Author Archives: RLP

Autism Spectrum Disorders Expert Witness

With more children being diagnosed with autism today than in past eras, much debate has arisen in the medical community and within families even.  What constitutes the diagnosis of autism?  What level of disability will arise once a diagnosis has been made?  Experts Cleringhouse LLC expert witnesses are world leaders who grapple with these questions and more every day.

If you are in need of an Expert Witness in Autism Spectrum, contact Experts Clearinghouse LLC today by calling us at 713-501-8526 or e-mailing at medexperts@gmail.com.  You can also use the form below.

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Taken from Wikipedia.org:

Autism is a neurodevelopmental disorder characterized by impaired social interactionverbal and non-verbal communication, and restricted and repetitive behavior. Parents usually notice signs in the first two years of their child’s life.  These signs often develop gradually, though some children with autism reach their developmental milestones at a normal pace and then regress.  The diagnostic criteria require that symptoms become apparent in early childhood, typically before age three.

While autism is highly heritable, researchers suspect both environmental and genetic factors as causes.  In rare cases, autism is strongly associated withagents that cause birth defects.  Controversies surround other proposed environmental causes;  for example, the vaccine hypotheses have been disproven. Autism affects information processing in the brain by altering hownerve cells and their synapses connect and organize; how this occurs is not well understood.  It is one of three recognized disorders in the autism spectrum (ASDs), the other two being Asperger syndrome, which lacks delays in cognitive development and language, and pervasive developmental disorder, not otherwise specified (commonly abbreviated as PDD-NOS), which is diagnosed when the full set of criteria for autism or Asperger syndrome are not met

Globally, autism is estimated to affect 21.7 million people as of 2013  As of 2010, the number of people affected is estimated at about 1–2 per 1,000 worldwide. It occurs four to five times more often in boys than girls. About 1.5% of children in the United States (one in 68) are diagnosed with ASD as of 2014, a 30% increase from one in 88 in 2012. The rate of autism among adults aged 18 years and over in the United Kingdom is 1.1%.  The number of people diagnosed has been increasing dramatically since the 1980s, partly due to changes in diagnostic practice and government-subsidized financial incentives for named diagnoses;  the question of whether actual rates have increased is unresolved

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Transvaginal Mesh Expert Witness

A Texas jury awarded a woman $73 million for complications stemming from her transvaginal mesh implant on September 8, 2014.  In Texas, tort reform has put a cap on punitive damages for medical malpractice cases but no such cap exists for cases against corporations.  In recent times and in Texas in particular, the number of expert witness requests for mass tort experts has increased while requests for medical malpractice experts has declined for us.

This cap has made the filing of medical malpractice cases difficult because of the high cost of the lawsuit itself, including retaining an appropriate expert witness.  Retaining an expert witness for a mass tort lawsuit can be even more financially difficult because of the number of hours the expert must work to become familiar with the existing literature of issue at hand.  With mass tort cases, there can be multiple plaintiffs the expert witness must review records for, again driving up the cost of litigation.  That is assuming you can find a doctor who is willing and able to serve as the expert witness in the first place.

Experts Clearinghouse can connect you with an urogynecologist that has the knowledge, expertise, and time to help your case.  Given the trends in our home state, we have adapted, able meet both medical malpractice and mass tort needs.

Thank you and advance always,

Robert Pham

Medical Malpractice versus Pharmaceutical Litigation

You my wonder how Experts Clearinghouse approaches medical malpractice expert witnesses versus pharmaceutical litigation expert witnesses.  We are asked everyday to bring the most qualified and appropriate expert to the table for these two scenarios, and to be honest, the difference in our approach is only minor.

First and foremost, we look for those physicians who are board certified in both instances.  We have a database of thousands of doctors who do not advertise that they do expert witness work.  If no one in our network is qualified or available, we have methods to expand our network as needed.  After 16 years in the industry, we are able to meet just about any medical expert witness need.

Second, we target those who are teaching.  We do this because we believe these individuals typically hold more weight in court.  Our network includes the full spectrum of academics, from clinical instructors to chairmans emeritus.  That spectrum is also geographically inclusive, spanning all corners of the United States.  If an area has a medical school in it or nearby, there is a good chance an Experts Clearinghouse  physician is present as well.

Finally, and herein lies the difference as well, the physician must have the necessary expertise and knowledge to speak to the issues at hand in the medical malpractice or pharmaceutical litigation.  In the case of medical malpractice, the standard of care must be known and practiced.  Deviations from this standard may indicate breech.  On the other hand, for pharmaceutical litigation, the effects of the drug must be understood.  The latest research findings for the drug are paramount.

Thank you and advance always,

Robert

Medical Expert Witness: Challenge of Fatigue

After 16 years in the industry, we have seen our fair share of extraordinary cases filled with stories, emotions, and at times, nearly unbelievable events.

With this experience, comes the danger of medical expert witness fatigue.  Plaintiffs and Defendants are added to the memory bank, but begin to be grouped together in the mind.  What was once shocking, becomes an essential case detail instead.

Because the well being of people hinge on our work, the emotional and psychological toll can at times be great.  And that wears on a person.

To combat that, we only need to look around to our families and loved ones.  We ask ourselves what we would want if someone we loved were a Plaintiff or Defendant in a case.  This always gives new meaning to our work and drives us to be at our best.

Advance always,

Robert Leonard Pham

RIP Connor

Medical Consultant versus Expert Witness

If you are a healthcare professional interested in doing medicolegal work, you may be wondering what kind of roles you can assume in a case.  This blog post will give you the basics.

Put simply, you must decide whether you want to be involved behind the scenes or be willing to testify.

Being behind the scenes as a consultant, you will evaluate the facts of the case through the pertinent medical records and relevant literature.  You will give the attorney  client your opinions, informing his or her next step.  You may be asked to write a report of your findings, but that report will not be submitted to the court.  You will not give your opinion under oath during deposition and trial.

Being a consultant is an attractive option to many, including a great number of nurses who offer medical record summaries to attorneys, but when testimony under oath is needed, so is a testifying expert witness.

The testifying expert witness will do all that the consultant will do, but his or her written report will be submitted to the court and, if necessary, he or she will give testimony during deposition or trial.

The testifying expert witness’s increased involvement means added time commitment and exposure to the stress of testimony, but the rewards of being the difference between success and failure during trial can be yours.

Experts Clearinghouse’s clients typically prefer to have medical professionals who testify as well, most likely because all roles are met by a single person.  Time and resources are saved.

Let us know if you would like to be involved.

Thank you, and keep pushing,

Robert Leonard Pham

The Ideal Medical Expert Witness

Ideal medical expert witnesses do exist, and there are certain qualities that Experts Clearinghouse targets when determining who we recommend for medical malpractice cases and pharmaceutical or product liability mass torts.

First and foremost, we target expert witnesses who are board certified in their respective specialties and subspecialties.  Are we saying that a doctor must be board certified to be a good doctor?  Absolutely not, but when it comes to demonstrating expertise within the courtroom, having the training necessary to be certified by an American Board of Medical Specialties entity certainly helps.  Certain states even require it.  As a practice, Experts Clearinghouse only recommends those who are board certified.

Second, we target those physicians who currently hold academic positions.  Again, we are not saying that this automatically means the physician is a good doctor, but what this demonstrates to a jury is that this physician commands enough respect among his or her peers to hold said position.  To be able to both practice and teach students medicine carries weight in the courtroom.

Coming hand in hand with teaching physicians often is the practice of research and publishing scientific papers.  Doing such demonstrates to a jury that this physician is up to date with the latest in one or multiple areas of expertise, even better when those said papers relate directly to the issues at hand in any given legal case.

As discussed elsewhere in this blog, presentability and communication skills are also paramount.  All of the credentials in the world do not carry much weight in the courtroom if the jury does not connect to or understand the expert witness.  I am thinking along the lines of the tree falling with no one around to hear analogy, although in this case, words are heard but the question is comprehension and impact.

As for the expert witness advertising him or herself as an expert witness, I am still on the fence regarding recommending or discouraging this practice.  I can honestly say that the practice is becoming more accepted in the industry, although generally, the medical expert witnesses that Experts Clearinghouse recommends do not advertise.  As stated previously, this is the choice of the expert.  Expert witness work is stimulating and worthwhile for many, and even better that one can be compensated for sharing ones expertise.  I consider myself a sort of expert on expert witnesses, especially medical, and I am glad I get a chance to help push along the tough cases which our beautiful legal system must face.

Because I am compensated for my expertise, I feel even more obligated to act in the most prudent and honest manner possible.  The ideal medical expert witness does the same.

The ideal medical expert witness will have a license in good standing and currently practicing, at least in some capacity.  Experts Clearinghouse has worked with clients who actually prefer Professors who are semi-retired because they have the time necessary for expert witness record and literature review and testimony, particularly for multi-plaintiff mass torts.

The ideal medical expert witness does not do too much expert witness work.  The definition of “too much” will depend on the client, but almost universally sought after is a balanced mixture of Defense and Plaintiffs work.

Are you the ideal medical expert witness?  Please let us know if you are interested in doing expert witness work.  We would love and honor the opportunity to work with you.

Keep pushing and thank you,

Robert Leonard Pham

 

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Medical Expert Witness Fees

There are a number of factors which can potentially dictate how much a medical expert witness can charge for his or her services.  They will be discussed in this blog post.

The first and most important factor is the type of degree the medical expert witness holds, assuming that the expert is still practicing with a license in good standing in their respective field.  Medical doctors are at the top of the pyramid with their doctorate level research colleagues (Ph. D.’s) and Pharmacists next followed by registered nurses and physical therapists with technicians last.

Below are typical minimums charged by the medical expert witness for record review and report writing.  The per hour starting points:

M.D. and D.O. – $250/hr.

Doctorate level research scientist or pharmacist – $150/hr.

Registered nurse or physical therapist – $100/hr.

Technicians – $75/hr.

Testimony whether in deposition or trial usually means higher rates for the medical expert witness, typically seeing a rate increase of a factor of one and a half to two.  The per hour starting points thus become:

M.D. and D.O. – $300/hr.

Doctorate level research scientist or pharmacist – $200/hr.

Registered nurse or physical therapist – $150/hr.

Technicians – $125/hr.

As for how much the medical expert witness can command, more details will be discussed below.

For an M.D. and a D.O., if you perform surgical procedures, typically you can command more doing expert witness work especially as your specialty and subspecialty are practiced by less people.

Also for an M.D. and a D.O., being Board Certified in your respective specialty and subspecialty will allow you to dictate more.  Almost all clients require their expert witness to be Board Certified, and Experts Clearinghouse’s own policy is to recommend only Board Certified physicians.

A factor which applies to all medical expert witnesses is whether or not the expert currently holds a teaching position in his or her respective field of expertise.  Department Chairs command the most followed by Professors, Associate Professors, Assistant Professors, and Clinical Instructors respectively.

Teaching at well known and respected institutions also usually means the medical expert witness can command more.

These are the typical fee factors which we have seen from the thousands of medical expert witnesses which we have been exposed to and placed since 1998.

Keep pushing and thank you,

Robert Leonard Pham

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Experts Clearinghouse LLC consistently delivers the most sought after medical expert witnesses to law firms, corporations, and governments who need them the most. Our network includes the absolute best credentialed and respected practitioners who testify in the toughest of scenarios, often when other networks have failed.

Call us today for your free initial consultation at 713-501-8526 or e-mail at medexperts@gmail.com.

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Urology

Experts Clearinghouse LLC consistently delivers the most sought after urologists to law firms, corporations, and governments who need them the most. Our network includes the absolute best credentialed and respected practitioners who testify in the toughest of scenarios, often when other networks have failed.

Call us today for your free initial consultation at 713-501-8526 or e-mail at medexperts@gmail.com.

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Experts Clearinghouse experts in this Specialty have a certificate issued by:  American Board of Urology

Subspecialties include:  Female Pelvic Medicine and Reconstructive Surgery, Pediatric Urology

Expert Witness Location Difficulty Level:  MEDIUM

States represented by the network:  Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Typical minimum fee for Record Review and Report Writing for this Specialty:  $250 per hour

Typical minimum fee for Testimony for this Specialty:  $300 per hour

For a more complete explanation of Fees, click here

Medical Malpractice issues:  Standard of care

Mass Tort involvements:  Urogynecologists for transvaginal mesh litigation related to pelvic organ prolapse or stress urinary incontinence

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Taken from Wikipedia.org:

Urology (from Greek ????? ouron “urine” and -????? -logia “study of”), also known as genitourinary surgery, is the branch of medicine that focuses on the surgical and medical diseases of the male and female urinary tract system and the male reproductive organs. The organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles,prostate and penis).

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Thus a major spectrum of the conditions managed in urology exists under the domain of genitourinary disorders. Urology combines the management of medical (i.e., non-surgical) conditions such as urinary tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

Urology has traditionally been on the cutting-edge of surgical technology in the field of medicine; including minimally invasive robotic and laparoscopic surgery, laser assisted surgeries, and a host of other unique scope-guided-procedures. Urologists are well-trained in open and minimally-invasive techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions.[1] In addition, urologists are pioneers in the use of robotics in laparoscopic surgery. Urology is closely related to (and urologists often collaborate with the practitioners of) the medical fields of oncology, nephrology, gynaecology, andrology, pediatric surgery,colorectal surgery, gastroenterology, and endocrinology.

Urology is one of the most competitive and a highly sought-after surgical specialty to enter for physicians, with new urologists comprising less than 1.5% of U.S. medical school graduates each year.[2][3] In Canada, Urology is an exceedingly difficult specialty to match, with less than 0.1% of the position dedicated to Urology.

Urologic surgeons, or urologists, undergo a very rigorous post-graduate surgical training period for a minimum duration of five years, of which 12 months must be completed in general surgery and 36 months must be completed in clinical urology. The remaining 12 months are spent in general surgery, urology or other clinical disciplines relevant to urology.[4] Upon successful completion of a residency program, many urologists choose to undergo further advanced training in a sub-specialty area of expertise through a fellowship lasting an additional 12 to 36 months. These may include: urologic surgery,urologic oncology and urologic oncological surgery, endourology and endourologic surgery, urogynecology andurogynecologic surgery, reconstructive urologic surgery (a form of reconstructive surgery), minimally-invasive urologic surgery, pediatric urology and pediatric urologic surgery (including adolescent urology, the treatment of premature or delayed puberty, and the treatment of congenital urological syndromes, malformations, and deformations), transplanturology (the field of transplant medicine and surgery concerned with transplantation of organs such as the kidneys, bladder tissue, ureters, and, recently penises), voiding dysfunction, neurourology, and androurology and sexual medicine. Additionally, some urologists supplement their fellowships with an additional Masters (2-3 years) or a PhD (4-6 years) in related topics to prepare them for an academic as well as a focused clinical job.

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Thoracic and Cardiac Surgery

Experts Clearinghouse LLC consistently delivers the most sought after thoracic and cardiac surgeons to law firms, corporations, and governments who need them the most.  Our network includes the absolute best credentialed and respected practitioners who testify in the toughest of scenarios, often when other networks have failed.

Call us today for your free initial consultation at 713-501-8526 or e-mail at medexperts@gmail.com.

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Experts Clearinghouse experts in this Specialty have a certificate issued by:  American Board of Thoracic Surgery

Subspecialties include:  Congenital Cardiac Surgery

Expert Witness Location Difficulty Level:  HIGH

States represented by the network:  Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Typical minimum fee for Record Review and Report Writing for this Specialty:  $250 per hour

Typical minimum fee for Testimony for this Specialty:  $300 per hour

For a more complete explanation of Fees, click here

Medical Malpractice issues:  Standard of care

Mass Tort involvements:

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Taken from Wikipedia.org:

Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax (the chest)—generally treatment of conditions of the heart (heart disease) and lungs (lung disease). Cardiac surgery (involving the heart and great vessels) and thoracic surgery (involving the lungs) are separate surgical specialties, except in the USA, Australia, New Zealand and in some EU countries, such as the UK and Portugal.[1]

Training

A cardiac surgery residency typically comprises anywhere from 9 to 14 years (or longer) of training to become a fully qualified surgeon. Cardiac surgery training may be combined with thoracic surgery and / or vascular surgery and called cardiovascular (CV) / cardiothoracic (CT) / cardiovascular thoracic (CVT) surgery. Cardiac surgeons may enter a cardiac surgery residency directly from medical school, or first complete a general surgery residency followed by a fellowship. Cardiac surgeons may further sub-specialize cardiac surgery by doing a fellowship in a variety of topics including: pediatric cardiac surgery, cardiac transplantation, adult acquired heart disease, weak heart issues and many more problems in the heart.

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General Surgery, Vascular Surgery

Experts Clearinghouse LLC consistently delivers the most sought after general and vascular surgeons to law firms, corporations, and governments who need them the most.  Our network includes the absolute best credentialed and respected practitioners who testify in the toughest of scenarios, often when other networks have failed.

Call us today for your free initial consultation at 713-501-8526 or e-mail at medexperts@gmail.com.

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Experts Clearinghouse experts in this Specialty have a certificate issued by:  American Board of Surgery

Subspecialties include:  Complex General Surgical Oncology, Hospice and Palliative Medicine, Pediatric Surgery, Surgery of the Hand, Surgical Critical Care

Expert Witness Location Difficulty Level:  MEDIUM

States represented by the network:  Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Typical minimum fee for Record Review and Report Writing for this Specialty:  $250 per hour

Typical minimum fee for Testimony for this Specialty:  $300 per hour

For a more complete explanation of Fees, click here

Medical Malpractice issues:  Standard of care

Mass Tort involvements:  General surgeons for Prempro related to breast cancer

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Taken from Wikipedia.org:

General surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladderand bile ducts, and often the thyroid gland (depending on local reference patterns). They also deal with diseases involving the skin, breast, soft tissue,trauma , peripheral vascular surgery and hernias.

Scope

General surgeons may sub-specialize into one or more of the following disciplines:

Trauma surgery/ Surgical Critical Care

In the United States and Canada, the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training in this field (most commonly surgical critical care) and specialty certification surgical critical care. General surgeons must be able to deal initially with almost any surgical emergency. Often, they are the first port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as thoracostomy, cricothyroidotomy, compartment fasciotomies and emergency laparotomy orthoracotomy to stanch bleeding. They are also called upon to staff surgical intensive care units or trauma intensive care units.[citation needed]

All general surgeons are trained in emergency surgery. Bleeding, infections, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide. This is most often done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Ruptures of the appendix and small bowel obstructions are other common emergencies.

Laparoscopic surgery

This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 0.3 to 1 cm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are now repaired mostly laparoscopically. Most bariatric surgery is performed laparoscopically.[citation needed] General surgeons that are trained today are expected to be proficient in laparoscopic procedures.

Colorectal surgery

General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease), diverticulitis, colon and rectal cancer, gastrointestinal bleeding and hemorrhoids.

Breast surgery

General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy, especially pertaining to the evaluation and diagnosis, of breast cancer.

Vascular surgery

General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.

Endocrine surgery

General surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glandsjust above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists, other subspecialty surgeons may assume responsibility for these procedures.

Transplant surgery

Responsible for all aspects of pre-operative, operative, and post-operative care of abdominal organ transplant patients. Transplanted organs include liver, kidney, pancreas, and more rarely small bowel.

Surgical oncology

Surgical oncologist refers to a general surgical oncologist (a subspecialty of general surgery), but thoracic surgical oncologists, gynecologic oncologists and so forth can all be considered surgeons who specialize in treating cancer patients. The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume—i.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted—even as common sense—that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer.

Cardiothoracic surgery

Most cardiothoracic surgeons in the U.S. (D.O. or M.D.) first complete a general surgery residency (typically 5–7 years), followed by a cardiothoracic surgery fellowship (typically 2–3 years).

Pediatric Surgery

Pediatric surgery is a subspecialty of general surgery pediatric surgeons do surgery on patients age lower than 18. pediatric surgery is 5–7 years of residency and a 2-3 fellowship

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