GI Vs Cardiology- Competitiveness

Discussion in 'Internal Medicine and IM Subspecialties' started by oprah23, Jun 1, 2008.

  1. oprah23

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    The impression I get after talking to a number of successful and unsuccessful applicants in and around my state- New Jersey is that in recent years GI has become most competitive fellowship to get, surpassing cardiology. Is this a local or nationwide trend. I am a First year IM resident and will be sending out applications next year for GI or Cardiology. I am wondering what is the reason for GI getting extremely competitive- ? Lifestyle/Pay/Other ??.
     
  2. MD2b06

    MD2b06 Senior Member
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    They're both very competitive. In general, GI has comparable pay with a better lifestyle than cardiology. In addition, it has a slight edge currently because it has fewer spots nationwide. Cardiology has more spots, but also probably twice as many applicants. Once a direct match to cardiology out of med school is established (there's currently talk of this from some prominent names in the field), it will exceed GI in terms of competitiveness and probably rival the most competitive specialties, the orthos, ent's, etc. The unwillingness to committ to 3 years of IM without a guarantee of a fellowship deters a lot of med students who are interested in cards from applying to internal medicine. Current proposals are in place to allow med students to match into a position out of med school that will enable you to do 2 years of IM and then 3 years of general cards, effectively saving a year of training. You can imagine how much resistance this is getting from internal medicine programs across the country. It may sound cliche, but pick the field you love, and don't worry about all the other stuff. You'll make a very comfortable living in either field.
     
  3. Fexofenadine

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    That's interesting. I didn't think Cardiology ever had problems recruiting excellent and well-qualified candidates into the profession. Vascular surg, however, did see a big drop in number of candidates applying into the field after gen surg...thus it made an attempt to truncate the no. of yrs required for board certification by establishing the integrated program for med school seniors. I would be surprised if Cards went along this route. If anything, cards will lengthen its training to include more research time. When my dad trained a million years ago, I believe cards was a 2 year fellowship program vs. 3 years now.

    I love Cards b/c I think as technology continue to advance, cardiologists will be performing more therapeutic procedures. It will be interesting to see how CT surg will change in light of this. In terms of income, it varies so much from one region to the next... It's hard to say which makes more: GI or Cards. Honestly, if money is the primary concern, do Derm! I love Cards.
     
    #3 Fexofenadine, Jun 1, 2008
    Last edited: Jun 1, 2008
  4. MD2b06

    MD2b06 Senior Member
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    There's no problem attracting people into cardiology as there are many many more qualified applicants than there are positions. There is a significant shortage of cardiologists in the US, and the shortage is predicted to only get worse over the next 10-12 years. Decreasing the length of training doesn't really do much to address the current and future predicted shortage as the # of qualified applicants already exceeds the number of spots. What needs to be done is to increase the number of fellowship spots across the country, something that isn't easy to do. The changes aren't being proposed in order to attract more applicants, although that will likely be the end result, but rather to decrease the length of training required to become a general cardiologist (5 vs 6 years), for which there is currently a great demand , and to enable those who eventually want to do a sub subspeciality to be able to receive adequate training before they turn 40! (Apparently many EP and interventional programs are going to 2 years) How well it will work, I have no idea.
     
  5. grendelsdragon

    grendelsdragon Synesthetic
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    First, I'd advise against choosing a specialty influenced by its relative competitiveness, which swings in cycles from year to year. In a lifetime of clinical practice spanning decades, it is a poor measure for job satisfaction.

    That being said, the popularity of some specialties also wax and wanes depending on $$$. For example, both GI and CV medicine became more competitive with the increase in reimbursible procedures (endoscopy and cardiac caths repectively). Therefore, $$$ is also dependent on reimbursements for these procedures. Overall, there is a national shortage of generalists (in many different medical specialties). There is appears to be a trend on Capitol Hill to decrease the reimbursements for many subspecialty procedures and increase reimbursements for generalist clinician visits (to both save money and increase the ranks of generalists). Don't be surprised if in several years there is some more parity in compensation for generalists and specialists. People tend to gravitate towards the balance of work vs. return in $.

    Bottom line is that you should gravitate towards clinical practice in a field you genuinely enjoy. In a lifetime of practice, a lot will change.
     
  6. kingofhearts

    kingofhearts SDN Donor
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    I am always amused when I meet residents who say they are torn between GI and cardiology.

    Both fields share:
    1. High salaries for an IM subspecialty
    2. Procedural nature (specific to EP and interventional cards).

    That's about it. EP and interventional cards use a totally different manual skillset than advanced endoscopy. They are very different fields: different patient populations, different disease processes, different management goals and even different personality types of practicing physicians.
     
    #6 kingofhearts, Jun 2, 2008
    Last edited: Jun 2, 2008
  7. gwen

    gwen Senior Member
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    i kind of agree with you there. its like my roomate who was torn between ophtho, derm and ENT. i think she was basically torn between which money making field she could actually get into - which seems to be the same scenario here.

    seriously, heart and guts - very different.
     
  8. Fexofenadine

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    Common guys. To be fair, since both fields (cards & GI) are procedure oriented, they tend to draw in hands-on people. I thought about plastics since my first year as a med student, but I fell in love with cards after rotating through it. All of my research in plastics went to waste. It's hard to make an informed decision without rotating through it. I like procedures and interventions, so I can see how fields like surgery or GI or Cards may all sound interesting.
     
    #8 Fexofenadine, Jun 3, 2008
    Last edited: Jun 3, 2008
  9. VCMM414

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    On the same token, pulmonology (even aside from critical care) is also a very procedure oriented field, but yet doesn't quite get the same attention as cardiology and GI.
     
  10. kingofhearts

    kingofhearts SDN Donor
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    Agreed. Cardiology and pulmonary/CC have much more overlap than cardiology and GI. Yet, the number of residents I have met torn between those two fields is significantly less.

     
  11. lemonade02

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    forgive me that i can't get it up for bronchs and consult pulmonology....i agree with fexo, gi and cards are two procedurally oriented fields and attract people that want to do both procedures and analytical prblem solving.

    ain't nothign wrong with liking two very dynamic and procedurally-oriented fields of IM. its completely different than someone who is deciding between plastics, derm, uro, radiology, and ophtho! there the common denominator is only money and lifestyle. give us some credit for choosing IM in the first place when we could have gone into such other fields.
     
  12. Domperidon

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    Well, between these two there's a lot more in common than just money and lifestyle...
     
  13. aProgDirector

    aProgDirector Pastafarians Unite!
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    The only proposal on the table is allowing residents in programs with IM and Cards at the same institution to "blend" their third year -- do both IM and Cards rotations, and save a year. There is no talk of a direct match from medical school that I know of.
     
  14. grendelsdragon

    grendelsdragon Synesthetic
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    Actually, there IS a proposal to create a short-track combined residency with 2 years internal medicine, 1 year transitional non-procedural cardiovascular medicine, and 2 years clinicial cardiology. The central goal of this residency is to create a fast track for training GENERAL CARDIOLOGISTS, of which there is a national shortage. The most notable proponent of this plan is Valentin Fuster. The problem is that it would be hard to secure promises in advance for trainees to become generalists when there is so much incentive to subspecialize (interventional, EP, imaging, etc.). Additionally, there is little enthusiasm within departments of medicine to implement such a plan. This short track concept has been "on the table" since 2004, but in my experience it has not gained much traction since then.

    If you are interested in reading more about the concept:
    http://content.onlinejacc.org/cgi/content/full/44/2/267

    I personally think this "short track" idea is flawed and will not get off the ground anytime in the near future.
     
  15. dragonfly99

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    I would think the IM program directors would fight the short-track cards idea tooth and nail. They need residents (read: indentured servants) to work in the hospital.
     
  16. Gastrapathy

    Gastrapathy no longer apathetic
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    The "short-track" thing has been tossed around for years. Unless cardiology were to break from the ABIM and not require IM board certification to take the cardiology boards, it isn't going to happen (so says a MACP who is always in the know).
     
  17. grendelsdragon

    grendelsdragon Synesthetic
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    I don't want to disagree with a "Master", but the most mainstream short-track proposal for cardiology (see link in my post above) would lead to board eligibility for accreditation in both IM and cardiology by the end of training. The political quandry is whether passing the IM boards should be required for the cardiology boards (as many cardiologists let their IM certifications lapse once they become cardiology certified).

    As I have said before, I am NOT a fan of short-tracking, as many medical students on this forum appear to be. Medicine and cardiology are very diverse fields and it is very hard to decide which field is most suitable for for a given person without first-hand experience provided during residency and fellowship. The same goes for subspecialty training (I know my colleagues and I have waffled a lot during our cardiology fellowships until we settled on our own happy trjectories--it's all so much fun!). I would not advocate any circumstance that restricts a trainee to a general cardiology practice up front. There are other ways to encourage the generalist track without securing an advanced uninformed promise.

    Irrespective of the short-track issue, there does appear to be an underground movement for cardiology to become a separate entity from the ABIM (if I'm not mistaken, a similar movement also exists for gastroenterology). To my knowledge, neither movements have much traction.
     
  18. Medalion

    Medalion Junior Member
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    Greetings
    I would have to agree with the posts that people who are torn between GI and cards is are torn between cash and cash. IM residents who are torn between GI and cards are the most bitter residents I have seen. They see IM residency as in obstacle in the way of them making tons of cash (ahem doing cardiology or GI). Who are these guys kidding? Please save me that they are both procedural.......... You will do far more variable procedures and technology in pulm/CC, but it will not offer the cash/lifestyle and you will have think a lot more. It is sad to see what the main drive for med students this day and age has become.
    On a more personal note, blood (cards) is ok but I will take spit (pulm) over **** (GI) any day.

    Peace
     
  19. hsans23

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    what are the soon-to-be hemeoncer residents like? that is what i will be someday b/c man am i just flat out called to that field
     
  20. sacrament

    sacrament somewhere east
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    Yeah, what a crazy crazy mixed-up world it is, when hard-working people who are in training for 10+ years want to make some money.

    I'm being sarcastic, of course. No other professional field is so ridiculous about money as we are. Before going into medicine I was a chemical engineer. I don't know the scoop these days, but at that point the average salary for chemical engineers was the highest among the engineering disciplines, and yet for some reason I doubt any of the electrical engineers got together to sneer at the chemE's... "Those petrol-heads are just in this for the cash. Who are they kidding, they don't really love thermodynamics!" And then I worked for Intel for awhile, which was a pretty well-compensated job, and for some reason none of my engineering peers made petty comments about me "just workin' for the money" or about how I should have turned down an executive-track job so that I could work for the municipal water system and drive a Honda. You know why? Because it's totally ridiculous, that's why. Nobody ever looks at you funny if you're ambitious and want to make some scratch, unless you have an M.D. after your name and then you're just sort of slimy.
     
  21. Medalion

    Medalion Junior Member
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    Hey, I don't know why you are taking it personaly. I am just ticked at the poor work ethic and cutthroat attitude of residents who are torn between cards and GI. That is what is laughable. I mean, the program director writing the letter or rec for these residents must have a pretty hard time writing two completely different letters. These residents are clearly asking the PD to lie for them, if you know what I mean.
    Take it or leave it.
     
  22. Strength&Speed

    Strength&Speed Need more speed......
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    Agreed. It's 90% about the money. I don't care that people do it for the money. it's just they manufacture all sorts of nonsense reasons.
     
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  23. Fexofenadine

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    Medicine is not what it used to be... Reimbursements are not as high. I sure hope that most people who are going through medicine are not motivated by money b/c one would be shocked by the current salary of most physicians. Sure, you can have a comfortable living with a physicain's salary, but it's by far from being wealthy. Our profession is both noble and demanding... and sometimes the reward is the simple satisfaction of salving the ravages of diseases. If money is truly a main factor.... take my advice: do orthodontics or business, not GI or cards.
     
    #23 Fexofenadine, Jun 13, 2008
    Last edited: Jun 13, 2008
  24. sacrament

    sacrament somewhere east
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    I don't take it personally, because I find it somewhat akin to somebody accusing me of being good-looking or smart.
     
  25. grendelsdragon

    grendelsdragon Synesthetic
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    Nicely said fexo.
    I know this is pretty cheesy, but the preface to the old Harrison's Internal Medicine made a huge impact on me when I was in medical school. I sometimes return to it when I need to regain my bearings... (please forgive the lack of gender neutrality. it's an old quote from the 50's).

    "No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering he needs technical skill, scientific knowledge and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this; he should be content with no less."

    I think the salary for an internist or any IM specialty would be more than sufficient to satisfy modest if not almost luxurious needs. In contrast with professions in industry, I think most people (myself included) find it somewhat obscene to seek out extreme affluence in compensation for treating the suffering or the infirm. I chose to be cardiologist because I love the practice, and I chose academic medicine (with its relative paltry financial compensation) because I love science and teaching. I think most people will be a lot happier choosing fields based upon genuine interest and satisfaction. OK, I'm off the soapbox now. Sorry.
     
  26. FrancisvsGoljan

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  27. Strength&Speed

    Strength&Speed Need more speed......
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    If you are one of the 10-20% of new matriculants into Cardiology who would do it despite the money, congratulations. However, I wouldnt extrapolate that to everyone. As altruistic as you would like everyone to be...the plain fact is that the higher paid specialties are invariably the most sought after. (that + lifestyle)

    I'm not trying to be a party pooper. I just hate hypocrisy. Although you may not possess it, it is present in almost unquantifiable amounts in this profession.
     
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    #27 Strength&Speed, Jun 14, 2008
    Last edited: Jun 14, 2008
  28. grendelsdragon

    grendelsdragon Synesthetic
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    Hehe, I am flattered that you think I am so young :D.

    I am way beyond matriculation... but an attending cardiologist and on faculty at one of the better known medical schools. I also resist being painted as naive (see my first post on this thread regarding $). I am, however, guilty of being rather romantic about the medical profession and believe that the 'heart' of its practice (please forgive the pun) is essentially philanthropic. I also do not ascribe to a wholesale caricature of any group of medical practitioners.

    Getting back to the primary topic of this thread, I am encouraging the participants to choose their medical specialty driven by intellectual interest and passion, whether it be general internal medicine, GI, cards or whatever. Just as an aside, insulting future gastroenterologists or cardiologists does not achieve anything. You never know, you may become one of them!:eek:
     
  29. Gas4Life

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    That's some pretty heavy perspective there.

    You are pretty cool for an old dragon based on your limited posts. I hope to train with fine attending physicians like you at my residency.
     
  30. grendelsdragon

    grendelsdragon Synesthetic
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    Thanks, G4L. :oops:
    However, my perspective is hardly unique. Good luck in your residency!
     

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