Cardiology!

[ffp]

Tarzi,

for IM, I say these would be the negatives:

- You do have lots of older patients with multiple, chronic problems. This can be frustrating.
- There's not so much instant gratification as with other specialties (ie. surgery). Sometimes it takes a long time to see results of your work.
- You have inpatients to follow (unlike radiology, anaesthesia, ER, path
- You do get to do procedures, but not every day (like surgery or anaesthesia)
- Residency is one of the medium-busy ones. A medicine junior does ~1 in 4 call on CTU, and can be very busy indeed. It's not as bad as some of the surgical specialties, but definitely a lot worse than specialties like rad onc or path!!!

Negatives of cardio:

- It's BUSY. Cardio is the busiest of the IM subspecialties, and the patients can be sick. You'll often find yourself dealing with several seriously ill patients at the same time. It can be stressful
- The training is very busy. There is some variation in programs across the country, but a cardio fellow is always busy (especially in the first year). It's quite standard for a PGY-4 to do 7 calls/month, and some programs demand in-house call for the first 6-18 months. Because people can have MIs or cardiac arrests any time of day, it means you often are up all night on call.
- Some people complain because cardiology is "only the heart", and find it monotonous to deal with only one organ system

Once you're an attending, your lifestyle will vary depending on the subspecialty you choose. Most cardiologists do rotate through call on CCU/ward services. When you're on call, you're busy (for the reasons stated above), however, if you join a large call group, you might not be on call very often (ie. group of 16 cardiologists - call 1 week out of 16)

if you do interventional, you will be busy the nights you're on call! Again, call frequency depends on the number of interventionalists. More=less call/individual. The other subspecialties are not as busy as interventional.

Yes, in any specialty you choose, you can decide to be an academic or a private-practice physician. You can divide your time between clinical, research, teaching, and admin. This is true no matter what specialty you pursue. There are plenty of academic cardiologists and plenty of private practice. In some centres, academic cardiologists are salaried instead of fee-for-service. they tend to make less than their private practice counterparts (b/c they don't get to bill for procedures), but it frees up time to do other things - ie. teach, research. A fee-for-service cardiologist would not be remunerated for these things.

Nonetheless, private practice/ fee-for-service cardiologists can still be involve in teaching (albeit unpaid). This is what I hope to do one day.

[Kirsteen]

Originally Posted by ffp

- You do get to do procedures, but not every day (like surgery or anaesthesia)

Hey there,

Just to add a wee bit: in my experience most surgeons don't have the ability to do procedures every day. Many I've worked with have protected OR time just two days per week and those who are fresh out of residency/fellowship, sometimes less. To belabour the point, I've seen some Interventional GI folk have more protected in-suite days per week than surgeons.

Cheers,
Kirsteen

[ffp]

Very true Kirsteen.

What I was trying to say is that as an IM resident, there will be opportunities to do thoracentesis, paracentesis, LP, bone-marrow biopsy, joint aspiration/injection, chest tubes, art lines and central lines.

The exposure to these procedures is not as consistent or as frequent as in a surgical or anaesthesia residency. There is A LOT of variation in how many procedures each resident is exposed to. For example... most residents in my year didn't get any chest tubes (or maybe 1 or 2). I got 7. On the other hand, I got 3 paracenteses (the bare minimum to meet our program's requirements). Most other residents got >10. It's just a case of which patients came in the day you were on call.

Some medicine attendings (regardless of subspecialty) perform and supervise all of the above procedures, and some do only a few, or none.

IM residency will afford you the opportunity to do procedures, but if you LIVE to do these things, and want to do them on a consistent, regular basis, you won't get it in IM residency (although you can in IM subspecialties like cardio or GI)

[leviathan]

Originally Posted by ffp

leviathan,
I think the best thing for you to do would be try to shadow a cardiologist, or cardio fellow. At UofS, they have a program for aboriginal high school and university students to be paired up with a doc for a day. I met one of these students through the preceptor he was paired up with, and he shadowed me for a few mornings at work, as well as a few nights on call. If you could get set up with something like that, it would be sweet.....

You still have lots of time... Remember.. you have ~3 years of med school to decide on a specialty, and if you do IM, you have another ~2 years to pick a subspecialty... so don't worry about it too much at this point... you might change your mind several times

FFP, I am just graduating with my bachelor's degree right now. I definitely have tons of time to decide, so I think I will hold off on any shadowing until I'm in medical school (I'm in no rush!). As you said, I agree I will probably change my mind a million times over, anyhow. I do some volunteer work in an emergency department here and I've watched some cardiologists perform echos, which is pretty cool stuff. Other than that, the cardio stuff I've seen is mostly just dealt with by the emergency physicians before they get consults or admit patients up into medicine.

[physiology]

Hello FFP,

Look West FFP In BC, the well known cardiologists all bill over a $1 million a year. One reads echos...and I think the others are interventional.

Anyway, they seem fairly happy with their jobs too. Unlike the bitter ophthalmologists who i've met, who also bill over a million a year, but incessantly complain of the lack of OR time for their cataract surgeries.

Physio

[physiology]

The cardiologists in BC are like that too...they operate patient factories at times. They're also somewhat a bit arrogant and extremely territorial. But hey, that encourages innovation and the cardiologists can push all they want. When the radiologists & CV surgeons fight back, then the technology will get REALLY good

Cardiology is great too in that it's extremely well-respected. There's a considerable amount of funding and you're the exception if you don't have some sort of cardiovascular disease over age 50.

In terms of lifestyle, I heard it can be brutal. Call for CCU can be tough, depending on how good your resident is.

Anyway, I have heard that jobs can be scarce in BC, but let me tell you, there are lot of male cardiologists who are going to throw in the towel soon, so maybe when things are said and done, there will be considerably more jobs opening up.

[Curious P]

Originally Posted by ffp

Jobs are scarce everywhere...

On that note, how are the job prospects for Cardiologists? Is there any way to predict what the market will be like in 5/10/15 yrs?


I've heard some rumours about a 5 year direct entry Cardio program in the works. Anyone else hear about such a program?

[ffp]

I've heard rumours about 5-year direct entry (ie. no IM residency required first). Right now they're just that - rumours. We actually debated this at one of the internal med half days last year. I've also heard rumours about cardiology going to 4 years (AFTER completion of IM, so that would make 7 years total). IMO, this is WAY too much, especially if you still have to subspecialize on top of that.

Job prospects for cardiologists are generally great if you choose the right specialty. If you do general cardiology, you will be GOLD. If you do echo and have your own machine, you can set up shop anywhere and pretty much start printing money. Cardiac imaging (CT-angio, MRI, nuclear) are going to be very hot commodities in the near future. EP is also still an expanding field with lots of opportunities. The problem comes if you want to do interventional. Right now, jobs in Canada are scarce. Some people tell me I won't have a hope of getting a job if I hope to do interventional (I'd be finished in 2011), while others tell me that lots of new centres will open up (ie. interior BC) and that lots of people will be retiring. I don't know who to believe. I won't let job prospects influence my choice of specialty, though.

[Curious P]

Thanks for the info ffp!

Here's an interesting article I found regarding the number of cardiologists in Canada: http://www.ccs.ca/download/position_...ts/ross_ed.pdf

[ffp]

Thanks for the interesting article Curious_P. Yep... I sure would be happy with a shorter training program. won't happen for me, but maybe in the next few years.

Also, I wonder where they even found ANY cardiologists under age 35! I'm about as young as one can mathematically be at my stage of training (without being Doogie Howser), and I'll be 33 when I'm done