Most in demand surgical specialties for global health

[Medstart108]

I'm trying to decide between two specialties, cardiac (I6) and general surgery. Unfortunately, i pretty much have to choose since my country offers few cardiac fellowships, most cardiac surgery residencies are direct entry now.

I have some interest in global health, i.e. doing some work in resource poor countries or just travelling and essentially learning from countries around the world one day.

What are the most in demand surgeons in global health both civilian and military? My guess is general, orthopedics, plastics and ophtho. Is there any room for a cardiothoracic surgeon trained through an I6 program to go abroad to do anything? Or are they too specialized and have to focus only on the heart?

My interest in global health and the idea of being a diverse surgeon, being able to do surgery generally (everything except head and neck and skin) makes me learn towards general. However, i have a strong interest in the heart, like the research aspect and like thoracic surgery.

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[bannie22]

You can always do Gen Surg and then subspecialize. There are way more hernia and gallbladders out there and performing those surgeries would be much more financially feasible and have much greater benefits to the general population than implanting one or two mechanical valves.

 

[WedgeDawg]

OB/GYN
^^^^ easily most valuable abroad

Then:
General Surg if you have c-section experience
Plastics
Ortho
Ophtho (if you have access to proper facilities which isn't necessarily a given)

This is for MSF anyway.
Basically, if you need a lot of technology, you're probably not going to be in much demand (neurosurg, CT surg)

Of your two choices, general surgery would be the most valuable abroad (again, especially if you have some obstetrical experience somehow)

 

[Med0123]

if you really like cardiac surgery and would like to have some experience in it, you could still do a residency in general surgery and THEN subspecialize in thoracic or cardiothoracic surgery. Hence you would have experience in the bread and butter of GS (hernia, GB etc.) but still would be confortable in the chest/neck

 

[Norskyboy]

Though the above posters are correct in that general surgery has more applicability to global humanitarian relief, cardiothoracic surgery does have a role in the arena. It is hard if not impossible to volunteer with organizations such as MSF, where the bulk of the services needed are either combat related or gen surg/OB/GYN. These organizations have a little need or the equipment and personnel to perform cardiac surgery. The niche, within other NGOs, for cardiac would be mitral valve repair. Mital stenosis, 2/2 rheumatic disease, is rampant with in the developing world. In particular, the pediatric and young adult population this is typically amenable through MV repair. If you are a congenital surgeon, The possibilities are even greater, as most developing countries lack any congenital services.

 

[doc05]

Though the above posters are correct in that general surgery has more applicability to global humanitarian relief, cardiothoracic surgery does have a role in the arena. It is hard if not impossible to volunteer with organizations such as MSF, where the bulk of the services needed are either combat related or gen surg/OB/GYN. These organizations have a little need or the equipment and personnel to perform cardiac surgery. The niche, within other NGOs, for cardiac would be mitral valve repair. Mital stenosis, 2/2 rheumatic disease, is rampant with in the developing world. In particular, the pediatric and young adult population this is typically amenable through MV repair. If you are a congenital surgeon, The possibilities are even greater, as most developing countries lack any congenital services.

sounds like better use of penicillin would be more cost-effective.

 

[kitsunepixie]

Almost any specialty is in need out there. I did 2 weeks in a remote village in Kenya doing just pediatric neurosurgery and they had our schedule absolutely filled for us before we even arrived--go with your passion!

 

[Norskyboy]

sounds like better use of penicillin would be more cost-effective.

So would diet and excercise within our country but we know how well that is going.

 

[Winged Scapula]

So would diet and excercise within our country but we know how well that is going.

Apples and oranges.


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[lymphocyte]

I can speak to MSF and similar "field-oriented" programmes, but @WedgeDawg pretty much nailed it.

1. OBGYN. By far.
2. General surgery.

Others --
Optho (check out the Fred Hollows Foundation)
Paediatric surgery... very, very high need. (But again, for general paediatric surgeons.)

Otherwise, the only role you'd have as a specialised adult surgeon would be to create capacity by training local surgeons, building up speciality hospitals, raising funds to donate specialised equipment. etc. Why? Because there just ain't that many perfusionists in Liberia... by which I mean, the technology to support speciality surgery is often unavailable; capacity-building is what you would be doing, not so much field work. And you'd probably only be doing this at regional centres or even large cities like Dhaka or Cebu.

I would caution against choosing a career-path based on "some interest" in global health. The burnout is tremendous. The work can be dangerous. Life in the field is not sustainable long-term. I respect the altruistic impulse, but you can probably do much more good by donating money for malaria nets than offering your specialised services to a small village.

For what it's worth, my recommendation is to go wherever your passion and technical enjoyment take you. There will always be some place for you in global health regardless of what you pursue. For example, one of my heroes in global health is actually an endocrinologist, who helped discover the link between iodine deficiency and cretinism. Using iodised salt, he raised the average IQ in large parts of rural China by ~20 points. It's the simple things...

Oh, and not sure if she's still active, but @BlondeDocteur has spoken about this topic very eloquently in the past.

 

[droliver]

Having spent months in Africa, it's General Surgery all day long as what's needed the most as it is such a flexible skillset. They kind of do it all in rural areas and mission hospitals.

An OBGYN is too limited in skillset for those kinds of setting to recruit (unless it's the spouse of the surgeon and they're there anyway), and a General Surgeon normally does all the surgical obstetrics and gynecology (those procedures aren't that hard if you're already fluent in abdominal surgery). That's true for simple orthopedics, vascular, trauma, thoracic, burns, GU, and most head and neck as well. Most of the volume of surgical cases I saw were hernia, goiters, burns (lots of open fires), and c-sections on a daily basis with a lot casting fractures (from falling off ox carts). Missionary surgeons also usually get taught the basics of decompressing subdural hematoma and pinning hip fractures.

CV surgeons and neurosurgeons are usually only in the largest and most populated cities in the 3rd world and patients must go there rather then be treated locally.