Surgical Oncology Fellow AMA

[Lem0nz]

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I don't actually know what the subspecialists are like in academics. If we have anyone in ortho/uro/ENT lurking they may be able to answer that question. I do not think the lifestyle in academics will be better or easier, just different. I suspect they still have pretty regular call burdens because those specialties can't share their call with general surgery like surg-onc can and I don't think they typically have a fellowship dedicated just to call like we do with trauma/acute care surgery.

So my guess is, not much different on the call front between academics and non-academic. But I don't actually know.

 

[chapulin colorado]

Though you can probably see the light at the end of the tunnel now (also, congrats!), hopefully you have a smidge of bandwidth left for a couple more questions.

1) How many fellowship programs would you recommend applying to?

2) I can't find it at the moment, but there was a thread some time ago where a few people gave their impressions of their interviews (I should see if there's a recent one), and IIRC there was a discussion that for some of the top/more prestigious programs, the chances of landing a spot there from the bulk of GS programs is virtually nil as they are effectively predetermined/set aside. Do you feel that's the case?

 

[DoctwoB]

I don't actually know what the subspecialists are like in academics. If we have anyone in ortho/uro/ENT lurking they may be able to answer that question. I do not think the lifestyle in academics will be better or easier, just different. I suspect they still have pretty regular call burdens because those specialties can't share their call with general surgery like surg-onc can and I don't think they typically have a fellowship dedicated just to call like we do with trauma/acute care surgery.

So my guess is, not much different on the call front between academics and non-academic. But I don't actually know.

Uro weighing in. Most places (academic or otherwise) will have a single urology call pool that all attending participate in. I've never heard of a urologic oncologist having separate uro onc call. There are no uro onc emergencies that a general urologist should be unequipped to handle and vice versa. That being said our call is usually pretty benign due to the relative rarity of urologic operative emergencies compared to general surgery. Now that I'm out in the community I probably average coming in 1 or 2x during a week of call and I take 1 week a month.

 

[Cath Up]

Were you trained in CRS/HIPEC or is that not a part of standardized training? If you want to eventually perform a procedure not done by everyone, do you just have to get lucky/extremely competitive and find a program with someone that does it?

 

[Lem0nz]

Though you can probably see the light at the end of the tunnel now (also, congrats!), hopefully you have a smidge of bandwidth left for a couple more questions.

1) How many fellowship programs would you recommend applying to?

2) I can't find it at the moment, but there was a thread some time ago where a few people gave their impressions of their interviews (I should see if there's a recent one), and IIRC there was a discussion that for some of the top/more prestigious programs, the chances of landing a spot there from the bulk of GS programs is virtually nil as they are effectively predetermined/set aside. Do you feel that's the case?

Apply to all of them. There aren’t enough to justify not applying to all of them.

I’m not sure about any program necessarily being off limits. They may have already chosen a probable candidate before the process starts which could be aggravating, particularly for the one per year or one every other year programs. But the big ones with multiple spots usually don’t have that problem actually as far as I can tell. The pedigree isn’t as important as how long your CV is from research acumen.

The problem is many GS programs don’t get you the volume of research to make you even remotely competitive for MSK or MDA and the ilk.

 

[Lem0nz]

Were you trained in CRS/HIPEC or is that not a part of standardized training? If you want to eventually perform a procedure not done by everyone, do you just have to get lucky/extremely competitive and find a program with someone that does it?

I was trained. I think most programs train in it now but it isn’t required. CRS is not super complicated, it’s just all of general surgery in a single operation that is longer. You’re really just managing your tolerance for morbidity which is more of an experience thing I’ve found (that’s my impression anyway).

You’d have to be more specific with your last question. Like what? Like robotic whipple/esophagus? Those are not standard and you’d need to really seek out a program with robust training that the fellow actually DOES and doesn’t watch for that skill set.

 

[Cath Up]

I was trained. I think most programs train in it now but it isn’t required. CRS is not super complicated, it’s just all of general surgery in a single operation that is longer. You’re really just managing your tolerance for morbidity which is more of an experience thing I’ve found (that’s my impression anyway).

You’d have to be more specific with your last question. Like what? Like robotic whipple/esophagus? Those are not standard and you’d need to really seek out a program with robust training that the fellow actually DOES and doesn’t watch for that skill set.

Yes, like that. Thank you!

 

[Dunkthetall]

If you’re still answering questions:

How easy would it be for a surgical oncologist to only focus on HPB and colon cancers? Are there a lot of turf wars between colorectal surgeons and surgical oncologists?

 

[Lem0nz]

If you’re still answering questions:

How easy would it be for a surgical oncologist to only focus on HPB and colon cancers? Are there a lot of turf wars between colorectal surgeons and surgical oncologists?

It could certainly be done. Your HPB practice would probably end up being <20% of your practice in reality in that sort of set up though. You'd be private practice at a smaller center (or in a multi-specialty group at a medium size community hospital) so you'd get the occasional HPB case that comes through but primarily deal with colon cancer and probably have a fair component of general surgery cases on top of it as well. Colon cancer is so prevalent that there's usually enough to support some colorectal surgeons and a surg-onc. In larger centers its unnecessary because surg-onc will just gravitate to HPB and be busy enough with that+sarcoma+melanoma+other weirdness that they don't need to take colon cases from CRS - and would rather have a great working relationship because 75% of your liver consults are going to come from colon cancer mets.

 

[IR3A4]

Damn. I suddenly want to do surg onc lmao.

As a second-year student who is now suddenly interested, any suggestions for ways to dive in and see if it's a good fit?

 

[Lem0nz]

On your surgery rotation I'd say you want to try to see an open whipple (or a robotic one but its a little less fun, beautiful anatomy but super tedious), a robot distal panc/spleen, some melanoma surgery so that you see it isn't all big things, some colon cancer resections (doesn't have to be with surg onc) and if you get a chance, spend a day with abdominal transplant and/or urology to see a nephrectomy (not a partial but a complete radical). Then imagine you're the guy they call when anyone either has a cancer, or has a complicated problem, in any of that anatomy. If being that guy (or girl!) sounds amazing, surg onc is a pretty freaking cool life.

Today I got called by a colorectal surgeon for a second opinion and to help her with a really complicated case. I'm only a month into my first attending job and she's got almost twenty years of experience but she was looking to me for help. That is a freaking humbling and awesome feeling. I certainly am not the world's best surgeon and I don't have all the answers, but it turns out I have a lot of them and I'm pretty good. It is without a doubt the product of excellent surgical training that came from my fellowship and residency.

I go to work and wonder why people pay me to do this because its really fun and I'd probably do it for free.

 

[IR3A4]

On your surgery rotation I'd say you want to try to see an open whipple (or a robotic one but its a little less fun, beautiful anatomy but super tedious), a robot distal panc/spleen, some melanoma surgery so that you see it isn't all big things, some colon cancer resections (doesn't have to be with surg onc) and if you get a chance, spend a day with abdominal transplant and/or urology to see a nephrectomy (not a partial but a complete radical). Then imagine you're the guy they call when anyone either has a cancer, or has a complicated problem, in any of that anatomy. If being that guy (or girl!) sounds amazing, surg onc is a pretty freaking cool life.

Today I got called by a colorectal surgeon for a second opinion and to help her with a really complicated case. I'm only a month into my first attending job and she's got almost twenty years of experience but she was looking to me for help. That is a freaking humbling and awesome feeling. I certainly am not the world's best surgeon and I don't have all the answers, but it turns out I have a lot of them and I'm pretty good. It is without a doubt the product of excellent surgical training that came from my fellowship and residency.

I go to work and wonder why people pay me to do this because its really fun and I'd probably do it for free.

That's incredible, thank you!