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a pediatric cardiac surgeon came to give our surgery interest club a talk and this was an actual quote from him..."i fix what the lord couldn't". that's some heavy stuff. then he went on to say that you can't just become a pediatric cardiac surgeon because you want to like you can a general surgeon or even adult ct surgeon where most people who graduate med school can if they work hard enough...but that you have to be talented enough to do it as it's the most technically demanding surgery out there that most other surgeons can't do. i have heard the same sentiments before and was wondering if you agree or not.
 

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a pediatric cardiac surgeon came to give our surgery interest club a talk and this was an actual quote from him..."i fix what the lord couldn't". that's some heavy stuff. then he went on to say that you can't just become a pediatric cardiac surgeon because you want to like you can a general surgeon or even adult ct surgeon where most people who graduate med school can if they work hard enough...but that you have to be talented enough to do it as it's the most technically demanding surgery out there that most other surgoens can't do. i have heard the same sentiments before and was wondering if you agree or not.
No... but they may very well have the longest training path.
 

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in their eyes....absolutely


edit: sample size 2 (1 of which may be that good)
 
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ESU_MD

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Without a doubt, congenital heart surgeons are in the upper echelons of surgical hierarchy/respect. Its a long road, and even when you are done training, you're still an apprentice for years as a junior attending in alot of places.

In my mind, the hard part is putting up with all the nonsense that goes into the training. And dealing with all the pediatrician-types and the parents.

Tailoring the patch on a norwood, splitting the valve on a complete av canal defect or re-implanting intramural coronaries on a switch are tough maneuevers, but they arent that much more advanced than any other "high end" surgery
 
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how difficult is it to get a fellowship in pediatric cardiac surgery? this guy made it sound as if you had to be nothing less than a superstar during an adult ct fellowship to be considered.
 

LucidSplash

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how difficult is it to get a fellowship in pediatric cardiac surgery? this guy made it sound as if you had to be nothing less than a superstar during an adult ct fellowship to be considered.
Peds Surg is the most competitive surgical fellowship out there.
 

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Peds Surg is the most competitive surgical fellowship out there.
I know pediatric surgery (as a subspec. of general surgery) is difficulty and highly competitive. However, the poster is asking about pediatric CARDIAC (aka congenital) surgery (a subspec. of cardiac surgery).

Knowing the folks I know and speaking with residents and more humble attendings.... the path is fairly strenuous and long. Success often depends on if you are actually willing to put up with another block of time as a "resident".

To put it another way, getting into a cardiothoracic residency/fellowship is ~less competitive then getting into the preceding general surgery residency. After one completes 2-3 yrs CT residency on top of a 5-7yr general surgery path, many are not interested in going into pediatric/congenital training. As there is uncertainty in cardiac/thoracic job market, I have heard there is more uncertainty and harder lifestyle in the pediatric cardiac field. Most places I have seen through my medical school & general surgery residency have one, occasionally two congenital heart surgeons.... thus Q1/2 call all the time. The adult guys do NOT in general provide any coverage for the pediatric patients.

So, I can not speak to its competitiveness or even more importantly desirability of the field.
 
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SLUser11

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Peds Surg is the most competitive surgical fellowship out there.
Depends on how you define competitive. A lot of people would argue that plastic surgery is more competitive, based on overall interest, # applicants, match rate, and general competitiveness of the applicants.


I just can't help but play devil's advocate....I think if you'd said plastics, I'd argue that peds is clearly more competitive.....

Anyway, Pediatric CT is a very small field, with small # spots and small amount of interest. It's really hard to assess how competitive it is, but I can say that it's definitely not very popular, meaning not many surgical residents want to do it.


And, of course, you can't find anyone more biased about their awesomeness than the peds CT surgeon himself, which is why none of us were surprised by your surgeon's comments.
 

LucidSplash

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I know pediatric surgery (as a subset of general surgery) is difficulty and highly competitive. However, the poster is asking about pediatric CARDIAC (aka congenital) surgery (a subset of cardiac surgery).

Knowing the folks I know and speaking with residents and more humble attendings.... the path is fairly strenuous and long. Success often depends on if you are actually willing to put up with another block of time as a "resident". To put it another way, getting into a cardiothoracic residency/fellowship is ~less competitive then getting into the preceding general surgery residency. After one completes 2-3 yrs CT residency on top of a 5-7yr general surgery path, many are not interested in going into pediatric/congenital training. As there is uncertainty in in cardiac/thoracic job market, I have heard there is more uncertainty and harder lifestyle in the pediatric cardiac field. Most places I have seen through my residency have one, occasionally two congenital heart surgeons.... thus Q1/2 call all the time. The adult guys do NOT in general provide any coverage for the pediatric patients.

So, I can not speak to its competitiveness or even more importantly desirability of the field.
This is what I get for both reading and responding via iPhone. Somehow I missed the fact that he was asking about pediatric CT surg. Thanks for setting me straight.
 

LucidSplash

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Depends on how you define competitive. A lot of people would argue that plastic surgery is more competitive, based on overall interest, # applicants, match rate, and general competitiveness of the applicants.


I just can't help but play devil's advocate....I think if you'd said plastics, I'd argue that peds is clearly more competitive.....

Anyway, Pediatric CT is a very small field, with small # spots and small amount of interest. It's really hard to assess how competitive it is, but I can say that it's definitely not very popular, meaning not many surgical residents want to do it.


And, of course, you can't find anyone more biased about their awesomeness than the peds CT surgeon himself, which is why none of us were surprised by your surgeon's comments.
I defer to the wisdom and experience of those above me in training, of course. My comments were largely based on the fact that while interviewing, I interviewed at some smaller "community-esque" programs and most had placed applicants into plastics fellowships within the last three years. Few had placed anyone into peds. In fact, more than one of these programs told me outright that if I probably did not want to be there if I wanted to do peds. So while plastics is still very competitive, my limited experience has had me rank peds over plastics in terms of competitiveness. :)
 

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Depends on how you define competitive.

...Pediatric CT is a very small field, with ...small amount of interest. ...I can say that it's definitely not very popular, meaning not many surgical residents want to do it...
That is definately my perception and the feedback I got during medical school and general surgery....
 

45408

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No... but they may very well have the longest training path.
One of our peds CT surgeons started college in 1982 and finished her last fellowship in 2004, I think. She did get a PhD in the middle. That's like being in 35th grade when you finish.
 

SLUser11

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I defer to the wisdom and experience of those above me in training, of course. My comments were largely based on the fact that while interviewing, I interviewed at some smaller "community-esque" programs and most had placed applicants into plastics fellowships within the last three years. Few had placed anyone into peds. In fact, more than one of these programs told me outright that if I probably did not want to be there if I wanted to do peds. So while plastics is still very competitive, my limited experience has had me rank peds over plastics in terms of competitiveness. :)
I'm not sure "attainable from a community program" makes a fellowship less competitive. That's just blindly assuming that the university applicant was somehow inherently more competitive. This is beating a dead horse, but there are plenty of community programs with more success than academic programs matching residents into things like plastics. It has to do with what type of resident the plastics programs are looking for.

As for Peds, it is a very small, self-selecting group of people interested in this specialty, almost all of which are at academic institutions, having done 2 years of research. This is why most community programs rightfully tell you to go somewhere else if you are one of those people in the small, self-selecting group.

Once, again it goes back to how we define "competitive." If we define it based on level of interest, ABSITE and step scores, and % match rate, plastics may very well be considered more competitive than peds. This is mostly speculative, and I once again admit I'm just playing devil's advocate.
 

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...My comments were largely based on ...at some smaller "community-esque" programs and most had placed applicants into plastics fellowships ...Few had placed anyone into peds...
Just for clarification.... you are still speaking to pediatric surgery (~subspec of general surgery) and NOT speaking to congenital, aka pediatric heart surgery (subspec of CT/CV surgery), the topic of this thread?:confused:
 

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Having been at two academic hospitals (one has a med stud, one as a resident), I've noticed that plastics is not taken very seriously. This might be just because n=2, or because academic surgeons have their ivory tower peculiarities. If this sentiment is widespread among academic centers, it might explain why plastics gets more community trained residents, than say, surg onc. That is not to say that plastics is any less competitive...

Regarding the original question, again, my n=2, but the peds cardiac surgeons did walk on water. They kind of did their own thing and no one else really knew what they were doing. I remember kind of looking through the op notes in bewilderment, and putting my stethescope on tiny babies thinking, "WTF am I doing?"
 
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Regarding the original question, again, my n=2, but the peds cardiac surgeons did walk on water. They kind of did their own thing and no one else really knew what they were doing. I remember kind of looking through the op notes in bewilderment, and putting my stethescope on tiny babies thinking, "WTF am I doing?"
hey u know there's a book about pediatric cardiac surgeons by the same title...don't know if u used that term by coincidence or not.

so do u guys think becoming a pediatric cardiac surgeon is something "teachable" if somebody is determined enough, or is it as that dude was making it sound like something u have to have an innate talent for? cuz man i know what u mean by "bewilderment"...such as the complex diagrams of the even more ubercomplex anomalies and how they fix them.
 

LucidSplash

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Just for clarification.... you are still speaking to pediatric surgery (~subspec of general surgery) and NOT speaking to congenital, aka pediatric heart surgery (subspec of CT/CV surgery), the topic of this thread?:confused:
Yes. Sorry, I realize it was confusing. But once SLU responded to my post with reference to peds surg, I wanted to continue that discussion despite the fact that it was not the original thread topic.:)
 

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...so do u guys think becoming a pediatric cardiac surgeon is something "teachable" if somebody is determined enough, or is it as that dude was making it sound like something u have to have an innate talent for? ...
As most have posted, yes, if you want to travel that road and work the labor, YES. It is not magic.
 

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Having been at two academic hospitals (one has a med stud, one as a resident), I've noticed that plastics is not taken very seriously. This might be just because n=2, or because academic surgeons have their ivory tower peculiarities. If this sentiment is widespread among academic centers, it might explain why plastics gets more community trained residents, than say, surg onc. That is not to say that plastics is any less competitive...

Regarding the original question, again, my n=2, but the peds cardiac surgeons did walk on water. They kind of did their own thing and no one else really knew what they were doing. I remember kind of looking through the op notes in bewilderment, and putting my stethescope on tiny babies thinking, "WTF am I doing?"
I believe that's because the vast majority of people trained in plastics go into community practice rather than academics (85%), and because even those who stay in academics rarely participate in bench research. I believe at last count there were perhaps 5 NIH-funded labs in the country where the PI was a boarded plastic surgeon.

Add those facts with the stereotypes of plastics people as venal, self-interested and lazy and then you really get rolling. ;)

Lastly, there are certain subsets of plastics which involve a great deal of technical wizardry (microsurgery, lots of hand, complex craniofacial procedures) but I don't think the bread and butter-- breast, body work, skin lesions-- is too demanding. I was doing my side of a panniculectomy/abdominoplasty as a MS4, and breast recon with tissue expander/implant exchange is a PGY-2 level case at the integrated programs. It's also difficult-- possible, but difficult-- to kill anyone in plastics, which merits obvious comparisons with something like congenital heart surgery.

I would imagine that congenital cardiac surgery is an extremely dedicated, self-selected group of people (certainly true at Columbia). You incur extra training for a worse lifestyle (very sick patients, lots of emergencies, births of lesioned kids occur at all hours, q2 call, etc) and lower reimbursement, plus you are 100% restricted to an academic practice. One person I know is a very devout Catholic (still goes to Mass every day), and he sees his work as part of his religious mission on earth, if that illuminates anything.
 

LucidSplash

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I'm not sure "attainable from a community program" makes a fellowship less competitive. That's just blindly assuming that the university applicant was somehow inherently more competitive. This is beating a dead horse, but there are plenty of community programs with more success than academic programs matching residents into things like plastics. It has to do with what type of resident the plastics programs are looking for.
Certainly, I'm not denigrating community-esque programs, as I intentionally applied to quite a few. I agree that it has to do with the type of applicant the program is looking for.

As for Peds, it is a very small, self-selecting group of people interested in this specialty, almost all of which are at academic institutions, having done 2 years of research. This is why most community programs rightfully tell you to go somewhere else if you are one of those people in the small, self-selecting group.
I'm not certain you can infer, in the same breath, that plastics applicants from community programs match because of the type of applicant the program is looking for but peds applicants are a self-selecting group who all want to do research and go to a big academic center for their GS training. It seems to me that anyone interested in peds knows that peds programs are looking for applicants with 2 years of research, etc. I don't think its "self-selection" in the way you are laying it out.


Once, again it goes back to how we define "competitive." If we define it based on level of interest, ABSITE and step scores, and % match rate, plastics may very well be considered more competitive than peds. This is mostly speculative, and I once again admit I'm just playing devil's advocate.
Agreed in that the key is how you define competitive. However, in my admittedly limited experience, it seems that there are a significant number of GS residents who don't seriously consider peds because of, among other factors, the perceived difficulty of matching. I think THIS is where the "self-selection" comes into play. Clearing the potential financial remuneration in plastics is what draws some of those applicants and peds surg can't compete with that. Thus the two fields tend to draw from different personality types (clearly a generalization and should be considered flexible as such).

So I play the devil's advocate as well, but I also admit I don't even have my degree yet and have an even shakier base for such kinds of speculation.
 

BlondeDocteur

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Lucid, I'm sure you wrote your post as I was writing mine above you, but you might check it. There are lots of differences between pediatric surgery (*all* jobs post-training are academic, research is required as a part of the career, must be extremely dedicated to advancing knowledge of pediatric surgical disease) and plastics, which primarily sends people into community practice and does little bench research as compared to other surgical fields.

Therefore it follows that pediatric surgery fellowships require lab years, and are generally-- though not necessarily-- taking residents from academic programs. Plastics is more open.

[Lest the fine PRS folks jump in and defend, of course there are exceptions. I was in one such lab, and went to the meetings, all last year. I'm speaking in generalities only.]
 

LucidSplash

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Lucid, I'm sure you wrote your post as I was writing mine above you, but you might check it. There are lots of differences between pediatric surgery (*all* jobs post-training are academic, research is required as a part of the career, must be extremely dedicated to advancing knowledge of pediatric surgical disease) and plastics, which primarily sends people into community practice and does little bench research as compared to other surgical fields.

Therefore it follows that pediatric surgery fellowships require lab years, and are generally-- though not necessarily-- taking residents from academic programs. Plastics is more open.

[Lest the fine PRS folks jump in and defend, of course there are exceptions. I was in one such lab, and went to the meetings, all last year. I'm speaking in generalities only.]
Yes, I think we were posting simultaneously. Your points, far more eloquently than my post, expressed where I was trying to go in my post.

So yeah. Basically I agree with BD.
 

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I believe at last count there were perhaps 5 NIH-funded labs in the country where the PI was a boarded plastic surgeon.
I can literally name 5 NIH funded labs at two plastic surgery programs. You are simply wrong. Actually, in my experience academic plastics is more basic science oriented compared to ortho or ENT and looking at the NRMP match statistics will confirm that plastics cares a lot more about research than other surgical subspecialties. But whatever, stereotypes are stereotypes and will never be altered by internet forum posting.

As for peds CT, they certainly go through a lot of training and their cases are complicated, but there's not a lot of variety to what they do and I'm just not convinced it's on a different league than other specialized areas of surgery. But THEY definitely seem to think it is, in my experience.
 

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With R01 grants? I don't think so.
 

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It is not hard to get a fellowship in congenital heart surgery. One only needs to look at CTSnet and see the numerous job openings for congenital heart surgery fellows (indentured servants) Even some of the finest congenital programs in the world have trouble recruiting.

Who in their right mind would want to spend all that time?

However, it is a bit more competitive to get your first job in this field. Its not really something you can do part time. Like the adult guys who take on the thoracic cases and eventually graduate to cardiac.
 

maxheadroom

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This might be a snarky question, but how much basic science research are Peds CT guys actively doing?

Basic science research is hardly the metric of academic surgery. Some of the most interesting NIH-funded research in surgery is CLINICAL research.
 

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I don't get the point of the debate... I don't think anyone believes you need the best ABSITE ever to get into peds CT, but I guess what the guy in the OP was trying to claim was that there's some sort of filter where if you don't have the magic "great hands" that you won't get the support to make it into peds CT. Anyone seen evidence of this?

I actually did read a book about some peds CT dude who supposedly had complication rates much better than everyone else and how the increased publicity around these complication rates was driving low-volume centers out of business, so there might actually be something worth talking about.
 

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...I actually did read a book about some peds CT dude who supposedly had complication rates much better than everyone else and how the increased publicity around these complication rates was driving low-volume centers out of business, so there might actually be something worth talking about.
There are few jobs out there upon grad, most jobs are solo or single partner with a heavy infrastructure of pedes ICU & pedes cardiology as standard of care (not to mention the OR staff). My take has been that pedes CT is such a small community... low volume center competition doesn't really exist. The competition for patients is less of a "local" thing as you are really competing accross STATES.
 

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One of our peds CT surgeons started college in 1982 and finished her last fellowship in 2004, I think. She did get a PhD in the middle. That's like being in 35th grade when you finish.
I feel her pain. There will be 18 years between when I started college and when I'll finish all my training.
 

Black Surgeon

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so are pediatric cardiac surgeons the top of the surgical hierarchy?
We only have one Ped CT guy on the CT service, and judging by the way he is treated around here at least, I say YES.
 

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Lucid, I'm sure you wrote your post as I was writing mine above you, but you might check it. There are lots of differences between pediatric surgery (*all* jobs post-training are academic, research is required as a part of the career, must be extremely dedicated to advancing knowledge of pediatric surgical disease) and plastics, which primarily sends people into community practice and does little bench research as compared to other surgical fields.

Therefore it follows that pediatric surgery fellowships require lab years, and are generally-- though not necessarily-- taking residents from academic programs. Plastics is more open.

[Lest the fine PRS folks jump in and defend, of course there are exceptions. I was in one such lab, and went to the meetings, all last year. I'm speaking in generalities only.]
Just wanted to add in that this definitely false. Any city medium-sized or larger will have private children's hospitals with pediatric surgeons. And they will be your typical private practice surgeons with no research obligations. Some may obviously choose to do research on their own, but not out of obligation.

There still seems to be some confusion in this thread. To summarize, the best that I understand it (anyone else feel free to chime in).

Pediatric surgery = general surgery residency --> peds surg fellowship. By and large, QUITE difficult to match. I personally have heard that it is the hardest fellowship to match from several people.

Pediatric CT surgery = general surgery residency --> CT surgery fellowship --> peds CT fellowship. Not that difficult. From my understanding, and from knowing someone who matched into it, if you are really that interested in peds CT, you will get a spot. It's not a big crowd and it's extremely self-selecting. I'm pretty sure if you want that badly enough, you will get a spot, and will likely have your pick (obviously if you were a bad or lazy CT fellow, then all bets are off).
 
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Lucid, I'm sure you wrote your post as I was writing mine above you, but you might check it. There are lots of differences between pediatric surgery (*all* jobs post-training are academic, research is required as a part of the career, must be extremely dedicated to advancing knowledge of pediatric surgical disease) and plastics, which primarily sends people into community practice and does little bench research as compared to other surgical fields.
Is this always the case? Are there academic positions that don't require research or is it implied with being an academic pediatric surgeon?
 

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Adding my two cents

1) pvt practice peds surg does exist
2) the issue with pedi CARDIAC surgery is not getting a fellowship but getting a job. There are only so many places that have the huge infrastructure to take care of very small, very sick and frequently very comorbid babies.
 

maxheadroom

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More and more Pedi Surgeons are in the community, partly because that's where there is more growth in the building of new children's hospitals that are not part of a major academic center. One of the handful of Peds fellows that I know is at the new Children's hospital (I think it's Dell) in Austin, TX.

Pedi CT surgery is kinda like Craniofacial surgery in Plastics -- there's a fair bit of interest, but very few jobs.
 

SLUser11

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Pedi CT surgery is kinda like Craniofacial surgery in Plastics -- there's a fair bit of interest, but very few jobs.
I've seen that first hand here in Wichita. Several plastics guys want to do pro-bono cleft lips, but the incidence of cleft lip is 1/1000, and there's about 5,000 births in Wichita/year (estimate), so there's 5 babies to go around. Now, one of the guys in town is well established as a cleft lip/palate specialist, so he gets 3-4 of those (and many others from across the state and mission trips), while the remaining plastic surgeons in town are doing maybe one surgery every 1-2 years.

I'm not sure how that all adds up, though, because I personally scrubbed 3 lips, 1 palate, and a pharyngoplasty during my one month rotation....I guess we have a big drawing area....
 

Black Surgeon

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2) the issue with pedi CARDIAC surgery is not getting a fellowship but getting a job. There are only so many places that have the huge infrastructure to take care of very small, very sick and frequently very comorbid babies.
Pedi CT surgery is kinda like Craniofacial surgery in Plastics -- there's a fair bit of interest, but very few jobs.
These statements are inaccurate and unfounded. There are just too few Congenital CT guys out there for the few trained ones to be looking for food. The guy on our service has to travel between cities every week because of just that reason: The scarcity of congenital CT surgeons. Since we're in the business of making unfounded statements, I'll do you one better and state that there are probably more Congenital CT jobs out there than there are surgeons to fill them. However, I do think the opportunities may be more predominant in the academic arena. There are many more Craniofacial trained plastics and ENT guys than congenital CT, so comparing the two is fallacious.
 
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Guile

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Can adult CT guys do any congenital work? Just like general surgeons can sometimes do AAA repairs (so I've read) or other surgeries in more rural, underserved areas that would usually go to vascular or surg onc in a larger city, can straight CT guys do the occasional Fontan or BT shunt when there's no other choice? I know they do them in fellowship while rotating on peds CT. Just curious.
 

Black Surgeon

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Can adult CT guys do any congenital work? Just like general surgeons can sometimes do AAA repairs (so I've read) or other surgeries in more rural, underserved areas that would usually go to vascular or surg onc in a larger city, can straight CT guys do the occasional Fontan or BT shunt when there's no other choice? I know they do them in fellowship while rotating on peds CT. Just curious.
No! and you'd be hard-pressed to find an adult CT that would even dare attempt anything even with the proper training unless he had the formal fellowship accredition and insurance coverage (or even a hospital that would allow it). The stakes are way too high when you're dealing with new borns, and their parents. Unless the said doctor is fond of lawyers.
 

Guile

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No! and you'd be hard-pressed to find an adult CT that would even dare attempt anything even with the proper training unless he had the formal fellowship accredition and insurance coverage (or even a hospital that would allow it). The stakes are way too high when you're dealing with new borns, and their parents. Unless the said doctor is fond of lawyers.
So I take it that all children in need of pedi CT work get life-flighted into the nearest center that has a peds CT surgeon? I don't know how urgently these surgeries must be done, i.e. if they can wait a few days to get to the nearest center. I was just trying to think how kids born in say rural Wyoming to the local family doctor or one OB in town get up the food chain per se to a super-fellowship trained peds CT surgeon. All kids with say transposition or Tetralogy aren't born in New York City or LA. Although I imagine heart defects that bad are likely caught by ultrasound early so the parents can prepare and deliver in a large tertiary care center.
 

SLUser11

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These statements are inaccurate and unfounded. There are just too few Congenital CT guys out there for the few trained ones to be looking for food. The guy on our service has to travel between cities every week because of just that reason: The scarcity of congenital CT surgeons. Since we're in the business of making unfounded statements, I'll do you one better and state that there are probably more Congenital CT jobs out there than there are surgeons to fill them. However, I do think the opportunities may be more predominant in the academic arena. There are many more Craniofacial trained plastics and ENT guys than congenital CT, so comparing the two is fallacious.
Are you basing this on your isolated, anecdotal experience, or a true knowledge of the Peds CT surgery job market?

I will say straight up that I have no idea how easy it is to find a job in this field. However, I'll also say that Pilot Doc definitely trumps you in experience, and I doubt he's making it up. And I think Max is comparing the concept of cranifacial plastics, not the actual amount of demand and # of surgeons....most plastic surgeons are "craniofacial trained."

But I'd definitely agree that there's probably more cleft lips than tetralogies.
 

Black Surgeon

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Are you basing this on your isolated, anecdotal experience, or a true knowledge of the Peds CT surgery job market?
I clearly stated that my statement about the job outlook was unfounded. There are only two studies focused exclusively on the field of congenital CT surgery. One was in 1992 and the other was in 2006 and neither of those studies illustrate much about the job outlook for congenital CT surgeons. I don't think pilot doc or max are qualified to have authority over the issue, as their experience is just as "isolated, and based on "anecdotal experience".

But I'd definitely agree that there's probably more cleft lips than tetralogies.
The vast majority of congenital surgeons do both adult congenital and pediatic congenital, so pediatric cases like "tetralogies" do not comprise a high percentage of their cases.
 
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maxheadroom

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I'm glad we have such well-informed medical students on SDN!

I have no access to high-quality research regarding jobs in Pedi CT Surgery. Instead, I rely on my friends in CT Surgery who uniformly say that "Congenital hearts are really cool, but there aren't enough patients to keep people busy." From what two different CT guys that I know say, there are places that want to hire someone with congenital training, but they'll only do one or two cases per month -- certainly not enough to be a high-volume congenital guy, especially fresh out of fellowship. Job openings in high-volume centers are rare and often go to a "Super Fellow" who has been waiting in the wings.
 

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So I take it that all children in need of pedi CT work get life-flighted into the nearest center that has a peds CT surgeon? I don't know how urgently these surgeries must be done, i.e. if they can wait a few days to get to the nearest center. I was just trying to think how kids born in say rural Wyoming to the local family doctor or one OB in town get up the food chain per se to a super-fellowship trained peds CT surgeon. ....Although I imagine heart defects that bad are likely caught by ultrasound early so the parents can prepare and deliver in a large tertiary care center.
What I have seen is that yes, numerous congenital defects are found in-utero. yes, planning is arranged pre-birth. yes, plenty of life-flights. yes, plenty of death prior to reaching a trained pedes CT surgeon. There are some community pedes intervent cardiology guys that can do some temporizing measures to give time to get to a center that does congenital. Current regarded "standard of care" for pedes congenital involves pedes card ICU with intensivists. In fact, unlike most other areas, pedes card intensivists can be afforded because there is re-imbursement seperate from the surgical reimbursement.

Much of the "adult work" done by congenital heart surgeons is re-do/follow-up procedures on folks that made it through pediatric congenital heart operations or other congenital defects in adults....

I find it hard to believe someone goes through GSurgery5-7yrs, cardiac 2-3 years, congenital 1-2yrs, maybe other research in between.... to go into the community, do CABGs and the occasional congenital case.... You really need some numbers to sustain the infrastructure. Yes, the congenital guy/gal can cover for some adult folks.... if they will tolerate the onerous degradation of such. However, I suspect, with limited exception they are only doing pedes/return adults.... cause their adult only "partners" can not really cover for them....
 
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SLUser11

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I clearly stated that my statement about the job outlook was unfounded......
The vast majority of congenital surgeons do both adult congenital and pediatic congenital, so pediatric cases like "tetralogies" do not comprise a high percentage of their cases.
From the way you quoted the other posts, it seemed like you were calling their statements unfounded, not your own.

As for the tetralogy comment, I was using it as a generic example of something rare, not as a summation of what I thought a peds CT surgeon's case load looks like.

Either way, let's just all agree that it's a small field that's difficult to both get into and to tolerate as a career, and that none of us are experts.

In my anecdotal experience at a couple different institutions, these guys were not at the top of the surgical hierarchy, though....
 

45408

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What I have seen is that yes, numerous congenital defects are found in-utero. yes, planning is arranged pre-birth. yes, plenty of life-flights. yes, plenty of death prior to reaching a trained pedes CT surgeon.
I did a rotation in a step-down peds ICU that took care of a lot of hypoplastic left hearts, and every one that I remember had been caught in utero, so the delivery was either at a place that could handle the surgery or there was a helicopter waiting for the baby. You can get a great look at the heart with a 20-week gestation ultrasound these days.
 

JackADeli

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...Either way, let's just all agree that it's a small field that's difficult to both get into and to tolerate as a career....
I would phrase it as being difficult to tolerate getting into...
...hypoplastic left hearts, and every one that I remember had been caught in utero, so the delivery was either at a place that could handle the surgery or there was a helicopter waiting for the baby...
I don't think we are saying anything different.
 

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I imagine it's not just about having magic hands but also making good decisions from second to second. I was on a pediatric liver procurement and the peds cardiac surgeon who was picking up the heart had a tremor. He was very methodical, calm, and confident, though. My advisor (neurosurgeon) was telling me that some people who look like they work beautifully end up with bad results and some people who look like they have hands of stone get great results... the difference (in his mind) was making the right decisions, knowing how to get out of trouble, and knowing when trouble was right around the corner.

There are few jobs out there upon grad, most jobs are solo or single partner with a heavy infrastructure of pedes ICU & pedes cardiology as standard of care (not to mention the OR staff). My take has been that pedes CT is such a small community... low volume center competition doesn't really exist. The competition for patients is less of a "local" thing as you are really competing accross STATES.
Hmm... not entirely sure about that. Between 1993-1995 in New York state, almost 2/3 of the surgeons who performed pediatric cardiac procedures did <75 cases. It's true that there were some low volume surgeons at high volume centers and some high volume surgeons at low volume centers (the paper didn't go into it).

http://pediatrics.aappublications.org/cgi/content/full/101/6/963

In New York, between 2002 and 2005, there were 4 hospitals with <50 cases (low volume); another 4 hospitals with 100-300 cases (moderate volume); 5 with 300-700 cases (high volume); and 1 with >700 cases (1807 total = ridiculous volume).

http://www.health.state.ny.us/nysdoh/heart/pediatric/docs/pediatric_congenital_cardiac_surgery_2002-2005.pdf

It appears to me that there is some "competition" from lower-volume places... I suspect it's more in the form of ingrained referral patterns, though. Some centers will refer to their in-house guy rather than send it down the street. The book everyone mentions, Walk on Water, mentions this.

JAD, there definitely is some interstate competition. Lots of babies getting transplanted at my institution are coming from out of state and some come from other countries...

I guess with numbers, you can read whatever you want into them. "There are lies, damned lies, and statistics."
 

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There are a few surgeons out there who do "part-time" congenital cases. These are mostly older guys, it is unheard of nowadays to get enough experience in your primary fellowship to do peds- however, these part-timers only do the easy cases- asd, vsd, coarct or maybe a straightforward tet. most of the complex cases gravitate to bigger centers which offer the ultimate fix for congenital heart ailments- transplant.

As far as the job market, I break bread with the congenital ct fellows once or twice a week. There are not that many (first) jobs out there. Basically, your chairman "sends" you to where you will go for your 1st job.

then again, there really arent that many congenital fellowships! i think there are less than 5 ACGME accredited, and I doubt there are many more nonacreddited ones.

most of the current leaders in the field just picked up their skills via on the job training.