There are ~100 new vascular surgeons being produced each year, with the new integrated vascular residencies really taking off, that number will likely grow to ~120-140 within the next 3 years. There are currently across the country 600-700 jobs available. The reason for the range is because the vast majority of these jobs are not listed anywhere. Some groups, both academic and private are waiting for the right person to come along looking for a job. At the same time, there are some places that just need a warm body because there is a dire need, and nobody wants to go where there is that need. They offer excessive (500k) and perks just because having a vascular surgeon available will generate a lot more in revenue, or they stand to lose revenue (loss of services provided, less governmental support or other funding sources). The number of offers depends on who you are, how hard you look for a job and how picky you are. Who you know in this business is very important. There are only ~2300 vascular surgeons in the US, who trains you and who can vouch for you means everything for your first job. When I go to a conference, my chairman and my division chief are always introducing me and other of our residents to other faculty or their former fellows, mainly because they are the people that may end up hiring us several years from now.
The raw number of options is higher for people who have done general surgery and then vascular fellowship. But, the cost is 2 years and most would now consider less training. An integrated resident clearly will have less open experience, especially in the abdomen, but will have a year+ more vascular training in much higher yield areas. The reality also is that the majority of people going into vascular have no interest in doing general surgery when you finish. Again, it goes back to people feeling like they "deserve" to do what they want. Well, most people feel after 5-7 years of residency, they should be able to only practice vascular and not be forced to do general surgery. For me personally, I did 2 years of research during my residency, so my total training time will be the same as doing GS residency, followed by vascular fellowship. But, the big difference is that I will have spent 7 years in a vascular training program, 5.5 years of which is focused vascular training/exposure. Compare that to your typical 2 year vascular fellow, who do you think is more desirable for that first job? I have also spent the last 2 years going to virtually every local, regional and national conference. While I still have 2 years before I start asking people about jobs, I feel like I have a huge edge because I pretty much know my top 10 choices and more importantly, they know who I am already.
As a first year attending, you can not have a practice that is limited to only a handful of procedures. Even at super specialized institutions, unless what you want to do is what nobody else wants to do (ie. dialysis access), you will have to have a somewhat general practice and help fill the gaps of that group. Hopefully you can find a group that needs someone to do what you are interested in, but you have to find a way to build that practice from the ground up. If someone is interested in one particular pathology or procedure, they generally will join a practice already doing it, go there, fill in the gaps and learn from the senior partners. Then they will either inherit the practice as the senior guys slow down, or get recruited by another institution to start their own program doing that set of procedures. While there are a handful of institutions out there that do truly crazy/new things. You would be surprised at the number of hospitals take care of difficult pathologies. It isn't just the Mayo, Cleveland Clinics etc.
