cardiology vs. anesthesia

[drseanlive]

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I am seriously contemplating between cardiology and anesthesia. Does anyone have any opionions regarding which field has a better future considering one likes them equally?

From my reading it seems like they make similar $, but the cards guys seem to have a more intense lifestyle...on the other hand it seems like longterm cards is a stable career; while anesthesia is threatened by certain changes (i.e. CRNAs)...I'd appreciate any input.

 

[lemonade02]

there's nothing to debate here..do you want to be a b!tch or one of the most important and respected physicians in the entire hospital? that alone should help you 'differentiate' between these two careers..but the truth is these careers are so different i suspect you can decide better for yourself after doing these respective rotations.

 

[dragonfly99]

I think anesthesia makes more than noninterventional cards right now.
If you do anesthesiology you'll have to deal with surgeons in the OR, some of whom can be rude to you.

If you do cardiology you will have to do an internal medicine residency first, which can be painful at times for many people who are a cards-type person. Also, you will have to apply to fellowship when you are a 2nd or 3rd year resident, which is pretty much like applying for residency again (only a little worse, b/c cards is hard to get whereas medicine residency is not). You'll have to spend the first couple of years of your residency wondering what attendings are thinking of you, and cultivating some for letters of recommendation, etc. and have to shoot for a high USMLE Step 2 and 3 score and probably try and do research while you are a medicine resident, which can be challenging.

They are both good fields. I agree you should do at least 1 full month rotation in each if possible, if you are having trouble deciding. It's hard for med students to make these decisions because they don't really have adequate clinical experience to make them.

I really don't see CRNA's taking over anesthesiologist's jobs any time soon,but I guess I can understand why you might be worried.

 

[res1]

there's nothing to debate here..do you want to be a b!tch or one of the most important and respected physicians in the entire hospital? that alone should help you 'differentiate' between these two careers..but the truth is these careers are so different i suspect you can decide better for yourself after doing these respective rotations.

This is one the most idiotic things that I have ever heard... maybe some people want to choose their careers based on how much other people respect them, but if I were you, I would rather choose something that I enjoy. To the OP: Cardiology and anesthesiology are both wonderful fields (as are a host of other medical fields, whether or not they are "respected"), each with excellent subspecialty options as well... while the practice settings are very different, the knowledge base definitely has plenty of overlap. Both specialties have an intimate understanding of cardiac physiology and pharmacology... do a rotation is both, and see which suits you better!! 🙂

 

[lemonade02]

the larger point i'm making is these careers are so different there really aren't any similarities in the day-to-day bread and butter....so don't try to compare the two without seeing for yourself what these two careers entail...but as far as the respect thing, you decide for yourself if it should matter or not. everybody's different.

 

[radslooking]

the larger point i'm making is these careers are so different there really aren't any similarities in the day-to-day bread and butter....so don't try to compare the two without seeing for yourself what these two careers entail...but as far as the respect thing, you decide for yourself if it should matter or not. everybody's different.

agreed lemonade. respect is actually a huge issue. Not for some people, which is fine. But if you are a leader, and are continually disrespected after all your training, it can certainly bother you. And it should.

 

[Myostatin]

The idea of being disrespected by surgeons as an anesthesiologist is largely antiquated, at least per my friends who are in anesthesia residency.

Overlap as stated above, is the cardiac/respiratory physiology and pharmacology. Everything else is very different - practice enviroment, diversity of experience, the types of procedures you will be doing. Income wise, anesthesia is comparable to non-invasive cardiology, with interventional/EP making significantly more - however, cards has a much higher roof income wise than anestheisa... unless you can find a full time position doing anesthesia pain-management.

 

[res1]

The idea of being disrespected by surgeons as an anesthesiologist is largely antiquated, at least per my friends who are in anesthesia residency.

Overlap as stated above, is the cardiac/respiratory physiology and pharmacology. Everything else is very different - practice enviroment, diversity of experience, the types of procedures you will be doing. Income wise, anesthesia is comparable to non-invasive cardiology, with interventional/EP making significantly more - however, cards has a much higher roof income wise than anestheisa... unless you can find a full time position doing anesthesia pain-management.

Definitely agree with above post. Both fields definitely have a knowledge overlap, but it ends there... practice settings and styles are VERY different; anesthesia does not involve clinic or any type of follow-up, so when you finish your job, you are done (a huge plus for some), while cardiology involves a ton of clinic, pateint contact, etc.. (a plus for others)... both fields also involve taking care of somtimes very critically ill patients and often attract people who love the "adrenaline rush" of medicine... ask yourself what type of rush/procedures you are looking for: i.e. helping to save the life of a dying paitent in the cath lab performing an emergent cardiac cath/stent/IABP vs. helping to save the life of a dying trama/ruptured AAA/aortic dissection patient in the OR/ICU, difficult airway in ICU in rapidly desaturating patient, hemodynamics in previously stable OR patient rapidly going down the toilet and needs intervention NOW.... PICK YOUR POISON!!

 

[GassiusClay]

RESPECT. Probably not going to get it in residency and fellowship.

People respect cardiologists, but sometimes, they don't think it's worth it because they work really hard and must follow up on rude patients who think they do jack and just give them a bunch of pills. They are doing well financially, but I was told by an EP attending my intern year that I should stick with anesthesia because he had to deal with a lot to get where he is now: 3 years IM, 1 year research, 3 years fellowship, 2 years EP=9 years post med school, divorced, now in late 40s covering consult pager at 3 hospitals (academic plus 2 affiliated private places) on (some) Saturdays. Not my thing even for respect.

Anesthesiology. RESPECT? from surgeons unless you show them what you know, which is interpreting crap for them. When a surgeon hears that you know physiology when you assess urine OP, vitals, ABG, they don't bit#h. There is certainly less in academics for non-cardiac, non-critical care attendings. Private practice: don't fight with the hands that feed you which goes both ways. Both sides want to finish cases and make money. And now that smarter people are heading into anesthesia versus surgery, I believe the future will be a lot different. Plus, most surgeons now have no clue on "preop" assessment of patients. They are too busy learning new tricks on doing cases. AND to my surprise, some don't trust CRNAs for various reasons (ex: CRNA said temp probe was out and kind of blew him off, but wasn't and the hiatal hernia repair case got interesting)

👍 or 👎? More like medicine = 👎

 

[copacetic]

RESPECT. Probably not going to get it in residency and fellowship.

People respect cardiologists, but sometimes, they don't think it's worth it because they work really hard and must follow up on rude patients who think they do jack and just give them a bunch of pills. They are doing well financially, but I was told by an EP attending my intern year that I should stick with anesthesia because he had to deal with a lot to get where he is now: 3 years IM, 1 year research, 3 years fellowship, 2 years EP=9 years post med school, divorced, now in late 40s covering consult pager at 3 hospitals (academic plus 2 affiliated private places) on (some) Saturdays. Not my thing even for respect.

Anesthesiology. RESPECT? from surgeons unless you show them what you know, which is interpreting crap for them. When a surgeon hears that you know physiology when you assess urine OP, vitals, ABG, they don't bit#h. There is certainly less in academics for non-cardiac, non-critical care attendings. Private practice: don't fight with the hands that feed you which goes both ways. Both sides want to finish cases and make money. And now that smarter people are heading into anesthesia versus surgery, I believe the future will be a lot different. Plus, most surgeons now have no clue on "preop" assessment of patients. They are too busy learning new tricks on doing cases. AND to my surprise, some don't trust CRNAs for various reasons (ex: CRNA said temp probe was out and kind of blew him off, but wasn't and the hiatal hernia repair case got interesting)

👍 or 👎? More like medicine = 👎

cardiologists tend to be gung ho about what they do. like REALLY passionate, partially because of the long road to get there. its their drug and lifeblood. and they get all starry eyed when they think about how cool what their doing is, lol. ****....im getting starry eyed thinking about become a cards one day.....first i gotta get into meds though...sigh. hey anyone care to comment on my profile. im worried about my not so hot gpa. i'b done a ton of cards research so far though...

 

[CanIMakeIt]

cardiologists tend to be gung ho about what they do. like REALLY passionate, partially because of the long road to get there. its their drug and lifeblood. and they get all starry eyed when they think about how cool what their doing is, lol. ****....im getting starry eyed thinking about become a cards one day.....first i gotta get into meds though...sigh. hey anyone care to comment on my profile. im worried about my not so hot gpa. i'b done a ton of cards research so far though...

Is there a particular reason u have chosen the schools u have chosen? e.g. Univ of South Alabama --> from what i remember when i was applying, USB did not take any out-of-staters (this might have changed) and with your EC, MCATs, GPAs shouldn't you be casting a wider net instead of selling yourself short (possibly being from canada is a factor)? I would have applied to more schools (more mid-tier schools instead of mostly safety schools...) but take what i say with a huge grain of salt, I have been out of the game for 4 years now so my knowledge is not so fresh).

Good Luck

 

[Dawkter]

Going through a similar dilemma right now and would like to know a few more thoughts on this topic. Love anesthesia but am unsure if I will be bothered by the lack of patient contact later on in my career. In addition, I truly enjoy the scientific aspects of both fields.

 

[EPADHA]

Going through a similar dilemma right now and would like to know a few more thoughts on this topic. Love anesthesia but am unsure if I will be bothered by the lack of patient contact later on in my career. In addition, I truly enjoy the scientific aspects of both fields.

Cardiology fellow at a university hospital in southeast here. Not sure how anaesthesia and cardiology salaries compare. If you are looking for lifestyle choose anesthesia-intense work, but less hours than cardiology. The anesthesiologists at my institution just dont understand cardiac pathology (like troponins, heart blocks, when to call a STEMI, flash pulmonary edema etc) very well or make an attempt to see what is REALLY going on which makes for very irritating postoperative consults. But I hope they are good at what they do.
Although cardiology is very intense and the hours are bad, you get to see patients in different settings( outpatient, inpatient and CCU) across a broader set of diagnoses, get to do all your procedures (imaging, cath, EP depending on what you prefer), you get a lot of respect from other physicians and patients, and cardiology can be very fulfilling as there is a quick 'fix' for a lot of problems. Personally doing cardiology has changed my whole outlook on prevention and atheroscleosis, and helped me take better care of myself. Although my life as a fellow is tough, I would do cardiology anyday over anesthesia.

 

[sevoflurane]

Cardiology fellow at a university hospital in southeast here. Not sure how anaesthesia and cardiology salaries compare. If you are looking for lifestyle choose anesthesia-intense work, but less hours than cardiology. The anesthesiologists at my institution just dont understand cardiac pathology (like troponins, heart blocks, when to call a STEMI, flash pulmonary edema etc) very well or make an attempt to see what is REALLY going on which makes for very irritating postoperative consults. But I hope they are good at what they do.
Although cardiology is very intense and the hours are bad, you get to see patients in different settings( outpatient, inpatient and CCU) across a broader set of diagnoses, get to do all your procedures (imaging, cath, EP depending on what you prefer), you get a lot of respect from other physicians and patients, and cardiology can be very fulfilling as there is a quick 'fix' for a lot of problems. Personally doing cardiology has changed my whole outlook on prevention and atheroscleosis, and helped me take better care of myself. Although my life as a fellow is tough, I would do cardiology anyday over anesthesia.

I see it differently. What is really going on? That's funny, cuz when **** hits the fan in the OR.... Well, let's just say I love getting an acute left main that has been sitting in the cath lab for 1.5 hrs. Chill out dude. Don't make these assumptions regarding our specialty cuz based on your comments u really don't get it. Maybe some of us don't want to deal with atherosclerosis or 40 patients in outpatient clinics (what's that?)
By the time they do get to our care, they are getting surgery. Emergent or not. Cardiology is a great specialty.... but it depends on what you want out of medicine. Some may enjoy cards. Some may enjoy anesthesia. I like AVRs, MVRs, CABGs, acute mains, temponade, thoracotomies, heart transplants, liver transplants, craniotomies, etc, etc. When is the last time you did or even saw one of those? Play nice in the sand box my friend.

 

[sevoflurane]

By the time they do get to our care, they are getting surgery. Emergent or not. Cardiology is a great specialty.... but it depends on what you want out of medicine. Some may enjoy cards. Some may enjoy anesthesia. I like AVRs, MVRs, CABGs, acute mains, temponade, thoracotomies, heart transplants, liver transplants, craniotomies, etc, etc. When is the last time you did or even saw one of those? Play nice in the sand box my friend.

FWIW, in my PP setting, I've never seen a cardiologist in the CVOR.

 

[sevoflurane]

Just depends on what you want out of medicine. It is a personal decision. Cards/interventional cards/Ep are great specialties to go after... but for the right person, so is anesthesia. 🙂

 

[sevo85288]

My interventional cards friends work hard. They are very tired and compensation is getting cut. Some of them are tired of getting radiation exposure all day long. Overall, they are happy but concerned.

Anesthesia can be good for the most part. Very reasonable lifestyle and good pay still. It is nice to enjoy life and not worry about the pager. Life is short.

Respect. You have to earn it no matter what you do.

I am seriously contemplating between cardiology and anesthesia. Does anyone have any opionions regarding which field has a better future considering one likes them equally?

From my reading it seems like they make similar $, but the cards guys seem to have a more intense lifestyle...on the other hand it seems like longterm cards is a stable career; while anesthesia is threatened by certain changes (i.e. CRNAs)...I'd appreciate any input.

 

[EPADHA]

just got back from a call. One tamponade (have to deal with those about once a month); sent one patient for an LVAD, and called off a STEMI called by my anesthesia colleagues in PACU (ST elevation on monitor does not qualify for STEMI!- the patient was in flash pulmonary edema from hypertensive emergency). Contrary to what you say, we do get to touch the heart although with needles and catheters 🙂 And I have seen most of the procedures you have written above, if it makes you feel better (mandatory surgical rotation for cardiology fellows in my program), And when surgeons say no to left mains, my overworked interventional attendings have to step in.
40 outpatients is not tough, if you like what you do. I am already seeing 10-15 patients in one half day of clinic. And once you know them, it takes 10-15 mins to see one patient.
Anyways I think I know what i am talking about. My conclusion is that anesthesiologists and internists (cardiologists) look at physiology differently, and have very different training. I do appreciate what the anesthesiologists do in the OR and outside of the OR. It is a stressful specialty. And we do need them when we need some one intubated in the CCU or cath lab.
For me as an internal medicine resident I used to envy my anesthesia colleagues, but not any more.

 

[Jephy1]

Midlevels (e.g. Cardiology physician assistants and CRNAs) are encroaching on the areas where physicians have traditionally exclusively practiced....and it's our fault/doing. The first step is to utilize their labor to help out and expand our abilities to see more patients and bill for more services. Their state and national organizations and political action committees then call to the attention of elected officials the cost savings available to all if they are given equal status to physicians AND the right to bill for services in competition with doctors. Politicians and hospital administrators, oblivious to how dangerous a cardiac catheterization or general anesthetic can be, love this idea-----and go for the cheap! Many hospitals today have the aforementioned doing caths and anesthesia with minimal supervision and only a few cardiologists and anesthesiologists in 'comfortable places' to capitalize on the matter. An exhaustive bureaucracy exists to conceal/hide/suppress the associated disasters. A costs savings is real and will cause this perversion to expand. Organized medicine has no campaign to motivate the public to "insist that a board-certified physician do your "cardiac catheterization" or "anesthesia".

Go into a specialty that will not likely be ruined by midlevels (derm and general surgery are two that are keeping out the interlopers)

 

[supp-2]

Derm will have plenty of midlevel encroachment as well as battles with family practice docs in derm-type practices..

Gen surgery will be immune from the midlevel shift.

Agree that Cardiology needs to recognize now to lock down against midlevels. In my area, midlevels really haven't made any headway outside of doing clinic for MDs. I haven't seen any in this part of the country actually doing caths, ect. Still don't think anyone will ever want (or allow if possible) a non-MD playing around in their heart. But, the specialty needs to be diligent in not allowing it to become like anesthesia.

 

[EPADHA]

Derm will have plenty of midlevel encroachment as well as battles with family practice docs in derm-type practices..

Gen surgery will be immune from the midlevel shift.

Agree that Cardiology needs to recognize now to lock down against midlevels. In my area, midlevels really haven't made any headway outside of doing clinic for MDs. I haven't seen any in this part of the country actually doing caths, ect. Still don't think anyone will ever want (or allow if possible) a non-MD playing around in their heart. But, the specialty needs to be diligent in not allowing it to become like anesthesia.

I think the concern about mid level providers is there, but they may never become a big threat. The big roles that NPs are fulfilling in cardiology include doing clinics, interrogating devices, doing consults, and in very rare circumstances (in some private hospitals on east coast) getting initial access in cath lab.
I dont think that they will ever read echos, nucs, implant devices, do ablations or do diagnostic caths. I think with the current reimbursement cuts, cardiologists will become more protective of their turf. As such with the echo exam being made almost mandatory by 2015 in that you would need that certification to get reimbursed for your reads, most internists/family practice docs are being whisked out of the business of reading echos. The point about patients not letting non-MD work on their heart is also well taken. There are times I forget that getting a diagnostic angiogram is a big deal for our patients.. So many times the whole family shows up with the patient for a routine left heart cath..Does that happen for colonoscopies? Remember that the overall rate of big complications ( perforation vs death/stroke/coronary dissection/bleeding requiring transfusion) is about the same.

 

[Southpaw]

just got back from a call. One tamponade (have to deal with those about once a month); sent one patient for an LVAD, and called off a STEMI called by my anesthesia colleagues in PACU (ST elevation on monitor does not qualify for STEMI!- the patient was in flash pulmonary edema from hypertensive emergency). Contrary to what you say, we do get to touch the heart although with needles and catheters 🙂 And I have seen most of the procedures you have written above, if it makes you feel better (mandatory surgical rotation for cardiology fellows in my program), And when surgeons say no to left mains, my overworked interventional attendings have to step in.

STEMIs are awful rare in the perioperative setting relative to NSTEMIs. I can't recall a single post-op cards consult for ? of STEMI in the PACU in my 3 years of residency, but I imagine it's happened. Based on your posting, it sounds like you get this consult regularly, which is very surprising to me. Regardless, what you consider cardiac pathology is well within the understanding of the anesthesiologist. I'm a little surprised you believe someone who cares for patients during cardiac, thoracic, and vascular cases among all others has no grasp of what you describe as cardiac pathology. Anyway, I'll let it slide as there's no point arguing here online.

For me, I chose anesthesiology because I still enjoyed the variety of medicine. While cardiology is a fascinating field, I still get a kick of taking care of kids and obstetric patients. I love doing regional. Cardiac cases are awesome and regardless of what anyone says, no one understands fluids, metabolites, and pressors and how they interact with anesthetics like the cardiac anesthesiologist.

Cardiology is cool and while at times I envy the cards fellows, at the end of the day I go home very happy with my choice. I love the breadth of practice within anesthesiology and think it's really tough to beat.

 

[Leo Aquarius]

You gotta try them both out. Shadow as much as you can and talk to more cardiologists and anesthesiologists. Forget respect, because you have to respect yourself at the end of the day and if you end up unhappy you will realize you made a silly decision. I for one love psychiatry, and nobody can steer me from that calling. If everyone sopped respecting good psychiatrists I would still love restoring mental health to others, having total career flexibility and demand, getting paid handsomely for it, and doing amazing research all after 4 short years of residency training! Think about it.

 

[yesno]

Bump. ER vs Cardiology vs Anesthesia thoughts anyone?

 

[gutonc]

Bump. ER vs Cardiology vs Anesthesia thoughts anyone?

I wouldn't want to do any of them.

Do you have an actual question about the different specialties that hasn't been discussed above?