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combining cardiology and cc

Discussion in 'Critical Care' started by todds, May 17, 2014.

  1. todds

    todds Member 10+ Year Member

    Jun 6, 2004
    Was torn about CC and Cards, not interested in Pulm so much but on the cards bandwagon now. Can't help but feel that I would still like some generalist practice and can't give up on CC even though love cards. I know I can combine CC by adding 4th year, but how feasible is this sort of practice in academics or community of doing general MICU then cards practice?

    The days I'm feeling ambitious I feel like doing cards, cc and adding interventional. The days I feel lazier I feel like just setting up echo/imaging shop + clinic and call it a day. Just trying to see if doing it all is feasible if I stay ambitious haha
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  3. deuist

    deuist Stealthfully Sarcastic Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Jun 14, 2004
    Although you can technically do a critical care fellowship after finishing cardiology, every single cardiologist I know is insanely busy and could never pick up additional shifts in the ICU. Once you add on interventional, your life is going to revolve around the cath lab. I certainly cannot imagine a community cardiologist pulling off the schedule that you mentioned. Maybe if you were at a really big academic center your partners might be willing to let you split time between the two fields: e.g., two weeks of cardiology alternating with two weeks of critical care.
  4. europeman

    europeman Trauma Surgeon / Intensivist 7+ Year Member

    Nov 12, 2007
    Maybe u should consider cardiac Surgey if you like the ICU so much
  5. Giic

    Giic 5+ Year Member

    Nov 18, 2012

  6. docoffice77


    Aug 10, 2014
    I think you are right in understanding doing cardiology, MICU, and interventional isn't feasible. When you do cardiology you are entering a whole new field in some respects which has multiple further subspecializations. Cardiology has become much more complex over the last decade that general cardiologists sometimes don't even do angios anymore (at least at my shop, a huge cardiology academic center). It's just too busy for them on wards and clinic and teaching, etc.

    So if you decide cardiology you are committing yourself to the heart/vascular disease and related conditions. As a cardiologist you will still see a lot of unrelated pathology however in both the clinic, hospital wards (on your primary service), and on consults for stuff not even related to the heart. You won't be the go to person for most of it but you'll have to deal with it and r/o, for example, lung pathology as a cause of symptoms. One example, cardiology called on a patient for syncope by ED... subsequently they discovered a brain tumor.

    If you decide interventional your life is in the cath lab, clinic, consults, and possible some ward pts depending on where you are. It's going to be mostly procedures day in day out.

    You already know about MICU. You don't have to do pulm/cc to get certified as cc though usually in MICU I think it's probably more ideal to have the pulm/cc background if you want to work with the complicated cases. Lots of big hospitals have separate ICUs for all sorts of conditions and the "medical" patients, aka super sick ones, are sent to the MICU which are usually staffed by pulm/cc guys/girls.

    But that being said cardiology has CCU and there are plenty of cardiologists doing mostly that. You'll still get a good amount of "medical" patients because there will be overflow to your unit when the micu is full.

    To me it sounds like you should do cardiology because that is ultimately where your passion is. Rest assured you will still see a lot of stuff. But you will lose a lot of your generalist training after years and years of just doing cardiology. My shop has a cardiology rotation where we are primary. ED was usually pretty good at getting us appropriate pts but when it wasn't related to the heart we were calling lots of consults, and that's because the attendings and fellows were not that good at unrelated conditions (which is fine because they are not trained to be good at unrelated stuff). A patient I saw in clinic yesterday was seeing about 6 specialists for problems which could all easily be handled by a pcp... he just started seeing endocrine for DM with HbA1c of 6.8 and started on januvia... Cardiology punted that management. But that is ultimately the way it is with most subspecialty people. You cannot be good at everything.

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