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I was quite shocked when i looked at the number of applicants into cardiac surgery on CaRMS: only 5 med students wanted cardiac surgery last year?!!!!

 

And by the way, is it true that cardiac surgeons in Canada barely find a job or what Ive been told was a sarcasm?

 

10x guys.

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Guest insantizer

two words- interventional cardiology

 

some say cardiac surgery is on the way back (i.e. cardiac surgeons)- the rest don't agree (which is why there were cardiac spots left after R-1)

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I expect that cardiac Sx is probably due for a bit of resurgence. There has been a big push on interventional for the past few years but new data coming out now shows mortality benifits to Cardiac Sx that can't be ignored.

 

A big study released a few weeks ago showed lower mortality for persons >65 and persons with Diabetes when treated with Sx vs. interventional. If anyone is really interested I'll try and dig it up.

 

I also expect that at some point there may be a merger of interventional cardiology and cardiac surgery. I remember hearing at one point that one center trained Cardiac Sx. to do interventional procedures and the Sx's ended up pretty good at it pretty fast.

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http://www.cardiothoracicsurgery.org/content/2/1/35

http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-54.html

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-4G1KSXX-4&_user=994540&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050024&_version=1&_urlVersion=0&_userid=994540&md5=da10a18abba7b42817bc31e6d9a7e9dd

 

 

This is probably why 5 students elect to go this route. It's not an easy residency when these are the prospects.

 

I don't think anyone can bet on whether or not cardiothoracic surgery will make a resurgence. Likely, due to their desire to keep their jobs, they will come up with something new. For business reasons, I highly doubt that they will easily move over to interventional cardiology.

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http://www.cardiothoracicsurgery.org/content/2/1/35

http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-54.html

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-4G1KSXX-4&_user=994540&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050024&_version=1&_urlVersion=0&_userid=994540&md5=da10a18abba7b42817bc31e6d9a7e9dd

 

 

This is probably why 5 students elect to go this route. It's not an easy residency when these are the prospects.

 

I don't think anyone can bet on whether or not cardiothoracic surgery will make a resurgence. Likely, due to their desire to keep their jobs, they will come up with something new. For business reasons, I highly doubt that they will easily move over to interventional cardiology.

 

Thanks guys for ur answers. In fact, Ill be honest with u, m REALLY REALLY disappointed!! Im not a med student yet, was decided to become one next year, but i was shocked to read about cardiac surgeons situation! This specialty was the only reason why i would choose med school! and now, m reconsiderin my choices.:confused:

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The specialty will always be around. There will still be lots and lots of cases where interventional isn't going to be enough. For example, right now interventionally placed valve replacements leak like sieves compared to surgically placed valves (that's what I understand anyway). While a leaky valve may do the job in a 70 year old who isn't going to be active, it may not be adequate for a 45 year old who still wants to play hockey etc. Plus, surgically they can repair the valves, which I don't believe inteventional can do at this point.

 

Interventional isn't an old system. We're still trying to figure out what it can and can't do vs. Sx as it's relatively new. Over time, the system will correct itself.

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http://www.cardiothoracicsurgery.org/content/2/1/35

http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-54.html

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-4G1KSXX-4&_user=994540&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050024&_version=1&_urlVersion=0&_userid=994540&md5=da10a18abba7b42817bc31e6d9a7e9dd

 

 

This is probably why 5 students elect to go this route. It's not an easy residency when these are the prospects.

 

I don't think anyone can bet on whether or not cardiothoracic surgery will make a resurgence. Likely, due to their desire to keep their jobs, they will come up with something new. For business reasons, I highly doubt that they will easily move over to interventional cardiology.

 

Just a note, but thoracic and cardiac are separate here for whatever reason - what we might see is a merger of cardiac and vascular or making cardiac a subspecialty of gen Sx again (you can still go that route - no idea how many people do).

 

Anyway, I have a definite interest in cardiac, though I wonder whether it would be too restrictive. As it stands, they do CABGs, valve replacements/repairs, repairs to congenital defects in the pediatric setting, pacemakers, ICDs, and, every now and then, a transplant. That's really about it. Some sort of research program seems to be a must too. Here some of the surgeons also have vascular training and so get into various aneurysms.

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Guest copacetic
http://www.cardiothoracicsurgery.org/content/2/1/35

http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-54.html

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-4G1KSXX-4&_user=994540&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050024&_version=1&_urlVersion=0&_userid=994540&md5=da10a18abba7b42817bc31e6d9a7e9dd

 

 

This is probably why 5 students elect to go this route. It's not an easy residency when these are the prospects.

 

I don't think anyone can bet on whether or not cardiothoracic surgery will make a resurgence. Likely, due to their desire to keep their jobs, they will come up with something new. For business reasons, I highly doubt that they will easily move over to interventional cardiology.

 

even if interventional cardiology and cardiac surgury somehow merged, or IC became a sub-sub specialty of Cx, it is highly unlikelty that this will create more jobs more cardiac surgeons. this is because cardiologists control the heart patients. interventional guys only refer patietns to surgeons when there the patients are way too complex, or nothing can be done for them in terms of classical interventional procedures. cardiologists have this knack for doing procdures themselves if they can. another example is cardiac imaging. much of this was developed by radiologists, but bcause cardiologists control the patietns, they invariably want to do this stuff themselves, hence the turf war. granted cardiac surgeons will always be around, but they will need to expand the range of things they do if thye want to thrive. cardio-thoracic surgeons will fare better than straight cardiac surgeons, or straight thoracic surgeons simply because they have an expanded range of procedures.

 

The specialty will always be around. There will still be lots and lots of cases where interventional isn't going to be enough. For example, right now interventionally placed valve replacements leak like sieves compared to surgically placed valves (that's what I understand anyway). While a leaky valve may do the job in a 70 year old who isn't going to be active, it may not be adequate for a 45 year old who still wants to play hockey etc. Plus, surgically they can repair the valves, which I don't believe inteventional can do at this point.

 

Interventional isn't an old system. We're still trying to figure out what it can and can't do vs. Sx as it's relatively new. Over time, the system will correct itself.

 

dont underestimate what sort of innovations IC guys can come up with. IC guys are now doing percutaneous valve repair (valve repair was once thought to be safely in the realm of cardiac surgeons).

 

Just a note, but thoracic and cardiac are separate here for whatever reason - what we might see is a merger of cardiac and vascular or making cardiac a subspecialty of gen Sx again (you can still go that route - no idea how many people do).

 

Anyway, I have a definite interest in cardiac, though I wonder whether it would be too restrictive. As it stands, they do CABGs, valve replacements/repairs, repairs to congenital defects in the pediatric setting, pacemakers, ICDs, and, every now and then, a transplant. That's really about it. Some sort of research program seems to be a must too. Here some of the surgeons also have vascular training and so get into various aneurysms.

 

if you really want to do procedures do cardio, then do a fellowship insay 2 sub fellowships. say EP, or transplant and or IC. this will give you a range in terms of procedures. i know 3 guys who have two subfellowships. one has IC and transplant under his belt. its fair to say his lifestyle sucks, lol, but at least he gets to do procedures.

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Very interesting, thanks. I suppose the plus side is that cardiac, thoracic, and vascular are all still possible fellowships following a gen surg residency. That's a long time to be in residency, but it helps. For myself, I'm interested (without having any experience to speak of!) in surg/critical care. Any insight into that route? (I know there are several here at Dal.)

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Hey, I've been there, too. I wanted to do cardiac surgery and even did a research project, only to be discouraged from going into it by my supervisor. :(

 

I think they cardiac surgeons really missed the boat on this one. They could have fought harder to keep interventional cardiology in their domain. Maybe it was a turf war they didn't want to fight...In Germany, I saw some of the cardiac surgeons do interventional stuff. Oh well, it's too bad how that turned out.

 

As for critical care, I think you can enter it through general surgery, anesthesia or internal medicine. Anesthesia is probably the more humane route, in my opinion. :P

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are there really unemployed cardiac surgeons, or unemployed MDs in general?

 

It is more of a question of where one must go to find a job. If you have to go to Des Moines Iowa to find a job, then sure you are employed, but you may not be where you want to be.

 

There are few places in Canada that Cardiac Surgeons can work (essentially tertiary care centers) and if they aren't hiring, then yeah, if you want to stay in the country, you may not be working in your field.

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Not really. My impression is that a community cardiologist could stabilize someone with an acute MI or unstable angina, and then refer them to the main centre for a CABG if necessary. In Nova Scotia, I don't think there are any cardiac surgeons outside the QEII/IWK in Halifax. Still, any major referring centre will have a few, so even though Saint John is not a "big city" really, it has a few cardiac surgeons.

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aren't cardiac surgeons needed in non-big city areas too?

 

They are, but I believe that the major limiting factor is that smaller non-tertiary care hospitals are generally not equipped to handle major cardiovascular cases. In other words, they just don't have the machines or the manpower.

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Thanks guys for ur answers. In fact, Ill be honest with u, m REALLY REALLY disappointed!! Im not a med student yet, was decided to become one next year, but i was shocked to read about cardiac surgeons situation! This specialty was the only reason why i would choose med school! and now, m reconsiderin my choices.:confused:

 

Cardiac surgery is the only reason you would go to med school?!

 

No offense, but there are a lot of other surgical specialties that you might want to look at. What exactly attracts you to cardiac surgery? I dare say that other specialties will also offer these attractive qualities. Don't get me wrong, I personally think cardiac surgery is great, but it's not the only great surgical specialty. You might want to look into vascular and/or thoracic surgery (and many others). And if you go to med school, don't be surprised if you change your mind after your experiences broaden.

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Guest copacetic
are there really unemployed cardiac surgeons, or unemployed MDs in general?

 

of course, simply because you have an MD doesnt mean you'll always have a job. just talk to al the umteen thousands of immigrant MDs who are dribing cabs, and what not. wasted talent. politics, protectionism, economics call it what you will. same applies to mds trained in north america. having an MD simply means you're less at risk that everybody else, but it doesnt mean you will always have a job. there is an old saying that goes 'physians are collectively the richest and the poorest group of citizens'.

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Guest copacetic
aren't cardiac surgeons needed in non-big city areas too?

 

They are, but I believe that the major limiting factor is that smaller non-tertiary care hospitals are generally not equipped to handle major cardiovascular cases. In other words, they just don't have the machines or the manpower.

 

well cardiac surgeons are not so much needed in big cities, so much as big cities are really the only place they can practice. you have to understand that with evey medical specialty you need a critical mass of patients in order to support that specialty. granted, many people will eventually have some sort of heart issue, but the heart issue they will/might have may not be of the nature or sort that a cardiac surgeon would handle. thus a certain amount of cases are required in order to sustain the activity of a cardiac surgeon. this means, youll need a certain population level, or catchment area with a certain population level. hence cardiac surgeons can really only practice in big metropolitan centres/areas. there is also the funding issue. cardiac surgery is amoungst the most resource intensive specialties out there, and youll need certain tools etc in order to practice. ORs, nurses, equipment etc. human resources will especially be limiting in canada (due to the publicly funded nature of our health care system). you're not gonna have the manpower resources to do all the fancy surgeries and what not in a smaller town.

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Guest copacetic
Hey, I've been there, too. I wanted to do cardiac surgery and even did a research project, only to be discouraged from going into it by my supervisor. :(

 

I think they cardiac surgeons really missed the boat on this one. They could have fought harder to keep interventional cardiology in their domain. Maybe it was a turf war they didn't want to fight...In Germany, I saw some of the cardiac surgeons do interventional stuff. Oh well, it's too bad how that turned out.

 

As for critical care, I think you can enter it through general surgery, anesthesia or internal medicine. Anesthesia is probably the more humane route, in my opinion. :P

 

cardiac surgeons really have no one to blame for themselves for allowing the scope of their practice to diminish. when Grüntzig came over from europe with his work on percutaneous intervention, they pretty much scuffed at him. granted, it was a young and unreliable technology, and CT surgeons being a naturally conservatively minded group were not as big on innovation as they should have been. cardiologists came by, and really built on Grüntzigs and other peoples work and came up with alot of procedures to help patients. som 40 odd years ago, people would scuff at you if you said you wanted to be a cardiologist. namely because there was so little that cardiologists had to help patients with. they all of 3 medications, and their scope of practice was limited. but they innovated, and diversified and are not widely regarded for their innovations. they came to essentially control the heart patients, and have become a sort of one stop shop. it sad really, now CT surgeons are left standing around as back up to IC guys in the cath lab in case something goes wrong.

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What's especially interesting how other surgical specialties have more easily adapted to endoscopic or percutaneous procedures - urology, for example, or laparoscopic techniques in gen surg. The cardiac and vascular surgeons just failed to adapt (though in Halifax, anyway, my understanding is that it's the interventional radiologists rather than cardiologists doing a lot of the work).

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Guest copacetic
What's especially interesting how other surgical specialties have more easily adapted to endoscopic or percutaneous procedures - urology, for example, or laparoscopic techniques in gen surg. The cardiac and vascular surgeons just failed to adapt (though in Halifax, anyway, my understanding is that it's the interventional radiologists rather than cardiologists doing a lot of the work).

the point about the laproscopic stuff is a good one. personally i forsee an oppurtunity for CT guys to regain some of the initiative by using more robotics and minimally invasive techniques. this would make CT surgery less risky, and more appealing off an option. they would regain some of their patient population this way, not much, but definetly some, and its a start. and robotics is not something i forsee cardiologists taking over any time soon since robotics is still used for surgery, and cardiologists are not trained as surgeons. the closes thing to surgery that a cardiologist will get to is implanting a cardioverter defibrillator device or pacemaker in a petient. ultimately the issue here is that the cardiologists now control, and will (for the forseable future future) control the management of heart patients. this is not to say that CT surgeons are done with. theyw ill alway have a place, and they always be well compensated for it (just not like before). also many CT guys WILL be retiring soon, and many programs have bee underfilled for the last couple of years so jobs should be opening up on a 10-15 year horizon. for someone who is entering med school now, or is in med school now, that places them in a good position to pick up one of these job oppurtunities as they open up when they finish their training.

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  • 6 months later...

Interesting article regarding this that I read recently.

 

http://circ.ahajournals.org/cgi/content/abstract/circulationaha;120/6/488

 

From some of the studies I have been reading like CABG vs stents it seems that cardiac surgeons still have a role. I think that maybe innovation is picking up too with stuff like MICS CABG (http://circ.ahajournals.org/cgi/content/abstract/120/11_suppl_1/S78).

 

 

I am definitely not dismissing this specialty quickly; I think in 10 years, when most of us could actually be certified in this, things may have changed. In 20-30 years, who knows what will have happened.

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  • 3 weeks later...
  • 2 weeks later...
Guest copacetic
Very interesting. Thanks for posting. Some of it is a bit different in Canada, but informative nonetheless.

 

dh

 

other than the training whats that different?

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