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Cardiology vs. Critical Care

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mytirf

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I realize this must be a common decision for some people and therefore was wondering people's opinions regarding cardiology vs. critical care fellowships.
Both offer the opportunity to care for sick patients but obvious also have different primary focuses.

What do people think about the ability to perform basic science research in each area? Any thoughts on burnout? Anyone else struggling with this decision? What are your thoughts? I would appreciate any insight anyone has in this decision, because right now I having a very hard time trying to decide which direction to choose.

thanks

-MT
 

oldbearprofessor

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I realize this must be a common decision for some people and therefore was wondering people's opinions regarding cardiology vs. critical care fellowships.
Both offer the opportunity to care for sick patients but obvious also have different primary focuses.

What do people think about the ability to perform basic science research in each area? Any thoughts on burnout? Anyone else struggling with this decision? What are your thoughts? I would appreciate any insight anyone has in this decision, because right now I having a very hard time trying to decide which direction to choose.

thanks

-MT

I am going to assume that by critical care you are primarily referring to PICU, not NICU, but the answer isn't that much different. Although it is certainly true that both PICU and cardiology take care of critically ill children, there are some substantial differences in academic careers (which I assume is your interest given your statement about basic science research).

Both areas are clinically intensive and do not have as much of a history of having faculty do basic science as some other pedi specialties. Right now I would say that there is more basic science being done in cardiology than PICU but that could change.

A bigger difference is that in PICU you will not do clinics. Like NICU you will be doing in-patient service only (or virtually only). Cardiology has a substantial clinic component. Similarly, cardiology has much more longitudinal care and long-term care. Consider how you feel about these, pro and con.

I've generally found that pedi cardiology fellows often have a passion for it from early in residency. They tend to like the intense cardiovascular physiology and focus of cardiology. PICU (and NICU) folks are more general physiology oriented and less often have picked the field as PL-1s. They often don't want to do clinics or general pedi, but don't want to be limited to babies either.

Good luck with your choice. These are both great fields and both very much areas in which combining clinical practice with basic science research is the way of the future!
 

CrazyPeds527

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This is the same battle i am grappling with as I am ready to begin residency. I have known for a long time that cardio physiology and congenital hearts are a true passion of mine...but i have the traditional problem that leads many people into the realm of critical care: a hatred for clinic! :laugh:

Nevertheless, i am hopeful that residency will allow me to develop real relationships with clinic patients and that will give me some perspective on real clinic, as opposed to "med student clinic"...which people have said is decidedly different.

I know there is a lot of basic science research in PICU that is being done at my institution, as well as clinical research, and the same is true for cardiology.

One thing you might see out there that i have started to think about as well is the prospect of doing a combined Cards/PICU fellowship (Boston, Pittsburgh, Milwaukee, CMH in Chicago and a few others offer these). The folks that i have met have had interesting thoughts on being double-boarded in making them competitive for jobs as attendings with training in both and practicing cardiac intensive care. On the other hand, 5 years is a long time for fellowship and a handful of people have said you don't need both to stay competitive for jobs.

Good luck with your decision!
 
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14022

First off, let me confess, I LOVE congenital heart disease. If you search my previous posts, I have posted on peds cards numerous times in the past. recently, I decided to pass on becoming a cardiologist in exchange for being an intensivist.

My primary reason is that I went from rotation to rotation, I liked everything, especially heme-onc and renal. Although I love congential heart disease/heart failure/heart transplant/cardiomyopathy, I hate electrophysiology, I started to realize that I hated EP, I never want to cath all day, I don't want to sit in a dark room and read echos nor stand at the bedside of a pt to perform one. So I realized that in PICU, I would still be exposed to congential heart disease/heart failure/heart transplant/cardiomyopathy without having to do all the other stuff and still being able to be exposed to other areas of peds that I enjoy as well. If I end up loving the cardiac areas of PICU fellowship so much, I can always then either do an extra year in cardiac critical care or try to combine a cards/picu fellowship.

Other reasons I find PICU more desireable is the lack of clinic and lack of intense long-term relationships with patients, which for others may be a huge disadvantage. I also love how you never bring your work home with you as a PICU doctor...once u leave the hospital, you have a colleague to take over. At our institution, there are 13 PICU faculty members and each does service anywhere from 4-24 weeks a year among the PICU, CICU, sedation service, and burn unit. The rest of the time is spent doing various activities, such as research, administration, teaching, etc. I like having so much time to pursue other activities outside of clinical service, which is less likely to be afforded to a cardiologist.

In terms of research, I think there is a lot of basic science in either. It is of course institution dependent. What I like about PICU is that almost any area of basic science can be applicable to your career on some level. Our fellowship program allows PICU fellows to do research with intensivists, cardiologists, hematologists, oncologists, etc.

In terms of competitiveness, cards is quickly becoming crazy competitive. PICU remains among the least competitive pediatric fellowships to obtain, as there are more spots than applicants each year, and great programs go unfilled year after year. Such a situation creates a high demand for intensivists, which makes the job market favorable.

I think to make this decision, you have to answer a few "simple" questions.
(1) Do you want to know everything about a single organ, or a lot about every organ?
(2) Do you want to see patients as an outpatient?
(3) Do you want to have long-term continuity of care?

If you can answer these, it will likely help narrow the choice down a bit.
 

oldbearprofessor

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I also love how you never bring your work home with you as a PICU doctor...once u leave the hospital, you have a colleague to take over.

You decided against cardiology?:eek: Now there's a surprise.

Although in a certain sense you do sign out patients at night in PICU (and NICU) and in "in-patient faculty" cardiology, I have to tell you that you do bring your work home with you as an attending in any of these fields.

In academic medicine, I spend 1-2 hours each evening (or more) doing "work" such as my journal editorship responsibilities, other grant and manuscript review and of course reading. But, in the sense you are talking about, I'm afraid that in an intensive care setting, when you are on duty for 2-4 weeks, when you come home you DO think about the patients, wonder about what is going on with them and plot what you'd like to do the next day.

Over time, one gets more control over this. I find this is worst for new attendings. It's very tough being in charge with no one above you for the first few years. Should you give indocin or ligate that PDA (or neither)? Should you recommend a trach or try to wean one more time?, etc, etc. I'm far from convinced that there is any difference between cardiology, PICU and NICU in the degree to which these affect your life at home after you sign out each day.

Regardless, PICU is a great field and I'm sure you'll enjoy it. Don't forget to stop by and visit when you interview "here".:) I know the PICU docs pretty well....
 
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14022

Although in a certain sense you do sign out patients at night in PICU (and NICU) and in "in-patient faculty" cardiology, I have to tell you that you do bring your work home with you as an attending in any of these fields.

I agree with everything you posted, and in any field with sick patients, your mind is frequently on the kids regardless of whether you are in or out of the hospital. I guess what I was specifically referring to was simply that in PICU you don't have primary patients and you are not a consult service. Once you leave the hospital, you are not going to get called in from home to see a kid in the ER, or to do an echo or procedure. And you won't get paged from parents in the middle of the night either.

With my wife expecting our first child, my perspective on lifestyle has changed dramatically over the past 8 months. I feel as if PICU, although just as busy and stressful as any other field in medicine, has a more predictable lifesyle, as you have your service time and call shifts that are well-defined. I find this very desirebale. And the fact I have the opportunity to learn about every area of medicine, I feel as if it is a great match for me.
 

oldbearprofessor

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With my wife expecting our first child, my perspective on lifestyle has changed dramatically over the past 8 months.

Mazel tov!! You'll get more sleep as a PL-3 I bet than when you're at home with the baby. :smuggrin: But the baby will be more fun!. :love:
 
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