I can see how you might be confused. The body part of the day is the SI joint, a joint I have an intimate familiarity with. Apparently we are barely able to walk.

sebBo, forget about the routine CABG. Ain't no such thing anymore. "The golden age of C-V surgery has past." You can write that down on a plaque (pun intended!). Unless you are talking about pediatrics and congenital stuff, C-V surgery is not a growing field. With all the medical treatment/angioplasty/stenting going on, the routine CABG has changed from a 50-something year old, good ventricular function, often without MI, to 75+ year olds, with impaired LV function, crappy anastomosis sites, and declining reimbursement. Pile on the endocrine/lung/renal/ppp(piss-poor-protoplasm) problems in this geriatric age group, and it ain't no picnic.

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Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)

I would say yes and no.

CT surgery has to evolve or die for sure. However with the advent of minimally invasive surgeries using robots you might see the advent of new surgical techniques... I agree that it is definately not growing though...

CT surg will never die for several reasons though

1. There is no pill that will cure a bullet wound... Shot through the chest? gotta open it... For that matter blunt thoracic injury with parenchymal injury... (ever heard of a steering wheel to the chest?)

2. Iatrogenic thoracic surgery. As the variety of cardiological interventions increase, by statistics this will increase the number of iatrogenic damage which requires surgical intervention.

Hopefully we will eventually graduate to an in house nighthawk system. Outsourcing would break us...we are doing upwards of 70 cross sectional imaging studies per night on a bad night plus a few hundred plain films to boot...without PACS...makes for a really crappy week. Every shad gets a head-toe CT on the Alpha traumas and PE protocols and Renal stone hunts have become the bread and butter of call (probably 90% gratis to boot).

I signed up with a few headhunters because I am tired of the absolutely brutal and never ending call we have and have finally decide, pending a miracle, that going through another damned partnership track is preferable to continuing like this....haven't been on my bike in nearly a year other than the 1.5 mile ride to work........unfortunately I am finding there are lots of jobs out there, but not a lot of 'good' jobs. I have even gotten to the point of looking at a telerad group, just so my training won't go to waste.

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That is just one more group of people that should be thrown screaming from a helicopter- George Carlin

[reply]CT Fellowship: smart move. Hicks did my dad's CABG while I was at U of R Med in '93. Plus the P3s would just be the tip of the iceberg.

The other avenue to consider from GS is Plastics. Very cool specialty. I did a lot of plastics stuff in the ER during residency, and I really enjoyed it.

The true tragedy about the MRI our training partner is getting tomorrow is that I can't say with 100% certainty which body part he wants to look at. He's got a few injury irons in the fire. Maybe he needs to have one of the brain.[/reply]

actually i could picture myself in 3 areas of surgery:
- bread and butter cardiac surgery (will never die, is just not as pleasurable as it used to be)
- congenital heart surgery (didn't get the chance to try that yet)
- plastics especially cleft kids - i wouldn't want to be one of those beverly hills pseudo doctors, injecting collagen in 120 year old lips to make them look like 110.

did you do your residency at u of r?

CT surgery and CV surgery are different. CV is declining, and will continue to do so. Zeus Robotics notwithstanding. Remember Heartport? That died out mostly too. Sure, some people will buy a million-dollar robot and play around with it. At the end of the day, this will just be a passing fad, too. I've seen this stuff, I've done this stuff, I've never seen anything as good as the direct vision, decompressed and unmoving ventricle, bloodless and still site distal anastamosis...and thats done with conventional cardiopulmonary bypass. Sure, it can be done other ways. Minimimally invasive without the robot is a heck of a lot less costly, with similar results. Sure, the proximal "no-stitch" anastamosis techniques are coming along nicely. The distals...they're another story. Believe me, the golden age of CV surgery has come and gone. By golden age, I mean where the CV surgeon was a major force, had the choice of decently healthy patients, and was making big money. None of those three things are true today...and they won't be true in the future...just ask one of them.

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Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)

AHH, the SI joint. Those get better on their own. In about a year.

Reading this thread, we sound like a bunch of miserable whiners. Then again, I guess the shoe fits. On the whole, medicine is just not the profession it used to be. Our only true obligation is to change our approaches to match the current trends...like Slick going with the NightHawk group (good move, slick). At GR this morning I heard a Trauma guy from Illinois talk about how his med center has begun delaying primary formal debridement of open fractures until the next day...so everyone can be well-rested! Ten years ago that was flagrant malpractice, and now there are studies and papers defending it, all initiated in the name of improving physician quality of life. This is the changing idiom of 21st century medicine.

My uncle (also a U of R grad) was a CT surgeon, and chairman of surgery here for years. I asked him how residency is different today, and he sort of shrugged vacantly and said "Well...they go home to their families. We never did that." A telling comment, but not a bad trend - especially for those of us with other interests.

I never had the patience nor the big brainbox for CT or vascular. Gen Surg? Sorry, but never ever ever. Ortho is perfect for me (BBMF: "Bone broke - me fix.") If not that, then I would've done Plastics, INCLUDING all the cosmetic stuff, because 1.) it's cool, and fun to see what you can do, and 2.) the reimbursement is killer.

I went to UR Med and then Dartmouth for residency. I stopped in at Strong last year and just plain didn't recognize the place. Plus, Roch has a great running/cycling/triathlon community. I used to run a little with the Hash House Harriers there, and cut my teeth on the bike with the GVCC. Great town, and great hospital.