vascular surgery vs.

[yinxzon]

---

Members don't see this ad.

Hi guys,
I am MS3 interested in vascular surgery. I think there are various new opportunities for innovation in the field. I know it is a competitive integrated path, though I am not sure if it is compared to say ortho, ENT or neurosurgery. It doesn't appear so from
http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf
http://www.nrmp.org/wp-content/uploads/2015/05/Main-Match-Results-and-Data-2015_final.pdf
The above makes me think I have a shot at a good program even though there are only 50+ spots.
The only other thing is I am wondering why there aren't more applicants to this field like ortho or neurosurgery? JAMA actually shows crazy hours, even compared to neurosurgery. I have done the vascular rotation as a student and likely I am not seeing the full extent of their hours...so can someone enlighten me whether what I have said is accurate?
I was always under the impression that neurosurg worked the most. It seems like neurosurgery is more competitive and makes more money per hour. Is this true? Why aren't more people interested?

 

[VisionaryTics]

Why aren't more people interested?

For both neurosurgery and vascular:

Horrible hours, ****show patients, bad outcomes, long/grueling residencies.

 

[SciencePlus]

I think I remember seeing the above graph before, and IIRC, the N was super low for most specialty responses (neurosurg N=25 ?). The high relative hours stated by nephrology, med onc, NICU, are not consistent with physicians where I trained. It is also shocking seeing the large difference between hospitalists and CCM hospitalists, considering contemporary contract offers stipulate similar hours (per discussions with residents/attendings).

Keep in mind that data on hours worked come from self-reporting, so take these studies with a grain of salt.

But yes, I agree with VisionaryTics that vascular and NS appear to have long, long hours. At my university, emergent cases come in all the time with operations potentially lasting 12 hours. Staff don't have post-call day restrictions.

 

[yinxzon]

Broad Category and Specialty Frequency Mean Wage, dollars Mean Hours
1. Neurological Surgery 22 132.33** 58.0
2. Radiation Oncology 42 126.32*** 52.9***
6. Thoracic Surgery 20 110.45** 64.9
7. Orthopedic Surgery 167 107.93*** 60.6
8. Ophthalmology 180 103.63** 51.7***
9. Dermatology 97 102.68* 44.9***
17. Emergency Medicine 391 87.47 47.4***
23. Vascular Surgery 33 80.47 68.0**

http://archinte.jamanetwork.com/article.aspx?articleid=226114

 

[tiedyeddog]

For both neurosurgery and vascular:

Horrible hours, ****show patients, bad outcomes, long/grueling residencies.

At least in neurosurgery there is the ability to do simple spine where the outcomes are better and the patients aren't as big of trainwrecks. Plus there is the layman's mystique of brain surgery. I got the feeling talking to the vascular fellows at my institution that jobs post-fellowship can be somewhat limited which is absolutely not the case with neurosurgery.

 

[Sirach38]

At least in neurosurgery there is the ability to do simple spine where the outcomes are better and the patients aren't as big of trainwrecks. Plus there is the layman's mystique of brain surgery. I got the feeling talking to the vascular fellows at my institution that jobs post-fellowship can be somewhat limited which is absolutely not the case with neurosurgery.

From my limited experience, this is not totally correct. Vascular surgery offers incredibly diverse options after finishing training. You can work 100+ hrs /week or work 40 hrs/week doing vein work/dialysis access.

 

[Sirach38]

Hi guys,
I am MS3 interested in vascular surgery. I think there are various new opportunities for innovation in the field. I know it is a competitive integrated path, though I am not sure if it is compared to say ortho, ENT or neurosurgery. It doesn't appear so from
http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf
http://www.nrmp.org/wp-content/uploads/2015/05/Main-Match-Results-and-Data-2015_final.pdf
The above makes me think I have a shot at a good program even though there are only 50+ spots.
The only other thing is I am wondering why there aren't more applicants to this field like ortho or neurosurgery? JAMA actually shows crazy hours, even compared to neurosurgery. I have done the vascular rotation as a student and likely I am not seeing the full extent of their hours...so can someone enlighten me whether what I have said is accurate?
I was always under the impression that neurosurg worked the most. It seems like neurosurgery is more competitive and makes more money per hour. Is this true? Why aren't more people interested?

Three things.

One, I would caution you that using the 2014 charting outcomes to gauge vascular surgery competitiveness is not exactly accurate for the most recent years. If you notice, during 2014 there were only 37 US applicants who applied to vascular surgery for 68 spots. Things have changed significantly since then. Last year there were 58 US applicants and I have been told that this year there were even more. 2014 was a less competitive year for vascular surgery. That being said, I still agree that vascular is not quite as competitive as ortho, ENT, or NSG. However, it is very close. Definitely more competitive than GS. I am on the interview trail this year applying to both VS and GS and the VS applicants that I have met at all of my VS interviews are on par with the GS applicants that I have met at only the top GS programs where I have interviewed and much more competitive than the applicants at some of the mid-low tier GS programs.

Two, residency is hard in any surgical sub-specialty but life after residency is what you make it. I know this gets said a lot over and over in "lifestyle" threads and we tend to shrug it off as med students but it really is the reality. I know vascular surgeons who regularly work over 100 hrs and I know others who work 40 hrs/week doing veins. Vein work can lend itself to a very friendly schedule. That being said, most of us that go into vascular do so for the big arterial cases which tend to have worse schedules (which most us don't mind). I have never heard of an applicant going into VS because they are passionate about venous work. However, I would caution that when thinking about vascular lifestyle, things are just not what they used to be. In the old days most of vascular surgery was open surgery (very sick patients, long surgeries, long ICU stays, etc.). Now, much of vascular surgery is endovascular, leading to a friendlier lifestyle with patients that often go home 1-2 days after an EVAR. Lifestyle in vascular is in general getting better but is still extremely dependent on your practice setting and interests.

Three, last year there were over 100 applicants to VS and I am told by some uncomfirmed sources that this year there are over 150. My point is, the word is getting out. The reason that there aren't more US applicants is that integrated vascular surgery is a relatively new training model compared to NSG or any of the other surgical sub-specialties. Not enough people know about IVS early on in med school and unless you come from a school with a strong vascular department, you may not be exposed at all to vascular surgery during med school. I anticipate that this will change as the 0+5 tract becomes more established.

 

[mimelim]

Hi guys,
I am MS3 interested in vascular surgery. I think there are various new opportunities for innovation in the field. I know it is a competitive integrated path, though I am not sure if it is compared to say ortho, ENT or neurosurgery. It doesn't appear so from
http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf
http://www.nrmp.org/wp-content/uploads/2015/05/Main-Match-Results-and-Data-2015_final.pdf
The above makes me think I have a shot at a good program even though there are only 50+ spots.
The only other thing is I am wondering why there aren't more applicants to this field like ortho or neurosurgery? JAMA actually shows crazy hours, even compared to neurosurgery. I have done the vascular rotation as a student and likely I am not seeing the full extent of their hours...so can someone enlighten me whether what I have said is accurate?
I was always under the impression that neurosurg worked the most. It seems like neurosurgery is more competitive and makes more money per hour. Is this true? Why aren't more people interested?

Broad Category and Specialty Frequency Mean Wage, dollars Mean Hours
1. Neurological Surgery 22 132.33** 58.0
2. Radiation Oncology 42 126.32*** 52.9***
6. Thoracic Surgery 20 110.45** 64.9
7. Orthopedic Surgery 167 107.93*** 60.6
8. Ophthalmology 180 103.63** 51.7***
9. Dermatology 97 102.68* 44.9***
17. Emergency Medicine 391 87.47 47.4***
23. Vascular Surgery 33 80.47 68.0**

http://archinte.jamanetwork.com/article.aspx?articleid=226114

Hi there,
Care to offer some advice?

http://forums.studentdoctor.net/threads/vascular-surgery-vs.1170880/#post-17144438


I was asking about lifestyle vs the field itself.
Not totally sure on vascular yet (maybe 70%) and I don't think I'll get more than the shadowing experience for others (NSG/CT) until MS4, by which time it'd be too late to change schedules. Those all have emergency surgeries, which I like a lot even though it hurts the "lifestyle". There seems to be pros/cons with either. I thought CT would be cool, will talk to others about a “dying field". Not sure if it is a myth. Obviously cant do more than one of them. Any advice is appreciated!

Please see if any of the following is incorrect?

NSG
+variety of disease
+/- best pay/hour and total
-longest residency

CT
+variety of disease, multiple organs
-slightly longer residency
-dying field? job market?

Vasc
+shorter residency 5 y. slightly easier to match
+better fit with my phd research interest
-worst pay/hour and longest hours
-less variety

Thanks again!

#1 Compensation - I caution you about most of the studies out there, including the JAMA articles. A lot of it is data from the early 2000s (10+ years ago) and vascular surgery reimbursment has changed tremendously since then with continued endovacular revolution. Compensation on average is going to be lower than NSGY, but there are huge ranges in both, especially in vascular. How much you make, especially outside of academics is more about setting up/building a practice than it is about the sub-specialty. You should not decide between these specialties based on this. They are far more similar than they are different on this front.

#2 Hours - We work long hours. On average, vascular has nearly always been near the top. That having been said, there is tremendous variation. Our academic faculty are well over those averages. Our community guys are well under that. Some private guys that I know work ~40-45 / week. It all depends on what you want to do, where you want to do it and how much you want to make. The same can be said about NSGY or CT. You should not decide between these specialties based on this. They are far more similar than they are different on this front.

#3 Competitiveness - Integrated Vascular is new. As in the programs only started in 2007. The interest level rises every year and we considered well over 100 applications for 2 spots. Every program has 1-2 spots. While competitive applicants are going to be sought after by every program, the vast majority of MS4s do not have 10+ peer reviewed publications and balling out of control LOR. The interview trail typically has a core group that will end up matching at the majority of the program, but matching at an individual program or even an individual city can be a tall order.

#4 Variety - Vascular has as much or more variety than NSGY or CT. It is a little bit of a silly discussion, but the vast majority of vascular guys do a little bit of everything and then focus on what they like. That means operating from the carotids down to the toes. I mean between yesterday and today, we will operate on the carotids, thoracic aorta, mesenteric vessels, upper extremity vessels, abdominal aorta, lower extremity arteries (no vein cases until after Thanksgiving). Between open and endo, there are more than enough different things going on.

#5 Training length - For all practical purposes they are all the same, minor variations based on research years and whatnot.

#6 CT is a dying field - Will always need to be around, but in limited numbers.

 

[dienekes88]

#6 CT is a dying field - Will always need to be around, but in limited numbers.

People have been saying this for 30 years. I'm not worried. With the rising cost of repeated interventions and space-age devices, even the CABG is making a comeback.

Never bet against technology; the next generation of cardiac surgeons has to keep up with transcatheter devices and miniaturized assist pumps.

 

[Rifampicin]

People have been saying this for 30 years. I'm not worried. With the rising cost of repeated interventions and space-age devices, even the CABG is making a comeback.

Never bet against technology; the next generation of cardiac surgeons has to keep up with transcatheter devices and miniaturized assist pumps.

Don't forget about total artificial heart transplant. Alain Carpentier's CARMAT in particular looks very promising. Imagine doing cool transplants without worrying about organ logistics...
http://www.businesswire.com/news/ho...latory-Approval-Finalize-Clinical-Feasibility

I think CT surgeons should be in a very comfortable position for the future... so long as they learn the newest non-PCI catheter-based procedures.
http://www.eacts.org/annual-meeting/video29am/acquired-cardiac/

To the OP:
I know you've set on vascular surgery, but I think you should also consider CT and (cerebrovascular) neurosurgery. Granted both are much smaller fields than vascular surgery (especially cerebrovascular/neurointerventional neurosurgery) but, just like vascular, they operate on blood vessels and they have lots of innovations coming in the future too. Of course lifestyle is going to be @!&? since those two mainly deal with ARTERIES (lots of emergencies, unpredictable hours, etc.), haha

 

[CyberMaxx]

#2 Hours - We work long hours. On average, vascular has nearly always been near the top. That having been said, there is tremendous variation. Our academic faculty are well over those averages. Our community guys are well under that. Some private guys that I know work ~40-45 / week. It all depends on what you want to do, where you want to do it and how much you want to make. The same can be said about NSGY or CT. You should not decide between these specialties based on this. They are far more similar than they are different on this front.

Could you share some insight on why exactly this is? What about vascular makes the hours longer than other specialties with similarly sick patients such as CT?

 

[Merely]

This is a really interesting field, I thought it was just as competitive as ENT or ortho

 

[dienekes88]

Don't forget about total artificial heart transplant. Alain Carpentier's CARMAT in particular looks very promising. Imagine doing cool transplants without worrying about organ logistics...
http://www.businesswire.com/news/ho...latory-Approval-Finalize-Clinical-Feasibility

I think CT surgeons should be in a very comfortable position for the future... so long as they learn the newest non-PCI catheter-based procedures.
http://www.eacts.org/annual-meeting/video29am/acquired-cardiac/

To the OP:
I know you've set on vascular surgery, but I think you should also consider CT and (cerebrovascular) neurosurgery. Granted both are much smaller fields than vascular surgery (especially cerebrovascular/neurointerventional neurosurgery) but, just like vascular, they operate on blood vessels and they have lots of innovations coming in the future too. Of course lifestyle is going to be @!&? since those two mainly deal with ARTERIES (lots of emergencies, unpredictable hours, etc.), haha

Honestly, I'm not a huge fan of the TAH. Maybe it's related to experience and familiarity, but I'd much rather do a BiVAD. As for transplant vs. TAH, I like sewing in the real thing. There's something magical about taking the clamp off and having the donor heart start.

Could you share some insight on why exactly this is? What about vascular makes the hours longer than other specialties with similarly sick patients such as CT?

Highly practice dependent.

 

[DoctwoB]

Could you share some insight on why exactly this is? What about vascular makes the hours longer than other specialties with similarly sick patients such as CT?

Because when something loses arterial flow (arms, legs, feet, gut, etc.) it needs to be fixed Urgently. Likewise if you get called into the OR for a vascular injury that can't usually wait. Finally, by definition all vascular cases are high risk with regards to peri operative cardiac events, strokes, bleeding, etc. which means dealing with sick people in the middle of the night. So while you can have good hours as a vascular surgeon doing lower risk cases (dialysis access, elective vein cases, etc), the field isn't as well set up for it as say ENT or Urology.

 

[yinxzon]

Found this line on a residency website:
By the fourth year, the focus shifts toward vascular surgery training with residents completing six months in advanced surgery rotations, including trauma and cardiothoracic surgery. The remaining six months and all of the fifth year is dedicated to vascular surgery.

I guess I am wondering how much participation eventually there is in trauma and cardiothoracic surgery for vascular surgeons.
I was under the impression that their breadth is larger considering there are more organs/real estate involved, hence I thought more variety of cases (lung/mediastinum/valvolpathy/thoracic aneurysms). That seems to be an attractive aspect. I am not sure if it is in reality. Vascular is mainly occlusive diseases even though the territories that it covers is large. However, revascularization/atherosclerosis is my main interest anyway.

On the other hand, in neuro it seems like people do those 1-2 yr fellowships to specialize. Perhaps in the end, their possible breadth is narrowed by specialization, I am not too sure. I asked a friend of mine and she said that people do specialize but are able to do what general neurosurgery allows them to do anyway.

I understand that they are similar in many ways. Please identify if there is something I am neglecting. I'm trying to gather information and appreciate the differences between the fields. Vascular is very interesting to me. For example, 5 in vascular compared to possible 8 yrs in neurosurgery. By the way, is it popular to pursue other fellowships after 5+0, ie. critical care?

 

[mimelim]

Found this line on a residency website:
By the fourth year, the focus shifts toward vascular surgery training with residents completing six months in advanced surgery rotations, including trauma and cardiothoracic surgery. The remaining six months and all of the fifth year is dedicated to vascular surgery.

I guess I am wondering how much participation eventually there is in trauma and cardiothoracic surgery for vascular surgeons.
I was under the impression that their breadth is larger considering there are more organs/real estate involved, hence I thought more variety of cases (lung/mediastinum/valvolpathy/thoracic aneurysms). That seems to be an attractive aspect. I am not sure if it is in reality. Vascular is mainly occlusive diseases even though the territories that it covers is large. However, revascularization/atherosclerosis is my main interest anyway.

On the other hand, in neuro it seems like people do those 1-2 yr fellowships to specialize. Perhaps in the end, their possible breadth is narrowed by specialization, I am not too sure. I asked a friend of mine and she said that people do specialize but are able to do what general neurosurgery allows them to do anyway.

I understand that they are similar in many ways. Please identify if there is something I am neglecting. I'm trying to gather information and appreciate the differences between the fields. Vascular is very interesting to me. For example, 5 in vascular compared to possible 8 yrs in neurosurgery. By the way, is it popular to pursue other fellowships after 5+0, ie. critical care?

You mean you found it on the CCF website 😉. Every program is slightly different. We value our trauma/CT chief rotations. But, none of us will be trained for those to be a part of our practice and none of us are really looking for it either. If we did, we would join the available pathways at our institution.

#1 Re: Trauma - depends where you are. The vast majority of vascular surgeons do not want trauma as a part of their practice. It increases the number of urgent overnight cases and consults in a field that already has more than just about anyone. While it is nice to sew on good protoplasm for a change, it is also a very different patient population. While I enjoy the action of trauma, you will be hard pressed to find a less compliant population. They are simply a population that I prefer not to work with.

#2 Re: Breadth of cases - next week we have scheduled 3 EVAR (one fEVAR), one open AAA, 6 LE angio +/- interventions, 34 access cases, 3 vein cases, 1 AVM excision/embolization, 2 carotid enarterectomies. Plus whatever comes in off the street of course. It is normal for a community vascular surgeon (which you sound like you are more inclined toward) to have a very 'general' practice. They may focus on something, but they do pretty much everything under the umbrella "vascular surgery".

#3 I don't know of anyone who has actually done CC after or during 0+5. We had a resident that was planning on it, but changed their mind. Most surgeons aren't looking for ICU call as a part of their practice, but the avenues exist for those that do.

The only way for you to really figure this out is to actually shadow/rotate on each service and see what you like/don't like. My closest friend from medical school is in NSGY. While I was transiently interested in it as an MS1, I am very very thankful that I didn't go into it.

 

[yinxzon]

Thanks! I may have misrepresented myself but I don't want to be a community VS. But thanks for the information! It was helpful.

 

[Fab5Hill33]

Vascular Surgery is getting squeezed by Interventional Cardiology and Interventional Radiology.

1) There is an oversupply of Cardiologists, and with declining reimbursements for their bread and butter, they're expanding into vascular work - especially PAD and EVAR.
2) The number of IR graduates has more than doubled over the past 5 years. There's now something like 230 fellows graduating every year whereas there used to be 80.
2b) IR has been granted it's own primary certificate by the ABMS. So IR fellowships are getting phased out nationwide and being replaced by residencies. Consequently if you're a med student and interested in vascular work, in just a few years, you'll have the option of doing a straight IR residency and not having to go through general surgery.
3) Lastly, as a Cardiologist, you've got a hand in heart and vasculature, and as an IR, you've got a hand in vasculature and other more cutting edge things like interventional oncology. So as a VS, you're stuck in the middle. You can do vasculature and... thats it.

The only other thing is I am wondering why there aren't more applicants to this field like ortho or neurosurgery?

 

[ThoracicGuy]

Vascular Surgery is getting squeezed by Interventional Cardiology and Interventional Radiology.

1) There is an oversupply of Cardiologists, and with declining reimbursements for their bread and butter, they're expanding into vascular work - especially PAD and EVAR.
2) The number of IR graduates has more than doubled over the past 5 years. There's now something like 230 fellows graduating every year whereas there used to be 80.
2b) IR has been granted it's own primary certificate by the ABMS. So IR fellowships are getting phased out nationwide and being replaced by residencies. Consequently if you're a med student and interested in vascular work, in just a few years, you'll have the option of doing a straight IR residency and not having to go through general surgery.
3) Lastly, as a Cardiologist, you've got a hand in heart and vasculature, and as an IR, you've got a hand in vasculature and other more cutting edge things like interventional oncology. So as a VS, you're stuck in the middle. You can do vasculature and... thats it.

And cardiologists should not be doing peripheral work. I can't tell you how many times I've seen vascular clean up their messes down the road instead of them getting the definitive procedure the first time.

 

[DoctwoB]

So on the one hand you could go to a one stop shop for your pvd with a surgeon who can do your angioplasty, stent, bypass, wound debridements, amputations, or medical management, as well as manage their own complications. Not to mention it's someone who has spent years actually assessing pvd patients, extremity wounds, cold limbs, etc.

On the other hand you could go to a catheter jockey who has minimal experience assessing or managing pvd and only has one trick in his arsenal. Sounds like a tough call . . .

 

[Fab5Hill33]

Or you could go to a really good "catheter jockey" that's spent their entire career learning to pick up subtleties on medical imaging, and who invented the field of endovascular therapy, and get the procedure done right and have a much lower risk of undergoing bypass, wound debridement, amputations, etc.

 

[Sirach38]

Or you could go to a really good "catheter jockey" that's spent their entire career learning to pick up subtleties on medical imaging, and who invented the field of endovascular therapy, and get the procedure done right and have a much lower risk of undergoing bypass, wound debridement, amputations, etc.

Data for this?

 

[ThoracicGuy]

Or you could go to a really good "catheter jockey" that's spent their entire career learning to pick up subtleties on medical imaging, and who invented the field of endovascular therapy, and get the procedure done right and have a much lower risk of undergoing bypass, wound debridement, amputations, etc.

I work with my IR guys directly on these things. They don't do them without the patient seeing me first. I have no problem with that. I do have to clean up cardiologist messes too much and you wouldn't believe how often I hear from a patient that their doctor fixed their leg before it even got to be a problem for them! Of course, I was seeing them for their thrombosed graft and having to do a fem-below knee bypass instead of an above knee bypass because the stent screwed up that option for us. Thanks guys!

 

[dienekes88]

And cardiologists should not be doing peripheral work. I can't tell you how many times I've seen vascular clean up their messes down the road instead of them getting the definitive procedure the first time.

It's slowly becoming a reality, and it's going to be hard to stop the interventional cardiologists from doing the peripheral stuff. I've met a couple cardiologists who prefer peripheral work to coronary stenting.

As things move towards endovascular routes, you'll see people who traditionally treated that process try to gain endovascular experience (vertical integration), and you'll see all of the endovascular experts try to broaden their scope (horizontal integration). I have no doubt there are vascular surgeons involved in TAVR programs.

 

[ACSurgeon]

I think peripheral endovascular therapy has really opened up an interesting new can of worms.

Basically because the bar has been lowered so much in favor of intervention (i.e. it's relatively easy to do and relatively low risk in the short term), we are seeing younger and younger patients with less and less disability being offered intervention. Or even the apocryphal stories like "they stented it before it became a problem!"

But we know historically that the overwhelming majority of claudicants don't progress to ischemia and tissue loss. They stay relatively stable for a long time.

We are changing the natural course of the disease process by intervening earlier on less severe lesions.

Even the best of endovascular interventions has a limited shelf life. And when these go down, it's bad news for the patient. It's (in principle) the equivalent of a coronary in-stent thrombosis - because unlike a bypass the patient can't rely on their limited but intact native circulation when the stent goes down.

We won't fully realize the downstream effects of this for a while, but as referenced above the vascular surgeons are already starting to deal with late complications in this patient group.

This. Also, with aggressive stunting of below knee disease, we are blocking off collateral circulation. So in line flow is ok, but they're not developing collaterals. So, when they're endovascular options run out, they have limited options.

 

[ComfortCreature]

Vascular Surgery is getting squeezed by Interventional Cardiology and Interventional Radiology.

1) There is an oversupply of Cardiologists, and with declining reimbursements for their bread and butter, they're expanding into vascular work - especially PAD and EVAR.
2) The number of IR graduates has more than doubled over the past 5 years. There's now something like 230 fellows graduating every year whereas there used to be 80.
2b) IR has been granted it's own primary certificate by the ABMS. So IR fellowships are getting phased out nationwide and being replaced by residencies. Consequently if you're a med student and interested in vascular work, in just a few years, you'll have the option of doing a straight IR residency and not having to go through general surgery.
3) Lastly, as a Cardiologist, you've got a hand in heart and vasculature, and as an IR, you've got a hand in vasculature and other more cutting edge things like interventional oncology. So as a VS, you're stuck in the middle. You can do vasculature and... thats it.

According to an IR fellow at my university, they're doing less peripheral vascular work and moving into things like TIPS because the interventional cardiologists and vascular surgeons took over. That may be just here in the southwest, though.

 

[Fab5Hill33]

It does vary hospital to hospital (moreso than region of the country). But the fact remains that the vascular pie is split three ways.

According to an IR fellow at my university, they're doing less peripheral vascular work and moving into things like TIPS because the interventional cardiologists and vascular surgeons took over. That may be just here in the southwest, though.

 

[ACSurgeon]

It does vary hospital to hospital (moreso than region of the country). But the fact remains that the vascular pie is split three ways.

I don't think that matters. I have yet to meet a vascular surgeon who isn't plenty busy

 

[Fab5Hill33]

You should meet the vascular surgeons at my hospital...

But the main point - and to answer the OP's question - is that there's a reason why vascular surgery isn't more popular among medical students, or at least as popular as Ortho or Neurosurg.

If you enjoy treating vascular disease and vascular disease only, then you can consider vascular surgery as a career. Just be aware that you're 1 of 3 specialities that does it. On the other hand if you want broader practice options, consider Cards or IR.

I don't think that matters. I have yet to meet a vascular surgeon who isn't plenty busy

 

[badasshairday]

We (IR) do all the carotid stents at our joint. Most of the time it is while we are going up to do acute stroke intervention and have severe carotid disease blocking our path. Angioplasty on the way up ASAP to get to the stroke lesion, do thrombectomy, then stent the cervical ICA on the way out.

Vascular surgery does all the EVAR, but if we (IR) had someone doing EVAR, it wouldn't be hard to get at least a few cases a month because we do all the screening ultrasound for AAA. Not to mention all the incidental AAA we see reading abd/pelvis CT for belly pain and renal stones. We could in theory nip all those and a surgeon would never even hear about it.

Carotid and peripheral arterial ultrasound is read by vascular while rads reads the AVF an AVG ultrasound. However it is a problem because vascular surgeons are often operating and can take days to turn around carotid studies while we can do it in an hour. Becomes a problem for work up and discharge for routine TIA admits.

In the end of you want pure vascular, open and endo, do Vascular surgery. Also you WILL do PAD endo work as a vascular surgeon based on traditional referral pattern; not true with IR. But don't count IR out of the game because we can drum up PAD business through alternate avenues, plus all the other non arterial work that keeps IR busy.

Cardiology is a black hole. They take anything and do everything they want because they control patient flow big time. They are the wild card and I know of cardiologists doing TEVAR and EVAR. Definitely look into cards if you like PAD endo.

 

[badasshairday]

My question is how many practicing vascular surgeons in the community are only doing vascular? My experience is that they are part of a general and vascular surgery group doing both general surgery and vascular surgery.

 

[Fab5Hill33]

I think that's certainly true at smaller and/or community hospitals. But then it begs the question in choosing between the following:

1) vascular surgery: do vascular surgery and supplement income with general surgery if volumes are not high
2) cardiology: do cardiology and supplement income by treating primary care issues in your office
3) interventional radiology: do interventional radiology and supplement income by reading diagnostic imaging (CT, MRI, US, etc.)

My question is how many practicing vascular surgeons in the community are only doing vascular? My experience is that they are part of a general and vascular surgery group doing both general surgery and vascular surgery.

 

[Winged Scapula]

My question is how many practicing vascular surgeons in the community are only doing vascular? My experience is that they are part of a general and vascular surgery group doing both general surgery and vascular surgery.

<shrug>

Sounds like a bad deal for them.

Our vascular guys only do vascular and the GS guys don't do vascular.

 

[badasshairday]

Wonder how common that is these days with the integrated vascular surgery programs. At least the with IR it is not too common outside of academics to do 100 % IR. 80% IR is not uncommon though. But still do 20% diagnoatics.

 

[mimelim]

Wonder how common that is these days with the integrated vascular surgery programs. At least the with IR it is not too common outside of academics to do 100 % IR. 80% IR is not uncommon though. But still do 20% diagnoatics.

We've had 1 trainee in the last 6 years from our hospital do any general surgery after they did vascular with us. And he is returning to our program as faculty in a couple of months and will no longer do any general surgery.

 

[badasshairday]

We've had 1 trainee in the last 6 years from our hospital do any general surgery after they did vascular with us. And he is returning to our program as faculty in a couple of months and will no longer do any general surgery.

Community or academic?

 

[mimelim]

Community or academic?

Academic.