How competitive is cardiology?

[stookie]

How competitive is cardiology? What is the lifestyle like? Ie. Hours worked, calls? etc.

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[SmallTownGuy]

1. Very

2. Long hours in most cases, lots of call in most cases.

 

[stookie]

Even if you practice non invasive cardiology?

 

[SmallTownGuy]

It depends on what you think is a bad lifestyle, and how much you are want to earn. Do not expect a big paycheck without long hours, this does not happen in cardiology (I am sure there are exceptions, I am speaking in general).

I am from New Orleans, LA. I recently did a cardiology rotation, and was able to do this with a private group (the largest in LA), due to the situation at my school post-Katrina. Speaking to the docs there confirmed what I already thought, you will be busy but well compensated.

Expect to work 65-80+ hours per week, with lots of call in fellowship. In private practice, expect to work 50+ hours per week, with variable call. You will be called back to the hospital lots because there are many sick patients in cardiology, and you will be expected to admit your own patients when they have MI, CHF exacerbation, arrythmia, etc. The non-invasive guys at the private group put in 10+ hours per day, this was split between seeing clinic patients, hopitalized patients and conducting studies.

I hope that this rambling answers some of you questions. In short, do not go into cards expecting great hours, with protected time off. It's better than it used to be, but still demanding.

 

[stookie]

I would like to get into non-invasive practice. Any info about it?

 

[SmallTownGuy]

What do you want to know about non-invasive. I am entering IM residency in July and was planning to do cards, so there may be more experienced people here who can shed some light.

Here is what I know from my experience:

1. requires 6 years training: 3 IM + 3 cardiology fellowship

2. generally involved in medical mgmt of cardiac issues (most common problems = CHF, MI, HTN, arrythmia) and non-invasive study interpretation (echos, ECG, stress tests, etc)

3. starting salary usually 225,000-250,000+, usually 1-2 years till you make partner, then you make more (potentially 7 figures)

4. long days for the most part (10-12 hours), and usually a good amount of call (usually the partners share call, typically you take call every 3-5 days). When you are on call, YOU WILL BE CALLED IN ALMOST EVERY TIME. Expect late night calls and having to go to the ER most call nights. This is because you have many sick patients in this field that require frequent admission to the hospital

This is all I can really tell you, and is based on my experience with one group. So it is not the final word. Perhaps other viewers can correct me on something or give more insight.

take care

 

[stookie]

What do you want to know about non-invasive. I am entering IM residency in July and was planning to do cards, so there may be more experienced people here who can shed some light.

Here is what I know from my experience:

1. requires 6 years training: 3 IM + 3 cardiology fellowship

2. generally involved in medical mgmt of cardiac issues (most common problems = CHF, MI, HTN, arrythmia) and non-invasive study interpretation (echos, ECG, stress tests, etc)

3. starting salary usually 225,000-250,000+, usually 1-2 years till you make partner, then you make more (potentially 7 figures)

4. long days for the most part (10-12 hours), and usually a good amount of call (usually the partners share call, typically you take call every 3-5 days). When you are on call, YOU WILL BE CALLED IN ALMOST EVERY TIME. Expect late night calls and having to go to the ER most call nights. This is because you have many sick patients in this field that require frequent admission to the hospital

This is all I can really tell you, and is based on my experience with one group. So it is not the final word. Perhaps other viewers can correct me on something or give more insight.

take care

Wow, I can manage a 10 hr work day, but being called in during the middle of the night is not my thing. What specialties are very family oriented?

 

[DoctorFunk]

I'm pretty curious about invasive cards. I'm well aware that there will be alot of midnight trips into the lab, but how often is call like that on average? Is this about the worst specialty available as far as getting yanked into work constantly?

 

[deleted87716]

What specialties are very family oriented?

I'll give you a hint: you used the word in your question.

 

[deleted87716]

I'm pretty curious about invasive cards. I'm well aware that there will be alot of midnight trips into the lab, but how often is call like that on average?

If you're in private practice, it usually depends on the size of your group. If you're in practice with three other docs, you'll likely be on call every fourth night, for example. Some groups cross-cover for each other, which can mean less call, but more work when you are on call, as you're covering more patients.

Is this about the worst specialty available as far as getting yanked into work constantly?

It's up there.

 

[stookie]

I'll give you a hint: you used the word in your question.

Ugh. I really don't want to go into primary care.

 

[deleted87716]

Ugh. I really don't want to go into primary care.

Well, you asked.

 

[SmallTownGuy]

Wow, I can manage a 10 hr work day, but being called in during the middle of the night is not my thing. What specialties are very family oriented?

Some of the better known "lifestyle" fields are derm, rads, gas, pathology, pmr.

That being said, your life will be what you make of it. Your priorities are your own to make. For example, FP and IM are two fields that are thought to have am uncontrollable lifestyle, but there are plenty of docs who work in HMOs and such that work 9-5 without call. I also know radiologists that work 60 hours a week and take call all the time (they value money more than lifestyle).

 

[mysophobe]

Is this about the worst specialty available as far as getting yanked into work constantly?

Yes.

 

[deleted87716]

there are plenty of docs who work in HMOs and such that work 9-5

You don't have to work for an HMO to have reasonable hours in primary care. As you said, your life is what you make it.

 

[SmallTownGuy]

You don't have to work for an HMO to have reasonable hours in primary care. As you said, your life is what you make it.

This is true. I was just using an example based on the private docs I have been exposed to.

You can also join a large group and take call like once a month or so. You can join a group with hospitalist who cover you call while you see patients in the office.

The options are many. I guess my point (if I ever get to it), was that I believe (with some exceptions) that your lifestyle is more the product of the practice environment that you place yourself in than your exact specialty.

 

[Dr. K]

What are the average USMLE scores and GPAs for successful candidates?

 

[deleted87716]

I believe (with some exceptions) that your lifestyle is more the product of the practice environment that you place yourself in than your exact specialty.

True, up to a point. Certain specialties are far less flexible in that regard than others, however, cardiology being one of them.

 

[SmallTownGuy]

True, up to a point. Certain specialties are far less flexible in that regard than others, however, cardiology being one of them.

Took the words right out of my mouth. I think that there are a handful of specialties (cards, ortho, gen surg) where it is extremely hard to find balance.

I was actually interested in cards for a long time, but I am starting to wonder if it is worth the effort and pain. I don't so much mind the work (but my soon to be wife might!), but it seems that these guys have so much information to keep up with that it is hard to find time for other stuff in life. The tech and treatments are always evolving, and I imagine that when the are not at work, they are reading journals at home.

I may try to find something a little less broad to try and find balance, or do general IM and learn a little about a lot.

 

[deleted87716]

I don't so much mind the work (but my soon to be wife might!), but it seems that these guys have so much information to keep up with that it is hard to find time for other stuff in life.

It's not so much the information as it is the schedule. For some reason, people usually have MIs at very inconvenient times (e.g., when you'd normally be sleeping).

 

[viostorm]

I'd really be interested in someone objectively answering the "how competitive is cards?"

Is it really as impossible as everyone makes it seem to get?

I can't imagine it is as competitive as things like ENT/Ortho/Plastics/Derm.

For example, 33% of cards spots went to FMG's/IMG's/DO's according to NRMP.

http://www.nrmp.org/fellow/match_name/msmp/stats.html

I'm getting really frustrated with residency search, everyone says everything it competitive, and I know it can't be! There are more spots then students! I know IM/Family are not ... but I would really like some insight into what is going on in Cards because right now it is something I'd really like to pursue.

Here are the things I think work against Cards being "VERY" competitive as people tout.

1) Most of the top *gunners* have already selected themselves into ortho/derm/ent ... they will never even apply for cardiology.

2) A 6-7 year fellowship, people can do heart transplants in the same amount of time!

3) I can't imagine that there is not some attrition after the 3 year IM residency where people are just like "I gotta start making some money"

Can someone from cards help me?

Lets get some real info, not just what people think:

1) What percent of cards fellows are AOA?
2) What is average step 1 cards fellows scored?

 

[SmallTownGuy]

Good questions, viostorm.

 

[VCMM414]

Are Step 1 scores even used for fellowship placement? I would think they are so far removed from fellowships that it makes little sense to continue to consider them. Nonetheless, cards and GI should still boast good Step scores simply because applicants from strong IM programs land more competitive fellowships, and these same applicants tend to have higher Step scores in order to land these residencies.

While it's true that many of the top applicants already selected themselves into derm/rad onc/plastics, remember that strong IM programs still have very strong students. Besides, there are limited number of seats for derm/rad onc/etc., so there are still many top scoring applicants out there in the IM world.

Having said that, I too don't believe that cardiology is as competitive as derm. I remember reading an earlier post in this forum (by a cardiology fellow?) stating that applicants coming from strong IM programs shouldn't have any problems matching into cards. This is in contrast with dermotology, where not every applicant is guaranteed to match even if he/she comes from a top 10 med school. In any case, does it really matter how difficult it is to place into cardiology? If it drives you, you should go for it.

 

[cfdavid]

I'm soon to start MS1, so clearly I lack experience. lol
But, when I was volunteering in the ED, I'd see cardiologists come rushing in like heros to save the day. I saw some, what must have been interventionalists, dudes come in to install temporary pacemakers etc. into guys that were in serious shape. Twenty minutes later the guy that just had an MI is talking to his family. Awesome stuff.

I'm sure it gets old receiving call at all hours of the night, but it also seems really rewarding. Like, they can see immediate results.

Anyone with experience care to comment??

 

[mysophobe]

6-7 year fellowship? What do you want to do, cards, EP, & interventional? If you're including the IM part, then you have to include the gen surg part. No one is doing heart transplants in 6-7 years, lol. It takes 6 years just to get to the CTS fellowship sometimes, which is 2-3 years, and then the transplant fellowship. Even if you took the shortest programs possible, it's still just about 10 years.

Anywho, I think if you come from a strong program you're probably okay. Doing your IM residency at a place with a cards fellowship program is a big plus too. You can get to know the cards guys and get in on some research/face time.

 

[viostorm]

6-7 year fellowship? What do you want to do, cards, EP, & interventional? If you're including the IM part, then you have to include the gen surg part. No one is doing heart transplants in 6-7 years, lol. It takes 6 years just to get to the CTS fellowship sometimes, which is 2-3 years, and then the transplant fellowship. Even if you took the shortest programs possible, it's still just about 10 years.

Anywho, I think if you come from a strong program you're probably okay. Doing your IM residency at a place with a cards fellowship program is a big plus too. You can get to know the cards guys and get in on some research/face time.

Ok, so I was freaking out when I wrote the post. Now I am more settled down.

So basically here is what I meant, to be an interventional cardiologist is what I consider a *long* time. I can't believe it takes 7 years to be competent in that. I think you will have to agree it is a very long time when compared with things like ortho where you learn to do hundreds of different surgeries in a 5 year program.

Cardiology: 3 IM + 3 Card disease + 1 fellowship (EP or Int)
Transplant: 5 gen surg + 2 thoracic surg + ????

I can't find any transplant fellowships either on Frieda or in 10 mins or so browsing through google that are specific to the heart. Most transplant fellowships are for liver/kidney

I actually looked at the cirriculum for most cardiothoracic fellowships and almost all included "cardiopulmonary transplant" on it.

Anyone have any comments or help you can offer on this?

 

[mysophobe]

If you can't imagine going for 7 years to be an interventional cardiologist, then don't. You will only be miserable. Orthopods learn to do a bunch of surgeries in 5 years, but it isn't "hundreds" of surgeries, and honestly, a total knee is a total knee is a total knee. Cardiology is long because you need a good foundation in medicine, and before you can get interventional you need to have a good foundation in general cardiology. Just be glad you don't want to be a pediatric heart surgeon or something.

 

[medoc]

...I'm sure it gets old receiving call at all hours of the night, but it also seems really rewarding...
Anyone with experience care to comment??

that's the rub, cfdavid. i see a dangerous trend in the logic i have observed not only in this thread, but in many of these threads regarding career choice. very little thought is given to the passion of practicing a given type of medicine, and most participants appear consumed by the time required for training, monetary compensation, prestige, etc.

as you stated, the principle factor in vocational choice should be passion, and the rest follows. i am finishing my cardiology fellowship in one of the most well-regarded programs in the country, and i can guarantee to you that the hours appear much shorter when you are doing what you perceive as your calling. as mentioned previously, the overall training period is long. but in today's super-specialized medical environment, it is not unreasonable. you will find similar time commitments for most clinical subspecialties. many people training in cardiology these days choose to undergo even further subspecialty training: vascular medicine, interventional, peripheral interventions, cardiomyopathy/transplant, electrophysiology, ECHO, advanced imaging(nuclear, CT, MRI), adult congenital heart, etc. let's face it. by choosing a medical career, we have all made a commitment to life-long learning. it appears that many participants in this thread want short work days, minimal training requirements, big salaries, etc.. these people are either setting themselves up for failure or very disappointing careers in medicine. many of us chose our career tracks with the understanding that the endeavor will be difficult, hoping that the gratification will follow. let me reassure you that you will most likely experience immense satisfaction in return for your efforts. and belive me, most people working in competitive and demanding subspecialties find time to lead full out-of-hospital lives.

i'll get off the soap-box now.
good luck in your medical career!

 

[cfdavid]

that's the rub, cfdavid. i see a dangerous trend in the logic i have observed not only in this thread, but in many of these threads regarding career choice. very little thought is given to the passion of practicing a given type of medicine, and most participants appear consumed by the time required for training, monetary compensation, prestige, etc.

as you stated, the principle factor in vocational choice should be passion, and the rest follows. i am finishing my cardiology fellowship in one of the most well-regarded programs in the country, and i can guarantee to you that the hours appear much shorter when you are doing what you perceive as your calling. as mentioned previously, the overall training period is long. but in today's super-specialized medical environment, it is not unreasonable. you will find similar time commitments for most clinical subspecialties. many people training in cardiology these days choose to undergo even further subspecialty training: vascular medicine, interventional, peripheral interventions, cardiomyopathy/transplant, electrophysiology, ECHO, advanced imaging(nuclear, CT, MRI), adult congenital heart, etc. let's face it. by choosing a medical career, we have all made a commitment to life-long learning. it appears that many participants in this thread want short work days, minimal training requirements, big salaries, etc.. these people are either setting themselves up for failure or very disappointing careers in medicine. many of us chose our career tracks with the understanding that the endeavor will be difficult, hoping that the gratification will follow. let me reassure you that you will most likely experience immense satisfaction in return for your efforts. and belive me, most people working in competitive and demanding subspecialties find time to lead full out-of-hospital lives.

i'll get off the soap-box now.
good luck in your medical career!

Great post. I might add that the interventional guy that came into the ED all disheveled in "yesterdays" wrinkled clothes and his hair all messed up, didn't seem torqued at all. He just handled the situation and did a great job. He saved the guys life, and then was talking to the guy's very grateful family. Again, it seemed very rewarding.

Good luck to you too medoc, in your fellowship.

 

[deleted87716]

i see a dangerous trend in the logic i have observed not only in this thread, but in many of these threads regarding career choice. very little thought is given to the passion of practicing a given type of medicine, and most participants appear consumed by the time required for training, monetary compensation, prestige, etc...as you stated, the principle factor in vocational choice should be passion, and the rest follows.

Agree 100%. That's only your second post? Keep 'em coming!

 

[viostorm]

that's the rub, cfdavid. i see a dangerous trend in the logic i have observed not only in this thread, but in many of these threads regarding career choice. very little thought is given to the passion of practicing a given type of medicine, and most participants appear consumed by the time required for training, monetary compensation, prestige, etc.

I think that was a great post, I do agree passion/interest should be a large factor in deciding what you want to do.

For me, this is a second career, and I am looking to be 41 when I get out of residency/fellowship. The things that were important to me at 21 are certainly not what are important to me now. I want to have a life and a family, and I want a career that facilitates that. Will I be able to make it to my kids little league game? Is being a cardiologist worth it if I can't?

Having been a paramedic working for $7 an hour at a job I love, I also want to be compensated well for what I do. Your job really isn't fun when you are working 100 hours/week just to pay the bills.

As far as length of training ... I really don't want to be a geriatric while I'm taking care of geriatrics. With non-traditional students, I think it is a big factor and something you have to consider.

So in summary I agree and disagree, I think it would be foolish to make a career change and not consider lifestyle and compensation.

All that being said, I'm obsessed with the heart. I just want to know what I'm getting into and how to go about doing it.

 

[gwen]

hey gyus,

as the future wife of a cardiologist and a physician myself, i was wondering if those who are already cards fellows could give me some insight. my fiance is planning on going into heart failure/transplant, he's starting his cards fellowship this july. how does CHF/Trnasplant compare to say, interventional or EP? he claims that it won't be as busy b/c he won't get called in for interventional procedures and also the money won't be as high b/c of that (which is completely fine by me...i'd rather have him home). but in any case, i don't think that he will be any less busier when it comes to pages and just being busy in general. but i wanted to get your opinion.

thanks!

 

[medoc]

hey gyus,

...my fiance is planning on going into heart failure/transplant, he's starting his cards fellowship this july. how does CHF/Trnasplant compare to say, interventional or EP? he claims that it won't be as busy b/c he won't get called in for interventional procedures and also the money won't be as high b/c of that (which is completely fine by me...i'd rather have him home). but in any case, i don't think that he will be any less busier when it comes to pages and just being busy in general. but i wanted to get your opinion.

thanks!

hello gwen,

chf/tansplant is a fantastic subspecialty for several reasons. he/she gets to participate in the care of the sickest and most complex cardiac cases in the hospital, and controls the gateway to some of the most aggressive treatment strategies available to medicine, i.e. vads (ventricular assist devices), transplants, experimental percutaneous procedures/devices, advanced surgical techniques, etc. the general relationship between the chf cardiologist and cardiac surgeons are on a different level than with the other cardiology subspecialties; there is much more synergy and collaboration. the dependance really does go both ways. further, the population of patients who will require the expertise of a cardiomyopathy specialist will only increase over time due to the aging population, and as more and more patients live through heart conditions due to the advances in general medical care and percutaneous procedures. as a result, you will find that there will be a greater demand for cardiomyopathy specialists over time. i think that the salaries are/will be commensurate with this demand.

this is a long segue to answering your question, but the above perks are also balanced by the very fears you just elaborated in your question. i have to say that the cardiomyopathy rotation of my cardiology fellowship was by far the clear winner for being the most time-consuming and demanding portion of my training. let me explain. while the cath jock may be on-call every several days (with regular shift work on the rest), the chf/transplant person has to be on-the-ready 24-7 because his/her patients are amongst the sickest cardiac patients in the hospital. a portion of his/her census will have pa lines and will require around-the-clock supervision of invasive monitoring and drips. he/she usually practices in a tertiary level referral environment, and transferred patients are often very sick and in extremis. there are lots of trips to the emergency room to take care of the outpatient population that decompensates frequently. having to come in for thansplants, however, is not a very common event. in sum, i have spent far more late nights/early mornings in the hospital on chf than on any other rotation. that being said, i loved the experience and consider it amongst my favorite specialties. i can only speak from personal experience and cannot claim it to be a universal phenomenon, however.

i should also caution you to not be overly concerned about your fianncee's inclinations at the moment. cardiology is a very diverse field, and i can guarantee you that he will change his tentaive career plans several times during his training.

best of luck to you and yours!

p.s. i make it a point to cook my wife a nice meal as often a possible, no matter how busy i am. if your hubby-to-be is smart, he'll do the same.

 

[gwen]

hey medoc,

thanks so much for your insightful post. that was really helpful. i think i'll even pass this on to him...perhaps to guide him in the next 3-4 years. his heart is set on HF/transplant esp b/c the program where he's going to is really good at transplant medicine.

thanks again!

gwen

 

[irlandesa]

As a female who is potentially interested in Cardiology, I'm just curious if anyone knows any female cardiologists with families. I'm not engaged or married yet, and am not 100% sure yet that I want marriage and children. But, no matter how much I love the speciality, I would hate to jump into a fellowship right after residency (I would probably apply during R3 at the earliest) and realize that I missed out on having any sort of personal life. On the other hand, I'd hate to be miserable in another specialty, and as we all know, having an easier work schedule doesn't mean you'll end up marrying the right person and having 2.5 beautiful children. I do know a fellow female colleague who is going into Cards and got married to a future GI fellow, but I don't think he wants kids. I can't even imagine how 2 people going through different hardcore fellowships at the same time could manage a child. Any thoughts?

 

[DrHeartMD]

I know a husband and wife cardiology pair and they have kids...they both work hard but its not impossible...remember that in any specialy work hours can be tailored to people's liking (though training is different)...i.e. I know some cardiologists who work in the VA and only work the VA hours (8-4 with no weekends except once every 4 weekends)...now they take a paycut, but they do a field they love and still enjoy their life...its all about choice...in terms of the husband wife cards pair I know, one does slightly academic medicine, and the other does private practice hardcore...in general though specialty choice should be based on your like or dislike of the profession, as the hours can always be cut back if you so desire...good luck

 

[KJT48]

Hello I'm a junior in high school and I'm interested in becoming a cardiologist but I have been reading lots of comments and I really don't want to be stuck in the labs all the time because I like working with people and actually get to see and talk to patients more than ever! So do you think being in this field I can still do that? Plus seeing these comments makes me feel like you have to be the top of your class all the time and you have to be all that and a bag a chips! So is that true?

 

[Instatewaiter]

A necro post for the ages. You bumped a 9 year old thread.

Cards is broken into invasive and non-invasive super-subspecialties. The invasive subspecialties are interventional (cardiac cath) and electrophysiology (EP). EP doesn't really have terrible hours, nor does it have common emergency procedures that need to be done in the middle of the night. Cath, however does. Depending on the size of the group you will be taking call every x number of nights.

The non-invasive specialties- general cards, heart failure/transplant, prevention, imaging do very little time in the "lab" other than diagnostic caths if they choose, right heart caths/biopsies for HF. You never know if you're going to really like cath.

In terms of competitiveness, it is one of the more competitive specialties of IM but it is doable.