Cards vs PCCM

[AnonymousDoctorGuyPerson]

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A crosspost since the PCCM forum is practically dead. But good to balance the bias regardless.

Came into residency planning to do PCCM. I genuinely love the MICU and all it has to offer (vent management, navigating shock, diversity of pathophysiology, other interesting support devices). It’s the kind of stuff that makes me feel like I’m really practicing medicine. That said, I’ve noticed that a lot of our attendings seem a little jaded, not necessarily burned out, but definitely more ambivalent about their career choice than I expected. However it it's difficult to tease that from the individuals, most are pulm researchers with an ICU obligation so ofc they're not be having the best time there.

On the flip side, the vibe on the cards side at my program is totally different. Every attending seems obsessed with the field. I also do enjoy Cards, I'd say as a single organ system it's been my favorite (though starting to really appreciate pulm physiology with vent management). EP especially has caught my attention with some of the coolest procedures I've got to experience in medicine, and I'm certainly an individual who loves to be hands on (almost went surgery if not for my love of pure physiology and medicine)

So now I keep asking mysely am I considering cards just because our specific cards department just seems more gung-ho about their jobs or do I think I'd actually prefer it 5, 10, 15 years down the road. I'll say this, every year a decent handful of people enter our program with thoughts of PCCM, and only 0 to 2 a year actually wind up applying (usually jumping to cards).

I guess I’m looking for input from people who’ve seriously considered both, how did you decide? I try to think of the future but I've never been good at that. I tell myself "which subject would I prefer to teach," which would be critical care but I'm unsure if that's enough


Appreciate any thoughts. And to add, as I see this come up a lot when people ask related question, yes I'd have no issue switching to and matching into cards if that became the decision so please don't let that impact your input.

 

[cards67]

What do you want to do and talk about everyday for the rest of your life? I would agree that nearly every cardiologist I've come across enjoys the specialty, but maybe not always their job. But what's cool, interesting and exciting for you now may not be the case in 10-20yrs. I enjoyed critical care and would've considered it if not for cards. Naturally I also enjoyed AHF but ultimately stuck with general. I'm glad I did. Now I just find inpatient stressful and bit of a drag, even though I'm not primary. I'm very content with my boring 9-5 clinic days. It's not hard to see how ICU can wear on you over time. I hardly see older folks working the ICU. Meanwhile there's plenty older cardiologists and pulmonologists. Inpatient is unlikely to be a lifelong career, so what do you want to do after? There's cardiac critical care but I wouldn't really recommend it.

 

[throwaway404]

The thing to keep in mind is that cardiology requires A LOT of imaging, with cardiac CT and cardiac MRI growing bigger with time. So there's that to consider. Half of the field is bases on radiology.

 

[shouldigomd]

Critical care is its own field and you don't have to do the classic pulm crit route. If you like the ICU you can be a cardiology critical care focused doc.