What do you guys think(Vascular Surgery vs...something else)

[SmokD]

I've always been very gung ho on going into Vascular Surgery. I don't know what it is, but vasculature interests me, always has. And I've always wanted to be a surgeon. Perfect fit, right? Doctors and professors have told me how reimbursements for vascular surgery aren't worth the number of hours you put into it, and how your patients will be the sickest of the sick. None of this really deterred me as I fully expected that and was ok with it....until I came across this study comparing annual hours spent be different specialties.

http://archinte.ama-assn.org/cgi/reprint/171/13/1211

Apologies if you can't access it from there. The title of the study is "Annual Work Hours Across Physician Specialties" if you wanna find it on your own.

Basically in this study Vascular Surgery blows other specialties out of the water in terms of hours worked. They set Family Medicine as "0", the point at which they compare other specialties to.

Top 3
Vascular Surgery +888 hours annually
Critical Care Internal Med +689 hours annually
Neonatal and perinatal medicine +564 hours annually

Bottom 3

Dermatology -346 hours annually
Occupational Medicine -360 hours annually
Pediatric Emergency Medicine -440 hours annually

If you do the math it means a Vascular Surgeon works 2.4 hours more per day than a FM Doc(not knocking family, its just how the study was constructed). I was just wondering what you all thought about this, in your experience is it really this bad? I'm too stubborn to change my mind, but I just want to know what I'm getting into

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[LucidSplash]

Anecdotally, based on my experience with the group associated with my residency program, vascular is frequently our busiest service in terms of cases on a given day. The vascular guys work a TON but it seems to me that in a lot of ways it is self-selecting even within the group. Undoubtedly this is due in part to the fact that they are the only vascular group in town (small-sized city) and they operate at all four of the hospitals around and travel between them sometimes multiple times per day and when on call are covering more than one hospital. Some of the vascular guys are busier than their colleagues and tend to overbook themselves for cases and this appears to be totally by choice.

Unless you intend to apply only to the integrated vascular surgery programs, you should probably not be comparing apples to oranges (vascular surgery vs critical care internal med vs neonatal and prenatal med vs derm and fm, etc). If you want to be a surgeon, you want to be a surgeon and you're better off comparing the time commitment among surgical specialties and sub-specialties. Honestly +2.4 hours/day seems like a lowball number based on my individual experience. Surgeons in most specialties and sub-specialties (not just vascular) tend to work longer hours than many other non-surgical fields.

 

[Dr.LeoSpaceman]

Our vascular group actually has it pretty good. They cover something like 8 hospitals, but there are 14 of them in the group. They end up taking like 1 weeknight per month and 1 weekend call every 3 months (understanding that they will get hammered by covering so many hospitals), and are on backup call maybe 1-2 more weekends in that time.

Overall the vascular services are busy, but it generally seems like they have less "emergency" calls than you would as a general surgeon. Yes, you will get your share of cold legs and ruptured AAAs, but that happens less frequently than appendicitis or cholecystitis. If you are in an academic center with residents to cover, many of the overnight vascular consults can be seen by the residents and wait for an intervention the next morning (whether it be angio or the OR).

 

[ESU_MD]

Another thing is that vascular surgeons have a strong propensity for making simple procedures much more complex and time consuming than they need to be. We've all seen the 2+ hour carotids, all day fempops, mystical voodoo prepping rituals, etc.. No wonder they are in house so much longer!

I think its gonna get worse since modern pure vascular fellows are getting less training in big open cases. An open AAA is becoming a double attending case!

 

[45408]

all day fempops

It's the all night fem-pops that turn into a fem-clot that really kill me.

SmokD - have you done a rotation on vascular? You shouldn't be making an entire career decision based on something that just discusses hours. You may find out that vascular isn't what you thought it was once you try it, or you'll see that you really like it.

 

[braluk]

I'm kind of PO'ed as I had written out a nice lengthy reply just to have my browser say I wasn't logged in and then having my post deleted.

Anyhow to the OP, I'm on vascular and yes the hours can really get up there. You'll have smooth days where the attending is out between 6-7 or really get slammed and be there the entire night, just to take them back to the OR again in an hour or two. This has happened several times for me on my call nights. Vascular is interesting in that you do plenty of endo work, some open work, and you see the wide gamut of disease. Vasculopaths just generally have coexisting complex disease like uncontrolled DM, CAD, CVA, and diffuse disease so cases can run very long with potential for revisit into the OR and long post-op stay. We do not get called into the ER for emergent cases as often as gen surg does, but when its a late night consult one can expect it to be complicated (either that or nonhealing foot ulcers). We tend to be the last ones in the OR. Clinic days are pretty intense, typically between 80-90 starting at 830 and often running until 7pm. To me, it seems like the Vascular surgeons are a self-selected crowd that thrive in the hours they pull- the three guys I work with at the VA seem to be pretty happy. I'd recommend you rotate at least 2-3 months of vascular in different settings (community, private, academic) if you have the time to feel it out and see if you would thrive in the lifestyle- this is especially true if you are really aiming for the integrated programs, since you will not be general boarded, be ineligible to do anything but vascular without starting all over so this is a decision that will affect the rest of your career. If I had to describe the lifestyle, I would say it is very fast paced, and can often change multiple directions during the day with emergent add ons, or whatever else can go wrong. The OR schedule can often get overbooked, so all it takes is one late case to go and the rest will just spiral delay after delay. Good luck with your choice.

 

[SmokD]

I haven't even done a surgery rotation yet. Just started 3rd year and I'm on IM right now, surgery next. I'm definately gonna do a few Vascular rotations as well as others if I can. I know I can't make a career decision just yet, but I'm not very fickle and get very excited about surgery 😀

An integrated program would be ideal, and I'd probably be somewhat competitive for it(242 on step 1) if I weren't a DO student. I would probably test to waters in the integrated world to see if I had a shot, but I would be perfectly happy in a mid-upper tier program and do a fellowship. I wanna stay practical on this.

 

[dilated]

That is the weirdest study ever. Med oncs and pulmonologists working far longer hours than orthopods or neurosurgeons? Riiiight.

 

[skiz knot]

That is the weirdest study ever. Med oncs and pulmonologists working far longer hours than orthopods or neurosurgeons? Riiiight.

Many community orthopods have pretty cush lifestyles. If you don't take (much) trauma call, your day is pretty predictable.

 

[ESU_MD]

I think the med onc guys work alot because they become primary care docs to all their patients. Like the renal docs.

 

[Radonkulous]

Think about IR. You can do endo stuff or oncology. There is so much variety that you can pick whatever you want.

 

[Smurfette]

Think about IR. You can do endo stuff or oncology. There is so much variety that you can pick whatever you want.

😕 Not sure what you mean by oncology. Radiation oncology and IR are different fields, with rad onc being a stand alone residency program and NOT a rads fellowship.

Within IR, you get a variety of things, but generally do not *only* do endovascular or *only* neuro stuff. Usually there is an IR guy (or two, if a big dept.) who is the 'neuro guy' or whatever specialist, but he does other stuff too. At some big institutions, they may superspecialize, but in most places, you get a little of everything....perc drains, permacaths, PTCs, fistulograms, IVC filters, etc., depending on referral patterns, of course.

 

[SocialistMD]

The other thing is that they were self-reported hours. Having conducted these surveys myself, I can tell you there are certain specialties that embellish the amount of time they spend at work. I wouldn't put any stock in this study. That, and I don't see why working a 10 hour day as opposed to an 8 hour day makes a difference when you are doing something you enjoy...

 

[Radonkulous]

😕 Not sure what you mean by oncology. Radiation oncology and IR are different fields, with rad onc being a stand alone residency program and NOT a rads fellowship.

Within IR, you get a variety of things, but generally do not *only* do endovascular or *only* neuro stuff. Usually there is an IR guy (or two, if a big dept.) who is the 'neuro guy' or whatever specialist, but he does other stuff too. At some big institutions, they may superspecialize, but in most places, you get a little of everything....perc drains, permacaths, PTCs, fistulograms, IVC filters, etc., depending on referral patterns, of course.

I'm talking about interventional oncology procedures. Check out SIR for the type of procedures. You can tailor your practice whatever way you want. For example, BCVI down in Miami is a heavy PVD program. I'm saying if he gets burned out in vascular, there are other options in IR he can pursue.

 

[OtoHNS]

To the OP- if you're really interested in "vasculature," another option would be a microvascular/free flap surgeon. You could do ENT residency --> Head and Neck/microvascular fellowship. This would limit you to reconstructing head and neck defects (though the flaps can be harvested from all over the body). Alternatively you could do plastic surgery +/- a microvascular fellowship and be able to use free flaps to reconstruct any defect in the body. Ortho is another potential route to doing this kind of surgery, we had a ortho hand surgeon at my residency institution who did his own free flaps.

 

[toxic-megacolon]

Another thing is that vascular surgeons have a strong propensity for making simple procedures much more complex and time consuming than they need to be.

I've seen this at so many institutions!

 

[SmokD]

Think about IR. You can do endo stuff or oncology. There is so much variety that you can pick whatever you want.

I hate looking at films and I don't think I can stand doing that for 4 years

To the OP- if you're really interested in "vasculature," another option would be a microvascular/free flap surgeon. You could do ENT residency --> Head and Neck/microvascular fellowship. This would limit you to reconstructing head and neck defects (though the flaps can be harvested from all over the body). Alternatively you could do plastic surgery +/- a microvascular fellowship and be able to use free flaps to reconstruct any defect in the body. Ortho is another potential route to doing this kind of surgery, we had a ortho hand surgeon at my residency institution who did his own free flaps.

Interesting, I'll have to look into that. With ENT I just wastn't sure if I'd like it, but I'll look into it.

 

[LucidSplash]

I hate looking at films and I don't think I can stand doing that for 4 years

As long as you realize that surgeons learn to read their own films so you'll spend a lot of time looking at them in surgery. Not as much as in rads, but still...

 

[SocialistMD]

As long as you realize that surgeons learn to read their own films so you'll spend a lot of time looking at them in surgery. Not as much as in rads, but still...

Especially in vascular, where you will be shooting your own angiograms and interpreting them intraoperatively. Add to that the fact that, at many institutions, it is the vascular surgery service that runs the vascular lab (that performs the lower extremity ultrasounds for "r/o DVT") with vascular attendings interpreting those studies, and you'll understand why many vascular surgeons have joint appointments with the department of radiology.

 

[SmokD]

I think I can deal with that, just the thought of looking at films all day every day makes me vomit.

 

[ESU_MD]

How often in the PACS era does a surgeon really go and discuss a case with the radiologist?

I dont remember the last time I went! Still get calls time to time with mandantory notifications of critical findings (dissection, etc) but usually have already made the dx myself.

I DO remember countless hours begging those people for hard copy films to do my intern duties though.....Imagine being constantly interrupted while trying to concentrate on your job by some intern.

 

[LucidSplash]

How often in the PACS era does a surgeon really go and discuss a case with the radiologist?

I dont remember the last time I went! Still get calls time to time with mandantory notifications of critical findings (dissection, etc) but usually have already made the dx myself.

I DO remember countless hours begging those people for hard copy films to do my intern duties though.....Imagine being constantly interrupted while trying to concentrate on your job by some intern.

We definitely usually make the dx ourselves; however, I'm constantly being encouraged (told) to go down to rads and discuss imaging with the bat/possum if there's a question not answered by the official read or we're not sold on the read, etc. We've done it as a team before too during rounds. Its not every day but I've definitely done it at least 10 times in the past year. Unfortunately its not an option at night as we have off-site nighthawks reading our films then.

And luckily, its a separate group of people in a separate location that deals with getting copies of films or getting outside films uploaded to PACS. I'm pretty sure it wouldn't get done if it was all the same peeps!

 

[45408]

Our radiologists are right down the hall during the day. We probably go talk to them at least once a week. It's pretty useful.

 

[Dr.LeoSpaceman]

Our radiologists are right down the hall during the day. We probably go talk to them at least once a week. It's pretty useful.

I've also gone to the reading room a number of times, but more frequently just call them to talk about the scan. Obviously with PACs you don't have to be in the same room to be looking at the scan, so it's just as easy to do it over the phone. I find that they are actually very happy to talk about it with you since they can actually get a clinical context/history that allows them to generate a better read.