toxic-megacolon said:
I think that many general surgeons would find IR tedious and a waste of their skill set they've spent so many years attaining. Most surgeons have no interest in doing those procedures. Futzing around with a needle inside someone is nothing like using a scalpel except that you wear a blue sterile gown.
I agree with the last sentence here. IR type procedures don't interest me too much. However, if you are wise as a surgeon, you will take steps to preserve your livilihood.
Witness cardiac surgery...they lost a lot of business when cardiology developed stents and made a huge mistake by ignoring stents instead of incorporating stents into their practice. Now cardiac surgeons are at the mercy of cardiologists, who angio everybody and decide who gets stents and who to send for surgery.
Now witness vascular surgery...who learned a valuable lesson from the cardiac experinece. If I were to go into vascular surgery, I would look for a fellowship that includes all manner of stents (including carotid). The vascular surgeons have managed to keep the endovacular AAA for themselves. The are also doing some catheter based throbolysis.
Up next...natural orifice surgery. Yes, as already mentioned, some pioneering GI docs are taking out appendixes endoscopically (not laparoscopically) via an endoscope, make a hole in the stomach, fetch the appendix, then close the hole in the stomach. It's still very experimental now, but we need to make sure we don't get left out of that. Patients in our vain society will love it...surgey without any skin scars!
The boundary between medicine and surgery is blurring in the layman's eyes. It drives me nuts when the media refers to a cardiologist as a surgeon (or as having performed surgery), or when pts say they've had surgery when they've really had cardiac stents put in. But I am hearing this with increasing frequency.
As for me, I like plain old fashoned stick your hands in via big incision surgery. I went to a med school whose surgery program included very little laparoscopy (lap choles only) Now I'm in a residency that does all kinds of lap things (appy, colon, spleen, adrenal...) I don't like laparoscopy anywhere near as much as regular surgery.(most of my fellow residents like it a lot, though) If I had realized how commonplace all these lap procdures are becoming, I might have done something different. But I realize that I have to learn it to survive, and adapt to the changing marketplace.
Key is to recognize that medicine is a market, which is also responsive to market demands. Pts will go to doctors who give them less pills to take every day but get the same results as more pills. Pts will go to surgeons who perform safe procedures with less pain, shorter hospital stays, smaller (or no) skin scars. Specialties will evolve over the next 20 years in ways we can't even imagine right now.