Oh I've been waiting for this
@mimelim...
What is the life of a Vascular Surgeon like after intern year? What does your schedule look like now?
What are the possible fellowships one can complete after Vascular Surgery?
How exactly do you become a CV surgeon? Thoracic residency followed by a Vascular fellowship or is it the other way around? Or both?
What is the biggest lesson you have learned in your second year?
What is a trauma rotation like while in a Vascular residency?
Vascular as a PGY2 is about the same as a General Surgery resident at the same level. You do a lot of critical care (SICU, CVICU) and when on surgical services you operate a lot more. You are expected to know how to do the most basic surgeries with minimal supervision and expected to be able to take care of most of the floor stuff without being asked. For the most part, if you work reasonably hard and pay attention your intern year, it is a natural progression. My schedule varies depending on whether I'm on a critical care month or a surgical month. Critical care looks something like this:
5am - Get sign out
5:30am - start pre-rounding
8am - Start rounding with the ICU team (intensivist, residents, pharmacy, nutrition, case manager, nursing)
11am - Finish rounds and start working on lines, calling consults, and getting plans into action
2pm - Fast rounds with the ICU/transplant teams
3pm - Admissions start to pour in from the OR
5pm - Start to sign out
Surgery looks like this:
5:30am pre-round on the people I'm worried about
6am - Run the list with the night intern and take care of the small things
7am - Run the list with the fellow
7:30am - 6pm OR/consults, on your feet all day running around, but for the most part, park it in one of the ORs
There are no official fellowships after the integrated vascular residency. This is meant to replace the Vascular fellowship. Some people do an extra year in veins or open aortas to get more numbers and contacts if that is what they are interested in focusing on. There really isn't such a thing as a CV surgeon training pathway. Its either CT or Vascular. You could theoretically do a fellowship in both Thoracic and Vascular and I've heard of people doing it, but it is a shift from how it used to be.
My biggest lesson? If you don't like what it looks like today - you sure won't tomorrow.
Trauma is... Nuts. At a big center with lots of penetrating trauma, things go from 0 to 60 in seconds. You go from feet kicked up to hands in chest in less than 10 minutes. As a second year I did 2 ED thoracotomies with just the attending and when you move at that pace, you are basically only limited by how much you know because nobody is going to stop you. It is an emotionally hard rotation. The people coming in look like you. They are young, they are healthy and they are very badly hurt. They aren't your sick, nursing home patient. They remind you of your friends/loved ones. If you can't compartmentalize, you will get torn to shreds emotionally. It just isn't for everyone.
Do you have any regrets concerning your medical school education or would you do anything differently?
What advice would you give to a rising medical student interested in surgery?
How have you managed, and how will you manage the financial debt accrued from med school?
My biggest regret about medical school was not spending more time on some of the specialty medicine services and really trying to understand them. I don't have time (or the energy) to learn Cardiology, Nephrology, Pulmonology etc. I get the cliff notes version, but not a whole lot more in residency. If its even remotely out of the ordinary, we consult. I think that if I could go back, I'd have spent less time writing page long H&Ps and spent more time trying to understand CKD, CHF, COPD etc. If you are interested in surgery, figure out if you love the OR. I mean really love it. Because, if you don't, you need to find something else to do. That is the biggest thing we get to do that others don't and we sacrifice a lot to be able to do it. The hours are longer, the people are on average meaner and the residency is longer. If you don't see the OR as a big reward for working hard, there is something else that you will enjoy doing a lot more.
I took out a fair amount of loans for medical school. My wife did as well for law school. She is an ADA and plans to remain in the DA for a good while (why she went to law school). She therefore qualifies for loan forgiveness in 9 years (after a total of 10). My residency is 7 years long. I plan to remain in academics. If I do that for 3 years, my loans will be forgiven as well. If I were to go private, my salary difference will easily make up the difference and I will pay off my loans in about 3 years. Between the two of us and our mortgage we owe ~500k. I'm not worried. We are busy and have inexpensive tastes. It will all work out in the end.
1. Do you feel like your technical background with its emphasis on systematic problem solving has provided any advantage or help to your clinic reasoning and/or judgment before or during a case?
2. Did you ever consider some sort of disability insurance while in medical school for your hands? Asking from the perspective of another "handy" person.
1. Yes, absolutely. Most people get there eventually, but the ability to lay out a solution to a problem is something that translates into everything you do. Directly, planning out an OR case, especially our endovascular cases. Being able to ask for things 15 minutes before you need them will cut a case length in half. Indirectly, being able to plan ahead and solve problems before they happen allow you to delegate things to NPs, PAs or interns so that when you get out of the OR the floor isn't a complete **** show.
2. I have disability insurance. Before you leave residency it is practically a requirement that you have it. (premiums get locked in early and waiting until you are in practice will make them skyrocket) I don't have a big plan, but it is enough to get us out of debt so I can go do something else.
How do you come to terms with spending the vast majority of your waking hours in a hospital for at least 5 years of a surgical residency? Surgery seems awesome but I don't understand how people get through residency (or beyond) without going crazy.
This is the easiest question to answer and by far the hardest to explain. I love what I do. Plain and simple. Surgery fits my personality and my strengths. I want to feel needed and even as a surgical PGY2 I get that. At 3am, if I'm in the hospital, I am the only one that can do a certain number of things. I'm one of maybe a couple that can do a laundry list of others. I like that pressure. I like the acuity. I like moving quickly. I'm an adrenaline junky. It helps to love medicine too. I don't mean the science, but the people part. I love working to help people and get a high when people recognize that you made a difference. I certainly don't think that everyone has this perspective in surgery, but that is what gets me by. At the same time, there are a lot of things that I dislike. Rigid hierarchy, malignant people, paperwork etc. Don't get me wrong, that stuff will drive you bonkers. And if it doesn't, you aren't normal. But, at the beginning of the day, I wake up happy. If I didn't, I'd go find something else to do.
