Echo Tech (RDCS) to MD--feedback

[medgirl91]

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Hey guys! I have posted a similar thread on this forum before about me being an echo tech (RDCS) and applying to med school. I obviously have a strong interest in pursuing Cardiology in the future (if I am competitive enough in med school). I truly love echo and Cards and I am excited to use my current knowledge base to benefit my future career as a physician. If I were ever fortunate enough to get into a Cards fellowship, I know my echo experience will greatly help me.

However, I hear horror stories all of the time about how Cards fellowships are extremely difficult with awful schedules. I am a female and I want to have a family. I currently live in Montana and work at a rural hospital. The hospital does not have a Cardiologist on staff and I am the only echo tech. Two internal med physicians are trained (kinda) to read echo and they frequently ask my opinion and usually copy my exact report to their final interpretation. My question is, do you guys think it is possible to have a family life during residency/fellowship, especially being a female (Cards is male dominant)? Also, how common is it that internal med docs read echo and are heavily involved in Cardiology without actually specializing? I used to work in a huge metropolitan hospital in MN and the Cardiology department was very very different than the tiny 23 bed hospital I work at now!

Also, one more little side note. Though I am 100% positive I am going to med school, I am just curious.....how marketable/useful would a Physician Assistant be to a Cards practice that is RDCS and certified to read echoes ?? So basically, they would have Cards experience, be able to perform echoes extremely well, and be able read echoes. Just wondering....

Sorry this post is all over the place!!!! Any feedback/comments welcome and appreciated!! And yes I know...I am a long way away from residencies and fellowships 🙂

 

[Socrates25]

Hey guys! I have posted a similar thread on this forum before about me being an echo tech (RDCS) and applying to med school. I obviously have a strong interest in pursuing Cardiology in the future (if I am competitive enough in med school). I truly love echo and Cards and I am excited to use my current knowledge base to benefit my future career as a physician. If I were ever fortunate enough to get into a Cards fellowship, I know my echo experience will greatly help me.

However, I hear horror stories all of the time about how Cards fellowships are extremely difficult with awful schedules. I am a female and I want to have a family. I currently live in Montana and work at a rural hospital. The hospital does not have a Cardiologist on staff and I am the only echo tech. Two internal med physicians are trained (kinda) to read echo and they frequently ask my opinion and usually copy my exact report to their final interpretation. My question is, do you guys think it is possible to have a family life during residency/fellowship, especially being a female (Cards is male dominant)? Also, how common is it that internal med docs read echo and are heavily involved in Cardiology without actually specializing? I used to work in a huge metropolitan hospital in MN and the Cardiology department was very very different than the tiny 23 bed hospital I work at now!

Also, one more little side note. Though I am 100% positive I am going to med school, I am just curious.....how marketable/useful would a Physician Assistant be to a Cards practice that is RDCS and certified to read echoes ?? So basically, they would have Cards experience, be able to perform echoes extremely well, and be able read echoes. Just wondering....

Sorry this post is all over the place!!!! Any feedback/comments welcome and appreciated!! And yes I know...I am a long way away from residencies and fellowships 🙂

Here's my thoughts:

1. Cards is probably the most difficult IM specialty to get matched into; that being said if thats what you want then go for it. Knowing what you want to do right off the bat will help you. Look for cardiology faculty immediately upon entry to med school and get in on some research projects with them. They will be able to write you excellent letters of rec years later when you need them.

2. Pay no attention to the myriad of fools who will come on this message thread with crap like "hey you're just a premed you have no idea what kind of specialty you would like so dont pigeonhole yourself into a field that you've never worked in before." Obviously you have good exposure to the field, so I'm assuming you are quite confident that its what you want to do for the rest of your life.

3. Consider going to med school with a cardiology fellowship attached. You'll have an inside track by getting to know those faculty well over the several years prior to applying (especially the fellowship director).

4. I'm shocked and appalled that IM docs are "reading" echos in a formal manner. This is a joke right? Are you seriously telling me that these IM docs interpretation goes on the final report? Thats insane. I always assumed that these small hospitals would have their echos over-read by cardiologists in big cities.

5. Even echo techs with years of doing echos arent allowed to formally read echos, so that applies even moreso to PAs/NPs who have a lot less experience looking at echos compared to an echo tech, even if the PA/NP is in cardiology. In terms of sheer volume of looking at echos, the echo techs trump everybody but cardiologists. NPs/PAs can give their unofficial interpretation like an echo tech does frequently; but it doesnt go on the final report unless there's some shenanigans going on with the cardiologist (or in your case, idiot IM docs) just inserting your comments.

6. What do you mean by "certified" to read echos? To my knowledge the only people "certified" to do that are cardiologists. If there's some weekend course that gives you a "certification" read echos as a non-cardiologist, then it sounds like a total sham to me.

7. What "training" about reading echos do these IM docs really have? Sounds very suspect to me. These guys sound extremely shady and they would get roasted in court should this ever come to light.

 

[BGriffin]

Agree with most of this post except that gi and allergy/immunology are more competitive than cards. Gi has about half the number of spots vs cards and allergy has only 100 some odd spots and it appears gi popularity is picking up every year whereas cards is level or decreasing slightly.

Here's my thoughts:

1. Cards is probably the most difficult IM specialty to get matched into; that being said if thats what you want then go for it. Knowing what you want to do right off the bat will help you. Look for cardiology faculty immediately upon entry to med school and get in on some research projects with them. They will be able to write you excellent letters of rec years later when you need them.

2. Pay no attention to the myriad of fools who will come on this message thread with crap like "hey you're just a premed you have no idea what kind of specialty you would like so dont pigeonhole yourself into a field that you've never worked in before." Obviously you have good exposure to the field, so I'm assuming you are quite confident that its what you want to do for the rest of your life.

3. Consider going to med school with a cardiology fellowship attached. You'll have an inside track by getting to know those faculty well over the several years prior to applying (especially the fellowship director).

4. I'm shocked and appalled that IM docs are "reading" echos in a formal manner. This is a joke right? Are you seriously telling me that these IM docs interpretation goes on the final report? Thats insane. I always assumed that these small hospitals would have their echos over-read by cardiologists in big cities.

5. Even echo techs with years of doing echos arent allowed to formally read echos, so that applies even moreso to PAs/NPs who have a lot less experience looking at echos compared to an echo tech, even if the PA/NP is in cardiology. In terms of sheer volume of looking at echos, the echo techs trump everybody but cardiologists. NPs/PAs can give their unofficial interpretation like an echo tech does frequently; but it doesnt go on the final report unless there's some shenanigans going on with the cardiologist (or in your case, idiot IM docs) just inserting your comments.

6. What do you mean by "certified" to read echos? To my knowledge the only people "certified" to do that are cardiologists. If there's some weekend course that gives you a "certification" read echos as a non-cardiologist, then it sounds like a total sham to me.

7. What "training" about reading echos do these IM docs really have? Sounds very suspect to me. These guys sound extremely shady and they would get roasted in court should this ever come to light.

 

[taurus70]

The Cards program that I matched at usually fills 25 to 50% of its spots with female applicants so yes it is possible to have a family and still be a cards fellow. It also depends on the size of the program i.e. more fellows equals less call. When you apply for an IM residency try to find one that yoiu fit in that has a fellowship program. It will definitely give you a leg up on the spot. Hope this helps.

 

[medgirl91]

Thank you guys for all of your help!!! I appreciate it!! I will do my best and work my hardest to make this happen. I am definitely sure this is what I want to do, and I feel being an echo tech has given me great exposure to the field of cards, I just hope my passions continue throughout the next years of my medical education. 🙂

 

[medgirl91]

Here's my thoughts:

1. Cards is probably the most difficult IM specialty to get matched into; that being said if thats what you want then go for it. Knowing what you want to do right off the bat will help you. Look for cardiology faculty immediately upon entry to med school and get in on some research projects with them. They will be able to write you excellent letters of rec years later when you need them.

2. Pay no attention to the myriad of fools who will come on this message thread with crap like "hey you're just a premed you have no idea what kind of specialty you would like so dont pigeonhole yourself into a field that you've never worked in before." Obviously you have good exposure to the field, so I'm assuming you are quite confident that its what you want to do for the rest of your life.

3. Consider going to med school with a cardiology fellowship attached. You'll have an inside track by getting to know those faculty well over the several years prior to applying (especially the fellowship director).

4. I'm shocked and appalled that IM docs are "reading" echos in a formal manner. This is a joke right? Are you seriously telling me that these IM docs interpretation goes on the final report? Thats insane. I always assumed that these small hospitals would have their echos over-read by cardiologists in big cities.

5. Even echo techs with years of doing echos arent allowed to formally read echos, so that applies even moreso to PAs/NPs who have a lot less experience looking at echos compared to an echo tech, even if the PA/NP is in cardiology. In terms of sheer volume of looking at echos, the echo techs trump everybody but cardiologists. NPs/PAs can give their unofficial interpretation like an echo tech does frequently; but it doesnt go on the final report unless there's some shenanigans going on with the cardiologist (or in your case, idiot IM docs) just inserting your comments.

6. What do you mean by "certified" to read echos? To my knowledge the only people "certified" to do that are cardiologists. If there's some weekend course that gives you a "certification" read echos as a non-cardiologist, then it sounds like a total sham to me.

7. What "training" about reading echos do these IM docs really have? Sounds very suspect to me. These guys sound extremely shady and they would get roasted in court should this ever come to light.

This is a very rural hospital in Montana. A cardiologist comes down once a month and checks everything (sort of). The IM docs must have taken some sort of post-residency training that is enabling them to read echoes. Their name goes on the report and everything. There are three docs that do this. Also, I have heard of PAs reading OB ultrasounds at another hospital in Montana so I was wondering if that applied to echo as well. I heard there was some Rads residency in Idaho for PAs that was enabling them to do this.

If anyone has anymore information about IM docs reading echoes or PAs reading tests I would love to hear more about this.....

THANKS AGAIN!!! 🙂

 

[dragonfly99]

I think it's extremely rare for IM docs to be reading echocardiograms, but it may not be illegal/technically shady. I have heard of DO docs who are not radiologists reading other types of ultrasounds, so I think there may be a way to get around the usual rules. I agree that it sounds like not a good idea, though...it actually takings looking at a LOT of echos to be able to read all the fine points.

I'm a female cardiology fellow, so I want to address some of your questions.
Cardiology, the last time I looked, was about 18% female fellows. That is a tiny number...I'm pretty sure it's less than even general surgery. There are reasons for this, but I won't go into what I think all of those are.
The difficult of having a family during med school/residency and fellowship is going to vary a huge amount according to exactly WHERE you are doing your training, in my opinion. I don't think this can be overstated. Again, this is based on my experience in med school and residency and fellowship and various things I've observed at various hospitals and med schools. The workload varies wildly according to where you train - where I am now, the way the med students are treated is drastically different than the way I was treated as a med student - we seriously walked around with a great amount of fear, would step and fetch it (whatever "it" was they wanted) for the residents and attending docs, and were always bringing in research papers, etc. At the hospital where I'm doing my fellowship, the students are notably more relaxed, they aren't pressured to do all that much work, and they go home at a reasonable hour.

At my med school, the one woman I can think of who had a small baby during 1st/2nd year couldn't complete the years on time, and had to do a 3rd year - this was because of the workload, and I honestly can't imagine how any woman with a small kid would have been able to complete our 2nd or 3rd year and still pass. There was one person who had a baby during 3rd year and took a whole year off, and one who had a baby during 4th year (during elective time) and that was fine. There are multiple med schools where you could have a baby, take time off, and be fine. Not that it would be easy, but it would be possible.

Having a baby during medicine residency would be really hard most places as an intern. It would be easier during 2nd/3rd years at most places. Again, residencies vary wildly as far as how hard they are going to work you and the "culture" of the place in terms of how well they would tolerate women with kids. I think the whole landscape is changing, and will change more by the time you are a resident, so its hard to predict what it will be like. For example, we used to work 30 hr overnight calls/workdays every 3rd or 4th day for a month at a time, and now interns can't EVER work more than 16 hrs (or is it 12?) so they can't ever take overnight call.

Having a baby during cardiology fellowship would not be advisable unless it's during a research year or something.

Most female cardiology fellows tend to cluster in a relatively small number of programs. If you want to take any maternity leave at all, it's probably better to be in a larger cardiology fellowship. Otherwise other people are going to get stuck with a lot of your call and that isn't good for morale, and people may end up resenting you. However, to me the most important thing has always been that the people training me, and hopefully the other fellows, are open minded about women and believe that I can be as good a cardiology as any male trainee. And I have that at my current program, despite being the only woman in the program. I like my program and I have never had people make comments about women not being able to do certain things or certain areas of medicine not being appropriate for women. I occasionally did encounter those types of comments in med school and to a smaller extent in residency, and it bothered me. It made me wonder what else these guys were thinking that they weren't saying out loud, and how it might potentially affect their evaluations of me and other female trainees. But I had a very strong feeling about my current program and I was not wrong - so I think the need to trust your gut when picking a med schools, residency and fellowship is very important.

 

[OB1🤙]

Dropping in on this thread from the Anesthesiology forum. Once you're in med school, check out anesthesiology, focusing on cardiac anesthesiology. We do our own intraop TEE exams and interpretations, with some TTE as well, which would fit someone with your background. It's a 5 year track (1 internship, 3 residency, 1 fellowship).

If you go to a residency with enough residents- mine had 22- there's plenty enough room to have kids during residency without disrupting others' schedules.

Cardiology is a great field, but know that it isn't the only option for someone who enjoys cardiac physiology.

 

[medgirl91]

Dropping in on this thread from the Anesthesiology forum. Once you're in med school, check out anesthesiology, focusing on cardiac anesthesiology. We do our own intraop TEE exams and interpretations, with some TTE as well, which would fit someone with your background. It's a 5 year track (1 internship, 3 residency, 1 fellowship).

If you go to a residency with enough residents- mine had 22- there's plenty enough room to have kids during residency without disrupting others' schedules.

Cardiology is a great field, but know that it isn't the only option for someone who enjoys cardiac physiology.

I have never worked at a hospital where the anesthesiologist did the TEE in the OR. Usually the surgeon would just call in the cardiologist and me (the echo tech) and we would do the TEE. Is it common for anesthesiologist to do TEEs or be heavily involved in cardiology?

 

[medgirl91]

I think it's extremely rare for IM docs to be reading echocardiograms, but it may not be illegal/technically shady. I have heard of DO docs who are not radiologists reading other types of ultrasounds, so I think there may be a way to get around the usual rules. I agree that it sounds like not a good idea, though...it actually takings looking at a LOT of echos to be able to read all the fine points.

I'm a female cardiology fellow, so I want to address some of your questions.
Cardiology, the last time I looked, was about 18% female fellows. That is a tiny number...I'm pretty sure it's less than even general surgery. There are reasons for this, but I won't go into what I think all of those are.
The difficult of having a family during med school/residency and fellowship is going to vary a huge amount according to exactly WHERE you are doing your training, in my opinion. I don't think this can be overstated. Again, this is based on my experience in med school and residency and fellowship and various things I've observed at various hospitals and med schools. The workload varies wildly according to where you train - where I am now, the way the med students are treated is drastically different than the way I was treated as a med student - we seriously walked around with a great amount of fear, would step and fetch it (whatever "it" was they wanted) for the residents and attending docs, and were always bringing in research papers, etc. At the hospital where I'm doing my fellowship, the students are notably more relaxed, they aren't pressured to do all that much work, and they go home at a reasonable hour.

At my med school, the one woman I can think of who had a small baby during 1st/2nd year couldn't complete the years on time, and had to do a 3rd year - this was because of the workload, and I honestly can't imagine how any woman with a small kid would have been able to complete our 2nd or 3rd year and still pass. There was one person who had a baby during 3rd year and took a whole year off, and one who had a baby during 4th year (during elective time) and that was fine. There are multiple med schools where you could have a baby, take time off, and be fine. Not that it would be easy, but it would be possible.

Having a baby during medicine residency would be really hard most places as an intern. It would be easier during 2nd/3rd years at most places. Again, residencies vary wildly as far as how hard they are going to work you and the "culture" of the place in terms of how well they would tolerate women with kids. I think the whole landscape is changing, and will change more by the time you are a resident, so its hard to predict what it will be like. For example, we used to work 30 hr overnight calls/workdays every 3rd or 4th day for a month at a time, and now interns can't EVER work more than 16 hrs (or is it 12?) so they can't ever take overnight call.

Having a baby during cardiology fellowship would not be advisable unless it's during a research year or something.

Most female cardiology fellows tend to cluster in a relatively small number of programs. If you want to take any maternity leave at all, it's probably better to be in a larger cardiology fellowship. Otherwise other people are going to get stuck with a lot of your call and that isn't good for morale, and people may end up resenting you. However, to me the most important thing has always been that the people training me, and hopefully the other fellows, are open minded about women and believe that I can be as good a cardiology as any male trainee. And I have that at my current program, despite being the only woman in the program. I like my program and I have never had people make comments about women not being able to do certain things or certain areas of medicine not being appropriate for women. I occasionally did encounter those types of comments in med school and to a smaller extent in residency, and it bothered me. It made me wonder what else these guys were thinking that they weren't saying out loud, and how it might potentially affect their evaluations of me and other female trainees. But I had a very strong feeling about my current program and I was not wrong - so I think the need to trust your gut when picking a med schools, residency and fellowship is very important.

Have you ever heard of PAs reading echoes?? The hospital I currently work at was thinking of hiring a Cardiology PA to help supervise stress tests/ and work in the echo lab. It seems like they thought he/she would be able to read echoes. I thought only cardiologists could do this. I am unaware of any certifying examination/credential that would allow a PA to do this. Do you have any info regarding this?

Thank you for all of your insight. I will definitely keep all of my options open and extensively look into all of the programs I apply to! I wish you the best in your career.

 

[OB1🤙]

I have never worked at a hospital where the anesthesiologist did the TEE in the OR. Usually the surgeon would just call in the cardiologist and me (the echo tech) and we would do the TEE. Is it common for anesthesiologist to do TEEs or be heavily involved in cardiology?

Nowadays, those that do a cardiac anesthesiology fellowship learn TEE, become TEE certified by the NBE, and do all their own intraop echos. Better for the patient to have someone who can perform and interpret the TEE present throughout the duration of the entire surgery, rather than once preop and once coming off pump.

Keep it in mind as you progress through med school, you may find you like it. Wiki.

 

[dragonfly99]

Yes, some anesthesiologists are very proficient in TEE's. They do them during cardiothoracic surgery, as mentioned above. My understanding is that it is generally only anesthesiologists with some extra training, and usually it is the ones who specialize in cardiothoracic anesthesiology.

I have never heard of PA's reading an echo and I do think you are correct that they aren't credentialed to do this. This doesn't mean that an experienced PA somewhere working in cardiology wouldn't recognize any findings on an echo - I'm sure there are some who do. But even for cardiology fellows, we have to prove that we did several months of reading echocardiograms and have someone certify that we are capable of reading echocardiograms. There aren't any PA fellowships that I am aware of that would train them to read echocardiograms. Running stress tests - yes, they do supervise stress tests. This is common in many places. I think you are right - the person doing the hiring must not have known this wouldn't be something they could get/find. Unless there is some sort of weird exception in some of the really rural states/places.