What’s cooler? Neurosurgery or Interventional Cardiology?

[mmmcdowe]

keep it civil or I'll start dropping drains.

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[Simba699]

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.

Surgery residents definitely have a more grueling schedule than medicine residents. No one is arguing that. I guess it’s cool to work harder during residency only to make less money and do less important procedures as a surgeon vs IC.

 

[Oh_Gee]

the real question here is "what's cooler than being cool?"

 

[LoGo]

the real question here is "what's cooler than being cool?"

Driving the pacific coast highway in a convertible Bentley back to your house in Newport where fresh salsa and tacos await on a Tuesday afternoon because you finished clinic at 2pm. #dermatology

 

[Radetzky]

They're both lame.

IC are the orthopods of cardiology.

NS "gcs too good to operate" "gcs too good to operate" "ah, it's too late to operate now, should have called me earlier"

 

[Simba699]

Driving the pacific coast highway in a convertible Bentley back to your house in Newport where fresh salsa and tacos await on a Tuesday afternoon because you finished clinic at 2pm. #dermatology

Oh in SoCal where there’s so many damn dermatologists that you’d be lucky to see enough patients to make what a FM does

 

[Instatewaiter]

This guy knows what's up.

But in reference to the OP: if you're at a bar and trying to take a girl home, I think there's more cache in the lay public with "neurosurgery" versus "interventional cardiology." When girls look at you with that blank stare, because this is clearly the crowd you're going after, you can then add "I'm a brain surgeon." Boom. Follow that up with, "You wanna get out of here?" and before you know it you have the clap. Congratulations.

The only problem is that neither the neurosurgeon nor cath jockey ever has time to be in a bar... soooooo....

 

[CTFellowMD]

I'm going to jump into this convo regarding the CT stuff, since there is a very large misunderstanding here. I am also going to immediately regret getting involved. Anyways, hereeeeee we go.

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

Yes, if one of our grafts acutely goes down we will call IC. This doesn't happen often. IC calls us much more often (they can't open a blockage, or they cause a perforation in the cath lab, etc). We do all of those other procedures as well, but generally aren't immediately available to do so because we are operating. Regardless, we are all on the same team with two different skill sets, and enjoy working with each other on complicated cases.

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

If your surgeons can not manage ARDS or cardiogenic shock, that is a massive problem. We don't just cut and let the cardiologists do everything else. At all the hospitals I've been at, the postoperative patients all remain in the CTICU, primarily managed by the CT surgeon. The preops may be in CCU vs CTICU depending on the situation, but the surgeon still makes quite a few of the decisions on the CCU patients.

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 realize you clearly have no idea what you are talking about, and have likely never actually participated meaningfully on a cardiac team. There are fairly strict guidelines on who should get a CABG -- it isn't just the "cardiologists decision" or when a patient has failed medical management. You do realize that the majority of our CABGs don't get percutaneous intervention right? The reason is that it isn't indicated in every patient. Cardiology also does not take over after the procedure. We keep the patients on our service and manage them through any postoperative issues until discharge.

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.

Again, what the hell are you talking about? General surgeons will manage their own septic shock patients, and cardiac surgeons will manage their own cardiogenic shock patients. I get that you're still a medical student according to your profile, but I am seriously concerned about what you're experiencing during your training so far.

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

Disagree here. Nearly any lesion can actually be treated with CABG. Doesn't mean that it's indicated though. If a patient can get the same result with PCI, then that is obviously the better option.

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

Again, not even close to reality. Stop posting.

 

[Gorne]

Surgery residents definitely have a more grueling schedule than medicine residents. No one is arguing that. I guess it’s cool to work harder during residency only to make less money and do less important procedures as a surgeon vs IC.

Dude we get it, you got low board scores. IM is still cool man.

 

[Simba699]

Dude we get it, you got low board scores. IM is still cool man.

Lmao bro anyone that can match cards or IC can match surgery. Surgery is NON competitive for any us md student lol. Unlike IC. If u wanna do IC u have to go to a good (competitive) academic IM program and cards program. U can go to any podunk community residency with a 220 step1 and become a surgeon lol

 

[Psai]

Lmao bro anyone that can match cards or IC can match surgery. Surgery is NON competitive for any us md student lol. Unlike IC. If u wanna do IC u have to go to a good (competitive) academic IM program and cards program. U can go to any podunk community residency with a 220 step1 and become a surgeon lol

You don't know what you're talking about so it woukd be a good idea to stop right there.

 

[Gorne]

Lmao bro anyone that can match cards or IC can match surgery. Surgery is NON competitive for any us md student lol. Unlike IC. If u wanna do IC u have to go to a good (competitive) academic IM program and cards program. U can go to any podunk community residency with a 220 step1 and become a surgeon lol

I was referring more so to the ultra-obvious inferiority complex you have.

 

[Simba699]

You don't know what you're talking about so it woukd be a good idea to stop right there.

What part of that was inaccurate at all?

 

[Simba699]

I was referring more so to the ultra-obvious inferiority complex you have.

I don’t think so lol. Just exploring various specialties and making unpopular opinions.

 

[Oso]

Infinitely applicable, although missing IM subspecialties.

Wow, IM, neurology, and derm are spot on.

I may or may not borrow the 'pointy kisses' thing for peds...

 

[Blackdogue]

Wow, IM, neurology, and derm are spot on.

I may or may not borrow the 'pointy kisses' thing for peds...

Neuro was probably spot on twenty years ago, not so much now, and definitely not in twenty more years. The new generation that wants to go into neuro is more action oriented, hence neurocritical care, more and more neurologists going interventional, vascular neurology, etc. I'm sure the treatments are not satisfying enough for someone who wants to go into surgery, cardiology, but please, "nothing can be done" is far from spot on.

 

[Oso]

Neuro was probably spot on twenty years ago, not so much now, and definitely not in twenty more years. The new generation that wants to go into neuro is more action oriented, hence neurocritical care, more and more neurologists going interventional, vascular neurology, etc. I'm sure the treatments are not satisfying enough for someone who wants to go into surgery, cardiology, but please, "nothing can be done" is far from spot on.

It was a joke bro.

I don't actually think the hand drawn cartoons accurately encapsulate the depth, variety, and intricacies of the depicted fields.

Also, I'm not actually going to go around telling children I have pointy kisses for them.

 

[Blackdogue]

It was a joke bro.

I don't actually think the hand drawn cartoons accurately encapsulate the depth, variety, and intricacies of the depicted fields.

Also, I'm not actually going to go around telling children I have pointy kisses for them.

Oh, sorry, but so many doctors have told me this seriously, that it was easy to believe you. As you probably figured out, I wanna go into neuro, and people are rarely encouraging. To the point that I'm really doubting my choice.

 

[Oso]

Oh, sorry, but so many doctors have told me this seriously, that it was easy to believe you. As you probably figured out, I wanna go into neuro, and people are rarely encouraging. To the point that I'm really doubting my choice.

Do what you find most interesting and what will bring you happiness. At the end of the day it's your job and your life. What other people think really doesn't matter. Also, **** the h8rs.

 

[IMreshopeful]

I'm going to jump into this convo regarding the CT stuff, since there is a very large misunderstanding here. I am also going to immediately regret getting involved. Anyways, hereeeeee we go.



Yes, if one of our grafts acutely goes down we will call IC. This doesn't happen often. IC calls us much more often (they can't open a blockage, or they cause a perforation in the cath lab, etc). We do all of those other procedures as well, but generally aren't immediately available to do so because we are operating. Regardless, we are all on the same team with two different skill sets, and enjoy working with each other on complicated cases.



If your surgeons can not manage ARDS or cardiogenic shock, that is a massive problem. We don't just cut and let the cardiologists do everything else. At all the hospitals I've been at, the postoperative patients all remain in the CTICU, primarily managed by the CT surgeon. The preops may be in CCU vs CTICU depending on the situation, but the surgeon still makes quite a few of the decisions on the CCU patients.



I realize you clearly have no idea what you are talking about, and have likely never actually participated meaningfully on a cardiac team. There are fairly strict guidelines on who should get a CABG -- it isn't just the "cardiologists decision" or when a patient has failed medical management. You do realize that the majority of our CABGs don't get percutaneous intervention right? The reason is that it isn't indicated in every patient. Cardiology also does not take over after the procedure. We keep the patients on our service and manage them through any postoperative issues until discharge.



Again, what the hell are you talking about? General surgeons will manage their own septic shock patients, and cardiac surgeons will manage their own cardiogenic shock patients. I get that you're still a medical student according to your profile, but I am seriously concerned about what you're experiencing during your training so far.



Disagree here. Nearly any lesion can actually be treated with CABG. Doesn't mean that it's indicated though. If a patient can get the same result with PCI, then that is obviously the better option.



Again, not even close to reality. Stop posting.

Hey man. I like working with you guys and appreciate that we have different skill sets that compliment each other

I have seen many cases where the CT surgeons call us to cath their grafts. It happens every month at least a few times. Whether or not the graft goes down. It can be due to misreading torsades as VF or VT or due to some other clinical change. This is at an institution which is very well regarded for CTS. So it does happen infrequently but not so infrequently that it’s something to blow off.

Re: ICU management. Yes our CTICU is run by a combination of CT surgery and intensivists. However I disagree with a good deal of the way they manage a lot of meds - antiarrhythmics, inotropes, vasopressors etc. and they’re often good about cardiac stuff when it suits them (post op stuff) but I’ve seen some disasters that need to be bailed out by the heart failure or EP or cardiac intensivist. There is definitely an ego component. Not generalizing all of CTS but saying that it happens at my institution.

You’re right in that every lesion can theoretically bypassed - but good luck suturing onto a calcified vessel with no target that could probably be approached with rota or diamondback. I’ve rarely seen the surgeons here tackle those with any degree of success. Also if the patient unlikely to have good graft anatomy etc.

 

[anbuitachi]

Hey man. I like working with you guys and appreciate that we have different skill sets that compliment each other

I have seen many cases where the CT surgeons call us to cath their grafts. It happens every month at least a few times. Whether or not the graft goes down. It can be due to misreading torsades as VF or VT or due to some other clinical change. This is at an institution which is very well regarded for CTS. So it does happen infrequently but not so infrequently that it’s something to blow off.

Re: ICU management. Yes our CTICU is run by a combination of CT surgery and intensivists. However I disagree with a good deal of the way they manage a lot of meds - antiarrhythmics, inotropes, vasopressors etc. and they’re often good about cardiac stuff when it suits them (post op stuff) but I’ve seen some disasters that need to be bailed out by the heart failure or EP or cardiac intensivist. There is definitely an ego component. Not generalizing all of CTS but saying that it happens at my institution.

You’re right in that every lesion can theoretically bypassed - but good luck suturing onto a calcified vessel with no target that could probably be approached with rota or diamondback. I’ve rarely seen the surgeons here tackle those with any degree of success. Also if the patient unlikely to have good graft anatomy etc.

I'm going to jump into this convo regarding the CT stuff, since there is a very large misunderstanding here. I am also going to immediately regret getting involved. Anyways, hereeeeee we go.



Yes, if one of our grafts acutely goes down we will call IC. This doesn't happen often. IC calls us much more often (they can't open a blockage, or they cause a perforation in the cath lab, etc). We do all of those other procedures as well, but generally aren't immediately available to do so because we are operating. Regardless, we are all on the same team with two different skill sets, and enjoy working with each other on complicated cases.



If your surgeons can not manage ARDS or cardiogenic shock, that is a massive problem. We don't just cut and let the cardiologists do everything else. At all the hospitals I've been at, the postoperative patients all remain in the CTICU, primarily managed by the CT surgeon. The preops may be in CCU vs CTICU depending on the situation, but the surgeon still makes quite a few of the decisions on the CCU patients.



I realize you clearly have no idea what you are talking about, and have likely never actually participated meaningfully on a cardiac team. There are fairly strict guidelines on who should get a CABG -- it isn't just the "cardiologists decision" or when a patient has failed medical management. You do realize that the majority of our CABGs don't get percutaneous intervention right? The reason is that it isn't indicated in every patient. Cardiology also does not take over after the procedure. We keep the patients on our service and manage them through any postoperative issues until discharge.



Again, what the hell are you talking about? General surgeons will manage their own septic shock patients, and cardiac surgeons will manage their own cardiogenic shock patients. I get that you're still a medical student according to your profile, but I am seriously concerned about what you're experiencing during your training so far.



Disagree here. Nearly any lesion can actually be treated with CABG. Doesn't mean that it's indicated though. If a patient can get the same result with PCI, then that is obviously the better option.



Again, not even close to reality. Stop posting.

You both got your uses and bail out each other ... It's not a competition, it's teamwork. Sometimes it's better to stent it open and other times you need to crack the chest. It's about what's best for the patient. At my workplace some IC cases cannot proceed without available CT surgeon to bail out (TAVR, lead extractions etc)

And in terms of managing patients, you both got your own styles. It doesn't matter who's taking care of the patient. What matter are the results. I've seen CTICUs where CT surgeons are adamant about managing the patient in a certain way and they usually get their way. It doesn't mean the patient ends up doing better. There's no data to support their decisions. I've also seen cardiologists especially in the CCU but also in CTICU who are just so focused on swan numbers and even sometimes cvp it's ridiculous. But hey they think they are right. So in the end the only thing that matters is patient outcome.