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Discussion in 'Surgery and Surgical Subspecialties' started by Reborn24, Dec 2, 2005.
I'm doing this from memory but here it goes:
Colorectal, Critical Care, Trauma, Cardiothoracic, Endocrine, Pediatric, Bariatric, Minimally Invasive (advanced laparascopic), Vascular, Breast, Oncology, Hepatobiliary, Hand, Plastic/Reconstructive, Transplant, Foregut, Thoracic (like CT without the cardiac surgery training).
Other Surgical Subspecialties have their own boards and only require a preliminary year of general surgery:
Neurosurgery, urology, ENT (aka otolaryngology), orthopedic surgery.
One former surgical subspecialty that is its own seperate field:
Some specialties are being shortened by only requiring 3 years of general surgery before entering specialty training : Combined plastics. Some talk of CT surgery going this route (maybe 4+3).
I know that this answer is more then you asked for, but it sounds like you are still early in your training and you should understand all of the options open to you.
so if u wanted to do a subspecialty. do u go apply into residency as a general surgeon or as an orthopoedic surgical residency
A related question, how competitive is breast surgery? Is it as competitive as a formal surg onc fellowship? Since its not technically an accredted fellowship, can you work as an academic breast surgeon directly out of a 5 year residency if you have a good experience during residency?
Breast is one of the least competitive fellowships. It barely even qualifies as surgery. The breast is basically a modified sweat gland. A breast fellowship is essentally just advanced derm training.
That is a good one FACS. I thought twice before writing that, but it is true, especially for gyn-onc. As for how orthopedic residency works, you simultaneously apply for an PGY-2 spot in an orthopedic program and a preliminary spot in general surgery. Sometimes, a program that accepts you for Orthopedics will also give you a designated preliminary spot at the same hospital. I'm not sure how competetive Breast Surgery is. Dr. Kim Cox should know better, I think she is interested in a breast fellowship.
Currently the breast fellowship match is not overly competitive statistically. In the past few years the number of applicants has been slightly below or barely exceeded the number of spots available, although I think this year will be slightly more (the match in next week). From looking at the applicant lists, there is a fair mix of applicants from very small community programs to big name academic centers. Overall however, the pool seems to contain fewer big name applicants than the surg onc pool and fewer that did dedicated research time in residency, based on my impressions from meeting a number of applicants.
I expect over the years that this will change however, as breast continues to define itself as a subspecialty. I am seeing job postings in both academia and the community that are for 100% breast positions seeking breast-fellowship trained surgeons (notice I said breast-fellowship and not surg-onc trained as was typical even 5 years ago). I expect that this trend will accelerate over the upcoming years as more and more breast centers seem to pop up like weeds. Also breast fellowship accreditation is still just under way with many of the programs in the match having still not gotten their first site visit. You can find the current list of training opportunities here.
Great info guys, thanks!
I wonder why its not as competitive... one of the few fields were you get to operate a lot and still have a good lifestyle. I suppose most surgeons hate good working hours though...
Seeing as I just went through the Breast Surgery fellowship match for 2006, I might be a bit more informed about such than others here.
Match results were communicated to the applicants by the Society of Surgical Oncology (which operates the Breast Surgery fellowship match) on December 1, 2005. An official statement on the number of positions filled, and by whom has not yet been made by the SSO. Anecdotally, as this year's group of applicants kept in contact with each other, we believe there to be 5 more applicants than there are positions for next year. But it remains to be seen if everyone we knew interviewing matched, and whether all the spots filled (I matched at UMDNJ-New Brunswick).
Every program I interviewed at agreed that the number of applicants has risen dramatically over the last couple of years and that they expect the increase to continue. Most further agreed that a Breast fellowship will soon become the gold standard or even required training as the public begins to demand such training from its surgeons. "You're getting in on the ground floor" was an oft-uttered phrase by program directors and faculty.
It is true that it is not a difficult match on the order of Peds or Surg onc but if you use the number of applicants per positions offered as evidence, then Trauma and Transplant (just to name two) would be less competitive than Breast.
Hope this helps.
It's always nice when the match results come early for the applicants (Dec 8th was supposed to be the official date that results were to be released). Congratulations on your successful match! I'm sure that you will be very pleased with the program.
It was a bit of a surprise to all of us, as we had not expected the results for another week (although we knew the match was run on 12/1). You can imagine the flurry of emails between the applicants as we all tried to figure out whether or not a joke was being played on us!
I'm looking forward to my year in New Brunswick (after I get over the sticker shock of rents!); its a great facility with great faculty.
Congratulations! I just found out yesterday that i have a colorectal fellowship for next year here in Canada. It's hard to believe that residency is almost over -- seems like yesterday when i was going the the residency match. Now i just have to pass those pesky Royal College exams (you guys in the US are lucky you don't have to go thru that trauma)
Congrats back at ya. I'm Chief of the Colorectal Service here now and admire those of you who want to do this for the rest of your lives!
We have our own trauma - the US Board Certification exams (written and oral).
Congrats to you as well tussy! Oh, and as Kimberli said, I feel equally traumatized by the ABS exams. Luckily for KC and me there are no extra exams for breast or surg onc!
Don't worry - i have to write the American Board of Surgery exams as well. There is no certification exam for Colorectal surgery in Canada, and so we must do the American one. The American Board of Surgery exam is a prerequesite. All of the residents in our program last year wrote the ABS - they said the Canadian exams were much harder.
well that doesn't sound pleasant. You are the winner of the most painful exams required!
if you do the breast fellowship, can u do reconstructions on pts who have had mastectomies? i would hop eso since it would be nice to offer that service to your pt and i don't see why u could't learn in in a year.
I'm sure there is someone out there that has it worse. I'm just procrastinating studying right now. Those Royal College exams - well, they are in May and June and you must pass them before you can start a fellowship or go into practice. Yuck.
um...who said breast wasn't competitive? i think the numbers are somewhere around 35 spots around the country with about 47 applicants this past match season. that means 25% of the applicant pool will be looking for something else to do. while this may not match up against pediatrics, it's not like there are unfilled spots *cough* ct *cough*. congrats to everyone on their new fellowship positions
don't think so, but insurance will pay for the reconstruction on most patients, so be sure to refer to plastics who can perform the TRAM flaps and other sophisticated reconstruction procedures sometimes required.
I have heard that Ob/GYNs are now applying for breast fellowship. What do you guys think about the chances of this becoming a subspecialty of Ob/Gyn?
Unlikely without additional training (there are reconstructive/oncoplastic breast fellowships, usually under the auspices of Plastics programs). The Breast Surgery fellowships accredited by the Society of Surgical Oncology generally only offer 1 month of Plastic Surgery training and 3-4 months of Breast surgery total. Remember these are multi-disciplinary fellowships, so you spend time on Rad Onc, Pathology, Breast radiology, Medical Oncology, as well as a required research project. There just isn't enough time devoted to Oncoplastics in most programs to allow you to become proficient at more than reconstruction with implants. TRAMS, DIEPs and the like would require more training although i agree it would be nice to be able to do these as well.
Many of the SSO programs take applications from Ob-Gyn residents, although General Surgery resident applicants fair outnumber them. Rather than becoming a subspecialty of Ob-Gyn, most I've talked to see Breast Surgery as becoming its own field, distinct from Ob-Gyn or Surg Onc.
yeah...I felt pretty lucky to have matched when I'm fairly sure others didn't this year (still waiting for the official word from the SSO).
what's the point of rotationg through onc and rad onc. yeah, it's nice to have the multidiscilinary approach, but u are not going to be prescribing radiotherapy and chemptherapy, are u? but as a general surgeon, u could be trained to do reconstructions. i really think it'a shame.
Because by truly understanding the allied fields, one's expertise in taking care of patients with Breast disease (both benign and malignant) is optimized. The actual "prescribing" of Radiation and Chemotx would of course be finally up to those field's respective practitioners, but is done in a multidisciplinary fashion, with everyone involved meeting and discussing the patient. The technical aspects of breast surgery are not challenging but the reconstructions, especially those involving free flaps, are and would be beyond the scope of a Breast Surgery fellowship.
IMHO it would take more than 1 year to sufficiently learn those techniques with any proficiency to be able to surplant Plastic Surgeons (who have had at least 2 years of Plastics training, as some with an additional year of Breast training). Many Breast surgeons feel that the area of reconstruction is best left to Plastic Surgeons and their focus should be breast disease and the medical/surgical management of the same.
Therefore, it is not a field for those who dislike office hours and less operating. It is not uncommon to find those interested in the field to have had a prior interest in medicine or non-surgical fields. However, as I mentioned in a post above, there are Breast onco-plastic fellowships which would be available to those who wish to further their training and do some reconstructions.