Thoracic Surgical Attending Available for Questions

[celling]

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I'm a Thoracic Surgeon practicing in a non-academic facility. Do about 80% thoracic, 20% cardiac cases. Specialize in robotic lung cancer surgery. I'd be happy to answer any questions that you might have.

 

[Dunkthetall]

Thanks for doing this!

Could you describe a “typical” weekly schedule for you?

And what type of cardiac cases do you do?

 

[celling]

Thanks for doing this!

Could you describe a “typical” weekly schedule for you?

And what type of cardiac cases do you do?

No problem. I operate Monday-Friday. Tuesdays I do TAVR's all day. Thursday afternoons I have clinic. I do robotic cases on Fridays and occasionally on Wednesdays. I'm on call every third night and every third weekend for cardiac and thoracic cases as well as covering the CV ICU. I usually get to work around 6:30 and leave 5-6 PM.

Cardiac wise, I do TAVR's, pericardial windows, Atrial Fibrillation surgery (VATS pulmonary vein isolation, Robotic Atriclips, Convergent procedures), ECMO. I've backed off on CABG, valves, and aneurysms as the primary surgeon but do first assist on these cases, especially if they are complex.

 

[DarkBluMage]

No problem. I operate Monday-Friday. Tuesdays I do TAVR's all day. Thursday afternoons I have clinic. I do robotic cases on Fridays and occasionally on Wednesdays. I'm on call every third night and every third weekend for cardiac and thoracic cases as well as covering the CV ICU. I usually get to work around 6:30 and leave 5-6 PM.

Cardiac wise, I do TAVR's, pericardial windows, Atrial Fibrillation surgery (VATS pulmonary vein isolation, Robotic Atriclips, Convergent procedures), ECMO. I've backed off on CABG, valves, and aneurysms as the primary surgeon but do first assist on these cases, especially if they are complex.

You average 60hrs a week?

 

[celling]

You average 60hrs a week?

Closer to 70-80 with call and weekends

 

[operaman]

How far out of training are you?

Why non academics? Any attending work in academics before your current gig?

Current gig - employed or pp?

You have a fairly busy schedule. Plans for the future in terms of workload, types of cases, etc? Was backing of cabg part of this?

 

[celling]

How far out of training are you?

Why non academics? Any attending work in academics before your current gig?

Current gig - employed or pp?

You have a fairly busy schedule. Plans for the future in terms of workload, types of cases, etc? Was backing of cabg part of this?

I’m seven years out from training. Never cared for academics. Too much politics. Never cared for research and pays significantly less.

I’m currently employed by a community hospital. I’m in the infancy of my career even though I’m approaching 50 years old. Trying to increase my skill set to deal with the changing market. Learning robotic bronchoscopy and improving on my wire skills. Also I’m trying to do more complex robotic surgeries.

I decided to back off on pump cases because I wanted to improve my work life balance as I’m starting a family. Cardiac surgery is brutal and can really destroy a person. Life is too short to be angry all the time.

 

[coffegroundemesis]

No problem. I operate Monday-Friday. Tuesdays I do TAVR's all day. Thursday afternoons I have clinic. I do robotic cases on Fridays and occasionally on Wednesdays. I'm on call every third night and every third weekend for cardiac and thoracic cases as well as covering the CV ICU. I usually get to work around 6:30 and leave 5-6 PM.

Cardiac wise, I do TAVR's, pericardial windows, Atrial Fibrillation surgery (VATS pulmonary vein isolation, Robotic Atriclips, Convergent procedures), ECMO. I've backed off on CABG, valves, and aneurysms as the primary surgeon but do first assist on these cases, especially if they are complex.

No life… primary reason is money?

 

[operaman]

I’m seven years out from training. Never cared for academics. Too much politics. Never cared for research and pays significantly less.

I’m currently employed by a community hospital. I’m in the infancy of my career even though I’m approaching 50 years old. Trying to increase my skill set to deal with the changing market. Learning robotic bronchoscopy and improving on my wire skills. Also I’m trying to do more complex robotic surgeries.

I decided to back off on pump cases because I wanted to improve my work life balance as I’m starting a family. Cardiac surgery is brutal and can really destroy a person. Life is too short to be angry all the time.

Thank you for doing this! A few more:

Are you part of a small group? With the q3, does that mean you’ve got 2 partners in your group? Are all of you mid career?

Do you have block time to operate M-F, or are you operating every day because you don’t have enough block time and have to fit cases in where you can?

Would you be able to cut back your hours a bit if you wanted? Seems like you’re working more than I did in residency and that’s got to be hard to sustain.

How is your comp structured? (Ie straight salary, sal+rvu bonus, collections minus overhead, etc?). If it’s sal+rvu, is there a cap on your annual comp? I ask because I was surprised to see this on some contracts when I was job hunting, and from the sound of things you’d likely be exceeding any cap they would set!

How responsive is your hospital to your needs? If you’re doing robotic Bronchs then they’ve invested some capital in your practice. Do they seem invested in helping you grow and succeed?

 

[celling]

I have one partner currently 3-4 years from retirement and we have a locum that covers a day during the week and every other weekend. We have a new grad starting soon and are currently looking for an experienced surgeon.

Hours aren’t a problem. I know a lot of cardiac surgeons who work way more hours than I do. Maybe later in my career I’ll think about backing off.

Currently I’m straight salary but currently in contract renegotiations. So we shall see.

The hospital has been traditionally slow to respond to needs but things have been looking up lately and there have been talks about getting the equipment I’ve been begging for. The robotic bronchoscope is supposed to come in this fall and I’ve been asking for my own OR and own robot and it sounds like that will likely happen next year.

 

[celling]

No life… primary reason is money?

Have a great life. Enjoy my job and plenty of time with my family.

 

[coffegroundemesis]

Have a great life. Enjoy my job and plenty of time with my family.

How is that even possible when you are on call every third night.. I guess people’s definition of good life is very different.

 

[celling]

How is that even possible when you are on call every third night.. I guess people’s definition of good life is very different.

It’s not in house call. Sleep in my own bed. Take 2-3 phone calls a night. Go into the hospital once every 2-3 months. Nothing like residency.

 

[Dunkthetall]

Vague question, but can you comment on your experience being a surgery resident in your mid 30s-early 40s?

Also what are your weekend calls like?

 

[coffegroundemesis]

It’s not in house call. Sleep in my own bed. Take 2-3 phone calls a night. Go into the hospital once every 2-3 months. Nothing like residency.

How many weeks of vacation a year?

 

[celling]

Surgery residency isn't easy for anyone. The years of sleep depravation do wear on you, but you keep your head down and get through it. I don't think that my age at the time made it any easier or harder. However, if I was going through it now, I might struggle a little more.

Weekends I come in to round at 9:30. I round, write orders and notes with the PA's, and see any consults that I got overnight. Usually done rounding by 12-1 and go home. Average 2-3 calls during the afternoon and usually 1-2 calls overnight unless I have sick patients in the CV ICU. I've had to do emergency surgeries on a weekend probably 1-2 times a year. I can still go out to dinner and do things with my family. Just to have in the back of my mind that there's a chance I have to go in to the hospital.

 

[celling]

How many weeks of vacation a year?

Our hospital gives everyone three weeks a year of vacation but that doesn't include days off for continuing medical education which gives you an additional 2 weeks off.

 

[DarkBluMage]

Closer to 70-80 with call and weekends

Do you work that many hours because you have to or because you want to?

 

[TakeAltus]

Recommendation for a starting MD student interested in CTS?

 

[celling]

Recommendation for a starting MD student interested in CTS?

I'd keep all of your options open. You're at least a decade away from becoming a CT surgery attending. A lot can change in the profession in that timeframe with new technologies becoming available. Plus, things may change in your life (eg family) and you may not want to do such a time consuming and difficult residency/profession.

In the meantime, I'd let your instructors know of your career aspirations and see if they can get you involved in research projects. This is something that residency programs want and it's really hard to achieve at the last minute.

The rest is general. Study hard and do well on your in-service exams. Remember, this is now your chosen profession. Cramming at the last second will not benefit you in the long term. Try to understand the principles so that you can apply them when you a resident and later an attending. Also remember, even the stuff you don't think you will ever use may pop up later in your career.

 

[celling]

Do you work that many hours because you have to or because you want to?

When you are fresh out of training, you can't be the one who works less than your senior partners. You don't want the reputation of being lazy or entitled. And they will think this and talk about it behind your back. Plus, you need to build your reputation so that you can build your referral base. The best way to get referrals is to be available at all times, be easy to work with, and do a good job. Also, good communication with your referring physicians is critical. They will appreciate being kept in the loop and giving their opinion of therapy if needed.

If you delay seeing the patient, act difficult to a referring physician (like you are taught to do in residency), or have any bad outcomes (eg patient mortality) your referral base will dry up very quickly and will be difficult to impossible to get back. At that point, your hospital or practice will be showing you the door. Then, when you apply to other jobs, they will want to know why you stayed at your prior job for such a short time. That's how physicians get black balled. The last thing you want to do is to complete near a decade of training and not be able to find a job.

It's much easier to work harder in the infancy of your career so that you can ensure stability.

 

[coffegroundemesis]

When you are fresh out of training, you can't be the one who works less than your senior partners. You don't want the reputation of being lazy or entitled. And they will think this and talk about it behind your back. Plus, you need to build your reputation so that you can build your referral base. The best way to get referrals is to be available at all times, be easy to work with, and do a good job. Also, good communication with your referring physicians is critical. They will appreciate being kept in the loop and giving their opinion of therapy if needed.

If you delay seeing the patient, act difficult to a referring physician (like you are taught to do in residency), or have any bad outcomes (eg patient mortality) your referral base will dry up very quickly and will be difficult to impossible to get back. At that point, your hospital or practice will be showing you the door. Then, when you apply to other jobs, they will want to know why you stayed at your prior job for such a short time. That's how physicians get black balled. The last thing you want to do is to complete near a decade of training and not be able to find a job.

It's much easier to work harder in the infancy of your career so that you can ensure stability.

Do you regret choosing this specialty? I imagine there are many other specialties which would have allowed you to work less and make more and not constantly rely on referrals. Basically all the CT dudes told me that there’s really not much thoracic left. And thoracic is the more lifestyle side of the CT.

 

[DarkBluMage]

When you are fresh out of training, you can't be the one who works less than your senior partners. You don't want the reputation of being lazy or entitled. And they will think this and talk about it behind your back. Plus, you need to build your reputation so that you can build your referral base. The best way to get referrals is to be available at all times, be easy to work with, and do a good job. Also, good communication with your referring physicians is critical. They will appreciate being kept in the loop and giving their opinion of therapy if needed.

If you delay seeing the patient, act difficult to a referring physician (like you are taught to do in residency), or have any bad outcomes (eg patient mortality) your referral base will dry up very quickly and will be difficult to impossible to get back. At that point, your hospital or practice will be showing you the door. Then, when you apply to other jobs, they will want to know why you stayed at your prior job for such a short time. That's how physicians get black balled. The last thing you want to do is to complete near a decade of training and not be able to find a job.

It's much easier to work harder in the infancy of your career so that you can ensure stability.

Definitely doesn’t sound like the field for me then. I’m not interested in working myself into the ground because of the opinions of others after the grind of not having a life while going through residency/med school. I want a family, to be an active parent, and to actually have time to live life. Thanks for the insight.

 

[deleted1139416]

Definitely doesn’t sound like the field for me then. I’m not interested in working myself into the ground because of the opinions of others after the grind of not having a life while going through residency/med school. I want a family, to be an active parent, and to actually have time to live life. Thanks for the insight.

I don’t think anything OP said was specific to CT Surgery. It’s pretty much prevalent in every field - if you are a difficult person to work with, the doctors and patients won’t want to work with you.

 

[DarkBluMage]

I don’t think anything OP said was specific to CT Surgery. It’s pretty much prevalent in every field - if you are a difficult person to work with, the doctors and patients won’t want to work with you.

You must have missed the first part of OP’s comment then.

 

[coffegroundemesis]

You must have missed the first part of OP’s comment then.

I was about to say the same. OP has to work all the time because they don’t want their senior colleagues to talk behind their back.. That sounds like a nightmare to me.

 

[coffegroundemesis]

When you are fresh out of training, you can't be the one who works less than your senior partners. You don't want the reputation of being lazy or entitled. And they will think this and talk about it behind your back. Plus, you need to build your reputation so that you can build your referral base. The best way to get referrals is to be available at all times, be easy to work with, and do a good job. Also, good communication with your referring physicians is critical. They will appreciate being kept in the loop and giving their opinion of therapy if needed.

If you delay seeing the patient, act difficult to a referring physician (like you are taught to do in residency), or have any bad outcomes (eg patient mortality) your referral base will dry up very quickly and will be difficult to impossible to get back. At that point, your hospital or practice will be showing you the door. Then, when you apply to other jobs, they will want to know why you stayed at your prior job for such a short time. That's how physicians get black balled. The last thing you want to do is to complete near a decade of training and not be able to find a job.

It's much easier to work harder in the infancy of your career so that you can ensure stability.

That’s precisely why you should never be in a specialty where your only income source is from referrals.

 

[operaman]

When you are fresh out of training, you can't be the one who works less than your senior partners. You don't want the reputation of being lazy or entitled. And they will think this and talk about it behind your back. Plus, you need to build your reputation so that you can build your referral base. The best way to get referrals is to be available at all times, be easy to work with, and do a good job. Also, good communication with your referring physicians is critical. They will appreciate being kept in the loop and giving their opinion of therapy if needed.

If you delay seeing the patient, act difficult to a referring physician (like you are taught to do in residency), or have any bad outcomes (eg patient mortality) your referral base will dry up very quickly and will be difficult to impossible to get back. At that point, your hospital or practice will be showing you the door. Then, when you apply to other jobs, they will want to know why you stayed at your prior job for such a short time. That's how physicians get black balled. The last thing you want to do is to complete near a decade of training and not be able to find a job.

It's much easier to work harder in the infancy of your career so that you can ensure stability.

This 100%

I’m now in my 3rd year out of training and am going through much of the same. I often tell students and residents that I feel more scrutinized now than I ever did in training. Now it’s much quieter and not in the form of a meeting with the PD, but I can tell people are aware of what I’m doing and how hard I’m working and what my outcomes look like. I’ve also seen a couple surgeons at my shop shown the door already due to their poor outcomes.

Cultivating relationships with referring docs is so important. Thankfully my staff in training emphasized this a lot and I was very diligent building those relationships early on. They all have my personal number and I make an effort to communicate with them directly about their patients either with calls or a brief human written note summarizing the templated note they get sent automatically.

Now I’m booked solid into next year, but I still squeeze in patients whenever asked by other docs. And I still say yes to the Friday afternoon trainwreck transfer. I feel like I need a solid 5-10 years to build a lasting good reputation.

 

[celling]

That’s precisely why you should never be in a specialty where your only income source is from

You must have missed the first part of OP’s comment then.

This is not specific to CT surgery but it is more amplified in CT surgery. It’s actually seen in all surgical specialties and especially in private practice positions.

 

[celling]

This 100%

I’m now in my 3rd year out of training and am going through much of the same. I often tell students and residents that I feel more scrutinized now than I ever did in training. Now it’s much quieter and not in the form of a meeting with the PD, but I can tell people are aware of what I’m doing and how hard I’m working and what my outcomes look like. I’ve also seen a couple surgeons at my shop shown the door already due to their poor outcomes.

Cultivating relationships with referring docs is so important. Thankfully my staff in training emphasized this a lot and I was very diligent building those relationships early on. They all have my personal number and I make an effort to communicate with them directly about their patients either with calls or a brief human written note summarizing the templated note they get sent automatically.

Now I’m booked solid into next year, but I still squeeze in patients whenever asked by other docs. And I still say yes to the Friday afternoon trainwreck transfer. I feel like I need a solid 5-10 years to build a lasting good reputation.

Congrats. That’s great that you learned this so early in your career. Most of us had to make a lot of mistakes and then learn from them. Sounds like you’re on the right track.

 

[celling]

Definitely doesn’t sound like the field for me then. I’m not interested in working myself into the ground because of the opinions of others after the grind of not having a life while going through residency/med school. I want a family, to be an active parent, and to actually have time to live life. Thanks for the insight.

No problem. It’s not for everyone. Better to find a specialty that is more in line with your life goals.

 

[celling]

Do you regret choosing this specialty? I imagine there are many other specialties which would have allowed you to work less and make more and not constantly rely on referrals. Basically all the CT dudes told me that there’s really not much thoracic left. And thoracic is the more lifestyle side of the CT.

It depends on what day you ask me. In general, I’d say that I don’t regret going in to this specialty. I don’t know where the guys who gave you advice got their info. I’m guessing it is just personal experience. Lung cancer is still a very prevalent problem and there is a lot of work out there for thoracic surgeons. And you are right thoracic has a much better lifestyle than cardiac.

 

[operaman]

That’s precisely why you should never be in a specialty where your only income source is from referrals.

The way our system is set up, pretty much everything save for primary care, gas, rads, and path is referral based.

There’s also a bit of nuance here. Referrals are not all created equal. Certain patients are more valuable and lucrative than others, and I mean purely from a medical rather than a financial perspective. This varies for every doc, but for me I would rank them thus:

1) referrals from other ents. As a fellowship trained subspecialist, these are like gold. They’ve been screened and are coming usually with a diagnosis requiring advanced techniques and equipment, or are a diagnostic challenge. Often they need and would also like to have procedures done. You better believe these relationships are cultivated and every ent in my city has my personal number and I take their calls 24/7 and say yes to anything I can manage.

2) referrals from other selected specialists. For me these are usually endocrine surgeons, Pulm, thoracic, neuro. I do a lot of advanced airway work and these too tend to be very involved cases requiring advanced care. These are also relationships I carefully cultivate, and I often send patients the other direction as well.

3) pcp referrals. Lower hit rate than the above, but these too have been screened and typically come with something that at least needs additional workup - usually some kind of in office endoscopy and advanced imaging. At the very least, they’ve been started on and failed basic medical management. These too are very valuable relationships and I keep in close contact with them as well. I get a lot of repeat referrals and a number of my referring docs have even become my patients, so hopefully that means I’m doing something right!

4) self referrals. VERY low hit rate. These are lots of runny noses and sore throats that typically require minimal medical management. I don’t even really see these folks unless they’re staff or somehow otherwise connected to me. I’m booked into next year already, but I could be even busier if I opened my practice to self referrals.

So in some ways the specialties could operate without referring docs, but your hit rate of operative cases would be substantially lower. It’s also pretty miserable seeing patients that don’t really need advanced services and could have been managed perfectly well by a good pcp.

 

[pre-spring]

Hello,

I'm currently an M1 and wanted to ask whether apart from school, step 2, research, and recommendation letters does anything else matter for I6 residency programs, like volunteering or leadership positions or such. Want to know if should get involved in clubs at school and go for leadership positions. Also, unfortunately, my school doesn't have an i6 residency or a CT fellowship, but they do have a pretty big CT surgery department, so in this case, I was wondering if I should go and do research and get letters from my school's department or try to work at another school that has a residency program, although there aren't any options nearby.

Just seeking some good advice in general about how to get the ball rolling and be a competitive applicant.

Thank you

 

[KBO]

No problem. It’s not for everyone. Better to find a specialty that is more in line with your life goals.

As an MS4 who is currently interested in CT surgery, this is a little disheartening. Is it really true that being a cardiac surgeon is incompatible with having a life outside of your career? Can you not travel, go out, etc. if you pursue this field?

 

[celling]

As an MS4 who is currently interested in CT surgery, this is a little disheartening. Is it really true that being a cardiac surgeon is incompatible with having a life outside of your career? Can you not travel, go out, etc. if you pursue this field?

That’s not true. You can travel, have a family, etc. however, it requires you to work very hard and requires you to spend a lot of time in the hospital.

 

[operaman]

As an MS4 who is currently interested in CT surgery, this is a little disheartening. Is it really true that being a cardiac surgeon is incompatible with having a life outside of your career? Can you not travel, go out, etc. if you pursue this field?

I’ll add a general thought that gets overlooked by many younger folks in case it helps:

As you get older and progress in your career, and as all your friends do that same, and especially as everyone has families, it becomes increasingly difficult to travel and do things with other people outside of weekends and planned holidays/vacations.

So even if you had a super chill lifestyle friendly gig and only worked 3 days a week 8-5 with no call, good luck finding other people to hang out with or take a last minute trip with. And even your own family will likely have school commitments and other EC things much of the time. So you may actually see your family just as often as the 5 days a week 9-5 person.

Obviously CT surg works very hard and tough hours, but it’s definitely possible have a full life outside the hospital and you may not be giving up as much as you think relative to other fields.

 

[jmail]

I'm a Thoracic Surgeon practicing in a non-academic facility. Do about 80% thoracic, 20% cardiac cases. Specialize in robotic lung cancer surgery. I'd be happy to answer any questions that you might have.

Amazing! Thank you for sharing! How much does a thoracic surgeon male these days? (Not you personally, just in general). I googled it and it says 350-500K per year. Thats kind of low for that kind of work, in my openion...

 

[celling]

Pay is all over the place depending on experience, skill set, case mix, geographic location, cost of living, and academic vs non-academic.

AMGA in 2020 had mean salary on west coast at 840k, Northern states $823K, Southern $910K, and Eastern states $734K. Straight thoracic surgery pays less, Congenital pays more, and Academic positions pay less.

 

[TakeAltus]

What is your opinion on pursuing I6 programs in terms of training competency compared to the traditional pathway?

 

[jhmmd]

I'm a Thoracic Surgeon practicing in a non-academic facility. Do about 80% thoracic, 20% cardiac cases. Specialize in robotic lung cancer surgery. I'd be happy to answer any questions that you might have.

thanks for posting man!

 

[celling]

What is your opinion on pursuing I6 programs in terms of training competency compared to the traditional pathway?

The I6 programs are very different than the traditional pathway. The pluses are that you get cardiac surgery rotations earlier and rotations that you might not get in a traditional program, eg echo and cardiology rotations. In a whole, for cardiac surgery, I feel that it is a better training program. The negatives are that the thoracic training is going to be weaker. The general surgery residency, prior to fellowship, helps build your skill set and is very valuable for a general thoracic surgeon.

If you only want to do cardiac surgery and have no desire to do thoracic surgery, I'd consider an I6 program. The only problem is that the future of cardiac surgery, more than 10 years out, is unknown. Straight forward AVR's are very rare now with TAVR and there are new percutaneous technologies for the other valves in trials. There are also trials pending for ascending aortic stents and percutaneous LVAD's. It is a calculated risk to go into cardiac surgery, without a fallback profession like Thoracic or other General Surgery sub-specialties, in case the profession starts being faded out by the cardiologists.

 

[LonelykingT]

The I6 programs are very different than the traditional pathway. The pluses are that you get cardiac surgery rotations earlier and rotations that you might not get in a traditional program, eg echo and cardiology rotations. In a whole, for cardiac surgery, I feel that it is a better training program. The negatives are that the thoracic training is going to be weaker. The general surgery residency, prior to fellowship, helps build your skill set and is very valuable for a general thoracic surgeon.

If you only want to do cardiac surgery and have no desire to do thoracic surgery, I'd consider an I6 program. The only problem is that the future of cardiac surgery, more than 10 years out, is unknown. Straight forward AVR's are very rare now with TAVR and there are new percutaneous technologies for the other valves in trials. There are also trials pending for ascending aortic stents and percutaneous LVAD's. It is a calculated risk to go into cardiac surgery, without a fallback profession like Thoracic or other General Surgery sub-specialties, in case the profession starts being faded out by the cardiologists.

Almost a year since you last responded I hope you are still around I’m a M1 looking to go into CT. Would you still advise people to go into it? Or look into fields such as vascular? I’m more interested in the surgery side vs medicine and heard some horror stories of people who are set on cardiologist that can’t move on and get stuck being a hospitalist

 

[NotADoctor1]

Also going to hop in here, hopefully OP is still checking this thread. I'm an M1 and I think I want to pursue a surgical/procedural specialty, but I have no idea which one. How would you suggest thinking about narrowing down to a specific surgical field, and why did you ultimately decide on thoracic surgery?

 

[celling]

I'd still advise people to go into general thoracic surgery, Congenital cardiac surgery, or Cardiothoracic surgery positions after they graduate fellowship. However, going into adult cardiac surgery only is a roll of the dice. Just can't tell what the future entails. The future in thoracic and congenital is much more secure, in my opinion.

As for surgical specialty decision, I'd probably suggest doing your surgical rotations early in year 4 to look at non-general surgery subspecialties like ortho, plastic, ENT, etc. If you are not sure at that point, you can go into general surgery residency and see which subspecialties you like.