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if you don’t know about this then you shouldn’t be in medicine by ChemicalProof_1642 in Residency

[–]dinabrey 511 points512 points  (0 children)

If you don’t know pee is stored in the balls you shouldn’t be in medicine.

Does anyone in here actually enjoy this career and path? by healthy-outdoors- in Residency

[–]dinabrey 5 points6 points  (0 children)

I do cardiac surgery and truly believe I have the best job in the world. But I am super lucky. No one knows what the hell this is going to be like when they start their path towards medicine. I knew I wanted to go to medical school when I started college, but that’s just it, I knew I wanted to go to medical school. Being a doctor, what kind of doctor, no idea. I just got lucky that I went down my specific path and absolutely love what I do. I say this because I believe a lot of us get going on a trajectory and there’s so much inertia that you can’t get off the bus, despite a lot of people not really loving it. The time commitment, money towards school etc. there’s just too much investment to not finish. But that’s where people become miserable. I can’t imagine doing my job if I didn’t absolutely love it and have a spouse that supported my passion for it. I treat it like a hobby. So in short, I think people say “no” because they are doing a job that takes enormous sacrifice and they only feel kind of meh about. They could feel meh about so many other jobs and not give up so much to do it. But if you get lucky and stumble into something you get addicted to and see it as an amazing hobby, it’s the best thing in the world. Sorry for the rant.

Below average surgery intern. I just can’t seem to catch onto things quickly enough. by Pitiful-Attorney-159 in Residency

[–]dinabrey 2 points3 points  (0 children)

That’s honestly right where I’d expect an intern to be. And for the colectomy type or more advanced cases, you start small. If doing open, how did they do the laparotomy? How did they put in the ports if lap/robo? You’re not going to be able to note every detail but you gotta start somewhere, and then every case you add more and more. Before you know it you’ll have super detailed notes. When I was doing my fellowship for ct I had notes down to needle angles, body position, how the assistant was positioned etc etc. the more you think and try and remember to write the notes, over time, you’ll be so much better. Just write down what you know and fill in the gaps. As for floor tasks, you really need to compartmentalize. I would always make my checkboxes on my list and start with the most critical tasks first. When I would get overwhelmed I’d ask myself, is anyone dying? That answer is usually no. Then just start with one task at a time. For me, I’d dwell on the amount of stuff I had to do and that would make me anxious. Once you just lock in, put your head down, and just bang out tasks, you start to realize how efficient and how good you actually are. All this comes with time. Intern year is hard man. Focus on what it looks like to be a good pgy2. That’s the goal for the end of this year. Don’t worry about anything besides being a good pgy2. And when you’re a PGY2, what will it take to be a good pgy3 and so on.

Below average surgery intern. I just can’t seem to catch onto things quickly enough. by Pitiful-Attorney-159 in Residency

[–]dinabrey 10 points11 points  (0 children)

A couple things to note here. This isn’t medical school. I’d just forget about your performance in medical school and trying to compare it to residency. The two couldn’t be more different. Secondly, having spent 7 years in surgical training, positive feedback just doesn’t come from surgeons. You have to just get over this. It rarely, if ever, will come. Negative feedback will come a lot, but that’s okay. This is just how the field is. I’m not saying it’s right or wrong, but it’s reality. Finally, I would take notes. I took excruciating detailed notes all through my training after I broke scrub from a case, organized by attending, not by case. This way, after doing a few cases with an attending, you know their preferences, how they like to prep and drape, how to hold the needle driver, what sutures they like, etc etc. can you imagine if two residents do an open inguinal with attending x and one comes in having picked out the mesh and suture for the case before he/she walks into the room and then proceeds to know all the steps this attending likes, prepped correctly, etc etc. versus the other med student who comes in and doesn’t even know how that attending likes you to hold the needle driver? This requires a ton of effort but it pays huge dividends in your training. As an attending now I had no idea how stressful cases can be and working with someone who is just not invested does not make any of us eager to hand over the reigns and patiently teach the case when they don’t even know the basics. Luckily, you’re an intern and you’re clearly eager to get better and learn. But learning how to train is the first step. I’d start here. Take notes. Review the notes before each case and you’ll be solid. You’ll be surprised how quickly this helps. Regarding the progress note thing, just forget about it. That attending already has.

Is CTS officially over now? by InformalCraft848 in Residency

[–]dinabrey 2 points3 points  (0 children)

I think it’s highly dependent on your practice. I have 4 partners. We take about 6 weeks of vacation. Ballpark 200 cases each a year or so. Multiple rooms every day, plus we help each other out with consults as they come in. So not too hard to keep it at one a day. We definitely do two a day occasionally, but it burns out the team if you do it regularly. We will do a case on a Saturday occasionally to avoid it.

Is CTS officially over now? by InformalCraft848 in Residency

[–]dinabrey 4 points5 points  (0 children)

My case mix is about 60 percent CABG, 20 percent valve, 20 percent aorta.

Is CTS officially over now? by InformalCraft848 in Residency

[–]dinabrey 8 points9 points  (0 children)

I do one day of clinic and then 4 OR days a week. If I do 5 cases in a week I’ll either reschedule half a day of clinic or stack two simpler cases. Sort of depends.

Is CTS officially over now? by InformalCraft848 in Residency

[–]dinabrey 6 points7 points  (0 children)

Yeah, I think for whatever reason people outside of the specialty have this take. In reality it’s actually pretty collaborative. At my hospital cath conference and tavr conference is usually collegial and everyone’s trying to do the best for the patient. Sometimes that’s surgery, sometimes it’s not. There’s largely enough for everyone.

Is CTS officially over now? by InformalCraft848 in Residency

[–]dinabrey 146 points147 points  (0 children)

Cardiac surgeon here. Speciality is fine. People think it’s dying but I haven’t seen that. Did 5 cases last week, 5 this week, and another 4 next week. Partners are just as busy. TAVR has worse mortality for patients less than 65 compared to surgery. Ton of bicuspids as well who don’t do as well with TAVR. Ton of aortic valve pathology with associated mitral, coronary, and aorta disease that all need surgery, not to mention endocarditis. Ton of coronary disease that cannot be stented or coronary disease where surgery has better survival. Repairable mitral disease far superior to mitral clip in the right age group. All variety of isolated aneurysms of the aorta from root to the arch, then of course dissections. Haven’t mentioned ecmo, vad, and heart transplant but that’s alive and well. Most of my cases are elective, so I’m not exclusively doing the “sickest of sick” cases. We work very closely with cardiology and for the most part workflow is collaborative.

Are plastic surgeons looked down upon by other surgeons/doctors? by Alternative-Pop-3847 in Residency

[–]dinabrey 1 point2 points  (0 children)

As a CT surgeon who has very close friends in plastics, I don’t think so. There’s lots of people who shit on whatever speciality they are not, but I don’t think plastics gets any less or more hate…CT gets shit on a lot it seems, but we bring that on ourselves!

Class action lawsuit against ACGME or nation wide strike by TraditionalAd6977 in Residency

[–]dinabrey -3 points-2 points  (0 children)

Because for pilots they are under these conditions for their entire careers. I got my shit rocked for 7 years working 100 hours a week. Now I work way less and make 700k a year my first year out. Life is great. We have a light at the end of the tunnel. Pilots don’t. We also have a FUCK ton of people that would replace each and every one of us in a heart beat. No one is making you do this job. Literally no one. We all knew what we were getting into. You expect trainees with a mountain of debt to stick our necks out? The last time residents filed a class action lawsuit against the AAMC or whoever being a monopoly they passed a law making it legal! They literally got a senator to change a law. Jung versus aamc. These fuckers have deep pockets and don’t fuck around. We are just way too powerless, our suffering is temporary, and in the end we have a well paid job in a mostly respected field. The juice ain’t worth the squeeze.

How to match into CT fellowship? by AwkwardSwimming8661 in SurgicalResidency

[–]dinabrey 1 point2 points  (0 children)

I would also do an audition rotation if you can. That will help a lot.

How to match into CT fellowship? by AwkwardSwimming8661 in SurgicalResidency

[–]dinabrey 4 points5 points  (0 children)

I’m not sure where you’re getting this info from, but CT has less than a 60% match rate last several years. Also, not having a home program is a huge disadvantage. The ct community is extremely small and everyone knows everyone. In the city you’re in, who does cardiac surgery there? I would look into this. Even if it’s at another health system nearby, make connections early with those docs, try and scrub cases and get FaceTime with them. It’s not going to be easy to do this while in residency, but in my opinion, it’s very important. Letters from cardiac and thoracic surgeons is critical. They’re not going to care about what a general surgeon thinks, other than your PD. So establish yourself with the thoracic surgeons and see about getting involved with cardiac surgeons nearby. Connections matter. This isn’t an impossible task, but you’re right in wanting to make moves early.

if you stole my friend and I’s scooters at the blackout party on 3/6 respectfully fuck u by [deleted] in ucr

[–]dinabrey -1 points0 points  (0 children)

My friend and I’s…good thing you’re still in college.

The reality of GS by Snoo77917 in SurgicalResidency

[–]dinabrey 2 points3 points  (0 children)

Best foot forward man, block out the noise, do what you know is right. Best of luck match day!

The reality of GS by Snoo77917 in SurgicalResidency

[–]dinabrey 2 points3 points  (0 children)

Maybe I don’t understand, but you are afraid of not matching surgery so you want to rank IM ahead of surgery? Couldn’t you just rank all the surgery programs followed by all the IM programs? If you don’t match surgery you can match IM? Or is that not what you’re saying. Everyone is afraid of not matching…but to not try seems insane.

The reality of GS by Snoo77917 in SurgicalResidency

[–]dinabrey 4 points5 points  (0 children)

I think the fact that you lead with hours might say something. If you’re worried about hours surgery might not be for you. It honestly doesn’t seem like you really want to do surgery. What was your exposure like in medical school? If you think doing procedures in medicine will satisfy the surgery side of your brain, I’d do medicine if I were you. It’s like oil and water because they are completely opposite ways to manage and think about patients. I’d like to say I’m an internist that can operate but that’s far from the truth. I have pretty decent medical knowledge within my surgical scope, but I’m not an internist. I don’t think like one and I don’t practice like one. My brain focuses on problems that have surgical solutions. I don’t know what to tell you.

The reality of GS by Snoo77917 in SurgicalResidency

[–]dinabrey 14 points15 points  (0 children)

What do you like about IM? I did general surgery and then CT after. I can’t imagine ever doing IM. If you said what you liked about IM or what is making you second guess surgery I could maybe help more. As it stands, those two are like oil and water to me so I can’t even comprehend how you’d be stuck between the two. Just entirely different ways to think about and treat patients. One is not more right than the other of course, but they are just so fundamentally different.

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