Interested in Kidneys

[Renal]

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Hence my username. This might make more sense in the urology forums, but seeing how active those are, I hope it's ok to ask here. If I'm interested in ultimately operating on kidneys (not just transplants), is there a way to do it through gen surg? Otherwise, should I aim for a residency in urology even though my primary interest lies outside of the bread and butter procedures in that speciality?

 

[Winged Scapula]

I'd be interested in seeing what other's experience was/is.

There are no kidney case requirements for ACS. The only ones I did were transplants. Since we had a Uro residency, they got all the Uro trauma and other types of Uro disease/injury/etc. rather than the general surgeons.

 

[SocialistMD]

Even within the urology community, it is difficult to "only" operate on kidneys. I was once in the exact same situation you were; I really enjoyed renal physiology and thought it would be cool to operate on them. First off, understand this; there is very little true renal physiology involved in renal surgeon practice (in fact, renal transplant probably has the most medical management involved), so if that is why you want to operate on them, you won't be happy. That said, a wise chief resident I had as a third year caught wind of my plan and told me I needed to see a liver transplant before I committed to the urologist--> kidney transplant surgeon track I was about to begin. From that first split liver transplant, I knew I wasn't a urologist, but a general surgeon. We deal with as much renal physiology as do the urologists (which satisfies that itch I always had), can perform nephrectomies in the face of an emergency/nasty NE tumor or GIST and know what to do when the urologist nicks the IVC or bowel when their (partial) nephrectomy goes bad. I chose the general surgery route to transplant, and now have found something I enjoy even more and I am glad I'm not locked into cystos and prostatectomies for the rest of my career (even though they bill like mad).

 

[core0]

Even within the urology community, it is difficult to "only" operate on kidneys. I was once in the exact same situation you were; I really enjoyed renal physiology and thought it would be cool to operate on them. First off, understand this; there is very little true renal physiology involved in renal surgeon practice (in fact, renal transplant probably has the most medical management involved), so if that is why you want to operate on them, you won't be happy. That said, a wise chief resident I had as a third year caught wind of my plan and told me I needed to see a liver transplant before I committed to the urologist--> kidney transplant surgeon track I was about to begin. From that first split liver transplant, I knew I wasn't a urologist, but a general surgeon. We deal with as much renal physiology as do the urologists (which satisfies that itch I always had), can perform nephrectomies in the face of an emergency/nasty NE tumor or GIST and know what to do when the urologist nicks the IVC or bowel when their (partial) nephrectomy goes bad. I chose the general surgery route to transplant, and now have found something I enjoy even more and I am glad I'm not locked into cystos and prostatectomies for the rest of my career (even though they bill like mad).

If you just do renal transplant (with the occasional KP) and access you can do very well. The trick is finding a program where vascular isn't doing all the access. Also unlike liver you can dump the patient back onto renal after the immediate post op period.

David Carpenter, PA-C

 

[Blade28]

The only experience we get with kidneys are the rare traumatic nephrectomies or tumor resections in kids.

 

[johnny_blaze]

Now I’m not sure if this is the case in the U.S but as far as I know you can subspecialise in paediatric urology following general paediatric surgery. You will find yourself doing very complex renal cases as a subspecilised surgeon. There are two paediatric urologists who both trained as general surgeons where I work. One of them still does general surgery on-call and the other does purely urology. There are still willies and scrotums to do but most of their major work is on the kidneys/upper renal tract. However, like I said before… I’m not sure if this is possible in the U.S.

 

[Pir8DeacDoc]

Unless I am wrong, here pediatric urology is a fellowship (2 years) after Urology residency, not general surgery.

 

[Winged Scapula]

Unless I am wrong, here pediatric urology is a fellowship (2 years) after Urology residency, not general surgery.

You are not wrong.

 

[Renal]

Very helpful responses. Socialist, the transplant route does sound interesting, unfortunately I would prefer a subspecialty with a more predictable schedule. I think what attracts me most to kidneys is the minimally invasive aspect and the predictable outcome of most procedures. What other subspecialties in gen surg share these characteristics and have relatively stable (not necessarily short) hours?

 

[core0]

Very helpful responses. Socialist, the transplant route does sound interesting, unfortunately I would prefer a subspecialty with a more predictable schedule. I think what attracts me most to kidneys is the minimally invasive aspect and the predictable outcome of most procedures. What other subspecialties in gen surg share these characteristics and have relatively stable (not necessarily short) hours?

Actually compared to the other transplant fields Kidneys are relatively benign as far as scheduling. Kidneys last a fair amount of time. More if you pump. Most transplants happen in the morning not in the dark of night.

David Carpenter, PA-C

 

[Winged Scapula]

Actually compared to the other transplant fields Kidneys are relatively benign as far as scheduling. Kidneys last a fair amount of time. More if you pump. Most transplants happen in the morning not in the dark of night.

David Carpenter, PA-C

Very true regarding the cold ischemia time and tolerance of kidneys for it, as well as the timing of most renal txps (which are increasingly living related/unrelated).

There is still the issue of organ harvesting as a transplant surgeon which almost always entails middle of the night runs/flights/etc. Fortunately, this isn't all the time.

 

[Renal]

Something I'd never considered before. So if you want to focus on kidney transplants, what kind of training do you need after a transplant fellowship?

Edit: Found some info: http://www.asts.org/fellowshiptraining/accreditedprograms.aspx

So most of the fellowship programs aren't just kidney. Any idea how competitive the few pure kidney fellowships are?

 

[Blade28]

Most transplant fellowships are at least kidney-liver, at least at the bigger programs.

 

[Pilot Doc]

Something I'd never considered before. So if you want to focus on kidney transplants, what kind of training do you need after a transplant fellowship?

Edit: Found some info: http://www.asts.org/fellowshiptraining/accreditedprograms.aspx

So most of the fellowship programs aren't just kidney. Any idea how competitive the few pure kidney fellowships are?

Not sure if you answered your own question, but you would need no extra training for a kidney only practice after a kidney txplant fellowship.

No idea how the landscape of kidney only vs general abdominal txplant training. Any reason why you would be opposed to training in liver/kidney and then going on to practice kidney only? You might well be able to formally or informally work out a kidney heavy setup anyway. Since there are no txplant boards, you don't have to meet any liver numbers.

 

[Renal]

Any reason why you would be opposed to training in liver/kidney and then going on to practice kidney only?

Unpredictable schedule during fellowship? Kidney transplant is sounding interesting because posters are saying it lends itself more to scheduling.

I appreciate all of the responses.

 

[Pir8DeacDoc]

If you only wanna do kidney transplant, then go for Urology. The Urologists will often do the donor and the transplant surgeon will do the receipient. A nice lap nephrectomy should fit what you're looking for in terms of predictable outcome and hours.

 

[SocialistMD]

Who only wants to operate on healthy patients whose only indication for surgery is that they have a friend/relative who needs one of their kidneys? To me, you don't get that gratification of "I've made a positive difference in this patient on whom I just operated."

Renal-
There are specific renal transplant fellowships (I know Pitt has one) that accept both urologists and general surgeons. However, if you do an abdominal transplant fellowship, you can still set up your practice such that you only operate on kidneys or kidney-pancreas. One of the transplant surgeons here does just that. He does a living kidney every Tuesday and Thursday, alternating between the donor and the recipient. He isn't really ever on procurement call (or when he is, it is typically an in-house donor or someone at our local transplant service's hospital here in town) because the procurement team is generally the team going to get the liver and they bring back the kidneys as well. The rest of his time is spent doing fistulas (which are very gratifying cases that urologists can't do).

Don't let me tell you what to do, but understand that if you go the transplant route, be it from urology or general surgery, you will not really be doing much of the prostate or bladder work, and general surgery offers you more options for what to do with your spare time. Again, really think about this, as you don't want to go into urology and find that operating on kidneys isn't as exciting as you now think and be stuck doing prostates/bladders when you really don't enjoy them. However, don't choose general surgery, hate it and then blame me for showing you things with rose-colored glasses. 😉

 

[Blade28]

To the OP: what year of med school are you in? These seems to be an awfully specific choice at this stage, IMHO.

 

[Amgen1]

"Unpredictable schedule during fellowship? Kidney transplant is sounding interesting because posters are saying it lends itself more to scheduling.

I appreciate all of the responses."


Don't kid yourself. Unless you are at a very specialized center, kidney transplantation will have bad hours.

Procurements will come at bad hours, and even with long ischemia times you will often end up doing transplants outside of your standard 7a-7p workday.

Transplant fellowships (either only kidney, Kidney-Panc, or whole abdomen) are grueling. They are not ACGME approved and don't have to follow the 80hr work week.

In addition, transplant patient's are tend to be sick patients with numerous comorbidities. This does not lend itself to a nice 9-5, elective practice.

However transplant can be incredibly rewarding if you do choose that route

 

[core0]

Unpredictable schedule during fellowship? Kidney transplant is sounding interesting because posters are saying it lends itself more to scheduling.

I appreciate all of the responses.

If you think that you are going to get a predictable schedule during fellowship in a renal transplant program you are in for a rude suprise. Notice those fellowship are not ACGME fellowships. That means the 80 hour work week goes right out the window. Also when you do a procurement you do procurement for the whole program. Our renal fellow does the kidney, pancreas and liver. You are going to get abused as much (if not more) than any other fellow.

David Carpenter, PA-C

 

[Renal]

Blade, I know it's early to decide on specific fellowships. Mainly, I was trying to get a feel for uro vs gen surg, which is a closer decision. The details provided by some of the posters here spurred more questions that I hadn't thought about before.

So far, I agree with Socialist and others that unless I want to do prostates and bladders in addition to kidney, which I do not, I shouldn't be thinking of doing uro. If anyone else has general advice about this, I'm all ears.

 

[Winged Scapula]

Blade, I know it's early to decide on specific fellowships. Mainly, I was trying to get a feel for uro vs gen surg, which is a closer decision. The details provided by some of the posters here spurred more questions that I hadn't thought about before.

So far, I agree with Socialist and others that unless I want to do prostates and bladders in addition to kidney, which I do not, I shouldn't be thinking of doing uro. If anyone else has general advice about this, I'm all ears.

I don't have any novel advice, but wanted to agree with AMGEN. While a renal txp PRACTICE may be relatively easy on the hours, most places which have fellowships are regional centers and don't focus on the living related/unrelated txp only. Therefore, you can expect during fellowship to do the cadaverics and the horrible hours that entails, in addition to the fact that its a non-ACGME fellowship. I have a friend doing an abdominal txp fellowship and his hours can, at times, make gen surg residency look like a cakewalk.

 

[core0]

I don't have any novel advice, but wanted to agree with AMGEN. While a renal txp PRACTICE may be relatively easy on the hours, most places which have fellowships are regional centers and don't focus on the living related/unrelated txp only. Therefore, you can expect during fellowship to do the cadaverics and the horrible hours that entails, in addition to the fact that its a non-ACGME fellowship. I have a friend doing an abdominal txp fellowship and his hours can, at times, make gen surg residency look like a cakewalk.

I would agree. Most transplant fellowships have you do kidney the first year and Liver the second year. Even cadaverics usually go the next morning. However, you end up on procurement for all the services. We use a rotation with the first year and second year dividing up procurement with the staff surgeons. It still means that someone is going pretty much every night and sometimes you may have multiple teams out, especially at a busy program. The second year is the real butt kicker. Do procurement come back do the transplant. If you get unlucky you are looking at six hours for procurement and another 12 on the transplant. Take the patient back to the ICU and get them stable enough to do the kidney the next day. It can make for a long day. One of the reasons there are way more Kidney only programs than Kidney Liver.

David Carpenter, PA-C