Advise needed - IC fellowship: concerns regarding IC and structural

[Dr. HWS]

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Hi everyone,

I’ve already applied for interventional cardiology this match. However, I keep having second thoughts and concerns and I want to get your input on:

I’m happiest when I’m in the cath lab. I also enjoy the structural aspects of IC and valve disease.

My biggest concern remains lifestyle. I know STEMI call is part of the job, but I’m worried about the impact frequent overnight calls will have on my quality of life in the long run. I tend to suffer significantly next day from middle of the night interruptions but not in a way that would impair my ability to perform. I had initially planned to pursue structural training following IC and, was hoping that with time, structural would become a standalone specialty, so I can focus on structural and avoid calls. However, I understand that the structural job market is very tight right now, and it seems unlikely that I’d be able to do structural-only work anytime soon following training. I am also considering keeping my general cardiology skills (echo, nuclear), so I can fall back on general cardiology if needed.

My questions are:

• Am I doing the wrong decision by pursuing IC?
• How realistic is it to find IC jobs with limited or no STEMI call? What pathways I could build in my career to get there? (Again I really enjoy STEMIs having been participated in STEMI calls, but my main concern remains the extent to which sleep deprivation affects my quality of life)
• Do you think structural will ever evolve into a standalone specialty? How realistic is this?
• For lifestyle purposes, are hybrid career models (IC +/- structural +/- imaging/general cards) practical, or do they end up being too fragmented?
• Looking back, would you still choose IC knowing what you know now about lifestyle and job market realities?

For those who have finished IC and are in practice, how realistic is it to eventually find a pathway with limited STEMI call? Do you see structural-only jobs becoming more or less accessible over the next few years?

Thanks for any advice.

 

[shouldigomd]

I mean general cardiology call is worse than STEMI call in my opinion. That pretty much throws a wrench in all of this post.

 

[Dr. HWS]

I mean general cardiology call is worse than STEMI call in my opinion. That pretty much throws a wrench in all of this post.

I don't know that I agree with this. General cardiology issues in most places are handled by in-house fellows/residents or cardiology nocturnist.

 

[NYknicks44]

When you are early career IC, the reason you get hired is to do stemi call. Unless you luck into a unicorn job, you will likely be doing a lot of stemi call. Everyone wants to a scheduled procedures with minimal or no call, which the folks with seniority will try to do.

It is very likely in the beginning that you won’t have any scheduled procedures and you will have to do stemi call and do add on cases.

Structural is very saturated. Most graduating structural/IC fellows have a little of everything.

 

[cards67]

I'm gen cards, I've never gotten woken up overnight or had to go in after hours and we don't have trainees or nocturnists of any sort either. If I were you I'd do IC fellowship. You can always do just gen cards later (or sooner) if things aren't to your liking. But at least you have IC in your backpocket in case the right opportunity comes up. It gives you options and you might regret not at least trying. No STEMI call is a pipedream and structural is saturated already (certainly in my area) and likely won't be its own thing anytime soon if at all. We have some guys that are "hybrid" as you call it along with IC+general folks, they're no different from each other.

 

[shouldigomd]

I don't know that I agree with this. General cardiology issues in most places are handled by in-house fellows/residents or cardiology nocturnist.

If you think most hospitals have in house residents/fellows or "cardiac nocturnists" you are sorely mistaken. Academic hospitals are the minority.