What’s cooler? Neurosurgery or Interventional Cardiology?

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In regards to coolness, it's tough to beat a bedside EVD in a crashing patient with an IVH or ICP issues.

Yeah it’s cool until you see a PA do it.

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Radiation to the head can be managed with lead caps, which have only really come into advent in the last few years. Also body IR procedures can be a LOT longer and use more radiation

Lead causing ortho issues definitely known issue, but also depends on how you wear the lead. The head of IC at Emory still takes STEMI call and he’s well into his 70s. There’s ways to keep the lead from weighing down on the shoulders, maintaining good posture, exercising, etc

In private practice IC the docs tend to do both procedures and office stuff/echos/nuclear imaging - so being purely procedural not actually how it is mostly practiced

I think your view might be a touch skewed

Yea, I’m in derm and my only exposures to these fields were in MS3/4 and through friends in the fields, so thanks for clarifying, good to know
 
Oh really? I didn’t know there was a groundbreaking new craniotomy procedure being done on patients in the middle of status. How about meningitis? Is there a new craniotomy to take out alllll the bacteria too?
I'm sure a neurosurgeon can give benzos or antibiotics if need be lol.
 
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I like you.

Also, no one has posted this meme yet. Shame on you all:
fEvkmSB2VR6gxLWkWODfdfVhSjfYRlBkNBJq-m-PXkQ.png
I like you too man. Someone has to literally sacrifice their lives and all that is meaningful to them in this world in order to take care of neurosurgical issues. I'm glad it wasn't me :D
 
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I like you too man. Someone has to literally sacrifice their lives and all that is meaningful to them in this world in order to take care of neurosurgical issues. I'm glad it wasn't me :D

Bro it’s not that big a deal lol. Most non academic neurosurgeons have a reasonable life. Pure PP spine guys have ophtho life for double the money. I doubt q2-3 STEMI call is any “easier” than the q4 NSGY call guys at a suburban hospital near me take.
 
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I'm sure a neurosurgeon can give benzos or antibiotics if need be lol.

Alright so what’s the point of medicine docs if surgeons can do everything. This is ridiculous
 
Alright so what’s the point of medicine docs if surgeons can do everything. This is ridiculous

Well, the surgeons don't have time to do everything, they need to do surgeries.
 
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Bro it’s not that big a deal lol. Most non academic neurosurgeons have a reasonable life. Pure PP spine guys have ophtho life for double the money. I doubt q2-3 STEMI call is any “easier” than the q4 NSGY call guys at a suburban hospital near me take.
7 years + fellowship is a long time man.
 
Lol. Yeah, the surgical equivalent of cardiology is interventional cards.

You medicine kiddos are so cute. Equating any medicine specialty and neurosurgery in terms of training difficulty is a joke. Y'all would die. Not figuratively. Literally die.

Sigh. Aside from the dickish tone, let me try to address some of this

1. Of course surgeons work hard and definitely longer hours than medical residents. They also do surgeries, which require incredible dexterity and skill. This doesn’t not negate the difficulty of training in medicine. We take care of incredibly complex and sick patients that many surgeons do not know how to manage - and thus when one of these patients ends up requiring surgery they ask for medical consultation. There is nothing wrong that. We also ask for surgical consultations on patients who have surgical issues. Being an elitist and snob about it is not what I intended nor should it be your viewpoint. A little respect goes a long way.

2. I never claimed that IC and neurosurgery were equivalent. I said that we have medical knowledge that neurosurgery does not. Neurosurgeons do not manage primary neurological disorders like MS or ALS in their clinics. IC docs will often manage medical issues like stable coronary disease, arrhythmias, heart failure, etc to varying degrees inpatient and outpatient because they are part and parcel of doing interventions. Hopefully that clarifies that. They also need to be able to read echos, stress tests, etc; I don’t think neurosurgeons typically read EEGs and sleep studies.

3. The degree to how much scutwork and how early someone comes in during residency is not indicative of how hard a field is. For what it’s worth I routinely came in at 5 am and stayed until 8 pm in the ICU and often on wards as an intern, and as a cardiology fellow first year I took call where I frequently got called in from home to evaluate patients while working full days before and after. So we do have rough days as well.

I don’t want to derail this topic of course but being defensive is really unhelpful and rude on your part
 
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Lol what? Neurosurgery no contest. They're the last line of defense when it comes to bad brain stuff happening. If the IC guy screws up, the CT surgeon needs to be called in.

When CT surgery patients crump they often call the IC guy to cath them and open up a blockage and/or put them on ECMO/stick in an IABP/Impella/Tandem. Goes both ways
 
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Well, the surgeons don't have time to do everything, they need to do surgeries.

Bro it sounds like you’re still in that naive state of education where you don’t understand that practicing medicine and surgery are different skills. Surgery needs medicine and medicine needs surgery at differing times.

Saying stuff like the only reason surgery doesn’t practice “medicine” is because they don’t have time to rather than because they don’t have the knowledge is frankly idiotic. Your basically saying that surgeons learn everything a medicine resident does while also learning surgery. So you think a CT surgeon understands cardiac physiology just like a cardiologist? Lol
 
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Lol, in medicine bragging rights come from insisting how hard you have to work to make money, whereas most humans would brag about how quickly and effortlessly they can make money. Sorry, nobody is in awe over your 100 hour call, but they are in awe over the hedge fund manager who snaps his fingers from his yacht and is $10m richer.

Upshot: Doctors are the stupidest chumps in the world?
 
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So you think a CT surgeon understands cardiac physiology just like a cardiologist? Lol

To this I can attest - definitely not

I don’t expect surgeons to be able to manage ARDS or cardiogenic shock. (Yeah yeah there’s a surgical critical care fellowship... still not all that good at medically managing stuff.). So it’s fine - to each their own
 
Lol, in medicine bragging rights come from insisting how hard you have to work to make money, whereas most humans would brag about how quickly and effortlessly they can make money. Sorry, nobody is in awe over your 100 hour call, but they are in awe over the hedge fund manager who snaps his fingers from his yacht and is $10m richer.

Upshot: Doctors are the stupidest chumps in the world?

Absolutely true although the corollary to that’s is that’s money =\= happiness. I would not be happy as a lawyer or hedge fund manager but I am happy as a doctor
 
Bro it sounds like you’re still in that naive state of education where you don’t understand that practicing medicine and surgery are different skills. Surgery needs medicine and medicine needs surgery at differing times.

Saying stuff like the only reason surgery doesn’t practice “medicine” is because they don’t have time to rather than because they don’t have the knowledge is frankly idiotic. Your basically saying that surgeons learn everything a medicine resident does while also learning surgery. So you think a CT surgeon understands cardiac physiology just like a cardiologist? Lol
I know I'm coming across as a troll, but humor me for a moment. Who is more prepared in these respective situations (to do something possibly meaningful)?

Surgeon with a patient in DKA who can rummage around on uptodate.

Medicine Doc with a patient who has a bleed and needs an ex-lap.

In a vacuum of course.
 
When CT surgery patients crump they often call the IC guy to cath them and open up a blockage and/or put them on ECMO/stick in an IABP/Impella/Tandem. Goes both ways
Crump how? Why would they need someone to cath a guy if they can just do a bypass or something themselves.
 
Crump how? Why would they need someone to cath a guy if they can just do a bypass or something themselves.

Bro lmao. U can’t just be like yea time for a CABG as a surgeon. Medicine docs monitor and treat patients when they are crashing from non trauma or surgical issues. Coronary artery disease is a medical issue that is cometimes treated surgically if the cardiologist deems it necessary. The surgeon only comes into the picture when cardiology requests it. Why? Because surgeons haven’t a clue how to manage the patient’s CV issues other than doing a CABG. Bypass isn’t just a willy nilly procedure a surgeon just does. It has to be indicated after patient has failed medical therapy and is not a candidate for percutaneous intervention. Cardiology decides that and calls CT for the procedure and then takes over right after the procedure.


I know I'm coming across as a troll, but humor me for a moment. Who is more prepared in these respective situations (to do something possibly meaningful)?

Surgeon with a patient in DKA who can rummage around on uptodate.

Medicine Doc with a patient who has a bleed and needs an ex-lap.

In a vacuum of course.

Bro. 1st of all, DKA doesn’t come close to bleed necessitating exlap in terms of acuity. Maybe compare septic shock: tachy, hypotensive, 104F to a trauma necessitating emergent exlap. The surgeon would cry themselves to sleep on seeing that pt just as the medicine physician would do so if they were asked to do an emergent exlap or crani.
 
Crump how? Why would they need someone to cath a guy if they can just do a bypass or something themselves.

Huh?

You do realize that not every lesion can be managed with just bypass right?

Now I’m convinced you are just working off a zero knowledge base
 
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Huh?

You do realize that not every lesion can be managed with just bypass right?

Now I’m convinced you are just working off a zero knowledge base


I'm asking under what conditions a CT surgeon would need to call in someone to do a cath.
 
Bro lmao. U can’t just be like yea time for a CABG as a surgeon. Medicine docs monitor and treat patients when they are crashing from non trauma or surgical issues. Coronary artery disease is a medical issue that is cometimes treated surgically if the cardiologist deems it necessary. The surgeon only comes into the picture when cardiology requests it. Why? Because surgeons haven’t a clue how to manage the patient’s CV issues other than doing a CABG. Bypass isn’t just a willy nilly procedure a surgeon just does. It has to be indicated after patient has failed medical therapy and is not a candidate for percutaneous intervention. Cardiology decides that and calls CT for the procedure and then takes over right after the procedure.




Bro. 1st of all, DKA doesn’t come close to bleed necessitating exlap in terms of acuity. Maybe compare septic shock: tachy, hypotensive, 104F to a trauma necessitating emergent exlap. The surgeon would cry themselves to sleep on seeing that pt just as the medicine physician would do so if they were asked to do an emergent exlap or crani.

A SICU doc wouldn't be able to handle septic shock?
 
I'm asking under what conditions a CT surgeon would need to call in someone to do a cath.

Bro!! That’s not how it works. Cardiology is always the primary team for cardiac patients. They call CTS to do something. CTS does it and then cardiology takes over again. You’re thinking is flawed in that you are thinking CTS is doing anything for the patient but the surgery they are asked to do
 
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Huh?

You do realize that not every lesion can be managed with just bypass right?

Now I’m convinced you are just working off a zero knowledge base

@NYCdude has been watching too much greys anatomy where they depict the surgeon as the ER doc, radiologist, pathologist, transport tech, cardiologist, and CT surgeon all in one
 
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The cool specialty is the one that fits your interests and gets you tap dancing to work everyday.
 
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Bro!! That’s not how it works. Cardiology is always the primary team for cardiac patients. They call CTS to do something. CTS does it and then cardiology takes over again. You’re thinking is flawed in that you are thinking CTS is doing anything for the patient but the surgery they are asked to do
Dude, the guy I quoted is the one who said "CT surgery patients" get IC consulted when they crash. I'm just asking about that situation. I've been in the CCU before, I get that cards is the primary team.
 
A SICU doc wouldn't be able to handle septic shock?

Septic shock should be able to be handled by a SICU doc sure. How well it is handled is a different story.

Cardiogenic shock is almost never well handled. Wrong pressors, no ability to assess cardiac output and perfusion, unable to determine when mechanical support necessary, no ability to manage MCS devices when present. Also
Doubt they would be able to handle someone with bad ARDS or such
 
I'm asking under what conditions a CT surgeon would need to call in someone to do a cath.

Graft goes down and need emergent PCI - this happens more than a little often
IABP needed
Impella needed
Cardiac tamponade

CT surgery does not do PCIs. Not sure why this is hard to imagine
 
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Graft goes down and need emergent PCI - this happens more than a little often
IABP needed
Impella needed
Cardiac tamponade

CT surgery does not do PCIs. Not sure why this is hard to imagine
And if the PCI fails, then they need to get them to the OR for a bypass, right?
 
And if the PCI fails, then they need to get them to the OR for a bypass, right?

Or let them infarct. This still underlies my point that IC and CT have a reciprocal relationship. If anything IC provides referrals and business
 
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I think some here need to realize that it’s a team sport and each speciality has their own strengths, skill sets, and relies on other speacialites. There is not one that can “do it all”.
 
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I think some here need to realize that it’s a team sport and each speciality has their own strengths, skill sets, and relies on other speacialites. There is not one that can “do it all”.

Agreed - that was the point I was making re: IC and CTS
 
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Hmm. Seems like this thread devolved into a measuring contest. Totally forgot to bring my tape measure. Hang on a sec. I’ll be right back. Nobody throw shade until then...
 
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Graft goes down and need emergent PCI - this happens more than a little often
IABP needed
Impella needed
Cardiac tamponade

CT surgery does not do PCIs. Not sure why this is hard to imagine

Let’s not pretend that CT surgery handled the invention of PCI well. They should have owned it, instead they saw the cardiologists sideline them as a specialty for a lot of their previous bread and butter pathology.

There’s no logical reason for why PCI is cardiology instead of CT surgery, it’s just a historical quirk like much of medicine.

This is why neurosurgery requires endovascular training for their residents. They don’t really want to cover that stuff, but it is a way to future proof the specialty and avoid the fate of the CT surgeons in case of breakthrough endovascular/minimally invasive therapies.

Most of the fighting in this thread is silly.
 
Let’s not pretend that CT surgery handled the invention of PCI well. They should have owned it, instead they saw the cardiologists sideline them as a specialty for a lot of their previous bread and butter pathology.

There’s no logical reason for why PCI is cardiology instead of CT surgery, it’s just a historical quirk like much of medicine.

This is why neurosurgery requires endovascular training for their residents. They don’t really want to cover that stuff, but it is a way to future proof the specialty and avoid the fate of the CT surgeons in case of breakthrough endovascular/minimally invasive therapies.

Most of the fighting in this thread is silly.

Likewise, interventional radiology did not exactly do its best protecting its turf against cardiologists who have taken over a lot of cardiac imaging and, of course, the realm of interventional cardiology.
 
Let’s not pretend that CT surgery handled the invention of PCI well. They should have owned it, instead they saw the cardiologists sideline them as a specialty for a lot of their previous bread and butter pathology.

There’s no logical reason for why PCI is cardiology instead of CT surgery, it’s just a historical quirk like much of medicine.

The logical reason why CTS lost out on PCI is clear: because they don’t own the referral network. Secondly, because PCI is not surgery. It’s an intervention that cardiologists can and have learned successfully. When that is the case, cardiology wins because of their vast superiority in understanding cardiac physiology. At the end of the day, the actual mechanical work of PCI isn’t all that complicated as we all know but the perioperative care during cardiac issues has to be done by a cardiologist and no one else. It’s not efficient for the cardiologist to do all that and just have them be seen by another service (CTS) just for a 45 min PCI. That’s why CTS didn’t just lose out on PCI, it never made sense for them to have it anyway. Ultimately this is and will only further happen with peripheral vascular disease, because again if one understands the physiology of vascular disease, endovascular intervention can be learned.

NSGY is a completely different story because neurology disease process is much different than neurosurgical pathology. NSGY has a much much better understanding of nervous system physiology than CTS ever had on CV physiology.
 
Let’s not pretend that CT surgery handled the invention of PCI well. They should have owned it, instead they saw the cardiologists sideline them as a specialty for a lot of their previous bread and butter pathology.

There’s no logical reason for why PCI is cardiology instead of CT surgery, it’s just a historical quirk like much of medicine.

This is why neurosurgery requires endovascular training for their residents. They don’t really want to cover that stuff, but it is a way to future proof the specialty and avoid the fate of the CT surgeons in case of breakthrough endovascular/minimally invasive therapies.

Most of the fighting in this thread is silly.

Well except that there are cardiologists trained in mechanical thrombectomy and carotid intervention. And a lot of surgeons don’t love endovascular training - there’s a reason vascular is probably the least popular surgical specialty

As for PCI being something that should have been CT surgery’s domain, cardiac catherization was invented by cardiologists. Gruentzig and Sones were the pioneers. So the argument is silly.

But sure whatever - this discussion is ridiculous and I’m gonna just end it there.
 
And this is why we are losing ground to mid-levels. While they are making a unified effort to better their profession here we are over behind the gym building arguing about whose peen is bigger.
 
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And this is why we are losing ground to mid-levels. While they are making a unified effort to better their profession here we are over behind the gym building arguing about whose peen is bigger.
No one but maybe anesthesiologists are losing ground to midlevels. Physician salaries are as high as they ever have been and the AMA lobby is strong. Only on SDN is there a midlevel scare.
 
The logical reason why CTS lost out on PCI is clear: because they don’t own the referral network. Secondly, because PCI is not surgery. It’s an intervention that cardiologists can and have learned successfully. When that is the case, cardiology wins because of their vast superiority in understanding cardiac physiology. At the end of the day, the actual mechanical work of PCI isn’t all that complicated as we all know but the perioperative care during cardiac issues has to be done by a cardiologist and no one else. It’s not efficient for the cardiologist to do all that and just have them be seen by another service (CTS) just for a 45 min PCI. That’s why CTS didn’t just lose out on PCI, it never made sense for them to have it anyway. Ultimately this is and will only further happen with peripheral vascular disease, because again if one understands the physiology of vascular disease, endovascular intervention can be learned.

NSGY is a completely different story because neurology disease process is much different than neurosurgical pathology. NSGY has a much much better understanding of nervous system physiology than CTS ever had on CV physiology.

Careful with that whole “ownership of the referral network” argument.

*cough* Stark *cough*

How do you hide a dollar from a neurosurgeon?

Give it to his son.

How do you hide a dollar from a cardiologist?

You can’t.

:angelic:
 
Sigh. Aside from the dickish tone, let me try to address some of this

1. Of course surgeons work hard and definitely longer hours than medical residents. They also do surgeries, which require incredible dexterity and skill. This doesn’t not negate the difficulty of training in medicine. We take care of incredibly complex and sick patients that many surgeons do not know how to manage - and thus when one of these patients ends up requiring surgery they ask for medical consultation. There is nothing wrong that. We also ask for surgical consultations on patients who have surgical issues. Being an elitist and snob about it is not what I intended nor should it be your viewpoint. A little respect goes a long way.

2. I never claimed that IC and neurosurgery were equivalent. I said that we have medical knowledge that neurosurgery does not. Neurosurgeons do not manage primary neurological disorders like MS or ALS in their clinics. IC docs will often manage medical issues like stable coronary disease, arrhythmias, heart failure, etc to varying degrees inpatient and outpatient because they are part and parcel of doing interventions. Hopefully that clarifies that. They also need to be able to read echos, stress tests, etc; I don’t think neurosurgeons typically read EEGs and sleep studies.

3. The degree to how much scutwork and how early someone comes in during residency is not indicative of how hard a field is. For what it’s worth I routinely came in at 5 am and stayed until 8 pm in the ICU and often on wards as an intern, and as a cardiology fellow first year I took call where I frequently got called in from home to evaluate patients while working full days before and after. So we do have rough days as well.

I don’t want to derail this topic of course but being defensive is really unhelpful and rude on your part

1. I don't know what I was being defensive about. I'm not defending anything just making fun of your delusions that your residency is anywhere close to neurosurgery. 5 AM-8 PM for like 2 months intern year? Oh nooooooooooo oh wait literally every surgical service works those hours year round. We don't have outpatient rheum or whatever to break it up.

2. Your quote about gallbladders is pretty funny and telling. A program that you graduate with 1300 gallbladders is probably a pretty damn good one (if unrealistic). But your mindset is that there's no value in doing more procedures.

3. Your "scut" is just basic patient care that you guys need to be capped for because caring for more than 8 patients or whatever is too challenging. Meanwhile we have a service of 20, see consults, and operate at the same time. Then take call overnight call without a postcall day. Yet I still dont work nearly as hard as the neurosurgery team.
 
1. I don't know what I was being defensive about. I'm not defending anything just making fun of your delusions that your residency is anywhere close to neurosurgery. 5 AM-8 PM for like 2 months intern year? Oh nooooooooooo oh wait literally every surgical service works those hours year round. We don't have outpatient rheum or whatever to break it up.

2. Your quote about gallbladders is pretty funny and telling. A program that you graduate with 1300 gallbladders is probably a pretty damn good one (if unrealistic). But your mindset is that there's no value in doing more procedures.

3. Your "scut" is just basic patient care that you guys need to be capped for because caring for more than 8 patients or whatever is too challenging. Meanwhile we have a service of 20, see consults, and operate at the same time. Then take call overnight call without a postcall day. Yet I still dont work nearly as hard as the neurosurgery team.

I was on service for 10/12 months of my intern year but sure bub whatever you say

Again nobody is denying that you work hard as a surgical resident. My other point was that the number of hours you work =/= how difficult the field is. Please find where I claimed that my residency is just as hard hours wise. Anywhere. As an interventional fellow I will be taking call essentially q2 and q2 weekends and we work super long days as well, FWIW

Also the last two points aren’t from my post - thank you come again
 
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