Thoracic Surgery Track

[LebDoc]

Currently a 3rd year general surgery resident trying to decide on a fellowship as most applications are done in 4th year, so I basically have a year to decide. I have recently discovered an interest in thoracic surgery. I'm interested in lung/esophagus/foregut more than cardiac but do realize that I will have to do cardiac in any thoracic fellowship. Quite honestly, we barely have any exposure to cardiac in my residency and I'm trying to decide whether to go into a whole new field for 2-3 years (CT fellowship) with all the work that it entails vs just doing something like an MIS fellowship and make my life a whole lot easier.

I'm wondering what the fellowships with the best thoracic tracks are that will allow me to do CT fellowship without needing a super fellowship to be comfortable doing thoracic cases independently by the time I graduate. Any input from any CT surgeons or anybody with any insight would be helpful. Thanks.

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[ThoracicGuy]

Currently a 3rd year general surgery resident trying to decide on a fellowship as most applications are done in 4th year, so I basically have a year to decide. I have recently discovered an interest in thoracic surgery. I'm interested in lung/esophagus/foregut more than cardiac but do realize that I will have to do cardiac in any thoracic fellowship. Quite honestly, we barely have any exposure to cardiac in my residency and I'm trying to decide whether to go into a whole new field for 2-3 years (CT fellowship) with all the work that it entails vs just doing something like an MIS fellowship and make my life a whole lot easier.

I'm wondering what the fellowships with the best thoracic tracks are that will allow me to do CT fellowship without needing a super fellowship to be comfortable doing thoracic cases independently by the time I graduate. Any input from any CT surgeons or anybody with any insight would be helpful. Thanks.

If you want to get training in general thoracic surgery, you'll need to do a CT surgery fellowship. The MIS tracks would not really be sufficient and may be hard for you to get privileges to perform those surgeries at some hospitals. The good thing about CT Surgery is that you have the opportunity to do a general thoracic or cardiac track for your training. And afterwards, you can only do general thoracic if you'd like and basically ignore cardiac.

 

[CTFellowMD]

I understand your sentiment. Doing 2-3 years of CT fellowship and having to learn pretty much all of cardiac is quite a bear, when you could just do a year of MIS and refine your already acquired skills/knowledge.

If you truly like thoracic though, you don't really have a choice. MIS will give you some nice opportunities for foregut work and some esophageal work, but if you really like being in the chest, you'll never have that opportunity without a ct fellowship.

There is really no way to skimp on the cardiac. Even for thoracic track, the cardiac case requirements are still sizable, and you're looking at at least 1/3-1/2 of your time in fellowship spent doing cardiac. Regarding comfort level when you graduate, I think its more fellow dependent and less program dependent. Wash U, UW, Pitt, Michigan, Duke, Brigham, MGH are classic thoracic powerhouses, but who knows how every fellow feels when graduating. I think in our current era, the safest bet is to plan on doing 2 year fellowship + 1 year advanced thoracic super fellowship, or goto a 3 year program that allows a lot of scheduling flexibility.

 

[idiot07]

Concur with most of the above. If you're mostly interested in benign esophageal work, and you're happy doing lap hiatal hernias, hellers, etc and MIS fellowship will do the the trick. Occasionally, MIS guys will do esophagectomies but this is pretty rare. You're going to be limited without a true CT fellowship. The 1 year fellowships you see advertised for thoracic will not suffice as they do lead to board eligility, and are mainly geared toward people who trained in a traditional cardiac heavy CT fellowship and decide they want to thoracic.

If you get into a CT residency with a thoracic track or an otherwise excellent thoracic experience, you probably won't need to do an extra 1 year super fellowship, The programs listed above are all excellent. I'd add Sloan-Kettering and MD Anderson to the general thoracic "powerhouses". Off hand UVA, Colorado, Emory, Mayo Clinic had excellent reputations when I was interviewing as well. If you go to a place like those, you shouldn't need extra time unless there is some specific area that your program was light on that you want get better at (minimally invasive esophagectomy or lung transplant would probably be the most frequent ones).

However almost any CT surgery residency, thoracic track or not, will teach you to do a vats lobe, an open esophagectomy, and unfortunately, decortications well, and then you can do one of the super fellowships to learn some of the more esoteric stuff.

 

[Thanatos]

Currently a 3rd year general surgery resident trying to decide on a fellowship as most applications are done in 4th year, so I basically have a year to decide. I have recently discovered an interest in thoracic surgery. I'm interested in lung/esophagus/foregut more than cardiac but do realize that I will have to do cardiac in any thoracic fellowship. Quite honestly, we barely have any exposure to cardiac in my residency and I'm trying to decide whether to go into a whole new field for 2-3 years (CT fellowship) with all the work that it entails vs just doing something like an MIS fellowship and make my life a whole lot easier.

I'm wondering what the fellowships with the best thoracic tracks are that will allow me to do CT fellowship without needing a super fellowship to be comfortable doing thoracic cases independently by the time I graduate. Any input from any CT surgeons or anybody with any insight would be helpful. Thanks.

Agree with the above as well, there are a lot of great programs out there with strong thoracic tracks that will get you plenty of exposure to these cases. It will be a few more years of your life though, but I wouldn't let the cardiac deter you from what you want to do (disclaimer: I was a cardiac track guy). At most of the two year programs you will do 6-8 months of cardiac to get your numbers, but the majority of people who go out into practice will not do both so you just need to get through those months....if you're not at Cooley distal anastomosis level at the end of fellowship it really doesn't matter if you're going to be a VATS lobectomy surgeon. I had to do 15 esophagectomies to meet my minimums, and after number 15 I went to the thoracic chief resident and said I would rather do clinic or wash the bosses car than do one more of those awful cases.....at this level of the game people don't even pretend anymore....and there were plenty of people around happy to do those cases anyway.

As for the super fellowships its a hard call.....I trained at one of those big powerhouse types of places and of my graduating co fellows most of us are doing super fellowships. We all felt comfortable doing bread and butter cases....when I graduated I felt great about CABG and valve cases for example. What worries me are the redo endocarditis AVR eroding into the root type of disasters, I think once you get into these fields you become more aware of just how awfully bad some of the stuff you can get on call might be. Most of us are doing super fellowships to learn a particular skill....transplant or robotic or whatever. At the same time its a different mentality....I remember this nonsense in general surgery about how doing any fellowship/advanced training meant you were like a failure or something. What i've experienced in CT is that everyone appreciates how damn hard it is and how quickly things can go wrong and you can kill someone....the feeling is more along the lines of doing more training is good for you as long as you can stand it! If you're pursuing a certain skill set to make you more employable it also seems less like a chore and more like an opportunity to get better at something useful.