What can students do in the 1st and 2nd years to explore and/or prepare for this career?

There are currently several opportunities for pre-clinical medical students to explore vascular surgery. The Department of Surgery offers an elective every fall quarter (SURG 160.10 – Introduction to Vascular and Cardiovascular Interventions) that introduces students to vascular surgery. Students who participate in this elective are also offered opportunities to shadow vascular surgeons in clinic and in the operating room. In addition to this elective, students are welcome to email vascular surgery faculty to set up a time to join them in clinic and the operating room.

The Division of Vascular and Endovascular Surgery has robust basic science as well as translational and clinical research programs. Vascular surgery faculty are very enthusiastic about mentoring students through research projects, and have mentored previous students in the yearlong and summer RAPtr programs. An ideal time to get involved in research is the summer between the first and second years of medical school. However, students are welcome and encouraged to work on clinical research projects alongside their pre-clinical coursework, if interested. Previous students have also participated in dedicated year-long research projects within the Division. Meeting with individual faculty members is the best way to explore potential research opportunities and get involved in research projects.

What common variations exist in the length/content of residency programs for this career?

There are currently two training pathways to become a vascular surgeon. The traditional pathway, also known as the “5+2” traditional fellowship, consists of a general surgery residency (5 years of clinical training, with optional research time) followed by a vascular surgery fellowship (usually 2 years), which results in a total of 7-9 years of training after graduation from medical school. This route allows for eligibility for board certification in both general surgery and vascular surgery, which is important if you are interested in private practice or rural surgery, and plan on practicing both general and vascular surgery. This route is supported by several decades of experience and graduates.

The integrated pathway, also known as the “0+5” fellowship, consists of a direct match into a vascular surgery residency program from medical school. Although the curriculum differs between institutions, these programs typically consist of 24 months of general surgery training followed by 36 months of vascular surgery training. These programs are typically 5 years in length, however, some programs have mandatory or optional research time, which may extend the training period.

Both pathways are accredited by the ACGME. However, the integrated pathway is a much newer pathway and first received accreditation in 2006. There are currently only a handful of graduates from each integrated residency program and several residency programs have yet to graduate their entering class. When choosing a pathway, it is important to understand your commitment to vascular surgery as well as your future career goals. Graduation from an integrated program will limit you to practicing vascular surgery exclusively. In a general surgery residency, you would have several additional years to decide on a subspecialty. Previously published data suggest similar operative experience, research experience, and confidence entering independent practice between graduates of the integrated and traditional programs. Vascular surgery faculty are happy to help guide you through this decision.

What common variations exist in this career after training?

Once vascular surgery training is complete, most graduates choose not to pursue additional training. However, graduates of the traditional pathway are eligible to receive training and board certification in any other sub-specialty of general surgery (e.g. acute care, transplant, cardiothoracic, etc.), if interested. There are also limited opportunities to receive training, but without additional board certification, in complex aortic surgery or complex endovascular techniques.

What is a typical work day for someone in this field?

A typical work day would vary depending on the practice setting. Most vascular surgeons spend 1-2 days in clinic and 2-3 days in the operating room per week. In an academic setting, 1-2 days a week may be dedicated to research and other academic responsibilities.

Some surgeons choose to focus on complex aortic pathology and would spend more time in the hospital and in the operating room. Others focus on venous disease and hemodialysis access and might spend more time in the clinic or stand-alone outpatient procedural centers. Some practices incorporate elements of each of these. The cases, hours, and call schedule vary between practice settings, but most days begin before 7AM and end around 6PM at least five days a week. The reported average hours worked per week is 71.1.

What is the culture of this career?

Vascular surgery is a fast-paced, exciting, and growing field that is rapidly becoming more diverse. However, vascular surgery is very demanding and tends to attract people who are hard-working, dedicated, and driven to provide the best surgical and medical care that they can for their patients.

How compatible is this career with raising a family? How is this different for men and women?

Vascular surgeons have families, hobbies, and interests outside of surgery. Although women are still underrepresented in vascular surgery, there are more women entering vascular surgery now than ever.

What are the most important qualities or character traits for a person in this field?

Vascular disease is diverse, complex, and often influenced by many medical, social, and personal factors. Patience, kindness, empathy, and an ability to communicate effectively are all characteristics that are helpful in addressing all of these aspects of vascular care. Vascular surgery is also a very technical field that rewards those with manual dexterity.

Vascular surgeons are vascular specialists and care for patients even when they are not surgical candidates. As such, vascular surgeons are invested in the long-term care of their patients and are interested in longitudinal relationships. Vascular surgeons also commonly work in large multidisciplinary teams within the clinic and the operating room and should have strong interpersonal skills.

How competitive are the residency programs in this field?

Matching into a vascular surgery fellowship from a general surgery residency is moderately competitive. There is generally the same number of positions offered as there are applicants. In 2018, only 66% of positions were filled by United States Medical Graduates and a handful of positions went unfilled.

Integrated vascular surgery residencies currently have a very limited number of positions (60 total positions in 2017) and typically have more than 100 applicants annually. In 2017, 80% of positions were filled by United States Medical Graduates and nearly all positions were filled by the Match. Integrated vascular surgery is generally regarded as a very competitive specialty to match into.

How competitive is the job market after residency?

As the United States population is aging and living longer, there is a projected shortage of vascular surgeons. The integrated pathway was created to help address these needs. Vascular surgery has a very positive job outlook.

What programs have been popular among UCSF applicants, or how should applicants go about considering programs?

When choosing integrated vascular surgery programs, it is important to select programs that are congruent with your career interests. Several programs are more oriented towards students who would like to become academic vascular surgeons. These programs either require or offer time for dedicated research or advanced degrees, which will extend the training period. Other programs do not have these opportunities. It is also important to assess the number of cases that residents are completing by the time they graduate to ensure adequate operative experience. Vascular surgery faculty are happy to help guide you through the process of selecting programs that best fit your interests.

What resources (e.g. websites, books, professional groups) would you recommend for students interested in learning more about this field?

The Society for Vascular Surgery (https://vascular.org/) is an excellent resource for students interested in vascular surgery. The Society offers medical student membership, research scholarships, travel scholarships, and other opportunities for medical students to get involved in vascular surgery. Attending the Vascular Annual Meeting is an excellent way to quickly gain exposure, knowledge, and insights into the field of vascular surgery. The Society for Vascular Surgery offers more than one hundred scholarships to attend this meeting every year, as well as a robust program dedicated to students. The Society also offers information about how to be a successful applicant to the traditional vascular surgery fellowships and integrated vascular surgery residency programs. The Western Vascular Society (http://westernvascularsociety.org/#) is a regional society which also offers scholarships to medical students to attend their annual meeting.