Why do so few people apply for Cardiothoracic Surgery and Neurosurgery?

Is the only reason so few FY2s apply for cardiothoracic surgery and/or neurosurgery, in comparison to other specialities, because of the small number of training posts available in the UK?

Probably - look at the competition ratios, even though there are few people applying the competition is huge.

They are also very niche specialities insofar as you need to know from very early on in your medical school career (realistically for those competition ratios) that you definitely want to be a neurosurgeon - I guess most people wouldn't, and instead go down a general medical/surgical route instead.



On the whole, most likely, yeh.



Specialities like cardiothoracics and neurosurgery aren't the bread and butter of medicine - compare with GP. There isn't a lack of either, as far as I know, and this is purely due to demand. These two specialities are confined to large hospitals - most little DGHs won't have cardiothoracic or neurosurgery departments, it's incredibly specific and not very cost effective. 8 at each level (with 8 levels) means there's 64 in training, not counting all of those in career grade posts, at consultant level, research, etc. That's quite a lot for such a niche specialty bearing in mind that only one hospital per region will have such a department.

e: http://www.sbns.org.uk/files/8113/3545/4150/Neurosurgical_Units.pdf Only 37 hospitals have neurosurgery departments - not very many. Quite a few on that list are more specific (e.g. paeds neurosurgery) which would probably not be counted in that training number. There's around 500 hospitals in the UK in total.

Might also worth considering the lifestyle of a trainee surgeon in those specialities. Many doctors want a good work life balance. I once asked the same question to another doctor who told me that her friend is doing surgery and pretty much works 7 days a week, I don't know If this is the norm though.

If the online testimonies are to be believed, surgical residents (particularly in the two specialities I mentioned) in the US can be expected to work 100+ hour weeks for 6-8 years.

Yeah but the USA is generally like that i think, they don't have a EU working time directive. Equally their training is shorter than ours so maybe they do more in less time, they don't do foundation years either, Here training in those specialities could take 8+ years after F1/F2 if you pass each consecutive year. I know surgeons work a lot in the UK still as most specialities but im not sure if they work 100+ any more.

Also worth nothing is that the pay for those two specialities is probably similar to another consultant in a different one (im not 100% sure though). So a lot of medics may just opt for a different speciality and still get similar pay, where as in the US im sure Neurosurgeons can earn far more than some specialities.

Although plenty of applicants think they want to save the world and do either CT or neurosurgery, the majority realise in medical school that it's not actually all that awesome, and choose something else.

And yes, both are pretty "niche" and super-specialised - interventional cardiologists do most of the work CT surgeons used to.

This is related more so to what others have said but you may have an idea as to why this is the case; why is it, despite the fact a good number of UK medical graduates emigrate to the US, it's pretty much unheard of for those coming from the UK to go into specialities such as cardiothoracic surgery, cosmetic surgery or neurosurgical residencies? There are other specialities which never seem to have any FMGs going into them (dermatology, orthopaedic surgery, opthalmology) but I specifically mentioned those three examples as, given just how much more doctors in those fields can expect to make in the US compared to the UK, wouldn't you expect it to be more common amongst British medical graduates?

In the case of cardiothoracics we went 12 years I understand in the UK without a single consultant vacancy coming up. 8 trainee posts a year is massive over supply and over that period would have put out 96 people after the first job to appear plus all the international applications… When coronary stents came in the cardiothoracic workforce was laid off in huge numbers.

Neurosurgery is much the same, my last block was at a large neurosurgical centre where people had been chasing consultant jobs for well over ten years after CCT.

Whilst both are interesting specialities I have no desire to end up fighting 40 people for a job that could come up anywhere in the country, especially when you then may have to wait years for the next opening somewhere else in the country.

Yeah, my understanding is that, regardless of the speciality, all Doctors under the NHS are subject to the same salary bandings. So Consultants will start on £75,249 irrespective of their field.

It's a different story in the private sector, however; given that some specialities will have a far greater demand than others. I recall this table which states that, on average, plastic surgeons have an income of £142,723 from private work alone.

You're right about neurosurgery in the US; it's fairly common, after completing their residency, for neurosurgeons to make in the region of $500,000-$1,000,000 (particularly if they have a private practice). They get paid pretty much minimum wage during residency, though.

Looking at the 2012 ratios, there were 254 applications for 16 spots in neurosurgery giving a competition ratio of 15.9 (the next highest is 10.4 in pub med). Does that mean potential applicants for these specialities have to effectively gear their entire medical school education towards these fields if they really want to get a place? If so, surely that's a bit counter-productive to the whole idea of experiencing every speciality for what is has to offer during medical school if all your efforts are going into this *one* field in order to publish papers, do fellowships etc?

This is related more so to what others have said but you may have an idea as to why this is the case; why is it, despite the fact a good number of UK medical graduates emigrate to the US, it's pretty much unheard of for those coming from the UK to go into specialities such as cardiothoracic surgery, cosmetic surgery or neurosurgical residencies? There are other specialities which never seem to have any FMGs going into them (dermatology, orthopaedic surgery, opthalmology) but I specifically mentioned those three examples as, given just how much more doctors in those fields can expect to make in the US compared to the UK, wouldn't you expect it to be more common amongst British medical graduates?

Because of the differences in our healthcare systems, I would hazard a guess that there isn't actually that much scope for private neurosurgery practice in the UK apart from spinal work (which probably is quite lucrative if you can do it, not all neurosurgeons do). The more elective, "lifestyle" oriented specialties like plastics/ortho, are the ones that bring the money in over here.

Also, do bear in mind that although those salaries look incredibly high, malpractice insurance for a neurosurgeon in the US can be over $200,000! Even in the UK where premiums are much lower, the increment in premium once you start doing private work is significant. I asked a cardiothoracic consultant if he did private work, and he said that the amount of work he'd have to do in order to make a profit after paying for rooms and insurance was just too much for him - he wanted to see his kids.

Are there any doctors that have both of this specialties combined?
Thoughts about combing specialities and is it worth it?
Any mentors?

Melbourne/ Australia

Are there any doctors that have both of this specialties combined?
Thoughts about combing specialities and is it worth it?
Any mentors?

Melbourne/ Australia