The 10 Things That They Don’t Teach You in Vascular Surgery Fellowship

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  1. Unless you are going out and setting up shop on your own, which is very unlikely, you will be signing a contract. The contract shapes your work life and forms the foundation of your business model. Not understanding this will set you up for headaches. It is worthwhile not only to have a lawyer review it, but also a business savvy physician.
  2. Every medical community has a Jabba the Hut, who is obvious, but there is usually a hidden Sith Lord as well.
  3. People generally will behave in ways that reinforce their worldviews. Add to that the fact that most people stop picking up new ideas or techniques after training, and you have people who practice as much on belief over evidence. This becomes dangerous in hospital privileging committees which are often a tool for killing off young competitors before they pose a threat. The Torquemadas and vascular Taliban are out there, young one, waiting to pounce on your first complication with that new-fangled whatchamacallit.
  4. The easy way to grade the livability and economic level of a town or a burg is looking at what car dealerships are there. Similar metric –is there sushi made by an actual Japanese sushi chef?
  5. Technically, you may press the EMTALA based federal law that you only need to be on call every third day to get paid for any extra days of call.
  6. Veins and dialysis access are far more complex and common than what you may think working for the chairman at Humanity’s Best Hospital. So are limb salvage and wound care.
  7. You are only as good as your team. As nice as you are, patients will hate you if you have an uncaring office staff or hospital rounding crew. As good as you are, your results will be poor without excellent anesthesia, critical care, and floor nursing. Take good care of your partners.
  8. Be careful about high paying jobs in tiny hospitals with no other vascular surgeons. The reasons for this are legion, and frankly, no matter how good you are, you need to be aged like good steak, and that means partners who have been out for a while seasoning you. Also, being solo means it is impossible to find coverage for vacation, unless you put it in your contract that the hospital or employer will pay for locums coverage during your vacation or fly you back first class if you need to come back from vacation and then return you to vacation with offsets for extra days –I have seen all of this and it can happen as long as you negotiate it.
  9. Strive to get better, and that means keeping track of metrics like OR times, contrast volume, fluoroscopy time, blood loss, length of stay, and complications, for standard cases like: Elective Open AAA Repair, EVAR, carotid endarterectomy, infrageniculate bypass with vein. You should get better every year.
  10. Open surgical skills are going to be far more valuable than you think, and it’s not the anastomosis. If all you want to do is the anastomosis and you think you “did the case” if that is all you got to do, you have been fooled by the oldest staff trick in the book. The value is in figuring out first why an operation is chosen, how it is performed, and how it is healed, and having plans B, C, D, and E. Even when an endovascular approach is planned, you have to have in mind the open alternative.

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