Peds Cards v. surgery

[personal jesus]

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I am a MS3 that is very interested in working with children with heart disease. That being said I have been working with a congenital heart surgeon and it seems like congenital heart disease is fundementally a surgical problem. Perhaps it is just the case at the hospital I work at but it seems like the surgeons make the primary decisions about the patient with the cardiologists working under the surgeons. I would like to hear resident/fellow's impressions of the role of the cardiologist with in patient cards patients. Thanks

 

[dsherida]

I did some research in peds cards for over a year and got to see A lot from a clinical standpoint and attend the Cath conferences where the cardiologists and surgeon's discussed cases. I would argue the opposite side that you did. The cardiologists are the ones who diagnose the disease with tests like echoes or caths. From that the surgeon's have the cardiologists go through the tests with them and hear their suggestions as to what they need to do. IT's amazing how well the cardiologists know the procedures. That being said, what the surgeon does in the OR may change as they open up the chest and find something unexpected. I think in most centers, there is a great relationship between surgeon and cardiologist. Sometimes there are heated arguments, but the cardiologist is the one who will take care of the kid for the rest of his life after the surgeon spends one day with them. Therefore, they both tend to have a lot of say into what happens. There's a good book called "Walk on Water" that follows the Cleveland Clinic's program before the surgeon there Roger Mee retired.

 

[14022]

I completely agree. The cardiologist collects all the data the surgeon needs before they decide to operate.

Also, many kids cannot be operated on right away for a variety reasons (eg, the kid may need to be a certain weight or they want to wait until pulmonary resistance drops to normal post-natal levels) so the cardiologists need to keep these kids alive with their abnormal anatomy and/or in heart failure until they get to the point where surgery can be done.

Finally, interventional cardiology is making huge strides in congenital heart disease. Cardiologists fix the majority of ASD's and some PDA's, VSD's, and stenotic valves/vessels. This has been the case for years. Up and coming is hybrid surgery. Look it up. Its fascinating.

So I am sure no one would disagree that the surgeon has the most control in the actual intervention for most congenital heart diseases, although it would be incredibly naive to think that the cardiologists are not as important as the surgeon for the success that these kids have pre- and post-operatively.

 

[BigNavyPedsGuy]

When I was an M3 my surgery chief resident told me that he the same problem as you when he was in med school. He said his advisor gave him some great stuff to think about: If you don't get the competitive fellowship, what would you rather be? A pediatrician or general surgeon? He went into surgery to do peds surg but got tired of training and was going to be a private practice general surgeon.

Both of the Peds surg fellows at my school are PGY9! If they went into CT surg they'd have to train even more after that. Your average peds cards fellow will be PGY4 or 5. Just more info to cloud your thoughts.🙂

 

[oldbearprofessor]

When I was an M3 my surgery chief resident told me that he the same problem as you when he was in med school. He said his advisor gave him some great stuff to think about: If you don't get the competitive fellowship, what would you rather be? A pediatrician or general surgeon?

The question is a reasonable one to answer - although the cross-over with interventional cards is bigger than one might think. Surgery and pediatrics are different fields and that's certainly the primary issue in resolving the question.

However, the premise of the question seems a bit surprising. I've not heard of any US residency grads that couldn't get a fellowship spots in whatever field they wanted so they had to become a general pediatrician. I don't have any idea why someone would become a general pedi if they got a "non-competitive" fellowship in the field you wanted.

Anyone here who is aware of a person (US grad or otherwise) who wanted to be a pediatric specialist and completed a US pedi residency, but couldn't get ANY pedi fellowship spot in the specialty of their choice, and thus defaulted to general pediatric practice for their career, please post it - I'd be interested to hear about it. I think this would represent a personal issue anomaly such as a person who could only live in one town due to family issues.

 

[jackjinju]

Well, the only example I could think of would be someone applying for peds ER, or allergy/immunology. I know people in the latter situation, but then again, A&I is a combined field, in that both IM and peds grads can apply for it, so it's not a real peds subspecialty. I can't imagine someone not placing into ANY rheum, endo, GI, NICU, PICU fellowship........

oh, and OBP...I didn't know you were a Buckeye fan!

Andrew

 

[oldbearprofessor]

oh, and OBP...I didn't know you were a Buckeye fan!

Andrew

I am an alumnus of The Ohio State University....won't say what degree I got there.😛

Furthermore, I personally met Woody Hayes several times - in his later years he was a friend of my fathers. I was at several OSU-Michigan games beginning with the disastrous loss in 1969 at Ann Arbor. I really respect both Woody and Bo. They were both great men. It's wonderful to see Tressel showing the type of respect for the university and its traditions that Woody and Bo did.

The funny thing is the degree to which my children (who weren't born or raised in Ohio) are Buckeye fans and I mean strong Buckeye fans.

Well, now, if only I could get some tickets for the Fiesta bowl.