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will CT surg be around in 10-15 years? or should one go into peds or heart transplant

Discussion in 'Surgery and Surgical Subspecialties' started by WildcatMD, Nov 23, 2005.

  1. WildcatMD

    WildcatMD Member
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    Say a person wanted to go into CT surg in 10-15 years (that's when one would be starting as an attending after residency)

    will you basically have to go the one extra year to go for pediatric CT surg or heart transplant just to have a job? since there will be hardly any need for regular adult CT with interventional cardiology being around?


    heart transplant - obviously not interventional

    pediatric CT - I looked up and read for a while on all of the various defects
    I've heard by word of mouth that some of them can be done interventionally by peds cardiologists (I believe septal defects for example)
    but looking at the anatomy of things like Tetralogy of the Fallot, transposition of the great arteries, hypoplastic left heart, pulmonary atresia, aortic stenosis, on and on...
    it seems as though these wouldn't be able to, not now, and probably never for some of them (just by the nature of what the defect is) will be able to be done interventionally
    seems like a pediatric CT surg wouldn't have to worry about losing his/her job to interventional procedures (ie like adult has)

    So what do you think, is it basically either pediatric CT or heart transplant fellowship after CT residency or pick another specialty??
     
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  3. njbmd

    njbmd Guest
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    Hi there,
    Do not worry about CT Surgery being around in 10 or 15 years. It will be there. Medicine goes in cycles and changes on a daily basis. It's part of the process. In surgery or anything else, do what you love and you will do it well. If you perform well, you will have an excellent career. You cannot possible predict how anything will be in the future but you can keep yourself as prepared as possible for change. Do not look at any specialty in terms of job security. Both of the CT fellows from my program had jobs waiting for them. To predict the demise of CT Surgery is premature.Things can change in an instant.

    njbmd :)
     
  4. WildcatMD

    WildcatMD Member
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    Thanks, I figured you'd be the one to respond
    I've seen a lot of your posts since I signed up for the site a bit ago, you seem very knowledgable

    I couldn't agree more with subspecializing merely for job security, without having a real passion for it

    I should have probably mention that I have worked mostly on a heart transplant unit and have seen some transplants, and absolutely love it
    heart failure a really interesting subject
    Also, when I was researching up the congenital defects, I found them amazing also, the huge variety of defects and the complexity of them fascinated me

    The point being, is that if I went into heart transplant or ped CT surg, it would definitely not merely be only for job security, but because I also like those fields too

    Also, I heard from another poster that the American Board of Thoracic Surgery is planning or already has changed the requirements for a CT residency from current program (5 years g surg + 2 years CT) to a combined program much like other surgery programs (3 years g surg + 3 years CT), so this cuts off a year

    Heart transplant and peds CT fellowships are currently a year, so by the time I get into it, with the change above, going into heart transplant or peds CT would be the same time as it takes to get into regular adult CT surg now

    There may be a need for adult CT, but I really don't want to operate on really really sick old people, which from my experience (I've also worked on the open heart ICU) is where it is heading
    This is another reason why heart transplant and peds CT is attractive, I like kids first off, and I really like the heart transplant patients (we've transplanted people as young as their 20's (1 person), but routinely get 40 and 50 year olds)

    So anyways, job security is only 1 reason (definitely the smallest one compared to interest in the field, patient population, and time to get there), although it is always something to think about
     
  5. WildcatMD

    WildcatMD Member
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    hey nbjmd (or anyone else with knowledge about this)

    I wanted to get some info specifically on whether and to what extent the other fields can be done interventionally

    well, just peds CT obviously (kinda hard to do an interventional heart transplant)

    from your surgical experience, do you know if many peds CT procedures can be done interventionally

    I've heart some septal defects can, but I would think many of the defects I mentioned in my original post probably simply wounldn't be able to be done interventionally simply because of the anatomy of the defect

    In other words, there will always be many defects that will remain having to be fixed by open heart surgery

    Any thoughts?
    Thanks


    Going to eat some turkey now :D
     
  6. njbmd

    njbmd Guest
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    Hi there,
    Most of my CABG patients are getting younger as opposed to older. Older patients are now more likely to be managed medically. My CABG patients are in their late 30s to 60s with a few in their 70s. Patients are still having loads of coronary artery disease even with the cholesterol lowering drugs. There are more diabetics (thanks to the sedentary lifestyle) and more hypertension. There are plenty of adult heart procedures for patients with heart failure and valve disease (the most interesting stuff outside the lung resections for me).

    Most of the pediatric heart defects are being repaired surgically. There are a couple of interventional procedures that are bridges until the child is big enough to tolerate the pump but most defects need surgical repair.

    Pediatric CT is alive and well as the number of children needing procedures is stable or increasing. (Children do not have coronary artery disease and are not amenable to stents). Our ability to detect pediatric heart defects is also more sensitive.

    njbmd :)
     
  7. RichL025

    RichL025 Senior Member
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    Anyone who doubts this, ask our medicine colleagues about how ID was considered a "dead field" 15 years ago <g>.
     
  8. ggx12

    ggx12 Junior Member
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    These 30yo AMI's are very interesting:
    Should you stent a 30 year old and keep his LIMAs for his late 50s, or do you do a CABG first and stent later? Should you avoid a redo?
     
  9. ggx12

    ggx12 Junior Member
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    ID=infectious diseases?
     
  10. RichL025

    RichL025 Senior Member
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    Yeah, sorry. One of my medicine preceptors told me when she applied for fellowship in the 80s, her mentors warned her away from it because, you know, antibiotics were going to completely eradicate all bacterial disease, and viruses weren't that deadly anyway ;)

    Interestingly enough, there's a similar story about Niehls Borh (? - the guy who invented quantuum theory) back at the start of the 20th century, being told not to go into physics because it was a "dead field."
     
  11. banner

    banner Senior Member
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    I'm not doing CT surgery, but I don't buy the doomsday scenarios. And these are not only exclusive to CT surgery. Hang around any service (medical, surgical or otherwise) long enough and they all swear that in 15 years, there field will be dead because so and so are stealing their cases or the PA's or NPs will do everything or the lawyers will ruin their field or it will be outsourced.

    All BS if you ask me. Why?
    1. I know of no unemployed physician that is not the result of personal choice.
    2. Predictions in medicine about what field will be hot or cold never completely pan out because medicine is always changing. Remember what you heard your first day of medical school "half of what we tell you today will be untrue when you graduate"?

    Cardiology used to be a really sleepy field where they just watched people die of MI's until the 80's. And now those bastards are doing everything under the sun. But, they too will cycle down when the next blockbuster drug that eliminates athersclerosis is developed.

    General surgery was supposed to be a dead field after proton pump inhibitors came and everyone started subspecializing, but then laparoscopy and bariatric surgery came.

    Medical students in the 1990's were all told that if they didn't go into primary care, they wouldn't have a job because insurance companies and medicare wouldn't pay for specialists anymore. Did that come true???

    Bottom line is that nobody has a good handle on what will happen to medical specialties in the future anymore than I can acurately predict the weather a year from now.

    So go for CT surgery if that's what you like. I doubt I'll see CT surgeons in the future on the sidewalk selling apples because they can't find a job.
     
  12. davvid2700

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    You dont have to wait till the future, CT surgeons are selling apples now because they cant find a job.. There are no CT groups hiring in any major city in america right now
     
  13. droliver

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    I'd agree with the sentiment that few predict a renaissance in CTVS, especially when you look back at the status & income they used to have. There's just very little enthusiasm from practicing surgeons and fellows for their lot. There will always be work and respectable income (but 1/2 to 1/3 of previous generations), but the cost/benefit calculus of getting there is too much for most students and residents anymore
     

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