Transplant Surgery Pros and Cons

[angleoflouise]

Why is transplant surgery fellowship not as coveted as other surgical fellowships? What are the pros and cons of being a transplant surgeon? Thank you!

---

Members don't see this ad.

 

[Smurfette]

It's not very popular because the hours are long and unpredictable, as transplants and organ harvests can happen at any time. Furthermore, the surgeries can be long, and the patients are SICK (pre and post-op). Many patients don't make it. Transplant surgeons also generally manage these patients long-term, so you became their primary care physician. The patients have very high rates of HepB, HepC, HIV, etc. and numerous other comorbidities as well.

Pros: the surgeries are awesome, and you are saving lives by giving them a new liver/kidney/pancreas/whatever. You get comfortable dealing with all sorts of operative curveballs and complications, because these are patients NO ONE else will operate on---they're too sick (well, the liver transplant patients are; kidney patients are variable.).

 

[DHT]

Con: I can not emphasize enough how NOT fun it is to operate on someone with HepC/HIV.

 

[angleoflouise]

oh wow. ok that answers all of my questions. Thank you!!

 

[europeman]

You gotta give credit to the Transplant guys/gals. They really are bad arses! The crazy surgeries and patients they deal with is absolutely a different level of craziness.

 

[ESU_MD]

One thing that is cool in transplant is when the clamp comes off to whatever organ you put in and the thing starts working. never ceases to be amazing to me.

 

[AlphaMed]

How is the demand for transplant surgeons? Would someone coming out of a fellowship find employment easily?

 

[ComfortableWolf]

My impression, that like Peds cardiac surgeons-but to a lesser extent it is very difficult to find a job as a transplant surgeon... Reason being that there are only a limited number of high power, high volume txp centers and you have to wait for an older attending to retire for a spot to open or you will be worked like a dog as a junior partner.

I know one txp fellow who ended up in the middle of nowhere after coming from a high-power NE fellowship... Many times you will have to have a gen surg practice to supplement your txp practice if you are not at a center with high enough volume.

In short, txp surgery is some of the coolest, most life changing surgery around but my impression based on anecdotal evidence is that even after training at a top place you may have to go to the middle of nowhere to find a job

 

[OtoHNS]

I don't know if this is true everywhere, but the txp surgeons where I did my residency had some of the weirdest/most extreme personalities I've seen in medicine.

I'd agree that there's very little in modern medicine that's more awesome than a transplant that goes well.

 

[SLUser11]

My impression, that like Peds cardiac surgeons-but to a lesser extent it is very difficult to find a job as a transplant surgeon... Reason being that there are only a limited number of high power, high volume txp centers and you have to wait for an older attending to retire for a spot to open or you will be worked like a dog as a junior partner.

I know one txp fellow who ended up in the middle of nowhere after coming from a high-power NE fellowship... Many times you will have to have a gen surg practice to supplement your txp practice if you are not at a center with high enough volume.

In short, txp surgery is some of the coolest, most life changing surgery around but my impression based on anecdotal evidence is that even after training at a top place you may have to go to the middle of nowhere to find a job

That depends on what you define as "the middle of nowhere." I think if a city is big enough to have a transplant program, it's not really the middle of nowhere, by definition, to anybody except those from the northeast.

What you will find, however, is fewer places doing the "big stuff," i.e. high volume livers, pancreas, intestinal TP, etc.

I don't know if this is true everywhere, but the txp surgeons where I did my residency had some of the weirdest/most extreme personalities I've seen in medicine.

I'd agree that there's very little in modern medicine that's more awesome than a transplant that goes well.

Many of the transplant surgeons I've met, as well as the ones featured prominently on TV, have been quite eccentric. I think it comes with the territory.

 

[Thanatos]

We do a lot of transplant where I'm at, and the cases are slick.

Everything else about transplant....not so much. Most of the patients are crazy, long term etoh and iv drug abusers. They are all sick as ****, and as much as I like learning to be capable to take care of patients this screwed up it gets old after awhile.

Most of the attendings micro-manage the hell out of the service and it seems like every patient is followed by some version of a transplant medicine service and ID, which means you spend an hour a day reading their notes (ie novels).

The worst however is when they come back to the ER with a headache, ingrown toenail, depression, runny nose, or mild reaction to the food at "that new cajun place" (true story, and i can't emphasize the word mild enough) and they get admitted to your service. No one else will touch them.

 

[ComfortableWolf]

That depends on what you define as "the middle of nowhere." I think if a city is big enough to have a transplant program, it's not really the middle of nowhere, by definition, to anybody except those from the northeast.

What you will find, however, is fewer places doing the "big stuff," i.e. high volume livers, pancreas, intestinal TP, etc.



Many of the transplant surgeons I've met, as well as the ones featured prominently on TV, have been quite eccentric. I think it comes with the territory.

Fair enough , let me rephrase.. I gusee the "the middle of nowhere" is an overstatement. The fellow was forced to take a job in a part of the country which was not high on his list of places to live... Like all jobs you have to go where there is work but it is depressing not to find a job in a part of the country in which you want to live after th brutality of a gen surg residency and a txp fellowship... With more education and training should come greater freedom... Unfortunately this is not the way it plays out in many super specialty fields

 

[cpants]

Con: I can not emphasize enough how NOT fun it is to operate on someone with HepC/HIV.

It's not bad at all. Double glove, a little vigilance. Seroconversion rate is almost unheard of for HIV and extremely low for Hep C even with a large bore hollow needle stick, which you are very unlikely to get.

 

[DHT]

It's not bad at all. Double glove, a little vigilance. Seroconversion rate is almost unheard of for HIV and extremely low for Hep C even with a large bore hollow needle stick, which you are very unlikely to get.

Yeah, but taking the antiretrovirals for HIV exposure is not fun and a 2% chance of converting to HCV doesn't seem so small when its you. Maybe its because I am not a seasoned veteran yet, but I am always on edge when operating on HIV or HCV which tends to take a lot of the fun away for me.

 

[thedrjojo]

We do a lot of transplant where I'm at, and the cases are slick.

Everything else about transplant....not so much. Most of the patients are crazy, long term etoh and iv drug abusers. They are all sick as ****, and as much as I like learning to be capable to take care of patients this screwed up it gets old after awhile.

Most of the attendings micro-manage the hell out of the service and it seems like every patient is followed by some version of a transplant medicine service and ID, which means you spend an hour a day reading their notes (ie novels).

The worst however is when they come back to the ER with a headache, ingrown toenail, depression, runny nose, or mild reaction to the food at "that new cajun place" (true story, and i can't emphasize the word mild enough) and they get admitted to your service. No one else will touch them.

Thats when it helps to have a good hepatology department at your hospital or one that has admitting rights... my program we do get some of the bounce backs, but a lot of these patients end up on hepatology... before the service became strong though, even the pre-tranplant people who werent going to get a liver any time soon were admitted to the transplant team...

From what I have heard, Kidney jobs are not hard to get, but liver jobs are few and far between... which makes sense since many more places are doing kidneys and they are the lesser desired transplant job...