Flexibility of working hours as a cardiologist in the US?

[Newfound]

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For starters, apologies - I know similar questions have been asked before, here and on other forums. I have tried to read through them all, but many threads have seen very different opinions thrown back and forth, and I don't quite know what to trust. Many posters and some acquaintances suggest that it's possible to tailor any career based on one's preferences, while others vouch for the complete opposite. Most statistics I've seen represent means, and rarely take into account call schedule. I would really appreciate real examples or directions to relevant data.

Short bio: I'm a European MD/PhD student, with a plan to graduate with both degrees in two years. During a period as a visiting researcher (as part of my PhD) in the US, I met my current partner, and I've since considered doing my residency in the US. I believe I'd have a reasonable shot at a good IM residency and an eventual cardiology fellowship. However, moving to the US would drastically increase my working hours compared to my strictly labor-regulated home country. I can handle this at the beginning of my career, but I don't know if I can stare at 40 years of 60-70h work weeks and not flinch. Friends in the US have cautioned me to be frank about this and I want to be honest to myself. I know I will eventually want to be present for my family and not be practically isolated from my European relatives. I've played around with the notion of other, more lifestyle-friendly specialties, but nothing fascinates me quite like cards does. During my rotations, I've loved the diagnostics, patient interaction, treatment decisions, exposure to all subspecialties, catching up on the literature, etc. The content just seems like a perfect fit.

So I wonder, to what extent is it actually possible to control your hours and call demands as a practicing cardiologist in the US? How dependent is this on subspecialty and practice setting? I already know I enjoy EP, heart failure and imaging more than interventional. I'm not committed to academic or private practice, or an inpatient vs outpatient focus. Location-wise I'd want to stay in one of a few major cities due to my partner's line of work. Though I'm not one to turn down additional compensation, I would pursue the field even if it came with a peds/FM salary. In my home country there's salary parity between specialties. My concern is more about the hours and flexibility.

 

[P Diddy]

For starters, apologies - I know similar questions have been asked before, here and on other forums. I have tried to read through them all, but many threads have seen very different opinions thrown back and forth, and I don't quite know what to trust. Many posters and some acquaintances suggest that it's possible to tailor any career based on one's preferences, while others vouch for the complete opposite. Most statistics I've seen represent means, and rarely take into account call schedule. I would really appreciate real examples or directions to relevant data.

Short bio: I'm a European MD/PhD student, with a plan to graduate with both degrees in two years. During a period as a visiting researcher (as part of my PhD) in the US, I met my current partner, and I've since considered doing my residency in the US. I believe I'd have a reasonable shot at a good IM residency and an eventual cardiology fellowship. However, moving to the US would drastically increase my working hours compared to my strictly labor-regulated home country. I can handle this at the beginning of my career, but I don't know if I can stare at 40 years of 60-70h work weeks and not flinch. Friends in the US have cautioned me to be frank about this and I want to be honest to myself. I know I will eventually want to be present for my family and not be practically isolated from my European relatives. I've played around with the notion of other, more lifestyle-friendly specialties, but nothing fascinates me quite like cards does. During my rotations, I've loved the diagnostics, patient interaction, treatment decisions, exposure to all subspecialties, catching up on the literature, etc. The content just seems like a perfect fit.

So I wonder, to what extent is it actually possible to control your hours and call demands as a practicing cardiologist in the US? How dependent is this on subspecialty and practice setting? I already know I enjoy EP, heart failure and imaging more than interventional. I'm not committed to academic or private practice, or an inpatient vs outpatient focus. Location-wise I'd want to stay in one of a few major cities due to my partner's line of work. Though I'm not one to turn down additional compensation, I would pursue the field even if it came with a peds/FM salary. In my home country there's salary parity between specialties. My concern is more about the hours and flexibility.

You can find a job in cardiology that has 40-50 hours/week with minimal call responsibilities, particularly in academics. You would just make less money, which does not seem to be a problem for you. Of the subspecialties you mentioned, I would steer clear of EP and HF if you are worried about hours, unless you plan on working in a lab most of the time with groundhog day cameos on the wards. Imaging would be good fit.

The bigger concern I see is getting through the training. You're looking at at least 6 years of 60-70 hour work weeks until you become a cardiologist.

p diddy

 

[nlax30]

Obviously there's going to be a lot of variability depending on the practice structure but in general Cardiology is and will probably remain one of the more demanding/time-intensive specialities just due to its nature. That said, I have seen jobs that are outpatient clinic only or hospital shift-work type only (think of a Cardiology Hospitalist) though those aren't the norm and are more feasible if your flexible in moving to where those opportunities might be.

Imaging certainly could be a good option. The fellowship isn't as intensive as the others though I really haven't seen that many imaging-only type of positions unless you go into academics leading a imaging department or something.

Interventional would be at the other end of the spectrum and once out in practice would certainly be expected to take STEMI call, though again depending on the practice structure you might find a setup where they'd let you opt out of STEMI call towards the end of your career and do just elective cases or transition to just clinic work.

 

[Instatewaiter]

You can find a job in cardiology that has 40-50 hours/week with minimal call responsibilities, particularly in academics. You would just make less money, which does not seem to be a problem for you. Of the subspecialties you mentioned, I would steer clear of EP and HF if you are worried about hours, unless you plan on working in a lab most of the time with groundhog day cameos on the wards. Imaging would be good fit.

The bigger concern I see is getting through the training. You're looking at at least 6 years of 60-70 hour work weeks until you become a cardiologist.

p diddy

I'm going to disagree with P diddy about both EP and HF.

Sure if you are at a transplant center where the cardiologists take the calls, HF is going to be brutal. However, there are many practices where HF is not that bad and has a similar schedule to the imaging/non-interventional schedules.

EP can be great actually. There are many private practices where it is a equal pay system between all the cardiologists (EP, imaging, HF, intervention etc). So, the EP guys, because they tend to bring in many more RVUs than the non-interventional guys, have either little or no call or days off to make up for it. It is all about the practice. Furthermore, there are rare instances when EP actually has to come into the hospital in the middle of the night. I am at a very large quarternary center and have not seen EP ever come in in 4 years.

I agree about what the other posters have said about imaging and interventional. Interventional tends to be bad everywhere. Patients are just so inconsiderate about having their STEMIs in the middle of the night/early AM. Imaging can be a good gig but often they are lumped into the non-STEMI call so again, it all depends on the practice.

 

[P Diddy]

I'm going to disagree with P diddy about both EP and HF.

Sure if you are at a transplant center where the cardiologists take the calls, HF is going to be brutal. However, there are many practices where HF is not that bad and has a similar schedule to the imaging/non-interventional schedules.

EP can be great actually. There are many private practices where it is a equal pay system between all the cardiologists (EP, imaging, HF, intervention etc). So, the EP guys, because they tend to bring in many more RVUs than the non-interventional guys, have either little or no call or days off to make up for it. It is all about the practice. Furthermore, there are rare instances when EP actually has to come into the hospital in the middle of the night. I am at a very large quarternary center and have not seen EP ever come in in 4 years.

I agree about what the other posters have said about imaging and interventional. Interventional tends to be bad everywhere. Patients are just so inconsiderate about having their STEMIs in the middle of the night/early AM. Imaging can be a good gig but often they are lumped into the non-STEMI call so again, it all depends on the practice.

It's not just about calls, but hours. EP may not get called in, but they're staying late to do their 9 hour ablations. And in some dream world HF may not take call, but will have to manage the crashing patient at any time, and a 20+ patient census. With even community centers taking care of LVAD patients, HF is becoming more labor intensive, not less. On the flip side, it has the best growth potential of any field in cardiology.

p diddy

 

[nlax30]

I think it's pretty variable and highly dependent on the location and practice structure in regards to the hours and patient/call load for EP and HF. Where I'm finishing my general fellowship is at a community program where the EP guys cover multiple hospitals and EP type consults go straight to them instead of through general first so their call can be BUSY. I'll be doing EP at a tertiary academic center where I'm sure the EP call is much different.

 

[Instatewaiter]

It's not just about calls, but hours. EP may not get called in, but they're staying late to do their 9 hour ablations. And in some dream world HF may not take call, but will have to manage the crashing patient at any time, and a 20+ patient census. With even community centers taking care of LVAD patients, HF is becoming more labor intensive, not less. On the flip side, it has the best growth potential of any field in cardiology.

p diddy

For "calls" about HF I meant calls about donor hearts (instead of like some centers where the surgeons take the calls)- not actual time on call. I think most are going to be hard pressed to find any group that would be ok with HF not taking any on-call time...

 

[P Diddy]

I think it's pretty variable and highly dependent on the location and practice structure in regards to the hours and patient/call load for EP and HF.

that is true. in the same vein there are interventional jobs based out of the VA that are cush-o-rama (I just coined and trademarked that phrase). and I know some academic echo practices that are quite onerous. but in general I would say imaging hours are much better than either EP or HF.

getting back to the OP, what you seek is available. Once in fellowship it will be imperative to actively canvas your seniors, faculty, and local cardiologists to ascertain your best options.

p diddy

 

[P Diddy]

For "calls" about HF I meant calls about donor hearts (instead of like some centers where the surgeons take the calls)- not actual time on call. I think most are going to be hard pressed to find any group that would be ok with HF not taking any on-call time...

thanks for clarifying. in my dream world HF wouldn't take any call!

p diddy