Multi-visceral transplant surgeons: interested in becoming one, tell me what I need to know

[greg.house1408]

I have been interested in transplant surgery for a long time. I've done some clinical research in the field, rotated through transplant as a 3rd year elective rotation, and have a personal desire to become a transplant surgeon. Lately, I've been considering the possibility of trying to specialize in multi-visceral transplant patients.

What are the things I need to know about caring for multi-visceral transplant patients and performing multi-vis operations? What are the job prospects for someone who can do multi-vis transplants in the already small community of transplant surgery? Is the already busy lifestyle of transplant made even more hectic by specializing in multi-vis? The institution where I am currently at does a few of these operations, and I was fortunate enough to see one patient for a month after his surgery. I don't think that this gave me a complete enough picture of the ins-and-outs of being a multi-vis surgeon.

Any advice or insight would be appreciated.

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[thedrjojo]

It's a niche within a niche. Even the busiest places are like 10 a year. And barely any of them exist. So there aren't many if any entry level jobs in transplant, let alone multi-visceral. Lifestyle is non-existent in all transplant (main reason I quit it). Patients can be slightly better than intestinal alone transplants because the liver actually helps the immunologically.

 

[frmrgs2doc]

@thedrjojo what are you doing now if you're not doing transplant? Did you decide to do another fellowship or general surgery?

 

[thedrjojo]

@thedrjojo what are you doing now if you're not doing transplant? Did you decide to do another fellowship or general surgery?

General surgery (past year was an attending with my residency, primarily as a small hospital we just took over)

however, I'm about to start at the VA hospital affiliated with my residency as site director

 

[frmrgs2doc]

Nice!! Congrats. I talked myself out of transplant after my rotation my PGY3 year (thank God I did it at a malignant place, dodged a bullet). Also your posts helped keep my eyes open about it.

 

[aorticonduit]

Transplant surgery is a difficult field, and many people who start out with training do not complete the fellowship. Those who complete the fellowship do not always find transplant jobs, too.

For those who love the field and are able to find jobs, it is a fantastic field. The surgeries are interesting, and the patients are grateful. You can save lives. It is simple-minded, wrong, and a disservice to OP to say lifestyle is "non-existent" for transplant surgeons. I would discourage people interested in transplant to take as gospel advice from someone who quit the fellowship.

Most surgeons who do MVT also do liver transplant. Some centers with meaningful volumes of MVT are Georgetown, The Cleveland Clinic, Mt. Sinai, Miami, and Nebraska. If you decide this is something you definitely want to pursue, it makes sense to do a fellowship where they do MVT. Check out this link to see what centers are doing intestine transplant, as this tracks with MVT volume: Center Data - OPTN

Happy to answer more questions if OP has any.

 

[thedrjojo]

Transplant surgery is a difficult field, and many people who start out with training do not complete the fellowship. Those who complete the fellowship do not always find transplant jobs, too.

For those who love the field and are able to find jobs, it is a fantastic field. The surgeries are interesting, and the patients are grateful. You can save lives. It is simple-minded, wrong, and a disservice to OP to say lifestyle is "non-existent" for transplant surgeons. I would discourage people interested in transplant to take as gospel advice from someone who quit the fellowship.

Most surgeons who do MVT also do liver transplant. Some centers with meaningful volumes of MVT are Georgetown, The Cleveland Clinic, Mt. Sinai, Miami, and Nebraska. If you decide this is something you definitely want to pursue, it makes sense to do a fellowship where they do MVT. Check out this link to see what centers are doing intestine transplant, as this tracks with MVT volume: Center Data - OPTN

Happy to answer more questions if OP has any.

I agree, don't take my advice as gospel.

I have great respect for the field and those able to do it. It wasn't for me, but it wasn't because the surgeries or patients. It was mainly because your intro paragraph.

I'm being a bit dramatic saying it's non existent, but compared to most specialties with surgery, it is pretty much the worst there is. You have almost zero say in when your cases go, you have almost zero control in how often you get to operate, you have the most critical patients in the hospital and if you are the type of personality going into transplant, you have a difficult time let other people make any decisions about them. In fellowship I many times felt the 'too many cooks' feeling since the surgeon, the rounding attending, and all the senior people weighed in on patients...

 

[Medstart108]

I agree, don't take my advice as gospel.

I have great respect for the field and those able to do it. It wasn't for me, but it wasn't because the surgeries or patients. It was mainly because your intro paragraph.

I'm being a bit dramatic saying it's non existent, but compared to most specialties with surgery, it is pretty much the worst there is. You have almost zero say in when your cases go, you have almost zero control in how often you get to operate, you have the most critical patients in the hospital and if you are the type of personality going into transplant, you have a difficult time let other people make any decisions about them. In fellowship I many times felt the 'too many cooks' feeling since the surgeon, the rounding attending, and all the senior people weighed in on patients...

Definitely felt this way when for heart transplant as well. The too many cooks in the kitchen was what got me a bit. Transplant rounds were always highly contentious, as one can imagine, but things got heated and i can't imagine that week after week of these things and people don't take it personally..