Pros and cons of doing the integrated vascular surgery route rather than the traditional 5+ 2 route?

jimmyd1

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Obviously saving two years is huge, but what about not being board certified in general surgery or not having enough exposure in general surgery?
 

gutonc

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I wouldn't say there are no cons, but they're minimal.

I did an integrated, research track IM residency/fellowship so I have some experience in this.

The biggest con is, what if you change your mind? You get midway through PGY3 and decide that you really want to do colorectal, or thoracic? Will you have the option to easily drop back into the regular GS program?

If so, then there's more or less no downside. But if that will potentially be an issue for you, it's something to take into consideration.
 
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AdmiralChz

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If you are at a big time Vascular program (which I assume most integrated programs are?) you will do some of the largest abdominal surgeries out there during your training in AAA work so you will get plenty, PLENTY of training in mobilizing bowel, taking down adhesions and performing emergent ex laps.

Agree with the above, though. Vascular is very specialized and home to some of the sickest patients in the hospital. It can be a high-intensity, high-workload specialty. Vascular fellows at my hospital probably work the worst hours out of all fellowships (at least surgical...) here, so really make sure you make an informed decision before entering into it. I will say they are doing some very cutting edge stuff with endovascular approaches and have seemed to hold off cardiologists and IR so appear very protected going forward.
 

mimelim

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Obviously saving two years is huge, but what about not being board certified in general surgery or not having enough exposure in general surgery?
Depends on your goals. Do you want general surgery as a part of your future practice? If yes, then you obviously need to go the 5+2 route. But, if you are like most graduating fellows/residents, you won't want it. You will want to do vascular all the time. There are enough jobs out there and everywhere that it is generally a non-issue.

You give up your chief years in general surgery in exchange for an extra 18 months of vascular surgery as a PGY2/3. That is a lot of extra vascular training. You will also spend an extra 36 months focused on/thinking about vascular surgery (even if on GS rotations). Again, a lot. If you want to do vascular surgery, you should aim to do an integrated program.

I wouldn't say there are no cons, but they're minimal.

I did an integrated, research track IM residency/fellowship so I have some experience in this.

The biggest con is, what if you change your mind? You get midway through PGY3 and decide that you really want to do colorectal, or thoracic? Will you have the option to easily drop back into the regular GS program?

If so, then there's more or less no downside. But if that will potentially be an issue for you, it's something to take into consideration.
I had offers to take a PGY3 spot in plastics and general surgery when I was a PGY3. They were locally available and I had shown interest/aptitude on PGY2 rotations on plastics and CRS. Given the quality of residents that typically populate a relatively small field, I don't think it would be hard to laterally transfer. Certainly not preferable and by no means any guarantees, and you may end up losing a year, but not the end of the world to be honest. Both the integrated plastics and GS programs were willing to offer me full credit for the 2 years of surgery that I had done (which was mostly general surgery anyways).

If you are at a big time Vascular program (which I assume most integrated programs are?) you will do some of the largest abdominal surgeries out there during your training in AAA work so you will get plenty, PLENTY of training in mobilizing bowel, taking down adhesions and performing emergent ex laps.

Agree with the above, though. Vascular is very specialized and home to some of the sickest patients in the hospital. It can be a high-intensity, high-workload specialty. Vascular fellows at my hospital probably work the worst hours out of all fellowships (at least surgical...) here, so really make sure you make an informed decision before entering into it. I will say they are doing some very cutting edge stuff with endovascular approaches and have seemed to hold off cardiologists and IR so appear very protected going forward.
I disagree somewhat. Open AAA numbers are going down, everywhere. Almost all big vascular programs have an integrated residency, but certainly not all integrated residencies have good access to open AAA cases. Every program out there will get you your numbers, but some will not get you much more. Obviously there are some centers that maintain strong numbers, but the reality is that trainees are far less comfortable in the belly as before. My emergent ex-lap numbers come from trauma, not from vascular. My comfort in the belly comes from my time with CRS. I do not think that you can depend at most programs on learning how to work with bowel from just your aortic cases.

On the other hand, I will say this, does it matter? I will be trained in AAA and even TAAA because we have a large open aortic program. But, unless I stay where I am training, it is unlikely that I will be performing many open AAA and never TAAA unless it is a rupture. The reality is that as our endo tech has improved, the number of patients requiring an open AAA has gone down significantly. Ideally, all trainees will be comfortable with everything under the vascular heading, but that just isn't realistic.

I do however agree, our hours suck. They are on par with NSGY.