Cardio vs. Pulm/CC vs. GI

[docscience]

I am a current intern at a low-mid tier residency program. I have decided that I do not want to do general hospitalist medicine/primary care. I am a lot more hands on and want to do a subspecialty that is very procedural. I have decided between pulm/cc vs. cards vs. gi

The one other caveat includes location. I would like to do my fellowship in a large city! Hopefully on the west coast - Seattle/Portland/San Fran/SD/Sacramento/Denver in that order

Can we discuss the pros and cons? Any ideas thrown in? Thanks!

Cards:
+ very acute medicine - unclogging a heart vessel/pacers/managing CHF/emergency cardioversions - incredible!
+ Good pay
+ Respect

- lifestyle sucks - any setting you are going to work a lot!
- competitive
- probably won't get to be picky about location

Pulm/CC:
+ "a real doctor" - good at treating multi system disease processes
+ I like bronching and starting lines! Very procedural!
+ Respected
+ less competitive than the other two - might get to be picky about location?

- lifestyle is hit or miss - probably more setting dependent
- pay is so so in academics

GI:
+ lifestyle is great - we all know the GI joke - if too unstable, can't scope til stable, if stable, they can wait to be scoped!
+ ERCP and such are very cool procedures!
+ good pay

- not much respect - people hate GI and how they just scope all day and how they are picky about who to scope
- not too much intervention - lots of turfs to surgery to take the tumor out

Let me know what you guys are thinking. I think I want to work in an academic center and teach...I like teaching medical students!

Any ideas on what specialties you are leaning towards? Why? Goals?
I need to start figuring it out, getting into research, and kissing some butts!

Any advice/tips are appreciated!

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[docscience]

anyone? bueller?

 

[KRichards62]

Sounds like you have a general idea about each subspecialty. I would suggest really focusing on what subject matter interests you the most. What bread-n-butter pathology could you see yourself dealing with every single day?

For example:
Cards - chest pain, a fib, CHF exacerbation
Pulm/CC - sepsis, COPD exacerbation, PNA
GI - GI bleed, liver failure, screening colonoscopy

While money, respect, and lifestyle can be tempting to prioritize in your decision making process - relatively speaking there is not that big of a difference between these specialties to guide your choice. Have you spent time rotating in any of these? The only way to know is to spend time doing it.

 

[gutonc]

anyone? bueller?

What do you want to do for the next 30-40 years? Do that.

 

[pseudoknot]

Focus on the work, the stuff that you think about, the diseases you spend most of your time treating. Don't worry about respect. Even if that's important to you, in real life people respect individuals, not specialties.

 

[theneh]

On the surface, cards seems to funnel into the usual suspects: chf, a fib, acs...but if you are looking to get a fellowship, there is an immense amount of pathology, growing emphasis on understanding biochemical physiology, genetics...and of course the many technical aspects of the profession from, cath's to nukes to your err day 2D echoes...you pretty much have to have research and will have no life for at least the next 5 years...
I'm an intern too, knowing this I still am gunning for a spot in cards...nonetheless, i would recommend that you pursue it only if you're truly passionate about it, cause it's a long road...

GI seems fun too...

 

[docscience]

On the surface, cards seems to funnel into the usual suspects: chf, a fib, acs...but if you are looking to get a fellowship, there is an immense amount of pathology, growing emphasis on understanding biochemical physiology, genetics...and of course the many technical aspects of the profession from, cath's to nukes to your err day 2D echoes...you pretty much have to have research and will have no life for at least the next 5 years...
I'm an intern too, knowing this I still am gunning for a spot in cards...nonetheless, i would recommend that you pursue it only if you're truly passionate about it, cause it's a long road...

GI seems fun too...

"err day" -

I agree..so much to learn in cards...physio to biochem to procedures to "film reads" to codes. The ability to treat super acute and chronic problems and to have procedural fixes is a big draw to the specialty in my mind.
But after having no life for 5 years, perhaps comes the dough and the career satisfaction if you are really into cardiology. You better research your butts off.

GI or Pulm/CC? Anyone thought about doing a hospitalist fellowship? Nephro? Heme/Onc?

I haven't seen much interest in Allergy and Immunology...easy gig and lots of money right? I have never done a rotation. Rheum seems very interesting also...just really cerebral and those docs are so good at the physical exam. Maybe I should do a rotation there also...I just need more elective time as an intern...too bad we have tons of wards time...😛