Integrated Vascular Surgery

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M

Mr. McDuck

So, I was looking at Frieda for something completely unrelated, and I happen to notice that "Vascular - Integrated" is now an option in the program search. Out of curiosity, I checked it and searched the whole country. Now, there's only one program so far, but I didn't realize that a 5-year VS program was going to be popping up so quickly. Maybe I'm just out of the loop.

What are your thoughts on this? Do you think these types of programs will be competitive, or do most applicants already struggle with the decision to pick surgery, let alone commit to a single subspecialty?

Here's the program's website, just in case anyone is curious:

http://www.dhmc.org/webpage.cfm?site_id=2&org_id=802&gsec_id=0&sec_id=0&item_id=41527

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So, I was looking at Frieda for something completely unrelated, and I happen to notice that "Vascular - Integrated" is now an option in the program search. Out of curiosity, I checked it and searched the whole country. Now, there's only one program so far, but I didn't realize that a 5-year VS program was going to be popping up so quickly. Maybe I'm just out of the loop.

What are your thoughts on this? Do you think these types of programs will be competitive, or do most applicants already struggle with the decision to pick surgery, let alone commit to a single subspecialty?

Here's the program's website, just in case anyone is curious:

http://www.dhmc.org/webpage.cfm?site_id=2&org_id=802&gsec_id=0&sec_id=0&item_id=41527

I talked to the Chair of Vascular Surgery at my school about this and he said alot of places will be converting to the 5 year plan soon. I'm definitely interested, but the turf war(s) with IR and interventional cards might be an issue.

Maybe someone can share some of their wisdom regarding this...
 
Yeah. I haven't started med school yet (hopefully will be this fall), but I've been a vascular PA for a couple of years, so I'm pretty sure that's where I want to go. Obviously, I'm going to keep an open mind, but it would be nice for me if these weren't too competitive, lol.
 
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Why Vascular? Meaning what is inherent in vascular surgery that makes this kind of program feasible.

Are there any other surgical subspecialties that are going down similar integrated routes?
 
I just interviewed at Dartmouth the other day (for GS not VS) and I thought from word-of-mouth on the interview trail that 3 programs were starting integrated vascular for next year (DHMC, Michigan (?), and another east coast school that I interviewed at....Lahey? BID? B&W?? UMass? I didn't pay much attention at the time as I am obviously not applying for integrated VS). I've gotten a lot of variation from program directors/ chairs on their thoughts about the path of general surgery/specialization...but I wouldn't be surprised if more and more fellowship/specialties went in the direction that vascular and plastics seem to be heading, to the aid or detriment of the field, who knows.
 
I had emailed FREIDA earlier this week about this issue and as a result of my correspondence they included the Vascular-Integrated link. They only have one school listed, but there are three approved programs: Dartmouth, Ann Arbor and Pitt. (See vascularweb.org for more info on that).

The people from vascular web informed me that they know of at least seven more programs that have applied or are thinking about applying for the new training pathway.

February 22-23 is the next time programs will be approved by ACGME so come then there will hopefully be more than just the currently approved three programs.
 
The University of Rochester will be starting a 3+3 program this coming year, and has been accepting applications throughout this current cycle. For those who are exploring this option, I would highly recommend Rochester.

The faculty are very well trained in endovascular techniques, and this might be something you should consider when exploring programs. Obviously endo is the future of vascular, but some places have older vascular surgeons who may not have been trained in the endo techniques back in their day. However, many that I have met have gone off for a 4-month fellowship or something similar to catch up. I have no doubt that they are trained well and proficient afterwards, but sometimes it just takes a little longer for newly trained folks to step aside for their trainees. So it's important to look for faculty who are really really comfortable with endo. A decent relationship with IR would be nice, too.

Some of the pros/cons that seem to go around...
Pros: Obviously, shorter total training time. While many comment that it's only one year saved, it is also to your benefit to spend less time on training that is not necessary for vascular surgeons. (This could be a con, depending on what you like). No need to mess around with complex lap procedures or Whipples if your future is in vascular. At Rochester, the first 3 years in "general surg" are also more tailored to the vascular resident, so you get extra time in vascular even earlier.
Cons: Well frankly, it's hard to decide that early to specialize. But in my opinion, if you really put vascular out there as a specialty like urology or plastics or ENT, then students might actually take the initiative to explore it earlier in med school because they know that it's another surgical subspecialty that has to be applied to right away. I would think that it's harder to recruit for vascular residents this cycle because the programs were kept so under-cover, and current 4th year med students weren't given enough advanced noticed (meaning 3rd year at the very least) to explore the field well enough to make that decision. But anyway, alot of folks only spend 4-6 weeks rotating through the other subspecialties before making a decision, and it's just as easy to spend 4-6 weeks on a vascular elective, too. So I guess what I'm saying is, once vascular gets its name out as a freestanding surgical subspecialty, I think med students would take more of an initiative to explore it (as long as faculty continue to support students!).

In speaking to a chief resident going into a vascular fellowship next year, I asked whether he thought that folks taking the fast track would be missing out, at a disadvantage, or looked upon differently than those who did the 7 year route. (My concerns being less experience with abdominal operations, less experience with trauma, etc). Without hesitation, he encouraged and supported the fast track, and then went on to remind me of how many "useless" operations he had to do - mainly, he loved vascular and knew he was going to do vascular, and by his chief year that's what he wanted to focus on. On the fast track, you wouldn't feel stuck like that. The vascular fellow I talked to voiced similar frustrations about his own training.

Sorry for the extra long post. I had been considering the vascular integrated route myself, so I had done some exploring. Best of luck to all those considering this track. I have personally spent some time on the vascular service at Rochester and would highly recommend them for this training program because of high volume and incredibly supportive faculty. Let me know if you have questions.
 
Why Vascular? Meaning what is inherent in vascular surgery that makes this kind of program feasible.

Are there any other surgical subspecialties that are going down similar integrated routes?

Well, at Cornell, it was mentioned that in the near future there may be multiple combined track programs for different fields including vascular, thoracic, cardio, surg onc, and colorectal. This is not set in stone.

As an applicant to gen surg residency, I am a little skeptical about how they will effect me as a surgical resident. Hypothetically, if I were to pursue vascular, I would not only be competing for fellowships with other similar 5 year gen surg categoricals, but also with those current medical students that applied directly into the vascular combined track 2-3 years from now. Are we going to get preferential consideration? Are we going to be forced to channel into the combined track programs if they are incorporated in our program?

Any thoughts on how you think or have heard about this effecting current gen surg applicants?
 
I have heard that the University of Rochester is also starting a combined Vascular program (it might be 6 years, not sure), but I got an email asking if I was interested in it months ago when the interview season started.
 
sorry, didnt see the previous reply about Rochester....strike that:)
 
I'm definitely interested, but the turf war(s) with IR and interventional cards might be an issue.

Maybe someone can share some of their wisdom regarding this...

In the past 10-15 years ago IR did the majority of peripheral vascular and aortic interventions. IR currently plays a minor role in treating peripheral vascular disease. We need to worry about interventional cardiology. They train many more cardiologists per year than vascular surgeons and IRs combined. Ultimately they get first crack at a lot of the vasculopaths, because they will see them first. The overflow and nightmare cases will find their way to you. Though this is not the case in academics, this is already a reality in private practice depending on where you go. There is no stopping cardiologists.

Don't get me wrong, no one else can do those crazy Ax fem, Fem-Fem grafts or NAISs so you will always have a job. But the frustrating thing about VS is that inevitably all your elegant complex graft-work will get occluded.

An old latin saying goes "All roads lead to Rome".

When considering VS vs IR as a medical student, a smug cardiology fellow once told me, "[in vascular surgery] all roads lead to AKA".

Do what you like, but realize that you WILL be competing with Interventional Cardiologists in the future.
 
As an applicant to gen surg residency, I am a little skeptical about how they will effect me as a surgical resident. Hypothetically, if I were to pursue vascular, I would not only be competing for fellowships with other similar 5 year gen surg categoricals, but also with those current medical students that applied directly into the vascular combined track 2-3 years from now. Are we going to get preferential consideration? Are we going to be forced to channel into the combined track programs if they are incorporated in our program?

Any thoughts on how you think or have heard about this effecting current gen surg applicants?

Rochester Vascular will be phasing out its 2-year fellowship program and will be taking vascular trainees into its integrated program only. This transition will occur over the next several years, meaning not until the new integrated vascular resident is far enough along so that there are no gaps in vascular trainees. If you want to do vascular, I suppose there will always be programs that will do the traditional post-GS fellowship training, so you would still have options, such as in plastics.
 
Hi,
I am one of the medical students that interviewed at Mich, Dartmouth, Pitt and Rochester this year for the integrated vascular programs. If anyone has any questions about the anything...let me know.


They are all stellar, prestigous programs in vascular and training would be exceptional (I believe) at all four.
 
well if the cardiologists can venture into the periphery then we should be able to venture in to the corinary arteries. Afterall to quote Dr. Ascher "the coronary arteries are muscular arteries off the aorta"
 
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