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

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Mahmoud Shah
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I was browsing some articles online and came across the 2013 speciality post competition ratios. You can view the figures in Table 1 of this article.

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?

Is the standard of applicant typically higher for the more competitive specialities? E.g. - Would you expect to find more applicants with PhDs applying for cardiothoracic surgery than general practice?

Also, is there any particular reason there are so few posts in these specialities? Would you not expect there to be a lack of cardiothoracic surgeons available throughout the UK if only eight are being trained at each level?
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Beska
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(Original post by Apologetic Cube)
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.

Is the standard of applicant typically higher for the more competitive specialities? E.g. - Would you expect to find more applicants with PhDs applying for cardiothoracic surgery than general practice?
On the whole, most likely, yeh.

Also, is there any particular reason there are so few posts in these specialities? Would you not expect there to be a lack of cardiothoracic surgeons available throughout the UK if only eight are being trained at each level?
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/8113/35...ical_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.
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raveen789
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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.
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Mahmoud Shah
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(Original post by Beska)
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/8113/35...ical_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.
That makes sense. I wouldn't have thought of cardiothoracic surgery as being a niche speciality, to be honest. Neurosurgery; yes, but not cardiothoracic surgery :hmmmm:...

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?

Would I be correct in thinking some of those 254 applications will be made up of people who have just decided to throw in an application to see what happens when, in reality, they've applied for other specialities and are perhaps not as set on neurosurgery as others may be?
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Mahmoud Shah
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(Original post by raveen789)
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.
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345rty
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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.
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Helenia
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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.
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raveen789
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(Original post by Apologetic Cube)
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.
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Mahmoud Shah
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(Original post by raveen789)
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.
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.
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Mahmoud Shah
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(Original post by Helenia)
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?
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Helenia
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(Original post by Apologetic Cube)
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?
Two major reasons I can think of: -

1) They're just not that popular. Most people just don't want to do neuro/cardiac surgery. Combination of horrible lifestyle, poor career prospects and the fact that the surgery really isn't as interesting as people imagine.

2) I imagine they're probably similarly competitive in the US, so wouldn't expect IMGs to get much of a look-in.
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Presidential
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(Original post by 345rty)
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.
Where can I find the information on consultant post numbers for each speciality? sounds like there is no point even going for such competitive jobs if your going to he hanging around for a consultant post for decades.
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plrodham1
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I can't speak for Cardiothoracics but having just completed an SSC in neurosurgery i will base my opinions on what i have experienced there.

1) High level of competition when applying
2) Lack of autonomy when junior - it seems to take a long time before the consultants will trust you, especially in terms of operating. SHO's seemed to spend little time in theatre and when they did they weren't really allowed to do much. In my previous SSC (ortho) SHO's were in theatre at least 2 days a week and were allowed to do some operations start to finish. It takes a long time to become competent in surgery and this is only made worse when you're not operating.
3) Pressure to do MD's/PhD's
4) Nightmare on calls - the regs worked a 1 in 8 on call which isn't that bad but the time spent on call is a nightmare. The phone does not stop and none of it is really that interesting (mostly query cauda equinas which will very rarely be true syndromes)
5) You never seem to leave the hospital on time (due to leave at 5 but very rarely leave before 6:30)
6) High level of competition for consultants jobs - with this there is also the threat that you may have to move across the country to find a job due to the scarcity of neurosurgical centres.
7) On call rota as a consultant is a nightmare in some specialities. I was with a paediatric neurosurgeon who worked a 1 in 3 on call system (fair enough you won't necessarily be called in but it will weigh on your mind as you try to nod off)
8) Long operations which at some points actually seem quite boring. I came into my SSC with thoughts that it was going to be incredibly advanced and fascinating but to be honest not as amazing as you expect it to be. A lot of time is simply spent agonizing over whether the tissue down the microscope is normal or abnormal and then just sucking it out with a cusa.
9) Unless you're a spinal surgeon the pay isn't that amazing compared to say plastics or ortho.
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Helenia
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(Original post by Apologetic Cube)
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.
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.
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nexttime
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Because they're really really dull?

(Original post by Apologetic Cube)
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?
Yes it is exactly like that, and yes it is very counter-productive, but that's the way things are. Fact is... very few people go into neurosurgery because they like neurosurgery. Its the other factors that're important for that kind of person.
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ukmed108
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(Original post by Apologetic Cube)
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?
All those specialties you listed are already super competitive in the US and because the US and UK systems are different they will invariably prefer a US grad over a UK grad or any other IMG unless the international is really out of this league in terms of application or exam scores.

This is why few UK grads end up in those specialties in the US.
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ukmed108
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(Original post by Helenia)
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.
Malpractice can be high but you have to remember that the average neurosurgeon bills over 800k a year and 200k still leaves you 600k, quite a high salary even then.
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Zharaibrahimi
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Are there any doctors that have both of this specialties combined?
Thoughts about combing specialities and is it worth it?
Any mentors?

Melbourne/ Australia
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plrodham1
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(Original post by Zharaibrahimi)
Are there any doctors that have both of this specialties combined?
Thoughts about combing specialities and is it worth it?
Any mentors?

Melbourne/ Australia
Out of curiosity, why would you want to combine the two. They're very different
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Helenia
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(Original post by Zharaibrahimi)
Are there any doctors that have both of this specialties combined?
Thoughts about combing specialities and is it worth it?
Any mentors?

Melbourne/ Australia
I'm pretty sure this isn't possible. The two specialties are very different and I don't think you could realistically develop/maintain adequate skills in both concurrently. Theoretically it might be possible to train in one and then switch to the other, but I very much doubt anywhere would want to employ/train you in both.
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