integrated vascular surgery residency

[jcarterw5515]

Does anyone know if any new integrated programs are going to be starting in the next couple of years or if any midlevel positions will be opening up in the next two years?

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[Castro Viejo]

Most certainly there will be more integrated Vascular Surgery residencies opening in the next few years. The Society for Vascular Surgery is quite interested in expanding the number of training opportunities both at the medical student level (through the integrated programs) and the resident level (through the establishment of new fellowships and expanding exisiting fellowship slots).

This, at least, is the impression most Vascular types are under. If it's any comfort, I know that a few of the Chicago area Vascular Surgery faculties are exploring the idea of starting up integrated residencies.

As for opening up mid level positions, I doubt that that will happen anytime soon since there are already quite a few concerns about how to handle the education of the junior Vascular Surgery residents and, if midlevel positions were to open up, more than a few programs will be accused of poaching residents from the associated General Surgery program. I doubt the American Board of Surgery, which for all intents and purposes, controls Vascular Surgery as a profession, would like that very much.

These are all just my opinions, of course, so take them for what they're worth. I'd probably give the Vascular Surgery Board a call regarding your questions for the official answer.

Good luck.

 

[beaverfetus]

I have a question which I also posted on mentor forum, feel free to respond to that one if you see it first, I'm just not sure how sluggish those forums are in terms of moderation...


so here is an essential repost from the mentor forum, forgive my impatience.

do you think graduates of integrated vascular residencies (the 5 year variety
) would be considered for ct programs? It seems like the overlap would make vascular surgeons ideal candidates, but you never know, and I'm sure the issue hasn't come up yet, because of the relative newness of vascular residencies.

I ask because I'm interested in training in both eventually. My fantasy training:

vascular 5 years, research years, ct training. job.

 

[Winged Scapula]

do you think graduates of integrated vascular residencies (the 5 year variety
) would be considered for ct programs? It seems like the overlap would make vascular surgeons ideal candidates, but you never know, and I'm sure the issue hasn't come up yet, because of the relative newness of vascular residencies.

Not currently, as you have to be General Surgery Board Eligible for most CTS fellowships.

However, as these new training schemes crop up, I imagine that there will be have to be alternate pathways (ie, you can't require people to be GS BE/BC if most of the training programs don't produce that).

Besides the above, I would wonder what advantage doing both CT and Vascular would offer you unless you are also interested in doing abdominal and peripheral work. We are entering an age of increasing specialization, not decreasing. I'd be interested in hearing from others if they think combining these fields will result in a realistic potential for practice and how that would be marketed. Would you be doing enough of each of the field's core procedures or spreading oneself too thin?

 

[beaverfetus]

thanks for the response. I hope common sense prevails and this is possible in the next 7-10ish years before I would be applying to ct programs.

 

[-Goose-]

Besides the above, I would wonder what advantage doing both CT and Vascular would offer you unless you are also interested in doing abdominal and peripheral work.

Just a m3's perspective here, but I spoke with a private practice CT surgeon who did both vascular and CT fellowships and he said it made it very easy to get a great job (excellent group, desirable city) immediately after fellowship vs. spending 2-3 years searching for a job or in an undesirable position.

 

[Castro Viejo]

Not currently, as you have to be General Surgery Board Eligible for most CTS fellowships.

However, as these new training schemes crop up, I imagine that there will be have to be alternate pathways (ie, you can't require people to be GS BE/BC if most of the training programs don't produce that).

Besides the above, I would wonder what advantage doing both CT and Vascular would offer you unless you are also interested in doing abdominal and peripheral work. We are entering an age of increasing specialization, not decreasing. I'd be interested in hearing from others if they think combining these fields will result in a realistic potential for practice and how that would be marketed. Would you be doing enough of each of the field's core procedures or spreading oneself too thin?

If the current jobs availabe are any indication, then I would think having formal training in both could potentially make you quite marketable.

There seem to be quite a few cardiovascular surgery groups who are aching to hire a peripheral vascular surgeon with endovascular training today, and I would think that one trained in PV and CV surgery would be highly desirable. But of course this probably would be quite closely tied into just how busy today's cardiac surgeon is. I mean, quite frankly, if cardiac operations are falling by the wayside and most CV surgeons are primarily playing around in the periphery in areas where a PV surgeon doesn't exist (there are only about 3,000 PV surgeons in the country), then what's the point of having CV training at all?

Sure, coronary stents may not be the panacea they once were, but I doubt that would stop many cardiologists from stenting them anyway. I mean, it sure as hell hasn't stopped them from stenting distal LE vessels and stenting the renals based on "angiographic criteria." So I personally don't think work for CV surgeons will pick up. I think plenty of them are heading into the community practicing PV surgery.

Does it spread oneself to thin? Probably. I don't know that any CV/PV surgeon would be able to procure enough hearts, aortas, and infrainguinal reconstructions to be particularly useful in an era of total outcomes based approach to surgery.

 

[mitchconnie]

Does it spread oneself to thin? Probably. I don't know that any CV/PV surgeon would be able to procure enough hearts, aortas, and infrainguinal reconstructions to be particularly useful in an era of total outcomes based approach to surgery.

I wholeheartedly agree. Cardiac surgery is already heavily scrutinized for outcomes in many markets, and I don't think it's a viable position to a be a low-volume cardiac surgeon.

Combined CT/PV practices are a relic from 15-20 years ago when there was often a lot of PV work done in CT training programs and endovascular treatments were for radiologists. Now these older CT guys continue to do open PV cases because the CABG volume has dropped and they need something else to do. So some CT groups want a PV guy with endovascular skills to build up that end of the practice, which is high-growth. Virtually no one is clamoring for more CT surgeons, because the case volume is not there anymore.

So sure, doing both CT and PV fellowships would make you more marketable than just doing CT, but it's the PV skills that are important (and specifically the endovascular component). You'd be just as marketable if you did the PV training alone.

 

[fmg]

Hello All,
I am applying for vascular surgery after finishing a g-surg residency. Any programs that you would recommend? any programs you will consider are not very good? Endo vs open based programs?. I'd Appreciate your input.
Thank you

 

[ESU_MD]

never really heard of someone doing vascular THEN ct.

usually by the time you are done vascular you are tired of being a resident and you have good jobs prospects

by the time you are done CT.. you are tired of being a resident and have NO job prospects, thus you do a vascular fellowship to feed your family.

vascular after CT would mainly be to learn the endvascular techniques. as you know- some CT surgeons like to be known as "cardioVASCULAR surgeons", and only do hearts and other vascular work.

the purists of the field consider lung/esophagus to be garbage cases for the general surgeons. (probably the same attitudes that lead to the demise of the field)

In my CV program we do ALOT of old school open vascular work. Any given day case load has open AAA, carotid, fem-pop, mesenteric revasc, in addition to CABG or valve!! too bad I wont be able to get board-certified in vascular too!

 

[james2333]

Wanted to bump this thread...

How difficult are these integrated vascular surgery programs to get into? Its been a few years since its inception, I was wondering if there are any students on here that can give feedback based on personal experiences.

I took a lot at Pittsburgh's statistics and saw that the average USMLE step 1 score for applicants in 2012 was about 236 with 8 > 245.

In general, what are these programs looking for? Is research very important?

I'm a DO student and I just finished up my general surgery rotation and got to scrub in on some vascular surgeries as well. I'm also interested a possible interventional residency such as cardiology or radiology that uses imaging intervention as well.

my USMLE step 1 is >245 and I am within the top 10% of my class and I've honored in all my rotations so far including surgery, but I also know how difficult it is to break into surgery as a DO.

If anyone can provide feedback to enhance my application that would be great or if there are any integrated vascular residents out there that would like to share their experiences in residency so far that would be helpful as well.

 

[DoctwoB]

Wanted to bump this thread...

How difficult are these integrated vascular surgery programs to get into? Its been a few years since its inception, I was wondering if there are any students on here that can give feedback based on personal experiences.

I took a lot at Pittsburgh's statistics and saw that the average USMLE step 1 score for applicants in 2012 was about 236 with 8 > 245.

In general, what are these programs looking for? Is research very important?

I'm a DO student and I just finished up my general surgery rotation and got to scrub in on some vascular surgeries as well. I'm also interested a possible interventional residency such as cardiology or radiology that uses imaging intervention as well.

my USMLE step 1 is >245 and I am within the top 10% of my class and I've honored in all my rotations so far including surgery, but I also know how difficult it is to break into surgery as a DO.

If anyone can provide feedback to enhance my application that would be great or if there are any integrated vascular residents out there that would like to share their experiences in residency so far that would be helpful as well.

As is the case with most competitive residencies, they are looking for the whole package. Step1, grades, research, work ethic, and personality. Being a DO may hurt your application, though it likely depends on each individual PD or chairman and how they view DO's. Doing an away rotation may help your chances if there's one program in particular you're interested in.

 

[mimelim]

Wanted to bump this thread...

How difficult are these integrated vascular surgery programs to get into? Its been a few years since its inception, I was wondering if there are any students on here that can give feedback based on personal experiences.

I took a lot at Pittsburgh's statistics and saw that the average USMLE step 1 score for applicants in 2012 was about 236 with 8 > 245.

In general, what are these programs looking for? Is research very important?

I'm a DO student and I just finished up my general surgery rotation and got to scrub in on some vascular surgeries as well. I'm also interested a possible interventional residency such as cardiology or radiology that uses imaging intervention as well.

my USMLE step 1 is >245 and I am within the top 10% of my class and I've honored in all my rotations so far including surgery, but I also know how difficult it is to break into surgery as a DO.

If anyone can provide feedback to enhance my application that would be great or if there are any integrated vascular residents out there that would like to share their experiences in residency so far that would be helpful as well.

You can expect a lukewarm response to your application coming from a DO school, regardless of your other statistics. Research importance depends on the program, but since most of them are at research heavy institutions, it is highly recommended. I know two students last year who had 250+ Step 1 applications who didn't match Vascular. The reality is that like every competitive field, scores matter, but since there are so few spots, programs can pick and choose the most interesting/best fit people for their program.

As an aside, while it is tempting to compare IR/IC to VS, they really aren't all that similar. Yes, they all do endovascular procedures, but that is the only overlap. How they think, how their days are setup, how their departments are setup are very different. The stereotypes that you have heard comparing medicine to surgery to radiology are based on truths and it is no different in this field. To save myself some time I'm going to C&P a PM I sent to someone else a week ago or so.

Integrated Vascular Surgery (IVS) is on the rise nationwide. Last year there were 36 programs, 41 intern spots. By my best guess there will be about 48-50 spots this year. It is a new model and there are about 30 programs that have been approved but do not have funding setup yet. With the limited slots, it is as competitive as ENT/Plastics, likely a shade less competitive as Derm. That having been said, you don't have to have 250+ steps and tons of research to match. I know ~25 of the 41 who matched last year. They were all good students and hard workers, but programs are looking for commitment and trainability, not just raw skills. I know that UCSF is opening an IVS program this year, I don't know of any others that are likely to open, but certainly in the next 2-3 years the number of slots will likely close to double nationwide. Also, keep in mind residency is a little different than medical school. Just because a program is attached to a big name undergrad doesn't mean it is a powerhouse vascular program.

Patient volume is on the rise in virtually every locale. Cards and IR are not surgeons. There are individual institutions with heavy Cards/IR presence, but no market is closed off to VS. While it will likely change, last year there were 6 available VS jobs per graduating fellow, more than any other specialty that I could find data on. The reality is that CV disease is everywhere. CAD, PVD, carotid disease, ESRD etc are not going anywhere any time soon. A VS will always have a job primarily because someone has to clean up after IR/Cards when they mess up and there will always be complex cases that can only be solved operatively. Frankly, I'm not worried.

Private practice VS pretty much means VS without open aortas. Outpatient veins ablations, dialysis access work and angios can be done. Most PP VS will also have a healthy mix of bypass work and more complicated endovascular work in the hospital. The fellows that graduated last year that I know (n=4) started between 225k and 400k. Wide range because of locations and PP vs. academic.

There is a lot of room for business/entrepreneurial/medtech. That is how VS keeps running. I am 3 months into my residency and I have probably 10 device reps on speed dial. The interface between industry and MD is extensive because it is a rapidly expanding field on the tech end. There are huge opportunities as an MD to be as involved as you want to be with them. It is not unusual for MDs to collaborate with or pitch ideas to industry.

A quick thing about Interventional Cards (IC) vs. VS. There are a couple of big differences that separate the two. First, training, IC is 3 years of IM residency, 3 years cards fellowship, 1 year interventional fellowship. VS is either 5 years of residency or 5 years gen surg + 2 years fellowship. Roughly equivalent. The difference is really medicine vs. surgery. To be blunt, I could not survive an IM residency. For ME they are just too slow. Too much fixation on small details, too much endless rounding.

I am on interventional cards right now as an IVS resident (we do about 4 months of IC). We start rounding at 10am (I get to the hospital about 7am) and round until 3pm on a good day and 7pm on a bad day. Mixed in are maybe 3-4 cardiac caths. By definition the cases IC do are the same. The vast majority only do heart caths. They are extremely good at them, but the territory while exceptionally important is limited. They are a procedural medical specialty. But MEDICAL. It is more a mindset than anything.

This is contrast to a VS service. I was on one of ours for 2 months in July/August. We start to round at 6am, (I arrive at hospital at 5am) so that we can start operating at 7:30am. Operate until cases are done ~3-6pm. Take care of things on the floor in between cases or after things are done. I would say on average we see twice as many patients as a typical medical team will in about half the time. The medical care is good, but there isn't a focus on preventative care, medical optimization, and tracking down unrelated issues, so things simply go faster. That is what I like, but it is NOT for everyone. It is a harder schedule, but it is much faster paced and if you enjoy it, it will go a heck of a lot faster than a shorter day of medical rounds.

Lastly, don't apologize for asking questions, especially about fields and figuring out what you are going into. This is important to figure out.

Hope this helps.

All I can really say is, if you have a strong application, VS counts as a separate specialty in ERAS, so it doesn't cost very much to try. Might as well give it a shot . Good luck.

 

[uclamimg]

mimelim,

Thanks for posting this PM. Do you have any idea why those 250+ students nay not have matched VS? For example, did they rank GS interspersed with VS programs? or lack of research, etc.?

 

[mimelim]

One of them ended up SOAPing into gen surg, best guess, applied to too few programs, lack of things outside of school, ie research or other projects. The other matched mid-level GS, I don't know their exact match list, but I doubt that it was higher than VS programs. They were geographically limited and applied to less than half of the VS programs. But these in the end are guesses.