HPB

[Roark10]

What's up Surg folk!

I recently matched into general surgery and am procrastinating the on-boarding process by looking ahead 5-7 years down the road. I know this topic has been brought up a couple of times - but most threads seem either old or not clear.

- Is it feasible to go into HPB surgery straight from general surgery? From what I've read on the limited information here and this study (https://www.hpbonline.org/article/S1365-182X(16)00054-X/pdf ) it seems so. I understand some of the super-fellowship type programs are more tailored to the large, complicated procedures (whipples, large liver cases etc.) but there are more minimally invasive techniques stressed at some programs. I also read on here how this fellowship makes the most sense when already having a job lined up.

- If it is feasible, how competitive is an HPB fellowship? And how would you go about making yourself competitive with just a general surgery background and no surg onc/transplant fellowship?


Thank you very much for all of your help!

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[mikeGR]

Welcome to the family Roark

First of all, it is very likely that you will change your mind regarding future fellowship during residency (and that's okay).

In terms of HPB training, you can look at this (and the refs), as well as prior topics here like this and this.

Briefly, for HPB training, there are 3 routes:
1) Straight HPB (AHPBA accreditation): 15 programs in North America (list here), 1 position each, 1 or 2 years long.
2) Surg Onc / HPB (SSO + AHPBA accreditation): 5 programs in North America (MSKCC, Hopkins, ?Pittsburgh, Louisville, Toronto), 1 position each, 2 years long.
3) Transplant / HPB (ASTS + AHPBA accreditation): Two more programs (Wash U and Toronto), a few more spots, usually 2 years long.

In terms of the job market, there are <5 prestigious academic HPB job openings per year, and more community and hybrid jobs. All of the above grads, as well as most straight surg onc and transplant grads will likely compete for these HPB jobs. So, overall, the market is fairly saturated for HPB. As a concept, dual SSO/AHPBA grads usually do a mix of HPB and surg onc, ASTS/AHPBA grads do a mix of HPB and transplant, and straight AHPBA grads do a mix of HPB and gen surg.

In terms of competitiveness, in very general terms, I would think it's SSO > HPB > transplant. The prestigious HPB programs, regardless of the track, are very competitive. In the last match 0/33 of SSO and 13/59 of ASTS programs went unfilled. Almost all SSO applicants have dedicated research time during residency and variable number/quality of publications.

I can answer any questions you may have about the surgonc/HPB track specifically but I don't know that much about straight HPB and transplant/HPB.