So my question is this: should I consider dropping my fall cts sub-I in favor of another one that maybe serves more realistic goals (i.e. another gen surg Sub-I)?
A CTS subI won't help your application at all - it won't be enough for I6 and GS won't care about it. Do it if you're interested in CTS and you want to learn more about the field. Don't do it if you think that your time could be better spent in a GS subI/you need another GS letter/etc.
Actually it isn't late in the game to be switching, unless you are looking at a super competitive specialty which requires lots of research (I don't have a clue if CT surgery is one of those).
It is too late for I6 (if you're planning on matching a year from now) and I6 is a super competitive specialty that requires a lot of research. Ironically I made the decision around this time in my M3 year to go all in for I6. I ended up realizing that I needed to take a research year, so I took a year off after M3 year and matched I6 after that.
It is an extremely competitive specialty to apply to directly out of med school, but the CT surgery fellowship is one of the least competitive after gen surg. I've been told by faculty that this is because graduating gen surg residents are much more sensitive to all of the talk about how miserable the CT surgery market is than are med students. You probably already know that CT surgeons have less work because stenting has replaced CABG in many cases, other than for 3-vessel disease. I don't imagine the trend of CT surgery losing ground to cardiology reversing itself anytime soon, since cardiologists are now doing more and more structural stuff intravascularly.
Disclaimer: I'm a current I6 resident. This is not true on many levels. First, CTS fellowships after GS were not competitive 5-10 years ago. I think CTS went through what Rads is going through now where there was an over expansion of training slots plus the decline (to some degree) in volume due to the proliferation PCI and TAVR meant that there was a period of time where the field was saturated. That has since corrected itself and now there is a shortage of surgeons. A lot of the old guard is retiring and there are fewer graduates. It's to the point where our graduating fellows this year are getting somewhere in the neighborhood of 6-7 offers both PP, aciprivate, and academic.
This is reflected in this year's CTS fellowship match where 100% of programs filled and the match rate was 73% (
http://www.nrmp.org/wp-content/uploads/2016/12/2016-Thoracic-Surgery-Match-Results-Statistics.pdf). I know a few of the people who matched and they all commented on what a bloodbath this year's match was with a lot of excellent candidates falling far down their rank lists or going unmatched.
As far as the CAD and structural heart disease market, the practice patterns are certainly changing, and I don't think there will be all that many isolated AVRs left in 10-20 years (although I would never get a TAVR if I was low-mod risk, but that's a different story). That said, there are still huge growth options out there for surgeons who are willing to branch out beyond isolated valves and CABGs. The aortic stent graft market is growing rapidly and it will grow even more with the Mona LSA trials, etc. And as far as CABG goes, the pendulum is starting to swing back towards CABG and away from PCI (something most cardiologists won't tell you: for non-ACS patients, PCI has 0 survival benefit. CABG does). I think this is only going to expand with the proliferation of minimally invasive and off-pump CABG. Honestly, if I had an isolated pLAD lesion, I would think long and hard about a mini LIMA-LAD over a stent, and I think things are going to continue to expand in that direction.
And I haven't even started about the demographic trends that are going to be strongly in our favor going forward. Or thoracic, which is as wide open a job market as you'll find.
In short: there are plenty of reasons not to do cardiac surgery, but the job market isn't one of them.
