Cardiology and Cardiothoracic Surgery


Disclaimer
The information below may be or may be not accurate. Do not use it as reference. It’s only to give a rough picture on what’ going on with the cardio world in Malaysia from observations of a mere medical student. Some corrections are needed.

This article has been published previously in NNSMA website. Due to inactivity of the website, I had to move the article to my blog with some touch-ups.

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I asked a random question to medical students here and elsewhere: what kinda specialty are you interested in? Fair enough, half answered “physician” and the other half answered “surgeon”. But most who are interested in surgical field choose cardiothoracic surgery. Neurosurgery follows next. I don’t know what’s so special about being a cardiothoracic surgeon. So you can operate on a heart. So what?

And those who answered “physician” want to be cardiologist!~ Fine! Heart is one of the most important organ. But why heart?

I’ve got some inputs from my observations during my elective posting in Institut Jantung Negara; about the life and career of cardiologists and cardiothoracic surgeons (read: CTS). This is not a generalization of other cardiologists and cardiothoracics people in Malaysia.

Okay after we graduate from this hellhole (don’t flame me arrr), we become House Officers (HO) for 2 years. Then we become medical officers (MO) for approximately 3 years. After these 4-5 years of being HOMO, we usually can specialize in a specific medical/surgical area, depending on our performances as doctors.

CARDIOLOGIST

To become a cardiologist in Malaysia, after those miserable 4-5 years of being HOMO, one will pursue further studies under several cardiologists at a particular university hospital. Locals go for UM, UKM, USM etc, overseas opt for MRCP in the UK or American Cardiology Fellowship or its similar Australian counterpart. The course usually takes 3-4 years. During this period of specialization you are called registrar or fellow.

After graduating the cardiology course, passing necessary exams, you’ll have to work at a hospital. Your title is now a senior registrar (read: SR). During my posting in IJN, I worked with a senior registrar. He looks young, late 20s or early 30s. But actually when I asked nurse, his age is 34! See how long you can be a junior specialist in cardiology? 5 years of HOMO and 4 years specialization. 9 long years!

Well, that is only senior registrar. They’re specialists, but they are not consultants. To become a consultant, you have to pass certain exams to upgrade oneself to become consultant. SR usually works for several years before eligible for examination to become a consultant.

Coronary angiography wiki

Basically in the mornings are ward rounds, then clinic till late afternoon. If there are medical discussions or Mortality and Morbidity conference (M&M), the cardiologists engage in them. One special day for heart failure and cardiac angiogram for each cardiologist. At free times, eat, go back to room, do research. My best hours during attachment in cardiology were in the clinic where at only a medical student level, I could learn important signs and symptoms, principles of drugs prescriptions, listening to heart murmurs etc etc.

CARDIOTHORACIC SURGEON (CTS)

Ok, we got thru medical school and 5 years of HOMO (Housemanship and MOship). Then we specialize in General Surgery. The specialization takes another 4 years. So only 9 years after med school you can get full gazettement as a general surgeon. Then serve 2 years under the government. General Surgeon is not a cardiothoracic surgeon (CTS) yet. To become a CTS of IJN, one will have to spend 6 years as SR (senior registrar) in Institut Jantung Negara. So before one can start becoming a CTS in Malaysia, one has to wait for 11 years.

First year SR basically did almost nothing of importance as a CTS, except case reports and holding retractors or suctions during surgery. At third year of SR, one gets to cut the the chest open, including sternotomy. To put a heart on bypass machine (extracorporeal circulation), a more senior SR is needed. Probably those in 5th or 6th year. After the 6th year of training, you’re already experienced to do relatively simple heart surgeries. Note the word simple.

After 6th year of SR, one becomes consultant. But even consultants can’t operate on everything. Some of them are qualified/licensed by the head of department of CTS to do more complicated heart surgeries. Some procedures are very complicated that not all CTS can do. I saw a senior consultant who’s at his late 40s couldn’t do a complicated surgery (Bentall Procedure, Hemiarch replacement = to replace dissected thoracic aorta). He has to be lead by the head of department, who did the procedure excellently!

CABG Wiki

Coronary Artery Bypass Graft (CABG @ Cabbage @ Bypass) make the most of the surgeries. Then followed by valve surgeries. But there’s superbly rare case of congenital heart disease is truncus arteriosus. If you watch Grey’s Anatomy, there’s one part when Burke asked the interns on truncus arteriosus before they can scrub in in his surgery. Only Christina could answer, but Meredith and Alex couldn’t, but at that time, Burke and Christina were not talking to each other.

Well, in IJN and in whole Malaysia, only one CTS can do the truncus arteriosus correction; the head of department of CTS. The case is so rare that happens only once per ten thousand of birth (needs checking please), but since IJN is only the place where truncus arteriosus correction can be conducted, I’ve seen two of this particular case.

So, even when you’re at your 40s, not all heart operations you can do! Some are so complicated that you have to give up the “hero” title to more senior consultant CTS. Don’t expect you can cut so much thing when you’re a surgeon. Remember, the first year you’re CTS, you only get to write case reports and assisting insignificantly. That is in IJN.

So, people, still wanna specialize in HEART?

26 thoughts on “Cardiology and Cardiothoracic Surgery

  1. Truth is frightening… and so is medicine. But most of us here seem happy all the time. A little frightening facts won’t hurt.

    This entry is merely frightening. It’s just a series of observation put together in one entry.

    The most senior CTS must be like late 50s or 60s something. But I don’t really understand the question😀

  2. Gee….IJN training is soooo tough and sooooo very long……even more tougher then American Thoracic Boards…….message to prospective CT surgeons……go to America……assure you you will be doing Bentalls in your 4th year…..and Truncus during second year of Paeds Fellowship……

  3. I am a malaysian (originally from Penang) doing my cardiology fellowship in Canada now. No doubt this is a challenging career and long training year. In Canada, we go to cardiology fellowship (very competitive) after 3 years of internal medicine. Then after 3 years of cardiology fellowship, you may want to further specialize in electrophysiology, interventional cardiology, heart failure, echo, cardiac MRI, cardiac CT. etc, this will take another 1-2 years. I guess the north american system is more organised than british system. When you are in, you are in and out for sure.

    Cardiac surgery is not hot in north america because you can’t get a job, CABG is getting less here and taken over by PCI. Even Neurosurgery, is diffcult to get job here because of interventional radiologists. General surgeon lost their skills to gastroenterologists here to do OGD, ERCP or colonoscopy.

    I haven’t back to Malaysia for years and really have no understandings on technology there. In here, surgery has changed from front line to last line in the past 20 years. Of course, the roles for surgeons always there.

    Bottomline: do what you have passion and enjoy in your life.

    • It does take long to train in cardiology but the years pass by quickly if you enjoy the speciality.

      I am currently working as a cardiology registrar in the UK but am interested in applying for a cardiology fellowship in canada, do you have any tips as where I should start.

      I tried to enquire but some of the programmes charge fees for IMG.

  4. omg!!!!?…….what the…..i can’t believe it….that a bit worried me…then the best option to the people who want CTS&cardiology is to go oversea….but according to chiew sk…it is still worrying me….ermm nvm i still have a log way to go…

  5. i’ve been dying to be a surgeon in this field.. thanks for the guideline.. i juzhope can do my best in next year spm..

  6. We should take an example from country like india…Even they are poor and having lots of slump, but the doctors,are so dedicated and most of them works just for the sake of the patient….Money is number two…..Can you just imagine,their salary for junior consultants just equal to our ‘cikgu’ only….This is malaysia…Cronyism and bad politics…That’s why we never improved….So sad….I wish there are more IJN in malaysia esp for sabah or sarawak…

  7. its too long to become a CTS…..the salary of CTS per month is RM50,000-100,000

    that why i wish to become a CTS….the salary is awesome!!!….

    im 16 now……

  8. Hi, may i know wat paper should i take to continue to be a CTS? as from what i know of, for example i can take the MRCS(if nt mistaken) after the medical studies. correct me if im wrong. and may i know the path to be a CTS in a faster way? is it a must to do HO first before continue the master studies?

  9. Hi, Efenem. I’m not doing medicine but I’m sorry to say that I don’t agree on what you’ve written in the passage. All I can see is complaint and discouragement. In contrast, Chiew SK described an unbiased scenario in Canada for future doctors-to-be as a reference, and quoted a good phrase: ‘do what you have passion and enjoy in your life’. It’s a life-long career journey in medical line. The one question you may want to ask yourself is why you’ve chosen medicine, as a doctor?

  10. To Cow Salya and nia:
    please concentrate on your spm first. Don’t keep of thinking of being a doctor until you complete your pre-u studies. Still thinking that doctors’ salary is high??? wait until you check this website http://pagalavan.com/2010/09/07/for-future-doctors-general-misconception-of-being-a-doctor-part-1/. Please spent some time on this website, it helps you on the path way of being”enthusiast” in studying medicine. Both of your talking reflect your immaturity. Cheers..

  11. dear future cardio or cardio wanna be….
    patients live is in your hand, leave no room for mistakes, even a minor one…
    long years of studies and practice are the base for building skycrapper
    if your base is shaky… imagine what will happen……….
    … and of course the heart, hard work, determination, and ‘a bit of luck’ are essential…

  12. can i ask something?im just a sencondary school student and i think that i want to be CTS but i know nothing about it actually.so,i dont understand the meaning of gazettement.and what is holding retractor actually..please explain to me..

  13. wow. i think im consider myself very lucky as medical student, got a chance to scrubbed in mitral valve replacement surgery and even the surgeon let me do 1 stitch on the valve.
    i really have no idea the pathway of being CTS in malaysia, and how hard it is.
    thank you for info, nice article btw.

  14. I’ve done few research about this career on being a cardiologist..but trust me it takes a long journey to reach the top,but if you are really sincerely wants to be a doctor,and not thinking about the salary..even years and tough shouldn’t be a problem.first,it doesn’t matter if u don’t have basic degree of medical,degree which are related or non related to science also can join in this career.but if you already in medical degree,it is bonus!but for those who are not,just finish your degree in what you are in now,(related to Sc or not),..then apply to enter the medical school.there are 3 to 5 university in overseas which accept any degrees to enter their medical school such as Nottingham,New Castle,Cambridge..etc(do research on medical school on9),entering medical school will take 4 years long,then you need to join in an internal medical residency for 3 years.another 3 years you may have to become cardiology fellowship with an addition of 2 years in sub-specialized program u choose.then only u become cardiologist.

    i am also in my way to start a degree in medical radiation(USM),being a cardiologist will be one of the list in my choosen career .but instead,if I choose to change it,i want to be an ultrasonographer…:)

    years and tough won’t hurt you if your heart sincerely to do it!you deserve high pay only when you are special…so,be specialized!!fighting!!

  15. 1) The pro – with less people in the field, the pay will be high
    2) The con – time consuming
    3) My quiery – can you not taking the MBBS/MD but straight away concentrate with heart surgery since the first year (or the 3rd year after you learn the basic) in medical school. If you have specialization, you may not need to learn those knowledge that are less needed. This will save time and cost. Off course the medical field have the minimum standard but many of the times we learn a lot but not being practised. It happens in other fields. In many other fields, in the 4th year (or even in the third year), students may start their specialization. Masters and doctorate is more towards teaching and research. Patients could not afford to wait long and pay hefty sums for the service. I opined that the journey to become qualified specialists should be more relaxed.

  16. Even after reading this..i still love the Cardiologist and Cardiothoracic Surgery🙂 I hope that i”ll be a doctor someday.Then..i’ll try to reach top in medical.Thanks for info.Btw,i’m 18 now..i think it’s not too late.Waiting for SPM results🙂

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