Why is vascular surgery cited as the specialty with the most hours worked?

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scrapy

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From my understanding, physicians have a decent amount of control over work hours after they finish residency/fellowship and get their first actual position as a fully licensed physician, but why is it that vascular surgeons work significantly more hours than even other surgical specialties?


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Because everyone eats like crap and no one works out. Also: the diabeetus

Vascular surgeons take care of the sickest patients in medicine, and there aren't that many vascular surgeons (for once a true shortage)
 
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Because everyone eats like crap and no one works out. Also: the diabeetus

Vascular surgeons take care of the sickest patients in medicine, and there aren't that many vascular surgeons (for once a true shortage)
So they have less control of how they work?
 
So they have less control of how they work?

It's more nuanced than this but in a way, yes. I personally know a vascular surgeon that didn't take a vacation in 15 years because he was the only guy that covered the level 2 trauma center that I worked at. Finally was able to hire a partner a few years ago so now there are 2 of them, and he still basically lives at the hospital.

What are you going to do when that AAA comes in the door ready to burst? Say no?
 
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It's more nuanced than this but in a way, yes. I personally know a vascular surgeon that didn't take a vacation in 15 years because he was the only guy that covered the level 2 trauma center that I worked at. Finally was able to hire a partner a few years ago so now there are 2 of them, and he still basically lives at the hospital.

What are you going to do when that AAA comes in the door ready to burst? Say no?

but what if you're only down to 5 guys left in fortnite
 
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You should also note they made an error in the Neurosurg hours. They entered the lower bound as -418 (see the chart) when really it is +418 (see the actual listed interval on the left side). So neurosurg is actually at #2-3 working about 14 more hours per week than a family med doc does.

They don't work significantly more than all other surgical specialties - hence the giant confidence intervals. Thoracic, neurosurg and "other surg" all have a ton of overlap in their CI
 
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From my understanding, physicians have a decent amount of control over work hours after they finish residency/fellowship and get their first actual position as a fully licensed physician, but why is it that vascular surgeons work significantly more hours than even other surgical specialties?



Where's the wise @mimelim when you need him?????

It's more nuanced than this but in a way, yes. I personally know a vascular surgeon that didn't take a vacation in 15 years because he was the only guy that covered the level 2 trauma center that I worked at. Finally was able to hire a partner a few years ago so now there are 2 of them, and he still basically lives at the hospital.

What are you going to do when that AAA comes in the door ready to burst? Say no?

Alright, let's try to do this without spending all night...

I'm not going to rehash the data on this (to save time), but there is a true vascular surgeon shortage in the US and it figures to get much larger over the next 20 years. There are several reasons for this.

#1 Pathology is on the rise. While smoking is holding steady or decreasing (depending where you are), obesity and ****ty diets aren't. It does not matter where you live, there are a lot of sick vasculopaths.
#2 The vascular surgeons in the US are old. 35-40% of the work force is looking to retire in the next decade. Mainly because of age, but a significant portion influenced heavily by burnout.
#3 We simply do not train enough people. We currently train ~150 people per year to be vascular surgeons. We need to be at about 250/year to be remotely close to the projected need.

There is nothing that we can do about #1 and #2. People are sick and they won't magically fix themselves. #2, there is a push to get older surgeons to stave off retirement, but at best it is a stop gap that delays the inevitable. #3 is challenging to change. First, we need more people interested in going into the field, but given the number of people applying and the caliber of students, that doesn't seem to be a huge issue. But, what is are the number of training spots. Again, don't want to go into the details of this because it would be a novel, but in short not only is it challenging from a government/ACGME perspective to pay for more training spots, as a community, vascular surgeons don't know how to train enough people. As a group, we have defined that everyone calling themselves a 'Vascular Surgeon' can take on everything that a 'traditional' vascular surgeon did. ie. they need 30+ open aortas to graduate. Where I trained, that was easy. I had more than double that. But, that is NOT the shared experience across the country. The single biggest factor holding back new programs and existing programs expanding is lack of open aortic volume. If you mandate that everyone is a 'complete' vascular surgeon, then you will always have this issue because simply put, there aren't enough open aortas across the country to train people on. For example, in our practice, there are some surgeons in the group that haven't done an open aorta in 5+ years. They simply do everything endo or ship to the flagship hospital for the open operation. One could argue that not everyone needs to be an 'aortic' surgeon to be a vascular surgeon. I myself hop back and forth over the fence on the topic depending on my mood and what else is going on. I feel extremely comfortable in and around the aorta, even as a relatively new attending. That having been said, from a career perspective, while I enjoy doing open aortic work, I don't need it to feel professionally satisfied and if someone told me that I wouldn't be doing them anymore because we had another way of taking care of them (either technologically or someone else would be doing the case), I would be perfectly fine with it. I also find that this is probably true for the majority of people I trained with, albeit, not all of them. Now, the flip side of this shortage is that the job market is pretty incredible for trainees coming out now. Everyone is hiring and many hospitals that aren't actively looking get super excited when you reach out to them. I could impress you with some salary numbers I was offered, but far more importantly, but difficult to understand, is the ability to dictate contract terms. There were several jobs that I could dictate essentially the entire contract. Enviable position to be in to be honest.

But, that is the macro picture of a global shortage, you have to pair that with a micro picture of how people practice to really understand why vascular surgeons have a poor lifestyle. The pathology somewhat dictates this. The bread and butter in vascular surgery are as follows: Peripheral arterial, venous, aneurysms, cerebrovascular, dialysis access. All 5 have pathology within them that can be taken care of as an outpatient on a semi-elective time schedule. On the flip side, all 5 have substantial emergent or urgent sides that demand intervention within hours or risk substantial life/limb threat. It is entirely possible for a vascular surgeon to simply pass on the emergency cases and have them triaged to other hospitals. It happens across the country. This doesn't mean that they have to be varicose vein only or boutique or anything like that. Many vascular surgeons simply don't think that they can take care of emergencies around the clock when they are the only surgeon available most of the time (or they don't have confidence in their ICU/other facilities necessary to take care of them). Fundamentally, the pathology that we deal with are bleeding and ischemia. Both of which demand prompt attention. That means being available when the pathology shows up, similar to obstetrics and being available when the baby shows up. Another substantial part of this is the fact that vascular surgeons are backup to other surgeons and proceduralists for bleeding. At least once a week and in training at least 3-5 times a week, we had to bail out other physicians because of bleeding complications from their procedures. The bulk were cardiologists, but far from the only ones. If I have to run to the cathlab to bail someone out, that means that my elective case gets put on hold, which means I start later, which means I stay later. Often this magnifies the actual time lost. For example, it is rare a bail out takes me more than 30 minutes, but it will often delay my case by 2+ hours.

What is the solution? Well, the obvious one is to train more surgeons. I am a huge proponent of increasing the requirements for vascular training across the board, except for open aortas and dropping that down substantially. This is an incredibly unpopular opinion. I don't have a problem with tiers of vascular surgeons with those congregating in 'open aortic centers' across the country doing the bulk of them. There are problems with this. It reduces access to open aortic surgery across the country at least as how we are currently setup. But, I think that the overall benefits would be well worth it. At present we do not require vascular surgeons to train in dialysis access. This is wrong and hurts a constantly growing need in the US. While dialysis access is considered the 'simple' or 'easy' part of vascular surgery, it is nuanced and the difference between good, bad and dated is substantial. It is frightening how poor the care is in some areas. It would help if we made the training at least a mandatory part.

The second solution, again, incredibly unpopular in the vascular surgery world is to train non-vascular surgeons to do parts of what a vascular surgeon does. Example, peripheral endovascular work. Currently cardiologists, interventional radiologists and others also work in this area. While many of the tools and techniques were developed by non-vascular surgeons, do not kid yourself. There is a substantial difference in training between vascular surgeons and the others. I spent 5 years training in endovascular techniques, never mind the 5 years worth of didactics, conferences and lessons from faculty and non-faculty alike. At the core of that teaching is the, medical management vs. endovascular vs. open treatment. There is no replacement for a single person that can deliver all three of those without needing to refer to someone else (and potentially lose out on $$$). It is a constant source of headache to take care of patients with stents where they shouldn't be, the wrong type of stents used and access site ****-ups that no intern in my training program would ever make. Despite the relatively low level of knowledge/training required for this, it is NOT a focused part of anyone else's training. There are plenty of good non-vascular surgeons out there doing peripheral arterial work. But, without even the most basic of training requirements and the inability to offer open solutions, as a group it will almost always fall short. I ran into this while I was looking at jobs. Several hospitals wanted to have a 'peripheral arterial ischemia' team. They wanted to have cardiologists, IR and vascular surgery taking turns covering the cold leg consults. That sounds great, unless you are the vascular surgeon. What happens when the patient from a medical standpoint SHOULD get an open operation when a non-vascular surgeon is on 'cold leg call'. a) they get the inferior operation or b) the vascular surgeon gets woken up to take care of the patient while someone else is collecting the 'cold leg call' $$$. This is not a once in a while thing. This is a weekly thing, in just about every locale.


So, at the end of the day, why are vascular surgeons busy? Because there are a lot of very sick people and we don't have enough people trained to do the job. I don't have easy answers, no one does. I am a huge proponent of multi-specialty groups (I am in one) that collectively take care of vascular problems. I think that it offers something in the vein of that second solution. But, it is far from perfect. But, to be clear, as others have pointed out, as with every specialty, there are huge confidence intervals on the numbers. If I wanted to make 350k and work 45-50 hours/week, it would be trivially simple. I wouldn't be doing the majority of what I trained to do, but there are plenty of good paying, schedule controlled jobs out there.
 
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Alright, let's try to do this without spending all night...

I'm not going to rehash the data on this (to save time), but there is a true vascular surgeon shortage in the US and it figures to get much larger over the next 20 years. There are several reasons for this.

#1 Pathology is on the rise. While smoking is holding steady or decreasing (depending where you are), obesity and ****ty diets aren't. It does not matter where you live, there are a lot of sick vasculopaths.
#2 The vascular surgeons in the US are old. 35-40% of the work force is looking to retire in the next decade. Mainly because of age, but a significant portion influenced heavily by burnout.
#3 We simply do not train enough people. We currently train ~150 people per year to be vascular surgeons. We need to be at about 250/year to be remotely close to the projected need.

There is nothing that we can do about #1 and #2. People are sick and they won't magically fix themselves. #2, there is a push to get older surgeons to stave off retirement, but at best it is a stop gap that delays the inevitable. #3 is challenging to change. First, we need more people interested in going into the field, but given the number of people applying and the caliber of students, that doesn't seem to be a huge issue. But, what is are the number of training spots. Again, don't want to go into the details of this because it would be a novel, but in short not only is it challenging from a government/ACGME perspective to pay for more training spots, as a community, vascular surgeons don't know how to train enough people. As a group, we have defined that everyone calling themselves a 'Vascular Surgeon' can take on everything that a 'traditional' vascular surgeon did. ie. they need 30+ open aortas to graduate. Where I trained, that was easy. I had more than double that. But, that is NOT the shared experience across the country. The single biggest factor holding back new programs and existing programs expanding is lack of open aortic volume. If you mandate that everyone is a 'complete' vascular surgeon, then you will always have this issue because simply put, there aren't enough open aortas across the country to train people on. For example, in our practice, there are some surgeons in the group that haven't done an open aorta in 5+ years. They simply do everything endo or ship to the flagship hospital for the open operation. One could argue that not everyone needs to be an 'aortic' surgeon to be a vascular surgeon. I myself hop back and forth over the fence on the topic depending on my mood and what else is going on. I feel extremely comfortable in and around the aorta, even as a relatively new attending. That having been said, from a career perspective, while I enjoy doing open aortic work, I don't need it to feel professionally satisfied and if someone told me that I wouldn't be doing them anymore because we had another way of taking care of them (either technologically or someone else would be doing the case), I would be perfectly fine with it. I also find that this is probably true for the majority of people I trained with, albeit, not all of them. Now, the flip side of this shortage is that the job market is pretty incredible for trainees coming out now. Everyone is hiring and many hospitals that aren't actively looking get super excited when you reach out to them. I could impress you with some salary numbers I was offered, but far more importantly, but difficult to understand, is the ability to dictate contract terms. There were several jobs that I could dictate essentially the entire contract. Enviable position to be in to be honest.

But, that is the macro picture of a global shortage, you have to pair that with a micro picture of how people practice to really understand why vascular surgeons have a poor lifestyle. The pathology somewhat dictates this. The bread and butter in vascular surgery are as follows: Peripheral arterial, venous, aneurysms, cerebrovascular, dialysis access. All 5 have pathology within them that can be taken care of as an outpatient on a semi-elective time schedule. On the flip side, all 5 have substantial emergent or urgent sides that demand intervention within hours or risk substantial life/limb threat. It is entirely possible for a vascular surgeon to simply pass on the emergency cases and have them triaged to other hospitals. It happens across the country. This doesn't mean that they have to be varicose vein only or boutique or anything like that. Many vascular surgeons simply don't think that they can take care of emergencies around the clock when they are the only surgeon available most of the time (or they don't have confidence in their ICU/other facilities necessary to take care of them). Fundamentally, the pathology that we deal with are bleeding and ischemia. Both of which demand prompt attention. That means being available when the pathology shows up, similar to obstetrics and being available when the baby shows up. Another substantial part of this is the fact that vascular surgeons are backup to other surgeons and proceduralists for bleeding. At least once a week and in training at least 3-5 times a week, we had to bail out other physicians because of bleeding complications from their procedures. The bulk were cardiologists, but far from the only ones. If I have to run to the cathlab to bail someone out, that means that my elective case gets put on hold, which means I start later, which means I stay later. Often this magnifies the actual time lost. For example, it is rare a bail out takes me more than 30 minutes, but it will often delay my case by 2+ hours.

What is the solution? Well, the obvious one is to train more surgeons. I am a huge proponent of increasing the requirements for vascular training across the board, except for open aortas and dropping that down substantially. This is an incredibly unpopular opinion. I don't have a problem with tiers of vascular surgeons with those congregating in 'open aortic centers' across the country doing the bulk of them. There are problems with this. It reduces access to open aortic surgery across the country at least as how we are currently setup. But, I think that the overall benefits would be well worth it. At present we do not require vascular surgeons to train in dialysis access. This is wrong and hurts a constantly growing need in the US. While dialysis access is considered the 'simple' or 'easy' part of vascular surgery, it is nuanced and the difference between good, bad and dated is substantial. It is frightening how poor the care is in some areas. It would help if we made the training at least a mandatory part.

The second solution, again, incredibly unpopular in the vascular surgery world is to train non-vascular surgeons to do parts of what a vascular surgeon does. Example, peripheral endovascular work. Currently cardiologists, interventional radiologists and others also work in this area. While many of the tools and techniques were developed by non-vascular surgeons, do not kid yourself. There is a substantial difference in training between vascular surgeons and the others. I spent 5 years training in endovascular techniques, never mind the 5 years worth of didactics, conferences and lessons from faculty and non-faculty alike. At the core of that teaching is the, medical management vs. endovascular vs. open treatment. There is no replacement for a single person that can deliver all three of those without needing to refer to someone else (and potentially lose out on $$$). It is a constant source of headache to take care of patients with stents where they shouldn't be, the wrong type of stents used and access site ****-ups that no intern in my training program would ever make. Despite the relatively low level of knowledge/training required for this, it is NOT a focused part of anyone else's training. There are plenty of good non-vascular surgeons out there doing peripheral arterial work. But, without even the most basic of training requirements and the inability to offer open solutions, as a group it will almost always fall short. I ran into this while I was looking at jobs. Several hospitals wanted to have a 'peripheral arterial ischemia' team. They wanted to have cardiologists, IR and vascular surgery taking turns covering the cold leg consults. That sounds great, unless you are the vascular surgeon. What happens when the patient from a medical standpoint SHOULD get an open operation when a non-vascular surgeon is on 'cold leg call'. a) they get the inferior operation or b) the vascular surgeon gets woken up to take care of the patient while someone else is collecting the 'cold leg call' $$$. This is not a once in a while thing. This is a weekly thing, in just about every locale.


So, at the end of the day, why are vascular surgeons busy? Because there are a lot of very sick people and we don't have enough people trained to do the job. I don't have easy answers, no one does. I am a huge proponent of multi-specialty groups (I am in one) that collectively take care of vascular problems. I think that it offers something in the vein of that second solution. But, it is far from perfect. But, to be clear, as others have pointed out, as with every specialty, there are huge confidence intervals on the numbers. If I wanted to make 350k and work 45-50 hours/week, it would be trivially simple. I wouldn't be doing the majority of what I trained to do, but there are plenty of good paying, schedule controlled jobs out there.

Pssh, I don't know what you're talking about. @TypeADissection keeps telling me the patients are all easy and awesome.
 
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Is the pay really in that ballperk per hour, similar to EM??

I know nothing about EM pay, so I leave it to others to make their own comparisons. I could have made ~700k with 125k signing bonus my first year out guaranteed for 3 years. Probably would work 60ish hours/week, but 'on-call' all the time.

You really shouldn't talk about hourly pay for non-shift workers though. It really isn't a good way of looking at things since that isn't how the money comes in or out. Most people eat what they kill. Some are better/more efficient hunters than others.
 
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Alright, let's try to do this without spending all night...

I'm not going to rehash the data on this (to save time), but there is a true vascular surgeon shortage in the US and it figures to get much larger over the next 20 years. There are several reasons for this.

#1 Pathology is on the rise. While smoking is holding steady or decreasing (depending where you are), obesity and ****ty diets aren't. It does not matter where you live, there are a lot of sick vasculopaths.
#2 The vascular surgeons in the US are old. 35-40% of the work force is looking to retire in the next decade. Mainly because of age, but a significant portion influenced heavily by burnout.
#3 We simply do not train enough people. We currently train ~150 people per year to be vascular surgeons. We need to be at about 250/year to be remotely close to the projected need.

There is nothing that we can do about #1 and #2. People are sick and they won't magically fix themselves. #2, there is a push to get older surgeons to stave off retirement, but at best it is a stop gap that delays the inevitable. #3 is challenging to change. First, we need more people interested in going into the field, but given the number of people applying and the caliber of students, that doesn't seem to be a huge issue. But, what is are the number of training spots. Again, don't want to go into the details of this because it would be a novel, but in short not only is it challenging from a government/ACGME perspective to pay for more training spots, as a community, vascular surgeons don't know how to train enough people. As a group, we have defined that everyone calling themselves a 'Vascular Surgeon' can take on everything that a 'traditional' vascular surgeon did. ie. they need 30+ open aortas to graduate. Where I trained, that was easy. I had more than double that. But, that is NOT the shared experience across the country. The single biggest factor holding back new programs and existing programs expanding is lack of open aortic volume. If you mandate that everyone is a 'complete' vascular surgeon, then you will always have this issue because simply put, there aren't enough open aortas across the country to train people on. For example, in our practice, there are some surgeons in the group that haven't done an open aorta in 5+ years. They simply do everything endo or ship to the flagship hospital for the open operation. One could argue that not everyone needs to be an 'aortic' surgeon to be a vascular surgeon. I myself hop back and forth over the fence on the topic depending on my mood and what else is going on. I feel extremely comfortable in and around the aorta, even as a relatively new attending. That having been said, from a career perspective, while I enjoy doing open aortic work, I don't need it to feel professionally satisfied and if someone told me that I wouldn't be doing them anymore because we had another way of taking care of them (either technologically or someone else would be doing the case), I would be perfectly fine with it. I also find that this is probably true for the majority of people I trained with, albeit, not all of them. Now, the flip side of this shortage is that the job market is pretty incredible for trainees coming out now. Everyone is hiring and many hospitals that aren't actively looking get super excited when you reach out to them. I could impress you with some salary numbers I was offered, but far more importantly, but difficult to understand, is the ability to dictate contract terms. There were several jobs that I could dictate essentially the entire contract. Enviable position to be in to be honest.

But, that is the macro picture of a global shortage, you have to pair that with a micro picture of how people practice to really understand why vascular surgeons have a poor lifestyle. The pathology somewhat dictates this. The bread and butter in vascular surgery are as follows: Peripheral arterial, venous, aneurysms, cerebrovascular, dialysis access. All 5 have pathology within them that can be taken care of as an outpatient on a semi-elective time schedule. On the flip side, all 5 have substantial emergent or urgent sides that demand intervention within hours or risk substantial life/limb threat. It is entirely possible for a vascular surgeon to simply pass on the emergency cases and have them triaged to other hospitals. It happens across the country. This doesn't mean that they have to be varicose vein only or boutique or anything like that. Many vascular surgeons simply don't think that they can take care of emergencies around the clock when they are the only surgeon available most of the time (or they don't have confidence in their ICU/other facilities necessary to take care of them). Fundamentally, the pathology that we deal with are bleeding and ischemia. Both of which demand prompt attention. That means being available when the pathology shows up, similar to obstetrics and being available when the baby shows up. Another substantial part of this is the fact that vascular surgeons are backup to other surgeons and proceduralists for bleeding. At least once a week and in training at least 3-5 times a week, we had to bail out other physicians because of bleeding complications from their procedures. The bulk were cardiologists, but far from the only ones. If I have to run to the cathlab to bail someone out, that means that my elective case gets put on hold, which means I start later, which means I stay later. Often this magnifies the actual time lost. For example, it is rare a bail out takes me more than 30 minutes, but it will often delay my case by 2+ hours.

What is the solution? Well, the obvious one is to train more surgeons. I am a huge proponent of increasing the requirements for vascular training across the board, except for open aortas and dropping that down substantially. This is an incredibly unpopular opinion. I don't have a problem with tiers of vascular surgeons with those congregating in 'open aortic centers' across the country doing the bulk of them. There are problems with this. It reduces access to open aortic surgery across the country at least as how we are currently setup. But, I think that the overall benefits would be well worth it. At present we do not require vascular surgeons to train in dialysis access. This is wrong and hurts a constantly growing need in the US. While dialysis access is considered the 'simple' or 'easy' part of vascular surgery, it is nuanced and the difference between good, bad and dated is substantial. It is frightening how poor the care is in some areas. It would help if we made the training at least a mandatory part.

The second solution, again, incredibly unpopular in the vascular surgery world is to train non-vascular surgeons to do parts of what a vascular surgeon does. Example, peripheral endovascular work. Currently cardiologists, interventional radiologists and others also work in this area. While many of the tools and techniques were developed by non-vascular surgeons, do not kid yourself. There is a substantial difference in training between vascular surgeons and the others. I spent 5 years training in endovascular techniques, never mind the 5 years worth of didactics, conferences and lessons from faculty and non-faculty alike. At the core of that teaching is the, medical management vs. endovascular vs. open treatment. There is no replacement for a single person that can deliver all three of those without needing to refer to someone else (and potentially lose out on $$$). It is a constant source of headache to take care of patients with stents where they shouldn't be, the wrong type of stents used and access site ****-ups that no intern in my training program would ever make. Despite the relatively low level of knowledge/training required for this, it is NOT a focused part of anyone else's training. There are plenty of good non-vascular surgeons out there doing peripheral arterial work. But, without even the most basic of training requirements and the inability to offer open solutions, as a group it will almost always fall short. I ran into this while I was looking at jobs. Several hospitals wanted to have a 'peripheral arterial ischemia' team. They wanted to have cardiologists, IR and vascular surgery taking turns covering the cold leg consults. That sounds great, unless you are the vascular surgeon. What happens when the patient from a medical standpoint SHOULD get an open operation when a non-vascular surgeon is on 'cold leg call'. a) they get the inferior operation or b) the vascular surgeon gets woken up to take care of the patient while someone else is collecting the 'cold leg call' $$$. This is not a once in a while thing. This is a weekly thing, in just about every locale.


So, at the end of the day, why are vascular surgeons busy? Because there are a lot of very sick people and we don't have enough people trained to do the job. I don't have easy answers, no one does. I am a huge proponent of multi-specialty groups (I am in one) that collectively take care of vascular problems. I think that it offers something in the vein of that second solution. But, it is far from perfect. But, to be clear, as others have pointed out, as with every specialty, there are huge confidence intervals on the numbers. If I wanted to make 350k and work 45-50 hours/week, it would be trivially simple. I wouldn't be doing the majority of what I trained to do, but there are plenty of good paying, schedule controlled jobs out there.

Awesome stuff. Added this to the directory for reference
 
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I know nothing about EM pay, so I leave it to others to make their own comparisons. I could have made ~700k with 125k signing bonus my first year out guaranteed for 3 years. Probably would work 60ish hours/week, but 'on-call' all the time.

You really shouldn't talk about hourly pay for non-shift workers though. It really isn't a good way of looking at things since that isn't how the money comes in or out. Most people eat what they kill. Some are better/more efficient hunters than others.
Is that 60ish including the usual on-call, or is it 60 expected + another 10-15 if you get unlucky that week?
 
I really have nothing more to offer than what @mimelim already wrote wonderfully. I echo all his sentiments and even though I train in a fairly cohesive HVI w/ CTS, Cards, IR and VS all working under one roof; there is a lot of questionable **** that goes down on a regular basis by the Cards guys that we are running in to bail out. So if you already have a full day of cases to go and now you're running in to bail someone else out it really does back the rest of your day into the evening. Plus the call teams start around 1500, so the amount of rooms available to bounce around and work in parallel becomes difficult if staffing doesn't want to stay. I am constantly reminded that although I willingly signed up to work these hours, the circulating nurse, scrub techs, CRNAs, etc. didn't necessarily also agree to work the 80+ hours a week this job occasionally demands. But sometimes we get lucky and I can start a bypass in one room while the attending and junior resident are knocking out fistulagrams and angios. I've been scarce to visit SDN lately mostly due to having lectures and manuscripts demanded of me, but at the end of the day, there isn't anything else I'd rather do. I think VS is a dope field and would encourage likeminded individuals to explore it and see if it's the right fit for them. Cheers.
 
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I know nothing about EM pay, so I leave it to others to make their own comparisons. I could have made ~700k with 125k signing bonus my first year out guaranteed for 3 years. Probably would work 60ish hours/week, but 'on-call' all the time.

You really shouldn't talk about hourly pay for non-shift workers though. It really isn't a good way of looking at things since that isn't how the money comes in or out. Most people eat what they kill. Some are better/more efficient hunters than others.

Is there a significant difference between the "lifestyle" of a PP vs. academic vascular surgeon?
 
According to an EM I talked to in my local area they can make 400-700 K depending on the number of shifts they take


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Is there a significant difference between the "lifestyle" of a PP vs. academic vascular surgeon?

I don't know about other specialties, but in vascular surgery, there really aren't that many true 'academic' jobs out there. Most places academic and private are going toward a hybrid model of compensation. Lifestyle depends on the hospital/practice you are at. In academic centers, you have a resident/fellow filter in terms of calls, but you tend to have to deal with more emergencies. Hours are highly variable across the spectrum of job types.
 
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I don't know about other specialties, but in vascular surgery, there really aren't that many true 'academic' jobs out there. Most places academic and private are going toward a hybrid model of compensation. Lifestyle depends on the hospital/practice you are at. In academic centers, you have a resident/fellow filter in terms of calls, but you tend to have to deal with more emergencies. Hours are highly variable across the spectrum of job types.

Interesting, thanks!
 
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