SurgONC

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Just wondering what people think about general surgeons becoming more involved in certain IR procedures. I've heard that IR fellowships for graduating radiologists are not very competitive as most rads don't want to do IR. I wonder if general surgery residency training and surgical fellowships will incorporate some IR procedures like TIPS, PTC, percutaneous biliary drains, chemoembolization, RFA and cryotherapy, and percutaneous G- or J-tube placement. I know the vascular surgery programs are now incorporating endovascular techniques in training. Maybe incorporating some of these non-vascular IR procedures in general surgery will help the field grow (since it seems like it's currently shrinking).

Just some of my random late night thoughts, as I try to decide between going into surgery or radiology......
 

factoid

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dude, listen: here's the plan for you. go into radiology and do a prelim year in surgery. if you really like surgery, then switch over. you can always go from radiology to surgery but it is a heck of a lot harder to go from surgery to radiology.


good luck.
 

toxic-megacolon

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SurgONC said:
Just wondering what people think about general surgeons becoming more involved in certain IR procedures. I've heard that IR fellowships for graduating radiologists are not very competitive as most rads don't want to do IR. I wonder if general surgery residency training and surgical fellowships will incorporate some IR procedures like TIPS, PTC, percutaneous biliary drains, chemoembolization, RFA and cryotherapy, and percutaneous G- or J-tube placement. I know the vascular surgery programs are now incorporating endovascular techniques in training. Maybe incorporating some of these non-vascular IR procedures in general surgery will help the field grow (since it seems like it's currently shrinking).

Just some of my random late night thoughts, as I try to decide between going into surgery or radiology......
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.
 
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SurgONC

SurgONC

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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.

factoid: HaHa, thanks for the advice. Today, I am going into surgery. Catch me tomorrow....maybe it'll be psych...

Toxic: I'm sure that's exactly what most general surgeons thought about laparoscopic techniques when they were first developed. Now, obviously, laparoscopy is widely accepted and expanding. And what about using the Da Vinci robot...seems like tedious work, and you don't even get to wear a blue sterile gown. Currently, general surgeons are not taking the prospect of transgastric surgery serious. I hope GI docs don't start doing transgastric cholecystectomies. I dunno...just pondering here....seems like maybe IR should be a fellowship that you can do straight out of general surgery residency, so that you can incorporate those techniques into a gensurg practice.
 

HTD

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I wouldn't worry. Specialites evolve. Sometimes, a specialty changes away from what you visioned at the beginning of a career, so you adapt or suffer. Those changes are driven by factors like technology and economics. Cardiac Surgery is a good example. I have friends in CTS that are thriving and freinds that are miserable. Adaptability helps.

Good advice that I have seen given before is to look at the bread and butter work of any specialty and see if you like that. Dont pick a job for what you do 20% of the time, but for what you do 80% of the time.

Good Luck!
 

supercut

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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.
 

HTD

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supercut said:
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.
In many cases, minimally invasive techniques are better for the patient. If you do like big operations, consider CT or Surg Onc. They too are going to smaller cuts, but less rapidly than others.

Good Luck!
 

Celiac Plexus

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HTD said:
In many cases, minimally invasive techniques are better for the patient. If you do like big operations, consider CT or Surg Onc. They too are going to smaller cuts, but less rapidly than others.

Good Luck!
I don't know about cts, but surg onc still does big, open, macho cases.

I also am lukewarm on laparoscopy, and enjoy not just the big cases, but also the smaller cases like breast, soft tissue, skin grafts, debridements...I even like hemorrhoids, sphincterotomies, perirectal cases... Basically any cases where there's a lot of cutting and sewing. I think there are still enough general surgery cases for the all the throwback types...
 

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Neurosurgery is well on its way to taking back endovascular coiling of intracranial aneurysms from the interventional radiologists (and even some neurologists are getting into the game). The benefit of a surgeon doing these things is that they are better trained to understand the risks and benefits of both procedures and can help the patient make the better choice for their condition. Doctors that do not perform the procedure should not be the ones discussing the risks and benefits of the procedure but I see it happen all the time.
 

droliver

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supercut said:
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!
Intraperitoneal endo-luminal surgery has always sounded completely ass-backwards to most people if for no other reason then you're adding a second gastrotomy or enterotomy for specimen retrieval which uneccesarily raises potential complications . It is conceptually flawed.
 
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Blade28

Plus I don't know if I want gastroenterologists creating said gastrotomy and then repairing it. Sounds scary to me.
 

johnny_blaze

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supercut said:
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.
It wouldn’t have made a difference if cardiac surgeons incorporated stents into their work. Why would a cardiologist refer a case to a surgeon for stenting if they can do it themselves? Vascular surgeons are in a different situation. They have more room for flexibility in their work as referrals to vascular radiology mainly come through them.
 

johnny_blaze

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Celiac Plexus said:
I don't know about cts, but surg onc still does big, open, macho cases.
hmmm i'd consider a median sternotomy quite an "open" case... and i'd consider thoracic aortic surgery to be quite "macho"... well in my eyes :D

I think CT is quite a good bet if you want open cases. The whole robotics thing sounds pretty weak to me as it's only current use is single vessel disease (IMA to LAD) which cardiologists usually stent anyway. "Minimally invasive" cardiac surgery exists but it just utilizes smaller incisions to avoid sternotomy.

Transplantation's a good bet if you want a lot of open cases (aside from donor nephrectomies which are usually done laparoscopically now)
 
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