Is the outlook for cardiothoracic surgery really that bad to where IM->Cards is better?

[Drrrrrr. Celty]

How long has it been since you’ve seen a gynecologist operate? Ever scrub in with one?

I'm curious how many Ob/Gyns don't run predominately surgery practices. The ones I did my rotation with did labor/delivery and surgery predominately.

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[deleted103644]

Exactly! Neuroradiologists and actually neurologists as well have both been trying to get into those fellowships for years but many of the programs are NSGY only, which protects the field. Too bad the heart surgeons didn't do this.

This shows a fair amount of ignorance of the history of interventional neuroradiology, relatively recently rebranded as endovascular neurosurgery.

I'm saying neurosurgery is the other guy taking it from radiology, not the other way around.

I don’t think neurosurgery really wants it, just wants to take control of it to avoid any future interventional technique taking away their bread and butter like for CT surgery. Far more lucrative to be a spine surgeon with a much better call schedule. It’s even hard to convince diagnostic neuroradiologists to do interventions, often more lucrative to read MRIs than do the longer procedures, and the call burden is very heavy, up to q1 in more rural areas.

Neurologists definitely want it.

 

[Taddy Mason]

Yeah I still find it hard to believe you ran into a lot of cardiologists who refer to themselves as cardiac surgeons. There might be the occasional rare egotist out there who’s doing IC and fancies himself a surgeon but I have never, ever met a cardiologist - IC or otherwise - who has made that claim. Neither have any of the fellows, attendings, one medical residents/attendings I’ve ever worked with.

Between IR, IC, and EP I can specifically name at least 12 physicians I’ve personally worked with who regularly referred to themselves as surgeons. Maybe it’s where I’m from, but in my experience it’s not an uncommon phenomenon. IMHO, it’s just an ego/insecurity battle.

 

[Taddy Mason]

I'm curious how many Ob/Gyns don't run predominately surgery practices. The ones I did my rotation with did labor/delivery and surgery predominately.

Their surgery skills though....I did my OB/ Gyn rotation right after surgery, and while surgery isn’t my cup of tea the stereotypes about OB/Gyns as surgeons exist for a reason.

 

[RNthenDoc]

Isaac George, MD | Columbia University Department of Surgery

I was having a high-self-esteem day, now I’m going to have to stand in front of a mirror carelessly smearing lipstick across my face while chanting,
“You’ll never be smart enough. Looks are all you have.”

 

[Dr G Oogle]

I'm curious how many Ob/Gyns don't run predominately surgery practices. The ones I did my rotation with did labor/delivery and surgery predominately.

Not to go off on a tangent but as an FYI

Most general obgyns don’t run a predominantly surgical practice (not talking about minor procedures like d&cs, hysteroscopies, LEEPs and tubals, but bigger cases like hysts, oncologic Surgery, pelvic floor surgery and even most endometriosis excisions ). The trend is that in most large and midsize metros and surrounding areas surgeries are performed by fellowship trained surgeons in Urogyn, oncology or minimally invasive surgery. Surgical training in OB/gyn is lacking for all but the simplest of hysterectomies and surgical volume in practice is not sufficient in most settings to even maintain those skills, though there are some good general obgyns that are also competent surgeons.

 

[Drrrrrr. Celty]

Not to go off on a tangent but as an FYI

Most general obgyns don’t run a predominantly surgical practice (not talking about minor procedures like d&cs, hysteroscopies, LEEPs and tubals, but bigger cases like hysts, oncologic Surgery, pelvic floor surgery and even most endometriosis excisions ). The trend is that in most large and midsize metros and surrounding areas surgeries are performed by fellowship trained surgeons in Urogyn, oncology or minimally invasive surgery. Surgical training in OB/gyn is lacking for all but the simplest of hysterectomies and surgical volume in practice is not sufficient in most settings to even maintain those skills, though there are some good general obgyns that are also competent surgeons.

I did my Ob/Gyn in a community hospital and pretty much the whole rotation was a combination of tubals, hysterectomies, ex-laps for adhesions, endometriosis, and a few others I cannot remember off the top of my head. Clinic in comparison was kind of more of an afternoon thing, see the perinatals, do some dopps, yearlys, etc.

Likewise my mom's Ob does a similar type of practice. So I kind of got the impression that this was the norm as opposed to the exception.

 

[VA Hopeful Dr]

I did my Ob/Gyn in a community hospital and pretty much the whole rotation was a combination of tubals, hysterectomies, ex-laps for adhesions, endometriosis, and a few others I cannot remember off the top of my head. Clinic in comparison was kind of more of an afternoon thing, see the perinatals, do some dopps, yearlys, etc.

Likewise my mom's Ob does a similar type of practice. So I kind of got the impression that this was the norm as opposed to the exception.

Yeah that's been my experience as well in areas up to 200,000 people.

 

[Dr G Oogle]

Yeah that's been my experience as well in areas up to 200,000 people.

Community hospitals are less prone to this change especially if they are lacking in subspecialist coverage but just like in other specialties, the outcomes are not as good if low volume surgeons are performing a particular set of procedures, a high volume generalist is one who does 12 or more hysts a year (avg 1 per month) and that represents only the top 20% of practicing generalists, those who do 30 or more or even 50 or more are even fewer in number. There is a lot of emphasis now on surgical outcomes and these depend significantly on surgical volume, but it will be another 15-20 years before these changes are more widespread. Even then, there will still be some generalists with heavy surgical practices but most will be done by fellowship trained people. For most obgyn residencies gynecological Surgery makes up somewhere around 18 months of total training, 2-4 months is in intern year where you don’t know anything so that leaves 14-16 months to learn how to take care of surgical patients which in my mind is not sufficient and the training requirements aren’t changing and probably getting worse. For example ABOGs response to decreasing volumes of abdominal hysterectomies is to lower the required number of those surgeries to graduate.

But again, I’m not trying to derail this thread so if anyone wants to discuss this further, perhaps a new thread can be started

 

[VA Hopeful Dr]

Community hospitals are less prone to this change especially if they are lacking in subspecialist coverage but just like in other specialties, the outcomes are not as good if low volume surgeons are performing a particular set of procedures, a high volume generalist is one who does 12 or more hysts a year (avg 1 per month) and that represents only the top 20% of practicing generalists, those who do 30 or more or even 50 or more are even fewer in number. There is a lot of emphasis now on surgical outcomes and these depend significantly on surgical volume, but it will be another 15-20 years before these changes are more widespread. Even then, there will still be some generalists with heavy surgical practices but most will be done by fellowship trained people. For most obgyn residencies gynecological Surgery makes up somewhere around 18 months of total training, 2-4 months is in intern year where you don’t know anything so that leaves 14-16 months to learn how to take care of surgical patients which in my mind is not sufficient and the training requirements aren’t changing and probably getting worse. For example ABOGs response to decreasing volumes of abdominal hysterectomies is to lower the required number of those surgeries to graduate.

But again, I’m not trying to derail this thread so if anyone wants to discuss this further, perhaps a new thread can be started.

What do you think qualifies as a community hospital? Last hospital I worked at had 800 beds and 20+ OB/GYNs...

My state has 3 OB/GYN residency hospitals. Only 1 of them has a minimally invasive trained surgeon. The rest have gyn-onc and urogyn which makes sense.

This isn't me disagreeing about the surgical skills of lots of OB/GYNs for what that's worth. I'm the most particular about where I refer people to OB/GYN compared to literally every other specialty.

 

[jdh71]

I wasn't trying to be rude.

I've been an attending surgeon for over a decade and my point was that I've probably seen and interacted with a lot more other physicians than someone still in training. I don't think that should come as a surprise to anyone.

The whipper snappers are running amok! They believe nothing!

 

[jdh71]

Yeah I still find it hard to believe you ran into a lot of cardiologists who refer to themselves as cardiac surgeons. There might be the occasional rare egotist out there who’s doing IC and fancies himself a surgeon but I have never, ever met a cardiologist - IC or otherwise - who has made that claim. Neither have any of the fellows, attendings, one medical residents/attendings I’ve ever worked with.

It doesn't take you too long or too far outside of the ivory towers to find this kind of thing especially in the more recent past. It's an optics things and some physicians cynically know that patients won't know and might be more impressed to use other titles. Think of the recent story about the dermatologist that sold herself as a "surgeon".

 

[Dr G Oogle]

What do you think qualifies as a community hospital? Last hospital I worked at had 800 beds and 20+ OB/GYNs...

My state has 3 OB/GYN residency hospitals. Only 1 of them has a minimally invasive trained surgeon. The rest have gyn-onc and urogyn which makes sense.

This isn't me disagreeing about the surgical skills of lots of OB/GYNs for what that's worth. I'm the most particular about where I refer people to OB/GYN compared to literally every other specialty..

Not talking about size of hospital or practice size, more like primary affiliation with medical school, like I said there is a trend towards having surgeries performed more by specialists rather than generalists not that it is the rule, there is significant ongoing debate about who should be performing surgeries and sub-specialty societies obviously being most vocal about it (full disclosure I am an FPMRS fellow so I have a bias). It wasn’t too long ago that generalists were doing prolapse Surgery and incontinence procedure and there are few new trained generalists who do so, people trained over 10 years ago may still do it but they are outcomes are no where near as good, the same can be said for things like breast cancer, lung cancer and colon cancer, yea a well trained general surgeon can probably take care of some of these but outcomes are better if done by a subspecialist surgeon. THe difference is that a well trained general surgeon has 5 years of surgical training compared to an extra 1-2 years of a fellowship whereas the very best trained obgyn has maybe 2 years and probably less training vs an extra 3 years of training for a gyn fellowship.

 

[VA Hopeful Dr]

Not talking about size of hospital or practice size, more like primary affiliation with medical school, like I said there is a trend towards having surgeries performed more by specialists rather than generalists not that it is the rule, there is significant ongoing debate about who should be performing surgeries and sub-specialty societies obviously being most vocal about it (full disclosure I am an FPMRS fellow so I have a bias). It wasn’t too long ago that generalists were doing prolapse Surgery and incontinence procedure and there are few new trained generalists who do so, people trained over 10 years ago may still do it but they are outcomes are no where near as good, the same can be said for things like breast cancer, lung cancer and colon cancer, yea a well trained general surgeon can probably take care of some of these but outcomes are better if done by a subspecialist surgeon. THe difference is that a well trained general surgeon has 5 years of surgical training compared to an extra 1-2 years of a fellowship whereas the very best trained obgyn has maybe 2 years and probably less training vs an extra 3 years of training for a gyn fellowship..

Yes, its well known that if you do one procedure over and over again you'll be better than someone who does less of it. Problem is, we're a pretty big geographically speaking country. Not everyone can make it to the local Mecca for Dr. Hysterectomy.

You also have to consider how much of a difference there is in outcomes. Statistically significant and clinically significant are quite different. There's also the concept of "good enough".

For example, in my own field we know that blind joint injections actually fail to make it intra-articular fairly frequently. But, outcomes are more or less unchanged as long as the steroid gets somewhere close to the joint. So is it worth the cost to send everyone to ortho to get U/S guided injections? Obviously not.

 

[mimelim]

I’ve never heard an IC person call themselves a surgeon. I’m starting IC fellowship in a year. We do endovascular procedures. Sometimes advanced procedures (TAVR, TMVR, Watchman, etc) and mechanical support too. But we are cardiologists. Y’all surgeons can keep the “surgeon” name.

Yeah I still find it hard to believe you ran into a lot of cardiologists who refer to themselves as cardiac surgeons. There might be the occasional rare egotist out there who’s doing IC and fancies himself a surgeon but I have never, ever met a cardiologist - IC or otherwise - who has made that claim. Neither have any of the fellows, attendings, one medical residents/attendings I’ve ever worked with.

Um, it is incredibly common for IC to try and bill themselves as surgeons. Is it the majority? Probably not. But 20%+, wouldn't be surprised. I certainly don't have the experience that @Winged Scapula does, but I think that it is far more concentrated over my 7 years because in vascular we interface more heavily with cardiology. But, in my experience it is a weekly occurrence. I understand why it happens. It is often very difficult for all of us to describe our exact role and make it map to and correspond to our titles. For example, cardiologist refers patient to his IC buddy who then doesn't feel comfortable with the intervention because it is more complex than they typically deal with, so they send to their other IC buddy who then either can't deal with it or ****s it up, then the patient ends up in front of CT surgery or vascular surgery. All of a sudden the patient has to understand/rationalize four different physicians seeing them for the same issue. There IS a logical progression to it, but at the end of the day the nuances dividing each of those providers is difficult for people to comprehend and there is a temptation for some to dumb it down to the point of saying that they are surgeons because they think patients will understand better. It happens several times a year where I have to explain to a patient that they haven't seen a surgeon yet, despite them insisting otherwise.

This is hardly unique to cardiology. People do this all over the place, both in medicine and outside of it. For example, over the weekend I had a friend (And IR fellow) trying to convince me to learn how to do kyphoplasties and join them in practice. Why? Because it generates 200+ RVUs for 20 minutes of work. If I started doing that in private practice, I can't really bill myself as a vascular surgeon to patients because it doesn't make logical sense, despite having a skillset that is very easily adaptable to the procedure itself. I would need to find a different way of describing myself to patients as well as referring docs.

 

[Dr G Oogle]

Yes, its well known that if you do one procedure over and over again you'll be better than someone who does less of it. Problem is, we're a pretty big geographically speaking country. Not everyone can make it to the local Mecca for Dr. Hysterectomy.

You also have to consider how much of a difference there is in outcomes. Statistically significant and clinically significant are quite different. There's also the concept of "good enough".

For example, in my own field we know that blind joint injections actually fail to make it intra-articular fairly frequently. But, outcomes are more or less unchanged as long as the steroid gets somewhere close to the joint. So is it worth the cost to send everyone to ortho to get U/S guided injections? Obviously not.

I agree with you about the principal of good enough, and it is probably true for most straightforward hysterectomies and other surgeries, but the problem arises when patients are more complex (obese, prior surgeries, multiple comorbidities) which is now more the norm (to be fair I’m in an urban hospital so my view is at least a bit skewed) There is a clear demonstration in gynecology between volume and outcomes (readmits, reoperation, lack of using laparoscopy or overusing the robotbot of which lead to higher costs, longer surgical times, higher complication rates). And I agree that the US is geographically large and specialists can’t be everywhere, but even in those cases a practice can select one or two people to be the surgeons and the rest to do their generalist thing, which would at least increase the volume for those one or two people.

 

[VA Hopeful Dr]

I agree with you about the principal of good enough, and it is probably true for most straightforward hysterectomies and other surgeries, but the problem arises when patients are more complex (obese, prior surgeries, multiple comorbidities) which is now more the norm (to be fair I’m in an urban hospital so my view is at least a bit skewed) There is a clear demonstration in gynecology between volume and outcomes (readmits, reoperation, lack of using laparoscopy or overusing the robotbot of which lead to higher costs, longer surgical times, higher complication rates). And I agree that the US is geographically large and specialists can’t be everywhere, but even in those cases a practice can select one or two people to be the surgeons and the rest to do their generalist thing, which would at least increase the volume for those one or two people.

And I think we do see that, or at least I do in my area. Most of the practices around me have someone who is basically just GYN with some minor procedures (D&Cs, EMB, that sort of stuff) while referring anything more to their partners. My father in law is an OB/GYN who retired to outpatient only with 1 other older guy. So their 2 operative partners are insanely busy.

On the other hand, there is a guy still practicing who is notorious for snagging a ureter at least once every other month...

 

[jdh71]

Um, it is incredibly common for IC to try and bill themselves as surgeons. Is it the majority? Probably not. But 20%+, wouldn't be surprised. I certainly don't have the experience that @Winged Scapula does, but I think that it is far more concentrated over my 7 years because in vascular we interface more heavily with cardiology. But, in my experience it is a weekly occurrence. I understand why it happens. It is often very difficult for all of us to describe our exact role and make it map to and correspond to our titles. For example, cardiologist refers patient to his IC buddy who then doesn't feel comfortable with the intervention because it is more complex than they typically deal with, so they send to their other IC buddy who then either can't deal with it or ****s it up, then the patient ends up in front of CT surgery or vascular surgery. All of a sudden the patient has to understand/rationalize four different physicians seeing them for the same issue. There IS a logical progression to it, but at the end of the day the nuances dividing each of those providers is difficult for people to comprehend and there is a temptation for some to dumb it down to the point of saying that they are surgeons because they think patients will understand better. It happens several times a year where I have to explain to a patient that they haven't seen a surgeon yet, despite them insisting otherwise.

This is hardly unique to cardiology. People do this all over the place, both in medicine and outside of it. For example, over the weekend I had a friend (And IR fellow) trying to convince me to learn how to do kyphoplasties and join them in practice. Why? Because it generates 200+ RVUs for 20 minutes of work. If I started doing that in private practice, I can't really bill myself as a vascular surgeon to patients because it doesn't make logical sense, despite having a skillset that is very easily adaptable to the procedure itself. I would need to find a different way of describing myself to patients as well as referring docs.

200 RVU?! For twenty minutes?!

Sell out. Sell out NOW!! Lol

 

[mimelim]

200 RVU?! For twenty minutes?!

Sell out. Sell out NOW!! Lol

https://www.aaos.org/news/aaosnow/jan15/managing1_t4.pdf

 

[jdh71]

https://www.aaos.org/news/aaosnow/jan15/managing1_t4.pdf

8+ wrvu tho

Still if you have a piece of that facility payment . . . Not bad.

 

[nimbus]

Between IR, IC, and EP I can specifically name at least 12 physicians I’ve personally worked with who regularly referred to themselves as surgeons. Maybe it’s where I’m from, but in my experience it’s not an uncommon phenomenon. IMHO, it’s just an ego/insecurity battle.

Perhaps it is regional. I’ve been practicing anesthesia for 20years and have never seen an IC, EP or IR refer to themselves as a surgeon. I work with them all as well as cardiothoracic and vascular surgeons. Honestly I don’t see why they would. The catheter and wire based specialties are arguably the most exciting area of medicine. The cardiologists and radiologists pioneered them and have the most advanced wire skills.

That said, CT surgery isn’t going anywhere. Some weeks we are crying uncle.

 

[nimbus]

For example, in my own field we know that blind joint injections actually fail to make it intra-articular fairly frequently. But, outcomes are more or less unchanged as long as the steroid gets somewhere close to the joint. So is it worth the cost to send everyone to ortho to get U/S guided injections? Obviously not.

To me that is sad. You can get an $8000 (soon to be $2000) ultrasound, watch a 5minute YouTube video and inject it correctly every single time.

 

[VA Hopeful Dr]

To me that is sad. You can get an $8000 (soon to be $2000) ultrasound, watch a 5minute YouTube video and inject it correctly every single time.

So you want to spent lots of money on the front end, then bill patients way more money for the procedure itself when it doesn't actually change outcomes?

Good call.

 

[nimbus]

So you want to spent lots of money on the front end, then bill patients way more money for the procedure itself when it doesn't actually change outcomes?

Good call.

It’s not much money at all and you don’t have to charge any more. It’s useful and inexpensive technology that helps you do exactly what you tell the patient you’re gonna do. If you tried it, I bet you wouldn’t go back. It’s 2018.

 

[Gurby]

It’s not much money at all and you don’t have to charge any more. It’s useful and inexpensive technology that helps you do exactly what you tell the patient you’re gonna do. If you tried it, I bet you wouldn’t go back. It’s 2018.

Pretty impressive quality I think for a phone app:

 

[nimbus]

Pretty impressive quality I think for a phone app:

Sorry to threadjack. This will be my last post here regarding this topic.



$8000

Philips Lumify | Portable Ultrasound Machine


$2000...soon to be released

Meet Butterfly iQ - Whole body imaging, under $2k

 

[VA Hopeful Dr]

It’s not much money at all and you don’t have to charge any more. It’s useful and inexpensive technology that helps you do exactly what you tell the patient you’re gonna do. If you tried it, I bet you wouldn’t go back. It’s 2018.

Once again, it costs the patient more (ultrasound guided injections bill higher) and MORE IMPORTANTLY doesn't change outcomes.

Why would I do something more expensive that doesn't change outcomes?

 

[Gurby]

That was freaking badass.

 

[Instatewaiter]

Perhaps it is regional. I’ve been practicing anesthesia for 20years and have never seen an IC, EP or IR refer to themselves as a surgeon. I work with them all as well as cardiothoracic and vascular surgeons. Honestly I don’t see why they would. The catheter and wire based specialties are arguably the most exciting area of medicine. The cardiologists and radiologists pioneered them and have the most advanced wire skills.

That said, CT surgery isn’t going anywhere. Some weeks we are crying uncle.

Agreed. Having worked at 3 different hospitals in different regions of the country) I can say no one I have ever worked with has called themselves a surgeon. I have seen literally hundreds correct patient's though. perhaps what's happening is the patient's get confused and tell the cts or vascular surgeon and they saw another surgeon and the surgeons assume everyone wants to be a surgeon.

To be honest, why would a cardiologist want to be a cardiac surgeon? Catheter based interventions are supplanting the majority of the bread and butter CTS cases and even for multivessel cad there are no differences btw cabg and pci if there is complete revascularization.

It is rare a patient would rather get open surgery. For times when there is a non-surgical option but the patient should get surgery, i have to basically force the patient to go to surgery.

 

[Winged Scapula]

Agreed. Having worked at 3 different hospitals in different regions of the country) I can say no one I have ever worked with has called themselves a surgeon. I have seen literally hundreds correct patient's though. perhaps what's happening is the patient's get confused and tell the cts or vascular surgeon and they saw another surgeon and the surgeons assume everyone wants to be a surgeon.

To be honest, why would a cardiologist want to be a cardiac surgeon? Catheter based interventions are supplanting the majority of the bread and butter CTS cases and even for multivessel cad there are no differences btw cabg and pci if there is complete revascularization.

It is rare a patient would rather get open surgery. For times when there is a non-surgical option but the patient should get surgery, i have to basically force the patient to go to surgery.

Perhaps and nope.

We know patients get confused. I correct patients all the time when they refer to a non-surgeon as a surgeon, an NP as a doctor, or me as an oncologist. This is not the problem we're talking about. We are talking about hearing non-surgeons tell patients they're surgeons, referring to the procedures they're doing as surgery and signing their notes, "Cardiac Surgery".

"...assume everyone wants to be a surgeon"? C'mon. In fact, we know most people don't want to. Perhaps your surgeons are that egotistical but most of are glad there are people who do things we don't want to do and that there those who share our interests.

This is a dumb argument. Why not believe us, especially given multiple similar experiences around the country. So you haven't heard it, doesn't mean it doesn't exist.

 

[mimelim]

I’ve never heard an IC person call themselves a surgeon. I’m starting IC fellowship in a year. We do endovascular procedures. Sometimes advanced procedures (TAVR, TMVR, Watchman, etc) and mechanical support too. But we are cardiologists. Y’all surgeons can keep the “surgeon” name.

Reminded me of this thread this morning...

CNN Front page...
Mark Hausknecht's shooting was over a grudge from 20 years ago, police say - CNN

Title on www.cnn.com Cardiologist performed surgery that left the suspect's mother dead. Now a manhunt is underway.

Now, this is obviously CNN putting this on here. Journalists don't always know the 'nuances' of medical things. My point is that this happens all the time and it is not uncommon for IC to bill themselves as surgeons. I know the neck of the woods where this happened. It would not surprise me that when the journalists were sourcing their story that when they called his office or asked other people in the area, they referenced him as a surgeon performing surgeries.

 

[TypeADissection]

It would not surprise me that when the journalists were sourcing their story that when they called his office or asked other people in the area, they referenced him as a surgeon performing surgeries.

Where I did my residency, there was a local cardiologist who was a mercenary of sorts. He dropped a bunch of stents in the tibials and surprise the leg went down and it became an acute issue for us on a Friday night while he was probably at a strip club making it rain. Anyway, we went to talk to the family and they kept referring to him as a cardiovascular surgeon. I thought it was because they just didn't know the difference, but then I came to find out this is actually how he referred to himself when talking to patients and families. People just don't know.

 

[gflo63]

Im a new surgical intern interested in CT surgery, I think that outcomes research and demand will keep the profession alive. However what are the odds that by the time I apply in 5 years all the CT spots are integrated?

 

[IMreshopeful]

Reminded me of this thread this morning...

CNN Front page...
Mark Hausknecht's shooting was over a grudge from 20 years ago, police say - CNN

Title on www.cnn.com Cardiologist performed surgery that left the suspect's mother dead. Now a manhunt is underway.

Now, this is obviously CNN putting this on here. Journalists don't always know the 'nuances' of medical things. My point is that this happens all the time and it is not uncommon for IC to bill themselves as surgeons. I know the neck of the woods where this happened. It would not surprise me that when the journalists were sourcing their story that when they called his office or asked other people in the area, they referenced him as a surgeon performing surgeries.

Yeah I’ve moved on from this. If someone wants to call themselves that, whatever. I don’t and I won’t. I have yet to meet anyone who does.

 

[Shambere]

How long has it been since you’ve seen a gynecologist operate? Ever scrub in with one?

I must agree, there is something intriguing and different about seeing a gynecologist operate, they perform surgery, but they've been their own thing for so long, that some traditions dont apply.

 

[mw18]

Im a new surgical intern interested in CT surgery, I think that outcomes research and demand will keep the profession alive. However what are the odds that by the time I apply in 5 years all the CT spots are integrated?

Very Low, approaching zero.

 

[aafisahar]

I was having a high-self-esteem day, now I’m going to have to stand in front of a mirror carelessly smearing lipstick across my face while chanting,
“You’ll never be smart enough. Looks are all you have.”

If it's any consolation, he probably just finished training like 5 years ago. I probably make more money as a PGY3 moonlighting my ass of than he makes in NYC in terms of real dollars.

 

[Shambere]

If it's any consolation, he probably just finished training like 5 years ago. I probably make more money as a PGY3 moonlighting my ass of than he makes in NYC in terms of real dollars.

what is your specialty?

 

[Neurointerventionalist]

This shows a fair amount of ignorance of the history of interventional neuroradiology, relatively recently rebranded as endovascular neurosurgery.

I don’t think neurosurgery really wants it, just wants to take control of it to avoid any future interventional technique taking away their bread and butter like for CT surgery. Far more lucrative to be a spine surgeon with a much better call schedule. It’s even hard to convince diagnostic neuroradiologists to do interventions, often more lucrative to read MRIs than do the longer procedures, and the call burden is very heavy, up to q1 in more rural areas

Neurologists definitely want it.

Back in 2000 90% of INR procedures were performed by neurorad, and yet in 2015 the thrombectomy share was rad 61% and nsg 16% (pubmed data); and this is US: in Europe it's only rad.

IC is a completely different story: Andreas Gruentzig and the first gen of IC were cardiologists, so nobody stole anything.

Hope that INR will find an identity (just like IR and IC did) to end turf wars between neurorad, neurologists and nsg.

 

[deleted103644]

Back in 2000 90% of INR procedures were performed by neurorad, and yet in 2015 the thrombectomy share was rad 61% and nsg 16% (pubmed data); and this is US: in Europe it's only rad.

IC is a completely different story: Andreas Gruentzig and the first gen of IC were cardiologists, so nobody stole anything.

Hope that INR will find an identity (just like IR and IC did) to end turf wars between neurorad, neurologists and nsg.

You misunderstand me. I’m not saying cardiothoracic surgeons were performing caths.

It’s that interventional cardiology procedures stole some of their bread and butter cases. Stenting versus CABG, TAVR vs open valve replacement, etc.

For neurosurgery, the equivalent is aneurysm clipping vs coiling.

If cardiology stole the techniques of cardiac cath from anybody, it would actually be the radiologists.

 

[Neurointerventionalist]

You misunderstand me. I’m not saying cardiothoracic surgeons were performing caths.

It’s that interventional cardiology procedures stole some of their bread and butter cases. Stenting versus CABG, TAVR vs open valve replacement, etc.

For neurosurgery, the equivalent is aneurysm clipping vs coiling.

If cardiology stole the techniques of cardiac cath from anybody, it would actually be the radiologists.

I was actually agreeing with you: it's INR that is rebranded by neurosurgeons, after neurorads trained them in endovascular techniques. Neurorads entered the fellowships before NSG just because... they were neuroradiological fellowship, as you can read in most US neurosurgeon CV ("interventional neuroradiology fellowship"), accepting neurosurgeons because of the shortage of neurorads; and like you said, I fear that the field is more and more unattractive...

In the US there will probably be so many IR and neurologists sharing most thrombectomies and many NSG (always more) and INR (always less) sharing most aneurysms/AVMs/DAVFs.
Very bad for the field, since doing both greatly and synergically improves expertise and the fragmentation of the community will result in worse meetings and education.

Cardiologists didn't steal anything as they developed coronay interventions on their own.

 

[IMreshopeful]

You misunderstand me. I’m not saying cardiothoracic surgeons were performing caths.

It’s that interventional cardiology procedures stole some of their bread and butter cases. Stenting versus CABG, TAVR vs open valve replacement, etc.

For neurosurgery, the equivalent is aneurysm clipping vs coiling.

If cardiology stole the techniques of cardiac cath from anybody, it would actually be the radiologists.

That is not theft. That’s developing a minimally invasive procedure that is equivalent to CABG (in many not all cases) and superior for high risk, non inferior for low to moderate risk patients (TAVR). That’s like saying triple therapy for H pylori stole gastrectomy