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Two- versus Three-year Cardiothoracic Training Programs: A Two Year CT Program is One Year Shorter Than a Three Year CT Program

Wednesday, July 15, 2009

"If given the option when choosing a cardiothoracic residency, should one choose a two-year program or a three-year program?"

A month or so back I was e-challenged by my new friend Stephen McKellar, a resident in a three-year CT residency to take the pro two-year program side in this e-debate. I want to start by saying that this is rather unfair (for Dr. McKellar), in that he has engaged me in a debate over what many would consider is the following fundamentally rhetorical question: When given the option of accomplishing the same thing in two years rather than three, what would you choose?

I tested this out on my both of my five year old sons and they both chose two. Though this question is rhetorical, I will go forth with this e-debate using the philosophical beliefs of Dick Van Patten, Henry David Thoreau, and William Wallace (as portrayed by Mel Gibson) to further support my case—that it is better to take two years to accomplish the same thing that others might accomplish in three.

Dick Van Patten starred in a well-loved TV show from the early eighties called, "Eight is Enough" which as the title suggests, detailed the life of his family with eight children. If he could rename the show it would have been "Seven is Enough." In other words, five years of general surgery and two of cardiothoracic. Why? The eighth child Nicholas Bradford was one too many. Adam Rich, who played the irresistibly cute baby of the bunch, faced many of the problems many child stars do when they enter adulthood, that being drug abuse and the law. If they kept it at seven then they would not have had this problem. Enough is enough. Its one of those "it is what it is" things. Seven years is enough.

In 1854 Henry David Thoreau published a book called, "Walden; or, Life in the Woods. " This wonderful book detailed his life living in a cabin off of Walden Pond, which is near Concord, Massachusetts. This book, which one could describe as the original "Man vs. Wild" description of how to live in the woods, also works as a philosophical instruction manual, focusing on things such as living on a budget and self-reliance, and how important these sorts of things are for your happiness and spiritual health. The reason Thoreau would argue that a two year program is better than three is that it is not a financially sound proposition. From a dollars and cents perspective it simply makes more sense to get to the finish line sooner rather than later. The sooner you can start making a real paycheck, the sooner you can get the "Man off your back" and start paying off your debts. Most of us have not been able to get through this process, particularly those of us who are married with children, without a truck load of MonopolyTM  money-sized debts. The longer your training is, the more time your debt has to snowball.   So, the sooner you can start making a paycheck commensurate with the work that you do, the sooner you will be able to achieve financial self-reliance. Thoreau would have it no other way.

"Aye, fight and you may die. Run, and you'll live… at least a while. And dying in your beds, many years from now, would you be willin' to trade ALL the days, from this day to that, for one chance, just one chance, to come back here and tell our enemies that they may take our lives, but they'll never take… OUR FREEDOM!" - Mel Gibson as William Wallace in Braveheart.

Probably the zenith of Mel Gibson's career—that pre-battle speech. It was pretty much all downhill from there. Though it seems irrelevant, I quote William Wallace because he would have felt that a two-year program is clearly superior to three. Why? Because it is one year closer to freedom. Our training, to put it perhaps in a glass is half empty light, is a form of what could be described as indentured servitude.

Here is the wikipedia definition of indentured servitude:  An indentured servant is a form of debt bondage worker. The laborer is under contract of an employer for usually three to seven years, in exchange for their transportation, food, drink, clothing, lodging and other necessities. Unlike a slave, an indentured servant is required to work only for a limited term specified in a signed contract.

Sounds familiar, doesn't it? Now, while I am grateful for all of the wonderful mentorship and guidance I have had over my 13 years of training (I count medical school), it has been clear to me, as well as my wife, that I have not been a free man over these last 9 years. I have been an indentured servant, as well as an apprentice. What this gets into is the service / education issues that we hear a lot about. Sometimes what we do is much more service than education (more indentured servant and less apprentice), and other times we are more the apprentice than the servant. Either way, the servant part never really goes away until your training ends.

One more analogy/hypothetical story: Let's say you sign up for a marathon and at the start of the race they get all the runners together. The organizer with the bullhorn explains the race rules.  "Welcome to the Fork in the Road Marathon! Today there will be a fork in the road at mile five. Turn right and you can run this race for 26.2 miles. Turn left and it is 39.3 miles (this is the exact difference if you do the math, 2/26.2=3/x). Any questions?"  You raise your hand and say, "Well do I get a cooler T-shirt, or a better medal? Something so my friends know I did the "Long" version of the marathon?"  The organizer says, "Nope, everyone gets the same T-shirt."  You scratch your head and say, "Well what's the point of the long route?"  The organizer says, "That's a good question. We don't really know either. But it is there for you if you want to do it!"

Obviously, one could argue that a person coming out of a three-year program is better trained than someone who is coming out of a two-year program. Likewise someone who trained for four years would be better than three. And so on. The real question is this: how much training, do you need? Clearly there are hundreds of CT surgeons out there who have completed two-year programs and have been out and operating on their own successfully within only a few months of finishing their training. Two (seven) is enough, and three is one too many.

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