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Non bariatric minimally invasive fellowship and job profile

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maverick_pkg

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hey guys

so if one does a min. invasive fellowship (not primarily bariatric), what kind of job opportunities can one expect?
also what kind of cases would one be doing after graduating?
would you essentially be a general surgeon?
 

ajlmd

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It depends what the situation is like where you want to practice. Having extra experience with Nissens, colons, solid organ, hernias, etc can be valuable if you are going to a medium-sized community with little other competition for those cases.

However, many larger cities and academics are saturated with "specialists" (colorectal, surgical oncologists, etc) and their training tends to be more accepted as a true specialty in comparision to MIS. In other words, you may be tripping over one another to get some of the more interesting and challenging cases. There is a lot of berry-picking and it's hard as a MIS person that doesn't focus in bariatrics to be able to claim much as their territory. Unless you like ventral hernias- not much competition there. So yes, a lot of us do end up really practicing mostly general surgery and taking care of the leftovers.

If you are considering a MIS fellowship to enhance your skills, great, but if you really are interested in focusing on minimally invasive colons or abdominal pathology outside of hernias and GERD, I would highly consider colorectal or surg onc.
 

ajlmd

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To add to the above, most non-bariatric MIS programs offer primarily inguinal & ventral hernias, colons and Nissens with some random things thrown in (adrenals, feeding access, solid organ.) You also may do quite a bit of endoscopy.

Keep this in mind- to obtain a national certificate from the Fellowship Council recognizing that you completed a MIS fellowship you need 150 "complex" cases. These are considered to be bariatrics, colons, bowel resection, inguinal hernias, some feeding access, and solid organ. Note that endoscopy and ventral hernias are NOT included. If you are at a program that does not involve bariatrics, getting the 150 cases may not be easy. Most programs will give you a certificate from that institution regardless but if you are going to spend a year of fellowship, I would advise making sure that you will be eligible for the national certificate.
 

maverick_pkg

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thanks. well am interested in academics and laparoscopy. so was considering thoracic (VATS/nissens/hellers/lap esophagectomies) and MIS. problem with surg onc is you do almost no laparoscopy during your fellowship and most of your practice is open. I dont dislike it, but would prefer a field with more laparoscopy.

we dont have much exposure to colorectal at our institute, so not sure what component of open vs laparoscopic stuff there is and also what variety there is.

what options would there be for someone interested in laparoscopy?

how is the option of hepatobiliary for a year followed by MIS for a year?

typically across the country do bariatric surgeons just do bariatric surgery or do they do a mixture of bariatric, foregut and other stuff (ours do just bariatric)
 
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