Vascular Surgery Fellow AMA

[Jolie South]

I am a first year vascular surgery fellow. Ask me anything about anything from surgery residency to fellowship.

I also didn’t match to my initial subspecialty choice when I first applied way back when and am now happy about it.

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[Adventurer753]

Been curious about what a vascular surgeon does exactly? Like bread and butter cases and then also the more rare but still consistent cases you'd be involved in?

Thank you

 

[DubbiDoctor]

Would someone who throughout his whole life has had below average motor skills - manifested in poor handwriting, clumsiness - be able to succeed as a surgeon, provided he puts in the expected number of hours into training?

 

[Jolie South]

Been curious about what a vascular surgeon does exactly? Like bread and butter cases and then also the more rare but still consistent cases you'd be involved in?

Thank you

So we treat a wide spectrum of disease.

Bread and butter cases include:
Carotid endarterectomy
Saphenous vein ablation
Peripheral aortograms/angiograms for PAD +/- stenting
Lower extremity bypass
Endovascular AAA
Creation of fistulas/grafts for dialysis

Depending on who you are, there are niche practices like for advanced endovascular treatment of AAA (FEVAR, chEVAR, physician modified grafts, branched grafts, etc), open management of thoracoabdominal aneurysms often in combination with CT, thoracic outlet syndrome decompression and first rib resection.

The same basic skill set is used to treat disease everywhere though. Good mix of open and endovascular cases and increasing use of endovascular for complex disease.

 

[Jolie South]

Would someone who throughout his whole life has had below average motor skills - manifested in poor handwriting, clumsiness - be able to succeed as a surgeon, provided he puts in the expected number of hours into training?

I think surgery is learned through a combination of natural talent and practice. Can you be a surgeon and have less than average motor skills? Yes, but you are going to work harder and have to practice more than your colleagues in residency to do the same tasks. There are also different categories of skills: some people are better at laparoscopy vs open surgery. In my field, endovascular skills are quite different than open skills.

If you are interested in surgery, I would advise you to see how it goes on your clerkship when you are learning basic skills such as knot tying and suturing.

I also am one of the clumsiest people I know and I also know surgeons with horrible handwriting so I don’t know if those are correlates for surgical talent/ability.

 

[Gurby]

What was your initial sub-specialty choice, and why do you think vascular is a better fit for you?

If you could go back in time, what advice would you give to your former M1 self with regards to choosing a specialty? Is there anything you could have done differently during med school that would have helped you rule out your original choice or rule in vascular more definitively?

Thanks so much for doing this!

 

[Jolie South]

What was your initial sub-specialty choice, and why do you think vascular is a better fit for you?

If you could go back in time, what advice would you give to your former M1 self with regards to choosing a specialty? Is there anything you could have done differently during med school that would have helped you rule out your original choice or rule in vascular more definitively?

Thanks so much for doing this!

I applied to urology. I think I did so for a number of reasons: it is a specialty with minimal emergencies and lots of advancing technology (I.e. robotics), but most of all because I had great mentors who encouraged me and taught me. I did not have that experience in general surgery rotations. Everyone was angry and annoyed all the time. Also, many non surgeons told me I was “too smart” to do general surgery.

I think I would say to M1s to keep an open mind. I said I would absolutely not do surgery when I was a first year. So much has changed!!

With regards to choosing surgery in general, you have to love it. If you can see yourself being happy doing anything else, do that. I couldn’t. I guess I am a masochist bc I like the life threatening injuries/illnesses. I like sick patients. A lot of general surgery is life and death.

I chose vascular bc I like trauma but I like to operate. I can do both and have practice that is whatever I make it by being a vascular surgeon. What is most scary to a trauma surgeon? Vascular injury and bleeding.

In vascular, there is also a lot of cool minimally invasive technology that is rapidly changing and advancing. So we do big surgery with small incisions.

 

[Jolie South]

Thanks so much for doing this. I have a few questions:

1) Can you elaborate on which specialty you were originally planning on applying to and how did you cope with finding a new specialty? I have been set on a surgical subspecialty since day 0, absolutely fell in love with the pathology and the people, and am facing a near 0% chance of matching. I am basically just going through the motions with the expectation that I will not match. It is eating me alive and I am really struggling to come to terms with the reality that I will not get to practice in this field. How did you convince yourself that things will be okay and that there is more to life?

2) Assuming you dual-applied gen surg + surgical subspecialty, any tips for this process? Did you apply to both specialties at the same program? Did any interviewers question your commitment to gen surg and how did you handle this?

Thanks again.

Well, I was devastated when I didn’t match urology and I had a good application and interviews. I think you just have to keep going to be open to other options. That is how general Surgery found me. I didn’t have the opportunity to scramble so had to do a prelim year. It is terrifying but you can find your place. Be that a new specialty that is procedure related or not.

And personally in recent life, with my father’s passing, I am learning that there are things more important than your career.

I did not dual apply to Gen Surg as I mentioned above. Did prelim year and applied for second year spots after the fact once I had thought about it.

 

[TypeADissection]

Sup JS. Thanks for doing this.

1. What are some things you wish you knew or had read up on before starting fellowship.
2. Recommend 1-3 essential textbooks for the 1st year fellow.
3. Do you miss consults for ileus vs early SBO vs partial SBOs? Just kidding. I know you don't.
4. You leaning towards private or academic?

Cheers.

 

[Gurby]

I applied to urology. I think I did so for a number of reasons: it is a specialty with minimal emergencies and lots of advancing technology (I.e. robotics), but most of all because I had great mentors who encouraged me and taught me. I did not have that experience in general surgery rotations. Everyone was angry and annoyed all the time. Also, many non surgeons told me I was “too smart” to do general surgery.

I think I would say to M1s to keep an open mind. I said I would absolutely not do surgery when I was a first year. So much has changed!!

With regards to choosing surgery in general, you have to love it. If you can see yourself being happy doing anything else, do that. I couldn’t. I guess I am a masochist bc I like the life threatening injuries/illnesses. I like sick patients. A lot of general surgery is life and death.

I chose vascular bc I like trauma but I like to operate. I can do both and have practice that is whatever I make it by being a vascular surgeon. What is most scary to a trauma surgeon? Vascular injury and bleeding.

In vascular, there is also a lot of cool minimally invasive technology that is rapidly changing and advancing. So we do big surgery with small incisions.

I am really interested in robotic surgery, and it's a bit disheartening to me that nobody in the vascular department at my hospital uses the da Vinci for anything. This is probably a pretty flimsy reason to pick a specialty, but I can't help being enamored of some of the robotic cardiac/thoracic/abdominal cases I've seen. I feel like there are some procedures vascular surgeons do that would definitely benefit from the stability of the da Vinci, but maybe many people just don't see it as worth the learning curve or extra cost/setup time, etc. Could you be a bit more specific about where you see vascular surgery going in the future, from a technology point of view?

Thanks again for letting us pick your brain!

 

[Jolie South]

Thanks, that is very helpful. I wish you all the best and am glad you found your way.

One more question, what are your hours like for vascular and any idea what the job market is like? If I end up in gen surg, would probably do vascular or trauma for the high acuity.

Job market is great. Old guys retiring. More jobs than surgeons.

I think I read a survey that said starting salary is $420s. I have a friend who went private practice and was offered $500.

Vascular is not a lifestyle specialty, especially if you like big aortic cases. I am in a cush fellowship and I work 6am to 7pm roughly every day with occasional overnight call. I think anything depends on what your practice set up is and how busy you want to be. I work with private practice guys who work a little less. Call for a week at a time and work one in four weekends.

At the end of your career, you can transition to veins and dialysis access and probably have a relaxing life.

 

[Jolie South]

Sup JS. Thanks for doing this.

1. What are some things you wish you knew or had read up on before starting fellowship.
2. Recommend 1-3 essential textbooks for the 1st year fellow.
3. Do you miss consults for ileus vs early SBO vs partial SBOs? Just kidding. I know you don't.
4. You leaning towards private or academic?

Cheers.

I don’t regret not reading but it would be nice to do a vascular rotation as a chief so you are not totally starting over. I hadn’t done vascular since 4th year and started blind and it was fine.

Current Therapy in Vascular and Endovascular Surgery is my jam. Best book. Almost like Cameron’s for vascular. I used the Strandness book for duplex. Also, VESAP is key for VSITE prep. You can easily get reps to pay for all these things.

Sometimes, I miss doing appys and choles.

When I am done with my military commitment, I will probably do a private practice job that works with residents. But who know?!

 

[Jolie South]

I am really interested in robotic surgery, and it's a bit disheartening to me that nobody in the vascular department at my hospital uses the da Vinci for anything. This is probably a pretty flimsy reason to pick a specialty, but I can't help being enamored of some of the robotic cardiac/thoracic/abdominal cases I've seen. I feel like there are some procedures vascular surgeons do that would definitely benefit from the stability of the da Vinci, but maybe many people just don't see it as worth the learning curve or extra cost/setup time, etc. Could you be a bit more specific about where you see vascular surgery going in the future, from a technology point of view?

Thanks again for letting us pick your brain!

i like the robot but don’t miss it too much.

I would never want to use it in an aortic case which is probably the only place you could.

In terms of technology, I just meant the quality of endografts and techniques to treat aortic disease that we would have never considered before. I think we are still in the infancy of endovascular surgery.

 

[AsianPersuasion]

I applied to urology. I think I did so for a number of reasons: it is a specialty with minimal emergencies and lots of advancing technology (I.e. robotics), but most of all because I had great mentors who encouraged me and taught me. I did not have that experience in general surgery rotations. Everyone was angry and annoyed all the time. Also, many non surgeons told me I was “too smart” to do general surgery.

I think I would say to M1s to keep an open mind. I said I would absolutely not do surgery when I was a first year. So much has changed!!

With regards to choosing surgery in general, you have to love it. If you can see yourself being happy doing anything else, do that. I couldn’t. I guess I am a masochist bc I like the life threatening injuries/illnesses. I like sick patients. A lot of general surgery is life and death.

I chose vascular bc I like trauma but I like to operate. I can do both and have practice that is whatever I make it by being a vascular surgeon. What is most scary to a trauma surgeon? Vascular injury and bleeding.

In vascular, there is also a lot of cool minimally invasive technology that is rapidly changing and advancing. So we do big surgery with small incisions.

Thanks for doing this. That bolded part is so interesting because I think a lot of us who wants the fast pace of trauma wouldn't think of that unless we're exposed to it.

1) Did you graduate from a GS program that implemented 2 years of research during your 5 years GS residency?
2) If you did, were you living off of loans during those 2 years?
3) Is vascular after GS really strict on research like surg onc and peds?

 

[Jolie South]

Thanks for doing this. That bolded part is so interesting because I think a lot of us who wants the fast pace of trauma wouldn't think of that unless we're exposed to it.

1) Did you graduate from a GS program that implemented 2 years of research during your 5 years GS residency?
2) If you did, were you living off of loans during those 2 years?
3) Is vascular after GS really strict on research like surg onc and peds?

1. Hell no

2. See above

3. Not strict at all. It is a self selecting pool. However, as with any graduate medical education as time passes there are more applicants for the same spots. It is becoming more competitive for that reason in addition to some programs converting to solely integrated vascular residency. I would have never done this even given the option bc I like the flexibility my Gen Surg board certification will give me. I am more comfortable in the abdomen and I can do trauma. However, not everyone feels this way and I certainly think integrated residency is a viable option.

 

[Fission Chips]

I applied to urology. I think I did so for a number of reasons: it is a specialty with minimal emergencies and lots of advancing technology (I.e. robotics), but most of all because I had great mentors who encouraged me and taught me. I did not have that experience in general surgery rotations. Everyone was angry and annoyed all the time. Also, many non surgeons told me I was “too smart” to do general surgery.

I think I would say to M1s to keep an open mind. I said I would absolutely not do surgery when I was a first year. So much has changed!!

With regards to choosing surgery in general, you have to love it. If you can see yourself being happy doing anything else, do that. I couldn’t. I guess I am a masochist bc I like the life threatening injuries/illnesses. I like sick patients. A lot of general surgery is life and death.

I chose vascular bc I like trauma but I like to operate. I can do both and have practice that is whatever I make it by being a vascular surgeon. What is most scary to a trauma surgeon? Vascular injury and bleeding.

In vascular, there is also a lot of cool minimally invasive technology that is rapidly changing and advancing. So we do big surgery with small incisions.

Any idea why you didn't match into Urology? Did your mentors mention anything in particular about your CV?

 

[Cyphix]

I applied to urology. I think I did so for a number of reasons: it is a specialty with minimal emergencies and lots of advancing technology (I.e. robotics), but most of all because I had great mentors who encouraged me and taught me. I did not have that experience in general surgery rotations. Everyone was angry and annoyed all the time. Also, many non surgeons told me I was “too smart” to do general surgery.

I think I would say to M1s to keep an open mind. I said I would absolutely not do surgery when I was a first year. So much has changed!!

With regards to choosing surgery in general, you have to love it. If you can see yourself being happy doing anything else, do that. I couldn’t. I guess I am a masochist bc I like the life threatening injuries/illnesses. I like sick patients. A lot of general surgery is life and death.

I chose vascular bc I like trauma but I like to operate. I can do both and have practice that is whatever I make it by being a vascular surgeon. What is most scary to a trauma surgeon? Vascular injury and bleeding.

In vascular, there is also a lot of cool minimally invasive technology that is rapidly changing and advancing. So we do big surgery with small incisions.

What are some of the unexpected similarities you’ve found between Vascular Surgery and Urology?

 

[Jolie South]

Any idea why you didn't match into Urology? Did your mentors mention anything in particular about your CV?

No idea. I was AOA, had good letters, did multiple electives, research, and a sub-I at another program. I interviewed at 14 programs.

My dean and chair talked to me about it extensively. They thought I was a good applicant and encouraged me to reapply. I was told the “holes in the Swiss cheese just lined up that way.”

 

[Jolie South]

What are some of the unexpected similarities you’ve found between Vascular Surgery and Urology?

Mostly, that we have a very unique skill set and other specialties really know little about what we do.

 

[Maskchamp]

That's awesome. I'm Canadian and I'll be an IMG in a couple of years. I do not want to practice in the States, but do you have any friends/colleagues up north or overseas that are vascular surgeons? Do they like their lifestyle? As cliche as it sounds, money is not that important to me and I am by no means wealthy. Just want something decent to start my life but more interested in kind of enjoyment, lifestyle of vascular surgery, if it's not boring, etc. Please let me know. We are learning about the veins and arteries and their histology, it's really really really cool stuff!

 

[neusu]

Carotids: awake or asleep? scope or no scope?

 

[Jolie South]

Carotids: awake or asleep? scope or no scope?

Asleep, but mostly because you need a very calm, non-anxious person to do awake. I have one attending who routinely does awake and it is nice to have that level of monitoring.

Scope? Do you mean shunt?
We shunt all patients.

 

[Jolie South]

That's awesome. I'm Canadian and I'll be an IMG in a couple of years. I do not want to practice in the States, but do you have any friends/colleagues up north or overseas that are vascular surgeons? Do they like their lifestyle? As cliche as it sounds, money is not that important to me and I am by no means wealthy. Just want something decent to start my life but more interested in kind of enjoyment, lifestyle of vascular surgery, if it's not boring, etc. Please let me know. We are learning about the veins and arteries and their histology, it's really really really cool stuff!

I don’t have friends in Canada, but I’m general I hear the market for jobs is much tougher. In the US, I will never be out of a job. I don’t know if their lifestyle is different than in the US but I suspect it’s not.

I mean it depends on you whether it’s boring or not. With any specialty, you have to rotate and get a feel for if it’s for you. I think you have to look at the negatives and if you can deal with the bad parts, then it may be a good fit.

 

[neusu]

Asleep, but mostly because you need a very calm, non-anxious person to do awake. I have one attending who routinely does awake and it is nice to have that level of monitoring.

Scope? Do you mean shunt?
We shunt all patients.

Lol I meant microscope. I'll just infer you don't use it then!

 

[mimelim]

Lol I meant microscope. I'll just infer you don't use it then!

Half of the people I know don't use loupes for carotids, and while I certainly use mine in every case, I can't imagine why you would use a microscope. Maybe I'm slowly being corrupted by the private mentality, but scopes must really slow down the procedure right?

 

[neusu]

Half of the people I know don't use loupes for carotids, and while I certainly use mine in every case, I can't imagine why you would use a microscope. Maybe I'm slowly being corrupted by the private mentality, but scopes must really slow down the procedure right?

I think during the learning curve, yes, it does. I can do it skin:skin in 45 min with a scope so idk.

 

[Jolie South]

I think during the learning curve, yes, it does. I can do it skin:skin in 45 min with a scope so idk.

We never use scopes, always use loupes.

 

[Gurby]

I think you have to look at the negatives and if you can deal with the bad parts, then it may be a good fit.

What are the worst parts of the specialty in your eyes, and what are the best parts?

 

[Jolie South]

What are the worst parts of the specialty in your eyes, and what are the best parts?

I like that we can handle what most surgeons are afraid of: bleeding. I like that due to training in general surgery and vascular I have a lot of flexibility in my career. I like sick patients and the perspective my broad training has given me.

Worst parts: I sometimes hate the amount of emergencies we have but really don’t mind that much if they are good cases. I sometimes get tired with how much we get called on DVTs and thrombosed fistulas/fistula problems.

 

[SpartanDOnoharm]

About how long is the average vascular surgery for most bread and butter cases?

 

[Jolie South]

About how long is the average vascular surgery for most bread and butter cases?

Really depends. Angios if diagnostic can take less than an hour. Carotids are like 1-2 hours on average. Some bypasses can be 3-4 hours.

 

[DubbiDoctor]

Do you wish you had done a categorical vascular program. Integrated plastics has seemed to completely replace fellowships. Do you think the same will happen for vascular and thoracic?

 

[AsianPersuasion]

I like that we can handle what most surgeons are afraid of: bleeding. I like that due to training in general surgery and vascular I have a lot of flexibility in my career. I like sick patients and the perspective my broad training has given me.

Worst parts: I sometimes hate the amount of emergencies we have but really don’t mind that much if they are good cases. I sometimes get tired with how much we get called on DVTs and thrombosed fistulas/fistula problems.

Not to be crass, but does VS, fix people's f88k ups like CT does for IC? If you do, how do you guys go about that? What does the patient think of it?

 

[Jolie South]

Do you wish you had done a categorical vascular program. Integrated plastics has seemed to completely replace fellowships. Do you think the same will happen for vascular and thoracic?

Nope. Glad I did it this way. I am board certified in general surgery also and my plan is to also occasional trauma call. Couldn’t do that with integrated.

I do not think integrated programs will replace fellowships. We are just now graduating the first integrated residents and I think we are still waiting to see data.

 

[Jolie South]

Not to be crass, but does VS, fix people's f88k ups like CT does for IC? If you do, how do you guys go about that? What does the patient think of it?

Yes, we fix cardiology’s problems all the time. Patients usually don’t say much. I just hate that cardiology calls us and gives no craps. Even if they have done procedures they have no business doing.

 

[TypeADissection]

Do you wish you had done a categorical vascular program. Integrated plastics has seemed to completely replace fellowships. Do you think the same will happen for vascular and thoracic?

I'm gonna take the contrarian viewpoint and say that I actually wish I had done an integrated residency instead. I came into general surgery with the full intent of returning to my hometown and joining the group there as a general surgeon. I looked forward to having a practice where I would have a nice mix of scopes, hernias, breast, colons, gallbladders, etc. At the end of my intern year I rotated on vascular surgery and by the third day it was very evident to me that this was what I was going to do for the rest of my life. I sat down with my PD and told him that as a PGY-2 I was going to reapply to integrated residencies and start all over again in a five-year program somewhere else. He told me to stay, that I wouldn't regret my general surgery training, etc. Long story short, I regret many times over not doing that.

It is true that there are many things about general surgery that I do not regret, for the training truly does steel into you the ability to think systematically and algorithmically (not sure if this is an actual word) under duress. However, unlike JS, I don't have the same passion for general surgery anymore and look forward to the day when I have nothing to do with it. I wish I could have just immersed myself in vascular for 5-years and then gone out and worked. The caveat is, I'm very very thankful for what general surgery has taught me in regards to navigating around an abdomen, managing critically ill patients and allowing me the time to just catch-up and get good at this surgery thing. I feel badly for those high-achieving students who match into vascular residency, because they kind of have to be good right away, whereas I've had time to grow into my skill set. Just offering a different viewpoint. Cheers.

 

[Jolie South]

I'm gonna take the contrarian viewpoint and say that I actually wish I had done an integrated residency instead. I came into general surgery with the full intent of returning to my hometown and joining the group there as a general surgeon. I looked forward to having a practice where I would have a nice mix of scopes, hernias, breast, colons, gallbladders, etc. At the end of my intern year I rotated on vascular surgery and by the third day it was very evident to me that this was what I was going to do for the rest of my life. I sat down with my PD and told him that as a PGY-2 I was going to reapply to integrated residencies and start all over again in a five-year program somewhere else. He told me to stay, that I wouldn't regret my general surgery training, etc. Long story short, I regret many times over not doing that.

It is true that there are many things about general surgery that I do not regret, for the training truly does steel into you the ability to think systematically and algorithmically (not sure if this is an actual word) under duress. However, unlike JS, I don't have the same passion for general surgery anymore and look forward to the day when I have nothing to do with it. I wish I could have just immersed myself in vascular for 5-years and then gone out and worked. The caveat is, I'm very very thankful for what general surgery has taught me in regards to navigating around an abdomen, managing critically ill patients and allowing me the time to just catch-up and get good at this surgery thing. I feel badly for those high-achieving students who match into vascular residency, because they kind of have to be good right away, whereas I've had time to grow into my skill set. Just offering a different viewpoint. Cheers.

I think wanting to do integrated is a fine thing and I don’t think one is better than the other.

Vascular was never on my radar as a student and I hated it when I was an intern. I made a sort of last minute switch in 4th year of residency to not apply to trauma/cc because I wanted a more operative practice and I am not all that into critical care all the time. However, I do like in vascular that we get some critical care still as our patients are sicker than most and we do some pretty big whacks.

 

[DrfluffyMD]

Yes, we fix cardiology’s problems all the time. Patients usually don’t say much. I just hate that cardiology calls us and gives no craps. Even if they have done procedures they have no business doing.

Whoever controls the patients, do all the procedures regardless whether they are actually capable of doing them or not.

 

[AsianPersuasion]

Whoever controls the patients, do all the procedures regardless whether they are actually capable of doing them or not.

That sounds hella scary.

 

[DrfluffyMD]

That sounds hella scary.

And then those people eventually learn and catch up till the outcome is mostly similar.

 

[mymembernames]

working with a vasc fellow and he's telling me salary offers in major cities are 250k is this right?

 

[Jolie South]

working with a vasc fellow and he's telling me salary offers in major cities are 250k is this right?

That’s lower than what I had heard. But I am not actively looking for jobs right now.

 

[Psai]

working with a vasc fellow and he's telling me salary offers in major cities are 250k is this right?

Maybe he works half the year with no call

 

[DrfluffyMD]

Maybe he works half the year with no call

Doesn’t work like that in surgery unless this person only does vein somehow

 

[DubbiDoctor]

I think wanting to do integrated is a fine thing and I don’t think one is better than the other.

Vascular was never on my radar as a student and I hated it when I was an intern. I made a sort of last minute switch in 4th year of residency to not apply to trauma/cc because I wanted a more operative practice and I am not all that into critical care all the time. However, I do like in vascular that we get some critical care still as our patients are sicker than most and we do some pretty big whacks.

Can you provide some insight into what "trauma surgery" actually is? Are they intensivists? Do they perform surgery, just like any other surgeon? Do they work in the ICU or ED? What is their compensation like? Can an EM physician who completes a surgical critical care fellowship (Critical Care Fellowships) become a trauma surgeon?

 

[LebronManning]

Are you afraid of encroachment from various specialties into VS? Seems like NSGY is doing CEAs (Neusu said he's doing them in 45 mins) and Interventional Cardiology will continue to try to stent everything. I think they have successfully entered the PAD stenting market and would've been more successful with carotid stents if the data with it wasn't so bad. Stents and this data may improve, they may not. And then there's the encroachment from IR onto almost every endovascular procedure you guys do including TEVAR. The advantage here may be that Vascular Surgery, in my opinion, is the MOST qualified to do all of the above. However, history has shown us that this is not always who wins turf wars. To me, a giant advantage of doing GS->VS is the flexibility you were talking about in being able to supplement your practice with GS procedures if VS starts losing turf battles.

Also, how do you deal with the population of vascular surgery patients? I heard they can be very tough in terms of self inflicted disease via smoking, etc. and also their continued non compliance even after you help them. Do you think this is overblown and if not how do you come to terms with this?

 

[LebronManning]

Can you provide some insight into what "trauma surgery" actually is? Are they intensivists? Do they perform surgery, just like any other surgeon? Do they work in the ICU or ED? What is their compensation like? Can an EM physician who completes a surgical critical care fellowship (Critical Care Fellowships) become a trauma surgeon?

Trauma Surgery is pretty much the management of trauma patients in the OR and SICU. Over the years, this has become much less operative and more managing their trauma in the Surgical Intensive Care Unit (SICU). Some trauma definitely still requires emergent surgery in the abdomen but this has become less common as imaging has improved as well as non operative treatment. They are surgical intensivists and they staff the SICU, not ED. They only come down to ED for trauma activations/alerts. They cannot manage Medical ICU patients.

An EM physician cannot be a trauma surgeon. I believe they can complete some sort of critical care fellowship, but not surgical as they are not allowed in the OR. You have to be a surgeon to perform surgery. I think the EM physicians who do CC fellowships just do it for the knowledge of managing CC patients as even most hospitals won't allow a EM physician to staff a MICU or SICU.

 

[DrfluffyMD]

Are you afraid of encroachment from various specialties into VS? Seems like NSGY is doing CEAs (Neusu said he's doing them in 45 mins) and Interventional Cardiology will continue to try to stent everything. I think they have successfully entered the PAD stenting market and would've been more successful with carotid stents if the data with it wasn't so bad. Stents and this data may improve, they may not. And then there's the encroachment from IR onto almost every endovascular procedure you guys do including TEVAR. The advantage here may be that Vascular Surgery, in my opinion, is the MOST qualified to do all of the above. However, history has shown us that this is not always who wins turf wars. To me, a giant advantage of doing GS->VS is the flexibility you were talking about in being able to supplement your practice with GS procedures if VS starts losing turf battles.

Also, how do you deal with the population of vascular surgery patients? I heard they can be very tough in terms of self inflicted disease via smoking, etc. and also their continued non compliance even after you help them. Do you think this is overblown and if not how do you come to terms with this?

IR doesn’t encroach on VS. We came up with those endovascular procedures.

 

[Jolie South]

Are you afraid of encroachment from various specialties into VS? Seems like NSGY is doing CEAs (Neusu said he's doing them in 45 mins) and Interventional Cardiology will continue to try to stent everything. I think they have successfully entered the PAD stenting market and would've been more successful with carotid stents if the data with it wasn't so bad. Stents and this data may improve, they may not. And then there's the encroachment from IR onto almost every endovascular procedure you guys do including TEVAR. The advantage here may be that Vascular Surgery, in my opinion, is the MOST qualified to do all of the above. However, history has shown us that this is not always who wins turf wars. To me, a giant advantage of doing GS->VS is the flexibility you were talking about in being able to supplement your practice with GS procedures if VS starts losing turf battles.

Also, how do you deal with the population of vascular surgery patients? I heard they can be very tough in terms of self inflicted disease via smoking, etc. and also their continued non compliance even after you help them. Do you think this is overblown and if not how do you come to terms with this?

I don’t think of it as a turf battle. I think there aren’t enough vascular surgeons to go around. We are the final common pathway for all these disease processes though. A cardiologist can never do a bypass or fix a disaster if they do EVAR. In places where vascular surgery has a dominant presence, there is still plenty of work to go around. And once there are bad outcomes from a particular specialty at a hospital, we will just say we are not going to back them up and that will be the end of that. Or we publish literature that says we have better outcomes. This literature is already out there for carotids.

I don’t think I will ever have to resort to doing general surgery to make money. If I do general surgery also, it’s because I want to.

 

[Big Bad Byron]

Do you ever feel like fainting during a surgery and if so what do you do to keep your head steady?