Specialties within Cardiology

[justgivememyMD]

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[Medstart108]

Many of those specialties do not have the same training pathways.

Cardiothoracic Surgery is a surgical residency that comes in 6 year direct entry programs or General Surgery + 3 year CV surgery fellowship
Vascular surgery is a surgical residency in and of itself, one thing that may change is the adoption of endovascular techniques by the time you are in training
Cardiology is a fellowship after 3 years of internal medicine residency training.

Following your 3 years of cardiology training you can go into interventional cardiology which usually requires 2 years of extra training, EP which I believe is 1 year, nuclear which is 1 year, Echo which is also 1 year, adult congenital (1 year) and there is another one heart failure/cardiac transplant which is one year as well.

So hope that helps.

If you go into cardiology you won't get much surgical exposure at all, you might spend a block or two with CV surgery in your gen cardiology training but you aren't going to learn surgical procedures there. They don't overlap that much, the earlier the paths diverge the more they differ from each other.

 

[22031 Alum]

Summed up well above. Those specialties are not lumped together just because they involve the heart. No cardiothoracic or vascular surgeon would ever call themselves a cardiologist or specialist within cardiology. That is specific to people who first do medicine or pediatrics training, then a cardiology fellowship.

A major decision point as a medical student will be whether you want to do a surgical specialty or not.

 

[justgivememyMD]

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[DrBowtie]

Hi thanks for your response. I understand the difference in training pathways for surgical vs. nonsurgical aspects of cardiology (general surgery vs. IM residency then each followed by the relevant fellowship).

However, I have heard interventional procedures have reduced the need of the CT surgeon. I have heard that cardio/vascular surgeries are repetitive and that there is not much of a future within this specialties. I was wondering about the economics of cardiology within Obamacare. Currently, interested in pretty much anything cardio, and preferably somethign surgical, but I don't want to regret my decision 10 years later when I could have gone into a higher paying specialty that I would be just about happy with.

For instance, is there still the potential to become a partner in a cardiology private practice and make bank? I am not greedy, love cardio, but I want to live a good lifestyle as all my business friends (who I don't think work as hard as medical people) will in the tech sector.

Everything you heard is far more nuanced than you can understand without training.

Decide if you want to do med school first. Then once you're in, figure out a specialty.

Economic factors change seemingly year to year so predicting anything out 10 years is just guessing.

 

[justgivememyMD]

i have been accepted to medical school. now what would be your advice to determine a specialty? what kinds of places should I look at (shadowing, research, rotations, etc?)

 

[ACSurgeon]

i have been accepted to medical school. now what would be your advice to determine a specialty? what kinds of places should I look at (shadowing, research, rotations, etc?)

Your approach is a little naive. Your first decision will be surgeon or not. So, shadow surgeons and internists, ask a lot of questions, etc. Ultimatly third year will be key to making a decision. Also, your step 1 score and third year grades will likely help you in the decision (ie- limit your options)

 

[ortnakas]

You'll do rotations in 3rd year and can make up your mind after that.

 

[ACSurgeon]

Also,
- CT is alive and well
- you'll make plenty of money in any of the mentioned specialties
- unless you match integrated CT surg or vascular, there's a good chance you'll need to do a residency plus fellowship. Common wisdom is to do the residency that you can see yourself dong for the rest of your life, as fellowship acceptance is far from guaranteed. Overall, CT surg fellowship is (currently) much easier to get after gen surg than cardiology fellowship is after internal med.

 

[DrBowtie]

i have been accepted to medical school. now what would be your advice to determine a specialty? what kinds of places should I look at (shadowing, research, rotations, etc?)

As said above, your next decision point is surgery or not surgery.

 

[Instatewaiter]

With regard to the question of whether or not interventionalists are taking volume from CTS the answer is yes and no.

High risk and now intermediate aortic valve replacements are done percutaneously as are high risk mitral replacements by interventional cards. A lot of these patients are patients the surgeons wouldn't touch anyway. These technologies are new so not as tried and true as a regular valve replacement

As each new generation of stents comes out, the outcomes improve. With the newest generation of bio absorbable stents, expect stenting to expand and Cabg to contract. There will always be a market for Cabg because some things just can't be stented.

With the new reporting requirements and the feeling these requirements are going to keep expanding, the surgeons are getting a little more gun-shy than they were in years past.

 

[DoctwoB]

With regard to the question of whether or not interventionalists are taking volume from CTS the answer is yes and no.

High risk and now intermediate aortic valve replacements are done percutaneously as are high risk mitral replacements by interventional cards. A lot of these patients are patients the surgeons wouldn't touch anyway. These technologies are new so not as tried and true as a regular valve replacement

As each new generation of stents comes out, the outcomes improve. With the newest generation of bio absorbable stents, expect stenting to expand and Cabg to contract. There will always be a market for Cabg because some things just can't be stented.

With the new reporting requirements and the feeling these requirements are going to keep expanding, the surgeons are getting a little more gun-shy than they were in years past.

(1) Data on new generations of stents (beyond drug eluting) being superior is sorely lacking

(2) On the contrary studies are suggesting PCI for CAD outside of STEMIs is vastly overused, and patients with 3 vessel disease are better served with CABG.

Interventionalists have taken a lot of volume from ct surgeons, but if anything the pendulum is starting to swing back in the other direction.