IM Hospitalist vs Cardiology (women in medicine) Northeast

[coffeeclothesaddict]

Hi everyone,

Current senior resident in IM. I love cardiology, (and have considered applying) however, I also really enjoy general medicine. I am nervous about applying for this field at this current time in my life given other competing time commitments (ie family life). Wondering what is the lifestyle and salary like if I pursue IM Hospitalist for at least a few years. My primary concern is not salary however I do have a lot of student loans to pay back and so that is a factor. Looking to live in the Northeast (must be within 45 minutes of a city ie NYC or Boston due to my spouse's schedule). Also if you're a woman and chose cardiology (or another very demanding field) even with a family, how did that work out for you during fellowship years. I have a very young baby and most likely wanting to continue to grow my family in the next few years.

Any help would be greatly appreciated!!

---

Members don't see this ad.

 

[cards67]

What's your goals and where do you see yourself in 5-10yrs? I think the long term view is more important here. Short term, you just kinda figure it out, whether in fellowship or attending. I'm not a woman, but know plenty mom's in cardiology and gen med. Cardiology lifestyle isn't necessarily bad and I know plenty women cardiologists with kids and they get by fine with help from spouse, family, caregivers, etc. Lot of them had kids in fellowship and you just kinda figure it out. If you're thinking of taking a few years off before applying, that could be a challenge but certainly not impossible. Attending life is not necessarily bad but If you're interested in part-time work, cardiology isn't really conducive to that. Of course, cardiology jobs will be more limited that gen med, and geographic restrictions will only make that worse. On the flipside I know gen med moms work anywhere from fulltime outpatient to part-time hospitalist, and honestly the part-time hospitalist gig sounds pretty sweet. Of course less pay but basically work 1wk/mo. And they all love it. Gen med just has more flexibility and options. In general, subspecialize if you really love it, especially if you can't imagine doing gen med. But financially it could take years, if ever, to break even.

 

[aafisahar]

fellowship is tough, especially that first year. after fellowship, you can be all outpatient and make 400k.

 

[collegestud2013]

Hi everyone,

Current senior resident in IM. I love cardiology, (and have considered applying) however, I also really enjoy general medicine. I am nervous about applying for this field at this current time in my life given other competing time commitments (ie family life). Wondering what is the lifestyle and salary like if I pursue IM Hospitalist for at least a few years. My primary concern is not salary however I do have a lot of student loans to pay back and so that is a factor. Looking to live in the Northeast (must be within 45 minutes of a city ie NYC or Boston due to my spouse's schedule). Also if you're a woman and chose cardiology (or another very demanding field) even with a family, how did that work out for you during fellowship years. I have a very young baby and most likely wanting to continue to grow my family in the next few years.

Any help would be greatly appreciated!!

Cardiology fellowship is rough with long hours so it may hard (but not impossible) to balance having a young child, especially if your spouse also has a busy career. The fellowships in the northeast, especially around NYC, are notorious for being very busy and tend to work you even harder. You will have more flexible options post-fellowship for a schedule with better work-life balance (as long as you're okay with taking a pay cut). If your goal is paying off student loans sooner doing general IM (either hospitalist or primary care) for a few years would make much more sense. You could in theory work as a hospitalist for a few years and then go back to fellowship (perhaps once your child as a bit older), but keep in mind that it can be much harder to match into any of the competitive IM fellowships like cards or GI if you're more than a few years out of IM residency.

From a financial perspective, the extra money you make doing general cardiology vs general IM is much smaller than most people think once you account for the 3 extra years of training required for cards and the higher tax brackets you pay at higher incomes, and the long hours cardiologists typically work to make the salaries you typically see.

 

[deleted980918]

There are some cush cardiology fellowships out there in the northeast, esp with regard to call schedules and clinical volumes. Not all fellowships are the same.

That being said, financially speaking it’s probably makes more sense to do hospitalist gigs.

 

[aafisahar]

There are some cush cardiology fellowships out there in the northeast, esp with regard to call schedules and clinical volumes. Not all fellowships are the same.

That being said, financially speaking it’s probably makes more sense to do hospitalist gigs.

to make cardiology money as a hospitalist, you gotta hustle, like 11 on/3 off, or nocturnist 7on/7off + extra shifts. not worth it imo.

sure the 3 year headstart helps, but hospitalist isn't exactly a lifelong career. It's rare to see a hospitalist at it for 10-20 years.

 

[Splenda88]

to make cardiology money as a hospitalist, you gotta hustle, like 11 on/3 off, or nocturnist 7on/7off + extra shifts. not worth it imo.

sure the 3 year headstart helps, but hospitalist isn't exactly a lifelong career. It's rare to see a hospitalist at it for 10-20 years.

FT cardiologist work ~60 hrs/wk average to make 500k/yr anyway. The difference is not that stark when you account for opportunity cost. I can make that much working 10 on/ 4 off.


Hospital medicine is not a lifelong career! and you think cardiology is. Which of the 2 is more stressful?

 

[CCM-MD]

FT cardiologist work ~60 hrs/wk average to make 500k/yr anyway. The difference is not that stark when you account for opportunity cost. I can make that much working 10 on/ 4 off.


Hospital medicine is not a lifelong career! and you think cardiology is. Which of the 2 is more stressful?

Agree with the opportunity cost and hours worked arguments. Hospitalist makes similar $/hour with fewer years of training.

But man that’s 20-22 shifts a month or 260 shifts a year, at $2000/shift. That is a ton of work and that per shift rate above the median for permanent, it’s more like $1800.

 

[NITRAS]

Agree with the opportunity cost and hours worked arguments. Hospitalist makes similar $/hour with fewer years of training.

But man that’s 20-22 shifts a month or 260 shifts a year, at $2000/shift. That is a ton of work and that per shift rate above the median for permanent, it’s more like $1800.

I make $300k/year (not in the northeast) working less than 20 weeks a year. A few of my colleagues cover a SNF for about an extra $100k.

My point is that you can get to $400k/year without killing yourself. Half my group has been year way longer than me, and I’ve been here 6 years.

 

[Splenda88]

Agree with the opportunity cost and hours worked arguments. Hospitalist makes similar $/hour with fewer years of training.

But man that’s 20-22 shifts a month or 260 shifts a year, at $2000/shift. That is a ton of work and that per shift rate above the median for permanent, it’s more like $1800.

There is a premium of $445/day extra for working extra days above what is stipulated in my contract. It would be 19.5 shifts at my shop.

I have a friend/co-worker who picks up (3-4) locum shifts about 1 hr away for $2280/day. She does not want to pick up extra shifts at my shop and instead does locum (1099) for tax purposes.

I dont get your argument TBH. If we make the same $/hr as cardiologist, do you think hospital medicine is more stressful/demanding than cardiology? Most in medicine would disagree.

Hospital medicine is not sexy because you are not a "specialist". Lol

 

[deleted980918]

Ultimately, you have to look at it from a bigger picture. Yes, hospital medicine makes more sense to you from a time and opportunity cost perspective. But if cardiology truly interests you, I would argue that your work day is better spent doing cardiology stuff than managing UTI/PNA/Dispo for the same pay when taking into account of opportunity cost etc. With all due respect to hospital medicine, I have heard people applying to card fellowship after few years of hospitalist gig but I have never heard cardiologists going back to hospital medicine. Focusing on the minute differences in pay per hour is extremely irrelevant because there are so many type of work and contracts out there. Follow your interest and passion, life will make it work.

 

[Splenda88]

I make $300k/year (not in the northeast) working less than 20 weeks a year. A few of my colleagues cover a SNF for about an extra $100k.

My point is that you can get to $400k/year without killing yourself. Half my group has been year way longer than me, and I’ve been here 6 years.

<20 wks/yr and still make 300k/yr! Your gig is good.

 

[aafisahar]

FT cardiologist work ~60 hrs/wk average to make 500k/yr anyway. The difference is not that stark when you account for opportunity cost. I can make that much working 10 on/ 4 off.


Hospital medicine is not a lifelong career! and you think cardiology is. Which of the 2 is more stressful?

eh depends. Sure, when you're on service, it's busy, but the rest of the time can be essentially all outpatient and/or laboratory work (echo/nuclear/cath). I signed for 410k + productivity and within 5 years most cardiologists will make >600k in incentives, production, and bonuses.

 

[CCM-MD]

Locum is not a fair comparison. Locum cc pays 4-6k a shift but arguing that it pays the same as spine surgery is not reasonable.

There are gen cards job with low call that pay half a mil. Def “easier” than slogging 20 hospitalist shifts (3 weekends a month). Common theme on SDN is to compare the best hospitalist jobs with average jobs in other specialties.

 

[Splenda88]

Locum is not a fair comparison. Locum cc pays 4-6k a shift but arguing that it pays the same as spine surgery is not reasonable.

There are gen cards job with low call that pay half a mil. Def “easier” than slogging 20 hospitalist shifts (3 weekends a month). Common theme on SDN is to compare the best hospitalist jobs with average jobs in other specialties.

Well, extra shifts above what stipulated in my contract is $2200+

 

[rokshana]

Ultimately, you have to look at it from a bigger picture. Yes, hospital medicine makes more sense to you from a time and opportunity cost perspective. But if cardiology truly interests you, I would argue that your work day is better spent doing cardiology stuff than managing UTI/PNA/Dispo for the same pay when taking into account of opportunity cost etc. With all due respect to hospital medicine, I have heard people applying to card fellowship after few years of hospitalist gig but I have never heard cardiologists going back to hospital medicine. Focusing on the minute differences in pay per hour is extremely irrelevant because there are so many type of work and contracts out there. Follow your interest and passion, life will make it work.

The premise there is that cardiology is that interesting that people go into it for the interest… if cards paid $200k/year…suddenly a lot less people would be interested in it…

 

[aafisahar]

The premise there is that cardiology is that interesting that people go into it for the interest… if cards paid $200k/year…suddenly a lot less people would be interested in it…

$kin i$ ju$t $o intere$ting, it'$ $o $ati$fying to treat $kin di$order$

 

[coffeeclothesaddict]

Thanks for all of the feedback on this post. My primary concern is not salary. Priority is work life balance. As long as I make >200,000 a year ill be happy with that and so I don't really care about salary so much as I do the job satisfaction and ability to find a practice or hospital that is a "good fit". My spouse's schedule is M-F 9-5 and will likely make more than I do whether I pursue hospitalist or cards so Id like a schedule that aligns more with that. So, while not totally opposed to 7 on 7 off of hospitalist, that wouldn't be ideal long term.

 

[The kitchen sink]

Go with cards, better long term career potential

 

[HemeOncHopeful19]

Thanks for all of the feedback on this post. My primary concern is not salary. Priority is work life balance. As long as I make >200,000 a year ill be happy with that and so I don't really care about salary so much as I do the job satisfaction and ability to find a practice or hospital that is a "good fit". My spouse's schedule is M-F 9-5 and will likely make more than I do whether I pursue hospitalist or cards so Id like a schedule that aligns more with that. So, while not totally opposed to 7 on 7 off of hospitalist, that wouldn't be ideal long term.

If your spouse is going to make more than a Cardiologist working 9-5 M-F you should do Cards (if you love it) and then work at a VA where your hours are super cush IMO. You're basically working for fun and/or to offset the cost of a nanny and housekeeper at that point, and yes I would say the same thing if you were a male with a high earning spouse.

 

[wamcp]

Thanks for all of the feedback on this post. My primary concern is not salary. Priority is work life balance. As long as I make >200,000 a year ill be happy with that and so I don't really care about salary so much as I do the job satisfaction and ability to find a practice or hospital that is a "good fit". My spouse's schedule is M-F 9-5 and will likely make more than I do whether I pursue hospitalist or cards so Id like a schedule that aligns more with that. So, while not totally opposed to 7 on 7 off of hospitalist, that wouldn't be ideal long term.

I know two hospitalists (both moms) who work part time as a hospitalist (nocturnist).

One does 6 shifts a month at 50% FTE, another at 8 shifts (66%). They make 145k and 195k respectively. They LOVE LOVE LOVE the lifestyle and flexibility it affords them. Both been doing it over several years (5 and 8).

They are getting about 24 or 22 full uninterrupted days off a month. And the 6 shifter typically has them all done in one go (6 on, 24 off).

No clinic then consult then read echos/nucs and then notes to write, patients to call back, call to take at home, or w/e cardiologists have on their plate.

And of course no 3 years of fellowship.

Dunno how often parttime cards can be flexible like that or if feasible.

 

[bronx43]

If your spouse is going to make more than a Cardiologist working 9-5 M-F you should do Cards (if you love it) and then work at a VA where your hours are super cush IMO. You're basically working for fun and/or to offset the cost of a nanny and housekeeper at that point, and yes I would say the same thing if you were a male with a high earning spouse.

VA jobs are actually few and far between (you can go search on the VA site). Most major metros have no openings and the ones that do are now getting tons of interest.

I expect that a spouse making more than a cardiologist working M-F 9-5 doesn’t have the most flexibility in the world, so going into a specialty with the plan of finding a VA job seems rather perilous.

 

[mszzeta]

If you don't like 7 on 7 off but prefers 8-5, Why not primary care? No fellowship requirement. PCP and hospitalist can make similar salary. Some PCP can be very successful financially depending on how the business goes

Cardiology might be sexy and make more money. But lifestyle wise, there is no way that cardiology can even be comparable to PCP, in general sense

 

[collegestud2013]

VA jobs are actually few and far between (you can go search on the VA site). Most major metros have no openings and the ones that do are now getting tons of interest.

I expect that a spouse making more than a cardiologist working M-F 9-5 doesn’t have the most flexibility in the world, so going into a specialty with the plan of finding a VA job seems rather perilous.

VA isn't the only place to find a job with better work-life balance. The other place would be academic positions, which can be more cush since you often have residents/fellows doing a lot of the work.

Historically, the VA was mostly either for older docs who were getting closer to retirement and wanted to cut back, or those who were just slow/inefficient and couldn't keep up with the fast pace of PP, and didn't mind having to deal with all the government bureaucracy. As a physician you're probably taking anywhere from a $100-200k pay cut per year from what you may make in the private sector depending on your specialty and you'll probably be at the bottom percentiles of pay within your specialty, and often get paid even less than those in academics. The only time I've seen VA jobs become popular (and thus more competitive to get) is when the job market in the private sector for the same specialty is in the dumpster. But nowadays it might be a bit more popular since there's more focus on work-life balance and reducing burnout than in the past, and with declining reimbursements the private sector jobs may also not seem as attractive.

If OP is okay with making around low $200ks per year and would prefer work-life balance with family, it's probably easier just to do general IM (outpatient or hospitalist) either in academics or VA, or work as a part time hospitalist (perhaps averaging 8-10 12 hr shifts per month instead of the usual 15 shifts that most places consider to be full time), than spend another 3 years in cardiology fellowship (unless she really likes cardiology and not doing it for the money). Some hospitalist jobs, especially those at academic centers, are Mon-Fri 9AM-5PM + rotating on call with colleagues (eg 7AM-5PM or 9AM-7PM on some days, and occasional weekends).