Headed to the ASCRS meeting tomorrow

[SLUser11]

I figure now is as good a time as any to declare myself. I am planning on a career in colorectal surgery, and I'm interviewing this fall for fellowship.

I'm heading to the ASCRS Annual Meeting in Minneapolis this weekend. I'm attending a lap colectomy workshop and getting face time with some of my potential future bosses.

Feel free to post here or PM me if you are also attending. If not, wish me luck as I ride the line between being a kiss-@ss and being completely invisible....

It will be interesting to see how my behavior on SDN will be affected during the interview process. Due to my posting patterns and username, I am far from anonymous, and I wonder if I'll dial it back a bit to prevent scaring off program directors......I doubt it.....

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[BlondeDocteur]

Well, personally, I've been reading this board for 2.5 years, and I can't think of a single thing you'd have to be worried about. If anything your posts are a credit-- you've spoken very highly of your program and provided a lot of good advice and perspective.

Hopefully you're prepared for a lifetime of ass jokes....

 

[Encephalectomy]

Good luck! I've really enjoyed reading your posts also and was wondering if you could maybe share what drew you to colorectal. Thanks!

 

[filter07]

I too think you are a credit to this forum and represent your program very favorably.

 

[Winged Scapula]

Agreed.

You've always defended your program with a loving but critical eye and cannot recall anything you've written here that would compromise your future career.

Have fun!

 

[SLUser11]

I appreciate the nice words, and I am fully prepared for a life's worth of @ss jokes.

As for what drew me to colorectal:

1. I like curing cancer, and the colon and rectal cancer population has excellent outcomes in comparison to some other cancers we cut out, such as lung/pancreas, etc.

2. I can continue to practice general surgery, which I enjoy a lot. I don't want to give up my choles and hernias just yet.

3. I really enjoy the surgeries. A lot of the laparoscopic and robotic surgeries that I enjoy the most are in colorectal surgery, e.g. lap colectomies, robotic TMEs. I also generally enjoy the other open-approach colorectal surgeries.

4. I believe that subspecialty training can lead to better outcomes in common diseases like rectal cancer and benign anorectal disease.

5. If I decide to opt out of general surgery call, the lifestyle is a little nicer. There aren't that many 2am colorectal emergencies.


Well, I'm checked into the room, and the pregnant wifey is getting hungry, so I'll stop for now. Time to explore Minneapolis....

 

[Musashi450]

Agree with the above. Long time reader and I've really appreciated your candid and honest answers. Good luck at the meeting!

 

[Rabbit Hole]

Your posts reflect how much dedication and passion you have for your career and it's clear that you have an incredible fund of knowledge as well as a sensible level of humility recognizing that there is far more to learn. You will be an invaluable asset to any program that takes you on. Have fun in Minneapolis. You have nothing to worry about Dorothy!

 

[Green Grass]

Time to explore Minneapolis....

If you are looking to splurge (because it is expensive), I highly recommend The Oceanaire Seafood Room. Delicious! There is also Manny's which is a pretty popular steakhouse.

Have fun in MN, aka God's Country.

 

[maverick_pkg]

I appreciate the nice words, and I am fully prepared for a life's worth of @ss jokes.

As for what drew me to colorectal:

1. I like curing cancer, and the colon and rectal cancer population has excellent outcomes in comparison to some other cancers we cut out, such as lung/pancreas, etc.

2. I can continue to practice general surgery, which I enjoy a lot. I don't want to give up my choles and hernias just yet.

3. I really enjoy the surgeries. A lot of the laparoscopic and robotic surgeries that I enjoy the most are in colorectal surgery, e.g. lap colectomies, robotic TMEs. I also generally enjoy the other open-approach colorectal surgeries.

4. I believe that subspecialty training can lead to better outcomes in common diseases like rectal cancer and benign anorectal disease.

5. If I decide to opt out of general surgery call, the lifestyle is a little nicer. There aren't that many 2am colorectal emergencies.


Well, I'm checked into the room, and the pregnant wifey is getting hungry, so I'll stop for now. Time to explore Minneapolis....

I am sure you have nothing to worry about congrats for the baby!

what made you choose this over MIS...cancer primarily? you think there are advantages being a colorectal surgeon for referrals over MIS surgeons, esp for colon surgeries? whats the case mix for colorectal that you see at your place?

 

[45408]

While I'm tempted to make a proctology joke, I heard a secondhand comment from a colorectal surgeon who said "Everyone deserves a happy butt." After a month of CRS with dozens of Crohn's and UC patients, I most certainly concur.

And I don't think you have anything to hide from anyone on SDN, although I still haven't figure out what your criteria are for bolding certain phrases.

 

[JackADeli]

....I like curing cancer, and the colon and rectal cancer population has excellent outcomes in comparison to ...pancreas...

All, come on, you know that robot will make the pancrease all better!!!

Good luck dude, have fun.

...what made you choose this over MIS...cancer primarily? you think there are advantages being a colorectal surgeon for referrals over MIS surgeons, esp for colon surgeries?...

I'm curious to hear your take on this as well. I suspect CRS training is more complete then MIS training. CRS is comprehensive from pre-op diagnosis, considerations of neo-adj (chemo in CA and immune suppressives in IBD), considerations of adjuvant, and longterm followup with surveillance. MIS may have touches of the diagnosis... However, MIS is fundamentally steered towards teaching operative technique and not so much global/big picture stuff.

MIS surgeon (i.e. GSurgeon with an additional year of laparoscopy) will still be taking primary general surgery call and not likely to be the first person you consult for CR cancer. On the other hand, MIS is not likely the first person to be called at midnight for thrombosed hemorrhoids or IBD patient with sepsis from peri-rectal abscess, toxic megacolon, obstruction, perf, etc... But, it really will all depend on community referral patterns.

 

[BlondeDocteur]

When I hear "MIS fellowship," I think "lucrative bariatrics practice." And when I hear "bariatrics," I run from the room screaming. Perhaps SL is the same?

 

[JackADeli]

When I hear "MIS fellowship," I think "lucrative bariatrics practice." And when I hear "bariatrics," I run from the room screaming. Perhaps SL is the same?

Yeh, the operations, Lap R-y could be fun.... but for me, only fun if I didn't see the patient before they were draped or after the operation. I just did not like dealing with the patient population or the pathology of the disease and patient population. I only liked the doing of the operation. In many instances it is a patient population non-compliant with life in general. the procedures are designed to overcome their non-compliance and/or make additional non-compliance difficult.

 

[Rabbit Hole]

And I don't think you have anything to hide from anyone on SDN, although I still haven't figure out what your criteria are for bolding certain phrases.

In this case, I think the bold phrases are the "high-yield" version of his response. I could be wrong.

As for what drew me to colorectal:

1. cancer

2. I can continue to practice general surgery

3. I really enjoy the surgeries

4. better outcomes

5. lifestyle

 

[maverick_pkg]

Yeh, the operations, Lap R-y could be fun.... but for me, only fun if I didn't see the patient before they were draped or after the operation. I just did not like dealing with the patient population or the pathology of the disease and patient population. I only liked the doing of the operation. In many instances it is a patient population non-compliant with life in general. the procedures are designed to overcome their non-compliance and/or make additional non-compliance difficult.

I fully agree....

When I hear "MIS fellowship," I think "lucrative bariatrics practice." And when I hear "bariatrics," I run from the room screaming. Perhaps SL is the same?

Is bariatrics extra-lucrative?

MIS is also foregut..Nissens/Hellers. Plus colons at some programs...kinda like laparoscopic everything in the gut, unless u do a bariatric only fellowship.

 

[SLUser11]

what made you choose this over MIS...cancer primarily? you think there are advantages being a colorectal surgeon for referrals over MIS surgeons, esp for colon surgeries? whats the case mix for colorectal that you see at your place?

MIS and colorectal seem like 2 completely different fields to me. As for cancer, the perioperative care is going to be stressed a lot more during an average colorectal fellowship. MIS docs can obviously advertise whatever they want, but the majority of fellowship trained docs are going to be primarily bariatric surgeons.

And I don't think you have anything to hide from anyone on SDN, although I still haven't figure out what your criteria are for bolding certain phrases.

It's relatively random. I'm not sure how to control inflection over the internet.

I'm curious to hear your take on this as well. I suspect CRS training is more complete then MIS training.

It's a reflection of the practice environment that I am in, but I really don't experience MIS and colorectal fighting over too many cases. MIS docs do bands and fat-passes, and probably nissens, etc, but when it comes to colorectal surgery, the volume is relatively unique. I just don't see most MIS fellows doing enough laparoscopic TMEs or lap proctocolectomy/IPAAs to justify doing them in practice. Also, the laparoscopic stuff is just one small part of big picture for colorectal surgery.

I fully agree....



Is bariatrics extra-lucrative?

MIS is also foregut..Nissens/Hellers. Plus colons at some programs...kinda like laparoscopic everything in the gut, unless u do a bariatric only fellowship.

WS can find you an article that she previously posted on medicare fat-passes, but I can't give you too much more info.

Also, shout out as I met one of your co-residents at the lap colectomy workshop this weekend. He seemed like a good guy, although his knowledge of Creighton basketball could use some work.

 

[maverick_pkg]

It's a reflection of the practice environment that I am in, but I really don't experience MIS and colorectal fighting over too many cases. MIS docs do bands and fat-passes, and probably nissens, etc, but when it comes to colorectal surgery, the volume is relatively unique. I just don't see most MIS fellows doing enough laparoscopic TMEs or lap proctocolectomy/IPAAs to justify doing them in practice. Also, the laparoscopic stuff is just one small part of big picture for colorectal surgery.



WS can find you an article that she previously posted on medicare fat-passes, but I can't give you too much more info.

Also, shout out as I met one of your co-residents at the lap colectomy workshop this weekend. He seemed like a good guy, although his knowledge of Creighton basketball could use some work.

whats the case distribution you guys have at your place...50% colon, 50% rectal? how much laparoscopic/robotic?

yeah he is one of the 4th years at my place. he really liked the cadaver operating u guys did. must have been fun. Yeah, probably, basketball is not his thing

 

[ACSurgeon]

Yeh, the operations, Lap R-y could be fun.... but for me, only fun if I didn't see the patient before they were draped or after the operation. I just did not like dealing with the patient population or the pathology of the disease and patient population. I only liked the doing of the operation. In many instances it is a patient population non-compliant with life in general. the procedures are designed to overcome their non-compliance and/or make additional non-compliance difficult.

Which is why I'm going into surgery... most docs have to deal with non-compliant patients, and treat what patient brought onto themselves. Personally, I'd rather do this through surgery in the OR rather than through talking/motivating/etc in the office.

 

[JackADeli]

Which is why I'm going into surgery... most docs have to deal with non-compliant patients, and treat what patient brought onto themselves. Personally, I'd rather do this through surgery in the OR rather than through talking/motivating/etc in the office.

I have to tell you that surgeons do have to "deal with non-compliant patients, and treat what patient brought onto themselves". Some might also point to bariatrics as the epitome of this. However, things such as vascular disease, COPD, lung CA, transplant, etc... are also often surgical intervention as a result of non-compliance. Surgical outcomes will very often depend on the pre-operative & post-operative "talking/motivating/etc in the office". Bariatric patients require a significant pre-operative w/u that includes dietary, psych, physician (usually surgeon) monitored diet. A patient that continues to gain weight prior to bypass is at significant increased risk and is a marker for post-op non-compliance. Similar things with the other disease/specialties I mentioned above.

So, if going into surgery, it is important to understand that you will have to engage in significant "talking/motivating/etc in the office". Your success will depend on it. Not everyone is good at the office based component and at the extremes if you want nothing to do with it you need to look at things like path and radiology. Before any path/rads folks try to flame, I am NOT saying all path/rads folks are antisocial.

 

[tussy]

welcome to CRS world! Yes, the butt jokes, proctology comments, etc get pretty tiresome, but i went into colorectal for the same reasons you are. Make sure you choose a fellowship that's doing lots of lap if that's what you're interested in. Once you finish you can tailor your practice to what you want anyway - if you build it they will come! Better to do a fellowship in a disease/area than to do it in a surgical technique (ie lap). The operation itself is such a small part of the overall patient care - the decisions that get you there in the first place and those after make more difference.

I'm not going to ASCRS this year - went to Mexico 2 weeks ago instead (and had way more fun than i would have in Minneapolis) - i'll make it next year in Vancouver! Have fun - it's a good meeting.

 

[Guile]

Glad to hear you have made a decision about which sub-specialty to pursue. CRC is a great field. I enjoyed the cases when I had the chance to scrub on a few. You can make a lot of people much happier afterwards.

If you're still in Minneapolis check out this bar Town Hall Brewery. Google Map. Great place. It's at the edge of a spot called 7 Corners, where a couple convoluted intersections and several traffic lights stack on top of each other. The bar is on the far corner, right where people have to make a big left hand turn after coming through the meat of the intersection. The bar is mostly windows, and on rainy nights you can turn your stool around and watch the headlights moving across the window against the rain. It's only a matter of time until someone misses the turn and crashes through glass and into the bar.

 

[JackADeli]

....Better to do a fellowship in a disease/area than to do it in a surgical technique (ie lap). The operation itself is such a small part of the overall patient care - the decisions that get you there in the first place and those after make more difference...

I would agree.

 

[ACSurgeon]

I have to tell you that surgeons do have to "deal with non-compliant patients, and treat what patient brought onto themselves". Some might also point to bariatrics as the epitome of this. However, things such as vascular disease, COPD, lung CA, transplant, etc... are also often surgical intervention as a result of non-compliance. Surgical outcomes will very often depend on the pre-operative & post-operative "talking/motivating/etc in the office". Bariatric patients require a significant pre-operative w/u that includes dietary, psych, physician (usually surgeon) monitored diet. A patient that continues to gain weight prior to bypass is at significant increased risk and is a marker for post-op non-compliance. Similar things with the other disease/specialties I mentioned above.

So, if going into surgery, it is important to understand that you will have to engage in significant "talking/motivating/etc in the office". Your success will depend on it. Not everyone is good at the office based component and at the extremes if you want nothing to do with it you need to look at things like path and radiology. Before any path/rads folks try to flame, I am NOT saying all path/rads folks are antisocial.

Haha... I'm not at the extreme at all... I actually love talking to patients, but not the way primary care docs do. God bless their hearts, but I could never do it .

 

[SLUser11]

welcome to CRS world!

Well, I'm back from the meeting and I had a very positive experience overall. The colectomy workshop was not too helpful, as 4 people shared a cadaver, and we get a lot of practice on real patients here in Wichita, but the program itself was excellent, and I shook a lot of famous hands. Everyone was pleasant and approachable, regardless of their professional status.

My overall impression is that colorectal fellowships are becoming increasingly competitive. The overall match rate for 2008 was 67%, and is not published for 2009 yet, but was subjectively worse per the current fellows. The match rate for an allopathic US grad (more relevant #) was 79%. (Peds is 59%, plastics roughly 50-60%, trauma 90%, CT 91%, Vascular 93%, transplant 89%).

I met several of the PDs at a special meet and greet, and got the impression that LORs and "who you know" play a very large role in landing interviews. ABSITE scores are next, and then research matters at the bigger places. Less important details include USMLE scores and place of residency. None of the big name places seemed turned off by my "community" status, but who knows, as I haven't been given interviews anywhere yet.

The hard part is deciding what type of program to target specifically. The "big dogs" do a lot of big, less-common cases such as SILS, Robotics, Lap TMEs, Lap IPAAs, while the smaller named programs offer a large volume of more practical procedures, e.g. anorectal, lap colons, colonoscopies, etc. An argument could be made that either category is more beneficial than the other for someone going out into practice.

I learned a great deal about the process, and gained a lot of knowledge of the programs that couldn't be found anywhere else. I strongly recommend the meeting for any residents interested in colorectal surgery. It's best to go as a PGY-4, as that immediately precedes the application process. Plan on staying until Tuesday night so as to not miss the meet and greet. It's also probably wise to get started on some colorectal research if the opportunity exists.

 

[Guile]

The hard part is deciding what type of program to target specifically. The "big dogs" do a lot of big, less-common cases such as SILS, Robotics, Lap TMEs, Lap IPAAs, while the smaller named programs offer a large volume of more practical procedures, e.g. anorectal, lap colons, colonoscopies, etc. An argument could be made that either category is more beneficial than the other for someone going out into practice.

Which programs do you think are the "big dogs"? I've heard good things about Minnesota and UT-Houston.

It's best to go as a PGY-4, as that immediately precedes the application process.

I thought most fellowships applied during PGY-4 and matched in spring of PGY-4? Is CRS different than other fellowships?

 

[45408]

It's also probably wise to get started on some colorectal research if the opportunity exists.

Have you done research? When did you start, and what kind of research did you do?

 

[JackADeli]

...and then research matters at the bigger places. ...None of the big name places seemed turned off by my "community" status...

...It's also probably wise to get started on some colorectal research if the opportunity exists.

I think that is the clincher. The programs know you can be well trained at the community programs. The shortfall is that numerous community programs may be disadvantaged at getting you research opportunities.

 

[Smurfette]

Which programs do you think are the "big dogs"? I've heard good things about Minnesota and UT-Houston.


I thought most fellowships applied during PGY-4 and matched in spring of PGY-4? Is CRS different than other fellowships?

No. All specialties match at different times, staggered by a few weeks (generally speaking)

Peds-match spring PGY4
Transplant-match spring PGY4
Vascular-match spring PGY4
Cardiothoracic-match spring PGY4
Plastics-match spring PGY4 (or spring PGY2 for new 3+3 programs)
Trauma-match fall PGY5
Critical Care-match fall PGY5
Colorectal-match fall PGY5
Breast-fall PGY5
MIS-fall PGY5

Not sure on burn, surg onc/HPB

 

[SLUser11]

Which programs do you think are the "big dogs"? I've heard good things about Minnesota and UT-Houston.


I thought most fellowships applied during PGY-4 and matched in spring of PGY-4? Is CRS different than other fellowships?

I will provide an answer, but keep in mind there are plenty of other programs with excellent training, many of which may be a better overall fit for residents.

Most famous: Cleveland Clinic, Lahey Clinic, Wash U, Minnesota, Mayo

Also very well-known: Oschner, Ferguson/Mich State, UT-Houston

There were several others that I am very interested in, but these are the ones that seem to have the biggest reputations.

Honestly, name brands aren't as important to me as strong clinical training, but these places became famous by providing strong training, so....


Apply at the beginning of PGY-5, match in November of PGY-5. It's a very late match. I believe the MIS match is also very late.

Have you done research? When did you start, and what kind of research did you do?

I did clinical research and a couple case reports. Case reports just occur over time. It's good to get started now thinking about possible clinical research projects, as the proposals and IRB approval can sometimes be time consuming, at least at my institution.

I think that is the clincher. The programs know you can be well trained at the community programs. The shortfall is that numerous community programs may be disadvantaged at getting you research opportunities.

Several places made a point of saying that research is not super-important. The bigger places want to be sure that you have an interest in research, but they have so many projects going that you will most likely involve yourself in one of those since it's only a one year fellowship.

 

[45408]

a CRS fellowship is one year? I thought it was two.

the more you know...

 

[Guile]

a CRS fellowship is one year? I thought it was two.

the more you know...

Same here. That's welcome news.