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Why CT getting the bad rep?

anon-y-mouse

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Nov 14, 2005
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  1. Resident [Any Field]
    Why are CT residencies getting easier to get into now a days? I hear there are more spots than applicants.

    *Also, was wondering if someone can post a link that lists surgical sub-specialities.

    ???? first off, CT is a *fellowship* of general surgery, which only had 1 unmatched spot in last years match. there is no such integrated CT program (yet). also, people's hearts will always need fixing thanks to the american diet. but perhaps the rise of interventional cardiology has something to do with what you're talking about, although i hadn't heard of any decline.
     

    The Buff

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    1. Attending Physician
      http://www.facs.org/medicalstudents/answer1.html

      That site has a listing of the surgical specialties and some general info on them.

      Some of the types listed require a fellowship. The stand-alone surgical residecies are:

      general(CT, vascular, colorectal are fellowships), neuro, optho, ortho, ENT, urology, plastics (sometimes--many a student's holy grail), OB/GYN.
       
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      Winged Scapula

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      1. Attending Physician
        ???? first off, CT is a *fellowship* of general surgery, which only had 1 unmatched spot in last years match. there is no such integrated CT program (yet).


        Hmmm...not sure where that came from. Do you have a reference? I know of at least 3 currently open positions off the top of my head (and I am not interested in CT at all).

        Oops! Sorry - ignore the above. I see that with "1 open spot" you were referring to general surgery, not CY surgery. :(

        The June 2006 match results for CT Surgery are posted at
        http://www.nrmp.org/fellow/match_name/thoracic/stats.html

        which shows that only 67% of the positions were filled after the match and scramble, and 92% of applicants who applied matched. There were 42 unfilled positions. This also doesn't include programs that don't use the NRMP for their match, but rather do it the "old-fashioned way" by having you apply directly to the program rather than use a centralized service.

        Nevertheless, this is more competitive than the previous years match in which there were approximately 50 applicants for 150 positions. Since then, programs have closed down, and more have applied.
         

        Winged Scapula

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        1. Attending Physician
          Why are CT residencies getting easier to get into now a days? I hear there are more spots than applicants.

          *Also, was wondering if someone can post a link that lists surgical sub-specialities.

          There are lots of threads dealing with the "Is CT Surgery dead" theme in the Surgical Forums. I suggest you start there because any comments I make here will be repeating what is detailed much more thoroughly there.

          At any rate, some of the more common reasons for avoiding CT Surgery are:

          1) the lifestyle - it can suck. We are in a lifestyle generation and not too many people want to come into the hospital in the middle of the night for patient emergencies or interrupt their schedule because someone is crashing in the cath lab or trauma bay.

          Even when you don't come in, some of your post-op patients can be very sick (although it IS amazing to see a post-op CABG moved out of the unit on POD #1 and go home on POD#3. They used to stay a week or more in the unit alone!). If you have residents, they'll deal with most of the stuff, but you'll still get called and if don't have residents, guess who gets all those middle of the night phone calls.

          In short, lots of emergencies, can't make plans when on call, very sick patients.

          2) the money is not what it used to be - ok, so you've never made $600K per year so $300K sounds good. But the old timers are griping. Heck, even Jarvik has been reduced to doing commercials these days.


          3) the "ingress" of cards, interventional cards and the damn public who is eating better and less likely to clog up their arteries and need you.

          But there will always be congenital defects, valve replacements and transplants - at least for the time being; so work is still available, and the old timers are getting close to retirement age.
           

          Winged Scapula

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          1. Attending Physician
            *Also, was wondering if someone can post a link that lists surgical sub-specialities.

            Heck, I'll list them.

            General Surgery - these generally require the completion of a full Categorical General Surgery residency (not counting the new integrated programs, of course)
            Bariatric
            Breast
            Burn
            Colorectal
            Critical Care
            Cardiothoracic
            Endocrine
            Hand
            Hepatobiliary
            Minimally Invasive
            Pediatric
            Plastic and Reconstructive
            Rural General Surgery
            Surgical Oncology
            Thoracic
            Transplant (Abdominal, no hearts)
            Trauma +/- Critical Care
            Vascular

            General Surgery Preliminary Training - these require 1-2 years of General Surgery before going onto Advanced Training:

            Neurosurgery
            Otolaryngology (ENT)
            Orthopaedics
            Urology


            General Surgery Preliminary Training - these specialties require 1 year of EITHER medicine or Surgery Prelim years. Most take the medicine year:
            Anesthesia
            Radiology

            There might be others as well.


            Then you have the unusual or super-specialties: ECMO fellowships, Pediatric CT, Mohs Microsurgery, Craniofacial, Aesthetic Breast, etc. which are too numerous to list.
             

            albaniandoc

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              There are lots of threads dealing with the "Is CT Surgery dead" theme in the Surgical Forums. I suggest you start there because any comments I make here will be repeating what is detailed much more thoroughly there.

              At any rate, some of the more common reasons for avoiding CT Surgery are:

              1) the lifestyle - it can suck. We are in a lifestyle generation and not too many people want to come into the hospital in the middle of the night for patient emergencies or interrupt their schedule because someone is crashing in the cath lab or trauma bay.

              Even when you don't come in, some of your post-op patients can be very sick (although it IS amazing to see a post-op CABG moved out of the unit on POD #1 and go home on POD#3. They used to stay a week or more in the unit alone!). If you have residents, they'll deal with most of the stuff, but you'll still get called and if don't have residents, guess who gets all those middle of the night phone calls.

              In short, lots of emergencies, can't make plans when on call, very sick patients.

              2) the money is not what it used to be - ok, so you've never made $600K per year so $300K sounds good. But the old timers are griping. Heck, even Jarvik has been reduced to doing commercials these days.


              3) the "ingress" of cards, interventional cards and the damn public who is eating better and less likely to clog up their arteries and need you.

              But there will always be congenital defects, valve replacements and transplants - at least for the time being; so work is still available, and the old timers are getting close to retirement age.

              I agree with the previous poster. I work in heart surgery and don't think it's worth going through something like 10 years of residency and making $250/year. A few of our surgeons started doing laser vein removals, a couple opened "rejuvenation" clinics where they prescribe steroids and growth hormones (at a much higher price than you would get them in Mexico, but this way it's legal) and finally a few are getting into doing general surgery stuff to keep up their income.

              Invasive cardiology has become quite aggressive these days so our open heart numbers diminish every year. A couple of years back I went to a Cardiac conference and Dr. Cox (not from Scrubs), the guy that I think invented the Cox ablation procedure, did a presentation on the future of CT surgery. His thoughts were that the patients will be sicker and sicker and most of the CT guys will be doing end-stage heart failure surgeries like resections of the ventricle and such. Of course now the minimally invasive stand alone ablation surgeries are becoming common and finally minimally invasive valve replacements and repairs. There are some things that will always need surgery to correct them but a lot of the procedures are being taken away from the CTs and given to cardiologists. Heck even the carotid stenosis is being treated with stenting nowadays.

              The call sucks. Our Orthos when on call get paid something like $700-1000/night, but our CT surgeons are expected to be on call with no pay. The lifestyle becomes taxing and I am not sure that in the end it is worth the money and the stress.
              It is my opinion that CT surgery is not one of the specialties in demand but who knows, in the future things might change.
               

              turkleton

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              Dec 26, 2006
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              1. Medical Student
                As more than one surgeon told me when I asked: "CT isn't a dying field. It is a dead field." A couple of the graduates of our program were having a hard time finding a job, and one was considering pursuing a critical care fellowship until he finally got offered a job.
                 
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