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Current state of a career in pediatric cardiology

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Cundiff1080

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Hey all,

So I'm a peds intern right now and discerning different career options. One that I really like, but am a little nervous about, is Cardiology. My biggest reservation surrounds the lifestyle and the career opportunities. When choosing a sub-specialty I'm putting a premium on lifestyle. I hope to have a big family and flourish outside of work. Thus, I don't want to do PCICU work and am not interested in a field where I'll be working long hours or with lots of call. There is a wide variety within cardiology from echo to EP to heart failure to intensive care. It sounds like some are more saturated than others (primarily EP and interventional from what I hear). I'm also nervous about availability of career options and their locations.

Ultimately, as a ped cardiologist am I going to be forced into working long hours with lots of call and/or be stuck moving across the country to find a job I like? Am I only going to have 3 cities in the U.S. to pick from when it comes to finding a job? I'm curious what y'alls understanding of the current market for ped cards jobs these days? I know there are private gigs but I don't know how common that is and how likely that is to break into?

Looking forward to hearing what y'all have to think!

Thanks!
 
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MonkeyRalph

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Honestly, it depends. Cardiology is not one of the "lifestyle" subspecialties, but depending on your area of interest and your willingness to do private practice, it can be pretty manageable. Of course, it's one of the more intense fellowships, but no matter what you subspecialize in, you should expect the training to be tough. In the end, you have to do something you love, or it's not going to be ideal anyways.

To answer your specific questions...
"Ultimately, as a ped cardiologist am I going to be forced into working long hours with lots of call and/or be stuck moving across the country to find a job I like?"
- More likely than not, yes, if you do academics, although you may get lucky
- It also depends on your subspecialty, the more in-demand ones are more likely to have openings close to your home, where the more hard-to-find openings may require you to move wherever the job is
- If you do general cardiology or private practice, this will be a little less likely

"Am I only going to have 3 cities in the U.S. to pick from when it comes to finding a job?"
- See above - depends on subspecialty

"I'm curious what y'alls understanding of the current market for ped cards jobs these days?"
- Still very saturated, especially on the coasts
- Still some jobs in imaging (echo/MRI/fetal), pulmonary hypertension, and heart failure/transplant
- Growing fields are prevention, adult-congenital
- Lots of jobs in ICU (but more likely if you are dual-trained)
- Less openings in EP, cath

"I know there are private gigs but I don't know how common that is and how likely that is to break into?"
- Depends on your training program, but there's jobs in general private practice cardiology in almost any town, but typically they have more clinical responsibilities (clinic days, call nights) than their academic counterparts, but less research/teaching responsibilities and higher compensation
 
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MEN2C

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As alluded to above, a lot of jobs require/expect additional training beyond the three year pediatric cardiology fellowship. Whether that's being boarded in an additional specialty like PICU, further ACGME approved training in something like adult congenital, or a non ACGME fourth year in stuff like imaging, Cath, EP, etc.
 
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BigRedBeta

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There's a good post in the Internal Medicine forum about what "top" cardiology (adults obvi) fellowships are looking for. Might be useful to read, keeping in mind that there are some significant differences between the peds and adult worlds.

The answer to all your questions is "it depends"...and unfortunately, there is an element of timing that you have no control over that may make or break your ability to find your best fit.

In general, cardiology is not considered one of the lifestyle fields (especially in fellowship) but to be honest with you, "lifestyle" means a lot of different things to a lot of different people. For some of us (the PICU/NICU/PEM folks come to mind), the thought of being at home attached to a pager or at the beck and call of nervous moms all night when we're trying to spend time with our families is untenable. We much prefer to leave work at work and when we're out of the hospital others are taking care of our patients, even if that means that we give up our nights, weekends, and holidays perhaps more often. For other people, not spending the night at the hospital is of the utmost priority and even if there is the risk of a phone call (or even lots of them), that's better than the alternative. So where your ideal "lifestyle" fits, may be perfectly amenable to any number of sub fields within cardiology or none at all.

Additionally, pediatric cardiology tends to attract a lot of superstars, and the need to be academically productive is probably higher than in any other pediatric subspecialty across the board. Writing papers takes time, mentoring fellows takes time, and these activities may fall outside of standard clinical hours. When my manuscript got accepted for publication 6 months after completing fellowship, I had a 48 hour turnaround to submit the final proof before it went up online...which meant that on Saturday afternoon I was on the phone with my mentors getting them to review it for the 87th time (and we still found things we wanted to change). So while you may have less service or clinic time in an academic position, there are other things that can demand your attention challenging that idea of lifestyle.

No one in pediatric fellowships ever talks about private practice, particularly as you go to bigger and bigger name institutions. If they do it's in hushed tones with lots of innuendo and in some cases derision. If you walk into a fellowship interview stating that's your primary goal, it's probably the fastest way to find yourself at the bottom of their rank list. As someone who joined a private practice PICU group, I can tell that there's a little bit of disappointment from my division head and fellowship director that I didn't add my name to the list of faculty members at premiere institutions. But I'm much happier and better compensated.

That balance between PP and academia impacts lifestyle in other ways. A pediatric cardiologist in PP can probably do well enough in any town with more than 150k people, particularly if there is a sizable, acute enough, NICU (. But that probably is a solo practice or at the most a 2 provider sort of set up. That may create a very different sort of lifestyle and different sorts of responsibilities. Bigger cities of course have more opportunities, but also tend to have academic centers to sweep up all the volume, so you have to find a unique niche and symbiotic relationship to function and recruit patients. Further some of the larger academic centers (eg CHOP and Northwestern/Lurie Children's) are fanning out into the distant suburbs and exurbs where general cardiologists may have been able to make a foothold for the routine stuff, creating relationships for any and all types of pediatric care. Depending on the needs of the community hospitals and the academic unit, you may find a perfect fit or feel completely overwhelmed by the bureaucracy.

Your assessment of EP and Interventional are pretty accurate but it's hard to know what things may look like in 6 years. People have been selling Interventional's scarcity for a while a now, that it's only a matter of time before the pendulum swings back the other way.

MonkeyRalph's description of the job markets is pretty spot from my vantage point - although I haven't meant many pediatric cardiologists that love pulmonary hypertension. 4th year CICU/dual PICU and cardiology folks are in demand EVERYWHERE right now, but again, in 6 years it's very possible that every place that can add a Cardiac Intensivist will have done so. 4th year fellowships are nice, but are very much a dual edged sword (see the adult cardiology thread I mentioned above), as having a niche makes you both more and less marketable. University ABC needs an EP person, with particular expertise in complex arrhythmia procedures for some sort of multispecialty clinic they want to open...might be your exact interest but they post the job in February of your 3rd year of cardiology fellowship instead of September of your 4th year EP year and so you're out of the running by the time you have demonstrated the credentials they need. Now everyone you talk to wants EP people focusing on genetics and channelopathies and you're left moving across the country for a position that kind of fits but not really. And depending on your sensibilities, you may have trained yourself out of a more general cardiology position either because of your interest or not wanting to feel like you've wasted a year of your life by not fully using that training.

TL; DR - pediatric cardiology is much less likely to work out for someone "not interested in a field where I'll be working long hours or with lots of call" than other fields in Pediatrics
 
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Capote1

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BigRedBeta, can you please post the link for the IM forum about what top cards fellowships are looking for? I tried searching for it and couldn't find it. Thanks!


There's a good post in the Internal Medicine forum about what "top" cardiology (adults obvi) fellowships are looking for. Might be useful to read, keeping in mind that there are some significant differences between the peds and adult worlds.

The answer to all your questions is "it depends"...and unfortunately, there is an element of timing that you have no control over that may make or break your ability to find your best fit.

In general, cardiology is not considered one of the lifestyle fields (especially in fellowship) but to be honest with you, "lifestyle" means a lot of different things to a lot of different people. For some of us (the PICU/NICU/PEM folks come to mind), the thought of being at home attached to a pager or at the beck and call of nervous moms all night when we're trying to spend time with our families is untenable. We much prefer to leave work at work and when we're out of the hospital others are taking care of our patients, even if that means that we give up our nights, weekends, and holidays perhaps more often. For other people, not spending the night at the hospital is of the utmost priority and even if there is the risk of a phone call (or even lots of them), that's better than the alternative. So where your ideal "lifestyle" fits, may be perfectly amenable to any number of sub fields within cardiology or none at all.

Additionally, pediatric cardiology tends to attract a lot of superstars, and the need to be academically productive is probably higher than in any other pediatric subspecialty across the board. Writing papers takes time, mentoring fellows takes time, and these activities may fall outside of standard clinical hours. When my manuscript got accepted for publication 6 months after completing fellowship, I had a 48 hour turnaround to submit the final proof before it went up online...which meant that on Saturday afternoon I was on the phone with my mentors getting them to review it for the 87th time (and we still found things we wanted to change). So while you may have less service or clinic time in an academic position, there are other things that can demand your attention challenging that idea of lifestyle.

No one in pediatric fellowships ever talks about private practice, particularly as you go to bigger and bigger name institutions. If they do it's in hushed tones with lots of innuendo and in some cases derision. If you walk into a fellowship interview stating that's your primary goal, it's probably the fastest way to find yourself at the bottom of their rank list. As someone who joined a private practice PICU group, I can tell that there's a little bit of disappointment from my division head and fellowship director that I didn't add my name to the list of faculty members at premiere institutions. But I'm much happier and better compensated.

That balance between PP and academia impacts lifestyle in other ways. A pediatric cardiologist in PP can probably do well enough in any town with more than 150k people, particularly if there is a sizable, acute enough, NICU (. But that probably is a solo practice or at the most a 2 provider sort of set up. That may create a very different sort of lifestyle and different sorts of responsibilities. Bigger cities of course have more opportunities, but also tend to have academic centers to sweep up all the volume, so you have to find a unique niche and symbiotic relationship to function and recruit patients. Further some of the larger academic centers (eg CHOP and Northwestern/Lurie Children's) are fanning out into the distant suburbs and exurbs where general cardiologists may have been able to make a foothold for the routine stuff, creating relationships for any and all types of pediatric care. Depending on the needs of the community hospitals and the academic unit, you may find a perfect fit or feel completely overwhelmed by the bureaucracy.

Your assessment of EP and Interventional are pretty accurate but it's hard to know what things may look like in 6 years. People have been selling Interventional's scarcity for a while a now, that it's only a matter of time before the pendulum swings back the other way.

MonkeyRalph's description of the job markets is pretty spot from my vantage point - although I haven't meant many pediatric cardiologists that love pulmonary hypertension. 4th year CICU/dual PICU and cardiology folks are in demand EVERYWHERE right now, but again, in 6 years it's very possible that every place that can add a Cardiac Intensivist will have done so. 4th year fellowships are nice, but are very much a dual edged sword (see the adult cardiology thread I mentioned above), as having a niche makes you both more and less marketable. University ABC needs an EP person, with particular expertise in complex arrhythmia procedures for some sort of multispecialty clinic they want to open...might be your exact interest but they post the job in February of your 3rd year of cardiology fellowship instead of September of your 4th year EP year and so you're out of the running by the time you have demonstrated the credentials they need. Now everyone you talk to wants EP people focusing on genetics and channelopathies and you're left moving across the country for a position that kind of fits but not really. And depending on your sensibilities, you may have trained yourself out of a more general cardiology position either because of your interest or not wanting to feel like you've wasted a year of your life by not fully using that training.

TL; DR - pediatric cardiology is much less likely to work out for someone "not interested in a field where I'll be working long hours or with lots of call" than other fields in Pediatrics
 

BigRedBeta

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What a top 5 cardiology program looks for, and should you even care.

Please don't take this as a gospel thread by any means and definitely ignore the subsequent uproar and insults hurled back and forth.
The original post in that thread is useful, and I think the take home points about what an academic career is are important. Because of the structure of pediatric subspecialties, there is a much greater resignation of one's fate to academic medicine than there is for adult trainees. It's not good or bad in my opinion (unlike some of the people in that thread), it just is what it is.
 
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amestramgram

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how does one get onto the SDN private Neonatology/ Pediatric Cardiology forum? I've been unable to find instructions explaining how. Thanks.
 
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MEN2C

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It doesn’t exist anymore.
 
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