General vs Interventional Cardiology

[whodatMD]

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I'm currently in cardiology fellowship and am having a tough time deciding between interventional vs general cardiology. Can you give some insight? Specifically:

1) What is the lifestyle difference between the two out in private practice?

2) Word is that with a surplus of interventionalists, many are also doing a lot of general cards as well. Is this the case

3) With this becoming a bigger issue, what is the job market looking like between the two now?

4) While not the most important aspect, is there still a significant pay difference between the two fields?

5) Finally, interventional procedures are a lot of fun, but in the long term it going to be worth it for the extra STEMI call and relative decreasing number of PCIs?

Thanks for your insight

 

[Tius]

I'm currently in cardiology fellowship and am having a tough time deciding between interventional vs general cardiology. Can you give some insight? Specifically:

1) What is the lifestyle difference between the two out in private practice?

2) Word is that with a surplus of interventionalists, many are also doing a lot of general cards as well. Is this the case

3) With this becoming a bigger issue, what is the job market looking like between the two now?

4) While not the most important aspect, is there still a significant pay difference between the two fields?

5) Finally, interventional procedures are a lot of fun, but in the long term it going to be worth it for the extra STEMI call and relative decreasing number of PCIs?

Thanks for your insight

My overall impression as a fellow:
1) Seems the interventional guys always will have a rougher lifestyle with STEMI's, tamponades, high risk ACS having to come in at night to cath. Though the general guy may not have to deal with those issues, those guys are usually reading images or seeing consults during the day time, and sometimes, given the rougher financial times, are seeing consults late into the evening.

2) I think the days of an interventionalist only cath-ing are in the minority. You're gonna be seeing general consults, hunting for the chest pain guy that needs a cath.

3) Seems broadly trained level 2 echo/nuc + interventional is still doing well due to the need for folks always needing someone to do STEMI call.

4) Honestly don't have a good grasp of this - its all anecdotal here. Interventionalists will probably still be making more but depending on the vol of the group you join and regional area, this could be all different. A couple of years ago, one of the interventional guys from my fellowship started out 350k at a small private group - though later I heard that he left due to them working him like nuts. A noninvasive guy in his class went to a large Chicago group, also starting 350k. I'm sure things such as the aforementioned along with negotiating of terms and stuff will play a huge variable in what you make. Also keep in mind, starting out 350k may only be for 2 years and then your salary is dependant on the RVU's you crank depending on the contract and practice model you go into.

6) This is something you'll have to answer for yourself. I'm an EP guy, and most guys in my fellowship detest looking at intracardiac rhythms and could care less whether someone has ORT vs ART vs A-tach or AVNRT. I enjoy it and that's why I'm doing EP though I know the job outlook sucks for EP now. On the other hand, I myself feel like coming in for a STEMI at 3AM is miserable. Yet those same guys who hate intracardiac electrograms are most of the guys who get a high out of coming in to open up a guy's coronary and save his life. Also keep in mind, what you enjoy or find palatable about the field now may change in 20 years when you're 50 about to hit your 60's. I've met plenty of attendings at our private hospital who I'm sure all were gung-ho about coming in for STEMI's when they were younger, who have told me personally at that age, you quickly get tired of dealing with STEMI activations for some guy with early repol, Brugada's pattern, or fake STEMI's. I'm sure when I'm 60, the 8 hour ablation for afib and hunting for CFAE's may not be as exciting either.

 

[whodatMD]

Thanks for your h1elp on this. So would it be safe to say that general cardiology may be the way to go given all the extra stress with interventionalist when most are doing lots of general anyway?

 

[Tius]

If it were me deciding between general, I would say whatever you enjoy the most. Cliche, I know, the SDN standard reply. However it really is true. You know you will make more money on ave as an interventionalist, but you will also work harder on ave and have more "bad nights" vs the general guy. But some guys like i mentioned before just love opening the damn coronaries, everything from getting access to torquing to getting the RCA, floating the wire and all that mess so if that is what you enjoy and you feel the bad nights/days are worth it, then do it. Moreover, I think you will be doing general whatever you choose, including ep. I'm prepared to be doing some form of general consults. The dream job of being an ep guy who sits in the lab and ablates everything to kingdom come doesn't exist in private practice anymore, unless you go to some random city in Alaska or take up an academic job where you're soley ep.

I think the only difference is as an interventionalist, you will have some days that are cath days and you cath and do less general and your colleagues may pickup the salck vs general means you will always be doing consults and reading studies in-between. Also, you have to take into consideration, in private practice when your group reviews your production, as an interventionalist, you can maintain RVU volume seeing less general consults given your procedures generate more rvu's. However, as a general guy, you only have consults, tte, tee and nucs. Now the caveat is there has to be that sweet spot where you see enough consults to generate procedures.

Keep in mind this is all anecdotal and just from experience rotating through hospitals.

 

[Trifling Jester]

I know several interventionalists who do not take STEMI call, or only do so because they are paid extra to take it. And some of them are relatively young. It all depends on your contract.

 

[whodatMD]

I know a lot is made about STEMI call, but at least where I train, general call is pretty rough too. How is it in private practice?

 

[sacrament]

I know a lot is made about STEMI call, but at least where I train, general call is pretty rough too. How is it in private practice?

This is going to vary tremendously from place to place. In my current position we average 1 STEMI a night (though my personal best/worst is five within ten hours), and when I'm covering both it's usually the general call stuff that occupies the majority of my time.