The problem with CT Surgery is General Surgery

[Leukocyte]

Dear guys:

I just want to share my frustration. I always wanted to be a CT surgeon, but now, I do not know what I want to be. I have already graduated, and I still have no clue what to go into. My "plan A" was to become a CT surgeon (Pediatric). My "Plan B" was.....nothing.

If you are interested in CT sx, please read this recent article provided (thankfully) by DO_Surgeon:

http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-54.html

The problem with CT sx, IMHO lays in its training requirement. Why in the world do we need to go through 5 to 7 years of General Surgery fixing hernias, removing gall bladders,...... while we can spend this same amount of time training to do chest sx, and LEARNING ABOUT THE HEART?

We spend most of our training in General Surgery!!!!! 5 to 7 years of General Surgery and ONLY 3 YEARS in CT surgery!!!!! Now why? Neurosurgens do not do that! Why should we?

You see, CT surgeons are competing agianst CARDIOLOGISTS. Doctors who know EVERYTHING about the heart IN SIDE OUT. If we need to successfully compete with our competitors, we need to KNOW WHAT THEY KNOW!!!!!!

You see, why spend 5 to 7 years learning about the GI system in General Surgery, while we can spend that time LEARNING ABOUT THE HEART and LUNG. You see, if we are competing with Cardiologists, then we should know what Cardiologists know!!!!

I know we "surgery types" hate "medicine", but an exception must be made here. CT surgeons NEED to now more Cardiology, and less about Hernias, Gall Bladders, soft tissue stuff......... We need to learn how to read Echos like they do. We need to know how to read EKGs like they do. We need to know Cardiac pathophyshiology like they do.

I say, forget GS training. Do only 2 years of GS to learn the basics of general surgical managment, then spend the rest of your training learning:

-Thoracic surgery.
-Cardiology and Interventionl Cardiology

CT surgoens should be more like Cardiologists than General Surgeons. They should be CARDIOLOGIST WHO CAN OPERATE. If we can become that, then plane old Cardiologists will not be able to compete with us.

But God, I hate this old school surgery mentality that "medicine people are lazy no goods, and I do not want to have anything thing to do with them." That will be fine and dandy if you are a General Surgeon, Trauma Surgeon, Vascular Surgeon, Colorectal.......

BUT NOT if you are a CT surgeon. We need to know Cardiology to compete with Cardiologists!!!!

Why are we spending MOST of our training removing Gall Bladders?????

Sorry for long post.

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[jpro]

Why don't you look into interventional cardiology? 7yrs vs 8yrs, of course you will have to do an IM residency. I have a feeling that interventional procedures will continue to fall into non-surgical specialties. Cardiologists who refer patients to a CT surgeon will eventually just do interventional prcedures themselves. The same thing is happening with neuologists doing more and more interventional work. I don't know how many congenital defects that can be fixed by a pediatric interventional cardiologist, or even if that specialty exists. If it's pediatric CT surgery you want then you probably will not have much competition from cardiologists.

 

[johnny_blaze]

There are some paediatric heart conditions treated with interventional procedures. I was under the assumption that this was also done by cardiologists. I dunno for sure though.

CT surgoens should be more like Cardiologists than General Surgeons. They should be CARDIOLOGIST WHO CAN OPERATE. If we can become that, then plane old Cardiologists will not be able to compete with us.

BUT NOT if you are a CT surgeon. We need to know Cardiology to compete with Cardiologists!!!!

I also enquired about this topic once before in this forum and was reminded that simply because of referral patterns, CT will always be in cardiology’s shadow… unlike with vascular, which has no medical equivalent. Theoretically speaking, if CT was actually able to muscle out cardiology by “learning their field”, do you honestly think the cardiologists would just sit there and let it happen? I doubt it. They’d probably start picking up the scalpels

 

[JudoKing01]

I know a chest surgeon who does almost no chest work. He's doing mediports and pacemakers all day with the occasional thyroid surgery. The only time I've ever seen him do a chest case is when he did a thyroidectomy and the thyroid was real down in the mediastinum and was like 12cm wide, lol.

 

[Leukocyte]

Why don't you look into interventional cardiology? 7yrs vs 8yrs, of course you will have to do an IM residency.

I would never do an IM residency, not even if they offered me one at Harvard with a guarenteed IC fellowship. Medicine folks are just "different".

I don't know how many congenital defects that can be fixed by a pediatric interventional cardiologist, or even if that specialty exists. If it's pediatric CT surgery you want then you probably will not have much competition from cardiologists.

Pediatric Cardiologists do Interventional procedures too. They do some THERAPEUTIC interventions, but most of their interventional work is Diagnostic. However Pediatric Cardiology is growing, and will soon catch up with their adult peers in IM.

Interventional Cardiologists do not work on kids. ONLY Pediatric Cardiologists do interventinal work on kids.

Again, Pediatrics and IM are similar in that they are both "medical fields", meaning:

-Long rounds
-Long and detailed H&Ps
-Long lists of differential diagnosis (even though they already know the problem)
-Lots of talking talking, and little doing doing

 

[Leukocyte]

Theoretically speaking, if CT was actually able to muscle out cardiology by “learning their field”, do you honestly think the cardiologists would just sit there and let it happen? I doubt it. They’d probably start picking up the scalpels

I really do not think so. It is easier to learn cardiology than to learn CT surgery.

Cardiology requires:

-Brains

CT Surgery requries:

-Brains
-Good Hand-Eye coordiation
-"A surgical personality" - aggressive, decisive,.......

Also, if there is one thing that "medicine" folks hate, it is surgery.

 

[VentdependenT]

I really do not think so. It is easier to learn cardiology than to learn CT surgery.

Cardiology requires:

-Brains

CT Surgery requries:

-Brains
-Good Hand-Eye coordiation
-"A surgical personality" - aggressive, decisive,.......

Also, if there is one thing that "medicine" folks hate, it is surgery.

These interventional cards guys in the CCU have some balls of steel. Tons of things can go wrong during and after a cath.

New article in NEJM considering coronary revascualrization turf battles
http://content.nejm.org/cgi/content/extract/352/9/857

 

[SocialistMD]

Leukocyte-

You are being short-sighted. You don't want to be a CT surgeon, you want to be a heart surgeon. There is much more in the chest than just the heart. That is why the training is different than that of a cardiologist with a knife. If you think there are slim pickings for CT surgeons, imagine how tough it would be if you were only certified to operate on the heart.

It actually sounds like you want to be a cardiologist who can operate but who somehow gets to avoid the internal medicine residency. The fact of the matter is, you can't have what you want; it isn't in the stars. Even cardiologists, who only have to "think" during their residency, still have three years of it in order to assure they are competent. You want to do this with surgery, despite the fact that surgeons are learning both the medicine as well as operative technique. It is an unrealistic goal.

Don't take this as a personal attack, as I have nothing against you personally, but perhaps you should spend more time "thinking" about why the programs are set up as they are rather than "acting out" first.

 

[Dire Straits]

the obituary for coronary bypass surgery is being written as we speak. i've heard from an inside source that the opening line of the obituary will read something like: interventional cardiology killed the cardiac star. no official word on when it will be published, but insiders say sometime in the next couple of years.

 

[Leukocyte]

.....you should spend more time "thinking" about why the programs are set up as they are....

Why, my friend? Why are "the programs set up as they are?" Because some old dudes who still think they are God said so?

We have to question the logic of our "grandfathers". We cannot take what they said in the past as bible. The world is changing, and we have to change with it. We cannot remain trapped by the logic of "the elders". We are living in our times, not theirs. I do not care what some 90 years old dude said 50 years ago. Today, we are the ones practicing, not him. Today, it is OUR field.

-In the past Plastics used to require GS, but people questioned the logic behind it and found out it does not make sense.

-In the past Gynecology used to be a subspecialty of GS, but people questioned the logic behind it and found out it does not make sense.

-Why can't we (the new generation of surgeons) question the logic behind "why programs are set up as they are", especially when our fellow CT surgeons are struggling? Why must we take the logic of "our elders" for granted? Clearly something is wrong in their "sacred" logic if CT surgery is about become extinct!!!

The fact is, we need to make changes to "save" CT surgery.

As for the other organs in the chest, well, Cardiac Surgery might not be the only part of CT surgery, but it is a major part of it. If it wasn't, then CT surgeons would not be struggling the way they are now. I have seen General Surgeons do Lung resections. I have seen Vascular Surgeons work on the Aorta.

Neurosurgeons, Orthopaedic surgeons, ENTs, Urologists, Plastic surgeons do not need to go through 5-7 years of GS, while CTs MUST do a COMPLETE General Surgery residency. Why? What is it about CT sx that needs 5-7 years of general surgical training?

Why cannot we just do 2 years of general surgery and spend the rest of our training learning CT surgery and Interventional Cardiology? What is wrong with this?

What is wrong with including Cardiology into CT surgical training? Is it not better than spending the same amount of time removing Gall bladders and fixing hemorrhoids?

I am not asking that we become Internists-Cardiologists, but we should have a solid knowledge of Cardiology, since this is "were the money is."

CT surgeons NEED to learn Interventional Cardiology procedures. They do not NEED to learn how to remove Gall Bladders. We have to learn Minimally Invasive procedures. That is were the future is going.

 

[Skinny]

Hey Leuko,

I know exactly what you are getting at but if you talk to almost any plastic surgeon who is not teaching at an integrated program you will see that almost all recommend that you do 5 years year of general surgery first. The important thing is patient care and during those 4th and 5th years of GS you learn how to run a service, manage post-op problems and be a competent surgeon regardless of what field you choose to do. My whole point is don't let 1-2 years of "extra" training get in the way of what you want to do. Remember, you probably spent more time than that deciding which outfit was the coolest to where to the spring formal during your 4 years of high school.

In a life of 80 years, 1-2 seems like nothing when you realize you spent more than that learning how to say 5 word sentences.

I wish you all the best!

 

[Dire Straits]

For the sake of playing devil's advocate...

canada has had 6 year cardiac surgery residencies for a while now. 2 years of gsurg, followed by an "enrichment year" (a fancy term for a research year), followed by 3 years of cardiac surgery. so they train for 5 years if you discount the research year. and from the people i've talked to they say canadian trained cardiac surgeons are top-notch. so why can't we also implement a similar training program?

disclaimer: canada does not have the 80 hour rule.

 

[Leukocyte]

Hey Leuko,

I know exactly what you are getting at but if you talk to almost any plastic surgeon who is not teaching at an integrated program you will see that almost all recommend that you do 5 years year of general surgery first. The important thing is patient care and during those 4th and 5th years of GS you learn how to run a service, manage post-op problems and be a competent surgeon regardless of what field you choose to do. My whole point is don't let 1-2 years of "extra" training get in the way of what you want to do. Remember, you probably spent more time than that deciding which outfit was the coolest to where to the spring formal during your 4 years of high school.

In a life of 80 years, 1-2 seems like nothing when you realize you spent more than that learning how to say 5 word sentences.

I wish you all the best!

Skinny, my friend, it is not about the number of years. It is about being efficient. And for CT sx, this is more important than any other field - since they are not finding jobs. Why are they not finding jobs? Because they are not trained in Interventional Cardiology.

Did studies show any difference between "Integrated Plastics guys" and "traditional guys"? Do studies say that "Integrated guys" are BETTER plastic surgeons than "traditional guys"?

Offcouse, it would be great to have all surgeons (Ophthalologists, Orthopaedic Surgeons, Neurosurgeons,......) do a complete GS surgery.
They might know more. But does it really matter. It is cost efficient? Will it make the Neurosurgeon, a better Neurosurgeon?

And frankly, as far as Plastics go, it really does not matter (in terms of employment) A Plastic surgeon in-training today, is a Plastic surgeon tommorow. No matter what route he/she took. But a CT surgeon in-training today might not be a CT surgeon tommorow. Why? Because they spent MOST of their training removing gall bladders instead of learning Interventional Cards. techniques.

Thanks Skinny for wishing me good luck....I REALLY need it if things stay the way they are today.

Good luck to you too!

 

[Dire Straits]

hey leukocyte,

we could extend your argument all the way back to med school. do people who want to be psychiatrists really need to take microbiology, gross anatomy, and molecular bio during the preclinical years? why should they do surgery rotations during third year? wouldn't it be most efficient to just make them take classes related to psych during the preclinical years (neuro, pharm, behav sci) and then spend the rest of the time taking psych and neuro rotations?

 

[Leukocyte]

hey leukocyte,

we could extend your argument all the way back to med school. do people who want to be psychiatrists really need to take microbiology, gross anatomy, and molecular bio during the preclinical years? why should they do surgery rotations during third year? wouldn't it be most efficient to just make them take classes related to psych during the preclinical years (neuro, pharm, behav sci) and then spend the rest of the time taking psych and neuro rotations?

Psychiatrists are Medical Doctors. So yes, any Medical Doctor needs BASIC medical training, BUT they do not need to be Internists!!!!

This is what I am saying, CT surgeons need BASIC surgical training that can be provided by spending 2 years in General Surgery, BUT they do not need to be General Surgeons!!!!

Other surgeons are doing this, why not CT?

The thing about Medical School is that it is a requirement for all physicians. But a Complete General Surgery residency is not a requirement for all surgeons.

 

[doc05]

your idea has some merit, but it's not going to happen anytime soon.

first off, CT does general first for historical reasons. when the whole CT thing started, the "chest guys" did general as well. Things have changed, but I can't imagine many surgeons want to add coronary caths to their bag of tricks.

a major problem relates to specialty choice and when med students make that choice. How much CT exposure does a typical 3rd or 4th year student get? and how much is sufficient at that early stage to decide on a career choice? More importantly, the technical and workload demands of CT surgery are arguably greater than any other surgical subspecialty (save perhaps neurosurg), which begs the question as to how programs would choose candidates among 4th year medical students with zero operative experience and little if any exposure to a demanding lifestyle.

 

[neilc]

even if they changed the residency system tomorrow....what would that do to "help" the field? at the end of the day, your heart patients come from the cardiologists. period. and, they are only going to send you what they cannot take care of.

so, while it may be a more effecient training program (and i agree that it sounds like it is), it still will not save CT surg from the interventional guys.

 

[SocialistMD]

CT surgeons need BASIC surgical training that can be provided by spending 2 years in General Surgery, BUT they do not need to be General Surgeons!!!!

What I am saying is that two years doesn't give a surgeon the basic surgical training needed to do CT surgery. Think of how many times you've seen a non-general surgeon manage a surgical patient in the ICU. Orthopods, urologists and ENTs do not do it, and the reason they don't is that they aren't trained to do so. Now think about how many times you have seen a patient post chest surgery in the ICU...

The training of a general surgeon isn't just about how to tie a knot and know where to cut; it is how to manage a patient. That knowledge can't be compressed into two years and still allow for the learning of the operative skills. It takes the brightest medicine residents three years to gain enough mastery of the human body to move onto a fellowship in cardiology; what makes you think a surgeon can gain the knowledge and skills needed in only two?

Chest surgery is built on general surgery and that is why it is a fellowship after general surgery. Very little learned in general surgery pertains to orthopedics, ENT or urology and that is why they break off so soon. The regions in which they operate can often stand freely of the other organs in the body (read: most people can have a procedure without too much risk to other vital parts of the body). Operating on the heart does not have this exclusion; it is intimately connected to the lungs, vessels and abdominal organs. You have to have the knowledge of these areas in order to anticipate problems that may arise and treat them accordingly. Sure, you could always consult medicine, but then you aren't caring for your patient.

If it is endovascular training about which you are worried, many CV programs are now offering it as a part of the fellowship.

 

[Smurfette]

I've also heard that CT training, as well as vascular, may be splitting to 3+3 integrated type of programs (kinda like plastics) in the near future. So don't lose all hope...talk to a CT surgeon at your school and find out what the status of this change is.

However, if you don't want to do CT enough to "endure" 5 years of GS residency, maybe you should try and do interventional cards. Anytime you are working in a body cavity (peritoneum or pleural, for example), it's a damn good idea to know how to fix other random things that can arise during the surgery---perf'ed bowel, lacerated liver, aortic aneurysm or dissection, etc. etc. All sorts of crazy things can happen. That's what the GS training gives you....you can't always wait for someone else to get paged to the OR stat, scrub in and save your patient if something non-cardiac happens that needs to be fixed NOW. Even if you haven't done a certain procedure since you were a resident, the fact that it's an emergency and you are familiar with the procedure will come in handy intra-operatively---or at least allow you to get started until help arrives.

I agree with the above poster...ortho, ENT and urology are so "narrow" in focus that more than a year (if that) of GS training is not overly useful to them. Neurosurg is also very narrow. At my institution, neurosurg and ortho are only consults on a patient if there are any medical issues in addition to the neuro or ortho injuries--it's the general surgeons or trauma team that cares for the patient in the mean time.

 

[Leukocyte]

I've also heard that CT training, as well as vascular, may be splitting to 3+3 integrated type of programs (kinda like plastics) in the near future. So don't lose all hope...talk to a CT surgeon at your school and find out what the status of this change is.

However, if you don't want to do CT enough to "endure" 5 years of GS residency, maybe you should try and do interventional cards.

Dear guys, it is NOT about the time. Not about the time........I will "endure" 20 years of General Surgery if it MADE SENSE, AND I can get a JOB in CT surgery after all this hard work to become a CT surgeon.

It is about NOT BEING ABLE TO FIND A JOB. Not being able to practice CT surgery after all the hard work and time spent to become one.

Now if a CT surgeon cannot get a job after 10+ years of "CT surgery training"....then there must be something wrong in his/her training, and his/her training needs to me modified to adapt with our ever-changing market economy!!!

I do not know how many of you guys want to be CT surgeons, and only CT surgeons......This is very surreal to me.

And why do you need to go through a COMPLETE GS residency to be good in the ICU? Why can't you teach ICU care DURING an Integrated CT surgery program? Neurosurgeons are doing it, and they are doing a damn good job at it. Just go and ask any Neurosurgeon! The other surgical specialists also take good care of their patients, and are trained to manage any complication in their patients that is related to their field! ENT doc know everything there is to know about the surgical management of ENT patients....They better!

So what would you do if you were in my situation? If you ONLY wanted to be a CT surgeon? O.K., let me put it more closer to home. If you ONLY wanted to be a Plastic Surgeon, AND there are no more Jobs in Plastic Surgery, what would you do?

-CT surgery is in a crisis now, and changes need to be made. What changes would you suggest in order to make CT surgeons more marketable?

 

[shahkg]

Are you serious? This is a ******ed thread...

Wait until you actually DO a residency to start commenting on what should be done and what shouldn't.

 

[Leukocyte]

Hmmm...A very mature response! How long did it take you to come up with that sentence?!!!

Please, let us act professional here. This is a debate. There is no right or wrong contribution.....However, contributimg something like "this is ******ed" as a response to a debate is,... well,... says a lot about the contributor!

 

[doc05]

One thing to consider is that your interest is particularly focused in peds. The big changes in the practice of CT surgery is mainly adult cases, and mostly CABG's (the bulk of their practice).

Peds will certainly be affected by interventional techniques, but certain problems (tetralogy of fallot, TGV) won't ever be treated endovascularly because a cathether can't remodel the heart.

You need to consider the job market for peds CT, which is affected by very different forces. It's a small job market, and if you don't want to see ANY adult CT cases, you'll need to be in a medium to large city at an academic center. With increasing prevalence of diabetes and an increase in average childbearing age, incidence of congenital defects might increase. On the other hand, given the aging of the U.S. population, overall birth rates might decrease, so there's no telling what demand will be like in peds CT.

 

[JudoKing01]

doc05 makes a very good point. You're focusing on adult CT surgery, but you specifically said you were interested in becoming a Peds CT surgeon, which has a different job market.

Also, you'd think that being able to practice general surgery would be a GOOD thing in today's adult CT sx market, since they'd be totally out of a job otherwise.

 

[Dire Straits]

How much CT exposure does a typical 3rd or 4th year student get? and how much is sufficient at that early stage to decide on a career choice? More importantly, the technical and workload demands of CT surgery are arguably greater than any other surgical subspecialty (save perhaps neurosurg), which begs the question as to how programs would choose candidates among 4th year medical students with zero operative experience and little if any exposure to a demanding lifestyle.

the same applies to neurosurgery residency. they have no problem picking people straight out of med school and turning them into competent neurosurgeons 6 years down the line. why can't it be the same for ct surgery? and as i've said before, canada has 6 year cardiac surgery programs straight out of med school where they do only 2 years of gsurg, and from what i've heard from attending and fellows who have worked with them, canadian-trained cardiac surgeons are excellent once they finish their 6 year training.

 

[blue2000]

Dear guys, it is NOT about the time. Not about the time........I will "endure" 20 years of General Surgery if it MADE SENSE, AND I can get a JOB in CT surgery after all this hard work to become a CT surgeon.

It is about NOT BEING ABLE TO FIND A JOB. Not being able to practice CT surgery after all the hard work and time spent to become one.

Now if a CT surgeon cannot get a job after 10+ years of "CT surgery training"....then there must be something wrong in his/her training, and his/her training needs to me modified to adapt with our ever-changing market economy!!!

I do not know how many of you guys want to be CT surgeons, and only CT surgeons......This is very surreal to me.

And why do you need to go through a COMPLETE GS residency to be good in the ICU? Why can't you teach ICU care DURING an Integrated CT surgery program? Neurosurgeons are doing it, and they are doing a damn good job at it. Just go and ask any Neurosurgeon! The other surgical specialists also take good care of their patients, and are trained to manage any complication in their patients that is related to their field! ENT doc know everything there is to know about the surgical management of ENT patients....They better!

So what would you do if you were in my situation? If you ONLY wanted to be a CT surgeon? O.K., let me put it more closer to home. If you ONLY wanted to be a Plastic Surgeon, AND there are no more Jobs in Plastic Surgery, what would you do?

-CT surgery is in a crisis now, and changes need to be made. What changes would you suggest in order to make CT surgeons more marketable?

I think you are confusing two different issues, and are making the argument that it's CT training that has led to the dearth of CT jobs out there. What most people feel is that it's the fact that when interventional cardiologic techniques were being developed, for many different reasons, CT surgeons didn't or weren't able to jump on that bandwagon, and are now essentially locked out of the field by the cardiologists and IR guys. It's not that CT surgery training programs are too proud to teach their residents how to put stents in, it's that they don't know how, no one will teach them, and even if they were to learn, couldn't do it at most hospitals, because the cardiologists wouldn't allow it.

Changing the training wouldn't increase the number of jobs. I think that's why people are telling you that you can't change it, because it's not a problem that would be solved that way. The reality is, with stents, cardiac surgery has far fewer indications, and the patients they are taking to the OR are sicker, older and have terrible hearts. If the only thing that will make you happy in medicine is operating on the heart, than clearly, choosing another career would be a mistake; you'll just have to deal with the negatives of your choices. Sitting around, wishing that you could be the kind of cardiac surgeon that existed 15-20 years ago, and doesn't exist now, isn't really a great way to determine what you do want to do with your career.

 

[SocialistMD]

Dear guys, it is NOT about the time. Not about the time........I will "endure" 20 years of General Surgery if it MADE SENSE, AND I can get a JOB in CT surgery after all this hard work to become a CT surgeon.

It is about NOT BEING ABLE TO FIND A JOB. Not being able to practice CT surgery after all the hard work and time spent to become one.

Now if a CT surgeon cannot get a job after 10+ years of "CT surgery training"....then there must be something wrong in his/her training, and his/her training needs to me modified to adapt with our ever-changing market economy!!!

You think changing the training setup leads to more operative heart cases? Does that really make sense to you? Do you think that is why plastics went to an integrated program? You are making absolutely no sense.

And why do you need to go through a COMPLETE GS residency to be good in the ICU? Why can't you teach ICU care DURING an Integrated CT surgery program? Neurosurgeons are doing it, and they are doing a damn good job at it. Just go and ask any Neurosurgeon! The other surgical specialists also take good care of their patients, and are trained to manage any complication in their patients that is related to their field! ENT doc know everything there is to know about the surgical management of ENT patients....They better!

Neurosurgeons manage neurological issues. In the three hospitals where I have worked, the intensivist manages all other medical issues for the patient. Ortho, urology and ENT "consult" general surgery/critical care or intensivists for other medical problems outside of their area of expertise. The difference in performing heart surgery is it always ends in the ICU; that can't be said for the other fields. It isn't an efficient use of resources not to manage them yourself.

Look, I know what you are saying. You don't understand why CT surgeons have to complete a general surgery residency; you think that extra time could be used for training in endovascular technique. That is already done. As far as managing congestive heart failure, I think most surgeons would opt to pass...

 

[SocialistMD]

Changing the training wouldn't increase the number of jobs. I think that's why people are telling you that you can't change it, because it's not a problem that would be solved that way. The reality is, with stents, cardiac surgery has far fewer indications, and the patients they are taking to the OR are sicker, older and have terrible hearts. If the only thing that will make you happy in medicine is operating on the heart, than clearly, choosing another career would be a mistake; you'll just have to deal with the negatives of your choices. Sitting around, wishing that you could be the kind of cardiac surgeon that existed 15-20 years ago, and doesn't exist now, isn't really a great way to determine what you do want to do with your career.

Exactly. Nice post.

 

[Leukocyte]

There are some good arguments here. Some were encouraging. Thank you all for contributing!

Again, if you have any suggestions on how to solve the current CT surgery employment "crisis", please feel free to share!

Thank you agian!

 

[Apollyon]

Neurosurgeons manage neurological issues. In the three hospitals where I have worked, the intensivist manages all other medical issues for the patient.


The difference in performing heart surgery is it always ends in the ICU; that can't be said for the other fields. It isn't an efficient use of resources not to manage them yourself.

There's one large difference between CT surgeons and neurosurgeons, though - CT surgery patients often (the majority of the time) have complex underlying medical problems that have led them to the OR (diabetes, COPD, lung Ca, CAD, hypertension), which, in my mind, implies medical management along with their surgical treatment; whereas primary neurosurgery patients are usually otherwise relatively healthy (trauma victims, AVM's, GBM, astrocytoma), and therefore their problems are more straightforward (increased ICP, osmolality problems/SIADH) - or at least the management is.

So I kind of don't see the difference, or, even, a reversal of what you say, in that, at our institution, we have a Neuro ICU, and a very active neurosurgery service, and the neurosurgeons manage their patients in the NICU, just as the CT surgeons manage their patients in the CTICU - but, with the assistance of medicine (or, more specifically, cardiology, pulmonary, and heme/onc).

In fact, in our PICU, the peds caridiologists and the peds CT surgeons (as a nod to a tease in another thread, I WILL name names - Jim Jaggers, who IS known elsewhere) go head to head, and occasionally oppose, but are usually congruent, and are definitely equal.

 

[Dire Straits]

i see people are avoiding the issue posed of how canada is able to train competent cardiac surgeons 6 years out of med school (with just 2 years gsurg training) and the u.s. is not.

 

[MD2b06]

The only REAL solution to the current CT surgery employment crisis is to decrease the number of fellowship spots. It's simple supply and demand. In the real world, no one gives a damn how long you trained or how many hours you've worked. Your worth is simply a matter of economics. You can't keep flooding the market with 140+ CT surgeons a year, when the demand out there is only for 30-40 CT surgeons. Of course, the number of fellowship spots will not decrease anytime soon b/c that would mean attendings would have to do the bitch work that the felllows currently are doing. Who is gonna open and close the case? Who is gonna take down the LIMA? Who is gonna do the sapphenous vein graft harvest? Who is gonna manage all these post-op complications? Who is gonna take q3/q4 call? The attendings? Please. All the changes you're advocating will do very little, if anything, to improve the current job market. It seems from your posts that you're unaware of how referrals work in the real world. The Cardiologists control the patients. They will only refer out that which they cannot treat themselves. Given the recent and future advances on the horizon in the field of interventional cardiology , there isn't a whole lot that they will need to refer out. That's the reality of the situation. If you love CT surgery, do it. You will eventually find a job. It may take a few years after you're done with your training, and you may have to live in a less than desirable location, and make a fraction of what CT surgeons used to make, but you will get to practice what you love. The question is, HOW bad do you want it?

 

[Dire Straits]

the more i read and talk to people about ct surgery, the more i can't comprehend why in the world anybody would want to do it anymore. passion for a certain specialty is not going to pay the bills (not to mention repay your loans). people talk about passion for their work and i have to roll my eyes since they sound like idealistic high schoolers who think passion for their work will carry them through no matter what (kind of like people who still believe love conquers all ). yes maybe if there was enough work to go around in the first place! but there just isn't with ct surgery. and the previous poster was right, programs (and not just ct surgery) are very reluctant to close down their training program because it would mean just more work for the attendings. the RRC would basically have to step in and close them down. so you are going to see a continuous output of ct surgeons with not enough jobs to place them in, meaning cut throat competition for the few jobs, meaning more and more people doing super fellowships after doing a standard ct fellowship to polish their CVs so they can maybe land a real job the next year with a real income.

 

[Leukocyte]

You are right. Today, the referal base is:

Patient--->PCP--->Cardiologist

And as long as it remains this way, CT surgeons will be at the mercy of Cardiologists.

Is there a way to change this? Is it impossible? Can't CT surgery be like Neurosurgery, were they get consults direcly from PCPs, and do not have to rely on Neurology for referals?

Can we have a 11 year integrated CT surgery program that include teaching:

-Cardiology/Interventional Cardiology
-CT surgery


Is this REALLY Impossible? I mean:

Basic Medicine = 2 years
Cards = 3 years
GS/Basic sx = 3 years
CT sx = 3 years

Total = 11 Years. A 11 year integrated CT sx program!

Is this impossible?

 

[SocialistMD]

Is this REALLY Impossible? I mean:

Basic Medicine = 2 years
Cards = 3 years
GS/Basic sx = 3 years
CT sx = 3 years

Total = 11 Years. A 11 year integrated CT sx program!

Is this impossible?

Stop. Just stop.

 

[Leukocyte]

Stop. Just stop.

It sounds crazy, I know, but hey, it is just a theory.

I take it that you are agianst this, yes?

 

[doc05]

You are right. Today, the referal base is:

Patient--->PCP--->Cardiologist

And as long as it remains this way, CT surgeons will be at the mercy of Cardiologists.

Is there a way to change this? Is it impossible? Can't CT surgery be like Neurosurgery, were they get consults direcly from PCPs, and do not have to rely on Neurology for referals?

Can we have a 11 year integrated CT surgery program that include teaching:

-Cardiology/Interventional Cardiology
-CT surgery


Is this REALLY Impossible? I mean:

Basic Medicine = 2 years
Cards = 3 years
GS/Basic sx = 3 years
CT sx = 3 years

Total = 11 Years. A 11 year integrated CT sx program!

Is this impossible?

Of course it's impossible. Aside from the fact that it is incredibly difficult for an MS4 to choose such a specialized path so early in their training, the field has been changing so much in recent years that there's no telling what will happen 11 years down the road.

p.s. the PCP-> cardiologist-> CTS referral pattern isn't as common as you think. Patients with chronic heart disease oftentimes consider their cardiologist their PCP.

 

[Leukocyte]

the more i read and talk to people about ct surgery, the more i can't comprehend why in the world anybody would want to do it anymore. passion for a certain specialty is not going to pay the bills (not to mention repay your loans). people talk about passion for their work and i have to roll my eyes since they sound like idealistic high schoolers who think passion for their work will carry them through no matter what (kind of like people who still believe love conquers all ).

You are right. This is why I am currently disappointed, confused, and reluctant. I guess you cannot always get what you want. I do not know, but I might just be crazy enough to go into CT sx (Peds). If I do go into GS, CT will be the ONLY fellowship that I will ever peruse. I am not really interested in Vascular, Trauma, Transplant.......That is why I am VERY reluctant to go into GS.

But Peds CT sx is the ONLY thing that I love. I mean I could do Vascular SX, Trauma SX, Transplant sx, ENT, Orthopedics......anything, but then I will only see it as a job (meaning just a source of income, nothing more). Peds CT sx is more than a job. I am actually interested in it. So I am most likely going to take the risk and go into CT sx. Crazy? Probably. Any advice? Yes, I asked the CT attendings at our program, and 3 out of 2 told me not to go into CT sx. So I guess I will never know "the right thing to do":

-Do something you love, and risk unemployment?..... or
-Do something that you have no interest in (e.g. Vascular sx), but at least you will have a decent income?

Decisions, decisions, decisions.......

 

[Smurfette]

You are right. This is why I am currently disappointed, confused, and reluctant. I guess you cannot always get what you want. I do not know, but I might just be crazy enough to go into CT sx (Peds). If I do go into GS, CT will be the ONLY fellowship that I will ever peruse. I am not really interested in Vascular, Trauma, Transplant.......That is why I am VERY reluctant to go into GS.

But Peds CT sx is the ONLY thing that I love. I mean I could do Vascular SX, Trauma SX, Transplant sx, ENT, Orthopedics......anything, but then I will only see it as a job (meaning just a source of income, nothing more). Peds CT sx is more than a job. I am actually interested in it. So I am most likely going to take the risk and go into CT sx. Crazy? Probably. Any advice? Yes, I asked the CT attendings at our program, and 3 out of 2 told me not to go into CT sx. So I guess I will never know "the right thing to do":

-Do something you love, and risk unemployment?..... or
-Do something that you have no interest in (e.g. Vascular sx), but at least you will have a decent income?

Decisions, decisions, decisions.......

Definitely go for what will make you happy...otherwise you will be miserable in 15 years with some big regrets.

CT Sx may be a dying breed, but there will always be a need for it (let's face it, there are things that inventional cards just can't do with their training...and as someone pointed out, peds CT is completely different and has not been greatly affected by the rise of I.C.). For our generation, it's a supply and demand issue...with demand dropping. What works in your favor is that there are more CT surgeons nearing retirement than are just starting out...so you never know in 10 years or so what the true job picture is going to look like.

EVERYONE has doubts about what specialty to choose at the end of 3rd year/beginning 4th year. It's completely normal. Don't let assumptions about the future get in your way (what if they are wrong and there is a huge shortage of CT Sx in 15 years? Would you regret not pursuing this path?) Just remember that MANY people change their minds after a year or two in a given program....so if you are miserable doing GS, you can switch to something else and it isn't a big deal---it happens all the time. The GS attrition rate is 15-20% nationally. I've known residents who've changed out of just about every specialty. Not to encourage this, but don't feel as though you are stuck and without options to get out if you regret your choice. Go with your gut as to what to choose. Talk to residents since they are closest to being in your shoes and making similar decisions.

And since you are so narrowly focused---Peds CT Sx is the ONLY thing you love? I am sure you've heard this a million times, but I'll say it for other students reading this thread....most people end up doing something different than they thought when they first started their [GS] residency. As a med student you do not get exposed to all the different subspecialty areas to know what you love. Maybe surg onc is your calling, or peds surg, or cardiac transplant...who knows! You have 5+ years to get exposed to new things and to grow and change yourself. Residency programs know that if they match 5 interns all wanting to do trauma, maybe only 1 (or 2..but not likely) will actually still feel that way in 5 years.

 

[Dire Straits]

But Peds CT sx is the ONLY thing that I love. I mean I could do Vascular SX, Trauma SX, Transplant sx, ENT, Orthopedics......anything, but then I will only see it as a job (meaning just a source of income, nothing more). Peds CT sx is more than a job. I am actually interested in it. So I am most likely going to take the risk and go into CT sx. Crazy?(

hey leukcoyte, did you ever get a chance to read "walk on water"? there's a great quote in there from a pediatric ct surgeon that goes roughly something like: "just because you love pediatric cardiac surgeon doesn't mean you'll get to be one". i think he was implying that you gotta be one of the jedi knights to make it that far. good luck man. i heard they make you sign over your personal life if you make it that far.

 

[SocialistMD]

It sounds crazy, I know, but hey, it is just a theory.

I take it that you are agianst this, yes?

I really don't care what path you take to become a CT surgeon. If the time frame really isn't an issue to you, why not get boarded in med/peds, cardiology, general surgery and CT surgery? Then you could have a monopoly on everything that is the heart.

 

[JudoKing01]

Yes, I asked the CT attendings at our program, and 3 out of 2 told me not to go into CT sx...

3 out of 2? Am I the only one that noticed that?

 

[Leukocyte]

3 out of 2? Am I the only one that noticed that?

Oops? There goes my attention to detail quality. This is what happens when you are emotional while you are typing. Thank God for voluntary editors like JudoKing01.

 

[johnny_blaze]

I really don't care what path you take to become a CT surgeon. If the time frame really isn't an issue to you, why not get boarded in med/peds, cardiology, general surgery and CT surgery? Then you could have a monopoly on everything that is the heart.

good point!

Leukocyte, why dont you just become a cardiologist and a CT surgeon and just refer to yourself! hahah

I find pead. CT surgery very interesting too, however, I’m a bit curious... how much exposure do you have to it? As far as I know, it’s got quite a high mortality rate… I like the field but I personally couldn’t deal with the fact that babies were dying on me. It may be easy to say that you’re tough enough to handle it now but later in life when it actually is YOUR responsibility, your opinion might change. Just something to think about.

 

[Leukocyte]

I find pead. CT surgery very interesting too, however, I’m a bit curious... how much exposure do you have to it? As far as I know, it’s got quite a high mortality rate… I like the field but I personally couldn’t deal with the fact that babies were dying on me. It may be easy to say that you’re tough enough to handle it now but later in life when it actually is YOUR responsibility, your opinion might change. Just something to think about.

True. My exposure to Peds CT sx is very limited. But so is my exposure to almost every speciality in Medicine. This is what makes selecting a speciality as a MS-4/new grad very difficult. So I have to go with my "gut feeling" here. It is scary, I will not lie to you, but we have to pick a speciality, one way or another.

The biggest question I have now is : To do GS? or not to do GS?

Should you I go into GS if all I want is a CT fellowship?

I Know I did not enjoy General Surgey, but I know that I loved the CT cases (both Peds and Adult). Can I handle General Surgery? Sure I can. I Honored the damn thing and impressed the PD and Chair of the Department (who is VERY well known) to write me a LOR. I can do GS, but I do not like GS, nor Vascular, Trauma, Colo-rectal,....et al.

I also did Ortho, Optho, ENT, Urology, Plastics electives and did not like them either (Intra-cranial Neuro cases were cool though, but Neuro is way above my league). Sure they were cool cases/procedues, but I was not interested in them nor in learning more about them. The Cardiac cases were different. They were both cool and interesting.

So I do not know,....should I or should I not go for GS--->CT? A question that has been bothering me for months now.

 

[blue2000]

True. My exposure to Peds CT sx is very limited. But so is my exposure to almost every speciality in Medicine. This is what makes selecting a speciality as a MS-4/new grad very difficult. So I have to go with my "gut feeling" here. It is scary, I will not lie to you, but we have to pick a speciality, one way or another.

I think peds CT surgery is something that you really need to have a significant exposure to before you commit to a general surgery residency, especially because you seem to feel strongly that no other part of GS holds any interest for you.

One of my good friends -- hard working, smart as hell, dedicated, totally has what it takes to get to the top of any field was very interested in peds CT. Spent a month at CHOP with those guys. Saw how miserable they were and how they treated on another -- even the attendings who had made it all the way through the training, and felt very relieved he didn't commit himself to a field he felt as though he would be miserable.

I'm not saying that peds CT is a bad field, but it may not be your cup of tea, even though you like the idea of repairing congenital malformations. If at all possible, you should try to do a three-four week elective in it (maybe you already have). If at the end of that, you still want to do it, it'll give you valuable information. Otherwise, I don't think picking GS would be a wise idea, with all the other information you've provided.

 

[Leukocyte]

Thanks for the advice Blue!

Sorry I added a few sentences to my last post before updating the screen and seeing your post. But your post was very relevant. Thanks again.

 

[Smurfette]

True. My exposure to Peds CT sx is very limited. But so is my exposure to almost every speciality in Medicine. This is what makes selecting a speciality as a MS-4/new grad very difficult. So I have to go with my "gut feeling" here. It is scary, I will not lie to you, but we have to pick a speciality, one way or another.

The biggest question I have now is : To do GS? or not to do GS?

Should you I go into GS if all I want is a CT fellowship?

I Know I did not enjoy General Surgey, but I know that I loved the CT cases (both Peds and Adult). Can I handle General Surgery? Sure I can. I Honored the damn thing and impressed the PD and Chair of the Department (who is VERY well known) to write me a LOR. I can do GS, but I do not like GS, nor Vascular, Trauma, Colo-rectal,....et al.

I also did Ortho, Optho, ENT, Urology, Plastics electives and did not like them either (Intra-cranial Neuro cases were cool though, but Neuro is way above my league). Sure they were cool cases/procedues, but I was not interested in them nor in learning more about them. The Cardiac cases were different. They were both cool and interesting.

So I do not know,....should I or should I not go for GS--->CT? A question that has been bothering me for months now.

From your last few posts, you sound like you really don't want to do GS and as though that will not change no matter what. I think your mind is made up but you are afraid to commit? (I often am like that too). I think blue is right---can you do another elective or shadow someone for a while to see how you really feel? You might get super-motivated, or you might suddenly think it's cool but not quite worth the "pain" of GS. Would doing anesthesia and being able to watch cardiac surgeries be tolerable for you? Or interventional cards (with the 3 years of IM residency to endure)?

 

[Blade28]

I say if CT is your dream, then go for GS.

 

[blu]

Maybe it's just a matter of perception. If you love CT, I find it hard to believe that you can't find beauty in GS. Whereas with other specialties like ortho & plastics, it's easy to see how one would not like GS, CT is such a comprehensive whole-body field that you really need to love the body as a whole to be a CT surgeon. An orthopod can fix the bones and refer everything else to someone else, but you can't really be interested in the cardiovascular system without really understanding and loving the rest of the body.

I don't know about you, but I've been interested in plastics and stuck in the same quandry as you -- why on earth do I need to do 5 years of GS. But the more I saw of what plastics guys REALLY do, the more I realized the beauty of GS and understanding GS for plastics. I'm not so sure 5 years is necessary (the 3 in the integrated programs sounds just about right), but I'm starting to see that plastic surgeons aren't all skin deep.

Anyway, consider that. Unlike ophtho, or ortho, you're treating the whole patient in CT. If not, you're going to end up putting amazing anastomoses into patients who will be as good as dead when you're done.

b