so are pediatric cardiac surgeons the top of the surgical hierarchy?

[Baby Boy]

Oh my Gawd!! Can we pleeeease end this thread? Who gives a rat's ass about pediatric CT surgeons? Every time I see this on the Surgery & Surgical Subspecialties area, it's like, please shoot me in the head. Flip the script please.

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[45408]

I don't think we are saying anything different.

I was just adding my experience.

 

[Black Surgeon]

Who gives a rat's ass about pediatric CT surgeons?

I do! It doesn't get much more "badass" than ped CT surgery.

Please shoot me.

well, if you insist....

 

[JackADeli]

...Between 1993-1995 in New York state, almost 2/3 of the surgeons who performed pediatric cardiac procedures did <75 cases...

In New York, between 2002 and 2005, there were 4 hospitals with <50 cases (low volume); another 4 hospitals with 100-300 cases (moderate volume); 5 with 300-700 cases (high volume); and 1 with >700 cases (1807 total = ridiculous volume)...

...with numbers, you can read whatever you want into them...

...few surgeons out there who do "part-time" congenital cases. ...these part-timers only do the easy cases- asd, vsd, coarct ...most of the complex cases gravitate to bigger centers which offer the ultimate fix for congenital heart ailments-...

I think both quotes go together.... Yes, it is how you read into the numbers....

This my take on the numbers. You can call it low volume "centers" and/or "part time" surgeons.... Often one and the same. But, you can have "high volume" centers with "low volume" surgeons.... Look at some of the major names that brag about their volumes. Not necessarily congenital example, they list >2100 cases per year. Let's presume it is general surgery. You look closely and they have 13 attending surgeons! That leaves around 150 cases each per year. Those 150 cases do not represent all colectomies and whipples or nissens.... That volume however does help to keep the support staff experienced and skilled. While, the individual surgeon's hands on "practice" is limited.

So, let's go to a 50 cases per year "center"/hospital. Neither the surgeon nor the staff are regularly experienced. I dare say, as noted by ESU, they are doing straightforward and easy stuff.... probably very little on-pump stuff. They are doing simple coarcs and ligations of PDAs. They may do some larger "kids" PFO closures. But, if they are doing any of the minor congenital that requires on pump, it has to be at a place that at least has more then 50 cases per year basic adult on-pump. Thus, they dabble in the simple off-pump congenital.

I suspect, most if not all congenital heart surgeons would argue these community folks doing PDAs and coarcs are not "true" congenital. In all honesty, a PDA ligation or coarct repair is within the realm of capacity of quite a few pediatric GENERAL surgeons.

So, it's in the numbers and would be interested in seeing what those <50yr places were doing.... I suspect cherry picking.

 

[Smurfette]

Agreed. The general peds surgeons do the PDA ligations at my program (they're pretty simple, I've done a couple)...but not coarcts or anything directly involving congenital heart defects...those get sent to a peds CT. That and neurosurg stuff are the only things they don't do.

Also, you can do peds CT through the peds surgery route...so some of the places with high volumes for the surgeons may represent all their cases, not just congenital heart stuff...also, all the line access stuff (broviacs) can really add up.

 

[Flank Pain]

I think peds surgery is just really really neat. I am also really interested in global health and the undeserved, in fact I almost went into family medicine. What is the call schedule at this program?

 

[Winged Scapula]

I think peds surgery is just really really neat. I am also really interested in global health and the undeserved,

For some reason I found your (presumed) typo quite amusing.

What is the call schedule at this program?

Call schedules vary by program and by rotation, not by specialty. But in my residency, the pediatric surgeons had the most add on, after hours cases than any other specialty - kids were always sticking things up their noses, down their throats, and ending up in the OR. Pediatric surgery is not a lifestyle specialty.

 

[beefballs]

I think he was being sarcastic

 

[Winged Scapula]

I think he was being sarcastic

Meh.

You're probably right...long day and I'm doped up on Tylenol PM so my wits aren't quite as sharp as usual.

 

[PoetMD]

Coupla things:

Regarding length of training- that will change with the 6 year programs up and coming. One can do a Peds CT fellowship following the 6 yr program, with elective time focused on Congenital in the 6th year, if one so desires.

Regarding fellowships- there are like 9 ACGME accredited programs now. And more on the way. But as some have correctly stated already, the big problem is where to find that first job. Despite the fellowship possibilities, there are just very very few jobs out there. And even then, you are like a junior attending for some quite time, taking q2 call (or more!). So it is a big gamble.

Regarding reimbursement- for a while as a junior attng you may be making in the 200-300k's, but it should be stated that if you do finally make it to the senior level there is BIG money. There are so few of these people who REALLY know what to do and have that type of experience that they can make >900k-1mil/yr. But it is a loooong way to that payday, for sure.

Regarding hierarchy- hard to say overall, but in the CT world at least they are extremely well respected

Regarding "innate talent required" - I have heard this too, from various people at various levels of training, but never from an established Peds CT attending. My personal belief: if you can get into a CT fellowship, then accepted by a ped CT fellowship, plus have the desire and dedication necessary than I think its definitely doable.

Regarding Pediatric General Surgery - at my school they'll put kids on ECMO and do some PDA closures, but no coarcts or anything else. Also someone posted earlier that you can do a "congenital heart fellowship after a pediatric general fellowship". This is false, only through a CT fellowship or Integrated CT program can you get near a pedi heart.