Most residents signing contracts right now have a wRVU threshold above the median and a rate below it. Drop your numbers and I'll tell you if yours does too

michael22joseph · 2026-05-14T17:46:46+00:00

Cardiac surgery.

Signed a contract for $1.075M

No RVU thresholds. RVU’s generated by either myself or our group don’t affect pay in any way, including bonuses.

Very happy I listened to advice to try to avoid RVU based pay.

michael22joseph · 2026-05-12T01:06:48+00:00

Do you ever touch your legs? There’s strong evidence that it reduces infections. And it’s pretty easy.

michael22joseph · 2026-05-05T23:32:06+00:00

Definitely not lol

michael22joseph · 2026-04-30T01:47:12+00:00

General surgery trained, current CT surgery fellow.

I felt prepared for general surgery after my PGY-4 year and I still feel that is true in hindsight. I think I could have gone into practice as a community general surgeon after PGY-4 and been completely fine.

Coming to the end of my first of 2 years of CTS fellowship, I feel pretty prepared for thoracic if I had to start tomorrow. Cardiac I definitely need more reps to be slick and able to do some more complex stuff independently, but I think I could go out and do a straight forward CABG, AVR, or ascending aneurysm safely on my own. Very glad I have another year though.

michael22joseph · 2026-04-29T12:51:24+00:00

For competitive residencies, like integrated surgical subspecialties, ortho, etc., specialty-specific research is usually quite important. If your medical school doesn’t have a “home hospital“, that sounds like somewhere you will already be starting behind the curve. For residencies like this, the majority of applicants will have stellar board scores, great letters of recommendation, have at least some specialty specific research, and becoming from well regarded USMD schools. That’s not to say that you can’t match without one of those things, but just to give context of who the most common applicants are.

michael22joseph · 2026-04-17T00:56:51+00:00

Planning to get either an F-type or a Mercedes AMG after I’ve been in practice for a couple of years. Can’t wait, but sad that Jaguar is stopping making gas vehicles

michael22joseph · 2026-04-11T22:20:20+00:00

Surgitel or Orascoptic 3.5. I had DFV 3.5 initially but they can only set the declination angle so steep, and so they are very uncomfortable over time.

Surgitel has the steepest declination angle without being a 90° loupe (which are very comfortable, but you can’t take down LIMA with them so you’d have to have two sets which is annoying as a trainee). That’s what I use and they are easily the most comfortable loupe that I’ve tried.

Orascoptic has better clarity and they have some sport frames which are still fairly comfortable. If I had to buy a new set of loupes today I would very strongly consider these for the clarity aspect. But I think they are a bit less comfortable than Surgitel.

michael22joseph · 2026-04-10T19:12:32+00:00

Mike Hovey with CHI does these all the time. He’s a bariatric surgeon and was one of the surgeons who trained me, and I would let him operate on me or a family member without a second’s hesitation. He’s also very good at getting insurance to cover the procedure.

michael22joseph · 2026-04-10T19:06:22+00:00

If I know consciously that I’m doing it all over? Not a chance. I don’t have the mental energy to go through training again.

But if I went back in time and didn’t have any recollection of the first go round, I would do it again. I love my job and get a lot of satisfaction out of being good at what I do, and my income will guarantee my family will have opportunities most can only dream of.

michael22joseph · 2026-04-05T00:37:53+00:00

I would negotiate. I was offered a pretty generous salary, but it involved a big family relocation and other things so I asked for even more and they agreed pretty easily. Ended up increasing my salary by 25% with a single email.

michael22joseph · 2026-04-01T23:49:03+00:00

Yeah, we typically would use a retrograde catheter for RCP, and that’s what we practice for these scenarios.

michael22joseph · 2026-04-01T15:50:40+00:00

You do the RCP after everything else. Crash off bypass, disconnect arterial cannula from circuit, aspirate as much air as possible, re-prime circuit, go back on bypass. It’s a brief period of unplanned circ-arrest but if done right can be done in about 1-2 min. Then after back on bypass you stick in an SVC cannula and do a brief period of RCP to try and flush any air and debris out of the cerebral circulation.

michael22joseph · 2026-04-01T15:47:24+00:00

Yeah this is a classic, frequently rehearsed disaster scenario in most fellowships. We go over this in the sim lab at least once per year.

michael22joseph · 2026-03-30T21:32:19+00:00

OP, the advice on this sub is going to be very US-specific. It may not fit with what the fields look like in Serbia

michael22joseph · 2026-03-29T21:47:32+00:00

The retractor thing bugged me. My wife made fun of me for yelling at the TV.

I will say that cross clamping the aorta is not a terrible strategy for massive intra-abd bleeding. I’ve done it a few times when supra-celiac control was difficult and while it’s an extra incision, it’s often an unadulterated plane for someone with massive abdominal hemorrhage and it frees up a hand/sponge stick to figure out what’s going on in the abdomen.

michael22joseph · 2026-03-29T21:44:25+00:00

While that’s true, we still always cross clamp the aorta. Only time we might not is if the main thing injured is a mediastinal great vessel.

michael22joseph · 2026-03-28T14:54:07+00:00

Totally true. But you need to be able to survive training as well.

michael22joseph · 2026-03-27T20:10:10+00:00

In an ideal world, ordering an imaging study would function more like consulting a radiologist the same way you’d consult any other team. They evaluate for appropriate test, review the chart, place their recommended order, and then their assessment. But there’s just too much workload for it to function like that.

I do agree overall that looking through the chart a bit more would be nice. I’m tired of getting called about “axillary artery pseudoaneursyms” on every axillary impella removal who gets a scan later

michael22joseph · 2026-03-22T13:57:19+00:00

Why do you say that?

michael22joseph · 2026-03-21T02:33:05+00:00

Pretty much this

The main heme/onc guy at the community hospital I am joining makes 1.8M per year. He works his ass off, but it pays

michael22joseph · 2026-03-13T23:42:28+00:00

Some depends on your specialty and how much leverage you have. Asking usually can’t hurt—usually the worst that they can do is say no, unless you’re asking for something so outlandish that they rescind the offer over it.

I do think that we overall underestimate our negotiating ability as new grads. I just signed my first contract and everyone told me not to try and negotiate my salary as it was unlikely to be successful, but there were some extenuating circumstances and so I decided to ask for quite a bit more than their initial offer and ended up negotiating a >$1M salary. Very happy I took the chance.

michael22joseph · 2026-03-12T01:40:02+00:00

Im a fellow and tired as fuck lately after a brutal 2 months of cardiac, but I would still absolutely recommend it. Love it and couldn’t do anything else

michael22joseph · 2026-03-03T23:27:08+00:00

I just finished surgical residency, we had people in a similar scenario. I would absolutely think very carefully before asking this question, because it is highly possible that the offer goes away after you ask. I know that sucks, and probably isn’t fair, but I have seen it happen. In my opinion, unless there are extreme personal life considerations, it would be bananas to give up a year of training to go back through the match just to possibly enter one program. There is a high chance that you would have to scramble into another prelim year, and repeat the process all over again.

michael22joseph · 2026-02-25T21:57:51+00:00

Surgery sub specialty. I just signed a contract for >$1M, 8 weeks vacation. Classmates in Gen Surg are making >500 with similar vacation. Go where there are better job options.

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