Vascular Surgery Outlook? (current md3 student)

[2PINZ]

Although it has only been 3 weeks into my third year but I'm finding myself gravitating towards internal medicine or vascular surgery. I was hoping some kind folks could shed some light on a couple questions:

1. What are some areas/techniques that vascular surgeons look to expand into or incorporate in the next 10-15 years? I understand they don't deal with the vessels of the heart or brain, but what about small/microvessel pathologies?

2. To what degree do vascular surgeons cross paths with oncology? I'm quite interested in cancer research and the future of genomic/personalized medicine, but I haven't come across much with regards to vascular surgeons being a part of that care team. I did come across this article, but I'm not sure how prevalent those cases are: [The place of vascular surgery in the treatment of cancer patients]. - PubMed - NCBI


I'm a bit timid about asking these long-term questions with my vascular surgery attending, just because I'm unaware of what intra-/inter-specialty politics may be going on. Thanks in advance.

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[vhawk]

There are very few medical fields that dont deal with cancer on a regular or semiregular basis....but vascular might just be one of them.

 

[TypeADissection]

There is a very large chasm that exists between IM and VS. The extent that most VS will be involved with cancer is probably going to be VTE related and providing recs because most primary teams just don't know what to do with DVTs anymore. At your quaternary places there will be cases now and then where Urology will ask for help if a RCC gets involved into the IVC. Surg Onc here will call us if they want help with SMA recon on a whipple but that's maybe 3-5 times a year at most. But in regards to being involved with Heme Onc on a regular basis, that's a pretty rare feat. There is a vascular surgeon in Houston that has developed a niche practice doing a lot of oncologic disease-based vascular intervention/recon, but I can't imagine that'd be common. Spend some time on a VS service and you'll see how the day in and day out flow of the service is quite unrelated to oncology for the most part. Cheers.

 

[mimelim]

Although it has only been 3 weeks into my third year but I'm finding myself gravitating towards internal medicine or vascular surgery. I was hoping some kind folks could shed some light on a couple questions:

1. What are some areas/techniques that vascular surgeons look to expand into or incorporate in the next 10-15 years? I understand they don't deal with the vessels of the heart or brain, but what about small/microvessel pathologies?

2. To what degree do vascular surgeons cross paths with oncology? I'm quite interested in cancer research and the future of genomic/personalized medicine, but I haven't come across much with regards to vascular surgeons being a part of that care team. I did come across this article, but I'm not sure how prevalent those cases are: [The place of vascular surgery in the treatment of cancer patients]. - PubMed - NCBI


I'm a bit timid about asking these long-term questions with my vascular surgery attending, just because I'm unaware of what intra-/inter-specialty politics may be going on. Thanks in advance.

The day to day between IM and VS is about as far apart as you can get. Hard to imagine trying to pick between the two, but that having been said...

1. Extremity PAD, Cerebrovascular, Venous, Dialysis access, aneurysms are going to be your bread and butter. How those are treated is rapidly changing and vascular surgery is at the forefront of that, but I don't for see moving into other vascular beds. There is too much work for too few of us already.

2. Virtually zero. There are niche practices (MDA has two vascular surgeons), but we do very little oncology related surgery. My role in RCC is as a technician. Manipulating and extracting clot/tumor from the IVC. Other than that, and the oddball rare once a year cases, have little to do with cancer. Most of us see this as a blessing.

3. Vascular surgery is tough from every single side. The hours are long and incredibly unpredictable. Compared to every other specialty in the endovascular space, vascular surgeons spend more time training. There is a vascular surgeon shortage in the US. I don't think there is a better job market right now for any specialty because of this.

 

[filter07]

One of the reasons why I chose vascular surgery is the lack of cancer. I simply have no tolerance for having everything I knew turned upside down based on randomized control trials every few years. I also don't like having other specialties tell me what I should or shouldn't do (tumor board).

Career outlook is incredible. But if you are seriously considering IM vs Vascular you need to get a little bit more experience before you worry about this.

 

[vhawk]

There is a very large chasm that exists between IM and VS. The extent that most VS will be involved with cancer is probably going to be VTE related and providing recs because most primary teams just don't know what to do with DVTs anymore. At your quaternary places there will be cases now and then where Urology will ask for help if a RCC gets involved into the IVC. Surg Onc here will call us if they want help with SMA recon on a whipple but that's maybe 3-5 times a year at most. But in regards to being involved with Heme Onc on a regular basis, that's a pretty rare feat. There is a vascular surgeon in Houston that has developed a niche practice doing a lot of oncologic disease-based vascular intervention/recon, but I can't imagine that'd be common. Spend some time on a VS service and you'll see how the day in and day out flow of the service is quite unrelated to oncology for the most part. Cheers.

You guys are doing SMA resections and recons for panc cancer? Or did you mean SMV? I kinda thought no one was doing those anymore. I'll do smv and hepatic, and applebys but not SMA.

And we usually do involve our vascular guys for all of that unless it's just a side bite smv resection

 

[TypeADissection]

You guys are doing SMA resections and recons for panc cancer? Or did you mean SMV? I kinda thought no one was doing those anymore. I'll do smv and hepatic, and applebys but not SMA.

And we usually do involve our vascular guys for all of that unless it's just a side bite smv resection

Yes. I meant SMV. Sorry for the confusion. But that’s a really far and few between thing for us here.