M4 starting to consider integrated vascular...with 12 days until ERAS.

themailman

5+ Year Member
Nov 11, 2010
53
21
Cary, North Carolina
Status
Pre-Medical
as stated above, your interview yield is probably going to be pretty low with no mention of vascular in your application. integrated programs are designed for those who are certain they want to pursue vascular. they have vascular research, have attended vascular conferences, have made vascular connections, have done vascular sub-i's...you get the picture. it is unlikely that a program would consider your application, although you may get a bite if you have high step scores. the number of available positions for integrated programs is very low, so they really want people that have a sincere interest in the field, not necessarily those that just liked the rotation.

you can give it a shot, though. there aren't that many programs and you shouldn't even apply to the bigger name places, so that will save you a little money. if you do get interviews though, you should have a really good reason on why you wanted to switch from general surgery. and don't bash general surgery in your interview. the vast majority of vascular surgeons were trained in general surgery.
 

mimelim

Vascular Surgery
7+ Year Member
Sep 19, 2011
4,878
14,339
Status
Attending Physician
So, yeah, I was planning on doing GS but now I'm starting to really like vascular. I did a few days at a small community hospital and really enjoyed it. I feel like I want to do integrated vascular now but...my application is entirely GS with no hints of interest in vascular.

Should I go forward with a GS application and do 5+2 or try to apply to 0+5 and just hope that I get enough interviews?
#1 There are a ton of reasons why vascular is not a good field to go into. I say this as someone who is in vascular surgery and will likely be for the remainder of his career. Several days at a community hospital is not enough to make an informed decision to commit to anything, much less the specialty that literally has on average the worst work hours of any specialty.
#2 There is a wide variety of programs out there. There are some programs that struggle to match every year. But, they are few and far in between. They are programs on probation or nearly on probation. They are programs with terrible education or malignant histories. In short, not programs that you want to be training at for 5+years. Most programs rank interest in vascular surgery as one of the very important factors in rank listing. Our median applicant has done 3 aways in vascular surgery, has 2 publications in vascular surgery and has attended 1 vascular conference in the previous year. And remember, we get 200+ applications for 2 spots. Assuming that you have a 260 Step 1 and 2, above average LOR and zero big guns advocating for you, you will get a look or two from some programs, but are not going to be seriously considered at the vast majority of programs. Certainly at ours, you would not get an interview. For programs that only have 1 or 2 residents per year, it is a big problem when a resident drops out. That risk is much much higher with someone who has a couple of days of vascular exposure vs. someone who has been investing in the field for months, if not years.

Now... here is a PM I got dated 8/20/2015:
----------------------------------------------------
Hello,

I have been reading many of your posts and I wanted to thank you for all the incredibly helpful advice that you have posted. I am a fourth year medical student who was set on going into GS until a couple of weeks ago when I started a Vascular Sub-I and absolutely fell in love with vascular. Now I am considering applying to the integrated vascular residency. I have a few questions for you and would be extremely grateful for your opinion.

1. Do you feel the integrated route provides adequate training in open vascular cases compared to the traditional route? I want to make sure that I finish training confident with doing open AAA.

2. Since I am just now falling in love with vascular, I have no letters of rec from vascular surgeons. All of my letters are from GS and surgical oncologists because I did my home Sub-I with surg onc. Do you think that not having letters of rec from vascular surgeons would kill my chances? I could ask some of the vascular attendings on my current Sub-I for letters although it might be pushing it time wise since applications are due in about three weeks. How bad would it look if I had no vascular letters?

3. I have no vascular research. Just two GS abstracts and a basic science paper from undergrad. Will this make matching into vascular difficult? My step 1 is a *** and my step 2 is a ***. Do I even have a shot to integrated with these numbers and research? I am a US applicant.

Sorry to bother you with these questions but I didn't know who else to turn to. Any feedback would be really appreciated. Thanks!

Have a great evening.
------------------------------------------------------
My response dated 8/23/2015:
Sorry, was on vacation last week.

#1 You will get better open vascular training at an integrated vascular program than doing general surgery first and then vascular. The best training sites in the country have all gone integrated. There are very few places that do large numbers of open aortas that don't have an integrated program. The reason that people don't feel confident doing open AAA is because we simply don't do that many anymore as a specialty. We push the endo frontier hard. Fenestrated, snorkel/chimney, etc are here to stay. There are just fewer and fewer patients undergoing open repair. You will graduate from every IVS program in the US with adequate numbers, but unless you go to a high volume open AAA program (Wisconsin, Wash U, MGH, Methodist, etc.) you are not going to necessarily feel comfortable doing them on your own after leaving.

The argument that people will make is that you will get better "open" experience as a general surgery resident. This is probably true given that you will do two chief years as a general surgery resident. Of course, this is at the expense of two years of your life. You will also spend a HUGE amount of intern, junior and chief level time learning laparoscopic skills that will not be particularly useful. Our interns second assist all the open AAA in our program so that they get more exposure earlier. I'd like to think that that is a lot more helpful than holding a scope during a lap chole.

#2 It is a hard sell to not have vascular letters. Vascular, like most sub-specialties is a small field. I went to SAVS, SCVS, SVS and VIETH last year. It is the same faces, the same institutions, over and over and over. When I interviewed at places, virtually every program had faculty that either trained with or trained the faculty at my home school as well as where I did aways. When I interviewed at the program I am at, the chairman asked me, "So if I called Dr. *program director at your med school* what would he say about you?" *mimelim answer*, chairman: "Ya, thats what he told me when I called him yesterday". We call letter writers on every single candidate we are seriously considering for our program. Certainly not everyone, but since programs only get to take 1 or 2 residents per year, we aim to get every single one of them right. We would rather not match than match a bad candidate. We can fill with absolute superstar IMG which is preferable to a ****ty American grad. I would try as hard as you can to get whatever letters you can. If you leave the big academic programs, you are going to find places that are a lot less name/networking oriented, but even places like SIU/Case/SLU are driven by strong faculty that know everyone. Is an application sunk? No. But, it is definitely an uphill battle.

#3 Vascular research is not a requirement, especially for non research/academic focused programs. Places that have mandatory research years are going to look for prior productivity, but even those aren't looking specifically for vascular research. Bonus for sure, but GS research + background is above average for sure. Steps ***/*** is competitive for any program in the country. By far your biggest deficiency is going to be letters in the field. Get what you can, quickly. Bug the faculty at your school, even if it is a 'weak' letter, you want them to know you are interested and available if something comes up.

If you don't mind sharing, what school are you at?

---------------------------------------------------------

Guess who I signed out our vascular service to 2 hours ago? Answer: That guy that PMed me on SDN who is now my intern. He setup the rest of his aways, he got great letters of rec from several well known faculty and he matched at our program. Could not be happier with him. The fact that he put together an incredibly strong application that quickly is a testament to the rock star that he is. I have a pretty big ego and I have little doubts that he will be a better surgeon than me in the end.

In summary: Are you what IVS programs are looking for? Do you have the numbers/drive/passion for it? If yes, then work your ass off, buff the **** out of your application, get the letters, get the experience and apply. If this is just a flirtation after a couple of days, don't waste your time and money.
 

DoctorLacrosse

7+ Year Member
Jan 18, 2012
1,921
2,153
The Intrawebz
Status
Medical Student
#1 There are a ton of reasons why vascular is not a good field to go into. I say this as someone who is in vascular surgery and will likely be for the remainder of his career. Several days at a community hospital is not enough to make an informed decision to commit to anything, much less the specialty that literally has on average the worst work hours of any specialty.
#2 There is a wide variety of programs out there. There are some programs that struggle to match every year. But, they are few and far in between. They are programs on probation or nearly on probation. They are programs with terrible education or malignant histories. In short, not programs that you want to be training at for 5+years. Most programs rank interest in vascular surgery as one of the very important factors in rank listing. Our median applicant has done 3 aways in vascular surgery, has 2 publications in vascular surgery and has attended 1 vascular conference in the previous year. And remember, we get 200+ applications for 2 spots. Assuming that you have a 260 Step 1 and 2, above average LOR and zero big guns advocating for you, you will get a look or two from some programs, but are not going to be seriously considered at the vast majority of programs. Certainly at ours, you would not get an interview. For programs that only have 1 or 2 residents per year, it is a big problem when a resident drops out. That risk is much much higher with someone who has a couple of days of vascular exposure vs. someone who has been investing in the field for months, if not years.

Now... here is a PM I got dated 8/20/2015:
----------------------------------------------------
Hello,

I have been reading many of your posts and I wanted to thank you for all the incredibly helpful advice that you have posted. I am a fourth year medical student who was set on going into GS until a couple of weeks ago when I started a Vascular Sub-I and absolutely fell in love with vascular. Now I am considering applying to the integrated vascular residency. I have a few questions for you and would be extremely grateful for your opinion.

1. Do you feel the integrated route provides adequate training in open vascular cases compared to the traditional route? I want to make sure that I finish training confident with doing open AAA.

2. Since I am just now falling in love with vascular, I have no letters of rec from vascular surgeons. All of my letters are from GS and surgical oncologists because I did my home Sub-I with surg onc. Do you think that not having letters of rec from vascular surgeons would kill my chances? I could ask some of the vascular attendings on my current Sub-I for letters although it might be pushing it time wise since applications are due in about three weeks. How bad would it look if I had no vascular letters?

3. I have no vascular research. Just two GS abstracts and a basic science paper from undergrad. Will this make matching into vascular difficult? My step 1 is a *** and my step 2 is a ***. Do I even have a shot to integrated with these numbers and research? I am a US applicant.

Sorry to bother you with these questions but I didn't know who else to turn to. Any feedback would be really appreciated. Thanks!

Have a great evening.
------------------------------------------------------
My response dated 8/23/2015:
Sorry, was on vacation last week.

#1 You will get better open vascular training at an integrated vascular program than doing general surgery first and then vascular. The best training sites in the country have all gone integrated. There are very few places that do large numbers of open aortas that don't have an integrated program. The reason that people don't feel confident doing open AAA is because we simply don't do that many anymore as a specialty. We push the endo frontier hard. Fenestrated, snorkel/chimney, etc are here to stay. There are just fewer and fewer patients undergoing open repair. You will graduate from every IVS program in the US with adequate numbers, but unless you go to a high volume open AAA program (Wisconsin, Wash U, MGH, Methodist, etc.) you are not going to necessarily feel comfortable doing them on your own after leaving.

The argument that people will make is that you will get better "open" experience as a general surgery resident. This is probably true given that you will do two chief years as a general surgery resident. Of course, this is at the expense of two years of your life. You will also spend a HUGE amount of intern, junior and chief level time learning laparoscopic skills that will not be particularly useful. Our interns second assist all the open AAA in our program so that they get more exposure earlier. I'd like to think that that is a lot more helpful than holding a scope during a lap chole.

#2 It is a hard sell to not have vascular letters. Vascular, like most sub-specialties is a small field. I went to SAVS, SCVS, SVS and VIETH last year. It is the same faces, the same institutions, over and over and over. When I interviewed at places, virtually every program had faculty that either trained with or trained the faculty at my home school as well as where I did aways. When I interviewed at the program I am at, the chairman asked me, "So if I called Dr. *program director at your med school* what would he say about you?" *mimelim answer*, chairman: "Ya, thats what he told me when I called him yesterday". We call letter writers on every single candidate we are seriously considering for our program. Certainly not everyone, but since programs only get to take 1 or 2 residents per year, we aim to get every single one of them right. We would rather not match than match a bad candidate. We can fill with absolute superstar IMG which is preferable to a ****ty American grad. I would try as hard as you can to get whatever letters you can. If you leave the big academic programs, you are going to find places that are a lot less name/networking oriented, but even places like SIU/Case/SLU are driven by strong faculty that know everyone. Is an application sunk? No. But, it is definitely an uphill battle.

#3 Vascular research is not a requirement, especially for non research/academic focused programs. Places that have mandatory research years are going to look for prior productivity, but even those aren't looking specifically for vascular research. Bonus for sure, but GS research + background is above average for sure. Steps ***/*** is competitive for any program in the country. By far your biggest deficiency is going to be letters in the field. Get what you can, quickly. Bug the faculty at your school, even if it is a 'weak' letter, you want them to know you are interested and available if something comes up.

If you don't mind sharing, what school are you at?

---------------------------------------------------------

Guess who I signed out our vascular service to 2 hours ago? Answer: That guy that PMed me on SDN who is now my intern. He setup the rest of his aways, he got great letters of rec from several well known faculty and he matched at our program. Could not be happier with him. The fact that he put together an incredibly strong application that quickly is a testament to the rock star that he is. I have a pretty big ego and I have little doubts that he will be a better surgeon than me in the end.

In summary: Are you what IVS programs are looking for? Do you have the numbers/drive/passion for it? If yes, then work your ass off, buff the **** out of your application, get the letters, get the experience and apply. If this is just a flirtation after a couple of days, don't waste your time and money.
that's an awesome story.
 
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Phloston

Lifetime Donor
7+ Year Member
Jan 17, 2012
3,660
1,353
Osaka, Japan
#1 There are a ton of reasons why vascular is not a good field to go into. I say this as someone who is in vascular surgery and will likely be for the remainder of his career. Several days at a community hospital is not enough to make an informed decision to commit to anything, much less the specialty that literally has on average the worst work hours of any specialty.
#2 There is a wide variety of programs out there. There are some programs that struggle to match every year. But, they are few and far in between. They are programs on probation or nearly on probation. They are programs with terrible education or malignant histories. In short, not programs that you want to be training at for 5+years. Most programs rank interest in vascular surgery as one of the very important factors in rank listing. Our median applicant has done 3 aways in vascular surgery, has 2 publications in vascular surgery and has attended 1 vascular conference in the previous year. And remember, we get 200+ applications for 2 spots. Assuming that you have a 260 Step 1 and 2, above average LOR and zero big guns advocating for you, you will get a look or two from some programs, but are not going to be seriously considered at the vast majority of programs. Certainly at ours, you would not get an interview. For programs that only have 1 or 2 residents per year, it is a big problem when a resident drops out. That risk is much much higher with someone who has a couple of days of vascular exposure vs. someone who has been investing in the field for months, if not years.

Now... here is a PM I got dated 8/20/2015:
----------------------------------------------------
Hello,

I have been reading many of your posts and I wanted to thank you for all the incredibly helpful advice that you have posted. I am a fourth year medical student who was set on going into GS until a couple of weeks ago when I started a Vascular Sub-I and absolutely fell in love with vascular. Now I am considering applying to the integrated vascular residency. I have a few questions for you and would be extremely grateful for your opinion.

1. Do you feel the integrated route provides adequate training in open vascular cases compared to the traditional route? I want to make sure that I finish training confident with doing open AAA.

2. Since I am just now falling in love with vascular, I have no letters of rec from vascular surgeons. All of my letters are from GS and surgical oncologists because I did my home Sub-I with surg onc. Do you think that not having letters of rec from vascular surgeons would kill my chances? I could ask some of the vascular attendings on my current Sub-I for letters although it might be pushing it time wise since applications are due in about three weeks. How bad would it look if I had no vascular letters?

3. I have no vascular research. Just two GS abstracts and a basic science paper from undergrad. Will this make matching into vascular difficult? My step 1 is a *** and my step 2 is a ***. Do I even have a shot to integrated with these numbers and research? I am a US applicant.

Sorry to bother you with these questions but I didn't know who else to turn to. Any feedback would be really appreciated. Thanks!

Have a great evening.
------------------------------------------------------
My response dated 8/23/2015:
Sorry, was on vacation last week.

#1 You will get better open vascular training at an integrated vascular program than doing general surgery first and then vascular. The best training sites in the country have all gone integrated. There are very few places that do large numbers of open aortas that don't have an integrated program. The reason that people don't feel confident doing open AAA is because we simply don't do that many anymore as a specialty. We push the endo frontier hard. Fenestrated, snorkel/chimney, etc are here to stay. There are just fewer and fewer patients undergoing open repair. You will graduate from every IVS program in the US with adequate numbers, but unless you go to a high volume open AAA program (Wisconsin, Wash U, MGH, Methodist, etc.) you are not going to necessarily feel comfortable doing them on your own after leaving.

The argument that people will make is that you will get better "open" experience as a general surgery resident. This is probably true given that you will do two chief years as a general surgery resident. Of course, this is at the expense of two years of your life. You will also spend a HUGE amount of intern, junior and chief level time learning laparoscopic skills that will not be particularly useful. Our interns second assist all the open AAA in our program so that they get more exposure earlier. I'd like to think that that is a lot more helpful than holding a scope during a lap chole.

#2 It is a hard sell to not have vascular letters. Vascular, like most sub-specialties is a small field. I went to SAVS, SCVS, SVS and VIETH last year. It is the same faces, the same institutions, over and over and over. When I interviewed at places, virtually every program had faculty that either trained with or trained the faculty at my home school as well as where I did aways. When I interviewed at the program I am at, the chairman asked me, "So if I called Dr. *program director at your med school* what would he say about you?" *mimelim answer*, chairman: "Ya, thats what he told me when I called him yesterday". We call letter writers on every single candidate we are seriously considering for our program. Certainly not everyone, but since programs only get to take 1 or 2 residents per year, we aim to get every single one of them right. We would rather not match than match a bad candidate. We can fill with absolute superstar IMG which is preferable to a ****ty American grad. I would try as hard as you can to get whatever letters you can. If you leave the big academic programs, you are going to find places that are a lot less name/networking oriented, but even places like SIU/Case/SLU are driven by strong faculty that know everyone. Is an application sunk? No. But, it is definitely an uphill battle.

#3 Vascular research is not a requirement, especially for non research/academic focused programs. Places that have mandatory research years are going to look for prior productivity, but even those aren't looking specifically for vascular research. Bonus for sure, but GS research + background is above average for sure. Steps ***/*** is competitive for any program in the country. By far your biggest deficiency is going to be letters in the field. Get what you can, quickly. Bug the faculty at your school, even if it is a 'weak' letter, you want them to know you are interested and available if something comes up.

If you don't mind sharing, what school are you at?

---------------------------------------------------------

Guess who I signed out our vascular service to 2 hours ago? Answer: That guy that PMed me on SDN who is now my intern. He setup the rest of his aways, he got great letters of rec from several well known faculty and he matched at our program. Could not be happier with him. The fact that he put together an incredibly strong application that quickly is a testament to the rock star that he is. I have a pretty big ego and I have little doubts that he will be a better surgeon than me in the end.

In summary: Are you what IVS programs are looking for? Do you have the numbers/drive/passion for it? If yes, then work your ass off, buff the **** out of your application, get the letters, get the experience and apply. If this is just a flirtation after a couple of days, don't waste your time and money.
Awesome post
 
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