Competition for sub-specialties

[Guest Kirsteen]

Hi there,

 

Hopefully I'll be fortunate to enter a medical program this September and with some positive thinking in mind, I've been having a look at different career paths. There are a few that interest me at the moment, some of which involve sub-specializing once within a general surgery (vascular and cardiac) or internal medicine (cardiology) program. I have a couple of questions with respect to this that on which I'm hoping some of you seasoned folks can provide some illumination:

 

1) How does the application process work when you move from a general residency to a more specific one? That is, can you only move to a sub-specialty residency at the location where you are undertaking your general residency? Is the application cycle annual, i.e., it occurs once per year? Also, who generally caretakes this application process?

2) With respect to competition, how fierce is it to enter these careers? Are there many folks applying for these positions each year, and if so, is there some area that houses statistics on that stage of the training process?

 

Cheers,

Kirsteen

[Guest Lorae]

Hey Kirsteen!

 

Cardiac surgery is a "direct entry" surgical program. You no longer start out in general surgery then apply and move into cardiac. You just match right into cardiac surgery through CARMS. I'm think there are still opportunities for general surgeons to sub-specialize into cardiac surgery (a.k.a. "the old way") but I'm not sure what the process is.

 

As far as the rest of your question, I am also interested in hearing the answer as I am interested in several sub-specialties.

 

Hope that helps.

[Guest moo]

I don't know about Canada, but in the US cardiac surgery is a fellowship completed after a general surgery residency. There is no match for this particular field and one just contacts the programs directly.

 

For cardiology, this is a three year fellowship following a medicine residency, in both Canada and the US. (Canada's internal medicine residency program is 4 years but I believe you apply out after 3 years. In the US, a general internal medicine residency program is 3 years.) In the US, about 70% of ACGME-approved programs are available through the NRMP Specialty Match. I would imagine the process would be similar in Canada.

[Guest therealcrackers]

For medicine subspecialties, including cardiology, there is a "match" that happens after the PGY-3 year... most of the information actually gets handed in during the fall of that year, and then there are interviews and interviews...

 

A general cardiology program exists that is usually a 2-year fellowship; I think it is 3 years at some of the more research intensive schools. There are also additional fellowships of 1 to 2 years in echocardiography, interventional cardiology, and electrophysiology after the general cardiology.

 

Thoracics is a PGY-6 and PGY-7 fellowship after general surgery, with mandatory training in cardiac surgery (6 months) and ICU (at least 3 months) over those two years.

 

Cardiac surgery is a PGY-6 program (I think --- somebody correct me!) that is direct entry from medical school --- at present there are single spots at 7 programs across the country, Toronto, UBC, UWO, McGill, and three others I can't remember but someone will.