Cards vs Critical Care

[josephf1]

Lets say you are a superstar at your IM prog and the PD of cards and critical care both are offering you a spot, now that the competition to get in is removed, its totally up to you. What would you decide?
My thoughts:
1) Cards:

Pros - more ego prestige, can do EP/Interventional and still make some buck, center of all IM, endless business

Cons - decreasing reimbursements, will be hard pressed to make over 350K in noninvasive going forward with cuts, long call, killer amounts of pts to round on as attending, weekends, uncontrolable hours, emmergencies rushing to hospital, endless chest pain consults that could get boring, many bogus GERD after all, radiation exposure if EP/interventional, may no longer hold its cache if salary down (aka surgery, rads)

2) Critical Care
Pros - you dah man, procedures, shift work, good salaries, massive shortage, eICU getting online, master 10 core things and your cooking, may be more ressitant to salary cuts as hospital based, dont have to deal with practice overhead
Cons - burnout, seing endless gomers die. annoying freaked out family members, bitchy nurses, can never be own boss and open private practice, depressing

Thanks, any feedback appreciated but Im sure most cards people are still hardocre stubbornyl cars, even though from speaking to fellows now I feel the money aint gonna be there and then the egos will all have to go clammering for GI spots - until that gets wacked too...

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[GiHunter]

go for cardiology

'you dah man' - man of what? gomers? ventilators (oo laa laa)
procedures - you means the ones interns and residents can become certified in?

cardiology is baller and always will be. look at those crazy procedues like ep ablations, mapping and caths. you also have the most grateful patients - how important are you to somebody if you busted open a clot or relieved their chest pain. cardiologist gets paid the big bucks because they work with an urgent critical organ where seconds of abnormality can lead to death. go for cardiology, no question in my mind but i'm going for gi so who knows

 

[muscles]

Google this: cardiology and the critical care crisis.

I am also having a similar dilemma and finally decided that I will pursue a cardiology fellowship with additional training to obtain certification in advanced critical care. Dr. Katz, in the article above, effectively argues the rationale and need for cardiology intensivists.

I'd be interested to hear other thoughts on this subject...

Happy thanksgiving all...

 

[josephf1]

"look at those crazy procedues like ep ablations, mapping and caths."
- is it that interesting to stick a femoral cath in someone and zap around their atrium with a laser or balloning and stenting another <50% area of the LAD? How many times can you do that before you wonder if a monkey can be trained to do that to? Do you need 16 yrs of education to do that?

"you also have the most grateful patients - how important are you to somebody if you busted open a clot or relieved their chest pain."
- Ever see the gratitude of a pt and family if they come back from the dead after 2 weeks on a respirator?

"cardiologist gets paid the big bucks because they work with an urgent critical organ where seconds of abnormality can lead to death."
Ok so what about the lungs, kidneys, liver, brain, blood, ... Only the heart matters?

I would still love to hear more input. The articale on Cards + ICU is very cool but thats FOUR years of training.

 

[Terex]

I have the same dilemma..I'm torn between critical care& Cards But I'm more of NON invasive cardiology/preventive cardiology not EP or Interventional..I'm happy seeing Heart failure patients gets well...One thing that makes me fear at with cardiology is its competitiveness..I'm from a University affiliated Community Hospital and I don't have any research/articles except for case reports presented to ACP yearly...I can get LORs from 1 attending that revoulutionalize Plavix and from a cardiologist from a University Hospital(University of MD& Johns Hopkins after my Heart failure rotation)...

I'm also interested with critical care as i practiced critical care for 5-6 yrs as a nurse before and i can get LORS from head of MICU& other CC/Pulmo attendings and I guess I have more chance of getting a CC/Pulmo fellowship than Cardiology fellowship BUT I love cardiology.. but how can I be more competitive? as I dont have much onterest with research..Kindly somebody help me to decide..

Lets say you are a superstar at your IM prog and the PD of cards and critical care both are offering you a spot, now that the competition to get in is removed, its totally up to you. What would you decide?
My thoughts:
1) Cards:

Pros - more ego prestige, can do EP/Interventional and still make some buck, center of all IM, endless business

Cons - decreasing reimbursements, will be hard pressed to make over 350K in noninvasive going forward with cuts, long call, killer amounts of pts to round on as attending, weekends, uncontrolable hours, emmergencies rushing to hospital, endless chest pain consults that could get boring, many bogus GERD after all, radiation exposure if EP/interventional, may no longer hold its cache if salary down (aka surgery, rads)

2) Critical Care
Pros - you dah man, procedures, shift work, good salaries, massive shortage, eICU getting online, master 10 core things and your cooking, may be more ressitant to salary cuts as hospital based, dont have to deal with practice overhead
Cons - burnout, seing endless gomers die. annoying freaked out family members, bitchy nurses, can never be own boss and open private practice, depressing

Thanks, any feedback appreciated but Im sure most cards people are still hardocre stubbornyl cars, even though from speaking to fellows now I feel the money aint gonna be there and then the egos will all have to go clammering for GI spots - until that gets wacked too...

 

[KRichards62]

is it that interesting to stick a femoral cath in someone and zap around their atrium with a laser or balloning and stenting another <50% area of the LAD? How many times can you do that before you wonder if a monkey can be trained to do that to? Do you need 16 yrs of education to do that?

Yes, it's that interesting. Percutaneous procedures have revolutionized the entire field of medicine and will only continue to do so. The "monkey" statement seems a little shortsighted, especially when the alternative in this discussion is CVLs, ABGs, LPs, and vent management. 16 years? I assume you are including undergrad and med school. Based on this logic, the minimum amount of time to practice ANY type of medicine is 11 years. So do you you need an additional 4-5 years of training to gain board certification in cardiology as well as preform complex procedures on a beating heart? Probably so.

I've got a lot of respect for the Pulm/CC docs, and ultimately it just comes down to personal preference. But in the future I wouldn't suggest making the procedure argument.

 

[Trifling Jester]

"look at those crazy procedues like ep ablations, mapping and caths."
- is it that interesting to stick a femoral cath in someone and zap around their atrium with a laser or balloning and stenting another <50% area of the LAD? How many times can you do that before you wonder if a monkey can be trained to do that to? Do you need 16 yrs of education to do that?

Have you seen an ablation? EP is one field I'd never worry about NP's, PA's, or whoever else encroaching upon...

-The Trifling Jester