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Pediatric cardiothoracic surgery????

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snooze7

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Anyone know the residency requirements for peds cardiothoracic surgery? I've heard 5 year general surgery and a 2 year cardiothoracic, but where does the peds part fit in? Thanks.....
 

maxheadroom

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Peds CT comes after the Gen & CT residency/fellowship. I think Peds CT is 2 or 3 years. There's a great new book out about Roger Mee at Cleveland Clinic. I think it's called "Walk on Water", but I'm not sure. While it doesn't focus on the fellowship, it does get fairly in depth with Dr. Mee's fellows. It's a super-long road for a very good reason -- those kids are deathly sick with intricate anatomy that requires a new approach every time you do it.
 

Idiopathic

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You are lookng at a ten year residency...i did a day with a local peds ct surgeon, and the dirt is this: after a gs residency, you have to apply for one of the ridicuously competitive peds surgery fellowship (only 30 in any given year) and from there go do peds ct fellowships. so you could go into this thinking peds ct and come out of it as a gallbladder surgeon (what else does a gs do) but 'walk on water' is a great book/
 

droliver

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Originally posted by Idiopathic
after a gs residency, you have to apply for one of the ridicuously competitive peds surgery fellowship (only 30 in any given year) and from there go do peds ct fellowships.

Incorrect. Pediatric Cardiac Surgery follows CTVS & not Pediatric Surgery Training. Depending upon your exposure during your fellowship, occassionally you may not even need the additional training to get privledges to do it if you join an academic division and get some additional mentoring in it
 

Idiopathic

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Originally posted by droliver
Incorrect. Pediatric Cardiac Surgery follows CTVS & not Pediatric Surgery Training. Depending upon your exposure during your fellowship, occassionally you may not even need the additional training to get privledges to do it if you join an academic division and get some additional mentoring in it

I sit corrected...my physician took a different route, and a much more difficult one.
 

Been there

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Well, There seem to be a lot of miss information on this board.

Lets set this straight one and for all.

General Surgery is usually from 5-7 years, but can alway be more

Plastic Surgery is both a fellowship and a residency but, most programs are becoming more like a residency than a fellowship.

Now for your question.

To become a ped-cardiothoracic surgeon, you need to get into a gen-surg program first. Most good academic programs are 6-7 years; cuz no matter what they tell you during interview, they (major major academic university) require you to do research (if you indicate the lack of desire to invest in research, plan on them not even ranking you.) Believe me I was there.

So now you're in a g-surg program and want to go Ped-CT, the name of the game is research (althought now a days, research is not essential, but if you want big names in CT like Stanford, Hopkins, UCLA, or any of the Havard Programs, you will need research). CT is usually 2-3 years. There are more three year than 2 year programs.

Now that you are in a CT-program and still want to pursuit Ped-CT, you can now apply to another fellowship. Most are 1 years. One ped-CT fellow told me, you can get one if you have a pulse. This one you don't have to do it in the States. cuz, I believe there is no ped-CT boards

Lets count, that is 7 years for g-surg, plus 3 years for CT, and one year for ped-CT= 11 years

well, there are talk about intergrated CT-surgery program like plastic residency (not fellowship). The plan is a 3-4 program. three years of g-surg, and four years of CT-surg. This will let you be CT-board eligible, and no longer g-surg board eligile. No program exist yet, but Hopkins use to have a 7 years straight track CT residency. That went out the door after the loophole for the 4 clinical years g-surg residency board eligibe was abolish.

One more thing, finishing a ped-surg fellowship will not get you CT-surg board eligibe; therefore no cardiac surgrey, but they can do peds- thoracic. Your mentor might be a thoracic guy only. If he operates on the heart, he will need to do a CT surg fellowship. Ped-surg doesn't teach you how to put people on the pump (cardio-pulmonary bypass machine).--sorry charlie.
 

ent_doc

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As a medical student I had a surgical chief resident who used to say, "If you want to do anything cool, it's 10 years." Of course, he went into CTVS
 

droliver

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Originally posted by Been there
Plastic Surgery is both a fellowship and a residency but, most programs are becoming more like a residency than a fellowship.

well, there are talk about intergrated CT-surgery program like plastic residency (not fellowship). The plan is a 3-4 program. three years of g-surg, and four years of CT-surg. This will let you be CT-board eligible, and no longer g-surg board eligile. No program exist yet, but Hopkins use to have a 7 years straight track CT residency. That went out the door after the loophole for the 4 clinical years g-surg residency board eligibe was abolish.

Two points:

1) more programs have abandoned the integrated/combined Plastic Surgery pathway in recent years then have started new ones

2) the outlined plans discussed by the Surgery RRC for the abbreviated surgery specialty programs for CTVS, Pediatrics, Transplant, and Trauma-Critical Care have all included the eligibility to sit for your General Surgery Boards with the 4+2 models. Vascular Surgery is a seperate issue and a very big political issues between the ABS & the Vascular Boards about how that future model would work out.
 

Been there

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Well, You may be right about plastic surgery, but the last time I checked, programs that use to be plastic fellowship are now switching over to the integrated program. For the same reasons why other surgical sub-specialities are trying to start integrated program (long training period and poor life style which leading to decreased number of surgical residency applicants).


The last time, I talk to a cardiothoracic chairman/program director, which is two months ago, he said the CT-board will not require g-surg board as a prerequisite for CT-board in the future, Since most CT-surg does not want to practice g-surg. The reason for 3-4 is that they felt it really takes three years to train a good CT surgeon, and a truncated 3 years of gen-surg will cause a lack of vascular surgery experience when these CT resident start the CT part of their residency; hence the extra year. All the other sub-speciality are try to get g-surg board eligible for their integrated program cause most of them are more like g-surg than CT-surg. Vascular, Peds-surg, and transplant are the only ones exploring the 4-2 track. I am currently in one of the fore-mentioned fellowship.
Plus, transplant does not have a board yet.
 

Been there

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Wow, you just opened a can of worm.

Paid depends on several factors.

In General:

If it is an NRMP matched position, they tend to pay you an R6 salary. Eventhough you may of spent 7 years in g-surg, only the 5 clinic years will be recongized. This salary varies from hospitals to hospitals and geographic regions to regions. But, they tend to be similar. So, you actually can result in a backcut as a fellow when compare to your chief residency salary. There are positives to this situation. For one, your position fall into the protection of RRC and the ACGME. Which mean to get rid of you for any reason, they have to give you due process. You are now actually a resident, and this also mean the regulation of 80hrs/wk and 24 hrs off/wk applys to you. They are actually required to educate you instead of slave drive you.

If it is not a match subspeciality, all bets are off. They can paid you what ever they want to nothing at all, and even sometimes, you have to paid them. Lets talk about some examples, transplant and laparscopic fellowships tends to give their residents better paid than others. They actually give them junior faculty status. This means the RRC and ACGME are not regulating these positions. They can terminate you at anytime (you can alway get a lawyer to stop that, but none the less, it can be painful). 80 hours/wk does not apply to you. They can make you take call q2 or even q1 call if they really love you. The other end of the spectrum will require fellows to pay the programs or fellows get no paid or get a post-doc salary (~20-30k) . These are endovascular fellowships and some facial plastic fellowships


As you can see it varies widely depending on these factors.
 

maxheadroom

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Ollie and I have a friendly disagreement over the nature of PRS integrated programs. As an integrated intern, I think that they are the way of the future. As a PRS fellow/traditional, he believes that the integrated model is a failed experiment.

While a couple of high-profile integrated programs closed several years ago, many more are using the under-the-radar "combined" model as a transition. WashU closed their integrated program several years ago because they were losing more than half of their junior residents during the prelim years. Now they're doing a combined approach while MacKinnon waits to see if their new juniors can hack it (their PGY-2s are the first of the new group). A few other programs closed, but mostly due to dumb faculty issues (Luce never filed the right paperwork for Case, USF couldn't keep the faculty stable). The only program that has started and ended an integrated program because of dissatisfaction with the product is Duke. Its website now boasts that all Duke PRS faculty/residents are BC GenSurg or BC in another surgical specialty.

Lots of programs are using the "combined" (pseudo integrated) model because they don't have to ask the RRC to do it. They just register for the match and take people with the promise that as PGY 4s or 5s they'll become PRS residents. A viable option, but, as I've written several times, riskier.

End rant. I'm post call and sleepy.
 

droliver

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Been There,

the CTVS thing with the surgery boards only makes it optional to do both (I suspect most people still would if experience with Plastic Surgery is any guide), the ability to sit for the ABS boards would be maintained with the 4 +2/3 proposals which has been an important issue for a large # of surgeons who mix in non-chest cases to their practice (more then you'd think in some surverys). The ability to be double boarded is also an important goal for the Vascular Boards with their aims as well for similar reasons.

I don't know of any new integrated PRS programs for the last several years (I could be wrong, anyone?). The # of positions offered thru both pathways (integrated & traditional) have been stable for almost 5 years when you look at the # positions offered. The # of applicants to both models has had tremendous sustained growth for years & is kind of immune to the "lifestyle" screening thats hurt Surgery & its related specialties. Market forces @ work, No? There's also a fairly high washout rate with the integrated model when the reality replaces the fantasy



Max,

I kid you not..... there are many fewer "under the table" arrangements left with Plastics Fellowships then there were 5-6 years ago. The maturation of the integrated program to ~ 50
% really weeded out almost all of the ones that were doing that. All you have to do is look @ the SFmatch results these days to see that its only a few people left now that match into positions without 5 or more years of training prior (this would include any of the programs which would take people in the "unofficial" integrated programs of years past as they would have to list those positions for the match technically even if they promise it to someone). When programs can cherry pick among fully trained applicants, there's little attraction for the people who try after 3 or 4 years these days

I certainly would not call it a failed experiment, I just think the models out there don't jibe with reality to me (and many others) in terms of your experience after abbreviated General Surgery versus full Surgery or ENT training. This has been the major problem with them at a number of programs. Duke was the most public course reversal, but trial versions of it have been unsatisfying at many of the top programs & scrapped. The roadblocks to suceeding @ many places are formidable, and more then a few of our visiting professors have described their disappoinment with it. Its my personal belief that a 4+2 (or 3) is the best compromise & would dovetail nicely with the proposed reformatting of the other surgical subspecialty models. There are certainly some programs on the other hand who seem more then happy with their integrated program and the products of it

I hope things are going well @ SIU and that you're studying harder for the Inservice exam then I am!
 

maxheadroom

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Ollie,

Didn't mean to call it "under the table", just that there are lots of combined positions available that aren't well advertised. UCLA & USC are two that come to mind -- you really have to work to find anything on their pages that documents their combined positions.

Several combined programs that I interviewed at last year indicated that they were in the process of applying to the RRC to become true integrated programs.

From my count last year there were about 20 true integrated programs and about 30 programs with combined positions available. Some were like WashU, Oklahoma, and several others who were in their first or second year of offering combined, so not many people knew about them.

All that I'm reading for the inservice is Grabb & Smith and Secrets. They have us take it just for the experience. I also have to take the ABSITE (dammit). No one cares how we do on ABSITE, though.
 
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