Cardiothoracic surgery vs. Interventional Cardiology

[XWISBU]

I have been interested in CT surgery for sometime but have often heard the theory that the subspecialty is dying. I was wondering how people in the field of cardiology feel about that theory since they seem to be the ones that take up what used to define CT surgery (CABG replace by PCTA). I don't understand how a specialty as critical as CT surgery could be replaced/eliminated. Any opinions would be appreciated. Thanks.

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[spyyder]

Interventional procedures have kept patients out of the OR by doing procedures that "intervene" before surgyer is needed. You keep the patient out of the OR, the surgeons got no work. Surgery is now a last resort treament and not like it was many years ago, as the only treament. Not hardly out of work, but not as lucrative as it once was, especially considering the lenght of training.

 

[tito8512]

its true wat u say about ct surgery bein the last resortfor treatment,but the time of training is the same as interventional cardiology.But i do think that ct surgery will always be needed,i dont c it as a specialty that will be eliminated.

 

[chanx314]

How did interventional procedures such as angioplasty end up in the cardiologist's domain in the first place? How does stuff like that get decided?

 

[spyyder]

because cardiology has control over cards patients, not radiology. run a search very well discussed

 

[chanx314]

I searched but couldn't find anything, what search words should I use, or where are these threads

 

[novacek88]

because cardiology has control over cards patients, not radiology. run a search very well discussed

I think he meant why did the cardiologists get control over the interventional procedures versus CT surgeons?

The reason why CT surgery is no longer in demand is due to many reasons

1. the answer above; cardiologists are performing so many interventional procedures that patients do not regress to the point that they require the services of a CT surgeon. Thus, the demand for CT surgery has dropped by nearly half in the past 2 decades

2. Many cardiology groups now employ CT surgeons and they will often make less than the cardiologists in that particular groups because they see less volume and basically wait for their cardilogist colleagues to refer patients to them.

3. Tough to find jobs; If you are interested in working in a somewhat popular large metropolitan city, you will have a difficult time finding a position after graduating from CT fellowship.

4. Reduced prestige: In the 80's, CT surgeons were almost celebrities. Now, the best general surery residents would rather go into plastics or bariatric fellowships where the $$$ is. Also, the general public can't distinguish between a CT surgeon and a cardiologist. They assume they are the same thing.

5. Training: It may take the same number of years to become a CT surgeon as an interventional cardiologist but the path to become a CT surgeon is far worse in regards to lifestyle. 5 years of general surgery is torture. IM residency isn't that bad especially the second and third year. You will have 3 or 4 bad call months a year but otherwise you will have regular hours. In general surgery, every month is like the worst IM call month and that's being generous.

 

[chanx314]

Yes that is what I meant, why did cardiologists get interventional procedures and not CT surgeons, since interventional procedures are actually surgery although minor surgery. But anyway, how does stuff life that, or what specialty gets to use what machine(i.e. nuclear stress tests for cardio, why didn't rads get that)?

 

[novacek88]

Yes that is what I meant, why did cardiologists get interventional procedures and not CT surgeons, since interventional procedures are actually surgery although minor surgery. But anyway, how does stuff life that, or what specialty gets to use what machine(i.e. nuclear stress tests for cardio, why didn't rads get that)?

Rads doe have nuclear stress tests. It depends on the hospital and it's political establishments as to what group does what. Rads and Cards are also fighting over who gets to read CT angiograms etc. There is a turf war.

 

[threepeas]

Yes that is what I meant, why did cardiologists get interventional procedures and not CT surgeons, since interventional procedures are actually surgery although minor surgery. But anyway, how does stuff life that, or what specialty gets to use what machine(i.e. nuclear stress tests for cardio, why didn't rads get that)?

cardiologists "own" the patient. the only reason anyone else (CT surgeon, radiologist) would see a cards patient is if it is referred by the cardiologist. It would be foolish for the cards community to refer patients for proceedures they can do themselves. FM/IM refer to cards (the gatekeepers), then cards refers further if necessary. it is a great position to be in and is what gives them so much power.

 

[medstud2006]

my understanding, admittedly limited, was that CABG is still the only procedure definitely shown to prolong life (stents etc reduced symptoms and limit inpatient days, but don't replace surgery). i would think that with an aging, overweight population that no CT is going to go hungry. (or cardiologist for that matter!).


ssssooo. do what you want to do. i have read similar threads on this forum regarding the concern that cardiologists would soon become endangered. riiiiiiiiiiiiiiiiiiiight.

 

[Noyac]

Its true that the number of CT cases is diminishing but there are still plenty of cases and interventional cards can't replace a valve as of yet. Ct surgeons also do chest cases like pneumonectomies, aortic arch repairs, etc. They will continue to find have cases even if cards eliminates CABG's. But there are lesions that can't be stented due to location and or numbers of lesions. So don't worry about the CT surgeons not having enough work.

 

[Saabdriver]

Actually several centers in the US and Canada are involved in a study doing percutaneous retrograde aortic valve replacements in patients with severe aortic stenosis and prohibitively high surgical risk. Interventional cardiologists are already replacing valves.

 

[viostorm]

I think there will always be room for CT surgeons, but not like the hay days of the 80's and early 90's where everyone was getting a CABG with AMI. No way a cardiologist will be a one stop shop for everything to do with the heart.

Bad triple vessel disease still requires CABG and heart transplants will always be done by surgeons.

 

[alpist]

ooıuo

 

[desktop35]

i am thinking about going into interventional cardiology but am wondering if those doctors ever have time to run their own clinic. Does anyone know how much time is spent in the hospital and how much time could be spent in a clinic?

 

[howelljolly]

i am thinking about going into interventional cardiology but am wondering if those doctors ever have time to run their own clinic. Does anyone know how much time is spent in the hospital and how much time could be spent in a clinic?

If by 'clinic' you mean an outpatient practice....

Your job is based out of your group practice, which has privileges to use the hospital, and cath lab... its not based out of the hospital itself.

Unless your cardiology group practice is set up otherwise, you'll probably have regular office hours, you'll go to see your inpatients before and after the office hours. And you'll have a day or two each week where you're in the hospital doing interventions on any of your patients which require them.

 

[J-Rad]

This only focuses on one half of the original question (sort of) but if you have a passion for CT surg, pediatric CT surgery will probably never be usurped by interventional procedures (there are SOME things that are more commonly done in the peds cath lab now and there are now some hybrid procedures, but some things will likely never be able to be done out of the OR). Something to think about. I highly doubt the pay is shabby in peds CT surg either.

 

[copacetic]

this is just speculation, but what i would like to see is for cards to become its own direct entry program, and have CT become a fellowship of cards (like interventional, or ep, or heart failure etc. is now). what do you guys think?

 

[howelljolly]

this is just speculation, but what i would like to see is for cards to become its own direct entry program, and have CT become a fellowship of cards (like interventional, or ep, or heart failure etc. is now). what do you guys think?

never in a billion years... on the first point
thats the most outrageous thing ive ever heard... on the second.

The key to being a cardiologist is being a good internist.
The key to being a CT surgeon, is being a good general surgoen.

How can you learn to manage a patient with a cardiac condition with the experience and skill above and beyond the level of an internist, when you cant even manage such a patient at the same level as an internist?

How can you be a CT surgeon if you dont know the first thing about surgical techniques, basics like how to create an anastomosis, or removing part of an organ without killing the patient (did you forget that CT is heart lung, and everything in the thorax?), or hemostasis, specific surgical procedures, opening and closing, using laparoscopes.....

 

[FatPigeon]

this is just speculation, but what i would like to see is for cards to become its own direct entry program, and have CT become a fellowship of cards (like interventional, or ep, or heart failure etc. is now). what do you guys think?

You won't understand until you're a third-year medical student. CT surgery is truly the pinnacle of surgery, requiring every bit of the 5 years of general surgery training inherent within the established route. The three years of training in surgery you're suggesting would allow for a mastery of (1st year) management of perioperative patients on the floor, (2nd year) confident suturing, tying, and pre/post-operative management, and (3rd year) actual dissection of structures and a decent level of comfort with some common instruments and techniques involved in an operation. Third-year residents, for whom I have an enormous amount of respect, are, frankly, probably at about the level of simple hernia repair....after having worked about 100 hours per week for 3 years. You want these people to do cardiac surgery? Think about it...

 

[copacetic]

lol, relax guys its just a thought. obviously i havnt starte M1 yet (wont be till july or so), but its great to see the passionate responses

 

[doc20]

this is just speculation, but what i would like to see is for cards to become its own direct entry program, and have CT become a fellowship of cards (like interventional, or ep, or heart failure etc. is now). what do you guys think?

pre-meds should be banned on making speculation on fellowships thread!
comeon people before posting think twice - am I going to look a ****** posting this question?
CT surgery after direct entry cardio program - you made my day

 

[howelljolly]

You won't understand until you're a third-year medical student. CT surgery is truly the pinnacle of surgery, requiring every bit of the 5 years of general surgery training inherent within the established route. The three years of training in surgery you're suggesting would allow for a mastery of (1st year) management of perioperative patients on the floor, (2nd year) confident suturing, tying, and pre/post-operative management, and (3rd year) actual dissection of structures and a decent level of comfort with some common instruments and techniques involved in an operation. Third-year residents, for whom I have an enormous amount of respect, are, frankly, probably at about the level of simple hernia repair....after having worked about 100 hours per week for 3 years. You want these people to do cardiac surgery? Think about it...

I think the poster was suggesting CT as a fellowship of Cardiology, as opposed to General Surgery... i.e. no prior surgery training at all.

 

[dragonfly99]

Agree with above comments.
That suggestion is ridiculous on its face.
Agree the key to being a good cardiologist is being a good internist, and the key to being a good subspecialty surgeon is having solid foundations in principles of general surgery.

There has been talk of potentially shaving a year off of traditional general surg. + cardiothoracic surg. pathway, by having a direct entry into an integrated general surg/cardiothoracic surgery residency from medical school, from what I hear. This would mean the program would take responsibility for training you in general surgical skills and then seamlessly integrating this with the CT surgery fellowship-type years. However, with the new work hours limits I don't know if this is happening, or will happen, vs. not.

 

[howelljolly]

hey leave New York out of this.

 

[FatPigeon]

I wouldn't be too surprised to see vascular surgeons eventually in worse shape than CT surgeons, since there will always at least be SOME procedures that require an open approach, but nearly ALL of what vascular surgeons do could theoretically be solved by some crazy intravascular minimally-invasive technique.

Of course, vascular surgery programs are trying to integrate all of this into their training but, as mentioned earlier, what incentive will cardiologists have to refer the patient? Given the high rate of MI among pts with peripheral vascular disease, I think everyone will be in agreement that the patient should stay under the wing of cardiologist if at all possible.

 

[doctor712]

Actually several centers in the US and Canada are involved in a study doing percutaneous retrograde aortic valve replacements in patients with severe aortic stenosis and prohibitively high surgical risk. Interventional cardiologists are already replacing valves.

And I work at one such center on the very trial you are referring to.
It's truly amazing technology!

D712

 

[Hulkpayne]

Who decides that these so called interventional procedures will be done by a Cardiologist and NOT by a Cardiothoracic Surgeon???.....Shouldn't this field go to the CTS?...I mean it is an Invasive procedure and call it whatever you want, it is simply a type of "Surgery"...and "Surgeons" should be the right people to do it!....Who decided to give this in the hands of the Cardiologist?

 

[Instatewaiter]

.

 

[Instatewaiter]

Who decides that these so called interventional procedures will be done by a Cardiologist and NOT by a Cardiothoracic Surgeon???.....Shouldn't this field go to the CTS?...I mean it is an Invasive procedure and call it whatever you want, it is simply a type of "Surgery"...and "Surgeons" should be the right people to do it!....Who decided to give this in the hands of the Cardiologist?

U mad?

 

[gutonc]

Who decides that these so called interventional procedures will be done by a Cardiologist and NOT by a Cardiothoracic Surgeon???.....Shouldn't this field go to the CTS?...I mean it is an Invasive procedure and call it whatever you want, it is simply a type of "Surgery"...and "Surgeons" should be the right people to do it!....Who decided to give this in the hands of the Cardiologist?

The most disappointing thing about this post is that now we're going to have to wait for your 2nd post before we get the cheap viagra/free porn spam you meant to include in your sig.

Bad spammer....no donut.

 

[hellomd2]

I'd like to ask a legitimate question, if that's alright - if one prefers the more hands on aspects of dealing with cardiovascular disease, which of these two fields would be more rewarding? I don't quite see it as black and white (but perhaps that's down to MSIIi inexperience).

Would someone interested in more hands on work, given the state of CTS, be advised to do interventional cardiology?

Any insight would be much appreciated!

 

[infarct]

I'd like to ask a legitimate question, if that's alright - if one prefers the more hands on aspects of dealing with cardiovascular disease, which of these two fields would be more rewarding? I don't quite see it as black and white (but perhaps that's down to MSIIi inexperience).

Would someone interested in more hands on work, given the state of CTS, be advised to do interventional cardiology?

Any insight would be much appreciated!

no...IC is not surgery. Do surgery if you want to be a surgeon. There are plenty of other fields on surgery that arent on the down swing.