endovascular without open

[open]

i notice a lot of grad doing endovascular fellowship but not open. Can any senior residents or recent grads comment on how useful/marketable this is for securing a PP/hospital-based practice? Do you have to do both to get an academic job?

[Guest]

Endo training is more important than open at this point for getting a vascular job. It allows you to take stroke call and generally opens up a number of revenue streams for a hospital that an open-only person will not be able to tap into. Given the direction the field is going, it also makes no sense to hire a vascular surgeon without endo training. Open training is still important for complex aneurysms, avms, bypasses, etc, but you simply won’t get referrals if all you have to offer is open surgery.

[Guest]

I think it depends on what you want to do. in my opinion if you're interested in having a vascular neurosurgery practice you should have both open and endo experience... Meaning fellowship in both unless you graduate from a heavy open vascular place. That being said I have met quite a few people who did endo to be almost an ACS type neurosurgeon. Do stroke, trauma, and spine. Their interest in open vascular or vascular in general isn't high, but they are interested in acute care surgery and having their spine practice. Now this isn't for everyone, but it's marketable.

[Guest]

(05-17-2020, 06:49 PM)Guest Wrote: Endo training is more important than open at this point for getting a vascular job. It allows you to take stroke call and generally opens up a number of revenue streams for a hospital that an open-only person will not be able to tap into. Given the direction the field is going, it also makes no sense to hire a vascular surgeon without endo training. Open training is still important for complex aneurysms, avms, bypasses, etc, but you simply won’t get referrals if all you have to offer is open surgery.

I am in practice <5 years, only did open, still get plenty of vascular referrals.  Be good at what you do, regardless of what it is.  Outcomes and reputation matter more in the real world than publications and pedigree.

[Guest]

So you’re clipping the incidental 6 mm pcom in a 70 year-old? The point is that without endo training you can’t offer the standard of care to every patient in this day and age. Sure you can take vascular call and take vascular referrals as part of your overall practice with only open training, but for aspiring med students and young residents if you want to be a CV specialist at an academic institution, you need endo training.

[Guest]

Endo without open is very much a viable career path. As the above poster stated, endovascular specialists are very valuable to hospitals, and can generate significant revenue via Stroke interventions and routine angio.

[Guest]

(05-18-2020, 07:35 AM)Guest Wrote: So you’re clipping the incidental 6 mm pcom in a 70 year-old? The point is that without endo training you can’t offer the standard of care to every patient in this day and age. Sure you can take vascular call and take vascular referrals as part of your overall practice with only open training, but for aspiring med students and young residents if you want to be a CV specialist at an academic institution, you need endo training.

I never said anything of the sort.  I work with NIR for things they treat better, or fail to treat sufficiently.  You are naive if you think endo is taking away open.  Look at the resurgence of CT surgery in the last 5 years as an example of while endo is great, much like your example, when you have a hammer, everything looks like a nail.  There a still a multitude of cases better treated with open vascular.

[Guest]

(05-18-2020, 12:59 AM)Guest Wrote: I think it depends on what you want to do. in my opinion if you're interested in having a vascular neurosurgery practice you should have both open and endo experience... Meaning fellowship in both unless you graduate from a heavy open vascular place. That being said I have met quite a few people who did endo to be almost an ACS type neurosurgeon. Do stroke, trauma, and spine. Their interest in open vascular or vascular in general isn't high, but they are interested in acute care surgery and having their spine practice. Now this isn't for everyone, but it's marketable.

Do you know what percent of each (vascular, spine, trauma) these people generally do?

[Guest]

Endo is not eliminating open, but most academic vascular practices are 70-80% endo unless you’re Lawton, and someone fresh out of training is going to have a tough time replicating that. All things being equal patients will prefer endovascular options, that is just reality. The point is that if vascular is what you want to do, you are seriously limiting your marketability without endo training.

[Guest]

(05-18-2020, 09:11 AM)Guest Wrote:

(05-18-2020, 07:35 AM)Guest Wrote: So you’re clipping the incidental 6 mm pcom in a 70 year-old? The point is that without endo training you can’t offer the standard of care to every patient in this day and age. Sure you can take vascular call and take vascular referrals as part of your overall practice with only open training, but for aspiring med students and young residents if you want to be a CV specialist at an academic institution, you need endo training.

I never said anything of the sort.  I work with NIR for things they treat better, or fail to treat sufficiently.  You are naive if you think endo is taking away open.  Look at the resurgence of CT surgery in the last 5 years as an example of while endo is great, much like your example, when you have a hammer, everything looks like a nail.  There a still a multitude of cases better treated with open vascular.

that hammer is becoming fine tuned day. yes, there are endovascular people out there who shouldn't be doing certain things, but open only is a dying art. i agree that there are still cases that are better managed open, no doubt. but to say that for vascular interest and have no interest in endo (plenty of people do) is unfortunately, quite naive. now if you're dual trained, you have what neurologists or radiologists cannot offer, and that is enticing to hospitals.