Thoracic Surgery as a Specialty

**pilly84** · 08-08-2005, 07:47 PM

Wow! What an empty forum!!!

Let's start a general discussion on thoracic surgery. Anyone considering this as a specialty?

**yeliab_cram** · 15-09-2005, 03:02 AM

hiya pilly! nice to have a blank canvas!

im considering surgery, and thoracics is one i havent ruled out yet - i like the idea of cracking ribs, blood and guts galore. but i havent had the opportunity to see any yet, i have been stuck with thyroid, breast, general and vascular (all of which fun in their own way but none of which really appeal that much!)

Marc (intercalating medic - leeds)

**simac** · 18-09-2005, 11:52 PM

I spent a week shadowing a thoracic surgery team, saw lots of operations. It was pretty good and looked really interesting, but then i've nothing to compare it to.

**little_miss_phonics** · 21-11-2005, 07:28 PM

Hiya,

I am applying to study Medicine this year and to get some unique work experience I went to Berlin and shadowed doctors and surgeons in the Deutsches Herzzentrum (German Heart Institute). My aunt works as a translator there and initially I thought it was just a general hospital and arrived to find that it was actually a really prestigious institute! Couldn't believe my luck. Anyway, I was able to watch open heart surgery every day for 2 weeks which was absolutely fantastic....as well as the 'usual' operations like bypass surgery and valve replacements I saw the implant of a heart assist device and a total artificial heart. I think that it is a fascinating area of surgery to go into although obviously very difficult - all the operations last at least 5 or 6 hours and that is only the basic ones. The surgeons I observed were doing 3 of these a day! If you are going to go into it then I think you have to be extremely motivated and have a huge amount of stamina.

I've got some great photos if anyone is interested. (yes, i was allowed to take pictures!)

Nicola

Email: little_miss_phonics@hotmail.com

**jedherman** · 15-05-2006, 11:39 AM

I'm a bit late jumping into this thread. I work in a radiology dept. and one of our 1st yr radiology registrars used to be a cardiothoracic registrar. He left after his 5th year as he saw no future in it. One of his colleagues has had to retrain in anaesthetics and another held on for 3 more years in the hope that there would be some jobs but then had to give it up too. This is serious. He wouldn't go back to square one if he didn't feel it a must. He said the main problem is cardiologists!! Traditionally cardiologists are 'medical' and the "heart surgery" was done by cardiothoracics who are 'surgical'. That is all good and well, but the introduction of interventional techniques like stenting has meant that open heart surgery is far less common and unfortunately for the cardiothracic guys, stenting and pacemaker insertions etc is all done by cardiologists. This was ultimately their own fault though, as in the 80s the cardio surgeons rejected new technologies such as stents and as a result the cardiologists took it under their wing, and now it has boomed!

He also said that your job would end up being a standby (for bad money)....waiting outside the cath lab in blues just incase something goes tits up, and even then you're dealing with someone else's cock up (who's getting good money)!

So things are looking good for cardiologists huh? Nah-uh, think again! Apparently, the new statins the drug companies are producing are so good at reducing blood cholesterol levels that they even break down atherosclorosis - so the cardiolgists are now underthreat! To add to their trouble CT angiograms provide better results, in less time, for less money and at less risk than interventional angios carried out by cardiologists. Sound like a bitter and twisted story? Maybe, but apparently the Society of Cardiology (or some organisation like that) have changed their name after 85 years to the Society of Cardiology and Vascular Surgery (or something like that!) because they are feeling under threat and are 'poaching' other specialties work!! Carotids are usually neurosurgeons work, kidneys' vessels is renal guys stuff, and the other blood vessels of the body is meant to be the vascular surgeons remit!

I'm only telling you what i've been told so don't get all uptight about it if you think it is a load of bull. As i say though, he wouldn't leave a speciality after 5 yrs as a reg for nothing.

**sweetie-pie** · 15-05-2006, 11:52 AM

This is why they are changing PG training, by managing entry into training programmes a la MMC the aim is that you dont end up with 50 senior registrars with no consulant post in cardiothoracics (which is needed, just not at the level of interest and competition there is now), or 600 SHOs all doing research trying to get registrar training numbers (numbers slightly exaggerated), so after FP the lovely people at MMC are "managing aspirations" to mean they will not end up with people twiddling thumbs waiting for a consultant to die, whilst dermatology, histopathology and other undersubscribed specialites go begging for trainees. it will be interesting.

**hawkeye_pierce** · 26-08-2006, 03:37 PM

At the moment CT surgery is a very unpredictable specialty to be in. There is fierce competition for consultant spots and as far as I know all NTNs have been frozen. However, this may change by the time we become SpRs. Don’t forget that cardiac surgeons will always be needed, just not in as much supply as there is now. Trauma, valve replacement, aneurysm repair, congenital defects, transplantation and surgical treatments for CHF are just some areas that cardiology cannot touch. CABG may only be needed for complex cases, left main stem disease, or following the failure of stenting.

Most junior that I have spoken to have already decided to avoid CT surgery. This means that once equilibrium is reached, new surgeons will be needed to replace the retiring ones and medical students now will be next in line. The demand for the CT surgeon may yet again arise. Arterial conduits have excellent outcomes and don’t forget that a stent is a foreign object and our bodies generally don’t like foreign objects in them.

**Kinkerz** · 04-04-2008, 07:27 PM

Take a look at this:

http://www.mmc.nhs.uk/Docs/st3_specialtysummary.pdf

Competition for Cardiothoracic surgery is very high, 53.2 applicants per place for ST3 training posts in March 2007.
Even the likes of Neurosurgery was 10.2 applicants per place, Cardiology was 15.0 applicants per place and Anaesthetics was 7.0 applicants per place.
So competition for Cardiothoracic is very, very tough!