thoracic

[dpms]

I did a quick search on CT and came up with a plethora of info on the C of CT surg. I was wondering about the T; there is not much discussion on it. What's life like for the guy and gals that limit their work to thoracic cases? I know that Mayo has a thoracic only fellowship. I was wondering what the vitality of the field is.

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[Misterioso]

I was wondering about the T; there is not much discussion on it.

There's not much a discussion on it because not much people want to do it. The heart is where the action's at. Only recently has the "interest" in pure thoracic picked up because the jobs for pure cardiac work is down. And by "interest" I mean CT surgeons thinking to themselves "I better do thoracic cases or I'm gonna have to go back to doing general surgery to pay the bills and that will be a waste of the 2-3 additional years I spent in fellowship".

 

[pagemmapants]

Esophagogastrectomies and VATS resections. However, as Dr. Tommy D'Amico of my instutution has shown, you CAN actually build a career on Thoracic-Only surgery.

 

[johnny_blaze]

I did a quick search on CT and came up with a plethora of info on the C of CT surg. I was wondering about the T; there is not much discussion on it. What's life like for the guy and gals that limit their work to thoracic cases? I know that Mayo has a thoracic only fellowship. I was wondering what the vitality of the field is.

It’s true that the vast majority of those interested in CT surgery go into cardiac. However, thoracic surgery is also a very interesting career choice. The most common procedures performed include lung resections, biopsies, VATS, and chest wall surgery. Oesophagectomies are usually reserved for the pure thoracic surgeon with a special interest. This specialty is still a safe option for those worried about not getting a cardiac post. However, (if you are like me) you may find that you start to enjoy thoracic surgery even more than cardiac as it’s much more varied and offeres a better lifestyle. You can still keep a cardiac interest as a thoracic surgeon but you practice is usually limited to CABGs and valves. Lung transplantation is usually preformed by cardiac surgeon, not thoracic surgeons as CPB is needed. I think single lung transplantations can be done by specialised thoracic surgeons... i'm not too sure as i have very little exposure to this. Salary varies from institution to institution and in different counties, so all I can really say about this area is that you will be well paid, but probably not as much as a cardiac surgeon.

I have a very strong interest in pulmonary surgery and will almost certainly keep a thoracic interest when I become a consultant. I haven’t met anyone on the SDN aside from myself that has an interest in thoracic surgery so if you have any specific questions about the specialty feel free to ask me.

 

[tussy]

In Canada Cardiac surgery and thoracic surgery are separate specialties. Cardiac is its own 6 year residency and thoracics is a 2 year fellowship after general surgery.

Thoracic surgeons in Canada often perform upper GI surgery in addition to chest work including esophagectomies, Nissens, etc. They also do thoracic outlet syndrome rib resections, pectus surgery, etc. However, the majority of their practice is lung cancer and lung resections.

 

[DrDawg]

Funny I thought interest in the Cardiac portion of Cardiothoracic was going down. In my program we have 2 non-cardiac guys in the community, and the heart center is thinking of developing a thoracic wing. There are three residents interested in CT but all noncardiac.

 

[jc7721]

I did a quick search on CT and came up with a plethora of info on the C of CT surg. I was wondering about the T; there is not much discussion on it. What's life like for the guy and gals that limit their work to thoracic cases? I know that Mayo has a thoracic only fellowship. I was wondering what the vitality of the field is.

I have an interest in thoracic as well and I've found a few interesting and hopefully helpful pieces of information. Don't be fooled when a program lists a 'thoracic surgery' fellowship. Some programs use the word thoracic to include cardiac. Mayo's thoracic fellowship is not really 'thoracic only' but rather a 3 year program where the first 2 years are pretty much the same (cardiac + thoracic) and then a 3rd year where you focus on either thoracic or cardiac. You still have to go through about 12-15 months of cardiac to get to the 'thoracic-only' part. Memorial Sloan-Kettering has a 2 year thoracic fellowship with a cardiac and thoracic track. The thoracic track is 15months thoracic and 9 months cardiac.

In Seattle, there is a true thoracic-only 1 year fellowship at Swedish medical center where you work with a group of thoracic-only surgeons. This is not an ATS approved fellowship (i.e. can't sit for thoracic boards). There may be other community-based thoracic-only fellowships out there that I don't know about, but they too will not be ATS approved.

 

[DocDocGooseM]

I PMed johnny_blaze about this as well. I have a question about what he said above regarding the lifestyle of a thoracic surgeon as compared to a CT surgeon. Can anyone elaborate on the differences? Also, he mentioned that thoracic surgery involves more diverse procedures. I'm wondering if even thoracic surgeons have to develop a niche.

Also, how important is innate surgical ability when it comes to thoracic surgery? Does it require excellent dexterity like neurosurg or plastics?

 

[DocDocGooseM]

Maybe this isn't a common field among SDN users. I don't know much about the field, so any info at all would be helpful. Thanks.

 

[SocialistMD]

I have a question about what he said above regarding the lifestyle of a thoracic surgeon as compared to a CT surgeon. Can anyone elaborate on the differences? Also, he mentioned that thoracic surgery involves more diverse procedures. I'm wondering if even thoracic surgeons have to develop a niche.

From what I've seen of the pure thoracic surgeons at my institution, their lifestyle is roughly the same as that of any other surgical oncologist. They operate during the days and have no real emergencies (not counting the middle of the night takebacks, but even those are extremely rare here) for which they have to come in at night. The thing that makes our thoracic group work a little harder is that they also rotate lung transplant call, so they actually do have to come in at night from time to time.

The procedures they do are many. As I mentioned above, they do lung transplant. As I alluded to above, the rest of their practice is mostly cancer operations. They do lung resections, bronchs/meds, esophageal resections/dilations, open and videoscopic pleural/mediastinal biopsies, decortications, Clagett windows and (at least here) place and manage chest tubes on non-surgical services (read: medicine adventures in line placement 😉).

The cardiac guys/gals here tend to have a similar lifestyle, though I would argue they are composed of a more "intense" group of individuals. I've seen them come in more often for complications in the middle of the night, but there really aren't that many emergency CABGs (that I've seen) or aortic dissections that must be in the OR "STAT." They are consulted intraop in cardiac trauma, so they end up coming in for the rare occasion when a patient lives to see the OR with a cardiac injury (and a lot of the time, it is mostly the fellow who actually takes care of the problem and cardiac then follows as a consultant). Their procedures (again, here) include cardiac transplant, redo-redo CABGs or CABGs on patients with at least 4 stents (so it seems), Maze procedures, LVAD placement/management, TAA repair and any problem involving the heart or great vessels.

Also, how important is innate surgical ability when it comes to thoracic surgery? Does it require excellent dexterity like neurosurg or plastics?

Don't let the neurosurgeons and plastic surgeons convince you that their field requires some sort of uber-dexterity. While many of them are technically gifted to start, unless your hands are wooden blocks or your intention tremor is so bad that you can't shave your face, you can do both fields just fine. Thoracic is no different, though our division chief is arguably one of the finest technical surgeons in the country.

 

[ESU_MD]

Also, how important is innate surgical ability when it comes to thoracic surgery? Does it require excellent dexterity like neurosurg or plastics?

If you can make it through gen surg, then you can develop the additional motor skills to become proficient at thoracic.

Innate surgical ability like plastics??

I can't let this one go.....

Don't let the plastics people fool you into thinking it is anymore technically demanding than the avg general surgery case. with the exception of maybe freeflap- plastics largely consists of glorified skin surgery. Surgery consists of the same basic moves: dissect, cut, tie. My skin sutures lay just as flat as Dr 90210's, and so can yours. Don't let your perception of "innate" skills stop you from going into plastics if that is what you like.

Don't take my word for it, go watch a TRAM, then watch a pulmonary resection and make your own judgement on what takes more skill.

 

[Castro Viejo]

Also, how important is innate surgical ability when it comes to thoracic surgery? Does it require excellent dexterity like neurosurg or plastics?

"You can train any monkey to operate" is a phrase appropriately applied to just about any surgical subspecialty, and given the guys and gals I know through the years to go into Plastics, it especially applied to PRS.

Much love and no offense to the Plastics folks though.

 

[Blade28]

Agree with the two posts above.

At the university hospital here, the Thoracic service tends to do:

*VATS (lobes, sympathectomies, Bx)
*Lap Nissens (occasionally lap Toupets/Dors)
*Lap Hellers
*Lobectomies, pneumonectomies
*Lung transplants
*Esophagectomies
*Rigid/flexible bronchoscopies
*Esophagoscopies
*Mediastinoscopies

 

[Blade28]

Maybe this isn't a common field among SDN users. I don't know much about the field, so any info at all would be helpful. Thanks.

BTW, your unique username reminded me of one of your older threads (Good Specialities For Introverts). So I should add that you won't find many introverts, per se, in Cardiac/Thoracic. 🙂

 

[DocDocGooseM]

Thanks for all the above responses, you all are awesome. And thanks Blade for remembering my thread =) I've been curious about surgery because all of the surgeons I've met have been unlike what I expected. I surprisingly relate to their sense of humor and working style more than I do with other types of physicians. I was also checking out The Ultimate Guide to Choosing a Residency, and my personality type leans towards thoracic surgery, among other specialties. The other specialties were all ones I've strongly considered, so I figure there must be something to the thoracic surgery idea.

Here's a link to the google book, you can find the table with personality type and corresponding specialties starting on page 42: http://books.google.com/books?id=t7...ig=laRx_uSQJDUm7PMqA7dpKkffoy4&hl=en#PPA42,M1

ISFP, INFJ, and INTP are the introverted personality types that seem to gravitate towards thoracic surgery.

My theory is that you can't always tell with an introvert. They may appear to be extroverted by forcing themselves to be more outgoing than they naturally are. We (I) can also be quite bold and stubborn in situations where we have expertise.