advanced cardiology fellowships: outlook and competitiveness

[throwaway1939]

So having matched into cardiology (in a program with all the subspecialties), been looking ahead to see what advanced fellowships have to offer. My understanding is as follows:

interventional -> most competitive, requires 1-2 additional years, becoming more saturated, not atypical to have salaries >500k, location is an issue.

EP -> 2nd most competitive, 2 years additional years, also saturated, salaries typically in the 350-450k range, can't be too picky about location.

Imaging -> not competitive, 1 year, no idea about location/saturation, salary similar to general cardiology 300-400k

advanced heart failure -> not competitive, 1 year, again, no idea about location/saturation, salary in the 350-450k range as far as I can tell.

Personally most interested in advanced heart failure, but all 3 heart failure fellows I've talked to have drunk the academic koolaid so I have no idea what a good salary looks like in advanced heart failure (they all got jobs in the 150-200k range, no idea about bonus/productivity/protected research time).

any help clarifying the above and providing more detailed practice information would be welcomed. I perused through the jobs in cardiology thread but it didn't really touch on what I needed since it had like 100+ ****posts in there.

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[Phospholipid]

Personally most interested in advanced heart failure, but all 3 heart failure fellows I've talked to have drunk the academic koolaid so I have no idea what a good salary looks like in advanced heart failure (they all got jobs in the 150-200k range, no idea about bonus/productivity/protected research time).

150-200k for a board certified Cardiologist with extra training of heart failure is extremely low. Heck, for any board certified physician of any field is low. Is that really the reality?

 

[nlax30]

150-200k for a board certified Cardiologist with extra training of heart failure is extremely low. Heck, for any board certified physician of any field is low. Is that really the reality?

Welcome to academics....

For a cardiac subspeciality that’s honestly prob on the low end but prob a realistic starting range for a lot of academic places. Obviously a lot of variability depending on location, pay structure. I know EPs that started at just under 200k at major academic centers.

 

[throwaway1939]

150-200k for a board certified Cardiologist with extra training of heart failure is extremely low. Heck, for any board certified physician of any field is low. Is that really the reality?

they all went academics. I don't know what kind of salary a community/private practice advanced heart failure cardiologist commands.

 

[IMreshopeful]

they all went academics. I don't know what kind of salary a community/private practice advanced heart failure cardiologist commands.

Salaries are higher across the board for private practice cardiology in all of these fields compared to academics. It’s also regional - if you want to stay in a large city, expect lower reimbursement

The first post is about correct overall. EP salaries can actually be much higher especially in the community. Job saturation is a waxing and waning thing especially for IC and EP now that a fairly large number of older physicians are beginning to retire

 

[cards67]

My opinion so take it for what it's worth. If you want to deal with tx, then that's likely an academic/major center, pay may not necessarily be low as posted but not necessarily making bank either. Lvads there's more options as more hospitals do lvads but no tx, but again hospital based job probably competitive salary is possible (300k+) but again mostly limited to hospitals. PP not much for HF unless you just want to take care of the more advanced HF patients or maybe those with tx/lvads in a small community. You really have to think hard about what you're interested in, what you want out of your career, work environment, etc. No point in doing interventional if you have zero interest, but if you do it's a good marketable skillset to have, salary sounds about right +/- few 100k depending on location. Market can vary and depends on your interests, networking, skillsets, etc. EP 2yrs is long and only worth it if you love it imo, market supposedly is saturated but not 100% sure. Imaging, salary is probably right, market can vary, you're competing with rads and you're relegated to large groups that have machines or hospitals. You could always do the extra year and if you don't find jobs you like, fall back on gen cards, it's better to have as much skillsets as possible imo.

 

[residentk3]

I can weigh in a little on EP. The market is supposedly saturated but I believe it’s on the brink of a huge shortage. As people live longer, more people will need devices and ablations. Fewer surgeons and general cardiologists are implanting devices. Most fellows coming out of general training aren’t putting in CRTs and His leads. Salaries are lower in academics and private in big cities (250-350k). But if you move an hour out, it almost doubles. This doesn’t factor in the docs who are about to retire

 

[ROBINHO]

for heart failure you can get 400-500 in non academic institutions. Some community hospitals have LVADs. And increasingly I am seeing some community hospitals/non transplant centers who have affiliations with huge centers whereby u stay locally all year round but spend 4 weeks doing transplant at a big center. Advantage for u is that u dont lose skills, advantage for big center is that you send them all your patients

 

[wamcp]

So having matched into cardiology (in a program with all the subspecialties), been looking ahead to see what advanced fellowships have to offer. My understanding is as follows:

interventional -> most competitive, requires 1-2 additional years, becoming more saturated, not atypical to have salaries >500k, location is an issue.

EP -> 2nd most competitive, 2 years additional years, also saturated, salaries typically in the 350-450k range, can't be too picky about location.

Imaging -> not competitive, 1 year, no idea about location/saturation, salary similar to general cardiology 300-400k

advanced heart failure -> not competitive, 1 year, again, no idea about location/saturation, salary in the 350-450k range as far as I can tell.

Personally most interested in advanced heart failure, but all 3 heart failure fellows I've talked to have drunk the academic koolaid so I have no idea what a good salary looks like in advanced heart failure (they all got jobs in the 150-200k range, no idea about bonus/productivity/protected research time).

any help clarifying the above and providing more detailed practice information would be welcomed. I perused through the jobs in cardiology thread but it didn't really touch on what I needed since it had like 100+ ****posts in there.

So when you say the word salary. Does that mean an average 40 hour work week that is all inclusive of time spent on seeing patients, documentation, calls etc? Just so we can have a level field to compare...

 

[Instatewaiter]

Heart failure

pay is in the $250 range for academic heart failure on the east coast (with the exception of one place I know of which pays mid to high 300s but works you to death). Most places give a premium above general cardiology for those with heart failure training- some as much as 100k more than general.

Non-academic jobs pay better and good jobs tend to be in the larger community hospitals that have a mechanical support program. Non-academic heart failure salaries tend to be in $350 on the low end and 550+ on the higher end. Some places offer in the mid 600s but these are rarer. Unless in a major city, non-academic chf pay of only $300k is probably a position that isn't going to be filled or will be filled with someone less than reputable. As previously discussed, jobs tend to be hospital employed and the CHF guys manage the impella/tandem/ecmo and lvad .

 

[JonNJMS2012]

I'd add one thought regarding EP - granted I'm not EP so take this with a grain of salt - it seems to me like every field of medicine that has had a big surge of interest as the technology becomes more sophisiticated and the reimbursement is great, that after a few years CMS tightens the belt and reimbursement plummets. As of right now, AFib is a real cash cow. You can do a PVI in 2-3 hours and get reimbursed 15k and then when the AF returns in 6 months you can do it all over again. I think we are seeing a relative "bubble" of EP salaries because its pretty easy to crank out expensive procedures that makes the EP groups tons of money. I know for a fact that there are at least a few AFib registries currently tracking outcomes and relating them to cost and I can make a confident prediction that AFib reimbursements will either tank or will be tied to longer term outcomes, in either case I think the salaries we have been seeing in EP will drop and the desirability of that specialty will follow.

 

[mayn]

Great thread.

Any people who have done advanced imaging care to weigh in on salaries and job prospects?

 

[TheNextLevel]

Agree that EP is a bubble right now.. Many folks who came into fellowship with zero interest are now doing observational research on AF ablation or His bundle pacing to buff up their resumes - these are the same folks who would have jumped on the interventional band wagon 10 years ago when that field was approaching a similar fever pitch. We'll see how it shakes out as they recently increased the fellowship length to 2 years and fellowship numbers have been at all time lows.

I also think it is worth mentioning that the structural job market seems to be completely saturated. Many very good fellows are bailing on plans to pursue a structural fellowship and instead focusing on a mix of general, IC, and peripherals.

It seems like the highest demand will be for general cardiologists for the foreseeable future. If you are willing to bust your butt seeing patients in clinic and rounding doing general cardiology with some imaging, there are great jobs everywhere for you.

Nobody at my institution pursues training in advanced imaging, it is generally viewed as a waste of time as you can get what you need for private practice imager in 3 years here.

 

[mayn]

Agree that EP is a bubble right now.. Many folks who came into fellowship with zero interest are now doing observational research on AF ablation or His bundle pacing to buff up their resumes - these are the same folks who would have jumped on the interventional band wagon 10 years ago when that field was approaching a similar fever pitch. We'll see how it shakes out as they recently increased the fellowship length to 2 years and fellowship numbers have been at all time lows.

I also think it is worth mentioning that the structural job market seems to be completely saturated. Many very good fellows are bailing on plans to pursue a structural fellowship and instead focusing on a mix of general, IC, and peripherals.

It seems like the highest demand will be for general cardiologists for the foreseeable future. If you are willing to bust your butt seeing patients in clinic and rounding doing general cardiology with some imaging, there are great jobs everywhere for you.

Nobody at my institution pursues training in advanced imaging, it is generally viewed as a waste of time as you can get what you need for private practice imager in 3 years here.

What kind of offers were the third years getting for general cardiology?

 

[nlax30]

What kind of offers were the third years getting for general cardiology?

On the low end I've seen around low-mid 300's starting for private/employed positions (non-academic) in desirable suburban areas. Certainly outliers and I've seen higher offers by about 100-150k, usually places a little more rural or at busy location where you will work your tail off for that.

 

[Bobbbyyyy]

I'd add one thought regarding EP - granted I'm not EP so take this with a grain of salt - it seems to me like every field of medicine that has had a big surge of interest as the technology becomes more sophisiticated and the reimbursement is great, that after a few years CMS tightens the belt and reimbursement plummets. As of right now, AFib is a real cash cow. You can do a PVI in 2-3 hours and get reimbursed 15k and then when the AF returns in 6 months you can do it all over again. I think we are seeing a relative "bubble" of EP salaries because its pretty easy to crank out expensive procedures that makes the EP groups tons of money. I know for a fact that there are at least a few AFib registries currently tracking outcomes and relating them to cost and I can make a confident prediction that AFib reimbursements will either tank or will be tied to longer term outcomes, in either case I think the salaries we have been seeing in EP will drop and the desirability of that specialty will follow.

15k/3hrs ????? HOLLY JUPITER

 

[Bobbbyyyy]

Agree that EP is a bubble right now.. Many folks who came into fellowship with zero interest are now doing observational research on AF ablation or His bundle pacing to buff up their resumes - these are the same folks who would have jumped on the interventional band wagon 10 years ago when that field was approaching a similar fever pitch. We'll see how it shakes out as they recently increased the fellowship length to 2 years and fellowship numbers have been at all time lows.

I also think it is worth mentioning that the structural job market seems to be completely saturated. Many very good fellows are bailing on plans to pursue a structural fellowship and instead focusing on a mix of general, IC, and peripherals.

It seems like the highest demand will be for general cardiologists for the foreseeable future. If you are willing to bust your butt seeing patients in clinic and rounding doing general cardiology with some imaging, there are great jobs everywhere for you.

Nobody at my institution pursues training in advanced imaging, it is generally viewed as a waste of time as you can get what you need for private practice imager in 3 years here.

what is the main difference between general cards and those who get an advanced imaging fellowship?
can general cards do MUGA scans? which specific imaging modalities can only those with an advanced imaging fellowship read?

also, what's the day to day like for those who have an advanced imaging fellowship? can they read scans 100% of the time or do they still mix it up with hospital consults?

 

[IMreshopeful]

what is the main difference between general cards and those who get an advanced imaging fellowship?
can general cards do MUGA scans? which specific imaging modalities can only those with an advanced imaging fellowship read?

also, what's the day to day like for those who have an advanced imaging fellowship? can they read scans 100% of the time or do they still mix it up with hospital consults?

1. General cardiology usually nets you (assuming you don’t go to some place with “prestige” that allows only level 2 in one imaging modality) the ability to get proficient at reading echos, TEE, nuclear, and usually the opportunity to read vascular studies, cardiac CT. Advanced imaging fellowships are varied but usually involve cardiac MRI training, structural heart imaging intervention training (like TEE procedural guidance), etc. So you can do a lot as a general cardiologist - however, if you want more MRI training and advanced echo training an advanced imaging fellowship can be helpful. Also helpful if you’re very interested in academics and want to do imaging research I suppose

2. MUGA scans are the domain of nuclear cardiology and are super easy to read. General cardiologists can easily learn how to read them.

3. Not having done an advanced imaging fellowship, your last question is best answered by someone else

Also I would focus on matching an IM position for now... not sure if this is just wishful future thinking

 

[Bobbbyyyy]

1. General cardiology usually nets you (assuming you don’t go to some place with “prestige” that allows only level 2 in one imaging modality) the ability to get proficient at reading echos, TEE, nuclear, and usually the opportunity to read vascular studies, cardiac CT. Advanced imaging fellowships are varied but usually involve cardiac MRI training, structural heart imaging intervention training (like TEE procedural guidance), etc. So you can do a lot as a general cardiologist - however, if you want more MRI training and advanced echo training an advanced imaging fellowship can be helpful. Also helpful if you’re very interested in academics and want to do imaging research I suppose

2. MUGA scans are the domain of nuclear cardiology and are super easy to read. General cardiologists can easily learn how to read them.

3. Not having done an advanced imaging fellowship, your last question is best answered by someone else

Also I would focus on matching an IM position for now... not sure if this is just wishful future thinking

thanks, yup, 1 step at a time, you're right, just curious about these things, no serious plans ATM other than trying to match into something

 

[nlax30]

15k/3hrs ????? HOLLY JUPITER

That $ number is more the total cost to the 'system' for an AF ablation.... considering cost of hospitalization, equipment, physician payment, etc. is That is no where near what the physician himself gets from the procedure.

 

[nlax30]

Advanced Imaging generally helpful if you have a specific interest in wanting to do Cardiac MRI and/or advanced structural imaging support for things like TAVR, Mitraclip, etc... OR if you want to go into academics in Cardiac Imaging or lead an imaging dept. If going into most private practice settings then likey won't make that much of a difference unless you specifically find a private job wanting an image for their structural program.

 

[cardsguy2017]

I'd add that doing an extra echo year for level 3, or just for structural, is a tough call when some programs out there let their general fellows get level 3 by their 3rd year and/or experience in structural. Maybe some places require that official echo fellowship year, but a gen cards program that allows level 3 is a significant perk.

 

[nlax30]

Yea I agree, I got that experience and ECHO/Nuc certified from general fellowship. I could've gotten CT if I really wanted to and spent some extra time my last couple months but by that time knew I wasn't going to need it. MRI was going to require the extra year. So definitely inquire about what you could practically obtain at a particular general fellowship.

 

[IMreshopeful]

I'd add that doing an extra echo year for level 3, or just for structural, is a tough call when some programs out there let their general fellows get level 3 by their 3rd year and/or experience in structural. Maybe some places require that official echo fellowship year, but a gen cards program that allows level 3 is a significant perk.

They are cracking down on this pretty hard - yes it’s theoretically possible but the guidelines released by ACC for what they really require for level 3 has become much more strict. For example if your institution doesn’t do strain imaging regularly you’re SOL

 

[Cor doc]

Anyone has any thoughts on the most recent MedAxiom report? Personally I am surprised to see that HF makes 10% less than general non invasive.

 

[cardsguy2017]

Anyone has any thoughts on the most recent MedAxiom report? Personally I am surprised to see that HF makes 10% less than general non invasive.

It's very broad survey so I wouldn't think too much about it. One hypothesis is more time spent with complex patients but not getting equally reimbursed for that time. Though I also tend to think HF is usually academic or at least hospital-employed positions, which could simply be offering lower salaries.

 

[mayn]

Anyone here who has done an advanced imaging fellowship? How did that affect future job prospects, are you primarily in academics?

I am interested in echo and considering an advanced imaging fellowship, just still weighing the pros and cons and looking for practical advice from someone who's actually done or in an imaging fellowship

 

[Travelergenius]

That $ number is more the total cost to the 'system' for an AF ablation.... considering cost of hospitalization, equipment, physician payment, etc. is That is no where near what the physician himself gets from the procedure.

Physician rVU is about 33 which reimburses $ 1200. Usually you end up getting some ghost rVU also if it is a new procedure for your center for a couple of years. So I assume about $1500.

 

[dd128]

Anyone here who has done an advanced imaging fellowship? How did that affect future job prospects, are you primarily in academics?

I am interested in echo and considering an advanced imaging fellowship, just still weighing the pros and cons and looking for practical advice from someone who's actually done or in an imaging fellowship

I went ahead and did the imaging year. Job prospects seem to be better and better, though you need to be aware you are still a general cardiologist just doing some extra reading, echo time, etc. If it's just echo you are interested in, I presume you are looking at structural procedures, which also seems to have an evolving job market.

From what I've seen anecdotally compensation is not higher after the fellowship and may even be slightly lower as you are limited to largely academic institutions at this time, if you want to utilize the imaging year skills. The private practice spots I saw were largely dominated by radiology or some really had no interest in even having anything to do with cardiac MRI or CT (older docs running the practice who have gotten by without it forever).

The decision to do the year for me was largely based on my interest level and the fact that I feel there is going to be a fairly large boom in advanced imaging utilization in the next 5-10 years as technology advances and becomes cheaper (but this is only my opinion).

 

[mayn]

I went ahead and did the imaging year. Job prospects seem to be better and better, though you need to be aware you are still a general cardiologist just doing some extra reading, echo time, etc. If it's just echo you are interested in, I presume you are looking at structural procedures, which also seems to have an evolving job market.

From what I've seen anecdotally compensation is not higher after the fellowship and may even be slightly lower as you are limited to largely academic institutions at this time, if you want to utilize the imaging year skills. The private practice spots I saw were largely dominated by radiology or some really had no interest in even having anything to do with cardiac MRI or CT (older docs running the practice who have gotten by without it forever).

The decision to do the year for me was largely based on my interest level and the fact that I feel there is going to be a fairly large boom in advanced imaging utilization in the next 5-10 years as technology advances and becomes cheaper (but this is only my opinion).

Thanks man! I am definately interested in advanced and structural echo, so that should hopefully help with finding a job looking for a structural TEE guy. Did you have to negotiate or discuss extra reading time or was that generally part of most job prospects? What does your general day/week look like?

 

[Tipoftheiceberg]

I went ahead and did the imaging year. Job prospects seem to be better and better, though you need to be aware you are still a general cardiologist just doing some extra reading, echo time, etc. If it's just echo you are interested in, I presume you are looking at structural procedures, which also seems to have an evolving job market.

From what I've seen anecdotally compensation is not higher after the fellowship and may even be slightly lower as you are limited to largely academic institutions at this time, if you want to utilize the imaging year skills. The private practice spots I saw were largely dominated by radiology or some really had no interest in even having anything to do with cardiac MRI or CT (older docs running the practice who have gotten by without it forever).

The decision to do the year for me was largely based on my interest level and the fact that I feel there is going to be a fairly large boom in advanced imaging utilization in the next 5-10 years as technology advances and becomes cheaper (but this is only my opinion).

Thanks for your input. Do you mind telling us what kind of practice you ended up in and what your day to day's like? I am going into advanced imaging as well and I am not sure of what to expect afterwards.

 

[shouldigomd]

How competitive is landing an IC position? After the cards interview trail and asking multiple people the vibe I get is that cards is the bottleneck... not IC. How important is having an IC position at your home institution? Should you put a "lesser program" above a better one if they have in house IC?

 

[aafisahar]

How competitive is landing an IC position? After the cards interview trail and asking multiple people the vibe I get is that cards is the bottleneck... not IC. How important is having an IC position at your home institution? Should you put a "lesser program" above a better one if they have in house IC?

I think IC at your home program is important. Moving again for another 1-2 years of training is a huge pain in the ass and many of us start families or already have families. You get to see how your program works, warts and all. IC is probably the most competitive subspecialty after cards, but for the most part, you'll land a spot if you were a decent fellow. Personally, if I couldn't get a spot in my home program, I'd not pursue a subspecialty, mostly because I love where (program and place) I ended up.

 

[shouldigomd]

I think IC at your home program is important. Moving again for another 1-2 years of training is a huge pain in the ass and many of us start families or already have families. You get to see how your program works, warts and all. IC is probably the most competitive subspecialty after cards, but for the most part, you'll land a spot if you were a decent fellow. Personally, if I couldn't get a spot in my home program, I'd not pursue a subspecialty, mostly because I love where (program and place) I ended up.

Thanks for the response. Yes, I agree that ideally locking an in house spot at a great place you love is the ideal situation. That being said I am talking about it from a strictly training perspective. Would you rank a program you didn't like as much over another for IC fellowship?

 

[MadLVAD]

How competitive is it to land an advanced imaging fellowship? Is it really important to be at a general cardiology program that has an advanced imaging fellowship in house?

 

[mayn]

How competitive is it to land an advanced imaging fellowship? Is it really important to be at a general cardiology program that has an advanced imaging fellowship in house?

As far as I know, not very competitive (similar to EP?).

When do people start applying for imaging fellowship?

 

[Ivabradine]

Bump. Any updates on salary and job opportunities for advanced imaging? I’m keeping all options open but this seems like a solid option for the future. Does AI push you towards academics only? I don’t mind academics but it’s the salary that turns me off. I don’t want to go through all these years of training to make anything less than $350-400k a year after graduation. It’s just not worth it.

 

[cards67]

It's only been a few years, I doubt much has changed. Do imaging if you're interested in it but understand you'll likely be relegated to academics, large hospitals or maybe large groups. You'll certainly be narrowing your job options. If you're on production it may even hurt you. But you can at least always fall back onto gen cards if things don't work out.

 

[Imdream]

Are there folks who do structural interventions alone, w/o coronaries or peripherals? If there are gigs like that, I imagine the lifestyle would be better, as there would be no calls involved, etc. The downside would saturated market and risk of malpractice

 

[Full Metal IC]

I doubt there are more than a handful of pure structuralists in the US. The vast majority of interventionalists at the very least still take STEMI call. But securing structural volume can be a challenge as a new grad, and a pure structural job early on is almost unheard of. It would be very unwise to go into intervention unless you are prepared to take some amount of STEMI call for the majority of your career. Peripheral work can be conducive to a healthier lifestyle.

 

[aafisahar]

Are there folks who do structural interventions alone, w/o coronaries or peripherals? If there are gigs like that, I imagine the lifestyle would be better, as there would be no calls involved, etc. The downside would saturated market and risk of malpractice

Only such jobs will be at big referral systems and will already have their structuralists. It takes a lot of work to break into that structure and usually requires climbing the academic ladder until you get the position.