Pediatric Surgery Cases

[UofM85]

I am a interested in pediatric surgery, but I have started to question my interests. I am at a large academic program with a pediatric surgery fellowship and I go daily to the OR board. Every time I look at the cases the peds surgeons are doing and majority of the cases are appy's, hernias, port-a-cath placement... I like large complex cases and I slowly coming to the conclusion they might not be all the common in pediatric surgery.
The field I would like to go in to most is pediatric cardiothoracic surgery, but I am hesitant due to my questioning whether or not it is a viable field. I need input from others who have more experience and knowledge on these issues. Thanks.

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[45408]

Here was a good thread: http://forums.studentdoctor.net/showthread.php?t=711492&highlight=peds

And here was a good post from another thread:

"peds CT", or congenital heart surgery as they would like to be called is a very unique sub-specialty.

I have had the privledge of rotating as a CT resident on one of the top congenital services in the world. These guys are the best of the best. It is one of the purest, refined forms of surgery in the sense that they need to understand the most complex physiologic/hemodynamic situations of these weird heart lesions, not to mention the technical skills they need to fix them.
Even the traditional "big-boys" (adult cardiac, peds surgery, neurosurg) can't hang with these guys- in fact congenital surgeons look down on them.

These guys dont put in chest tubes for parapneumonic effusion, or fix tracheaesophegeal fistulas, do lung resections or even ligate the average patent ductus arteriosus- they relegate these menial tasks to the pediatric general surgeons. Its funny how even a highly competitive field like peds general surgery can be looked at as a dumping ground by another service!

There is only one way to arrive at this pinnacle of surgery- complete dedication. hard work itself is not enough. PGY-10+ are common in this field. getting into a congenital fellowship is relatively easy. I bet there are less than 20 per year who seriously pursue this field. This is one of the few fields where you have to have superior technical skill to succeed. There are some cases I cant ever see how someone could let a resident attempt! getting a job is the hard part. everyone knows everyone.

in the old days, adult cardiac surgeons did the pediatric cases too- Most of the old timers from the golden days of the Cooley era have retired. These guys did congenital cases because they invented the techniques and they filled the void. Today, very few if any residents who come out of CT fellowship are exposed to enough "peds CT" to do anything more than simple ASD, VSD. The requirements for cardiac residents is 10 congenital cases, and general thoracic residents dont need ANY congenital cases!! its just too specialzed now.

It is an interesting field, but I could never do it...

 

[joehuf]

I think you've come to the right conclusion about peds surgery. There is definitely the occasional congenital defect, big trauma case, or tumor but a majority of your cases are smaller. You have to see the challenge in doing those cases exceptionally well. If you do a hernia repair on a 60 yo cirrhotic and the hernia recurs, it's looked on differently than a healthy 5 yo. Also, in my opinion there's a huge push for utilizing minimally invasive techniques in peds, even for larger cases. So it's definitely not a "blood and guts" type field like transplant or trauma.

As for Congenital CT, I agree with the post above. I would add that in addition to a long training time, unless you're in one of a few large congenital centers you will probably be by yourself or with one other Peds CT surgeons at your hospital. That means you're basically on call 24/7 and you can't even take vacation without some sort of coverage (and adult CT guys as a rule hate covering congenital patients)

 

[Buzz Me]

It's still very early...you're barely halfway through your intern year. Why not rotate onto both the Peds Surg and CT Surg services and see what you think of the case mixes when you're actually doing them? Lots of people start off liking "big whacks" and while you may see the occasional exotic case on Peds Surg (TEF, large Wilm's, etc.) the bread and butter are the smaller cases.

 

[45408]

Also, the exotic cases put a lot more gray hair on your head and hours to your time card. You will probably feel a bit differently after you've been doing this for a bit longer. Maybe not - I can think of a few surgeons who are far into their careers who routinely tackle some monster cases - but just something to think about.