Cardiology attending AMA

[Instatewaiter]

I've been putting this off for years but I guess it's time to do one of these.

As the thread name implies, I'm an attending cardiologist (and my job is awesome). I'm a handful of year out from fellowship.

If you have questions ask away...

---

Members don't see this ad.

 

[trashacct01]

Hi. Thanks for doing this. I just have a couple simple questions:

1. What type of work setting are you currently in? Hows the job market?
2. Whats your typical and non-typical work schedule like (days, hours, times)?

 

[Kardio]

I've been putting this off for years but I guess it's time to do one of these.

As the thread name implies, I'm an attending cardiologist (and my job is awesome). I'm a handful of year out from fellowship.

If you have questions ask away...

Only if they could?

 

[SoUpsetICreatedAnAccount]

Are you happy with your career choice?
Do you work in an Academic setting?

 

[Planes2Doc]

What made you interested in cardiology?

 

[Frogger27]

Do you think that 2 years is necessary for EP fellowship?? From my understanding it used to be 1 year but was recently expanded to 2 years.

Do they get compensated well for this? PGY8 is a lot of post grad training

 

[Instatewaiter]

Hi. Thanks for doing this. I just have a couple simple questions:

1. What type of work setting are you currently in? Hows the job market?
2. Whats your typical and non-typical work schedule like (days, hours, times)?

Hospital owned practice. Job market is wonderful. I have had multiple job offers in the area without looking for a new job.

Schedule depends on the day. I work in blocks between inpatient and outpatient. This is nice because I have less to juggle.

Inpatient times work 10-12 hours per day 5 days a week

Outpatient time I work 4 days a week 6-7 hours per day

In addition I take call every 9th day (on average) which also means I work ~5 weekends a year. All said and done, this is a probably a lighter schedule for a cardiologist. I know many work 12 hour days 5-6 days per week.

 

[4thtimeretaker]

Were you able to moonlight any during residency or fellowship?

 

[Instatewaiter]

What could a DO student do to get into a Cards, and eventually EP, fellowship?

Sure.

For IM fellowships, where you do residency matters a lot. Therefore get into the best residency. This is one way DOs can struggle- IM is often harder to match at the top IM residencies as a DO.

However, once you're in a fellowship, getting into EP is easy.

 

[Instatewaiter]

Are you happy with your career choice?
Do you work in an Academic setting?

Very happy. I made the right choice. My schedule is great, my work is very interesting and I'm by no means struggling financially. Almost everyday I go to work, I save a life. Unlike some other specialties where you never know if you make a difference, it is blindingly obvious for me. I also attend in the CCU so people aren't exactly having a good day when they see me. So, I can make it a lot better.

I do not work at a university but I work where there are residencies/ fellowships linked with university. It is semiacademic. I came from a few big name academic programs before this so I made a conscious decision to leave true academics. Truthfully the pay is 2-3x outside of academics so unless you are gung ho for research, it doesn't really make sense to stay.

 

[I'mJustCurious]

What are some routine/habits that you developed during medical school that allow you to match into a competitive specialty?

 

[Instatewaiter]

What made you interested in cardiology?

In order:

Best physiology
Can actually improve quality and quantity of life
Most data of any specialty
Most actively changing
Allows you to have longitudinal relationships w patients
Broad specialty- can be like surgery or primary care based upon the super specialty within carda
Good pay
Good job market
Reasonable prestige

 

[RocuROMANium]

What are you typically doing during your inpatient days? What is the most interesting part of your job?

 

[trashacct01]

Hospital owned practice. Job market is wonderful. I have had multiple job offers in the area without looking for a new job.

Schedule depends on the day. I work in blocks between inpatient and outpatient. This is nice because I have less to juggle.

Inpatient times work 10-12 hours per day 5 days a week

Outpatient time I work 4 days a week 6-7 hours per day

In addition I take call every 9th day (on average) which also means I work ~5 weekends a year. All said and done, this is a probably a lighter schedule for a cardiologist. I know many work 12 hour days 5-6 days per week.

Do you have a spouse? Kids? If so, how do they fee about your hours? I'm very interested in cardiology but I don't see that schedule being very family friendly.

 

[Instatewaiter]

Do you think that 2 years is necessary for EP fellowship?? From my understanding it used to be 1 year but was recently expanded to 2 years.

Do they get compensated well for this? PGY8 is a lot of post grad training

I think 2 years is needed. Beyond devices( pacemakers, defibrillators), if you want good training for ablations, you need more than a year. There is more they do as well with watchman etc.

They get paid well. In academics 250-350k. In private practice 350-900k +. Of the cardiology specialties, they ate one of the best paid.

For reference cardiology can be broken up by specialty:
General cards- 3 years after IM
Prevention-1 yr after gen cards
Imaging - ie MRI/CT/advanced echo 1--2 years aftrer general
Advanced heart failure/ transplant/mechanical support- 1 yr after general
Electrophysiology (EP)-1-2 yrs after gen
Interventional 1-2 years after general

 

[Instatewaiter]

Were you able to moonlight any during residency or fellowship?

Where I did residency I couldn't moonlight. It was a well-known residency which had previously been in trouble for duty hour violations. So, they didn't let us moonlight (moonlighting counts for duty hours). Honestly this was kinda nice bc as a resident it would have been tough.

In fellowship we had built in moonlighting. I more than doubled (almost tripled) my salary by moonlighting my last few years of fellowship.

 

[deleted965528]

I came from a few big name academic programs before this so I made a conscious decision to leave true academics.

Truthfully the pay is 2-3x outside of academics so unless you are gung ho for research, it doesn't really make sense to stay.

Did you also go to a big name med school? Do you think the big name helped you land a comfortable job?

What about someone interested in teaching and mentoring? Would academia be recommended or nah?

 

[4thtimeretaker]

Where I did residency I couldn't moonlight. It was a well-known residency which had previously been in trouble for duty hour violations. So, they didn't let us moonlight (moonlighting counts for duty hours). Honestly this was kinda nice bc as a resident it would have been tough.

In fellowship we had built in moonlighting. I more than doubled (almost tripled) my salary by moonlighting my last few years of fellowship.

Thank you so much for this, so when you did moonlight in your fellowship years, how many hours a week did you find your self working in total?

 

[Instatewaiter]

What are some routine/habits that you developed during medical school that allow you to match into a competitive specialty?

I skipped class.

My school was nice in that it has a syllabus with all the info you need and lectures were recorded. I am not an auditory learner so class was useless. Instead I Stayed home and read/studied the syllabus. So the take home lesson is know your learning style and play to your strengths.

Obviously this wouldn't have worked well at another school.

I treated school like a job- work all day, even if I wasnt at class.

 

[Instatewaiter]

What are you typically doing during your inpatient days? What is the most interesting part of your job?

So I do heart failure/transplant. That means I tend to see the ICU patients. This is also why I am one of the CCU attendings.

My inpatient days start in the ICU. I arrive around 630am and get to work stabilizing the disasters from overnight. I make the decisions and have my cadre of residents/NPs follow out the orders in the am. This may involve a few urgent procedures but my day is minimally procedural. Once the ICU is stabilized I get to work on the consults on the regular nursing floor. Most of these are heart failure related (ie they have heart failure, a Transplant or LVAD( permanent artificial heart pump).

I come back a few times a day to check in on the icu. I do all TEEs (procedure with an echo down the throat) inthe ICU and central lines/temp wires in the ICU.

I am usually done between 5-7 (usually closer to 530, rarely 7 or later)

Most interesting part: the sick patients. Not everyone likes really sick patients but that is what interests me. I like the crashing patient do or die type of situation. I can tell you that wasn't the case when I started training but where I trainedwas high acuity and a lot of ICU work. It got me very interested in it.

 

[Instatewaiter]

1) Is the bulk of your work doing stents and angioplasties? An overly pessimistic cardiologist once told me he does the same thing every single day

2) What time in the morning do most cardiologists begin working (inpatient / cath lab)? 6AM, 7AM, 8AM?

edit: I see you answered some of these points in later replies

I am not an interventionalist. I can do caths but my current job doesn't really require it.

My day is varied. As I alluded to above, cards can be anything you want. The Cath jockeys do the same thing all day (and most love it). I went into fellowship thinking I'd do Cath but changed my mind. I am so someone who really likes variety so I chose something that leads to much more variety.

I start work at 630am. Many of my colleagues start at 7. Rarely do cardiologists start after 8. This may seem early but it doesn't to me Anymore (and I hate the mornings).

 

[Instatewaiter]

Do you have a spouse? Kids? If so, how do they fee about your hours? I'm very interested in cardiology but I don't see that schedule being very family friendly.

Yup- wife and a cadre of kids.

My hours aren't that bad, truthfully. Anything you're going to do that is high powered is also going to have long hours- banking/finance/business/law. It's no different in medicine. Cardiology often has longer hours than some other med specialties but not always. My inpatient time is busy but my oupatient time is cush. It balances out.

Some of the girls I dated before my wife couldn't deal with the hours. My wife is also a professional (nonmed) so she gets it. I recommend you find someone who doesn't suck and who can understand the schedule bc no matter what specialty you do, at times you will have long hours...

The hours have been fine and mine are better than many other professional jobs. If you're expecting to be home at 4pm everyday, expect to be either unemployed or a teacher.

 

[I'mJustCurious]

Yup- wife and a cadre of kids.

My hours aren't that bad, truthfully. Anything you're going to do that is high powered is also going to have long hours- banking/finance/business/law. It's no different in medicine. Cardiology often has longer hours than some other med specialties but not always. My inpatient time is busy but my oupatient time is cush. It balances out.

Some of the girls I dated before my wife couldn't deal with the hours. My wife is also a professional (nonmed) so she gets it. Fine someone who doesn't suck...

The hours have been fine and mine are better than many other professional jobs. If you're expecting to be home at 4pm everyday, expect to be either unemployed or a teacher.

Noted.

 

[Instatewaiter]

Did you also go to a big name med school? Do you think the big name helped you land a comfortable job?

What about someone interested in teaching and mentoring? Would academia be recommended or nah?

I went to a state school. I did match to top tier residency and fellowship. That helped land a good job.

I teach and am not at a true academics place. My job is a little on the rare sielde. But you're right a teaching career is easier at an academic program. The pay just sucks...

 

[Planes2Doc]

In order:

Best physiology
Can actually improve quality and quantity of life
Most data of any specialty
Most actively changing
Allows you to have longitudinal relationships w patients
Broad specialty- can be like surgery or primary care based upon the super specialty within carda
Good pay
Good job market
Reasonable prestige

Those are some great points! I'm really glad you found a specialty that you're so passionate about!

 

[Instatewaiter]

Thank you so much for this, so when you did moonlight in your fellowship years, how many hours a week did you find your self working in total?

I added 40-60 hours per month on top of fellowship . In Total probably 70 hours/week ( would have been 50-60 hours w/o moonlighting). It was totally manageable. Now, I spent 3 years in residency at the 80 hourmark so even with moonlighting it was easier in fellowship.

As an aside, everyone bitches about the hours in training. And yes they can suck but you rapidly get used to them.

 

[PA_dud3]

Do you ever work with any Nephrologists? What is the relationship in general between your work and other Physicians? (Sorry if this has been asked similarly.)

 

[Instatewaiter]

Do you ever work with any Nephrologists? What is the relationship in general between your work and other Physicians? (Sorry if this has been asked similarly.)

Of course.

The sicker patients tend to have other organ systems that are dysfunctional. So I work closely with nephrologists, pulmonologist and neurologists most commonly. For the most part, the other docs tend to defer to the cardiologist.

Nephro has pros and cons. The physiology is very interesting. Unfortunately that isn't really what you do day in and out. Instead much of your day is writing dialysis orders. I think if the day to day work was like the physiology, it would be a popular specialty. Currently, it is not competitive.

 

[DrStephenStrange]

I've been very interested in Cards since undergrad as most of the doctors I have shadowed were Cardiologists or Cardiothoracic surgeons, but I'm also attending a DO school, which means it's gonna be hard for me to land top IM residencies. So what does it take really to land a good IM residency program especially as a DO? From what I've heard from others, you need to land an IM residency program that already have Cards fellowship in-house, was that the case for you? And do you think it would help when trying to get a cardiology fellowship? (Edit: how much does it help really if it does?) Lastly, assuming you're an MD, did you have any DOs in the residency and fellowship programs you were in?

 

[Frogger27]

Did you go into IM knowing you wanted to do cardiology? If not cards, what else could you see yourself being happy in and why?

 

[Instatewaiter]

I've been very interested in Cards since undergrad as most of the doctors I have shadowed were Cardiologists or Cardiothoracic surgeons, but I'm also attending a DO school, which means it's gonna be hard for me to land top IM residencies. So what does it take really to land a good IM residency program especially as a DO? From what I've heard from others, you need to land an IM residency program that already have Cards fellowship in-house, was that the case for you? And do you think it would help when trying to get a cardiology fellowship? (Edit: how much does it help really if it does?) Lastly, assuming you're an MD, did you have any DOs in the residency and fellowship programs you were in?

To land a good residency it takes strong board scores, a very strong performance on the wards, good LORs often with someone making calls for you. For the top tier programs research is a must. For mid tier university programs, research is something you should very strongly consider. Finally your interview is important. Don't be a serial killer...

Having a cardiolgoy fellowship in house is something you should look for, especially if you're going to a community IM program. This helps bc your likelihood of matching to cards coming from a community program is poor unless you can get a fellowship in house. It also means the residency is stronger.

The place I did my residency didn't traditionally interview DOs for their medicine program so there weren't any. We sent half the class into cardiology. This was bc the cards faculty we're interested in teaching. My fellowship had no DOs in it but had taken a few in the past.

 

[Instatewaiter]

Did you go into IM knowing you wanted to do cardiology? If not cards, what else could you see yourself being happy in and why?

I went into medicine with an open mind. I knid of had a top 3 options going in- pulm critical care, GI or Cards but I want gung ho for all or any of those.

I was open to any specialty probably except allergy- nothing against it but I really never like immunology so knew it wasn't going to be a good fit.

Currently I could be happy in pulm or heme onc. Not sure I'd really want to do GI for a multitude of reasons.

 

[Frogger27]

I went into medicine with an open mind. I knid of had a top 3 options going in- pulm critical care, GI or Cards but I want gung ho for all or any of those.

I was open to any specialty probably except allergy- nothing against it but I really never like immunology so knew it wasn't going to be a good fit.

Currently I could be happy in pulm or heme onc. Not sure I'd really want to do GI for a multitude of reasons.

I don't want to divert this too far away from Cardiology, but do you mind elaborating on this?

I only ask because a lot of students who have the procedural mindset tend to think of doing either cards/GI and I would be interested to hear on what made the difference for you

 

[nlax30]

Do you think that 2 years is necessary for EP fellowship?? From my understanding it used to be 1 year but was recently expanded to 2 years.

Do they get compensated well for this? PGY8 is a lot of post grad training

Instatewaiter addressed this above and I agree with what was said.

IMHO 2 years definitely needed for EP. The field while relatively young is advancing rapidly and for most general cardiology fellows has a pretty steep learning curve. At times it feels like a different language all together. In the past yea it was 1 year though most of those folks spent a good chunk of their general fellowship focused on EP. Currently at a lot of places I don't think there is a much dedicated EP exposure unless you have a motivated fellow seeking it out.

In general EP compensation is pretty good and on par with Interventional. Obviously will vary based on the practice structure but it's obviously very procedural orientated so can be very productive from a RVU standpoint if you are busy. If you are a very busy private practice or employed EP generating 20,000 RVUs a year (not unheard of though I wouldn't want that lifestyle) and getting $50 an RVU then that's $1mil/year.

8 years post grad training is a LOT, trust me. It's still a great field with a pretty wide variety of procedures and ability to acutely help and even cure certain diseases with a single procedure.

 

[Instatewaiter]

I don't want to divert this too far away from Cardiology, but do you mind elaborating on this?

I only ask because a lot of students who have the procedural mindset tend to think of doing either cards/GI and I would be interested to hear on what made the difference for you

Yeah- so the group of patients seen by GI are rather different than other groups of patients- you get the liver patients who are either predominantly alcoholism can or drug users (hep c) or have PSC and are usually super nice and are going to die... the chronic abdominal pain patients who are a hastle to deal with and ibd and colon cancer aren't exactly fun to deal with either. GI bleeding isn't my cup of tea and chronic diarrhea is ****ty... Pun intended.

The major procedures arent super fun as you're either gagging people or shoving a tube up their ass. The physiology isn't exactly fun either

 

[Frogger27]

Instatewaiter addressed this above and I agree with what was said.

IMHO 2 years definitely needed for EP. The field while relatively young is advancing rapidly and for most general cardiology fellows has a pretty steep learning curve. At times it feels like a different language all together. In the past yea it was 1 year though most of those folks spent a good chunk of their general fellowship focused on EP. Currently at a lot of places I don't think there is a much dedicated EP exposure unless you have a motivated fellow seeking it out.

In general EP compensation is pretty good and on par with Interventional. Obviously will vary based on the practice structure but it's obviously very procedural orientated so can be very productive from a RVU standpoint if you are busy. If you are a very busy private practice or employed EP generating 20,000 RVUs a year (not unheard of though I wouldn't want that lifestyle) and getting $50 an RVU then that's $1mil/year.

8 years post grad training is a LOT, trust me. It's still a great field with a pretty wide variety of procedures and ability to acutely help and even cure certain diseases with a single procedure.

Thanks for jumping in and answering my Q. I saw on the cardiology board that you were an EP and actually had thought previously about messaging you some specific questions.

I just finished M2 and during my board prep I was up one night studying arrhythmias. Stumbled upon some Youtube videos of some ablation and other EP procedures and thought they were the coolest thing ever. I really did not know much about EP and kind of thought that all cardiology procedures were done by the interventional trained folks. I'm starting on IM in the fall and get to rotate with cardiology for two weeks, so I am planning on asking if I can spend a day/two working with EP trained cardiologists.

Seems like it is an awesome field (now just to figure out if it is 8 years of training awesome 😉)

 

[nlax30]

Yea 8 years is a long time. A lot of us feel that while EP should be 2 years they could easily take a year off if Internal Med and/or General Cards. Just not sure when something like that would happen...and likely not in time for it to matter to you.

 

[Frogger27]

Yea 8 years is a long time. A lot of us feel that while EP should be 2 years they could easily take a year off if Internal Med and/or General Cards. Just not sure when something like that would happen...and likely not in time for it to matter to you.

Yeah it would be nice if there was a direct pathway after PGY2 or possibly after PGY4 where they had an integrative path and condense the training, but Lord knows how long this stuff takes to happen

 

[notretired]

Sure.

For IM fellowships, where you do residency matters a lot. Therefore get into the best residency. This is one way DOs can struggle- IM is often harder to match at the top IM residencies as a DO.

However, once you're in a fellowship, getting into EP is easy.

How do you think this plays out for USMD's? For example would I be doing myself a disservice by going to a low ranked state school vs. a mid-tier private if my ultimate goal was to go into cards? I chose to go to med school with the intention of going into cards; probably a bit unusual but I am almost thirty and have worked in a tertiary role in cards for almost five years. I would like to minimize debt if possible, but if this will lead to an uphill battle then I would readjust accordingly.

 

[Instatewaiter]

How do you think this plays out for USMD's? For example would I be doing myself a disservice by going to a low ranked state school vs. a mid-tier private if my ultimate goal was to go into cards? I chose to go to med school with the intention of going into cards; probably a bit unusual but I am almost thirty and have worked in a tertiary role in cards for almost five years. I would like to minimize debt if possible, but if this will lead to an uphill battle then I would readjust accordingly.

Well I went to an unranked state school and matched to one of the big 4 IM programs. 2 people from my med school also matched to the same program this year... So, no, as long as it is a US MD school, you will have the ability to match well. Now, realize that the guy from Harvard is also more likely to have some leeway to match into Hopkin's IM program than you.

Also paradoxically some of the more expensive schools will be less after grants/scholarships etc so wait until financial aid is decided before assuming something is more expensive.