6 training programs are still in the infancy.

Hey Celling, I hope you are well. Ive been looking more at training pathways and I am interested in pursuing the 4+3 pathway as I feel it is more for me. Do you have any advice in regards to applying to these programs and in regards toile doing away orations? I have to submit my schedule soon for 4th yr and I am not sure if for the 4+3 I should do general surgery aways in these programs or like CT surgery electives. Any advice from you or anyone else would be amazing and greatly appreciated

 

[axfem]

Bumping an old thread

But since you're a new grad, what's the verdict on the CT surgeons jumping on the TAVR wagon? There is no denying that it is the way of the future and that it will kill open AVR volumes within the next decade. Did you get any TAVR training during fellowship? Are there CT surgeons who actually do TAVRs on a regular basis (and I mean actually doing the procedure and not just standing next to the interventional cardiologist)?

Thank you!