Dr. George Tolis, Jr.

It is very interesting to note the recent surge of "Junior Attending" positions that are offered on the ctsnet job blog. This is in stark contrast to the paucity of "Real Attending" positions offered. One has to wonder what is the origin of this phenomenon. The argument offered by the employers is that just like any other surgical field, cardiac surgery has branched off to several sub-subspecialties (mitral valve repair, off pump CABG, complex aortic surgery, atrial fibrillation surgery, robotic surgery etc) that the standard two or three year fellowship is just not enough to get graduates out in the real world. If there is an advanced laparoscopic surgery or a hepatobiliary surgery fellowship surgery, why shouldn't there be an advanced adult cardiac surgery fellowship?

The argument certainly seems to be solid. However, it does not appear to work that well in practice. Although many candidates who accept these "junior attending" positions find them very helpful in their pursuit for further experience in cardiothoracic surgery, a large number of recent graduates find themselves trapped in an unpleasant situation where they operate less than they did in their chief year of their formal training and spend most of time improving their LIMA harvesting technique, become experts in chest tube and central line placement after 5PM and perfect their wire twisting and subcuticular closure technique.

When looking for further training opportunities, the astute candidate should make sure that "Junior Attending " means :

1) Admitting privileges for all patients, not only for readmissions with wound infections
2) Independent operating for all cases, not only for mediastinal re-exploration for bleeding
3) First assisting for all cases, not only for the ones done by the disgruntled attending that no one else wants to scrub with
4) Your "Junior Attending" predecessors have benefited from this experience

Remember that the 80 hour rule does not apply when your status changes from "resident" to "attending". When everyone else is going home after an all nighter in the hospital, your recent promotion may not end up serving you that well...