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Yikes. I meant rad onc, not once. 
Cardiology or Ophthalmology
- Thread starter Chalazion12
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Absolutely well written!!
I have an interest in cards too, am just afraid the hefty lifestyle may weigh me down. Luckily I still have plenty of time to figure that out because I am a rising MSII.
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A couple of points in support of what others have said re:cards.
My father practices in the largest cardiology group in my city and I have been in and around cardiology my entire life. It's a fallacy to believe that you will have complete control over how "hard" you will have to work, particularly when starting in the field. The realities of working in a group practice will never allow one to unilaterally dictate their level of involvement and the number of hours they put in. This has been stated here before and I think it's worth emphasizing. Don't choose cardiology based on the notion that you can simply work half as much for half the pay. Your partners/employers simply won't stand for it.
That said, if one enters a large enough group practice, the hours can be livable. This is particularly true if you live in the boonies. For instance, I know an interventionalist who started in rural GA with a salary of 700k and relatively liberal off days.
As much as the hours, though, is the fact that you will be managing very sick patients - this has to be a draw for you. If you are not comfortable living with the stress of managing sometimes unstable patients with 90 min DBT, then cards is not for you. The differences between Optho an Cards in this regard is significant. I like to sleep at night and I've come to realize that the inherent stress of Cardiology would prove to become a burden as I grew older. YMMV.
As far as money is concerned, cards is THE most secure among IM subspecialities. The wealth of tech and procedures involved assure that. Even if PCI were to bite the dust (doubtful), you still have tons of imaging modalities and EP to fall back on. Money will never be a problem for cardiologists, relatively speaking.
My father practices in the largest cardiology group in my city and I have been in and around cardiology my entire life. It's a fallacy to believe that you will have complete control over how "hard" you will have to work, particularly when starting in the field. The realities of working in a group practice will never allow one to unilaterally dictate their level of involvement and the number of hours they put in. This has been stated here before and I think it's worth emphasizing. Don't choose cardiology based on the notion that you can simply work half as much for half the pay. Your partners/employers simply won't stand for it.
That said, if one enters a large enough group practice, the hours can be livable. This is particularly true if you live in the boonies. For instance, I know an interventionalist who started in rural GA with a salary of 700k and relatively liberal off days.
As much as the hours, though, is the fact that you will be managing very sick patients - this has to be a draw for you. If you are not comfortable living with the stress of managing sometimes unstable patients with 90 min DBT, then cards is not for you. The differences between Optho an Cards in this regard is significant. I like to sleep at night and I've come to realize that the inherent stress of Cardiology would prove to become a burden as I grew older. YMMV.
As far as money is concerned, cards is THE most secure among IM subspecialities. The wealth of tech and procedures involved assure that. Even if PCI were to bite the dust (doubtful), you still have tons of imaging modalities and EP to fall back on. Money will never be a problem for cardiologists, relatively speaking.
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Hey sorry to dig this up but not only do I find myself torn between the same bizarre dichotomy of career choices (I'm a MSIV who is taking a year off) as the original OP of this article but I am also curious about some of the issues that were brought up by different people in the replies in the thread and wonder if things have changed since some of these things were written.
One of the most important things to me was the debate people had about whether it is possible to practice cardiology in such a way that you can work less while making less. I would be mostly interested in non-interventional cardiology or EP, as I understand its almost impossible to have decent hours as an interventionalist.
So I've heard and read different things. Some people say if you find a private practice with many partners and practice non-interventional cardiology then its possible. I've also heard that if you focus mainly on reading echos, stress tests, and maybe doing one or two days of clinic a week then it is also possible to have decently controllable work hours. I mean working 50-60 hours with only sporadic weekend/night call to me would be considered a decent work schedule. However I've also read that its hard to find private practices that would let especially junior members start out by working less and earning less. Some people have also written or told me that actually academic faculty have more manageable lifestyles given that they have more teaching responsibilities/ they don't have to stress about seeing a certain number of patients for business reasons.
I understand this is sort of an annoying topic for some cardiologists; I've been told that if you are thinking about lifestyle concerns then you shouldn't even think about doing cardiology: only do it if you love it. I mean I really enjoy the material of cardiology and I understand that doctors have to make sacrifices. However the stories I hear about cardiologists who never show up to their kids' games, who are divorced multiple times, and who basically have no life outside their practice makes it seem like it's such an unfair price to pay to be a cardiologist. I would appreciate any further input people have about this issue. I would especially love to hear input from private cardiologists.
One of the most important things to me was the debate people had about whether it is possible to practice cardiology in such a way that you can work less while making less. I would be mostly interested in non-interventional cardiology or EP, as I understand its almost impossible to have decent hours as an interventionalist.
So I've heard and read different things. Some people say if you find a private practice with many partners and practice non-interventional cardiology then its possible. I've also heard that if you focus mainly on reading echos, stress tests, and maybe doing one or two days of clinic a week then it is also possible to have decently controllable work hours. I mean working 50-60 hours with only sporadic weekend/night call to me would be considered a decent work schedule. However I've also read that its hard to find private practices that would let especially junior members start out by working less and earning less. Some people have also written or told me that actually academic faculty have more manageable lifestyles given that they have more teaching responsibilities/ they don't have to stress about seeing a certain number of patients for business reasons.
I understand this is sort of an annoying topic for some cardiologists; I've been told that if you are thinking about lifestyle concerns then you shouldn't even think about doing cardiology: only do it if you love it. I mean I really enjoy the material of cardiology and I understand that doctors have to make sacrifices. However the stories I hear about cardiologists who never show up to their kids' games, who are divorced multiple times, and who basically have no life outside their practice makes it seem like it's such an unfair price to pay to be a cardiologist. I would appreciate any further input people have about this issue. I would especially love to hear input from private cardiologists.
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bump
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bump -- these concerns are relevant to me too. Can a cardiologist work ~60 hrs/week? Is this possible in academics, private practice, or both?
why would you be worried bout divorces? as a cardiologist you should be having multiple honey's on the side and no wife. Being at home? you should be at the club/hotels pickin up 20 year old chiks! Kids? Cap that mess, you don't wanna be paying child support and denting your exotic car funds.
Harharaharhar, just kidding for all the altruistic types out there. I'm a PGY3 med resident and will be starting cardiology next year. I've done tons of rotations during PGY1-PGY2 as far as cardiology, know many of the fellows and rotated with some private attendings, so that's my experience. Take it with a grain of salt.
If you're looking for lifestyle, you should probably be a pornstar. It's true you can have somewhat "decent" lifestyle in private practice as noninvasive. But as an associate. you're gonna be expected to take the brunt of the call. It may not be STEMI call, but you're gonna be getting called for a.fib rvr's, cardiogenic shocks, recurrent chest pains, arrhythmias. Sometimes, you may have to come in, whether truly because the patient's status is going downhill or because you may not feel confident enough from whoever is talking to you over the phone about their description, and don't wanna risk sitting at home while the guy drowns in his own fluids. It's just the nature of the beast. I think the lifestyle won't start improving as a private practice physician until you become partnered up and are fairly senior.
As far as academics, its true the hours are more manageable. You have residents/fellows running the CCU and consult services for you. You typically probably won't cover clinical services more than a couple of months. However, you'll still be doing clinic, and whatever specialty you are i.e. cath vs echo vs general diagnostics, you're still going to be interpreting studies and seeing clinic patients. On top of that, depending on your contract, you will be expected to be performing some academic work, i.e. research, acquiring grants or giving lectures. I'm not sure you can just say I'm academics and not going to do anything but sit on my hands all day while the residents/fellows do all the work. As far as EP, those guys work like horses. Sure most of the things are elective, and their problems are less acute. However, complex ablations and bi-v insertions can take upwards of 6 hours. You're probably 1 of 2 guys covering an entire hospital, so the work can mount up very quickly. You'll still have to cover your own clinic between all the procedures. 12 hour days are not out of the norm for an ep guy. Noninvasive can be deceptively busy. Lets think about this, how often do we order echos? Chest pain, suspected CHF, chest trauma, dissections, any a.fib/flutter who wants to be cardioverted. Nucs? Chest pain basically will get nuked these days unless you're so high-risk or pre-test probability is so high that they go straight to cath.
Deciding between specialties, lets be realistic, as far as things are currently, nobody is gonna be a poor doctor. Maybe in 2014, we all shall be poor together. At that point, the decision comes down to what particular in the specialty attracts you? The type of pathology? the procedures involved? The thought process? Ophtho - though limited in scope is fairly deep in knowledge and they have their own gadgetry and language that nobody outside their specialty really understands. If you love everything about vitreous humor, rods and cones and conjunctivitis, then do optho. Rads is all about knowing how the rays, photons, electrons interact with tissue densities, and how to interpret the studies and, at least ideally, attempt to correlate with the history. If you like looking at pictures and figuring a ddx from images and the hpi do rads.
In the end, this is something you're gonna be doing for upwards of at least 20-30 years, if not more. Do you really wanna suffer in a specialty where you hate it just for money and lifestyle, especially when neither is really guaranteed these days with constant cuts and impending reforms.
Harharaharhar, just kidding for all the altruistic types out there. I'm a PGY3 med resident and will be starting cardiology next year. I've done tons of rotations during PGY1-PGY2 as far as cardiology, know many of the fellows and rotated with some private attendings, so that's my experience. Take it with a grain of salt.
If you're looking for lifestyle, you should probably be a pornstar. It's true you can have somewhat "decent" lifestyle in private practice as noninvasive. But as an associate. you're gonna be expected to take the brunt of the call. It may not be STEMI call, but you're gonna be getting called for a.fib rvr's, cardiogenic shocks, recurrent chest pains, arrhythmias. Sometimes, you may have to come in, whether truly because the patient's status is going downhill or because you may not feel confident enough from whoever is talking to you over the phone about their description, and don't wanna risk sitting at home while the guy drowns in his own fluids. It's just the nature of the beast. I think the lifestyle won't start improving as a private practice physician until you become partnered up and are fairly senior.
As far as academics, its true the hours are more manageable. You have residents/fellows running the CCU and consult services for you. You typically probably won't cover clinical services more than a couple of months. However, you'll still be doing clinic, and whatever specialty you are i.e. cath vs echo vs general diagnostics, you're still going to be interpreting studies and seeing clinic patients. On top of that, depending on your contract, you will be expected to be performing some academic work, i.e. research, acquiring grants or giving lectures. I'm not sure you can just say I'm academics and not going to do anything but sit on my hands all day while the residents/fellows do all the work. As far as EP, those guys work like horses. Sure most of the things are elective, and their problems are less acute. However, complex ablations and bi-v insertions can take upwards of 6 hours. You're probably 1 of 2 guys covering an entire hospital, so the work can mount up very quickly. You'll still have to cover your own clinic between all the procedures. 12 hour days are not out of the norm for an ep guy. Noninvasive can be deceptively busy. Lets think about this, how often do we order echos? Chest pain, suspected CHF, chest trauma, dissections, any a.fib/flutter who wants to be cardioverted. Nucs? Chest pain basically will get nuked these days unless you're so high-risk or pre-test probability is so high that they go straight to cath.
Deciding between specialties, lets be realistic, as far as things are currently, nobody is gonna be a poor doctor. Maybe in 2014, we all shall be poor together. At that point, the decision comes down to what particular in the specialty attracts you? The type of pathology? the procedures involved? The thought process? Ophtho - though limited in scope is fairly deep in knowledge and they have their own gadgetry and language that nobody outside their specialty really understands. If you love everything about vitreous humor, rods and cones and conjunctivitis, then do optho. Rads is all about knowing how the rays, photons, electrons interact with tissue densities, and how to interpret the studies and, at least ideally, attempt to correlate with the history. If you like looking at pictures and figuring a ddx from images and the hpi do rads.
In the end, this is something you're gonna be doing for upwards of at least 20-30 years, if not more. Do you really wanna suffer in a specialty where you hate it just for money and lifestyle, especially when neither is really guaranteed these days with constant cuts and impending reforms.
As an ophthalmologist, I find this humorous (but true). Trying to read one of our notes is like trying to decipher hieroglyphics.
I am a senior cardiology fellow going on to an interventional fellowship - so consider my biases as you proceed.1) Where government is the biggest payer - reimbursement will ALWAYS go down - cash business (Lasix, Plastics, etc) will survive health care reform because they do not depend on Medicare/aid payments. I am doing cards cause I LOVE going to work every day - but show me a cardiologist in 10 years making a million a year - probably doing something shady - its gonna change and cardiology is a major target of health care reform (the cardiologists of the 80s and 90s screwed the pooch royally for us)
2) Yes you do have to be smart to be a cardiologist (and an opthalmologist, and a GI, and a Rheum, etc) - whoever posted otherwise is mistaken. That was just a dumb comment.
3) GI does not have the "lifesaving" satisfaction to the extent that a poster above suggested - if you require that satisfaction, only Cardiology and PCCM( (of the medical subspecialties) enjoy that satisfaction as a matter of bread and butter. The GI fellowship at the 2 institutions I trained worked waaaaay harder than the cards fellows - FYI.
4) I suspect many people feel the same, but I went into medicine knowing I was gonna work hard, but that everyday would be a change of scenery and have meaning - it was the opposite of cubicle life - so consider that 80hrs doing something you love, can seem much shorter than 40hrs doing something you hate.
5) Just my personal experience - the reasons I said I liked fields in my senior year of med school, turned out to all be B.S. Be honest with yourself, and don't let the tree-huggers/Koom-baya (sp?) MDs of the world make you feel bad for considering, income, prestige, bad-ass-edness, etc, they shouldn't be sole motivators, but they are not wrong. I personally needed to be in a field where I can come in and save the day - that was important to me, therefore, Geriatrics - a very noble and necessary field (my dad and sis) - wasn't gonna cut it for me. Good luck to all you students figuring this all out.
6) Cardiology is best field EVER!
