A Medical Student's Questions about Cardiology

[vwoo123]

Hey everyone, I have some questions about cardiology that I just can't seem to get satisfactory answers for from professors at my school, so I figured SDN would be a good place to look.

First of all, a little bit about me: I'm currently a 3rd year medical student at an unranked, but I believe to be solidly average (if not above average), medical school. I have done decently well in my 1st and 2nd year classes (top 20% - 30% as a guesstimate), and also on my usmle step 1 (239). I have had a strong interest in cardiology since I started medical school, and I would just like some advice from both current cardiologists and other students or residents interested in pursuing cardiology.

Here are my questions:

1) I am interested in cardiology because...
A) the heart is the organ I find the most fascinating. It seems to be such a simple organ, but functions and dysfunctions in such complex ways. I also feel that understanding the pathophysiology of the cardiovascular system comes very naturally and easily to me. B) I have shadowed an interventional cardiologist before, loved the procedures he performed, and can really see myself doing what he does in the future. C) I feel that cardiology is one of those fields in medicine where you can make a huge difference for your patient in a relatively short amount of time (i.e. a patient who could barely walk across the room previously, can how walk his dog in the park after having a stent placed). I prefer these kinds of cases over those where all you can do is manage a chronic and incurable disease (i.e. a nephrologist managing his dialysis patient). My question is, do you guys feel these are good reasons for me to seriously consider cardiology?

2) I have heard a lot of negative things about the future of cardiology, and especially interventional cardiology. People have been saying that many of the procedures done currently by cardiologists will soon become obsolete. For example, advanced imaging techniques will replace angiograms and even echos, and use of newer and better drugs will be able achieve better patient outcomes than invasive procedures like ballooning and stenting. First of all, are these claims true? If they are, am I going to finish a cardiology fellowship only to find there is nothing left for me to do because the evil radiologists have taken over the world? I am much less concerned about compensation; if the government wants to pay less for procedures, that's fine. I am concerned, however, that I may eventually find there are no useful procedures left for me to do.

3) I know this is a bit early for me, but where can I find some information about which internal medicine programs (not necessarily just the most prestigious ones) give good medicine training and have high success rates in terms of sending their residents onto competitive fellowships such as cardiology?

I apologize for the wall of text, but there are so many things in my head I want to talk about. I would appreciate any help you guys can offer me with these questions. Thanks in advance!

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[Scean]

bump for this, the answers to these questions interest me as well...

 

[elwademd]

i'm an internal medicine resident who isn't interested in pursuing fellowship. here's my take.

First of all, a little bit about me: I'm currently a 3rd year medical student at an unranked, but I believe to be solidly average (if not above average), medical school. I have done decently well in my 1st and 2nd year classes (top 20% - 30% as a guesstimate), and also on my usmle step 1 (239). I have had a strong interest in cardiology since I started medical school, and I would just like some advice from both current cardiologists and other students or residents interested in pursuing cardiology.

Here are my questions:

1) I am interested in cardiology because...
A) the heart is the organ I find the most fascinating. It seems to be such a simple organ, but functions and dysfunctions in such complex ways. I also feel that understanding the pathophysiology of the cardiovascular system comes very naturally and easily to me. B) I have shadowed an interventional cardiologist before, loved the procedures he performed, and can really see myself doing what he does in the future. C) I feel that cardiology is one of those fields in medicine where you can make a huge difference for your patient in a relatively short amount of time (i.e. a patient who could barely walk across the room previously, can how walk his dog in the park after having a stent placed). I prefer these kinds of cases over those where all you can do is manage a chronic and incurable disease (i.e. a nephrologist managing his dialysis patient). My question is, do you guys feel these are good reasons for me to seriously consider cardiology?

that you're interested in and of itself should be enough!
you see a benefit in it for your patients, as well as yourself. you enjoy it as well.

as far as chronic and incurable disease... there's always congestive heart failure, which is one of the top 3 medicare diagnoses!

2) I have heard a lot of negative things about the future of cardiology, and especially interventional cardiology. People have been saying that many of the procedures done currently by cardiologists will soon become obsolete. For example, advanced imaging techniques will replace angiograms and even echos, and use of newer and better drugs will be able achieve better patient outcomes than invasive procedures like ballooning and stenting. First of all, are these claims true? If they are, am I going to finish a cardiology fellowship only to find there is nothing left for me to do because the evil radiologists have taken over the world? I am much less concerned about compensation; if the government wants to pay less for procedures, that's fine. I am concerned, however, that I may eventually find there are no useful procedures left for me to do.

ah, the part that really led me to respond to this.

cardiologists, interventional radiologists, and to some extent cardiothoracic surgeons are theoretically stepping on each other's toes. but does it mean that in the future, there will be no role for cardiologists.

as much as interventional radiologists can do procedures... they don't always know what i'd consider to be routine medicine. i know radiology residents who don't/won't get their dea license, figuring that they don't prescribe medicines, nor do they really know their medicines!

the reason i bring that up is continuity of care. while the ir guy/gal may or may not be able to place a stent into the l.a.d. in the future... what about further medical recs... follow up and adjustment/management of medications... follow up visits in clinic... those are things i don't think that i'd get from my ir colleagues, that i know that i can get with my cardiology colleagues.

also, are the ir guys/gals acls trained? that's a big deal for some of these patients, and stenting someone with an unprotected left main is not an easy task... and not something i'd take lightly as an internist referring my patient for a procedure!

so, to me, just because a doctor has the ability to do a procedure, doesn't mean that he/she should do it.

also remember, interventional cardiologists also know basic cardiology, so even if you did "lose" procedures, you still have cardiology knowledge that an ir guy/gal doesn't have and will not have.

3) I know this is a bit early for me, but where can I find some information about which internal medicine programs (not necessarily just the most prestigious ones) give good medicine training and have high success rates in terms of sending their residents onto competitive fellowships such as cardiology?

I apologize for the wall of text, but there are so many things in my head I want to talk about. I would appreciate any help you guys can offer me with these questions. Thanks in advance!

i don't have great answers on where to get that info.


not sure if i helped, but i don't think you should be discouraged by the potential of interventional radiology encroaching on the realm/area of interventional cardiology, as at worst you'll still have a background of cardiology to fall back on.

 

[vwoo123]

Thanks for the reply, elwademd...I thought I was not going to get a single reply to this thread! I'm glad you brought up the continuity of care issue, because that's actually one of the biggest reasons i am far less interested in interventional radiology than interventional cardiology.

I love the procedures in both fields, but I really don't think I would feel very much like a doctor as a radiologist; they are very good at what they do, but at the same time there are so many aspects of medicine they just do not deal with. If I were to become a cardiologist, I will have trained in internal medicine and feel like i will at least be able to talk to patients should they have questions concerning their weird looking rash or constant heartburn.

Anyway, day by day I'm leaning more towards cardiology, whatever the future holds for this field. Now that I've bumped this thread, let's get some more discussion going. I'm sure more people have something to say about this than just the few of us : )

 

[elwademd]

Thanks for the reply, elwademd...I thought I was not going to get a single reply to this thread! I'm glad you brought up the continuity of care issue, because that's actually one of the biggest reasons i am far less interested in interventional radiology than interventional cardiology.

I love the procedures in both fields, but I really don't think I would feel very much like a doctor as a radiologist; they are very good at what they do, but at the same time there are so many aspects of medicine they just do not deal with. If I were to become a cardiologist, I will have trained in internal medicine and feel like i will at least be able to talk to patients should they have questions concerning their weird looking rash or constant heartburn.

Anyway, day by day I'm leaning more towards cardiology, whatever the future holds for this field. Now that I've bumped this thread, let's get some more discussion going. I'm sure more people have something to say about this than just the few of us : )

no problem.

keep continuing to work hard in medical school.

i think the continuity of care is a big issue, and one that many patients may also take into conisderation (given a choice of course). i know plenty of people who go into radiology because they don't enjoy a lot of patient interaction/continuity of care/history and physical... so it will be interesting to see where the future of interventional radiology goes.

hopefully some more people, esp. those interested in cardiology, will chime in and give you their perspective.

 

[nutcancer]

MS4 here so take my comments with a grain of salt.

You're right about less need for invasive procedures (COURAGE trial, CCTA imaging, cardiac imaging, etc.).

HOWEVER, if you are only interested in the IR part of radiology, I WOULD NOT do IR. As far as I'm concerned, IR is a dying field. I'm going to get flamed for this but let the facts speak for themselves: IR is the easiest fellowship to get in radiology. Nobody wants to do IR. IR is so not in demand that they now offer an advanced pathway to match into IR right out of med school or after finishing an internship year. Don't go into IR - the advancing technology CANNOT keep up with the rate at which other providers steal the technology you invented and mastered. Cardiologists own the heart and are now being trained to do peripheral work. Vascular surgery came down out of the dumps by stealing IR work -- its now one of the hottest fields in surgery all over again. All that will be left for IR are the scraps (PICC lines, TIPS, etc.). Bottom line -- don't do IR unless you really somehow enjoy the work they're doing.

Back to my first point about less need for invasive procedures like angiograms and interventions (COURAGE trial). Its quite amazing that CCTA can map out all the coronaries and cardiac MR can beautifully show all the heart anatomy and function. The thought of non-invasive tests should scare any cardiologist. But let's be frank here. Cardiologists are already just buying their own CT and magnets and reading the studies themselves. Siemens and other CT manufacturers already make CT scanners which only show the heart/coronaries and 'subtract' the rest of the chest so you have no liability in missing chest findings. Its unethical but its already out there. Why? Because the person who owns the patient owns where they go for their work-up. If cardiologists need their patient to get a ccta or a cardiac mri, do you think they'll send them to another center to get expensive testing done? no! they'll buy their imaging machines and read it themselves for full reimbursement! Radiology is a fantastic field but they will further lose their scope of cardiac imaging. My point basically is don't let the fear of non-invasive imaging technologies scare you from being a cardiologist. You're just going to end up stealing those technologies in the future anyway!

 

[Teejay]

MS4 here so take my comments with a grain of salt.

You're right about less need for invasive procedures (COURAGE trial, CCTA imaging, cardiac imaging, etc.).

HOWEVER, if you are only interested in the IR part of radiology, I WOULD NOT do IR. As far as I'm concerned, IR is a dying field. I'm going to get flamed for this but let the facts speak for themselves: IR is the easiest fellowship to get in radiology. Nobody wants to do IR. IR is so not in demand that they now offer an advanced pathway to match into IR right out of med school or after finishing an internship year. Don't go into IR - the advancing technology CANNOT keep up with the rate at which other providers steal the technology you invented and mastered. Cardiologists own the heart and are now being trained to do peripheral work. Vascular surgery came down out of the dumps by stealing IR work -- its now one of the hottest fields in surgery all over again. All that will be left for IR are the scraps (PICC lines, TIPS, etc.). Bottom line -- don't do IR unless you really somehow enjoy the work they're doing.

Back to my first point about less need for invasive procedures like angiograms and interventions (COURAGE trial). Its quite amazing that CCTA can map out all the coronaries and cardiac MR can beautifully show all the heart anatomy and function. The thought of non-invasive tests should scare any cardiologist. But let's be frank here. Cardiologists are already just buying their own CT and magnets and reading the studies themselves. Siemens and other CT manufacturers already make CT scanners which only show the heart/coronaries and 'subtract' the rest of the chest so you have no liability in missing chest findings. Its unethical but its already out there. Why? Because the person who owns the patient owns where they go for their work-up. If cardiologists need their patient to get a ccta or a cardiac mri, do you think they'll send them to another center to get expensive testing done? no! they'll buy their imaging machines and read it themselves for full reimbursement! Radiology is a fantastic field but they will further lose their scope of cardiac imaging. My point basically is don't let the fear of non-invasive imaging technologies scare you from being a cardiologist. You're just going to end up stealing those technologies in the future anyway!

You are very correct. Whatever imagings or techniques IR'S invent about the heart, interventional cardiologist will invade it sooner or later for the same or more pay. Nobody should get discouraged on the future of IC. Its an evolving field with lots of promises in the near future.