Enjoy cardiology, but not procedures. Make sense to go into field?

[Eyeaboutthat]

Hi SDN,

I've really enjoyed all my cardiology rotations and love the pathophysiology, imaging, and medical management of cardiology. I don't love the procedural aspect though, I have a tendency to freeze or get stressed when it comes to performing procedure-oriented tasks. I've read that most fellowships have you doing hundreds of caths throughout the three years. Are there any fellows/attendings who can comment on their thoughts on going into the field if you like the imaging/pathofizz/medical management aspect but not the procedural ones?

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[Cor doc]

Hi SDN,

I've really enjoyed all my cardiology rotations and love the pathophysiology, imaging, and medical management of cardiology. I don't love the procedural aspect though, I have a tendency to freeze or get stressed when it comes to performing procedure-oriented tasks. I've read that most fellowships have you doing hundreds of caths throughout the three years. Are there any fellows/attendings who can comment on their thoughts on going into the field if you like the imaging/pathofizz/medical management aspect but not the procedural ones?

It’s definitely possible to have a completely non-invasive practice/career in both academics and private practice if you focus on seeing consults, clinic, and reading images. You will however be expected to have a minimum number of diagnostic caths during your fellowship which COCATS level 1 (I believe its 100 caths which can be RHCs or coronary angiograms which is very doable). If you can get through that, then definitely consider it.

 

[IMreshopeful]

It’s definitely possible to have a completely non-invasive practice/career in both academics and private practice if you focus on seeing consults, clinic, and reading images. You will however be expected to have a minimum number of diagnostic caths during your fellowship which COCATS level 1 (I believe its 100 caths which can be RHCs or coronary angiograms which is very doable). If you can get through that, then definitely consider it.

50/100 have to be coronary angiograms

OP, yes you can become a cardiologist and not do procedures in your practice. Most cardiologists read echos and nuclear studies and see patients in clinic or hospital consults. Some read CT or MRI scans etc. Doing interventions or pacemakers or ablations typically requires more training. This is up to you.

Also all cardiology programs are somewhat different - some are heavily clinical and you do a lot of procedures, some very few. You have to do a minimum number at most places to meet basic requirements but otherwise it’s largely dependent upon how you design your own schedule.

 

[cardsguy2017]

I think it's absolutely fine, you just have to get thru training where you'll have to cath and likely put in lines and such. Your discomfort with procedures could very well be due to lack of familiarity and training but under proper guidance in a cards program you very well could gain more confidence

 

[morte7]

I think it's a great idea; noninvasive physiology and hemodynamics is the future of cards anyway. I foresee both fewer overall procedures, and greater likelihood that what procedures remain will be done by subspecialists. As PCI volume decreases due to newer-generation stents, better meds, and fewer diagnostic caths to begin with (as concepts like CT-FFR take hold and begin to reduce overall cath lab volume) interventionalists are going to move more into the diagnostic cath space on days when they can't fill their schedule with TAVRs. This is already happening in a number of private practice jobs my colleagues have taken. I think the invasive general cardiology jobs will become a thing of the past before long. Cards is only going to become more subspecialized as the evidence mounts for noninvasive risk stratification. Imaging and heart failure have a big future role (and EP follows heart failure.) Even inpatient stuff like lines, etc will become pretty outsource-able to the growing trend toward staffing ICUs with general "intensivists."

I agree with everyone else however that procedures during fellowship are not avoidable, nor should they be. Every cardiologist should at least learn how to do them; whether you continue or not beyond the basic minimal requirement will be pretty optional. Also agree that sometimes just doing a lot of them reduces the overall stress and anxiety around procedures.

 

[AblateMD]

Agree with above, particularly morte point on future trends. I'd add that even now far and away the best job market is for general cardiology. I know some mid to large centers would kill to get people who would be satisfied with doing clinic, consults, and service (if there is one)

 

[Eyeaboutthat]

Thank you so much everyone for your helpful and reassuring comments! Much appreciated

 

[cardsguy2017]

I think it's a great idea; noninvasive physiology and hemodynamics is the future of cards anyway. I foresee both fewer overall procedures, and greater likelihood that what procedures remain will be done by subspecialists. As PCI volume decreases due to newer-generation stents, better meds, and fewer diagnostic caths to begin with (as concepts like CT-FFR take hold and begin to reduce overall cath lab volume) interventionalists are going to move more into the diagnostic cath space on days when they can't fill their schedule with TAVRs. This is already happening in a number of private practice jobs my colleagues have taken. I think the invasive general cardiology jobs will become a thing of the past before long. Cards is only going to become more subspecialized as the evidence mounts for noninvasive risk stratification. Imaging and heart failure have a big future role (and EP follows heart failure.) Even inpatient stuff like lines, etc will become pretty outsource-able to the growing trend toward staffing ICUs with general "intensivists."

I agree with everyone else however that procedures during fellowship are not avoidable, nor should they be. Every cardiologist should at least learn how to do them; whether you continue or not beyond the basic minimal requirement will be pretty optional. Also agree that sometimes just doing a lot of them reduces the overall stress and anxiety around procedures.

Not to divert too much from the OP but these is are interesting points that I tend to agree with as well.

 

[nlax30]

I'll agree as well. VERY feasible to be a busy general cardiologist and not do procedures. I would probably say that the majority of general cardiologists don't really do many procedures with the exception of TEEs.... (and with exception of HF cardiologists of course).

During your fellowship you will of course need to participate in and meet certain minimum numbers of certain procedures but once out you can certainly focus on a clinical non-procedural Cardiology career. The job market is pretty strong for general cardiologist as they are essentially the foundation of a Cardiology group and feed all the other sub-specialists.