Surg Onc/ HepatoPancreaticoBiliary

[TIGER STYLE]

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How competitive are these fellowships nowadays? How much research do you need? Thanks

 

[Winged Scapula]

Not.

Little to none I suspect.

 

[SocialistMD]

Surg Onc is much more competitive than HPB, as there are only 19 SSO approved fellowships and it leaves the door open to more lifestyle friendly concentrations like endocrine or skin/soft tissue. If you know you want to do HPB, it is probably more beneficial to do an HPB fellowship or even an abdominal transplant fellowship, especially if your residency exposure with these procedures is limited.

 

[TIGER STYLE]

Great Advice, thanks. In Regards to HPB, do I need research, and do you know if there are many spots avail. around the country? I will research deeper into it, of course, just thought you might know of hand...

Thanks everyone

 

[SocialistMD]

Great Advice, thanks. In Regards to HPB, do I need research, and do you know if there are many spots avail. around the country? I will research deeper into it, of course, just thought you might know of hand...

Thanks everyone

There are several threads on this subject. Look to the fellowship council's website for the number of spots.

 

[Amgen1]

http://www.surgonc.org/uploadedFile...SSO_AHPBA_Common_Match_Announcement060109.pdf

you can now apply to both surg onc and HPB at the same time

 

[TIGER STYLE]

Great Info. Thank you!

 

[Winged Scapula]

Did you change the title?

For some reason I thought, when I responded earlier, that it said just HPB (no Surg Onc).

If it did, I apologize...Surg Onc: competitive, very academic, probably need research.

 

[Biscuit799]

From what I understand, Surg Onc is very competitive and loaded with MD/PhD's. I could be wrong, it's happened before...

 

[surgres88]

From what I understand, Surg Onc is very competitive and loaded with MD/PhD's. I could be wrong, it's happened before...

You don't have to be a PhD, but research is needed. Good to go to a program with a good track record. Attendings who will make phone calls for you is essential.

Unsolicitied but given anticipating next possible questions...

Where to find this info on track records, check dept. home pages for alumni listings. If they are going to MD Anderson, MSK, etc take a closer look at this place. Another key point is...if every year someone is going into this specialty it probably speaks to the mentoring the faculty is doing for the residents. As I have gone through residency my upper levels tend to go to the specialty their mentor is in. Though, you can say chicken or the egg, resident was interested in the this specialty so sought out mentors in that specialty. But you need a good environment and available opportunities to be able to place yourself in an advantageous position, especially for competitive fellowships.

 

[maverick_pkg]

Surg Onc is much more competitive than HPB, as there are only 19 SSO approved fellowships and it leaves the door open to more lifestyle friendly concentrations like endocrine or skin/soft tissue. If you know you want to do HPB, it is probably more beneficial to do an HPB fellowship or even an abdominal transplant fellowship, especially if your residency exposure with these procedures is limited.

So you are saying if one is interested in liver and pancreas cases, it is better to go HPB route rather than surg onc? Is that because of more concentrated training - HPB is 1 year while surg onc is generally 2-4 months in HPB+potential 6 months elective?

so reason for surg onc to be so much more competitive than HPB is lifestyle friendly concentrations like endocrine or skin/soft tissue? Wont it be better to do endocrine fellowship then? Thanks

 

[Amgen1]

So you are saying if one is interested in liver and pancreas cases, it is better to go HPB route rather than surg onc? Is that because of more concentrated training - HPB is 1 year while surg onc is generally 2-4 months in HPB+potential 6 months elective?

so reason for surg onc to be so much more competitive than HPB is lifestyle friendly concentrations like endocrine or skin/soft tissue? Wont it be better to do endocrine fellowship then? Thanks

I think this is an ongoing debate in the academic world. you will get different answers depending on who you ask.

training models are so variable

is it better to have your rt hepatectomy by a surg onc surg vs. HPB surg vs. transplant surg . . .

note that at the large surg onc centers many of the the HPB surgeons have done surg onc + HPB/transplant training

debate continues on to the other surg onc divisions as well

Surg onc vs breast surg? surg onc vs colorectal surg? surg onc vs endocrine surg?

 

[SocialistMD]

So you are saying if one is interested in liver and pancreas cases, it is better to go HPB route rather than surg onc? Is that because of more concentrated training - HPB is 1 year while surg onc is generally 2-4 months in HPB+potential 6 months elective?

so reason for surg onc to be so much more competitive than HPB is lifestyle friendly concentrations like endocrine or skin/soft tissue? Wont it be better to do endocrine fellowship then? Thanks

As Amgen pointed out, it is a matter of debate amongst those in the field. We have three HPB surgeons; one is a self-made man and the other two did surg onc fellowships at MSK. That said, we have an HPB fellowship that rotates on transplant and HPB. What you stated is the argument for why a specific HPB fellowship would be better, but there are people who would point out that a well-balanced surgical oncologist (with a stress on the onc, as there is a lot of med onc knowledge acquired during a surg onc fellowship) can provide more "complete" care and counseling than the HPB surgeon (though I'm not sure I personally agree).

To address the endocrine issue, it is simply tough to get a job as an endocrine oncologist because it is such a great job and because that is something that is still in the domain of the general community surgeon (thyroids, skin, soft tissue and breast), meaning the referrals to a tertiary center are generally fewer (though the total number of cases is still larger simply because the diseases are more common). In this case, the surgical oncology fellowship makes you more marketable because you can start out as the HPB guy at your hiring institution, pay your dues, and then move into the endocrine side once the institution's current endocrine guy moves on.

 

[maverick_pkg]

is it better to have your rt hepatectomy by a surg onc surg vs. HPB surg vs. transplant surg . . .

so what is the general feeling out there regarding liver/pancreas surgeries and what do people prefer? We hardly do them at our program so dont have the exposure. Which would provide the best training as a fellow? Which gives the best job opportunities?

also why is surg onc so much more competitive than HPB or transplant?

 

[Winged Scapula]

so what is the general feeling out there regarding liver/pancreas surgeries and what do people prefer? We hardly do them at our program so dont have the exposure. Which would provide the best training as a fellow?

If you want to focus on liver, then your best fellowship option would be HPB; pancreas, Surg Onc. If you want to do both, then probably Surg Onc, but remember Surg Onc is a huge field, so in most cases, you get only a few weeks on each organ (ie, 6 weeks breast, melanoma, 8 weeks esoph, etc.).

Which gives the best job opportunities?

Probably Surg Onc - if an employer is looking for bang for their buck, its going to be the surgeon who can do thyroids, gooses, melanoma, colorectal, etc. rather than just livers and biliary system.

also why is surg onc so much more competitive than HPB or transplant?

MUCH better lifestyle than transplant, fewer positions and fewer job opportunities outside of academic medical centers. Its also seen, at least in my experience, as more prestigious than some of the other fellowships - probably because it is so highly academic.

Most Surg Onc procedures are planned; most liver transplants are not. If you limit your practice to living related kidneys, then you can have a nice 0730-5:00 practice in the community.

 

[SocialistMD]

so what is the general feeling out there regarding liver/pancreas surgeries and what do people prefer?

I don't think it really matters. Most HPB fellowships are relatively new, and most of the people who are training them are either surgical oncologists by training or by practice (the Lillemoes, Pitts, and Strasbergs of the world).

Which would provide the best training as a fellow? Which gives the best job opportunities?

The answer to both of these depends on what you want to do with your life. If you know you want to be an HPB surgeon, then either would be fine, as there are pros and cons of each that probably negate each other. If you aren't sure you want to do HPB, surg onc will allow you to branch out easier. Likewise for job opportunities, if you apply for an HPB position, either is probably the same, as programs want warm bodies that know what they are doing with HPB, and both routes will ensure you are capable.

also why is surg onc so much more competitive than HPB or transplant?

Lifestyle.

 

[core0]

Most Surg Onc procedures are planned; most liver transplants are not. If you limit your practice to living related kidneys, then you can have a nice 0730-5:00 practice in the community.

It would be pretty hard to do just a living related kidney program. I'm not sure there are actually any out there. On the other hand with pumping becoming more widespread its pretty unusual for the kidney folks to work late. You can almost always defer it to the next day. The only time they seem to go late is when you get a donor kidney with a lot of travel time on it already. There are a lot of community programs that just do kidneys and vascular access and do well. As long as you stay away from the pancreas😉.

David Carpenter, PA-C

 

[maverick_pkg]

thanks guys. how common is living liver donor transplants ie what percentage of liver transplants are living liver donor. was trying to find online but couldnt come up with a common number

 

[core0]

thanks guys. how common is living liver donor transplants ie what percentage of liver transplants are living liver donor. was trying to find online but couldnt come up with a common number

There were about 2 DDRTs for every LDRT in 2008 (10,550 vs 5,967). Your answer can be found in the OPTN data bank:
http://optn.transplant.hrsa.gov/latestData/viewDataReports.asp

To get the numbers click on national data then select donors in the top box and kidney in the bottom box. Then select all donors by donor type in step 2. Once you get used to the OPTN search engine its very powerful.

David Carpenter, PA-C

 

[Winged Scapula]

It would be pretty hard to do just a living related kidney program. I'm not sure there are actually any out there. On the other hand with pumping becoming more widespread its pretty unusual for the kidney folks to work late. You can almost always defer it to the next day. The only time they seem to go late is when you get a donor kidney with a lot of travel time on it already. There are a lot of community programs that just do kidneys and vascular access and do well. As long as you stay away from the pancreas😉.

David Carpenter, PA-C

I know a few txp surgeons who try and only do LRKD and some general surgery.

Its unusual but it can be done, although at the risk of loosing patients. And as you note, the cold ischemia time for kidneys is debateable and always increasing.

Stay away from livers, pancs and small bowel if you want some sleep. 😀

FYI...I think your numbers above reflect RENAL transplants. The user was asking about LIVER transplants...for which LIVING related donors are generally single or double digits per year (in my quick perusal of the interesting link).

 

[maverick_pkg]

thanks for the link

 

[core0]

I know a few txp surgeons who try and only do LRKD and some general surgery.

Its unusual but it can be done, although at the risk of loosing patients. And as you note, the cold ischemia time for kidneys is debatable and always increasing.

Stay away from livers, pancs and small bowel if you want some sleep. 😀

FYI...I think your numbers above reflect RENAL transplants. The user was asking about LIVER transplants...for which LIVING related donors are generally single or double digits per year (in my quick perusal of the interesting link).

I thought the conversation had moved to renal. To do living donor liver only would be pretty much impossible. There were 249 LDLTs done last year. I would doubt that any center did more than 20 last year. Any little slip up in outcomes and you would be done.

The other issue with LD transplant is that you double your inpatient population and double your chance of complications. Not exactly conducive to sleeping at night.

David Carpenter, PA-C

 

[Winged Scapula]

I thought the conversation had moved to renal. To do living donor liver only would be pretty much impossible. There were 249 LDLTs done last year. I would doubt that any center did more than 20 last year. Any little slip up in outcomes and you would be done.

The other issue with LD transplant is that you double your inpatient population and double your chance of complications. Not exactly conducive to sleeping at night.

David Carpenter, PA-C

YOU AND I were talking about the beans, but post #18, right above your link, asks about livers, so I assumed you were responding to that.

What you do with the LDRT is have Urology do the donor nephrectomy so they are on their service, and you only have the transplanted patient on your service. More sleep for you. 😉

NB: not that I have ever seen it done that way, but there are places where Uro does the donor case, so I imagine it can be done.