How are the first graduates of the integrated 5 year vascular programs doing?

[redstripes13]

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I'm interested in the integrated vascular programs, and I know that the first graduates are just coming out / have been working a few years. How have they been doing, job-wise and skills-wise? Are they as marketable as someone in a trad 5+2 track? Are they up to par, skills wise?

 

[igap]

I'm interested in the integrated vascular programs, and I know that the first graduates are just coming out / have been working a few years. How have they been doing, job-wise and skills-wise? Are they as marketable as someone in a trad 5+2 track? Are they up to par, skills wise?

I heard that most of them are doing fellowships in open vascular surgery.

 

[Med0123]

I heard that most of them are doing fellowships in open vascular surgery.

???? 😕

 

[mimelim]

I'm interested in the integrated vascular programs, and I know that the first graduates are just coming out / have been working a few years. How have they been doing, job-wise and skills-wise? Are they as marketable as someone in a trad 5+2 track? Are they up to par, skills wise?

A few presentations that might interest you.

Makaroun talking about the data from the people who applied for Pitt this year:
http://www.vascularweb.org/APDVS/Do...eting Presentations/9 Makaroun APDVS 2012.pdf

Pitt Surveyed SVS about 0+5 residents:
http://www.vascularweb.org/APDVS/Do...ng Presentations/16 0-5 survey APDVS 2012.pdf

Rectenwald talks about the early years:
http://www.vascularweb.org/APDVS/Do...esentations/19 APDVS Lessons Learned 2012.pdf

 

[redstripes13]

Thank you for the informative posts!

 

[Poetic Silence]

They should change the name from vascular surgery to phlebology. It would be pretty sweet if these guys became both surgical as well as medical specialists of the vascular system. Kind of like how ENT and urologists can do nonsurgical things as well as perform surgery.

 

[Apollyon]

They should change the name from vascular surgery to phlebology. It would be pretty sweet if these guys became both surgical as well as medical specialists of the vascular system. Kind of like how ENT and urologists can do nonsurgical things as well as perform surgery.

Vascular medicine is already its own subspecialty, either after IM, or after cardiology fellowship.

 

[Poetic Silence]

Vascular medicine is already its own subspecialty, either after IM, or after cardiology fellowship.

For real? I didn't see it on the list of recognized board certified specialties.

 

[Apollyon]

For real? I didn't see it on the list of recognized board certified specialties.

They may not be recognized yet, but I know people that have done both tracks.

 

[Poetic Silence]

Very interesting. All these people doing vascular work. Vascular surgeons, phlebolohists, cardiologists, cardiovascular surgeons, interventional radiologists. . .

Who's the actual vascular expert here?

 

[neusu]

Very interesting. All these people doing vascular work. Vascular surgeons, phlebolohists, cardiologists, cardiovascular surgeons, interventional radiologists. . .

Who's the actual vascular expert here?

Don't forget the cerebrovascular neurosurgeons. Whole different ball of wax.

 

[jinascalpel]

I heard that most of them are doing fellowships in open vascular surgery.

well we are dealing with an N of 1 or 2 at this point, and one is doing an advanced aortic (open and endo) fellowship, so this is incorrect.

The current crop of program directors are an impressive group of people. The interview trail basically consists of shaking hands with the entire authorship of Rutherfords.These academic leaders are staking their reputations on the new training programs. None of them seem the least bit concerned about the progression of their senior residents, and some are ecstatic about their results.

The only reservations I hear voiced, relate very specifically to large open abdominal vascular cases. Namely that the 0+5s won't be ready to do complex aortic work. That being said, I think very few 5+2 residents are getting the numbers to be comfortable with those procedures initially. Training people in open aortic work is going to become increasingly difficult regardless of paradigm.

It's likely that people trying to become the next Cambria/ Safi are going to do fellowships in aortic work. this is just the natural progression of the specialty. Nobody is going to do super-fellowships to get in 80 more fem-distal bypasses, the residents are getting those numbers in spades.

As far as the poster who was mentioning the competitive/ turf war nature of vascular specialization:

It's a 2 horse race at this point between cardiology and vascular surgery. vascular IR has been driven towards the fringe with regards to peripheral vascular work. yes there are institutional variations, but this is the national trend. cerebrovascular work is a different story, but not worth getting into.

cardiology has a big advantage with regards to patient control, and number of practitioners. Vascular has an advantage in the fact that they know what they are doing, and actually treat their patients appropriately, which seems to matter to some referrers. Plus when patients present to the ED with dry gangrene, the reflex call is not to interventional cardiology, it's to vascular. Vascular ends up treating more critical limb ischemia while cardiologists spend their time trashing the SFAs of patients that probably should have just started a walking program for their claudication.

vascular has very little home turf. they fight with cardiology, and IR over peripheral work. IR over venous access. Transplant over fistula creation. Neurosurg/ NVIR over cerebrovascular work, and just about everyone with regards to vein work. All that being said, it is difficult to find a vascular surgeon who doesn't have enough procedures to do. there are a lot of patients to go around.

and that concludes my post-call treatise.

 

[europeman]

They can do everything except many complex things in the belly. They will need general surgery consultations or in reality transplant will just take over the complex abdominal stuff like portocaval shunts, hepatic artery bypasses, and open sma work


European

 

[Poetic Silence]

Or they could add an abdominal fellowship?

 

[mimelim]

They can do everything except many complex things in the belly. They will need general surgery consultations or in reality transplant will just take over the complex abdominal stuff like portocaval shunts, hepatic artery bypasses, and open sma work


European

I've been around Vascular now for 3 years on an off and I've never seen general surgery get called in on a patient. CV/CT for type A dissections, yes. Neuro IR for high carotid work, yes. IR for filters/TDCs that we are too busy to do ourselves. But most vascular surgeons I have seen feel very comfortable doing big open abdomen cases. That may change with the 0+5 training, but that is certainly not the current model everywhere.

 

[ESU_MD]

Vascular medicine is a good job for an older surgeon too, or someone looking to slow down and focus on office, reading vascular studies etc. dont know the training pathway though

 

[ESU_MD]

I've been around Vascular now for 3 years on an off and I've never seen general surgery get called in on a patient. CV/CT for type A dissections, yes. Neuro IR for high carotid work, yes. IR for filters/TDCs that we are too busy to do ourselves. But most vascular surgeons I have seen feel very comfortable doing big open abdomen cases. That may change with the 0+5 training, but that is certainly not the current model everywhere.

Doing an SMA bypass is something any vascular surgeon will do, and certainly is something a general surgeon should be able to do as well. Esp in a rural area, it is not an advanced move to sew in an bypass.

On the other hand, very few vascular surgeons will tackle thoracoabdominal aneurysms outside of an academic center. Not so much for the technical challenge, but these patients are alot of work. Even the big boys like Safi et al have significant mortality/ morbidity.

I do agree that there are fewer open cases to go around though. It could get scary in a few years, but since i was lucky to catch the tail end of the open days, at least it will be job security. The cardiologists will always need someone to fix their perforations etc!!

 

[Skialta]

I don't really agree, I am a vascular fellow and feel pretty good about complex abdominal aortic and visceral bypass cases. I haven't counted recently but 1 year in I have 60 abdominal cases or more. We are a large referral center and it seems most aneurysms these day are juxtarenal. The only tube grafts getting placed are ruptures as straight up EVARs are cherry picked.

 

[mimelim]

Doing an SMA bypass is something any vascular surgeon will do, and certainly is something a general surgeon should be able to do as well. Esp in a rural area, it is not an advanced move to sew in an bypass.

On the other hand, very few vascular surgeons will tackle thoracoabdominal aneurysms outside of an academic center. Not so much for the technical challenge, but these patients are alot of work. Even the big boys like Safi et al have significant mortality/ morbidity.

I do agree that there are fewer open cases to go around though. It could get scary in a few years, but since i was lucky to catch the tail end of the open days, at least it will be job security. The cardiologists will always need someone to fix their perforations etc!!

My point was that the cases that require a GS specialist are infrequent. TAAA are localized to big academic centers, which tbh is a good thing given how few most people will do in their training.

I asked during my 0+5 interviews at places about not being a level 1 trauma center. My favorite response was:

"We have interventional cards here, we are never short on trauma."

 

[Dr.LeoSpaceman]

I can tell you that the staff here loves the 0+5 residents, and the residents like the program too.

On the other hand, I can see how it's hastening the movement of Vascular Surgery into the land of Plastics, Urology, etc.

And while the brevity of "Who needs trauma when we have interventional cards" is not lost on me, it's not at all accurate. Operating on a true trauma patient is different than operating in an emergent case. The altered physiology of the patient makes the decision making much different. Of course, one could argue that there isn't really a role for "vascular surgery" in a trauma OR since you shouldn't be doing a 4 hour bypass on a trauma patient. An isolated GSW or fracture with vessel injury, sure. But your multiple GSW/major blunt trauma patient needs damage control (including shunts if necessary) then delayed management by vacular surgery once they've been stabilized. Even the book answer for aortic transections is delayed (endovascular) management. The reasoning being that if the transection is bad enough to need emergent management, they're probably dead at the scene. If they make it to the trauma bay, they can be managed nonoperatively until their other injuries (which they would almost certainly have) are stabilized.

Finally, there may be enough open aortic work to go around for vascular residents, but the the people it's affecting are general surgery residents. Even some of my younger attendings were doing 40-50 open aortic cases in residency. I might do 15, most of which I'll be double scrubbed with a vascular fellow. Even recently, I was doing an open AAA, and the vascular attending wanted the fellow to open the belly, expose and close since "I'll be opening and closing many bellys". Ultimately, is this a problem? Who knows...just another opportunity to lament the continued decline of the "true" general surgeon.

 

[mimelim]

It was a joke... At the expense of interventional cards...

 

[Poetic Silence]

I don't get it. . .

 

[mimelim]

I don't get it. . .

Interventional cardiology has a bad rep for going into places they shouldn't and doing things that they likewise shouldn't. If they run into a complication, they require a surgeon to get them out of it. A lot of IABPs, valve issues, etc etc.

A good example today, but not about an interventional cardiologist: Patient had 5 18 gauge stab wounds to the lateral neck including puncture of the carotid artery and a retained wire in their iliacs spanning the bifurcation. All from trying to get central venous access in an ICU.

 

[europeman]

I'm only referring to the newly graduating 5 year vascular residents


European

 

[Poetic Silence]

Seems like their training leaves them short.

 

[greatsaphenousv]

Hi everybody,
I had a question to which I was hoping I could get more insight. I was born and raised in the US, and after 12th grade completing high school in the US, I went to University of Manchester medical school for the 6 year medical program. University of Manchester is ranked the 34th best medical school in the world, according to QS World University Rankings for medicine (http://www.topuniversities.com/unive...edicine?page=1). I got a USMLE Step 1 of 257, and a Step 2 CK of 253. I still need to take my Step 2 CS which I will next month. In addition between my 5th year and 6th year, I decided to take one year off and do vascular surgery research with my school department, and got 4 publications in it that year. I am now entering my final year, and am in the midst of applying to "integrated vascular surgery residency programs" as well as general surgery residency programs.

I wanted your opinions on my chances of matching at a integrated vascular surgery residency program. I will apply to each and every one, and I am ready to go anywhere. And what about General Surgery, and is there any general surgery programs I should look at in specific which have a good fellowship placement into Vascular Surgery. My home state of South Carolina, has no integrated vascular surgery residency programs. Thank you all.

 

[ESU_MD]

I love interventional cards. They put food on my table.

 

[filter07]

Open super fellowship. What a sad state of affairs.