Cardiologists Vs Hospitalists

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When my cards senior told me the measly packages being offered this year, I was surprised.
Cardiology is facing a crisis........while pulmCC , GI and HemOnc have 400 fellows churning out per year we get 800 people in the market and with massive cuts, it has bought down a inflexible demand curve further down.
cardiology is not worth screwin your lifestyle over.....
This thing is becoming evident to IM residents the nrmp stats show that in last 3 years competitiveness of cardiology has come down massively.
 
duckie99 said:
2. Making more money in gross doesn't necessarily leave you with more disposable income. A person who makes more than 510k will have his/her taxes increase with this new "fiscal cliff" deal by 73k+... that totally blows for them. Why would you want to make that much? Just work a little less for 450k and you end up keeping a lot more of your money.
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err, no, that's not how taxes work. He/she would be taxed at today's rates until the first 400 or 450 (depending on family status) and only above those amounts would the higher rate kick in. So in reality, he/she is looking at about a 6k tax bill that is higher this year than next.
 
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Soon to be interventional cardiology fellow here. I do 4-5 moonlighting shifts a month as a hospitalist. From a strictly monetary standpoint its not a slam dunk that cardiology is worth it, unlike years past. However, I personally can't imagine being a hopsitalist long term - what you get to do on a daily basis in cardiology is so much more rewarding its night and day - I'd still chose to be an interventional cardiologist even if the absolute pay was the same as hospitalist (interventional is still definitely signficantly higher at present, but who knows what the future holds). You've gotta do what you love as the reimbursement climate is ever changing. Not to say that hospitalist work is not highly valuable and necessary, but personally if I'm going to be up at 3 AM when I'm 50 yrs old it better darn well be to make a difference in a life and death situation like primary PCI rather than doing some admission of questionable necessity or fielding calls from the floor on med orders.
 
Myostatin said:
Soon to be interventional cardiology fellow here. I do 4-5 moonlighting shifts a month as a hospitalist. From a strictly monetary standpoint its not a slam dunk that cardiology is worth it, unlike years past. However, I personally can't imagine being a hopsitalist long term - what you get to do on a daily basis in cardiology is so much more rewarding its night and day - I'd still chose to be an interventional cardiologist even if the absolute pay was the same as hospitalist (interventional is still definitely signficantly higher at present, but who knows what the future holds). You've gotta do what you love as the reimbursement climate is ever changing. Not to say that hospitalist work is not highly valuable and necessary, but personally if I'm going to be up at 3 AM when I'm 50 yrs old it better darn well be to make a difference in a life and death situation like primary PCI rather than doing some admission of questionable necessity or fielding calls from the floor on med orders.
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Quick question. For general cardiologists, do most groups have the on-call person work the following day?
 
bronx43 said:
Quick question. For general cardiologists, do most groups have the on-call person work the following day?
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I don't know about most, but some cardiology groups do give the on call person the following day off.

p diddy
 
Myostatin said:
Soon to be interventional cardiology fellow here. I do 4-5 moonlighting shifts a month as a hospitalist. From a strictly monetary standpoint its not a slam dunk that cardiology is worth it, unlike years past. However, I personally can't imagine being a hopsitalist long term - what you get to do on a daily basis in cardiology is so much more rewarding its night and day - I'd still chose to be an interventional cardiologist even if the absolute pay was the same as hospitalist (interventional is still definitely signficantly higher at present, but who knows what the future holds). You've gotta do what you love as the reimbursement climate is ever changing. Not to say that hospitalist work is not highly valuable and necessary, but personally if I'm going to be up at 3 AM when I'm 50 yrs old it better darn well be to make a difference in a life and death situation like primary PCI rather than doing some admission of questionable necessity or fielding calls from the floor on med orders.
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Trifling Jester said:
I'm not aware of any fields where you get a post call day as an attending...
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Then the issue becomes that you don't have to be up at 3am as a hospitalist if you don't want to be. Or if you are, then you're not going to be working the following day. Depending on the size of your cards group, you may take Q4-5 call, which I would NOT want to be doing when I'm 50. A good plan that I've heard is to do hospitalist straight out of residency, then when you're burned out, you can pick up a chill general IM outpatient gig somewhere. More likely than not, salaries will be approaching parity at that point and you won't lose much financially from doing GIM vs specialty.
 
KarmaIsTruth said:
True.

I just believe cardiologists ought to be fairly compensated for their additional 3+ years of training. It seems they do, but only at the expense of more hours. Hourly rate stays roughly the same - it seems.
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I am sure the future intensivist in me and my other fellows would love to see that compensation for the gruelling days we spend chaine dto the ICU. CMS feels differently. Not everyone gets compensated the same for those extra years.

And for the earlier posts, there is a large ceiling obviously for invasive cards. I am not so sure about the non invasives as compared to the hospitalists. I have had multiple offers ranginf from 240k-270k right out of residency for 7 on 7 off 12 hour days, 15-20 pts. Yes hospital medicine sucks, hence the critical care track, but it is quite tempting at times to just finish up and take a gig where I average 42 hours per week (84-0-84-0..etc..) and go on vacation every other work. Oh yes, and no overhead, no office work etc etc.
 
The nice thing about hospitalist gig is you can essentially work as much as you want or as little as you want. Theres definitely something to be said about that flexibility....
 
Ahh the good old days of cardiology....

We are a victim of our own enthusiasm , we madmecardiology a crappy field.

800 fellows graduating every year , dropping reimbursements...while gi people keep a solid hold on the no of positions ~390 and make sure they are high valued asset, they some how don't come up with any trials that makes colonoscopy redundant for screening.
 
salk said:
Ahh the good old days of cardiology....

We are a victim of our own enthusiasm , we madmecardiology a crappy field.

800 fellows graduating every year , dropping reimbursements...while gi people keep a solid hold on the no of positions ~390 and make sure they are high valued asset, they some how don't come up with any trials that makes colonoscopy redundant for screening.
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If we could magically cut down the number of cardiology slots to 400 to match GI, the existing crop in 10 years will not be able to deal with the two burgeoning epidemics in cardiology (baby boomers hitting 60s and 70s and the obese prediabetic kids growing up to develop premature CAD- being in the southeast I am seeing one of the first waves with people in their 20s-30s presenting with premature CAD, and most of they are fat and then start smoking to lose weight!). The mortality due to CAD has declined in the US population, thanks to cardiology- I think we have to thank secondary prevention and primary PCI for STEMI. Better treatments for heart failure and ICDs help as well.

I think that of all the medical specialities, cardiology is the only victim of its own success. I dont think there is any percutaneous intervention that has been shown to be as beneficial as PCI for STEMI, but look at the way PCI is headed. I think in most states and with medicare, if your door to balloon time is >120 mins there are heavy penalties.
The same standards that are being applied to cardiology (by insurance agencies, the government and academic bigwigs who come out with appropriateness criteria) dont exist for many specialties, or are in a primitive stage. It reminds me of how the smart kid in school destroyed himself in school for being 'too smart'.

For example, why does medicare even reimburse for vertebroplasty when the data are so weak??
 
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salk said:
Ahh the good old days of cardiology....

We are a victim of our own enthusiasm , we madmecardiology a crappy field.

800 fellows graduating every year , dropping reimbursements...while gi people keep a solid hold on the no of positions ~390 and make sure they are high valued asset, they some how don't come up with any trials that makes colonoscopy redundant for screening.
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To Salk: You hit it out of the ballpark bro.

To EPADHA: The argument that we need more cardiologist to prepare for the rise in need is complex one... One can also make the argument that the less favorable future practice(due to more physicians graduating than retiring, CMS and private health insurances companies holding hands as they cut reimbursement year after year, and our own colleagues trying to one up each other with the next big RCT to show what else we do is not p <0.05 so hey CMS go ahead and cut some more reimbursements) will only reduce the crop of qualified physicians that would want to take on the additional training as this whole hospitalist vs cardiologist discussion has been showing so the future patient population still be doomed.

Also someone should to go to the radiation oncology forum and ask the ones who already got in about how they would feel about opening up the applicant pool and training more people (http://jco.ascopubs.org/content/28/35/5160.full) as more people are dying from cancer...

I have a feeling they'll stick to their 140 per year nationally so they can keep the field thin and get their ridiculous (in the sense of what they actually do to what they get paid ratio) salary as people wait in line to see our busy rad onc colleagues.

OP
 
EPADHA said:
For example, why does medicare even reimburse for vertebroplasty when the data are so weak??
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Simple because we don't have bunch of orthopods somewhere spending months and years, dedicating their career to getting big RTC showing that vertebroplasty compared to giving the patient a lollipop (placebo arm) shows no morbidity/mortality or even quality of life or healthcare cost effectiveness worth a hoot and publishing their trial on the cover of NEJM and going to be national conferences and preaching the gospel. No we only have that in cardiology.

OP
 
OptimusPrime said:
Simple because we don't have bunch of orthopods somewhere spending months and years, dedicating their career to getting big RTC showing that vertebroplasty compared to giving the patient a lollipop (placebo arm) shows no morbidity/mortality or even quality of life or healthcare cost effectiveness worth a hoot and publishing their trial on the cover of NEJM and going to be national conferences and preaching the gospel. No we only have that in cardiology.

OP
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exactly. For various reasons, cardiology tends to attract hyper-type As who like to indulge in pissing contests to boost their egos... I think we all need to take a step back , and see which way our specialty is headed. I won't be surprised if in 5-7 years, there will be quite a few cardiology spots that are unfilled. By then IMGs in internal medicine programs would be far less (due to annual increase in graduates of American schools); and I am not sure many people will defer paying their medical school loans to do very rigorous specialties like cardiology so that they can make amounts comparable to hospital medicine. At present IMGs, I think, account for nearly 40% of cardiology fellows..
 
OptimusPrime said:
Simple because we don't have bunch of orthopods somewhere spending months and years, dedicating their career to getting big RTC showing that vertebroplasty compared to giving the patient a lollipop (placebo arm) shows no morbidity/mortality or even quality of life or healthcare cost effectiveness worth a hoot and publishing their trial on the cover of NEJM and going to be national conferences and preaching the gospel. No we only have that in cardiology.

OP
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Reimbursement for diagnostic caths and PCIs isn't dropping because cardiologists are doing RCTs to prove they aren't effective. It's already way beyond reasonable doubt that they are the best treatment modality for ACS. Reimbursement is dropping because cardiology is a big target for the CMS, and it was first in line of what is most likely massive cuts across the board. They started out with imaging, then moved to cardiology, because it's easy pickings. Next, they'll move onto other highly reimbursed procedures like vertebroplasties, hip replacements, etc. It's only a matter of time before it all falls down.
 
bronx43 said:
Reimbursement for diagnostic caths and PCIs isn't dropping because cardiologists are doing RCTs to prove they aren't effective. It's already way beyond reasonable doubt that they are the best treatment modality for ACS. Reimbursement is dropping because cardiology is a big target for the CMS, and it was first in line of what is most likely massive cuts across the board. They started out with imaging, then moved to cardiology, because it's easy pickings. Next, they'll move onto other highly reimbursed procedures like vertebroplasties, hip replacements, etc. It's only a matter of time before it all falls down.
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In theory I agree with you but I have a high suspicion the surgical specialties will not go as easy as cardiology (we do have the medicine gene in us and by nature IM is used to getting slapped around) when CMS starts slashing reimbursement.

Regardless the argument is the same; less reimbursement will in time lead to less qualified people in all the medical fields.

The smarter college grads will decide not to spend the next decade of their life going from test to test only to end up in field that requires ever more documentation/paperworks, even long hours, ever decreasing compensation while the responsibility and threat of lawsuits (forget tort reform) is the same.

Heck go to a 2 year business school and join a private health insurance company and you can work as the physician's boss, cutting their reimbursements and limiting their options while you give yourself a bonus at the end of the year when the physicians hard work brings your company a net profit yearly.

Or if you're really a go getter join any of these so called too big to fail wall street businesses, gamble with people's life savings, give yourself 7 figure bonuses when your gamble pays off and 6 figure bonuses you muck it up and lose people's life savings and almost crash the world economy. As you can tell I'm still not over the market crash 🙄

OP
 
OptimusPrime said:
In theory I agree with you but I have a high suspicion the surgical specialties will not go as easy as cardiology (we do have the medicine gene in us and by nature IM is used to getting slapped around) when CMS starts slashing reimbursement.

Regardless the argument is the same; less reimbursement will in time lead to less qualified people in all the medical fields.

The smarter college grads will decide not to spend the next decade of their life going from test to test only to end up in field that requires ever more documentation/paperworks, even long hours, ever decreasing compensation while the responsibility and threat of lawsuits (forget tort reform) is the same.

Heck go to a 2 year business school and join a private health insurance company and you can work as the physician's boss, cutting their reimbursements and limiting their options while you give yourself a bonus at the end of the year when the physicians hard work brings your company a net profit yearly.

Or if you're really a go getter join any of these so called too big to fail wall street businesses, gamble with people's life savings, give yourself 7 figure bonuses when your gamble pays off and 6 figure bonuses you muck it up and lose people's life savings and almost crash the world economy. As you can tell I'm still not over the market crash 🙄

OP
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Yeah, I think IM will get all their money makers slashed before surgery sees any red, but there's no other end game for anyone in this business. General surgery had nothing to say or do when their procedures took huge hits throughout the 90s and 2000s only to see their surgical counterparts like ortho or ENT keep their money.

The issue with smart people going into medicine is that there is only X number of jobs paying >150k. Wall Street jobs offering high salary potentials are HARD to come by. You've got essentially no shot unless you went to a top 20 undergrad and/or have connections up the wazoo. Most people in medicine don't qualify. And even if they do qualify, they'll simply displace the people who would have gone into business (and who are also very very capable people) into medicine. It's just a game of musical chairs. In the end, you need smart people in medicine, but not the smartEST - those people usually end up at hedge funds or hard science (physics, math) academics.
 
http://ht.ly/jIFje

Navigating the "Valley of Death:" Health Care in Turmoil

The American health care system has never been at a more dramatic crossroads. As ACC President William Zoghbi, MD, puts it: "This change is mammoth, it is historic, and it affects everyone's life involved in health care."


I find the cowboys part funniest

Bottom line: can you thrive in this time of change?
Dr. Walpole cited an old African proverb: if you want to go fast, you go alone; if you want to go far, you go together. "The days of us being cowboys are over

hee - haw
 
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I hope you guys find the article to be insightful.

ACC chooses them well

And no offense to the wannabee cardiologist cowboys
 
Hospitalist from what I understand is exhausting, 7 on 7 off. How about like 4 on and the rest off, part-time equivalent.
 
nope80 said:
How about the salary of part time hospitalist vs part time cardiologist? Any input?
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In the current market, I can't imagine there is any desire for "part-time cardiologists." I'm sure there are some people in specific circumstances doing it, but I wouldn't count on being able to arrange this for yourself unless you go solo and have some other semi-magical method of covering your overhead apart from seeing patients.
 
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michaelrack said:
A cardiologist who only works 50 hours per week
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ba-dum-tss-159289.PNG
 
haha🙂....i didn't realize market was so tough and figured there was at least some room for part time (all the women that want to raise their young children etc etc)
 
nope80 said:
haha🙂....i didn't realize market was so tough and figured there was at least some room for part time (all the women that want to raise their young children etc etc)
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They call those women hospitalists.

I have 4 or so friends from residency who went in planning on Cards or GI. Then they had kids and realized they'd never get to see them again. Half are now doing primary care, the other half are hospitalists. Most of them work about 3/4 time.
 
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Impressive
We had a faculty who was certified in pulm, cc, IM and ANAESTHESIA .....
 
Hey moderators,

This thread had highest no of views, among others.

i was just wondering, what are the criteria for putting a thread in sticky section.
 
Is Josephf still around? If so, what are you doing now? Did you end up going hospitalist or did you stick with cards? If the latter, how are the offers?
 
hey Bronx

I am gonna do hospitalist, signed 7 on 7 off at 300+ near UAB
My seniors who did non invasive are getting the same.....but I do get 2nd thoughts sometime
 
Does anyone think that the hospitalist gig--as sweet as it is--won't last? I mean, what is the financial inventive to do 3 years of cards (or more) to make the same as hospitalist?
 
salk said:
hey Bronx

I am gonna do hospitalist, signed 7 on 7 off at 300+ near UAB
My seniors who did non invasive are getting the same.....but I do get 2nd thoughts sometime
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That's actually a fantastic offer. Is it 300k base or with productivity bonus? Most of the spam job postings I've been getting in my inbox are around 220k-250k base.
 
Silent Cool said:
Does anyone think that the hospitalist gig--as sweet as it is--won't last? I mean, what is the financial inventive to do 3 years of cards (or more) to make the same as hospitalist?
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I don't think it'll last - at least not these 250-300k for 7 on/7 off gigs. With the same stroke, I don't think the 350K+ jobs for cardio will last, either. As far as the incentive for cardio, it just depends on person. If they don't get enough interest, it may go the way of neurology with 1 +3.
 
bronx43 said:
I don't think it'll last - at least not these 250-300k for 7 on/7 off gigs. With the same stroke, I don't think the 350K+ jobs for cardio will last, either. As far as the incentive for cardio, it just depends on person. If they don't get enough interest, it may go the way of neurology with 1 +3.
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Isn't it all geographical nowadays? I have friends moving south starting at 450K interventional. I understand reimbursements will go down but it's going to get so bad that some places offering 450 starting will not get more than 350K max ?

With TNT being said, I ave friends starting up north at 250K for interventional.
 
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salk said:
310 base, 40k signing bonus, with productivity bonus

Why does cardiology has to suffer the doom?

GI folks are making 550k fresh off, in decent mid size areas

ACG made so much hue and cry about proposed but this didnot translate to actual change s in offer

http://d2j7fjepcxuj0a.cloudfront.ne...ummary2013ProposedMedicarePFSandOPPSRules.pdf

For Example on practice link, there are around 400 GI opening and 89 in cardiology
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Wait, 310 base with productivity bonus? WTF. Where is this hospital? How big of a town are we talking?
 
salk said:
310 base, 40k signing bonus, with productivity bonus

Why does cardiology has to suffer the doom?

GI folks are making 550k fresh off, in decent mid size areas

ACG made so much hue and cry about proposed but this didnot translate to actual change s in offer

http://d2j7fjepcxuj0a.cloudfront.ne...ummary2013ProposedMedicarePFSandOPPSRules.pdf

For Example on practice link, there are around 400 GI opening and 89 in cardiology
Click to expand...


Where the heck is GI starting off 550K....I look at all the different specialty forums and every single one has the "doom and gloom" regarding their specialty. I'm sure we'll all be fine and the 300 plus salaries will still be there.
 
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