ortho or ct?

[HiddenTruth]

Hey people, I'm just an MS-2, though I have some questions. Well I saw an open heart surgery last year and I was just so facinated by it that ever since then I was so interested in being a CTS. I hear that it takes abt 7-8 years to officially become a CTS. Can someone tell me the exact breakdown in terms of gen surg and fellowship? No direct program into CT like ortho? I am also interested in ortho, though I hear it is very competetive. can someone gimme some cons and pros regarding both ( in terms of lifestyle, salary, patient care, more satisfaction in which?) I feel as if int med or any "medicine" based specialty you are simply trying to "prolong" the patients care..I mean when im in clinic all we do is prescribe this and that...there are no measures in preventing the patient from comming back...where as in a surgical specialty you are "fixing" the patient...and seems so much more satisfying...let me know what you guys think...and some opinions on both those specialties..thanks a bunch...(which is more competetive?)..outlook of the future?

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[doc05]

ortho is very competitive, but the work is glorified carpentry. Pt. satisfaction is high. Pay is quite good, the work is physically demanding and hours are long.

cts is not as competitive as it used to be. this is a longer route, 7-8 years. the work can become monotonous, as most of what you do is CABG. outcomes are usually good, pay is good but nowhere near the salaries of the 1980s. hours are very long.

 

[Winged Scapula]

Originally posted by HiddenTruth
I hear that it takes abt 7-8 years to officially become a CTS. Can someone tell me the exact breakdown in terms of gen surg and fellowship? No direct program into CT like ortho? I

Currently, CTS requires at least 5+ years of general surgery (some academic programs will require some time in the laboratory) and CTS fellowship adds another 2-3 years. So you are looking at a minimum of 7 years, with most fellows being around PGY 9 or above.

There is some talk of "direct track" CTS programs (as well as for Vascular) but there are no current programs actively doing this yet.

 

[LuckyMD2b]

Originally posted by doc05
ortho is very competitive, but the work is glorified carpentry. Pt. satisfaction is high. Pay is quite good, the work is physically demanding and hours are long.

cts is not as competitive as it used to be. this is a longer route, 7-8 years. the work can become monotonous, as most of what you do is CABG. outcomes are usually good, pay is good but nowhere near the salaries of the 1980s. hours are very long.

Glorified carpentry? you could say that about any surgical specialty... Vascular surgery is glorified plumbing so is urology. Is Ct surgeon is a glorified cardiac technician? Thats so dumb

I don't understand how CABG can be come anywhere near monotonous. I'm just a naive first year. But I saw coronary arteries for the 1st time about a week ago on my cadaver, and I think it's amazing that you could anastamose anything to something so small. One of our anatomy profs is a retired CT surgeon from Isreal and when I talk to him I can see that he really misses operating, it's so sad. I bet he would beg to differ on your opinion that CT is monotonous. He says he still remembers every patient he lost. I've read "Walking on Water" and the surgeons in that book talk about the thrill and challenge of performing the perfect CABG.

When your holding someone's life in your hands (darn near playing God), you must have ADHD or some isht if you think that's monotonous .

 

[Been there]

Don't worry, you will feel that way in 6-7 years.

 

[maxheadroom]

After assisting on a few CABGs, I was ready to stick a #11 blade in my right carotid. It's that brutally boring.

 

[Winged Scapula]

Originally posted by LuckyMD2b
When your holding someone's life in your hands (darn near playing God), you must have ADHD or some isht if you think that's monotonous .

Take it from us, if you are one of the few who DON'T find it monotonous, you are either a born CTS, have an extremely high tolerance for boredom, are insane, or a little of all of these.

 

[Dr.alfa]

CTS in NOT CABG

CTS its CABG+valves+heart failure+(remodelling, lvad)+arrhythmias+aneurysms+Emergency CTS+transplantation+++++, etc etc etc.

Most people that say CTS is boring have not seen a single of congenital operation (and i'm not talking about ASDs, or simple VSDs).....

 

[Gator05]

I'm also curious about the newer OPCABG and minimally invasive CABG; aren't these new twists challenging enough to make the routine a little more, um, exciting?

It's quite a testament to modern medicine that we've made a thoracotomy, cardiac arrest, CPB, graft anastamosis, and recovery from these enormous insults to the body routine and "boring". My grandfather had his first bypass when they were just getting started; he was in the hospital for weeks, and it was a gutsy procedure then. He recently had another, minimally invasive/off-pump (not sure of the details) CABG; was extubated within hours of completion, and was home within a couple of days.

It may be boring, but it's a boring miracle that this can be done so routinely.

 

[Been there]

Originally posted by Dr.alfa
CTS in NOT CABG

CTS its CABG+valves+heart failure+(remodelling, lvad)+arrhythmias+aneurysms+Emergency CTS+transplantation+++++, etc etc etc.

Most people that say CTS is boring have not seen a single of congenital operation (and i'm not talking about ASDs, or simple VSDs).....

yes, you are right, but lets be honest with yourself. Count up the numbers of valves, congential cases, and transplants in a single year and try to tell me that your cabg numbers are not at least 10:1 ratio.

1) There are far less valve operation these day since we can treat rhematic fever with PCN at an early stage.

2) Most CT-surg do not do congential repairs except for your VSD and ASD.

3) Aneurysms are being stented by the vascular surgeons

4) Unless your are at an academic center or a transplant center, most CT-surgeons do not perform transplant (since, it really require a transplant team---with coordinators, nurses, and cardiologist).

Yes, you can say that you work at Texas heart, Baylor, Hopkins, and Stanford and lead me to think you are doing all the above, but even at those insitutions, they have specialist for each of those operations. I can't remember the last time Ped-Ct surgeon perform a Type A dissection repair.

 

[Dr.alfa]

Originally posted by Gator05
I'm also curious about the newer OPCABG and minimally invasive CABG; aren't these new twists challenging enough to make the routine a little more, um, exciting?

It's quite a testament to modern medicine that we've made a thoracotomy, cardiac arrest, CPB, graft anastamosis, and recovery from these enormous insults to the body routine and "boring". My grandfather had his first bypass when they were just getting started; he was in the hospital for weeks, and it was a gutsy procedure then. He recently had another, minimally invasive/off-pump (not sure of the details) CABG; was extubated within hours of completion, and was home within a couple of days.

It may be boring, but it's a boring miracle that this can be done so routinely.

Ooohh not another off/on pump debate....

Minimal (anything minimal) is a step forward to CTS. That's for sure.

Off pump CABG is another step forward.The tricky task is to decide who will go for off pump and who will go on pump. When the whole off pump thing started everyone was eager to adopt it. Now that things have cooled up a bit the facts are these:

1) Off pump and on pump are DIFFERENT operations. ***One cannot replace the other***.

2) There are *certain* patients that will benefit from off pump. A patient with an atherosclerotic aorta will benefit from an off pump LIMA->LAD without any manipulation of the accending aorta. Also older patients, patients with stroke risk factors, patients with coagulation problems.

3) The incidence of a screwed anastomosis is greater in the off pump group. That does not mean that an off pump anastomosis cannot be perfect, but if you do 100 off pump and same 100 on pump chances are you will screw more off pump.

4) In a standard risk patient, it does not make sense to risk an anastomosis by doing it off pump. It does not make sense to do complex grafting off pump (sequencial). If you screw a seq graft you've screwed everything.

5) CTS in not in the same place that was 20 years ago. Interventional cardiology can also revascularize, quicker, cheaper, with low hosp, stay. CTS MUST sell now the one thing that a piece of metal in the coronaries will never (in my opinion) achieve: 50-60% LIMA patency in 20 years. So QUALITY is the main concern. So the revasc MUST be FLAWLESS.

6) You must know on pump. PERIOD. If you wanna do off pump you MUST GO AND LEARN off pump. PERIOD. You must know what is best for each individual patient. Afterall patients want from you a flawless operation. Off pump/ on pump does not matter for him/her.

 

[Dr.alfa]

Originally posted by Been there
yes, you are right, but lets be honest with yourself. Count up the numbers of valves, congential cases, and transplants in a single year and try to tell me that your cabg numbers are not at least 10:1 ratio.

1) There are far less valve operation these day since we can treat rhematic fever with PCN at an early stage.

2) Most CT-surg do not do congential repairs except for your VSD and ASD.

3) Aneurysms are being stented by the vascular surgeons

4) Unless your are at an academic center or a transplant center, most CT-surgeons do not perform transplant (since, it really require a transplant team---with coordinators, nurses, and cardiologist).

Yes, you can say that you work at Texas heart, Baylor, Hopkins, and Stanford and lead me to think you are doing all the above, but even at those insitutions, they have specialist for each of those operations. I can't remember the last time Ped-Ct surgeon perform a Type A dissection repair.

1)FACT: VALVES ARE GOING UP (check the STS stats, clev clinic stats). In my institution its 60-65 % CABG, 30-35 Valve (of which 30-40% bivalve) and 5% rest.

2) sure most cts dont do congenital. Have you asked yourself why? its besause CABG was $$$$$. Noone bothered studying congenital anatomy, pathophysiology, hemodynamics of congenital and begin reading, publishing, etc. Now that CABG is getting more sophisticated, things change. I know ct surgeons who have forgotten what a valve looks like. Their motto was "why bother with valve [not to mention bi-valve] when i can get easy $$ from CABG (back in 90's). They start to change. Things *will* change.

3) Accending? Aortic Dissection?

4) things will change in the era of LVAD, TAH in the very near future.

sure, things are not like this everywhere and i am NOT in an high tech institution. CTS needs attitude readjustment and rebirth.

 

[Gator05]

Thanks for the info on on-pump/off-pump CABG. I know it's a touchy subject, whose final verdict is still in the works.

My point was OPCABG adds a new element to a "boring" procedure. From an anesthesia stand point, OPCABG is a good bit more exciting as the heart is manipulated.

I'll throw in more 2 cents and state that as the population ages, we'll see more and more valves that wear out. Granted, we may also see cath technology advance to assist in their repair.