You make some valid points. And, of course your rationale for how a specialty becomes lost like CTS is true, just generally speaking.
Obviously none of us know the future of cards. But, we do know that medicine has and is continuing to evolve into as minimally invasive as possible. So, first off, if there's no PCI (which I don't think will happen), there will be other things that people will learn how to fix by interventional techniques. I'm returning from a year off at a high powered research place, and the guys here are trying to pubish a new method they have established to fix mitral regurg. Aortic valve replacements are already being done by interventionalists (obviously not as bread and butter as PCI). So, things come and go, but I don't think you can say that cards will be like CTS, because if a minimally invasive procedure comes out, it's the cards guys that are gonna be doing it.
Also, in terms of PCI, there is no way that it is going to be lost in the relative near future. First off, in private practice, patients dictate their care (for those of you that don't know). Patients demand what they want done if they are given options. Secondly, the study that everyone talks about stents not being as effective is the Courage trial, as we all know. In real life those type of patients rarely exist. The average joe does not have the most optimal BP, cholesterol, sugar, etc. that he can choose medical rx as the option vs. PCI. Additionally, living in a technologically and media driven society, people want the "best" therapy out there. If you give the averae joe the option to put a stent vs. meds, they are more than likely to choose a stent, unless of course there are new complications and events we come to find out. Medical therapy, as shown in these studies, is not practical for most Americans. People want something "done" usually.
On another note, I was talking to a really successful cards guy the other day over dinner (a friend's dad), and he was telling me about all these new bio-degradable stents that are now coming out (i don't know much about them). So, bottom line is, technology and biotechnology companies are always striving for better and better for, obviously, economically driven purposes. And, new things will come out if DES are known to be a problem. Just medical therapy is hardly ever going to become the treatment of choice, because it's not practical and effective for most Americans. And, bottom line is, when there is an option, your patient dictates their care.
Yes, you should always do something you're interested in. But, I just wanted to shine some light into this increasingly heated debate about stents since the Courage trial has been published.
Also, sorry to hear about your dad, but YOU dictate how much you want to work and how supportive your spouse is. You don't have to work 80 hours if u want to make 3-400k, but if u want to make a million, yes u do. Other specialties usually don't have the sky as a limit, and that's why cards, I think, gets labeled as a ridonculously difficult lifestyle. Most people fail to mention, at the expense of....$$$$. Work 50 hrs a week and make 300K and see your kids. Also, I think the spouse situation is very dependent on the person and the culture. If you have a strong, supporting spouse, and understands that working 80 hrs/wk the first 7-10 years of your career is acceptable, so you can live comfortably down the road and work less later, it shouldn't be a problem. The marriage thing is way too relative and quite dependent from person to person. I think where most people get into trouble is the greed factor and the stress from working ridiculous hours that carries into the family dynamics. Obviously we should be sensible enough to draw the line somewhere. Again, just my humble opinion.
