Advice Needed – Choosing Between IC vs EP

[Mdinfo]

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Hi everyone, hope all is well.

I’m currently a cardiology fellow and at the stage where I’m deciding between Interventional Cardiology (IC) and Electrophysiology (EP). I enjoy procedures and am not particularly drawn to imaging (TTE/TEE are the least interesting to me), but I’m torn between these two paths. I’d greatly appreciate insights, especially from those actively practicing in these fields.

1. Interventional Cardiology (IC):
I like the subject — maybe because I’m more familiar with cath from prior exposure working with cardiologists in the cath lab. However, I have concerns about the call burden, the stress that comes with the schedule, and, most importantly, the interpersonal dynamics. I’m not sure if it’s just my current environment, but I’ve found IC personalities harder to deal with, with more hierarchy and politics than I’d prefer.

2. Electrophysiology (EP):
I find the lifestyle more favorable compared to IC, and the procedures are fascinating. The EP attendings I’ve met are also generally very approachable and respectful. My concern is that I’m not naturally strong in EKG interpretation or EP concepts — which I think is partly due to lack of exposure, but I do wonder if it’s a sign of a mismatch rather than just a knowledge gap.

I’d love to hear your honest perspectives on what life is like in each specialty, what you enjoy most, any real-world salary differences and what you’d do differently if you had to choose again

Thanks in advance!

 

[shouldigomd]

In my opinion the decision shouldn't be that hard as the two fields are very different. I am an IC so naturally biased that way. In terms of things that shouldn't really sway you one way or another... Both can be highly procedurally based and there are many EP docs that are in the lab more than IC's but this is highly variable depending on the job. EP vs IC personalities are overall different but obviously this is variable and not a reason to pick one over another. The procedures are so different. Insert my bias... A pacemaker is a glorified central line and this will be your bread and butter. I can't imagine anything more boring than moving leads around / mapping / ablating ... for hours. Obviously I am sure it is more engaging when you are the one doing it and processing the info. Some food for thought below about each.

EP
-lifestyle clearly better as there are no emergencies and often no call or weekends. More predictable.
-job market better as EP is in demand and overall also has the edge in terms of $$
-because EP is more in demand you can find more positions where you can do pure EP without general if that is something you want to do
-may not seem like a big deal but it is ... 2 year fellowship. I wouldn't worry about the EP learning part.



IC
-on call changes the lifestyle but how frequent depends on the group you join. Can be as miserable as every other day or as chill as 1 in 7 without general.
-emergency life saving situations. Some people love this some people don't. These situations are what i love most about my job. You have someones life in your hands.
-often times you have to take general call and nearly always do a significant amount of general cardiology.
-a more saturated job market which can also lead to more political drama
-there is more procedural versatility. Even without a dedicated structural year you can branch out to other procedures based on your interest. I didn't do a dedicated structural year but in addition to your typical IC stuff I do watchman, PFO/ASD closure, valvuloplasty, peripheral interventions, PE thrombectomy / lytics as a new interventionalist.

 

[Mdinfo]

In my opinion the decision shouldn't be that hard as the two fields are very different. I am an IC so naturally biased that way. In terms of things that shouldn't really sway you one way or another... Both can be highly procedurally based and there are many EP docs that are in the lab more than IC's but this is highly variable depending on the job. EP vs IC personalities are overall different but obviously this is variable and not a reason to pick one over another. The procedures are so different. Insert my bias... A pacemaker is a glorified central line and this will be your bread and butter. I can't imagine anything more boring than moving leads around / mapping / ablating ... for hours. Obviously I am sure it is more engaging when you are the one doing it and processing the info. Some food for thought below about each.

EP
-lifestyle clearly better as there are no emergencies and often no call or weekends. More predictable.
-job market better as EP is in demand and overall also has the edge in terms of $$
-because EP is more in demand you can find more positions where you can do pure EP without general if that is something you want to do
-may not seem like a big deal but it is ...

Thanks for your input. I do feel that the variety of procedures in EP is more limited compared to IC (and I do enjoy procedures in general). However, I’ve been told by both EP and IC attendings that no matter which field you choose, it eventually becomes routine and loses some of its initial “shine,” and then it’s more about what’s practical and sustainable.

One IC attending told me he regrets going into IC because he has very little time for family. Another mentioned that STEMI calls are stressful, and that he would be many times happier going back to EP — even though he never fell in love with EP, he still recommends it. Hearing these things from IC attendings honestly freaked me out, especially since I can’t imagine waking up for emergencies in the middle of the night for the rest of my career (though I realize that’s not completely avoidable in either IC or EP).

I’m not “in love” with EP, but I don’t dislike it either. It feels like a different language that I’d need to learn, and many EP attendings have reassured me that it’s just a matter of time before it clicks. I don’t want to choose one field and constantly look back wondering “what if.” I do like IC (maybe because I’m more familiar with it), but I don’t want the constant emergencies or the draining personality dynamics I’ve sometimes seen in that environment (with all respect to the many great people in IC).

On the other hand, EP tends to have a more pleasant work culture, and I could see myself working with that kind of team for years. While many EP cases can be managed medically if you wanted to, the specialty still has the advantage of a high degree of autonomy — few people outside EP truly understand what you do. The main drawback is that EP requires an extra year of fellowship, which matters since I have kids, but realistically one extra year is a small trade-off for a lifelong career.

 

[ihoop24]

In my opinion the decision shouldn't be that hard as the two fields are very different. I am an IC so naturally biased that way. In terms of things that shouldn't really sway you one way or another... Both can be highly procedurally based and there are many EP docs that are in the lab more than IC's but this is highly variable depending on the job. EP vs IC personalities are overall different but obviously this is variable and not a reason to pick one over another. The procedures are so different. Insert my bias... A pacemaker is a glorified central line and this will be your bread and butter. I can't imagine anything more boring than moving leads around / mapping / ablating ... for hours. Obviously I am sure it is more engaging when you are the one doing it and processing the info. Some food for thought below about each.

EP
-lifestyle clearly better as there are no emergencies and often no call or weekends. More predictable.
-job market better as EP is in demand and overall also has the edge in terms of $$
-because EP is more in demand you can find more positions where you can do pure EP without general if that is something you want to do
-may not seem like a big deal but it is ... 2 year fellowship. I wouldn't worry about the EP learning part.



IC
-on call changes the lifestyle but how frequent depends on the group you join. Can be as miserable as every other day or as chill as 1 in 7 without general.
-emergency life saving situations. Some people love this some people don't. These situations are what i love most about my job. You have someones life in your hands.
-often times you have to take general call and nearly always do a significant amount of general cardiology.
-a more saturated job market which can also lead to more political drama
-there is more procedural versatility. Even without a dedicated structural year you can branch out to other procedures based on your interest. I didn't do a dedicated structural year but in addition to your typical IC stuff I do watchman, PFO/ASD closure, valvuloplasty, peripheral interventions, PE thrombectomy / lytics as a new interventionalist.

Not to hijack OP's thread, but I have a few questions that may be pertinent to them as well:

What does your schedule look like? Are you in PP or academic?
How did you tap into peripheral stuff/PFO/watchman etc, without a structural year? Did you aim to do as many as you could during IC fellowship or are you able to learn on the job as an attending?

Thanks!

 

[cards67]

Your attendings are correct, it all becomes routine and you have to think about what you want to see, do and talk about everyday for the rest of your life. The mundane, bread and butter stuff because the excitement and thrill of things can wear off. Consider that pure EP jobs are pretty common whereas IC you're more likely to be doing gen cards as well. But with IC it might be easier to cut back to just gen cards down the road. Knowledge and ability will come with time, that's why you're in training. And I wouldn't sweat interpersonal dynamics, there are difficult characters everywhere, just gotta deal with it. I've never found EP folks to be any better or worse. Not that you necessarily have to love EP, but I feel like it should be more than "don't dislike". Is gen cards not an option?

 

[Mdinfo]

Thank you! Maybe it’s more about unfamiliarity than “dont dislike”. To be honest, I’m not entirely sure, which is why I’m reaching out to get the opinions of seniors in the field. I don’t see myself doing gen card — I prefer to sub specialize.

 

[shouldigomd]

Making career choices based on personalities you encounter in training is silly so I would remove that argument from your list of pro/con's. Personalities are obviously highly variable and also differ significantly in training vs academics vs private vs location. Don't sleep on general cardiology. It allows for the most flexibility in nearly every aspect and the job market is great. Many general cardiologist don't "sub-specialize" but ultimately practice advanced: congenital / imaging / pulm htn / heart failure and do their own diagnostic heart caths.

Not to hijack OP's thread, but I have a few questions that may be pertinent to them as well:

What does your schedule look like? Are you in PP or academic?
How did you tap into peripheral stuff/PFO/watchman etc, without a structural year? Did you aim to do as many as you could during IC fellowship or are you able to learn on the job as an attending?

Thanks!

PP. I take 1:5 IC call. Typical week is 8am to 5pm M to F. I do 1 weekend every 5 weeks. Get exposure in as much as you can during training. Don't go crazy so that you are absent from your bread and butter cardiology stuff but try and get enough of a taste of the things you could see yourself doing in the future. Vascular access and catheter techniques are pretty much the same no matter what procedures you are doing. Once you start as an attending you will see the culture and what procedures you can tap into depending on your hospital.