Cardiology vs Heme Onc

[ukdoc74]

Was wondering if I could get some insight from internal medicine residents that considered one of these specialties.

What are the upsides and downsides of each field. I am not interested in interventional cards so it would essentially be noninterventional cards vs heme onc. So if you had to compare noninterventioanal cards vs heme onc, what is lifestyle and reimbursement like in comparison.

Also, which field is considered more intellectually stimulating and why?

Than you very much for your help.

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[BlackNDecker]

I had initially planned to pursue Cards...however, only cardiac imaging really interested me. This would have pretty much meant an academic/research intensive career and that doesn't appeal to me. Alot of the clinical researchers are now working re-donk-ulous hours (i.e. 4 am to 7 pm).

Some individual thoughts on cards:
1. Cardiac Imaging
- incredible imaging techniques are allowing us to understand "plaque" biology in a whole new way. Unfortunately, this hasn't really changed the management of coronary artery disease. At the moment, the really exciting stuff is limited to research.
- rapid advances come at a considerable cost. Declining reimbursement and cost-effective health care may limit short-term career prospects.
- search for articles related to radio-tracer imaging of plaque biology for more info

2. Electrophysiology
- radiofrequency ablation for the management of AFib hasn't quite panned out like the EP guys hoped
- nonetheless, there is an endless supply of people needing pacemaker and/or defibrillator implantation

3. Interventional Cards
- Just saw a banner on here selling lead "skull caps"
- apparently, the interventional guys are exposed to the equivalent of 30 head CTs per year😱
- Awesome physiology cases, but at the end of the day it reminded me too much of surgery and I didn't like wearing the lead vest

4. Clinical Cards
- Declining reimbursement for Echo (40% reduction) and severely reduced reimbursement for consults MAY drive down salaries
- You really gotta like bread & butter cards

When I added up all of the above, Cards didn't really fit me. The bread and butter consult, "troponin elevation" often isn't even cardiac related. That would get really frustrating late at night.

HEME/ONC
- Not alot to say, here except...DAYUM these guys get beat down!! Probably the hardest working fellows in the hospital.
- If clinical trials are your thing, this is a great field
- I saw some trainwrecks and some awesome cases....but a rotation or two was enough for me.

 

[dragonfly99]

hem/onc has better hours as a fellow and in clinical practice.
Not sure about the money side, but I believe hem/onc probably makes comparable to noninvasive cards, if not more.

Fewer middle of the night emergencies for hem/onc fellows than for cards fellows...I seldom sleep through the night on cardiology call without having to go in to the hospital and/or answer multiple phone calls from the ER or my residents. I am lucky that my program doesn't require me to stay in house on call my calls, as some programs do, but I often have "home call" for days or even weeks at a time.

If you like basic science research or clinical trials, there is a lot of that to be done w/cards or hem/onc. With hem/onc you really need to be good with end-of-life care and hospice issues. Cardiology you honestly need to as well if you manage many CHF patients, but a lot of the interventional guys avoid that.

 

[roswel]

These 2 fields can be compared under following headings... I was also in ur shoes last year. I could not convince myself to choose invasive cardiologist (with stressful lifestyle), and picked hemonc over non invasive card for my future...So my analysis is likely biased toward hemonc

Field choice; Its a personal thing. One have to do elective to see what he/she likes based on quality of life/reimbursement/future. All charm of cardiology is in Interventional cardiology (more money also upto 800k in south). Someone can put hemonc higher than non invasive cards (which basically is close to IM, especially if in future, medicare says all caths should be done by invasive cards so he can place stent at same time/no diagnostic cath. One can put non invasice higher as still lots of stuff echo/stress test/variety than hemonc (hemonc depressing, but only inpatient not out pt, hemonc in pt where resident rotate and hate hemonc is actually hospice service in most cases. To see real hemonc one should to dlinics as 90% hemonc is outpt. Hemonc have also variety with 100 different kind of cancer with 1000 different treatment with every pt responding in a different way....

Competetiveness: cardiology is more competetive in most programs than hemonc. Though residency program, usmle score matters more in cards and research experience matters more in hemonc. Links work in both

Lifestyle as a fellow. In most program, at least in my university, cardiology fellows work more than hemonc fellows.

Lifestyle as attendng: hemonc have more controlled hours with more out pt practice/less stressful cases than non invasive cards. Less chances of law suites. In Academic again hemonc enjoys better lifestyle than cards.

Reimbursement: A broad range in both fields especially in private practice. From my program fellows going to academics from both hemonc and non invasive cards starting salary was 200k to 250k. In private practice non invasice cardiology fellows got starting offers from 300 to 450k. In hemonc I can put exact sallaries region wise for fellows going from my program ; Florida 280k, Florida 375k, west vergenia 500k, vergenia 280k, Gerogia 420k, and one fellow went to far far place at 620k but neares airport was 4 hr drive from that place, and mcdonald was biggest resturent.

Pay cuts: Are affecting both fields but physicians always find different ways to make money...starting salaries are going higher in both fields

On the other hand a hospitalist have more controlled vacation time with 14 day on 14 day off which both these fields dont enjoys as both fields have continuity of care. In my program I saw a hospitalist who see 88 patient in hospital a day, likly make 500k and consult all consultants to manage his pts and have 2 NPs to do H&P and D/C summaries

Most important thing is one should like what one decide to do for whole life....

 

[staup]

Roswel, thanks for your input.... That starting salary number for an academic job seems kinda high, do you mind me asking what universities hired your fellow classmates at a starting salary at 200K?