Cardiology PCP

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KeikoTanaka

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Hey all,

I am a first year medical student, so I obviously have a lot to learn. But I have a question - Right now it seems like I have an interest in everything, I just think all aspects of medicine are awesome... from the physical exam, to medications, to seeing ppl get better, and to be a "face in the community" everyone trusts/ knows (I wanna live in a small town).

So before starting school I was working as a scribe for an orthopedist who told me about a PCP in the area that he had a good relationship with who referred him a lot of patients. I came to found out he was also a fully trained cardiologist but wanted to still work as a PCP.

I love this idea because since starting CardioPulm in Physio, I've found it to be the most fascinating thing I've learned thus far. Obviously I have a lot more to experience and know there may be other things I really like, but given I've scribed for ED physicians, an IM PCPs, and Orthopedists, I do really love the idea of being "someone's doctor". But, I'd also still love to be trained in a highly skilled area of medicine, as I think this would not only be good for business, but also just help keep me interested in medicine longer as I am someone who feeds on variety (Which is why I kinda didn't like Orthopedics, every complaint was either a knee or a shoulder).

Sorry to get side tracked - but my question is basically: Is it feasible to spend 3 additional years to become a cardiologist just to have it as a supplement to a PCP salary? Or does it not really matter because the money you can make doing additional cardiology things will off set the loss of financial income for 3 years of residency and 3 years of fellowship? Obviously some may think I'm crazy for even being okay with that, but honestly if I loved what I did anyways and wanna do it till I'm like 70... (I'm only 26 now)... I think the gains would eventually offset the time commitment to get it done.

But that of course leaves me with other lingering questions: Lets say I don't get into a Cardiology fellowship...It's not the worst thing in the world... but is there a way to bolster yourself as a candidate if you have aspirations like this? Would programs frown down upon this type of model? What are other options for IM docs who have goals to be Cardiologists but also want to retain generalist IM skillset - are there other pathways of proving yourself as a doctor then going back and applying to be a Cardiologist? Or is your application kind of restricted to all the things you did in school/residency?

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Hey all,

I am a first year medical student, so I obviously have a lot to learn. But I have a question - Right now it seems like I have an interest in everything, I just think all aspects of medicine are awesome... from the physical exam, to medications, to seeing ppl get better, and to be a "face in the community" everyone trusts/ knows (I wanna live in a small town).

So before starting school I was working as a scribe for an orthopedist who told me about a PCP in the area that he had a good relationship with who referred him a lot of patients. I came to found out he was also a fully trained cardiologist but wanted to still work as a PCP.

I love this idea because since starting CardioPulm in Physio, I've found it to be the most fascinating thing I've learned thus far. Obviously I have a lot more to experience and know there may be other things I really like, but given I've scribed for ED physicians, an IM PCPs, and Orthopedists, I do really love the idea of being "someone's doctor". But, I'd also still love to be trained in a highly skilled area of medicine, as I think this would not only be good for business, but also just help keep me interested in medicine longer as I am someone who feeds on variety (Which is why I kinda didn't like Orthopedics, every complaint was either a knee or a shoulder).

Sorry to get side tracked - but my question is basically: Is it feasible to spend 3 additional years to become a cardiologist just to have it as a supplement to a PCP salary? Or does it not really matter because the money you can make doing additional cardiology things will off set the loss of financial income for 3 years of residency and 3 years of fellowship? Obviously some may think I'm crazy for even being okay with that, but honestly if I loved what I did anyways and wanna do it till I'm like 70... (I'm only 26 now)... I think the gains would eventually offset the time commitment to get it done.

But that of course leaves me with other lingering questions: Lets say I don't get into a Cardiology fellowship...It's not the worst thing in the world... but is there a way to bolster yourself as a candidate if you have aspirations like this? Would programs frown down upon this type of model? What are other options for IM docs who have goals to be Cardiologists but also want to retain generalist IM skillset - are there other pathways of proving yourself as a doctor then going back and applying to be a Cardiologist? Or is your application kind of restricted to all the things you did in school/residency?

Glad you have an interest in cardiology, it's a great field. In cardiology, you can absolutely be "someone's doctor" while still not necessarily being a PCP (heart failure comes to mind). Being a PCP and a cardiologist is possible, but not a common pathway for a variety of reasons. If you dilute down your cardiology practice with general medicine, you are likely going to lose some of your cardiology skills due to not doing cardiology day in and day out. A lot of cardiology is reading echos, nuclear studies, and possibly performing catheterizations or other procedures depending on if you choose a subspecialty, and it may be hard to find a job in a primary care practice that allows you to also continue practicing these aspects of cardiology. Furthermore, the pay differential between the two specialties is huge, and most people don't want to take 3 extra years to train to make $200k less per year.

I was also like you when I started medical school, I loved all of medicine and it was fairly difficult to choose a specialty. Once I got into IM, medicine became more routine, but the cardiology problems always seemed more interesting than other pathologies. I also realized that cardiology has not only significant depth, but more breadth than you might think. Cardiology is still satisfying even for those that need variety.

Your interests are very likely to mature as you go through your training, so I wouldn't stress too much now about things after medical school. You'll find what you're passionate about and it may turn out to be something you had no idea you liked.
 
Glad you have an interest in cardiology, it's a great field. In cardiology, you can absolutely be "someone's doctor" while still not necessarily being a PCP (heart failure comes to mind). Being a PCP and a cardiologist is possible, but not a common pathway for a variety of reasons. If you dilute down your cardiology practice with general medicine, you are likely going to lose some of your cardiology skills due to not doing cardiology day in and day out. A lot of cardiology is reading echos, nuclear studies, and possibly performing catheterizations or other procedures depending on if you choose a subspecialty, and it may be hard to find a job in a primary care practice that allows you to also continue practicing these aspects of cardiology. Furthermore, the pay differential between the two specialties is huge, and most people don't want to take 3 extra years to train to make $200k less per year.

I was also like you when I started medical school, I loved all of medicine and it was fairly difficult to choose a specialty. Once I got into IM, medicine became more routine, but the cardiology problems always seemed more interesting than other pathologies. I also realized that cardiology has not only significant depth, but more breadth than you might think. Cardiology is still satisfying even for those that need variety.

Your interests are very likely to mature as you go through your training, so I wouldn't stress too much now about things after medical school. You'll find what you're passionate about and it may turn out to be something you had no idea you liked.

Thank you for such a thoughtful response. This was really what I needed to hear - Most people say you really should focus on just one specialty and master it - so I get that Cardiology is really no different. Love to hear there is such a breadth to Cardiology than I would have thought, I can't wait for rotations! Thank you.
 
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Hey all,

I am a first year medical student, so I obviously have a lot to learn. But I have a question - Right now it seems like I have an interest in everything, I just think all aspects of medicine are awesome... from the physical exam, to medications, to seeing ppl get better, and to be a "face in the community" everyone trusts/ knows (I wanna live in a small town).

So before starting school I was working as a scribe for an orthopedist who told me about a PCP in the area that he had a good relationship with who referred him a lot of patients. I came to found out he was also a fully trained cardiologist but wanted to still work as a PCP.

I love this idea because since starting CardioPulm in Physio, I've found it to be the most fascinating thing I've learned thus far. Obviously I have a lot more to experience and know there may be other things I really like, but given I've scribed for ED physicians, an IM PCPs, and Orthopedists, I do really love the idea of being "someone's doctor". But, I'd also still love to be trained in a highly skilled area of medicine, as I think this would not only be good for business, but also just help keep me interested in medicine longer as I am someone who feeds on variety (Which is why I kinda didn't like Orthopedics, every complaint was either a knee or a shoulder).

Sorry to get side tracked - but my question is basically: Is it feasible to spend 3 additional years to become a cardiologist just to have it as a supplement to a PCP salary? Or does it not really matter because the money you can make doing additional cardiology things will off set the loss of financial income for 3 years of residency and 3 years of fellowship? Obviously some may think I'm crazy for even being okay with that, but honestly if I loved what I did anyways and wanna do it till I'm like 70... (I'm only 26 now)... I think the gains would eventually offset the time commitment to get it done.

But that of course leaves me with other lingering questions: Lets say I don't get into a Cardiology fellowship...It's not the worst thing in the world... but is there a way to bolster yourself as a candidate if you have aspirations like this? Would programs frown down upon this type of model? What are other options for IM docs who have goals to be Cardiologists but also want to retain generalist IM skillset - are there other pathways of proving yourself as a doctor then going back and applying to be a Cardiologist? Or is your application kind of restricted to all the things you did in school/residency?
This does happen in some competitive markets like New York City. I saw this when I was a resident there. A lot of it has to do with some patients who like the prestige of saying “my PCP is also a cardiologist“. I would guess that most of the patients who see that PCP cardiologist are the “worried well”, and probably don’t have exceedingly complicated multi systemic issues.
 
I can certainly understand the feeling of being fascinated with almost every aspect of medicine in the early stages. I would be willing to bet that as you progress through your clinical training you will gravitate and start to develop more focused interest in a specific area....whether that be general IM or Cardiology.

Even if you do pursue Cards training and still want to keep a foot in the IM workd I think it’s a field well suited to that. A lot of systemic diseases obviously have CV implications and whether we want to or not during my general cards clinic we essentially acted like a PCP to a decent number of patients.... usually limited to those that were younger with not many other medical issues (thinking of the 55yr guy who presents with his first MI and now just follows up with you for his CAD and HTN), or those that don’t have a strong PCP.

In my area we have a lot of patients on Medicare managed care programs so they usually have very involved PCPs who run the show.
 
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