Pediatric Cardiothoracic Surgery Route

[blargh123]

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I am planning to become a pediatric surgeon; however, CT surgery also interests me, so I have thought about maybe just combining the two. From what I've researched, though, ped CT surgeons go through cardio residency/fellowships and never need to do their fellowship in pediatrics; however, I don't know if this would leave me able to perform many types of surgeries on children, or if it would limit me to only CT surgeries.

With the rising integrated CT-general surgery residencies, I have thought about doing that and then the fellowship in pediatric surgery. But, what I read says that to get into any pediatric fellowship, you NEED to be an ABS certified general surgeon. Do these integrated residencies allow that? All I ever see them mention is that you are qualified, after completion, to take the exams to be a certified CT surgeon.

Ultimately, I'm curious: is there anyway to get into pediatric CT surgery without having to go general residency, peds fellow, CT fellow, CT peds fellow? Or is my idea of being able to do it all just kind of silly? I do want the realistic answers, please! I don't mind if I can't do it all -- I know I have a habit of biting off more than I can chew -- but if I could do more than just CT surgeries in children, that'd be great!

I so heavily apologize if this has been answered anywhere else; I feel like I'm asking too many specific questions that I can't seem to easily find what I'm looking for. Thank you all for your time, though!

 

[tvelocity514]

Are you in the US? If so, you can do a 6 year integrated cardiothoracic surgery residency followed by a 2 year pediatric cardiothoracic surgery fellowship. You'll be ABTS certified (instead of ABS)- but I'm pretty sure that's ok (attending will clarify soon).

 

[themockjock]

Are you in the US? If so, you can do a 6 year integrated cardiothoracic surgery residency followed by a 2 year pediatric cardiothoracic surgery fellowship. You'll be ABTS certified (instead of ABS)- but I'm pretty sure that's ok (attending will clarify soon).

The I6 programs make you CT board eligible. You aren't GS board eligible after I6 programs but that doesn't matter for the most part; even though there are few I6 graduates as of yet, there are plenty of traditionally trained CT surgeons that don't bother renewing their GS boards and do just fine. It's rare to need to do GS stuff as a CT surgeon and when you do (bedside ex-lap in the CVICU), the s**t is hitting the fan and your hospital's acute care surgery service is going to be involved anyway.

Getting back to your question, there is no way really that you could do both. If by some miracle you made it through all of that training and get a job and find a hospital willing to give you privileges to do both, you would have to give up your peds GS practice for several years and essentially function as junior peds CT staff just to learn how to do the difficult cases. Generally people who come out of peds CT fellowships are NOT yet practice ready. Then once you're ready to practice CT, you haven't done general peds in a while.

Focus on being good at one or the other. If you try and do both you'll likely end up being mediocre to bad at both. Surgeon and center volumes have a direct impact on mortality (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269112/) and doing both will put you on there wrong side of the bell curve.

To think you could do both Kasais and Norwoods (and do them both well) is folly. Pick the one you like more and try and pursue that one (although realize that both peds GS and CT are among the most competitive and rarified fellowships in medicine and so it is far from guaranteed you'll get one).

 

[ACSurgeon]

The I6 programs make you CT board eligible. You aren't GS board eligible after I6 programs but that doesn't matter for the most part; even though there are few I6 graduates as of yet, there are plenty of traditionally trained CT surgeons that don't bother renewing their GS boards and do just fine. It's rare to need to do GS stuff as a CT surgeon and when you do (bedside ex-lap in the CVICU), the s**t is hitting the fan and your hospital's acute care surgery service is going to be involved anyway.

Getting back to your question, there is no way really that you could do both. If by some miracle you made it through all of that training and get a job and find a hospital willing to give you privileges to do both, you would have to give up your peds GS practice for several years and essentially function as junior peds CT staff just to learn how to do the difficult cases. Generally people who come out of peds CT fellowships are NOT yet practice ready. Then once you're ready to practice CT, you haven't done general peds in a while.

Focus on being good at one or the other. If you try and do both you'll likely end up being mediocre to bad at both. Surgeon and center volumes have a direct impact on mortality (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269112/) and doing both will put you on there wrong side of the bell curve.

To think you could do both Kasais and Norwoods (and do them both well) is folly. Pick the one you like more and try and pursue that one (although realize that both peds GS and CT are among the most competitive and rarified fellowships in medicine and so it is far from guaranteed you'll get one).

And ped surgery fellowships are actually decreasing in number in upcoming years. So, it'll only become harder. Also, depending on what stage you're at in training, CT surgery fellowships may or may not exist by the time you finish GS training, so you might want to consider doing an I6 residency in CT surgery. In short, you can either become a pediatric CT surgeon OR a general pediatric surgeon. Not both.

 

[el_pistolero]

Also, while the field itself is called paediatric cardioTHORACIC surgery, paed CT surgeons only treat congenital cardiac pathologies, despite their extensive knowledge in cardiopulmonary physiology and thoracic anatomy as adult CT surgeons.
Paediatric thoracic surgical cases like pectuses, recurrent pneumothorax, CDH, TOF, etc. go to general paediatric surgeons. Again, this is because congenital cardiac surgery is already very complex on its own.

In short, I guess...
paed CT surg: limited to congenital cardiac conditions (in both children and adults); lots of highly complex, technical operations; super-specialised service
general paed surg: treat almost all surgical conditions in children (apart from brain, heart, and bones), very broad scope; some complex operations like Kasai; specialised service, though less specialised than paed CT surg I suppose

I just think it's something to consider if you're interested in either paed CT surg or general paed surg, since, as others have mentioned, it's impossible to practice both...

 

[dienekes88]

I am planning to become a pediatric surgeon; however, CT surgery also interests me, so I have thought about maybe just combining the two. From what I've researched, though, ped CT surgeons go through cardio residency/fellowships and never need to do their fellowship in pediatrics; however, I don't know if this would leave me able to perform many types of surgeries on children, or if it would limit me to only CT surgeries.

With the rising integrated CT-general surgery residencies, I have thought about doing that and then the fellowship in pediatric surgery. But, what I read says that to get into any pediatric fellowship, you NEED to be an ABS certified general surgeon. Do these integrated residencies allow that? All I ever see them mention is that you are qualified, after completion, to take the exams to be a certified CT surgeon.

Ultimately, I'm curious: is there anyway to get into pediatric CT surgery without having to go general residency, peds fellow, CT fellow, CT peds fellow? Or is my idea of being able to do it all just kind of silly? I do want the realistic answers, please! I don't mind if I can't do it all -- I know I have a habit of biting off more than I can chew -- but if I could do more than just CT surgeries in children, that'd be great!

I so heavily apologize if this has been answered anywhere else; I feel like I'm asking too many specific questions that I can't seem to easily find what I'm looking for. Thank you all for your time, though!

What?

General Surgery -> Pediatric Surgery Fellowship
Vs.
General Surgery -> Cardiothoracic Fellowship -> Congenital Fellowship
Integrated Cardiothoracic surgery -> Congenital Fellowship

That's all there is.

I don't understand the following statement: "but if I could do more than just CT surgeries in children." Just CT surgeries in children. Just. Congenital heart surgery is probably the most technically complex specialty that exists. It is also incredibly tricky from a conceptual standpoint. What else would you want to do? Lap appys? Hernias? You can't be good at neonatal switches and Norwoods if you're doing anything else. Don't get me wrong; I like doing hernias as much as the next guy. However, congenital is something completely different. If you aren't living, breathing, and dreaming about these congenital heart lesions... your results just won't be as good as someone who is 100% dedicated.

 

[Winged Scapula]

I usually roll my eyes at some of the intraspeciality peen measuring at what's the most difficult ("Breast surgery is for those who aren't technically skilled", "Liver patients are the sickest so our job is harder", "General surgeons shouldn't be doing colons", etc) but dienekes is correct: Peds Congenital CT is so challenging, so demanding that you'd better be 100% in the game and not dividing your skills elsewhere doing General Peds Surg.

 

[epsilonprodigy]

Agree with what others have said. I think it's also worth noting the significant risk to your own career in this field. Not that that alone should deter you if you're set on it, but just understand that many good surgeons have seen their referrals dry up after a run of bad luck, and are back to doing CABG's before you can say "total anomalous pulmonary venous return." Hopefully that won't be you, but I think it's worth making sure you like bread and butter CT just in case.

If you haven't, read "Walk on Water," about Roger Mee.