Help choosing a subspeciality

[hellothereeverybody2]

Hi all,

I'm currently in my cardiology fellowship and I was hoping to get advice on pros and cons of the different subspecialties within cardiology. I'm at a point now where I have liked all the fields within cardiology (including gen cards) and I'm struggling trying to make a decision. Perhaps some "inside" information such as work/life balance, expected salary, call structure, etc. would be helpful to know in order to sway my decision.

For those in practice or those who made their decisions, would you choose the same subspecialty again? Why or why not? And is there truly a big gap between intervention/EP and the rest of the fields in terms of salary? Thanks so much for any advice.

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[nlax30]

Yea it can be a tough decision and ultimate lifestyle will be highly variable on what sort of practice you join.... academic vs private group vs employed.

Probably an initial decision is would you like to be primarily procedural based or not. If so then obviously interventional and EP are great choices. Ultimately I ruled out interventional as I didn’t want take stemi call for the rest of my career and I felt structural was the interesting aspect of IC which would’ve required an additional year anyway. I’m biased but EP has a wide range of interesting procedures which have potential to greatly and acutely improve patients lives, involves the use of incredible technology, and seems to be changing/advancing with new techniques each year.

I also enjoyed most aspects of general cardiology, namely imaging and briefly considered an advanced imaging fellowship. Cardiac CT and Cardiac MRI were fascinating to me but I didn’t feel like I wanted to make that the focus of my career.

Work/life balance will very greatly. Obviously something like private practice IC will likely have the most grueling lifestyle. General cardiology though can also be a chore if you are having to cover multiple hospitals, frequent call and expected to be productive which is generally harder doing consultative type work vs procedures.

Salary in general higher for IC and EP which should be very similar. I know private practice EPs who are very productive (they work a lot) and make 7 figures. I also know general cardiologists that are in well run private groups who make high 6 figures. Private will generally be more than academic by at least ~100-250k. Theoretically in academics you could enjoy less call, have fellow coverage, and practice in a atmosphere that should have culture appealing to those who like to teach.

Honestly there are soo many variables it’s impossible to say anything beyond very broad general statements.

Decide if you want to be primarily procedural.
Decide if you want to practice in academics or a private setting.
Could also think about which cardio “issue” you like dealing with more... HF, valve disease, CAD, vs arrhythmias....