Help deciding between Cardiology and Heme/Onc Fellowship

[IdkLol2049]

Hello all,

I am trying to plan out my future and decide what kind of research to take on to best prepare myself for fellowships. I loved both Cardiology and Heme/Onc. If I did cardiology I think I would do interventional and maybe structural. I love procedures and I love how much variety you can get in cardiology. You can get acuity, continuity of care, you can do imaging, procedures, etc. That being said, I also love Heme/Onc. The science behind it is fascinating, it is very cerebral and changes rapidly, and there are a ton of awesome new things coming out. The future of the field is so bright. CAR-T cell therapy, immunotherapy, etc. It's an amazing field and I feel like they have a better lifestyle than cardiology. Although I understand that can vary a ton by practice setting.

Does anyone have any input/advice on how I can figure out what I want to do with my life? Thank you and my apologies if this was a stupid question.

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[dozitgetchahi]

These are fairly different types of subspecialties - one is much more cerebral (as you pointed out) while the other can be much more procedural. Heme/onc can also be much more outpatient focused, possibly also with a better lifestyle.

 

[HemeOncHopeful19]

I haven't met many Oncologists who would say they love procedures. Our "procedure" is writing/signing chemo orders in the EMR. I would start there.

I think both fields are interesting and can be rewarding careers. The only poke I'd give at Cards is that while Onc is usually seen as the "depressing field" they are still the #1 cause of death and we are just #2

 

[Ubba]

These specialties probably could not be more different if you are thinking of interventional/procedural cards. Heme/Onc has basically no procedures other than bone marrow biopsies, and those probably aren't going to scratch the itch of someone procedurally-minded. The headaches in H/O mostly come from following endless labs that often result after-hours. But it is a rewarding field, especially for the connections you form with patients (though cardiologists also earn love and respect from their patients). Would you rather nerd out on ECG waveforms and echo metrics or the names of a few hundred genetic mutations and various head-to-head studies comparing disease-free survival vs overall survival vs event-free survival, etc.?

By and large, H/O probably has a better lifestyle than Cardiology, but a noninvasive cardiologist could probably customize a decently-paying 9-4, 4-day-a-week gig if desired.

 

[gutonc]

How does the lifestyle during fellowship compare between H/O and Cardiology?

I'm not going to say it's irrelevant, but it's pretty irrelevant. What things are like for 3 years shouldn't be what helps you decide what you want to be when you grow up.

Cards fellowship is definitely much more intense than hem/onc fellowship overall. But if you really want to do cards, but do hem/onc for the lifestyle in fellowship instead, it will suck much harder overall than the difference in lifestyle during fellowship.

My first year of hem/onc fellowship was more intense than any of my years of residency, but improved drastically after that. My cards friends had a similar first year experience, but the improvement over time was less dramatic.

 

[cards67]

Interventional/structural is somewhat saturated in a lot of areas. If your idea is being in the cath lab everyday, that's unlikely to happen. It's not uncommon for IC to do a lot of gen cards as well. Plus their lifestyle is worse and their pay isn't always much better. Gen cards lifestyle can be pretty decent too, it's a lot of clinic, but everything depends on specific job. Bang for your buck, it's hard to beat gen cards, EP and probably hem-onc. Cards fellowship was tough 1st year, easy years 2-3. Just have to think about what kind of patients/disease you want to see everyday, the bread and butter, how you see yourself practicing, etc.

 

[aafisahar]

I haven't met many Oncologists who would say they love procedures. Our "procedure" is writing/signing chemo orders in the EMR. I would start there.

I think both fields are interesting and can be rewarding careers. The only poke I'd give at Cards is that while Onc is usually seen as the "depressing field" they are still the #1 cause of death and we are just #2

Do heart failure, can get the worst of both worlds.

 

[obiwan]

Do heart failure, can get the worst of both worlds.

Such a true statement

 

[bobow98]

These two specialties are like Heaven and Hell, and which is which depends on which specialist you ask.

 

[mszzeta]

Hello all,

I am trying to plan out my future and decide what kind of research to take on to best prepare myself for fellowships. I loved both Cardiology and Heme/Onc. If I did cardiology I think I would do interventional and maybe structural. I love procedures and I love how much variety you can get in cardiology. You can get acuity, continuity of care, you can do imaging, procedures, etc. That being said, I also love Heme/Onc. The science behind it is fascinating, it is very cerebral and changes rapidly, and there are a ton of awesome new things coming out. The future of the field is so bright. CAR-T cell therapy, immunotherapy, etc. It's an amazing field and I feel like they have a better lifestyle than cardiology. Although I understand that can vary a ton by practice setting.

Does anyone have any input/advice on how I can figure out what I want to do with my life? Thank you and my apologies if this was a stupid question.

The worst part of hem/onc is that you see a lot of end-of-life patients which is emotionally depressive to me. I know there are sick pts in Cards but overall a better mix.

 

[HemeOncHopeful19]

The worst part of hem/onc is that you see a lot of end-of-life patients which is emotionally depressive to me. I know there are sick pts in Cards but overall a better mix.

I would grant you the Onc patients may be more AWARE of their own mortality but since I’m not in Cards clinic I wouldn’t be able to say that for sure.

 

[CatFactorial]

Hello all,

I am trying to plan out my future and decide what kind of research to take on to best prepare myself for fellowships. I loved both Cardiology and Heme/Onc. If I did cardiology I think I would do interventional and maybe structural. I love procedures and I love how much variety you can get in cardiology. You can get acuity, continuity of care, you can do imaging, procedures, etc. That being said, I also love Heme/Onc. The science behind it is fascinating, it is very cerebral and changes rapidly, and there are a ton of awesome new things coming out. The future of the field is so bright. CAR-T cell therapy, immunotherapy, etc. It's an amazing field and I feel like they have a better lifestyle than cardiology. Although I understand that can vary a ton by practice setting.

Does anyone have any input/advice on how I can figure out what I want to do with my life? Thank you and my apologies if this was a stupid question.

If the appeal of heme/onc is immunotherapy,

Realize that the prototypical community outpatient heme/onc job primarily involves chemotherapy and anti hormonal therapy, with the exception of adding checkpoint inhibitors to the latest solid tumor indication.

The road to CAR T/NK/effector cell, BITEs, and the still reigning immune therapy, allogeneic transplant, is malignant hematology, which generally is far more inpatient and a different role from the above.

Finally, if you want to combine immunotherapy with general internal medicine, consider transplant. It is teh pwn.

 

[Jay2910]

If the appeal of heme/onc is immunotherapy,

Realize that the prototypical community outpatient heme/onc job primarily involves chemotherapy and anti hormonal therapy, with the exception of adding checkpoint inhibitors to the latest solid tumor indication.

The road to CAR T/NK/effector cell, BITEs, and the still reigning immune therapy, allogeneic transplant, is malignant hematology, which generally is far more inpatient and a different role from the above.

Finally, if you want to combine immunotherapy with general internal medicine, consider transplant. It is teh pwn.

Hey, when you say transplant . . .I was just googling and most of the stuff comes up with is transplant fellowship, done by surgery residents. Is there a special transplant fellowship? I heard of transplant floors, BM transplant floors etc. . .. Is that what you are talking about?

 

[whoknows2012]

Hey, when you say transplant . . .I was just googling and most of the stuff comes up with is transplant fellowship, done by surgery residents. Is there a special transplant fellowship? I heard of transplant floors, BM transplant floors etc. . .. Is that what you are talking about?

BMT was what they were referring to. You would do a heme/onc fellowship and depending on where you train, go right into BMT or do a BMT fellowship (1yr)

 

[Splenda88]

Heme/onc

Better work life balance and more $$$. More money is always good.

 

[TransformerInWestVirginia]

I haven't met many Oncologists who would say they love procedures. Our "procedure" is writing/signing chemo orders in the EMR. I would start there.

I think both fields are interesting and can be rewarding careers. The only poke I'd give at Cards is that while Onc is usually seen as the "depressing field" they are still the #1 cause of death and we are just #2

I know you are joking, but the reality of the situation is most cardiac patients are 60-70-80 even 90+. And the pain of dying is comparatively way more short lived.
Compared to oncology patients: many are in the 20s and 30s with excruciating bone pain, many of which have lost the light in their eyes.

 

[HemeOncHopeful19]

I know you are joking, but the reality of the situation is most cardiac patients are 60-70-80 even 90+. And the pain of dying is comparatively way more short lived.
Compared to oncology patients: many are in the 20s and 30s with excruciating bone pain, many of which have the light in their eyes.

I think people severely overestimate the number of heartbreaking cases of malignancy in people in their 20s-30s.

Ask yourself what you would think is the difference in Cardiac vs Cancer deaths in that age group. The actual number is about 200 people per year.

 

[gutonc]

I think people severely overestimate the number of heartbreaking cases of malignancy in people in their 20s-30s.

Agreed. So many IM residents primary exposure to oncology cases (at least as interns) is managing BMT disasters in the ICU and taking care of the few inpatient chemo admits we still do for solid tumors (mostly sarcoma).

Nationwide, the total number of new sarcoma cases + BMT patients in a year is ~20K. This is compared to almost 2M new cancer diagnoses (these include a ton of non-melanoma skin cancers...if you only consider "real" cancers, the number is more like 1M) each year. So most IM interns only get exposure to the sickest 1-2% of people with cancer, and therefore develop an opinion on oncology from extremely limited and massively biased data.

This would be like your entire cardiology experience coming from being the intern on the destination LVAD service and trying to decide if cardiology was the right fit for you based solely on that super sick, tiny fraction of all cardiology patients.

 

[TransformerInWestVirginia]

I agree to what you both are saying. There are probably 100 success stories of good outcomes, early recognition, early cure for every 1-2 disasters.

I actually don't have any BMT experience, but I get the point. I had an averse reaction to the metastatic cancer patients with the incurable pain.

Full respect for oncologists, and people do probably overestimate "how sad" it is. That being said, I formulated my opinion for myself through direct experience in the hospital.

 

[timpview]

Agree- the age of the patient is a huge deal.

Dealing with kids/teens/moms dying of cancer would be horrific for me as a Cardiologist

With that said it’s one thing to have to witness it (or care/manage it) and a whole another thing to cause it.

Have a case or two where you cause the death (dissect/perforate an artery) in an elective type procedure and where you witness them code/die in seconds to minutes and it’s something that will haunt you for a long time.

Both can be tough..

Perhaps the best answer is when in doubt go with the specialty with less call.

 

[wamcp]

 

[Ubba]

Agree- the age of the patient is a huge deal.

Dealing with kids/teens/moms dying of cancer would be horrific for me as a Cardiologist

With that said it’s one thing to have to witness it (or care/manage it) and a whole another thing to cause it.

Have a case or two where you cause the death (dissect/perforate an artery) in an elective type procedure and where you witness them code/die in seconds to minutes and it’s something that will haunt you for a long time.

Both can be tough..

Perhaps the best answer is when in doubt go with the specialty with less call.

Unfortunately, we in H/O are not immune to these mental challenges. >95% of the meds we give are straight-up toxins and inevitably cause morbidity at the least. Sometimes mortality. We just hope that the healthy parts of the body can outrun the cancer cells enough for us to give just the "right" amount of poison. If we had better options, we'd use them.

The longer I train and practice, the more I realize that PM&R is truly the best specialty.

 

[Señor S]

Between those two I would pick H/O: similar/better compensation (from what I know), better lifestyle and what I feel is a brighter future.

 

[CatFactorial]

I agree to what you both are saying. There are probably 100 success stories of good outcomes, early recognition, early cure for every 1-2 disasters.

I actually don't have any BMT experience, but I get the point. I had an averse reaction to the metastatic cancer patients with the incurable pain.

Full respect for oncologists, and people do probably overestimate "how sad" it is. That being said, I formulated my opinion for myself through direct experience in the hospital.

Just another bit about the sadness aspect of BMT

Allo transplant is done mostly as curative therapy for patients already in remission. Yes they can crash and burn but outcomes are dramatically better/safer than before and we transplant people in their late 70s now

 

[aafisahar]

Just another bit about the sadness aspect of BMT

Allo transplant is done mostly as curative therapy for patients already in remission. Yes they can crash and burn but outcomes are dramatically better/safer than before and we transplant people in their late 70s now

Sounds like vadding someone in their late 70s.

 

[CatFactorial]

Sounds like vadding someone in their late 70s.

Nah VAD is more like maintenance chemo

 

[TAVR4life]

Cardiology for sure. Not many specialities where a patient is literally about to die and you intervene and save their life and they get discharged the next day. Mid-level encroachment is less of a worry as no one understands the heart and everyone is afraid of it. Chest pain is number 1 cause of ER visits which means you'll always be in demand.