I-6 Thoracic Surgery (non-cardiac) lifestyle

[SLM914]

im an MS-3 and up until this week I had pretty much no idea what I wanted to do. I had been toying with the idea of a residency in Medicine with ultimate fellowship in Cardiology or Pulmonology (both interventional) versus Thoracic surgery either integrated or through more traditional General Surgery means.

I absolutely loved my Thoracic surgery rotation but my biggest concern is the lifestyle as an attending. I would like to mostly or occasionally have weekends off. I would also like to be able to take my wife put on dates, and eventually when we have kids to be there for their games and performances and just be there.

However, those concerns were alleviated a bit when I spoke to a thoracic surgeon (non-cardiac), an anesthesiologist and an emergency medicine doctor who all told me that in their opinion, once residency training is complete, the work-life balance of an interventional cardiologist is not that much better than a thoracic surgeon.

So with all that said, I plan to start gearing up now to start doing some research in thoracic surgery, getting my name out there and coming up with an overall strategy. (I can always decide late in my MS3 year to change my mind and go back to aiming towards Internal Medicine or Gen Surgery).

My questions regarding my remaining time in medical school are:
1) what should my expectations be with 230 step1 score? Probably low enuogh to keep me from getting almost any interviews but i figure if I do 3 aways at various sites and come off well perhaps that won't mattter much?
2) how does one do meaningful research during rotations. I barely have time to study, how will I write a peer reviewed paper that will be published in time for my application in 9 months.
3) anything else I can do to give myself best leg up besides step2?

Questions about residency
1) what should my expectations be with starting a family. I'm a guy, but my wife and I planned to have 3 kids in the next 8 years. Do you know anyone that's been able to get through residency and manage starting a new family at the same time?
2) what are the best non cardiac track programs? I know BWH obviously has a one but are the rest simply mixed?

Questions regarding post-training:
1) when people talk about CT surgeons struggling are they talking about mostly the cardiac sides of things? If I want to do non-Cardiac will I be effected?
2) is work-life balance for a non cardiac thoracic surgeon better then a cardiac one? Is it bettter than interventional cardio/pulm in medicine like I've heard?

Other thoughts?

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[deleted547339]

im an MS-3 and up until this week I had pretty much no idea what I wanted to do. I had been toying with the idea of a residency in Medicine with ultimate fellowship in Cardiology or Pulmonology (both interventional) versus Thoracic surgery either integrated or through more traditional General Surgery means.

I absolutely loved my Thoracic surgery rotation but my biggest concern is the lifestyle as an attending. I would like to mostly or occasionally have weekends off. I would also like to be able to take my wife put on dates, and eventually when we have kids to be there for their games and performances and just be there.

However, those concerns were alleviated a bit when I spoke to a thoracic surgeon (non-cardiac), an anesthesiologist and an emergency medicine doctor who all told me that in their opinion, once residency training is complete, the work-life balance of an interventional cardiologist is not that much better than a thoracic surgeon.

So with all that said, I plan to start gearing up now to start doing some research in thoracic surgery, getting my name out there and coming up with an overall strategy. (I can always decide late in my MS3 year to change my mind and go back to aiming towards Internal Medicine or Gen Surgery).

My questions regarding my remaining time in medical school are:
1) what should my expectations be with 230 step1 score? Probably low enuogh to keep me from getting almost any interviews but i figure if I do 3 aways at various sites and come off well perhaps that won't mattter much?
2) how does one do meaningful research during rotations. I barely have time to study, how will I write a peer reviewed paper that will be published in time for my application in 9 months.
3) anything else I can do to give myself best leg up besides step2?

Questions about residency
1) what should my expectations be with starting a family. I'm a guy, but my wife and I planned to have 3 kids in the next 8 years. Do you know anyone that's been able to get through residency and manage starting a new family at the same time?
2) what are the best non cardiac track programs? I know BWH obviously has a one but are the rest simply mixed?

Questions regarding post-training:
1) when people talk about CT surgeons struggling are they talking about mostly the cardiac sides of things? If I want to do non-Cardiac will I be effected?
2) is work-life balance for a non cardiac thoracic surgeon better then a cardiac one? Is it bettter than interventional cardio/pulm in medicine like I've heard?

Other thoughts?

Interventional cards has a terrible lifestyle. As a general rule, the doctors that take care of the sickest patients have the worst lifestyles - some fields have tempered this by working shifts. IP can be pretty cush as there are no emergencies, but few places outside of major academic centers need full-time IP guys, and the ones that do are generally already full.

Can't speak to surgical training. I'm not a surgeon.

 

[AdmiralChz]

The first decision you need to make is medicine vs surgery, because you're going to be spend a long time doing either one before you get to your ultimate goal (and those are the skills you will fall back on). The interventional cards vs CT surgery mindset and overall work/training pathway is completely different.

 

[dienekes88]

im an MS-3 and up until this week I had pretty much no idea what I wanted to do. I had been toying with the idea of a residency in Medicine with ultimate fellowship in Cardiology or Pulmonology (both interventional) versus Thoracic surgery either integrated or through more traditional General Surgery means.

You need to think about what specifically drew you to interventional cards and interventional pulmonology as opposed to general cardiology/heart failure or pulm/ccm/ILD, etc.

I absolutely loved my Thoracic surgery rotation but my biggest concern is the lifestyle as an attending. I would like to mostly or occasionally have weekends off. I would also like to be able to take my wife put on dates, and eventually when we have kids to be there for their games and performances and just be there.

What did you love about thoracic surgery? There are always going to be sacrifices. That's life.

However, those concerns were alleviated a bit when I spoke to a thoracic surgeon (non-cardiac), an anesthesiologist and an emergency medicine doctor who all told me that in their opinion, once residency training is complete, the work-life balance of an interventional cardiologist is not that much better than a thoracic surgeon.

So with all that said, I plan to start gearing up now to start doing some research in thoracic surgery, getting my name out there and coming up with an overall strategy. (I can always decide late in my MS3 year to change my mind and go back to aiming towards Internal Medicine or Gen Surgery).

Interventional cardiology can have a tough lifestyle, though it depends in large part on regional referral patterns, practice size, and non-clinical workload.

My questions regarding my remaining time in medical school are:
1) what should my expectations be with 230 step1 score? Probably low enuogh to keep me from getting almost any interviews but i figure if I do 3 aways at various sites and come off well perhaps that won't mattter much?

You just have to be worried about being screened out. I've heard about this at some programs.

Doing 3 aways and coming off well liked will primarily mean that you'll get 3 interviews and have a better chance of matching at those programs. It's a very small field, and the residency is challenging. It's always better to go with a known-quantity.

2) how does one do meaningful research during rotations. I barely have time to study, how will I write a peer reviewed paper that will be published in time for my application in 9 months.

Best to probably try to jump on an existing project. Find folks at your institution doing research in cardiac and thoracic surgery and ask if you can help with literature reviews, abstracting data, etc.

This is all stuff that happens in the evening and on weekends. Unfortunately.

3) anything else I can do to give myself best leg up besides step2?

If you are an MS3, you can always do a research year between MS3 and MS4.

Questions about residency
1) what should my expectations be with starting a family. I'm a guy, but my wife and I planned to have 3 kids in the next 8 years. Do you know anyone that's been able to get through residency and manage starting a new family at the same time?

Yes. It's tough, and different people have varying degrees of success. The only thing I've learned from watching other people deal with this is the following: you can't have it all.

2) what are the best non cardiac track programs? I know BWH obviously has a one but are the rest simply mixed?

Questions regarding post-training:
1) when people talk about CT surgeons struggling are they talking about mostly the cardiac sides of things? If I want to do non-Cardiac will I be effected?
2) is work-life balance for a non cardiac thoracic surgeon better then a cardiac one? Is it bettter than interventional cardio/pulm in medicine like I've heard?

Other thoughts?

Cardiac is bouncing back. General thoracic job opportunities are considered to be quite good overall.

Generally speaking, thoracic jobs have a better lifestyle than cardiac, but it also depends on the practice. In thoracic, if you are director of the VV ECMO program, doing lung transplants, and only have one partner... suddenly your lifestyle is not so great.

I think you need to elucidate for yourself (or maybe for the boards) exactly why you want to do interventional cardiology, interventional pulmonology, and thoracic surgery... but not cardiac surgery, general surgery, or HPB, etc.

Good luck with your decision.

 

[idiot07]

Just finished fellowship last year.

Good advice above. I will say most of the integrated programs are geared toward those interested in cardiac. I know UPMC has an integrated thoracic track spot. I would suspect programs with strong gen thoracic training programs, i.e. Duke and UW would be good spots to apply to as well. I also think when it comes to general thoracic surgery, the traditional 5+2/3 training program has a lot of advantages. The skill set overlap between general thoracic surgery and general surgery is much larger than cardiac. I suspect you are going to develop better mis skills in a gen surgery program, and you're going to finish being more comfortable in the belly and being potentially a more versatile surgeon. You also have some more outs if you decide thoracic surgery isn't for you.

As for lifestyle, training in CT surgery is difficult no matter which pathway you take. You're going to make some sacrifices along the way. It's very possible to have a family during residency, but your wife is often going to have to function independently. Being in an area where she can have family help and the cost of living isnt extravagant can help this. As stated above general thoracic lifestyle is pretty good. The main operative emergency is a perf'd goose which are relatively rare. Residents and er Dr's can do chest tubes. As previously mentioned the main variables are ecmo and transplant, but most thoracic surgery jobs won't have these. That being said general thoracic patient population is pretty sick and it's not uncommon to get a lot calls at night. Also, it's still a bit of a niche role, so sometimes it's hard to find a job in a given geographical area even if the overall jobs prospects are good. I think the cardiac surgery job outlook is excellent.

I thought about doing IP for a while as well. I would be wary of this unless you want to practice pulmonology/critical care and just want to do more procedures on the side. While I have loved all the IP guys I have worked with and value their contributions to patient care, you end up being limited to mainly diagnostic procedures and chest tubes. As an adjunct to icu care or a pulm clinic, I think this would be pretty cool, as a stand alone career, I'm not so sure. The training length is not much different. Also, as has been said it's hard to find a pure IP job, the procedures don't bill well, and a lot of time you have to cover the ICU as well to make up your salary.

 

[SLM914]

Just finished fellowship last year.

Good advice above. I will say most of the integrated programs are geared toward those interested in cardiac. I know UPMC has an integrated thoracic track spot. I would suspect programs with strong gen thoracic training programs, i.e. Duke and UW would be good spots to apply to as well. I also think when it comes to general thoracic surgery, the traditional 5+2/3 training program has a lot of advantages. The skill set overlap between general thoracic surgery and general surgery is much larger than cardiac. I suspect you are going to develop better mis skills in a gen surgery program, and you're going to finish being more comfortable in the belly and being potentially a more versatile surgeon. You also have some more outs if you decide thoracic surgery isn't for you.

As for lifestyle, training in CT surgery is difficult no matter which pathway you take. You're going to make some sacrifices along the way. It's very possible to have a family during residency, but your wife is often going to have to function independently. Being in an area where she can have family help and the cost of living isnt extravagant can help this. As stated above general thoracic lifestyle is pretty good. The main operative emergency is a perf'd goose which are relatively rare. Residents and er Dr's can do chest tubes. As previously mentioned the main variables are ecmo and transplant, but most thoracic surgery jobs won't have these. That being said general thoracic patient population is pretty sick and it's not uncommon to get a lot calls at night. Also, it's still a bit of a niche role, so sometimes it's hard to find a job in a given geographical area even if the overall jobs prospects are good. I think the cardiac surgery job outlook is excellent.

I thought about doing IP for a while as well. I would be wary of this unless you want to practice pulmonology/critical care and just want to do more procedures on the side. While I have loved all the IP guys I have worked with and value their contributions to patient care, you end up being limited to mainly diagnostic procedures and chest tubes. As an adjunct to icu care or a pulm clinic, I think this would be pretty cool, as a stand alone career, I'm not so sure. The training length is not much different. Also, as has been said it's hard to find a pure IP job, the procedures don't bill well, and a lot of time you have to cover the ICU as well to make up your salary.

Thank you both! This is incredibly helpful information as I move forward with some decisions.

Do you know of other programs besides UPMC, Duke, UW that have particularly strong gen thoracic programs? I did some browsing and it seems BWH also has a dedicated thoracic track but I haven't been able to identify any other programs that specifically highlight gen thoracic training....

 

[themockjock]

Do you know of other programs besides UPMC, Duke, UW that have particularly strong gen thoracic programs? I did some browsing and it seems BWH also has a dedicated thoracic track but I haven't been able to identify any other programs that specifically highlight gen thoracic training....

Those are the big ones among the I6 programs at least. I want to echo the posters above and say that I really think that if you are serious about doing general thoracic, you should strongly consider general surgery followed by thoracic fellowship. Even though they operate in the same neighborhood, cardiac and thoracic are pretty different beasts. Having a strong backing in minimally invasive surgery that you can only get from a full general surgery residency will really help you in thoracic - aside from traditional VATS stuff, minimally invasive esophagectomies, lap hellers, nissens, EGDs, etc. are all done by our thoracic staff.

And as an I6 resident, I'm not ashamed to admit that my lap skills are pretty mediocre. We just don't have a ton of time on general surgery and when I'm doing GS, I'm trying to get open cases that are more relevant to me. This is true of most of the residents in my program - all but one of us want to do cardiac and the outside rotations (CCU, cath lab, echo, cards floors, etc) are set up to that end.

In fact, it's to the point that my program, after having closed its traditional fellowship a couple years ago, is in the process of bringing back a thoracic only fellowship within the next couple years...

 

[ncrassa]

I interviewed for I6 last year with a heavy interest in general thoracic; I'm now a general surgery intern at a program with a strong CT department offering I6, 4+3, and the traditional fellowship.

I honestly thought the bulk of I6 programs were very cardiac oriented, and many programs did not feel they could realistically tailor their I6 rotations to someone interested in thoracic. Most senior thoracic faculty also felt the general surgery training is absolutely pivotal for thoracic surgery (foregut, MIS). There are exactly three I6 programs in the country where a budding thoracic surgeon might flourish: Pittsburgh (well rounded), Duke (well rounded), and the Brigham (less lung transplant). I would recommend doing general surgery in a program with a 4+3 option and a strong thoracic faculty (WashU and Duke were popular destinations last year; BWH would also be a good option).

Feel free to message me with more questions. Good luck.

 

[SLM914]

I interviewed for I6 last year with a heavy interest in general thoracic; I'm now a general surgery intern at a program with a strong CT department offering I6, 4+3, and the traditional fellowship.

I honestly thought the bulk of I6 programs were very cardiac oriented, and many programs did not feel they could realistically tailor their I6 rotations to someone interested in thoracic. Most senior thoracic faculty also felt the general surgery training is absolutely pivotal for thoracic surgery (foregut, MIS). There are exactly three I6 programs in the country where a budding thoracic surgeon might flourish: Pittsburgh (well rounded), Duke (well rounded), and the Brigham (less lung transplant). I would recommend doing general surgery in a program with a 4+3 option and a strong thoracic faculty (WashU and Duke were popular destinations last year; BWH would also be a good option).

Feel free to message me with more questions. Good luck.

Thanks. This has all been very helpful. I have been told that many of the 4+3 programs actually require 2 years of research so they are more like 9 years. Is that generally the case?

 

[SLM914]

I'm getting a bit ahead of myself here but for programs that require residents do research (either 4/3 programs or GS programs), does the research have to be done at the institution you are doing residency at? Can it be done in another country entirely?