Vascular surgery programs

[speedyxx626]

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Hey all, an MS-3 here. I've decided that I'm fully committed on applying to integrated vascular surgery programs and was wondering if anybody had general information about the different programs and what they liked/disliked about each of them. Any general advice about applying to vascular surgery from recent interviewees or matches residents would be great as well. Thanks in advance!

 

[mimelim]

I am a PGY5 in one of the big programs. We just wrapped up our most recent cycle in terms of interviewing and rank list creation. As with most smaller residencies, this is all about fitting particular programs. Residencies have between 1 and 14 trainees in them, they aren't huge and trying to get the best person that works for that program is by far the most important thing. We can talk via PM about program specifics.

However, in general... For starters, geography tends to be incredibly important for most people, so most people start there. Then there is academics. Virtually every program in the country is going to give you a solid vascular foundation and prepare you to function as a vascular surgeon, but not every one of them is going to prepare you equally for a career in academics or busy private practice. It can be difficult to suss out exactly what the opportunities are, especially without visiting the different programs, but programs tend to guide people toward particular practice types and it is worthwhile to note where graduates end up.

Regarding the application process, your Step scores are on the books already, so after that it is LOR and research that have the biggest impact outside the interview. It is standard for people to have 3-5 letters from vascular surgeons. Certainly not every applicant has them, but you will be among the few if you don't. It is also not atypical for faculty to call (or now text) letter writers asking about applicants since most of them know one another. This is an incredibly small field and people know each other. You should aim to do several aways at programs that on paper you think you are most interested in. 30%+ of our current trainees did either research with us or an away with us prior to matching with us. This is not an atypical story.

 

[SpikesnSpookes]

Just wondering from a financial standpoint, how well are vascular surgeons compensated? Also - how is the private realm?

 

[mimelim]

Just wondering from a financial standpoint, how well are vascular surgeons compensated? Also - how is the private realm?

As with virtually every specialty out there, the range is rather large. The different types of practices alone makes the numbers feel a little silly. But, for a fresh graduate, going by offers I've seen, ~320k to stay in an academic practice around here and ~400k guaranteed for the first 2-3 years in private and then largely eat what you kill model after that. But, if there is one take home point from virtually every fresh graduate that I have talked with, the salaries are largely irrelevant and typically not up for negotiation. What is important is everything else in the contract. In academics, what exactly you are expected to do, how much dedicated research/clinical/teaching/administrative time there is and how much support are you going to likely get from senior faculty, research coordinators, etc. In private, how are they going to help you grow your practice, who are you competing with for patients as well as resources?

For current graduates there are ~6 jobs open per graduate. It is a resident/fellow driven market, high demand for well trained surgeons and low supply.




Or you can take that job in Montana that nobody has for the last 4 years that I keep getting mailers about... I think they are up to offering ~600k starting... Still haven't figured out what is exactly wrong with it yet...

 

[Hemorrage]

I am a PGY5 in one of the big programs. We just wrapped up our most recent cycle in terms of interviewing and rank list creation. As with most smaller residencies, this is all about fitting particular programs. Residencies have between 1 and 14 trainees in them, they aren't huge and trying to get the best person that works for that program is by far the most important thing. We can talk via PM about program specifics.

However, in general... For starters, geography tends to be incredibly important for most people, so most people start there. Then there is academics. Virtually every program in the country is going to give you a solid vascular foundation and prepare you to function as a vascular surgeon, but not every one of them is going to prepare you equally for a career in academics or busy private practice. It can be difficult to suss out exactly what the opportunities are, especially without visiting the different programs, but programs tend to guide people toward particular practice types and it is worthwhile to note where graduates end up.

Regarding the application process, your Step scores are on the books already, so after that it is LOR and research that have the biggest impact outside the interview. It is standard for people to have 3-5 letters from vascular surgeons. Certainly not every applicant has them, but you will be among the few if you don't. It is also not atypical for faculty to call (or now text) letter writers asking about applicants since most of them know one another. This is an incredibly small field and people know each other. You should aim to do several aways at programs that on paper you think you are most interested in. 30%+ of our current trainees did either research with us or an away with us prior to matching with us. This is not an atypical story.

What would you say is the step 1 cutoff?

 

[mimelim]

What would you say is the step 1 cutoff?

Depends on how competitive the program is, ie the number of applications they are getting. I don't think anyone has a hard cut-off at or above 235, but I also don't recall interviewing anyone this year with less than that. Community programs or programs in areas where there are less applicants trying to go to are generally going to need to interview more people and typically lower scores. Still quite competitive, but some locales are a hard sell.

 

[SpikesnSpookes]

As with virtually every specialty out there, the range is rather large. The different types of practices alone makes the numbers feel a little silly. But, for a fresh graduate, going by offers I've seen, ~320k to stay in an academic practice around here and ~400k guaranteed for the first 2-3 years in private and then largely eat what you kill model after that. But, if there is one take home point from virtually every fresh graduate that I have talked with, the salaries are largely irrelevant and typically not up for negotiation. What is important is everything else in the contract. In academics, what exactly you are expected to do, how much dedicated research/clinical/teaching/administrative time there is and how much support are you going to likely get from senior faculty, research coordinators, etc. In private, how are they going to help you grow your practice, who are you competing with for patients as well as resources?

For current graduates there are ~6 jobs open per graduate. It is a resident/fellow driven market, high demand for well trained surgeons and low supply.




Or you can take that job in Montana that nobody has for the last 4 years that I keep getting mailers about... I think they are up to offering ~600k starting... Still haven't figured out what is exactly wrong with it yet...

Why is this so much lower than neurosurg/ortho? I went to the VAM last year and it doesn't make sense with the demand and growth of vascular surgery. Even CT surgeons at my institution make more. Do you see this increasing in the future?

 

[mimelim]

Why is this so much lower than neurosurg/ortho? I went to the VAM last year and it doesn't make sense with the demand and growth of vascular surgery. Even CT surgeons at my institution make more. Do you see this increasing in the future?

I'll be honest, I don't have the foggiest idea of the compensation for private practice guys in other specialties. I have no way of knowing if it is actually lower than the others and by how much. But, a lot of it depends on how valuable the different surgeons are to the hospital. There is a cost to doing operations and in general hospitals pay the people who are more economically efficient more. I do not know the nuances of spine surgery or joint from ortho, but my guess is that those are the guys getting paid the big bucks based on how those procedures impact the hospital.

 

[Radz123]

I recently read that Neurosurgery performs the most profitable procedures by unit time and there is a now a big push in hospital systems to hire more Neurosurgeons to help their bottom line. I imagine that explains part of their compensation.

 

[SpikesnSpookes]

I am a PGY5 in one of the big programs. We just wrapped up our most recent cycle in terms of interviewing and rank list creation. As with most smaller residencies, this is all about fitting particular programs. Residencies have between 1 and 14 trainees in them, they aren't huge and trying to get the best person that works for that program is by far the most important thing. We can talk via PM about program specifics.

However, in general... For starters, geography tends to be incredibly important for most people, so most people start there. Then there is academics. Virtually every program in the country is going to give you a solid vascular foundation and prepare you to function as a vascular surgeon, but not every one of them is going to prepare you equally for a career in academics or busy private practice. It can be difficult to suss out exactly what the opportunities are, especially without visiting the different programs, but programs tend to guide people toward particular practice types and it is worthwhile to note where graduates end up.

Regarding the application process, your Step scores are on the books already, so after that it is LOR and research that have the biggest impact outside the interview. It is standard for people to have 3-5 letters from vascular surgeons. Certainly not every applicant has them, but you will be among the few if you don't. It is also not atypical for faculty to call (or now text) letter writers asking about applicants since most of them know one another. This is an incredibly small field and people know each other. You should aim to do several aways at programs that on paper you think you are most interested in. 30%+ of our current trainees did either research with us or an away with us prior to matching with us. This is not an atypical story.

I was told by the vascular surgeons at my large institution that doing an away rotation for integrated vascular would not be necessary and can in fact backfire. Is this true?

 

[mimelim]

I was told by the vascular surgeons at my large institution that doing an away rotation for integrated vascular would not be necessary and can in fact backfire. Is this true?

Of the top 10 on our rank list, 3 did aways with us. On the other hand, there was someone that did an away with us who is near the bottom of our list. Clearly it can backfire, on the other hand, 30% of our program did aways with us, research with us or had some other connection to the program.

Is it necessary? No. The majority of IVS residents did not do aways at the program that they are at. It depends how good of an applicant you are and how impressive you are in person vs. on paper. I can tell you this though, a solid known quantity is always going to go to the top of a program's rank list over someone 10% better on paper, but not known to the program.

 

[SpikesnSpookes]

Of the top 10 on our rank list, 3 did aways with us. On the other hand, there was someone that did an away with us who is near the bottom of our list. Clearly it can backfire, on the other hand, 30% of our program did aways with us, research with us or had some other connection to the program.

Is it necessary? No. The majority of IVS residents did not do aways at the program that they are at. It depends how good of an applicant you are and how impressive you are in person vs. on paper. I can tell you this though, a solid known quantity is always going to go to the top of a program's rank list over someone 10% better on paper, but not known to the program.

Thank you for the info!! Sorry to bother you with so many questions, but is there a rank list of the integrated vascular programs? What is considered top 10? I'm interested as I will be applying this upcoming year.

 

[mimelim]

Thank you for the info!! Sorry to bother you with so many questions, but is there a rank list of the integrated vascular programs? What is considered top 10? I'm interested as I will be applying this upcoming year.

There are only ~50 programs, there is no 'ranking' of programs. This is no different than every other specialty. Not everyone is looking for the same thing in a residency. Virtually every program in the country will train you to be a good, competent vascular surgeon, some just have perks of going there (like exposure to particular pathology, access to community bread and butter services, research etc), But, so as to not be totally useless, here is a basic framework...

Super Academic vs. Academic vs. Community - Most, if not all programs offer at least some opportunities to get your name on a paper here and there, case reports, case series, etc. But, there are varying levels of faculty interest and institutional support at different programs. Some places have mandatory research years with publication requirements (Pitt, Methodist, Northwestern etc) they have large research branches to support resident/faculty endeavors. Some have more access to basic science than others. Some are more focused on device design, etc. For me, it was all about clinical research and trial design. My retrospective research turned into now 4 on going clinical trials, some investigator driven and one industry sponsored. You simply can't do that at every program. But, again, I'd say that the majority don't want or need it.

Case volume - This is devilishly tricky to suss out, but probably one of the more important things. Every program will get you your numbers, otherwise, they wouldn't be graduating people. But, how much do they fudge (legally) things? And how much extra are you getting? Are you getting 30 CEAs or 100? What about non-tracked cases? Dialysis access is bread and butter in the community, yet some big name programs lack it as a significant part of their practice. Others will graduate you with 500+ access cases. Trauma is another hit or miss at different programs. Which is either a bummer, or a God send, depending on your personal preferences. Amputations are another bread and butter that many vascular surgeons would rather not be doing, but the difference between someone that did a couple in their residency vs. learning to do it well in good volume makes a difference, especially if you are going into the community. Compared to 30 years ago, every program is going to hurt for open aortas, but compared to each other, there are obviously centers that are still doing a fair number, while others have to fudge things to get their residents their ACGME required numbers. Not everyone wants open aortas to be a part of their future practice. Thus, this may be a complete non-issue, or alternatively it could be a big freaking deal.

And then there are the general residency factors, geography being a big one. The number of people looking to go to Springfield, IL is much lower than Chicago, IL. Thus, Northwestern is a heck of a lot more competitive than SIU, despite the fact that they are both solid programs. They just simply offer different things to go along with their different locations. Another major factor is how old the program is. Every new program has growing pains. Don't fall for the, "oh we've been training fellows for years and have GS residents rotating with us all the time, of course we can train IVS residents". It is bull****. Taking a fully trained GS and teaching them vascular or taking on a GS resident for a month is not the same as teaching someone from the ground up (MS4) how to be a doctor. I say this as the first entering class in my residency. I honestly think that we have the best residency in the country. But, it took many years to get there and there were definitely struggles along the way. That isn't to say that newer programs can't be incredibly strong. It just will take a certain type of resident to excel in a constantly shifting and changing environment.

I could go on and on and on about this. Feel free to PM me if you want more specifics, always happy to talk vascular with people 🙂

 

[speedyxx626]

There are only ~50 programs, there is no 'ranking' of programs. This is no different than every other specialty. Not everyone is looking for the same thing in a residency. Virtually every program in the country will train you to be a good, competent vascular surgeon, some just have perks of going there (like exposure to particular pathology, access to community bread and butter services, research etc), But, so as to not be totally useless, here is a basic framework...

Super Academic vs. Academic vs. Community - Most, if not all programs offer at least some opportunities to get your name on a paper here and there, case reports, case series, etc. But, there are varying levels of faculty interest and institutional support at different programs. Some places have mandatory research years with publication requirements (Pitt, Methodist, Northwestern etc) they have large research branches to support resident/faculty endeavors. Some have more access to basic science than others. Some are more focused on device design, etc. For me, it was all about clinical research and trial design. My retrospective research turned into now 4 on going clinical trials, some investigator driven and one industry sponsored. You simply can't do that at every program. But, again, I'd say that the majority don't want or need it.

Case volume - This is devilishly tricky to suss out, but probably one of the more important things. Every program will get you your numbers, otherwise, they wouldn't be graduating people. But, how much do they fudge (legally) things? And how much extra are you getting? Are you getting 30 CEAs or 100? What about non-tracked cases? Dialysis access is bread and butter in the community, yet some big name programs lack it as a significant part of their practice. Others will graduate you with 500+ access cases. Trauma is another hit or miss at different programs. Which is either a bummer, or a God send, depending on your personal preferences. Amputations are another bread and butter that many vascular surgeons would rather not be doing, but the difference between someone that did a couple in their residency vs. learning to do it well in good volume makes a difference, especially if you are going into the community. Compared to 30 years ago, every program is going to hurt for open aortas, but compared to each other, there are obviously centers that are still doing a fair number, while others have to fudge things to get their residents their ACGME required numbers. Not everyone wants open aortas to be a part of their future practice. Thus, this may be a complete non-issue, or alternatively it could be a big freaking deal.

And then there are the general residency factors, geography being a big one. The number of people looking to go to Springfield, IL is much lower than Chicago, IL. Thus, Northwestern is a heck of a lot more competitive than SIU, despite the fact that they are both solid programs. They just simply offer different things to go along with their different locations. Another major factor is how old the program is. Every new program has growing pains. Don't fall for the, "oh we've been training fellows for years and have GS residents rotating with us all the time, of course we can train IVS residents". It is bull****. Taking a fully trained GS and teaching them vascular or taking on a GS resident for a month is not the same as teaching someone from the ground up (MS4) how to be a doctor. I say this as the first entering class in my residency. I honestly think that we have the best residency in the country. But, it took many years to get there and there were definitely struggles along the way. That isn't to say that newer programs can't be incredibly strong. It just will take a certain type of resident to excel in a constantly shifting and changing environment.

I could go on and on and on about this. Feel free to PM me if you want more specifics, always happy to talk vascular with people 🙂

Thanks a lot Mimelim. This post, just like every other one you post is gold. Any idea if the number of total applicants increased this current cycle or is it about the same as last year? Seeing the trend I'd assume the number has gone up. Unfortunately that would mean the number of applicants per spot is even higher now considering there aren't any new positions this year....

 

[mimelim]

Thanks a lot Mimelim. This post, just like every other one you post is gold. Any idea if the number of total applicants increased this current cycle or is it about the same as last year? Seeing the trend I'd assume the number has gone up. Unfortunately that would mean the number of applicants per spot is even higher now considering their aren't any new positions this year....

For us, this year was about the same number of applicants, scores went up a smidge, but probably just variance.

 

[SpikesnSpookes]

For us, this year was about the same number of applicants, scores went up a smidge, but probably just variance.

What do you not like about your job? Any other fields of medicine you were considering, and why did you choose vascular over them?

 

[doc05]

I recently read that Neurosurgery performs the most profitable procedures by unit time and there is a now a big push in hospital systems to hire more Neurosurgeons to help their bottom line. I imagine that explains part of their compensation.

That is nonsense. And not enough neurosurgeons to hire