How many of your residents changed mind on fellowship?

[addy]

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Going into MS3.

As of right now, when I envision my career, I can only really see myself doing peds CT + VAD fellowship (unless peds VAD is just a pipe dream...whch it's definitely not) or neurosurgery w a functional neurosurgery/DBS fellowship...or rural gen surg in the middle of of nowhere.

With the exception of the last choice, that's ~10 years of training AFTER medical school.

I guess my question is, how many of your residents/co-residents/colleagues banked on doing fellowships coming into residency but ended up ditching them because the road was too long or their life's circumstances changed?

 

[swoopyswoop]

if you could ONLY be happy doing one specific branch of surgery and would be miserable doing gen surg, dont go into gen surg.

 

[Winged Scapula]

Going into MS3.

As of right now, when I envision my career, I can only really see myself doing peds CT + VAD fellowship (unless peds VAD is just a pipe dream...whch it's definitely not) or neurosurgery w a functional neurosurgery/DBS fellowship...or rural gen surg in the middle of of nowhere.

With the exception of the last choice, that's ~10 years of training AFTER medical school.

I guess my question is, how many of your residents/co-residents/colleagues banked on doing fellowships coming into residency but ended up ditching them because the road was too long or their life's circumstances changed?

Only one that I can recall.

What was more common was switching interests during residency and changing the choice of fellowship.

 

[cpants]

Going into MS3.

As of right now, when I envision my career, I can only really see myself doing peds CT + VAD fellowship (unless peds VAD is just a pipe dream...whch it's definitely not) or neurosurgery w a functional neurosurgery/DBS fellowship...or rural gen surg in the middle of of nowhere.

With the exception of the last choice, that's ~10 years of training AFTER medical school.

I guess my question is, how many of your residents/co-residents/colleagues banked on doing fellowships coming into residency but ended up ditching them because the road was too long or their life's circumstances changed?

I'm not sure how you narrowed down the only things you can see yourself being happy with to 3 completely unrelated specialty/subspecialties. Please elaborate.

 

[TraumaLlamaMD]

I'm not sure how you narrowed down the only things you can see yourself being happy with to 3 completely unrelated specialty/subspecialties. Please elaborate.

Before starting clerkships, to boot! However made up your mind is now, know that it may well change as you actually begin to experience these careers.

 

[addy]

I'm not sure how you narrowed down the only things you can see yourself being happy with to 3 completely unrelated specialty/subspecialties. Please elaborate.

Before starting clerkships, to boot! However made up your mind is now, know that it may well change as you actually begin to experience these careers.

You're both right. Let's rephrase the question--what if, after MS3, you're interested in things that have a long road attached? How many of those people actually follow through with those plans vs giving up due to length of training?

 

[ACSurgeon]

You're both right. Let's rephrase the question--what if, after MS3, you're interested in things that have a long road attached? How many of those people actually follow through with those plans vs giving up due to length of training?

52.6%

 

[Winged Scapula]

You're both right. Let's rephrase the question--what if, after MS3, you're interested in things that have a long road attached? How many of those people actually follow through with those plans vs giving up due to length of training?

Are you looking for data or anecdotes? I'm not sure there is much available for the first.

Who cares how many people change their mind? Whats's important is what you want to do. There are some people who really want to do a specialty that takes 10 years to complete but end up doing something else because of family/other concerns. There are others who see it through and regret it. Many others complete their training and they're glad they did.

Are you asking us if YOU should embark on a long road of post medical school training?

 

[addy]

Are you looking for data or anecdotes? I'm not sure there is much available for the first.

Who cares how many people change their mind? Whats's important is what you want to do. There are some people who really want to do a specialty that takes 10 years to complete but end up doing something else because of family/other concerns. There are others who see it through and regret it. Many others complete their training and they're glad they did.

Are you asking us if YOU should embark on a long road of post medical school training?

I'm asking, anecdotally, how other people with such high aspirations (for the lack of better word) fare through the training process-- be it family, financial concern, etc. I have no reason to believe I will be any different than the others, even if I want to be. So, if you guys were to say "most people in my class were dead set on a long path but ended up going something shorter bc of length of training" then I know I'm being naieve and should expect/mentally prepare myself that peds CT may not happen and I should be even more open-minded than I would have been otherwise. I guess I'm also just trying to figure out what it's like out there--how many of the people who are actually double fellowship, or in the case of Dr. Spinner and Kendal Lee at Mayo, double residency are unique people or if a lot of people want do do stuff like this but life just doesn't allow it.

I wasn't expecting my question to be so confusing, my bad. I rescind my inquiry, I think I got my answer. thanks.

 

[Winged Scapula]

I'm asking, anecdotally, how other people with such high aspirations (for the lack of better word) fare through the training process-- be it family, financial concern, etc. I have no reason to believe I will be any different than the others, even if I want to be. So, if you guys were to say "most people in my class were dead set on a long path but ended up going something shorter bc of length of training" then I know I'm being naieve and should expect/mentally prepare myself that peds CT may not happen and I should be even more open-minded than I would have been otherwise. I guess I'm also just trying to figure out what it's like out there--how many of the people who are actually double fellowship, or in the case of Dr. Spinner and Kendal Lee at Mayo, double residency are unique people or if a lot of people want do do stuff like this but life just doesn't allow it.

I wasn't expecting my question to be so confusing, my bad. I rescind my inquiry, I think I got my answer. thanks.

I would venture most people simply aren't interested in that sort of practice and/or spending the years doing the training. Fellowship training is common (over 75% in academic programs) but you are talking about superstars; most of us are bush league/common ranks.
It goes something like this:

1) Percent of pre meds who say they're going to medical school and become a super-surgical specialist and actually do it: very very low
2) Percent of pre-clinical medical students who say they're going to become a super-surgical specialist and actually do it: very low
3) Percent of senior medical students who say they're going to become a super-surgical specialist and actually do it: low to moderate
4) Percent of surgical residents who say they're going to become a super-surgical specialist and actually do it: moderate to slightly high

Double fellowship trained surgeons are the exception rather than the rule. Most people simply either don't have the interest, the time or find that they (like me) just want to start working. After all, when you super specialize you run the risk of being relatively unemployable or only finding your services needed in a few select markets/environments. I mean how many people do you really need to have with an MD/PhD designing biomedical devices to reduce/treat abnormal electrophysiologic impulses?

So its not that your question was confusing per se, its just that we wanted to know why you were interested because that would help us answer the question better and for you to realize that most programs aren't collecting this data and making it publicly available, thus all we have is a, "I know a coupla guys" type answer.

 

[addy]

That was great, thank you!

Keep on keeping on.

 

[dienekes88]

Going into MS3.

As of right now, when I envision my career, I can only really see myself doing peds CT + VAD fellowship (unless peds VAD is just a pipe dream...whch it's definitely not) or neurosurgery w a functional neurosurgery/DBS fellowship...or rural gen surg in the middle of of nowhere.

With the exception of the last choice, that's ~10 years of training AFTER medical school.

I guess my question is, how many of your residents/co-residents/colleagues banked on doing fellowships coming into residency but ended up ditching them because the road was too long or their life's circumstances changed?

Congenital and a VAD fellowship? Interesting combination. Most people who go into congenital do it for the complex reconstructions and not to put in devices. Having said that, one of the slickest surgeons I know did exactly that. If you want to do cardiac surgery, consider doing an integrated program 6-8 years (depending on whether 2 years of research is involved) + fellowship (congenital or VAD/Tx). Just realize that there are not many congenital jobs out there.

I don't know if you really want a long training program to be some kind of super-specialized guy or if you like devices... even in the world of neurosurgery, it was my understanding that cerebrovascular is the technically challenging stuff, e.g. open aneurysm clipping and EC-IC bypass, but I'm not really involved in that world.

 

[addy]

Congenital and a VAD fellowship? Interesting combination. Most people who go into congenital do it for the complex reconstructions and not to put in devices. Having said that, one of the slickest surgeons I know did exactly that. If you want to do cardiac surgery, consider doing an integrated program 6-8 years (depending on whether 2 years of research is involved) + fellowship (congenital or VAD/Tx). Just realize that there are not many congenital jobs out there.

I don't know if you really want a long training program to be some kind of super-specialized guy or if you like devices... even in the world of neurosurgery, it was my understanding that cerebrovascular is the technically challenging stuff, e.g. open aneurysm clipping and EC-IC bypass, but I'm not really involved in that world.

Well, my thinking is that pediatric VADs are going to be a thing in the next few years. Sure, not high enough volume, but they're going to be happening and I'd love to be a part of that in either a device development or consulting role. I know a double fellowship might not be the best way to meet that goal, but I also just really want to do a peds fellowship in whatever it is I do for reasons too personal to explain on here.

Is there any specific reason why you mention an integrated program? My mentor at one of the big cardiac centers said he would rather see me do a Fast Track or the normal 5+3 way...

 

[ThoracicGuy]

Well, my thinking is that pediatric VADs are going to be a thing in the next few years. Sure, not high enough volume, but they're going to be happening and I'd love to be a part of that in either a device development or consulting role. I know a double fellowship might not be the best way to meet that goal, but I also just really want to do a peds fellowship in whatever it is I do for reasons too personal to explain on here.

Is there any specific reason why you mention an integrated program? My mentor at one of the big cardiac centers said he would rather see me do a Fast Track or the normal 5+3 way...

The traditional pathway is becoming scarcer these days as more programs switch to the I6 model. Yes, there will continue to be some traditional programs, but they will be more competitive as time goes on. If you are strongly interested in CT surgery, applying to I6 programs would make sense.

Now as far as the time it takes, that's really up to each person. I've had students tell me that they'd love to go into surgery, but its 5 years long! I ask what they'd like to do otherwise so they often mention something like GI or cardiology. Well, for those you spend 3 years in IM and then 3 years in fellowship. That's 6 years right there, already a year more than general surgery. So what if it takes a year or two more than some of your peers. In the end, if you get trained to do what you are passionate about, it will be worth it.

As an aside, I do know at least one person who did General Surgery -> CT surgery -> Transplant/VAD fellowship -> Congenital fellowship. If you did that track all the way through without any research or gap years and with a 2 year CT surgery program, that would get you to 9 years of training. You could also be triple boarded at that point - general surgery, thoracic surgery, and congenital thoracic surgery.

 

[addy]

The traditional pathway is becoming scarcer these days as more programs switch to the I6 model. Yes, there will continue to be some traditional programs, but they will be more competitive as time goes on. If you are strongly interested in CT surgery, applying to I6 programs would make sense.

Now as far as the time it takes, that's really up to each person. I've had students tell me that they'd love to go into surgery, but its 5 years long! I ask what they'd like to do otherwise so they often mention something like GI or cardiology. Well, for those you spend 3 years in IM and then 3 years in fellowship. That's 6 years right there, already a year more than general surgery. So what if it takes a year or two more than some of your peers. In the end, if you get trained to do what you are passionate about, it will be worth it.

As an aside, I do know at least one person who did General Surgery -> CT surgery -> Transplant/VAD fellowship -> Congenital fellowship. If you did that track all the way through without any research or gap years and with a 2 year CT surgery program, that would get you to 9 years of training. You could also be triple boarded at that point - general surgery, thoracic surgery, and congenital thoracic surgery.

Thanks for the great response, I really appreciate you taking time out of your day to do so.

My question now would be...

Would you even want to be boarded for GS, Thoracic and Congenital?

I guess my question is rooted in ignorance-- if someone is boarded for both CT and GS, does that mean they could feasibly have a practice (non academic, I assume) where they're doing both GS procedures and cardiac procedures on a daily basis??


Also, would you mind PM'ing me the name of this person? I'd be interested in looking them up. If you're not comfortable doing that, can you shed light on what kind of a practice he has going? Is he/she doing VADs and Peds CT and nominal "other" CT procedures?

Thanks so much!

 

[ThoracicGuy]

Thanks for the great response, I really appreciate you taking time out of your day to do so.

My question now would be...

Would you even want to be boarded for GS, Thoracic and Congenital?

I guess my question is rooted in ignorance-- if someone is boarded for both CT and GS, does that mean they could feasibly have a practice (non academic, I assume) where they're doing both GS procedures and cardiac procedures on a daily basis??


Also, would you mind PM'ing me the name of this person? I'd be interested in looking them up. If you're not comfortable doing that, can you shed light on what kind of a practice he has going? Is he/she doing VADs and Peds CT and nominal "other" CT procedures?

Thanks so much!

Typically people that do cardiac surgery will do cardiac and maybe some general thoracic. People that do general thoracic may do some general surgery depending on the job. Those doing congenital often only do congenital, but you have to have thoracic boards to get congenital boards. There are some congenital surgeons that will also work on adults depending on the location and politics of their practice.

As for the person I mentioned, he is still doing training. He's interested in potentially pediatric VADs and transplants, hence his multiple fellowships.

In my experience in training, attendings that I had that were VAD/transplant trained would usually do regular adult cardiac as well.

 

[dienekes88]

Well, my thinking is that pediatric VADs are going to be a thing in the next few years. Sure, not high enough volume, but they're going to be happening and I'd love to be a part of that in either a device development or consulting role. I know a double fellowship might not be the best way to meet that goal, but I also just really want to do a peds fellowship in whatever it is I do for reasons too personal to explain on here.

Is there any specific reason why you mention an integrated program? My mentor at one of the big cardiac centers said he would rather see me do a Fast Track or the normal 5+3 way...

Not sure what the benefit of doing a Fast-Track (4+3) or a Traditional 5 + 2 or 3 is other than that it is something with which your mentor is more familiar. However, your mentor probably went through general surgery when it was still mostly open surgery. So much of general surgery is laparoscopic now, and even a lot of the open stuff is done with staplers. When I was an intern and junior resident, I used to LOVE doing inguinal hernias and cimino-brescias, because they were the only cases in which you actually got to sew. I'm not sure what the added value of doing a ton of laparoscopy would be for a heart surgeon. I would venture to say that there is even very little carryover to port access mitral valves.

On the other hand, if you think you're going to do general thoracic (and it doesn't look that way from your post), then there is a lot of value, because general thoracic guys do a ton of VATS. Additionally, mobilizing the stomach for conduit in an esophagectomy, heller myotomies, abdominal approach to some diaphragmatic hernias, etc. means that you should be pretty familiar with the abdomen and laparoscopy. I would venture a guess that 4+3 or 5+2 (general thoracic track fellowship) would be the optimal way to pursue general thoracic surgery.

Thanks for the great response, I really appreciate you taking time out of your day to do so.

My question now would be...

Would you even want to be boarded for GS, Thoracic and Congenital?

I guess my question is rooted in ignorance-- if someone is boarded for both CT and GS, does that mean they could feasibly have a practice (non academic, I assume) where they're doing both GS procedures and cardiac procedures on a daily basis??


Also, would you mind PM'ing me the name of this person? I'd be interested in looking them up. If you're not comfortable doing that, can you shed light on what kind of a practice he has going? Is he/she doing VADs and Peds CT and nominal "other" CT procedures?

Thanks so much!

Very unlikely for a cardiac surgeon to be doing general surgery cases or taking general surgery call. There is some overlap when it comes to general thoracic and general surgery, e.g. foregut surgery.

You don't have too much experience around the hospital, so I recommend taking some time to learn more about the fields of general surgery, adult cardiac surgery, general thoracic surgery, heart transplant/VAD, and congenital heart surgery prior to making the fairly bold claim that the only thing you want to do is VADs in children. Heck, you may even want to put in a few VADs or put an adult on ECMO before you decide that you want to do the pediatric version. Keep an open mind.

Typically people that do cardiac surgery will do cardiac and maybe some general thoracic. People that do general thoracic may do some general surgery depending on the job. Those doing congenital often only do congenital, but you have to have thoracic boards to get congenital boards. There are some congenital surgeons that will also work on adults depending on the location and politics of their practice.

As for the person I mentioned, he is still doing training. He's interested in potentially pediatric VADs and transplants, hence his multiple fellowships.

In my experience in training, attendings that I had that were VAD/transplant trained would usually do regular adult cardiac as well.

Agree. It's not easy to have a 100% VAD/Transplant practice unless you're in a very high volume place or already have an endowed professorship.

 

[DoctwoB]

How anyone can ever put up with the kind of abuse that being a CT super-fellow entails with the knowledge that they are already a fully trained and employable general and/or CT surgeon baffles me. Some fellowships seem to entail a much improved lifestyle from residency, CT is not one of them. Much respect to those who stick through it.

 

[cpants]

Well, my thinking is that pediatric VADs are going to be a thing in the next few years. Sure, not high enough volume, but they're going to be happening and I'd love to be a part of that in either a device development or consulting role. I know a double fellowship might not be the best way to meet that goal, but I also just really want to do a peds fellowship in whatever it is I do for reasons too personal to explain on here.

Is there any specific reason why you mention an integrated program? My mentor at one of the big cardiac centers said he would rather see me do a Fast Track or the normal 5+3 way...

You have to decide what your goals are and then try to achieve them. For most people pursuing multiple fellowships is a waste of time and certainly a huge financial mistake. They will end up focusing on one more than the other based on economic realities. Think about it...after doing one fellowship after say CT surgery you are already a subspecialized subspecialist. Do you really think there is a lot of need or demand for you to have a dual subsubspecialty? The answer is that there isn't, and you probably won't make more money doing it. It's easy to be starry-eyed as an MS3, but you will become more of a realist each year. Believe me 300k in loans capitalizing yearly starts to get pretty real when you are in year 7 of postgrad training and deciding whether to add on another 2 years. Eventually, most people will want to start a family, stop living in a tiny cheap apartment, etc.

The decision to do any fellowship (let alone 2 fellowships) is an economic one and should be treated that way. You are making an investment of both time and large amounts of money (hundreds of thousands in lost wages and additional debt per year) for each year you extend your training, and most people don't think this way. The reasons to extend training are: because you need additional education to be able to compete for jobs in a certain market (ie. a high power academic job or NYC), you are not adequately trained in residency to do certain procedures that you very much want to do during your career, or maybe because you want to improve lifestyle career-long (ie. reproductive endo from ob/gyn). Facing this choice at the end of an already extensive training, many people choose to enter practice. Sure, you may not be able to do x procedure, but is it really worth say $500,o00 to gain that skill? If you will be making a similar salary either way? These aren't easy choices.

The reason for your interest seems to coincide with wanting to get involved with device design. This is certainly a valid and lofty goal, but you might consider that additional fellowships might not be the best way to achieve this. Most fellowship time is spent learning to do highly technical operations. In other words, after 2 fellowships, you will still have no idea how to design a VAD. Your goals might be better met pursuing a masters in engineering in addition to a single fellowship or some other hybrid pathway.

Finally, while it is good to have big goals, I would encourage you to enter clerkships with an open mind. I would guess that most medical students end up changing interests during the clinical years. Your personal passion for congenital cardiac physiology may be better incorporated into a career as a neonatologist or pediatric cardiologist than a congenital CT guy. See what happens.