My attending says CT surgery has a nice lifestyle.....true?

[maverick_pkg]

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Well all posts here comment on CT surg having one of the worst lifestyles. I was asking one of the CT surgeon at our program and he, in contrast said that the life style is very good especially in an academic setting.

His point was ruptured aneursyms were pretty much the only emergency cases and the usual stuff like CABGs, valves are all done electively. Plus you have residents taking care of patients in the hospital with calls not very frequent.

So I was wondering why it is said to have one of the worst lifestyles.

 

[Dimoak]

I think it's just a "to each their own" type of deal. Even the most notoriously rough (in terms of lifestyle) specialties often have certain aspects that if presented the right way would make one wonder why the specialty has such a negative rap. I think some of the reasons why people feel CT is rough for lifestyle includes length of cases, fairly sick patients, potentially long followups, severity of complications, "poaching" by intercards of what used to be CT cases (probably not an issue in academics). Finding a job seems to also be a concern for some fellows and it seems some feel they may end up doing a fair amount of GS if they go into PP. But lately, it doesn't seem like this has been as much of a concern for CT fellows. Just my 2¢.

 

[maxheadroom]

CT is typically a pretty busy job. CABGs and Valves are done emergently fairly often (at least at my place).

 

[PoetMD]

what about Peds CT? Anybody know about how hard these surgeons work? Seems like there are fewer cases so is the lifestyle as bad? then again there may be fewer cases but there's also fewer congenital ct surgeons at any given place so perhaps it still adds up to a lot of hours....

just curious cuz we dont have one of these at my school and I've always been interested in this area

 

[maverick_pkg]

I think some of the reasons why people feel CT is rough for lifestyle includes length of cases, fairly sick patients, potentially long followups, severity of complications, "poaching" by intercards of what used to be CT cases (probably not an issue in academics). Finding a job seems to also be a concern for some fellows and it seems some feel they may end up doing a fair amount of GS if they go into PP. But lately, it doesn't seem like this has been as much of a concern for CT fellows. Just my 2¢.

well the valves and CABGs I have seen after 3 months of the rotation typically take 5-6 hours. The CT surgeons here do 1 case a day so their day starts at 8am, OR till 1-2pm, then other stuff - seeing consults, round etc till 6-7pm. Doesnt seem bad at all

CT is typically a pretty busy job. CABGs and Valves are done emergently fairly often (at least at my place).

Hmmm is that typical everywhere?...havent seen one done emergently here. Its generally done within next couple of days. Very rarely would we do 2 cabgs/valves in 1 day.

 

[Black Surgeon]

I'm an aspiring and hopefully future CT surgeon. The two CT surgeons I have shadowed at an academically affiliated heart center have both told me not to go into CT if I want family time. In fact, they both told me not to go into CTS at all. According to them, "the sacrifice is too great and the field is dead and getting buried". But again, keep in mind that those guys were practicing CT surgeons when the average yearly salary was ranging from $800k to a million. This probably lends strength to their disgruntled attitudes towards the field. From what I've observed, they really are extremely busy. One of them loves telling me about how he doesn't see day light for days at a time. He is off to work at 4 AM (when its still dark), often spends the day in the OR and gets home at around 9 PM. "just in time to put the kids to bed, but hey! Someone has got to do it" he says.

 

[dynx]

well the valves and CABGs I have seen after 3 months of the rotation typically take 5-6 hours. The CT surgeons here do 1 case a day so their day starts at 8am, OR till 1-2pm, then other stuff - seeing consults, round etc till 6-7pm. Doesnt seem bad at all



Hmmm is that typical everywhere?...havent seen one done emergently here. Its generally done within next couple of days. Very rarely would we do 2 cabgs/valves in 1 day.

WHoa! Thats slow. I think most do at least 2 a day. I worked with one that started at 7am and his goal was 3 by 3. that is done with 3 cases by 3pm. Of note, his turnover time was literally zero as he'd have someone cracking the chest of his next case while he was finishing the first.

 

[maxheadroom]

I agree, most of the CT guys that I worked with (back in the dark ages) did at least two cases per day and often three. They almost always had a second room. The PA would close leg & chest on the first case and the surgeon would head over to the second room to get things started.

Emergent/urgent CABGs & Valves are pretty common around here. I don't know the details, but I get the impression that when Cards calls you come running.

CT is NOT a good lifestyle specialty, regardless. You get the patients who have been stented multiple times. Sewing your graft into wire isn't much fun. The patients can be super-sick. The patients stay in house for a long time (at least a week). Not my idea of a good time.

 

[maverick_pkg]

WHoa! Thats slow. I think most do at least 2 a day. I worked with one that started at 7am and his goal was 3 by 3. that is done with 3 cases by 3pm. Of note, his turnover time was literally zero as he'd have someone cracking the chest of his next case while he was finishing the first.

well we dont have fellows and residents rotate on CT as 2nd years and thus we dont do too much. Attendings crack the chest and stay till closing. So typically cases start around 8:30am with vein harvesting, chest gets cracked by 8:45, patient put on bypass and the real case starting by 10am or so, till 12pm. then closing may take an hour or hour and a half depending how easily the patient comes off the pump and the like.

u didnt touch on the lifestyle. if they finish by 3pm do they go home by 6pm? what kind of emergencies do they get and how frequent?

am interested in CT but all we see is cabgs/valves. whats the mix of cases out there in the academic/community setting. is it the same?

 

[Dimoak]

u didnt touch on the lifestyle. if they finish by 3pm do they go home by 6pm? what kind of emergencies do they get and how frequent?

This really depends on your facility and practice structure. I think the usual surgical mantra applies; if you're done with your regularly scheduled cases by 3pm, checked on PTs, completed all of your documentation, some days you can leave by 6pm, some days you might leave earlier, some days you might leave later (and at any point you might end up going back to the hospital later that night). Frequency also depends on facility and practice type (is it a heart referral center, how many surgeons, fellows, PAs available to spread work across). Emergencies would include iatrogenics, ACS not responding to less-invasive intervention, opening up botched interventional cases, trauma, etc.

am interested in CT but all we see is cabgs/valves. whats the mix of cases out there in the academic/community setting. is it the same?

If you're out in a PP community setting, CABGs and valves will probably be your bread and butter and make up at least 50%+ of your cases. In academics, if you're a junior faculty, it'll be somewhat similar to that except you'll occassionally get something more interesting like a Battista or Blalock-Taussig, etc. As a senior faculty, you may be in a position where you can cherry-pick the most interesting cases for yourself and do very little if any CABGs and valves.

 

[maverick_pkg]

Emergencies would include iatrogenics, ACS not responding to less-invasive intervention, opening up botched interventional cases, trauma, etc.

how frequent are these? I have never seen an incidence where our CT surgeons have had to come in the middle of the night, and its been 2 years. Exceptions are the rupturing AAAs and the chest traumas. so if u dont mind, what kind of iatrogenics? what kind of unresponsive ACS? surprisingly havent seen that many botched up interventional cases, even though am at a university hospital

 

[JackADeli]

...If you're out in a PP community setting, CABGs and valves will probably be your bread and butter and make up at least 50%+ of your cases. In academics, if you're a junior faculty, it'll be somewhat similar to that except you'll occassionally get something more interesting like a Battista or Blalock-Taussig, etc. As a senior faculty, you may be in a position where you can cherry-pick the most interesting cases for yourself and do very little if any CABGs and valves.

I am not sure about your numbers or case load description.
First, I'm no congenital cardiac expert.... but I think Blalock-Taussig is a pediatric/congenital procedure relative to TOF. Junior and senior academics will see these if they are congenital trained.... You do not occassionally do congenital work like that (i.e. Blalock Taussig ) ....congenital trained are not going to have bread and butter CABG & valves even if junior.

Second, I don't know of anyone that is performing a "Batista". Again, it is not a procedure that a junior academic is going to "occassionally" perform. Look it up and you might see why.... something about little benefit and great risk to patients.

Third, I have not seen any academic ADULT cardiac faculty not do CABG/Valves. In fact, at the academic level what I have seen is a large number of re-do CABG & valves. These are not cherries by any stretch. As far as I have seen, straightforward CABG & valves are actually the cherries to pick at the university. The over-all volume of cardiac cases CABG etc.. has in many ways shrunk. This has left everyone including senior academics takeing whatever they can get. I have not seen senior academic faculty sitting around passing off CABG & valves while waiting for the ellusive white rhino.

Your inferences and statements suggest you are talking on a subject you know little about... maybe you watched the HBO movie on Blalock or the 20/20 & 60 minute segment on Batista....

I found your previous posts

...I'm not in med school yet (hopefully I will be some day)...

...I know the topic of MD/JDs has been discussed before ... Are there any people here doing a different MSTP at Illinois and can give me some of their impressions or feelings on how the program is run?

 

[Dimoak]

I am not sure about your numbers or case load description.
First, I'm no congenital cardiac expert.... but I think Blalock-Taussig is a pediatric/congenital procedure relative to TOF. Junior and senior academics will see these if they are congenital trained.... You do not occassionally do congenital work like that (i.e. Blalock Taussig ) ....congenital trained are not going to have bread and butter CABG & valves even if junior.

Second, I don't know of anyone that is performing a "Batista". Again, it is not a procedure that a junior academic is going to "occassionally" perform. Look it up and you might see why.... something about little benefit and great risk to patients.

Third, I have not seen any academic ADULT cardiac faculty not do CABG/Valves. In fact, at the academic level what I have seen is a large number of re-do CABG & valves. These are not cherries by any stretch. As far as I have seen, straightforward CABG & valves are actually the cherries to pick at the university. The over-all volume of cardiac cases CABG etc.. has in many ways shrunk. This has left everyone including senior academics takeing whatever they can get. I have not seen senior academic faculty sitting around passing off CABG & valves while waiting for the ellusive white rhino.

Your inferences and statements suggest you are talking on a subject you know little about... maybe you watched the HBO movie on Blalock or the 20/20 & 60 minute segment on Batista....

Yup, you're right, except for the HBO movie, 20/20, and 60 minute segments part. .

 

[maxheadroom]

I agree with JackADeli.

Congenital cases in most centers will go to a dedicated surgeon who does the congenital stuff. At most major centers, there is a super-fellowship trained Peds Cardiac surgeon -- most adult CT sugeons don't want to touch a kid if they haven't done extra training.

CABGs and Valves are the main cases for most Cardiac guys. The CT surgeons that I know love those cases -- they love the predictability and focus on the minutia of the cases that they do. You'll be a miserable bastard if you go into CT with the intention of doing something besides CABGs and Valves.

I'm not trying to attack Dimoak, but this isn't the first time that s/he has written authoritatively about a subject of which s/he has little or no first-hand knowledge.

 

[Khirurg]

In my experience, it really depends on a surgeon. True, that most ACS is now taken care of by interventional cardiologists, but every once in a while you have tight left main, which has to be bypassed. You have pericardial windows and dissections, but those don't really happen too frequently. Most of the emergencies, are the iatrogenics or prior operations that don't stop bleeding and have to be taken back.
I think it is about how busy do you want to make yourself. Not plastics, but not general surgery either.

 

[johnny_blaze]

as a CT trainee... this is my take on this topic...

In a nutshell,

Lifestyle can be good or bad depending on your practice

Adult cardiac = medium (worse if you’re doing thoracic aortic surgery)
Cardiothoracic = good – medium (routine thoracic not so bad)
Pure thoracic (+foregut oncology) = medium
Transplant = medium to bad
Paediatric = bad

Paed CT is the worst out of all of these… it is VERY sub-specialised and the units are generally small, meaning a lot of work will come your way. Children present with multiple conditions meaning that operations need to be planned very well. Junior consultants in this field may still need to do cases with senior consultants if rarities arise. Takes a long time before you reach independent confidence.