Cardiology Fellowship Lifestyle

[Anita Shirley]

Hi, I had a question about fellowships. In order to become a cardiologist, there is normally a three year fellowship after a three year internal medicine residency, right? Can anyone help give me an idea of what lifestyle during fellowship is like? Are you still working the same hours as residents? Are you still on call/working overnight as often? I ask because I'm trying to figure out how feasible it would be to try to have a family during that time. I know there are people out there who do it, and people who don't, but if lifestyle is similar to that of a resident, it might be worth waiting, or going into a specialty that doesn't require as much training. I know I should enter the field that most interests me, but there are practical considerations and I don't want to be 35 before having my first kid (not that it's a bad thing, but I, personally, don't want to wait that long)

Thanks so much!

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[k96tw01]

lots of variability on the call setups of the different cardiology programs. Generally you should anticipate the hours being similar to residency if not longer. Call tends to be more home call but you will probably be busy. Some programs (like ours) have gone to in-house night float rotations at one of the hospitals but we cover a total of 3 hospitals... we also front load our call over the 3 year fellowship so 1st years take the bulk and you end up with only about 15 calls as a 3rd year. Obviously the total number of general cardiology fellows greatly effect scheduling as well (we have 18).

...basically, as many permutations of call scheduling that you can think up are probably what exist out there with tremendous variation from institution to institution.

That being said... in my 3 years we had two female fellows each go through a pregnancy/maternity leave... as always, the program will adapt and the calls will still get covered.

 

[Anita Shirley]

Thanks for your help! The part about it being frontloaded is what I've heard from some other people too. If a fellow did want to have kids during years 2/3, do most fellowship programs have formal maternity leave, etc built in?

 

[nope80]

bump

 

[ProgCoordinator]

Thanks for your help! The part about it being frontloaded is what I've heard from some other people too. If a fellow did want to have kids during years 2/3, do most fellowship programs have formal maternity leave, etc built in?

Usually it will be possible to take maternity leave without having to extend your training. By utilizing research weeks/months plus elective weeks/months you should be okay. The key will be to make sure your core rotations are complete (or can be completed) along with your maternity leave within the three years of training.

You can combine all of a year's allotted vacation and sick days for 100% salary. That should give you 5-6 weeks. Then you can typically take up to six more weeks at 80%.

 

[dragonfly99]

I found the hours to be substantially better in fellowship versus residency.
the hours in both residency and fellowship can vary a lot from program to program (especially internal med residency, which varies a lot in intensity from place to place).
I know women who took maternity leave during cardiology fellowship - in general they mostly went to fellowships that had more than 3 fellows/year...the smaller programs it might be more of a drain for one person to be out. I don't know of any program that would prohibit you from taking maternity leave. Pretty much all the big university hospitals have maternity leave policies. Especially for med school and medicine residency, there are so many students and/or residents at most places, it is not that big a deal for one person to be gone for a couple of months. But it could be a hardship in fellowship...some cardiology places only have 3 ppl/year for a 3 years fellowship, so one person being gone could muck up the call schedule for everyone else, potentially.

 

[macintoshblade]

I found the hours to be substantially better in fellowship versus residency...

100% true. Cardiology fellowship lifestyle is much better, than in IM residency.

 

[joejabjab]

For my fellowship, our toughest months (CCU) can be very demanding; to me, similar to some of the tough ones from residency. That said, there are a lot fewer tough months in fellowship.

 

[nope80]

really? that is very interesting because I always thought fellowship would be a 100x harder. I bet its really program specific. For one, I always see the fellows in the hospital rounding late. And they take such frequent call and when they do they can be in the hospital for 24+hrs at a time. We only do that once a month in our IM residency on floors.
What is the average number of fellows per yr for fellowship programs? Where I am a resident, its a smaller program, about 3 fellows per yr.

 

[CanIMakeIt]

really? that is very interesting because I always thought fellowship would be a 100x harder. I bet its really program specific. For one, I always see the fellows in the hospital rounding late. And they take such frequent call and when they do they can be in the hospital for 24+hrs at a time. We only do that once a month in our IM residency on floors.
What is the average number of fellows per yr for fellowship programs? Where I am a resident, its a smaller program, about 3 fellows per yr.

Average is about 3-5/yr. Largest program CCF had 13, a few others have between 7-10/yr but average programs have 3-5/yr.

 

[joejabjab]

For me, fellowship has on occasion been more stressful, but less total hours in-house when compared to intern year (my program had Q4 in house 30-hour calls). Call for fellowship has presented some higher stress situations (bigger decision making), than residency, but call months during residency can be equally as busy. During fellowship, some calls are terrifically busy (sometimes over 30 hours in house), some are pretty light (since we take home call).

Hope that sheds a little light on the question.

really? that is very interesting because I always thought fellowship would be a 100x harder. I bet its really program specific. For one, I always see the fellows in the hospital rounding late. And they take such frequent call and when they do they can be in the hospital for 24+hrs at a time. We only do that once a month in our IM residency on floors.
What is the average number of fellows per yr for fellowship programs? Where I am a resident, its a smaller program, about 3 fellows per yr.

 

[Anita Shirley]

At the not so small programs (i.e., 5-7 fellows/year), how often do you typically do weekend call? Is most weekend/overnight call from home? I'm sure it varies by program, but any input is appreciated! Also, I'm assuming you get a few weeks of vacation during your clinical years, but otherwise, are pretty much the majority of all rotations inpatient? What is the outpatient:inpatient time like? During your one year of research, are you also expected to do call such that your hours are not really better than they were during the first two years?

Thanks so much!

 

[whodatMD]

To answer your question, many programs are fairly front-loaded. At my program (6 fellows per year) 1st years do all weekend call (1-2 per month) and we split the weekday call. Other programs have night float, but keep in mind this will be nothing like the vast majority of practices. Overall, most moderate sized places have fellows taking call 2-4 times a month.

Most rotations are inpatient, but as with internal medicine, you will have a clinic assigned weekly per ACGME guidelines (and so you can be an extra hand for the attendings in clinic)

Keep in mind this is Cardiology, not Rheum or Allergy. Most places I interviewed, you are working 10-13 hour days many of the time, which isn't too far off real practice, FYI. It's never been considered a "lifestyle" field for a reason, so expect middle of the night calls for the rest of your career, but it's very rewarding and easily the most interesting field in the medical field.

 

[Anita Shirley]

Thanks for your input! Your're right, it seems like an incredibly rewarding and interesting field and I know it's not a "lifestyle" field, and 10-13 hour days during fellowship does not seem awful if its what you have to go through to get where you need to be and get the training you need; but 13 hours/day as an attending + weekends would be tough if you wanted time for other things.

Overall though, do you think it's better than intern year/inpatient months during R2/R3 years of internal med? There seem to be mixed opinions on this thread. It seems like the fellows at my school are always running around and are super busy. It would be hard to be working as hard as an intern when you're in your 30s.

 

[whodatMD]

As for cardiology fellowship, at least where I train, the days or just as long if not longer than as an intern, (7a-5-7p most days), but you have more full weekends off. The work is a lot better though since you aren't just an IM "grunt" doing notes all the time. You'll be doing caths, echo, nuclear, consults, EP, CCU rotations as well as just a sprinkling of plane old hospital floor work. It was significantly more rewarding.

Probably more importantly, however, is what is like AFTER training. There is a saying in cardiology that "call is forever" meaning that almost all jobs will have call responsibilities. But unlike other fields, you're call will be busier given the nature of cardiology. And while you'll hear people talk taking a job without call and getting paid less, realistically there are few jobs without call simply because no one likes it, so they aren't going to bring someone on who isn't willing to take their share.

The days will definitely be 10-13 or longer (i.e. 7a to 5-7+) hours many days in practice since you will be doing much more than JUST covering clinic or rounding on patients. If you do something like interventional cardiology, then expect a much heavier call burden and later nights, usually somewhere from q3 to q7 depending on the group. I'm not trying to scare anyone, but let's be realistic.

All that being said, there are a few other things to consider regarding this.
1) most all specialist jobs in medicine require some form of call
2) the work is much more rewarding than just being a Hospitalist H&P/discharge summary jocky (hence why despite the good pay and ample time off, hospitalists have a 23% satisfaction rate)
3) cardiology is really the only field where you really cover the entire scope of practice (procedures, imaging, clinic, consults, CCU)
4) dealing with the heart is very rewarding since you are dealing with a very serious and complex organ system - no one gets super excited when their joint starts flairing again afterall
5) You will be well compensated for your work and dedication - remember the old saying "ya gotta pay to play"

Hopefully this helps put things into perspective

 

[Anita Shirley]

Thanks so much for your helpful and detailed reply, I really appreciate it! That's a really good point you make about the work being more satisfying and that even though you're working as long as interns, it's not all scut work. It's hard to get an appreciation of that as a med student because all you see is the scut work, so it's not something you think about.

This may be a dumb question, but what do you mean, even as an attending "you will be doing much more than JUST covering clinic or rounding on patients?" Aren't you pretty much in clinic or (if you're on call or on service for a week), rounding on patients in the hospital? By much more, do you mean coming in for emergent procedures if you're an interventional cardiologist? Even if your call is busy, unless there is an emergent procedure, my understanding was you could do it from home for a good portion of the time (read EKGs from home, etc)? Lastly, if you are working 12 hour days as an attending, what are your thoughts on whether cardiology is a field that is receptive to people working part time (like 4 days a week)? I've heard mixed things and since it tends to be a male-dominated field, I wonder if working part time is actually something that people do

Thanks again!

 

[whodatMD]

To answer your questions, in private practice (and even in the large academic center where I am training) cardiologists have multiple responsibilities. You see patients in clinic, see consults interpret ECGs/stress tests/echos, and round on your patients. Depending on your specialty, you'll also be being procedures (pacemaker placements, interventional procedures, TEEs).

It sounds like you may need a little more experience in the medical field if you think cardiac issues don't require middle of the night evaluation. Anytime there is an abnormal ECG, some weird arrhythmia on the telemetry, abnormal troponin as well as legitimately sick patients with life-threatening arrhythmias, heart attacks, severely decompensated heart failure, symptomatic bradycardia all lead to cardiac evaluation. Since post docs aren't that comfortable with cardiac issues, you'll have to see patients in the middle of the night from time to time.

Regarding cardiology as part-time gig, I'm sure there are some out there, but expect to make a fair amount of less money in the process.

It sounds like you are still early in your training. I hate to break this to you... the medical field in general requires a fair amount of personal sacrifice regardless of the field. Even "cush" jobs like radiology, optho, and anesthesia aren't 9-5 jobs with no weekend or holiday call. Cardiology is a little more demanding career (and why we are among the top paid physicians) because there are many potentially life-threatening emergencies and most other physicians don't understand the field very well, which keeps us busy.