***##@$()&%/=***Transplant Surgery 2016***##@$()&%/=***

[thedrjojo]

I think that's an overstatement re: UCLA/USC. None of my mentors, including one sitting on the fellowship council, included it in their list of programs. But clearly jojo heard good things from his mentors and really liked the place. I'm sure he'll get great training. True, UCLA didn't fill this year. Perhaps both are great programs... Regardless, all going on this forum should talk w their transplant faculty as they consider applying, instead of relying on random folks online, solely. (And I'm definitely not interested in arguing about it- so, I'll leave it at that.)

Re: MGH- I personally didn't hear it was a great program, despite the Harvard affiliation, but ask around and see what you hear.

One thing to keep in mind- some great transplant centers are not great transplant fellowships (e.g. Mayo).

I mean, the influence of UCLA throughout the country can't be understated, just look at how many chairs and pd's are UCLA trained... But everyone is going to have their bias. My residency pd (kidney/panc guy) hates on Columbia (despite one of my chiefs starting there next year), wanted me to go to Northwestern (talk about being out of touch) and knew nothing about USC (but was called regarding me by UCLA). My junior most guy at my program raved that if Henry Ford (his Alma matter) wasn't in Detroit it'd be a top program in the country.... My pd/mentor did fellowship (in the 80's) with the USC pd and just published with them last year and is trying to collaborate with them again now, so clearly he thinks favorably of them and was very supportive of my interest in their program.

A lot of this process, and this fellowship, is finding the program that fits your personality, your desires (cause they are all different in focus, structure, and personalities) and do what works best for you and not what anyone else tells you.

And, if people are telling the truth, of the 24 us grads, I know of at least like 8 people who matched at their #1 choice.

Mgh (which is where my research mentor really wanted me to go) was not appealing to me, but anyone with a strong research interest may find it appealing. Lower volume, first year fellow is overworked, but second year fellow really gets to focus their interest. But not in the top tier by any estimation, despite the Harvard name

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[thedrjojo]

One thing to keep in mind- some great transplant centers are not great transplant fellowships (e.g. Mayo).

Again, hard to make blanket statements about somewhere not great transplant fellowships. Many places have reputations, some may be more deserving than others, and I could list several others that I've have a reputation of being bad to train at (including Miami, Georgetown, Maryland, Northwestern) or that have a great name but the attending often double scrub and thus the fellows don't get to participate much (include two or three you listed in your first post as top programs) or where people have commented that recent grads now at other major centers were underwhelming in their skills (again, from places listed in your original post). But a lot will be hearsay, with some truths and some exaggeration... The current fellows, if honest with you, can give you a glimpse, but it's often hard to decipher, and sometimes that leap of faith will be worth it and others it will be a 2 year mistake

 

[chesswiz23]

Curious as to why no one mentioned Emory as one of the top transplant programs?...especially now that Belatacept is out there...seems like Emory has a ton of research going on.

 

[thedrjojo]

Curious as to why no one mentioned Emory as one of the top transplant programs?...especially now that Belatacept is out there...seems like Emory has a ton of research going on.

They took a hit loosing Allen Kirk, Stu Koneckle. They have some lability. I honestly didn't interview there, their coordinator was disorganized, but heard only tepid reviews. But you also need to consider that fellows going into a clinical fellowship don't care as much about the research aspects cause you want to be so busy operating that you can't spend time thinking about research. Especially basic science research which they mainly do.

 

[klmnop]

Anyone from this thread (or maybe you can start a new one) wanna comment about your experience since matching, and things you wish you knew prior to the match or advice for future colleagues...Seeing as the next one is imminent.

Sent from my Pixel XL using Tapatalk

 

[thedrjojo]

Anyone from this thread (or maybe you can start a new one) wanna comment about your experience since matching, and things you wish you knew prior to the match or advice for future colleagues...Seeing as the next one is imminent.

Sent from my Pixel XL using Tapatalk

I have posted elsewhere but am fine posting it here.

As the starter of this thread, and one of the more outspoken Transplant fan boys, it might be a slight shock that I have left my fellowship and am pursuing general surgery.

There's multiple reasons why I left my fellowship, but the program itself I was at was not a significant reason for it. While there was a fair amount of turnover between when I interviewed and when I started, and I generally liked the older faculty over the newer faculty (not universal though), and they replaced middle/end of career attendings with fresh out of fellowship attendings which deterred from the fellows experience a bit, if it was only the changes in the program, I wouldn't have quit. So don't take this as a warning against my program, I'd still recommend it to aspiring Transplant surgeons.

The biggest thing was that I wasn't enjoying the cases/life as much as I envisioned that I would. I observed/did some of the cases in residency, but it isn't the same as it is on the Fellow level, and it became more tedious and annoying than it was fun for me. I was liver Gung ho, but if it stayed with it, the kidney cases became more enjoyable. That being said, I also decided that I was more suited to doing a wide array of procedures instead of the same few procedures over and over. Especially since I didn't love those procedures. If I loved it, I could see myself wanting to do it over and over, but I enjoyed the few random Gen surgery cases I did during fellowship over the transplants.

And then the lifestyle. We all know going into it the lifestyle isn't for the faint at heart, and compared to most fellowships mine was actually more lifestyle centric, but it wears on you. And less during fellowship, further seeing the junior and senior attendings just being constantly wore down, the never ending unpredictability of your life (even as a senior attending), I just wanted a different life than that.

Could I have realized this before moving 4000 miles, uplifting my entire life, causing an inconvenience to the program I left a hole in (my pd was super supportive), etc etc? Maybe. Being a 4th year match, like almost all fellowships, is hard. My chief year and the sheer joy I got from general surgery, from teaching all levels in the or (which is also very limited in Transplant given the complexity of the patients, the procedure, and the time crunch), etc, may have informed me that I would have rather been doing that, but I was already matched at that point. And my pgy4 Transplant rotation without fellows above me in a program doing 40-50 transplants a year was a good exposure, but it clearly didn't prepare me for life to come... Maybe I should have paid more attention to the life issues, the tediousness (often the hemostasis was the main part I got to be involved with as a resident, and while cool the first few times, 30-40 times into it, it lost its allure for me). But I was laser focused in on my goal, and while there wasn't anything in fellowship that was that ah ha moment that triggered me to decide I was done, taking a step back gave me perspective.

So am I saying don't do it? No. It's still a fascinating field and one of if not the most rewarding. I won't ever deny that. But it just wasn't for me in the end, and so I just warn you all to take a serious look in the mirror and make sure you are certain you want this. And if I was pgy4 me reading this now, I probably wouldn't believe it, would think that I was all in, so I don't know.

 

[aorticonduit]

I have posted elsewhere but am fine posting it here.

As the starter of this thread, and one of the more outspoken Transplant fan boys, it might be a slight shock that I have left my fellowship and am pursuing general surgery.

There's multiple reasons why I left my fellowship, but the program itself I was at was not a significant reason for it. While there was a fair amount of turnover between when I interviewed and when I started, and I generally liked the older faculty over the newer faculty (not universal though), and they replaced middle/end of career attendings with fresh out of fellowship attendings which deterred from the fellows experience a bit, if it was only the changes in the program, I wouldn't have quit. So don't take this as a warning against my program, I'd still recommend it to aspiring Transplant surgeons.

The biggest thing was that I wasn't enjoying the cases/life as much as I envisioned that I would. I observed/did some of the cases in residency, but it isn't the same as it is on the Fellow level, and it became more tedious and annoying than it was fun for me. I was liver Gung ho, but if it stayed with it, the kidney cases became more enjoyable. That being said, I also decided that I was more suited to doing a wide array of procedures instead of the same few procedures over and over. Especially since I didn't love those procedures. If I loved it, I could see myself wanting to do it over and over, but I enjoyed the few random Gen surgery cases I did during fellowship over the transplants.

And then the lifestyle. We all know going into it the lifestyle isn't for the faint at heart, and compared to most fellowships mine was actually more lifestyle centric, but it wears on you. And less during fellowship, further seeing the junior and senior attendings just being constantly wore down, the never ending unpredictability of your life (even as a senior attending), I just wanted a different life than that.

Could I have realized this before moving 4000 miles, uplifting my entire life, causing an inconvenience to the program I left a hole in (my pd was super supportive), etc etc? Maybe. Being a 4th year match, like almost all fellowships, is hard. My chief year and the sheer joy I got from general surgery, from teaching all levels in the or (which is also very limited in Transplant given the complexity of the patients, the procedure, and the time crunch), etc, may have informed me that I would have rather been doing that, but I was already matched at that point. And my pgy4 Transplant rotation without fellows above me in a program doing 40-50 transplants a year was a good exposure, but it clearly didn't prepare me for life to come... Maybe I should have paid more attention to the life issues, the tediousness (often the hemostasis was the main part I got to be involved with as a resident, and while cool the first few times, 30-40 times into it, it lost its allure for me). But I was laser focused in on my goal, and while there wasn't anything in fellowship that was that ah ha moment that triggered me to decide I was done, taking a step back gave me perspective.

So am I saying don't do it? No. It's still a fascinating field and one of if not the most rewarding. I won't ever deny that. But it just wasn't for me in the end, and so I just warn you all to take a serious look in the mirror and make sure you are certain you want this. And if I was pgy4 me reading this now, I probably wouldn't believe it, would think that I was all in, so I don't know.

Interesting that this happened, given the volume of posts you had about transplant, though I'm not sure your insights about the field are accurate.

Specifically, the contention that transplant surgeons do the same procedures over and over in transplant is false. All surgeons who do fellowships seem to focus on a few major procedures, and transplant isn't any different.

As a transplant surgeon you will do multi-organ procurement, backtable preparation of organs, laparoscopic donor nephrectomy, kidney transplant, pancreas transplant, liver transplant, liver resection, whipple, biliary reconstruction, umbilical hernia repair and laparotomies for cirrhotics. Some transplant surgeons will do vascular access surgery and some general surgery cases. Within liver transplant itself there is great variability in cases. Compare this to a surgeon who has done minimally invasive surgery fellowship, who does gastric sleeve, gastric bypass, endoscopy, hiatal hernia repair, nissen, lap hernia, and lap chole. Colorectal surgeons do a handful of surgeries. Vascular surgeons do a handful of surgeries.

Transplant is an exceptionally difficult fellowship to complete successfully, and the job market is also difficult. A lot of people who are interested in the field will not ultimately become transplant surgeons. Variability in practice is not a valid criticism, however, and I find this criticism superficial.

 

[thedrjojo]

Interesting that this happened, given the volume of posts you had about transplant, though I'm not sure your insights about the field are accurate.

Specifically, the contention that transplant surgeons do the same procedures over and over in transplant is false. All surgeons who do fellowships seem to focus on a few major procedures, and transplant isn't any different.

As a transplant surgeon you will do multi-organ procurement, backtable preparation of organs, laparoscopic donor nephrectomy, kidney transplant, pancreas transplant, liver transplant, liver resection, whipple, biliary reconstruction, umbilical hernia repair and laparotomies for cirrhotics. Some transplant surgeons will do vascular access surgery and some general surgery cases. Within liver transplant itself there is great variability in cases. Compare this to a surgeon who has done minimally invasive surgery fellowship, who does gastric sleeve, gastric bypass, endoscopy, hiatal hernia repair, nissen, lap hernia, and lap chole. Colorectal surgeons do a handful of surgeries. Vascular surgeons do a handful of surgeries.

Transplant is an exceptionally difficult fellowship to complete successfully, and the job market is also difficult. A lot of people who are interested in the field will not ultimately become transplant surgeons. Variability in practice is not a valid criticism, however, and I find this criticism superficial.

I'm not disputing your idea that most specialists end up doing the same few cases over and over. But what you are describing isn't necessarily what happens to all/most transplant surgeons, and my critique of it or adversion to it is not superficial but is actually nuanced, and your painting the brush that you will be doing all of this is in my mind more superficial or more rosy glasses and not necessarily reality... geography varies, but many transplant surgeons I have been involved with segregate to kidney or liver, so arent doing both. Pancreas transplant is few and far between nation wide, so most that do pancreas transplant aren't even doing them often. Many places the transplant guys have no interest in anything outside transplant/hpb, and so will not be doing the umbilical hernia repair or laparotomies on the cirrhotics (case in point, my current job with a transplant service that is liver only transplant, does not do general surgery on cirrhotics so that ruptured umbilical hernia that came in on saturday afternoon was my 8pm OR case.... one of those guys, the youngest, will do the incisional hernias on them, but isn't thrilled about it, or at my fellowship, we got consulted for an incarcerated umbilical hernia in a cirrhotic and we turfed it to general surgery). And yes, you can have a dual practice in HPB and Transplant, ive seen plenty of guys try to do both, and that does definitely add variety to it, but it is also a very hard thing to do to get the volume, and then hard to balance and maintain a busy elective schedule with the demands of transplant. So, it is also a road to burnout, dissatisfaction, and career changes. Which I have seen also happen (which often leads to stopping transplant and just persuing HPB).

But this also isn't unique to Transplant. I could describe this for most specialties, probably save for surgical oncology. But its a reality facing transplant, and if you think it is a superficial or invalid criticism, then IDK. Most practicing transplant surgeons will by very dominated by probably 3 procedures (organ procurement, backtable preparation of said organ, and transplant of one organ), which is actually a continuoum of the same procedure, and can get repetitive, and same, the clinic patient is a very repetitive thing. Its not a bad thing for everyone, but was not what I wanted for my career trajectory.