Why Cardiology?

[Handsome88]

Why are you interested in Cardiovascular medicine (Cardiology)?
I don't want to know about lifestyle, hours, or pay. I want to know what is special about it's scope of work, the subject, and the nature of the job. Why do you prefer it over other medical fields? What does Cardiology have that EM doesn't, for example. If you just love the heart and studying it, then why not CT surgery?

On the other hand, what are the cons of Cardiology? Do you find it boring and repetitive (same problems, chest pain, CHF,...etc)? Do you only get older chronic patients? Do you feel that you make a difference?

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[boanssi]

I'm interested in an answer as well.

 

[P Diddy]

I'm interested in an answer as well.

If we have to convince you to do it, you shouldn't do it.

p diddy

 

[atach]

why cards over em? because i want to be smart and want to do something interesting. em is inpatient outpatient medicine with the exception of trauma (which the surgeons handle anyway.

cards also has instant gratification unlike most other fields. somebody comes in near death and have the possibility of walking out. nothing more satisfying than that.

why cards over ct surgery? i like the procedures better and being able to spend time with patients over years is a definite perk.

 

[boanssi]

If we have to convince you to do it, you shouldn't do it.

p diddy

Good point, but not exactly true. I'm still an M2 and I enjoyed studying both cardiovascular anatomy and pathophysiology. I was just interested in knowing what draws cardiologists to this field.

 

[jbing222]

Good point, but not exactly true. I'm still an M2 and I enjoyed studying both cardiovascular anatomy and pathophysiology. I was just interested in knowing what draws cardiologists to this field.

it's a very fair question, and i'm surprised more people haven't chimed in (i'd like to hear some thoughts on this myself). then again, the sad truth is that you probably disqualified a huge chunk of people when you asked for a better justificiation than just pay and lifestyle.

 

[bronx43]

You really have to like cardiac physiology to want to go into cardiology. I agree that prestige and compensation potential are huge reasons for attraction, but I would think that most people going into cardiology find that the heart is inherently more interesting than say... the gut. For me, I like that cardio is more conceptually based than most medical specialties, and that I can think through many problems from a physics and physiologic standpoint to come up with an answer. Another draw is the ability to do a lot of procedures, especially if you want to go into interventional or EP.
EM is a totally different beast from internal medicine. If you think you like physiology and the heart, then realize that EM physicians know only enough about the heart to keep patients alive and stable enough to make it up to the floor, OR, or cath lab. This isn't really a knock on them, as they really have to have a tremendous breadth of knowledge to be able to deal with anything that walks, runs, or crawls through the door.
As far as CT surgery, it comes down to the dichotomy between surgery vs medicine. Do you LOVE surgery? Do you think you'll be miserable doing anything else? If the answer is yes, then you are probably a surgeon, and should go into a surgical specialty. If you like the heart, then CT surgery would be a no-brainer.

 

[GalenAgas]

How realistic is it really for people, who want fellowship training when 1st matching IM, to get it 6 years later in EP/Interventional?

Is it like med school where everyone is Integrated Plastics/Ortho/Radiology/Derm until they take step1 and then they're just trying to make it through and end up matching at a uncompetitive program in FM/EM/IM?

 

[bronx43]

How realistic is it really for people, who want fellowship training when 1st matching IM, to get it 6 years later in EP/Interventional?

Is it like med school where everyone is Integrated Plastics/Ortho/Radiology/Derm until they take step1 and then they're just trying to make it through and end up matching at a uncompetitive program in FM/EM/IM?

No, because the residency program that you matched into plays a HUGE role in whether or not you are able to match the fellowship of your choice. If you are at a big name academic center, then you pretty much get to have your pick of specialty, as long as you don't completely screw up in residency. If you are at some small community program, the odds are stacked against you from day 1.

 

[GalenAgas]

No, because the residency program that you matched into plays a HUGE role in whether or not you are able to match the fellowship of your choice. If you are at a big name academic center, then you pretty much get to have your pick of specialty, as long as you don't completely screw up in residency. If you are at some small community program, the odds are stacked against you from day 1.

How do you "completely screw up in residency"
What does that entail precisely?

What does it take to differentiate yourself from the other residents at that level of training? More reading? Work Ethic? Innate ability?

 

[GalenAgas]

How much of general cardiology is Clinic?

ie talking to non-adherent patients about why they should take their antihypertensive. Does the boring stuff every reach you guys or do the primary care guys take care of all of that stuff.

 

[floppy valve]

I agree with P Diddy...

You need to spend some time introspecting. What is it about Cardiology which attracts you? is it physiology? is it abt the advanced interventional techniques? electrophysiology? someone mentioned something about "instant gratification" -- well, apart from stenting a coronary, or shocking a patient out of a VTach/Fib or dealing with CCU patients, I doubt if anything else offers instant gratification... heart failure can be extremely frustrating if patients are non-compliant (but the insurance companies ding the caridologist for the readmissions... ignoring the fact that mrs.X went to PF Chang's for hot/sour soup!!!)

from my experience during last yr's interviews, I feel the interviewers want to know your story. look inside... try connecting the dots. Maybe u did a project on electricity or pumps during high school... maybe you remember a good EP case? maybe you helped conduct ACLS courses? or worked as an EMT? or taught CV physiology to students during college? any research experience? you need something on those lines.

Try joining the dots!

Other pointer: please DO NOT write about your grandmom who was hospitalized for CAD! One of the PDs told me that that story is an absolute cliche.. and can be a deal-breaker!

 

[P Diddy]

How do you "completely screw up in residency"
What does that entail precisely?

What does it take to differentiate yourself from the other residents at that level of training? More reading? Work Ethic? Innate ability?

Residency evaluations are almost entirely subjective. To screw up, you need to be a standard deviation away from acceptable behavior/knowledge/skills (and sometimes more), which is no mean feat.

The key to screwing up is exhibiting a pattern of negative behavior. Repeated tardiness or absences, persistent knowledge deficits (this can be objectively measured by inservice examinations), and skill proficiency below your peer group despite feedback/admonition can all tank your fellowship chances. This list is not inclusive. Conversely, even if you're a slightly below average applicant at a strong residency program, you will match, though possibly not at the fellowship of your choice.

All of the attributes you listed will differentiate you from your peers, but the one that is easiest to remedy and highest yield is hard work. If you put in the time, your evaluators will see it. If you put in the time (more reps), you will get better. If you don't put in the time, people will notice, and your evaluations will be colored appropriately.

p diddy

 

[P Diddy]

How much of general cardiology is Clinic?

ie talking to non-adherent patients about why they should take their antihypertensive. Does the boring stuff every reach you guys or do the primary care guys take care of all of that stuff.

General cardiology is typically a mix of clinic and non-clinic responsibilities and can be heavily weighted toward either end, depending on the practice type and the interest of the cardiologist.

In private practice (PP), there is usually a lot of clinic. That's how income is generated, both from the visit itself and the services the visit engenders. I don't know any PP cardiologists who only see patients in clinic; the non-invasive cardiologists usually also read EKGs and imaging studies. In some PPs, cardiologists can become experts in the group (i.e. imaging expert) and focus on those non-clinical duties at the expense of clinic.

In academics, you could be a general cardiologist and have one 1/2 day of clinic a week, particularly if you spend most of your time in research. There aren't too many straight general cardiologists in academia as it's so specialization oriented, though. The 'academic' general cardiologists do a lot of clinic (clinical professors) because someone has to see the patients, right? You should know that even procedural/imaging cardiology specialists in academia see patients in clinic.

I have little sympathy regarding your comment about 'the boring stuff' as I serve as the PCP for some of my patients and enjoy doing so. You will be dealing with gen int med problems in your clinic, but can punt them to their PCP if you see fit or are uncomfortable. You'll have to keep up on your gen med training to some extent since many medications interact with or affect cardiovascular medications, and vice versa.

p diddy

 

[GalenAgas]

General cardiology is typically a mix of clinic and non-clinic responsibilities and can be heavily weighted toward either end, depending on the practice type and the interest of the cardiologist.

In private practice (PP), there is usually a lot of clinic. That's how income is generated, both from the visit itself and the services the visit engenders. I don't know any PP cardiologists who only see patients in clinic; the non-invasive cardiologists usually also read EKGs and imaging studies. In some PPs, cardiologists can become experts in the group (i.e. imaging expert) and focus on those non-clinical duties at the expense of clinic.

In academics, you could be a general cardiologist and have one 1/2 day of clinic a week, particularly if you spend most of your time in research. There aren't too many straight general cardiologists in academia as it's so specialization oriented, though. The 'academic' general cardiologists do a lot of clinic (clinical professors) because someone has to see the patients, right? You should know that even procedural/imaging cardiology specialists in academia see patients in clinic.

I have little sympathy regarding your comment about 'the boring stuff' as I serve as the PCP for some of my patients and enjoy doing so. You will be dealing with gen int med problems in your clinic, but can punt them to their PCP if you see fit or are uncomfortable. You'll have to keep up on your gen med training to some extent since many medications interact with or affect cardiovascular medications, and vice versa.

p diddy

Thank you for your responses P.Diddy. What would you say is the most fulfilling aspect of what you do?

For those of us who love instant results (like in some interventional/EP procedures or in surgical specialties) would you say general cardiology would not be a good fit?

Thanks for taking the time to respond to med students!

 

[cardforlife]

Well, I might not be the one who is suitable to answer the question, because I failed cards fellowship some times. But I think your question of 'why cardioogy' is very fair one to ask, and I was surprised at seeing only a couple of relevant answers so far. Maybe everyone else is in the post-match residency heaven and does not need this forum anymore. (Don't be upset, that's the life, and another wave of innocently passionate people will hit here around this summer) Note that mine would be also not relevant, but this is kinda story that I have, should you want to know.

In my case, I liked physics VERY much in high school. Thought about doing physics forever, but human body was like a pinnacle of physics to me (don't ask me why I thought like that). When I came to med school, I thought about CT surgery or Ortho (!) for my future career just because those fit into the 'physics dream' that I had in the realm of medicine. Then I wanted to be a cardiologist since MS2, when I learned physiology and pathology. I taught CV physiology for med school juniors as a MS3. As a MS4, I liked Medicine more than surgery because medicine people actually think more and logical than CTS friends. I knew that I gotta be a good Medicine doc first to be a good cardiologist, and focused on studying medicine. So I was pretty much determined from the beginning. I wanted to be a good physician-scientist in cardiovascular disease.

But why failed repeatedly? Because I am a foreign medical graduate from good (but not top-notched) IM residency program. (Again, that's the life. I accept legitimate discrimination.) When I came to the US for training, I found out the cards make good money and relatively nice lifestyle, and hence very competitive even among the US grads. But I know many of my friends would have their own genuine reasons to choose that path. Even, I think it is reasonable to follow money and lifestyle. It's your life, and following whatever reason that fits you will be totally fine.

I was undaunted up until last year, but now I am not sure. I am thinking of going back to my country, or going somewhere else to be a cardiologist because no programs in the United States would accept me. It is very sad given my long list of publications and academic achievements during and after my residency training. Well, I came to the US because I wanted to be a cardiologist, and now thinking of leaving here because I still want to be a good cardiologist.

 

[CV student]

That's sad. I am sure you know networking can help even a moderately competitive candidate to get a fellowship. May be you should volunteer or work in a program where there is a track record of taking IMG, and not necessarily looking at pedigree of medical school training. My heart is with you.

 

[P Diddy]

Thank you for your responses P.Diddy. What would you say is the most fulfilling aspect of what you do?

For those of us who love instant results (like in some interventional/EP procedures or in surgical specialties) would you say general cardiology would not be a good fit?

Thanks for taking the time to respond to med students!

Making patients better is the most fulfilling aspect of my job. The fact that this occurs in a field that is the flagship of internal medicine with a continuous influx of new technologies, evidence based therapies to improve patient's lives, therapies that improve patients' lives quickly, and intelligent/driven colleagues is icing on the cake.

If you like instant results, it's hard to find a better field in IM than cardiology, but you would have to sub specialize in EP/interventional.

p diddy

 

[Liberty_99]

Well, I might not be the one who is suitable to answer the question, because I failed cards fellowship some times. But I think your question of 'why cardioogy' is very fair one to ask, and I was surprised at seeing only a couple of relevant answers so far. Maybe everyone else is in the post-match residency heaven and does not need this forum anymore. (Don't be upset, that's the life, and another wave of innocently passionate people will hit here around this summer) Note that mine would be also not relevant, but this is kinda story that I have, should you want to know.

In my case, I liked physics VERY much in high school. Thought about doing physics forever, but human body was like a pinnacle of physics to me (don't ask me why I thought like that). When I came to med school, I thought about CT surgery or Ortho (!) for my future career just because those fit into the 'physics dream' that I had in the realm of medicine. Then I wanted to be a cardiologist since MS2, when I learned physiology and pathology. I taught CV physiology for med school juniors as a MS3. As a MS4, I liked Medicine more than surgery because medicine people actually think more and logical than CTS friends. I knew that I gotta be a good Medicine doc first to be a good cardiologist, and focused on studying medicine. So I was pretty much determined from the beginning. I wanted to be a good physician-scientist in cardiovascular disease.

But why failed repeatedly? Because I am a foreign medical graduate from good (but not top-notched) IM residency program. (Again, that's the life. I accept legitimate discrimination.) When I came to the US for training, I found out the cards make good money and relatively nice lifestyle, and hence very competitive even among the US grads. But I know many of my friends would have their own genuine reasons to choose that path. Even, I think it is reasonable to follow money and lifestyle. It's your life, and following whatever reason that fits you will be totally fine.

I was undaunted up until last year, but now I am not sure. I am thinking of going back to my country, or going somewhere else to be a cardiologist because no programs in the United States would accept me. It is very sad given my long list of publications and academic achievements during and after my residency training. Well, I came to the US because I wanted to be a cardiologist, and now thinking of leaving here because I still want to be a good cardiologist.

So have you become one now !?

 

[IMreshopeful]

So have you become one now !?

You dug up a 6 year old thread for this?

 

[Liberty_99]

You dug up a 6 year old thread for this?

Ya sorry for bump !! But wanted to know if that sad story had a happy ending !!