Help me decide between Ortho and IM/Cardiology

[GolDRoger]

Hello all,

M3 student that has been back and forth between ortho and IM, specifically to do cardiology, this year. I realize that the two are completely different fields, and everyone always says to first decide if you want to do surgery or not and go based off that afterwards. The thing is - I love the OR/surgery, there are some things about it that I will list below that I don't like, but I also love the cath lab/clinic. Honestly I don't find myself leaving the OR unless I'm in a gen surg/vascular/anything not ortho case. I love the OR when I'm watching ortho because of the tools, how awesome the surgeries are to me, the culture of everyone, etc... I will go further into my pros and cons below but just wanted to also say that I came into medical school wanting to do ortho. Worked in ortho and shadowed it a ton before medical school and have a bunch of research/activities in ortho. I really started considering cardiology this year because I've always enjoyed learning it and explaining it/teaching it to fellow students. I realized I had a knack for understanding it early on and upon shadowing cardiologists (IC and EP) I found that I love the procedures they do as well. I'm torn between the two and have been going back and forth like crazy. My wife is sick of me because of how much I talk about it haha. So just wanted to hear everyone's thoughts. Here's sort of my pros and cons list:

Orthopedic surgery pros: love how much you are working with your hands whether thats in clinic, in the OR, etc. Love how tangible and quick everything is. Love the idea of seeing displaced fractures and working out how exactly I will fix it and the discussions physics-wise that occur with that. Love the culture and the guys - have been working with one program for 5+ years now when I was a medical assistant and now medical student. I'm great friends with all the residents and attendings. Obviously the money is there. Love the respect that comes with orthopedics and obviously the power which everyone knows ortho is the hospital admin's baby who they will always take care of.

Orthopedic surgery cons: One thing that especially worries me is whether I will last when I'm 50+ years old. Orthopedic surgery seems taxing on the body and I do plan to get more built over the next year but I'm not necessarily a huge guy or work out often right now. I worry that in order to make a living in ortho everything depends on how much you operate and if I were to be not in shape or old I wouldn't be able to continue working if I wanted to. Another thing is I want to have kids in the next couple years, and I worry that the amount of hours in residency would not allow me to do that (versus cardio with IM it also takes a while but it's chiller process to get to cardiology vs ortho is a HARD grind all 6 years). Another thing is losing all the medical knowledge I've accumulated - part of me wants to be able to treat my kid when I'm sick and I feel it would be difficult for me to do that in ortho.

Cardiology pros: Love the heart and understanding pathophys of different heart conditions. Love teaching and how much teaching is involved in IM and cardio. Love the technology that is there with IC and EP. love the procedures (stenting, ablations, etc). love the respect that comes with cardiology and the fact that I can have great effects on people's lives and truly save lives. I do enjoy how much research is emphasized in this field. Obviously, cardiologists are very well paid and respected. Being able to keep all of my medical knowledge that I have accumulated in medical school and residency and use it. Another reason is that if a family member is sick or i guess if someone is on an airplane dying I would actually know things to be able to save them. Maybe a lame reason but I think I would like that.

Cardiology cons: super long path... like i said I'd be looking at IC or EP and that's 7-8 years post med school. That is a very long time for me but I guess ortho would also be 6 years and I feel I might age more in ortho residency than IM -> cardio. I've heard lifestyle can be quite rough. Not sure how much midlevels are involved but have heard they are more involved and can be very annoying. The poor outcomes I feel could bother me but not so much that it would make me hate my life or anything. The amount of call (though I hear ortho is a lot of call too). The fact that I wouldn't necessarily be able to see tangible results quickly. People have also called me a fool for wanting to do cardio when I have a good application for ortho and can match if my step 2 is good (haven't taken yet). Would feel bad I guess if I regret my decision later as a cardiologist and then looking back at ortho wondering what could have been.

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[gutonc]

Ortho Pros: Fat cash
Ortho Cons: 3 divorces
Cards Pros: You, onc and ortho keep the hospital solvent, so you can pretty much get whatever you want
Cards Cons: STEMI call (assuming IC)

 

[Apollyon]

Ortho Pros: Fat cash
Ortho Cons: 3 divorces
Cards Pros: You, onc and ortho keep the hospital solvent, so you can pretty much get whatever you want
Cards Cons: STEMI call (assuming IC)

Also, don't forget the worst 3 years of Cards: IM residency.

 

[GolDRoger]

Ortho Pros: Fat cash
Ortho Cons: 3 divorces
Cards Pros: You, onc and ortho keep the hospital solvent, so you can pretty much get whatever you want
Cards Cons: STEMI call (assuming IC)

Does the fat cash not apply to Cards considering if one were to do EP or IC? And is the 3 divorces for real…. Hahaha

 

[GolDRoger]

Also, don't forget the worst 3 years of Cards: IM residency.

True, I feel that it will suck for sure, but I feel like first 3 years of ortho could also suck considering how much gets placed on interns / early years in general

 

[Apollyon]

True, I feel that it will suck for sure, but I feel like first 3 years of ortho could also suck considering how much gets placed on interns / early years in general

Yeah, but, if you're into the OR, you get to go, even in those earlier years!

 

[gutonc]

Does the fat cash not apply to Cards considering if one were to do EP or IC? And is the 3 divorces for real…. Hahaha

It's not ortho fat cash. With ortho you can own an ASC and do outpatient hips or knees all day every day, own your own imaging, hire anesthesia on your own and pay them what you can get away with. Nobody's running an outpatient cath lab for elective caths.

And the first divorce is pretty much guaranteed. The 2nd and 3rd depend on how well you structure your prenup and how much you have to work to pay spouse #1 when it's over.

 

[LucidSplash]

I would encourage you not to consider the suckiness of the training as all of that is finite and inherently less meaningful to your longterm happiness than what your life will be like as an attending.

I also strongly encourage you to look at the parts of each specialty that you like the least and determine which, if any, of the parts you don’t like would cause you more pain that the parts you enjoy could make up for.

As an example I enjoyed both gen surg and vascular. Ultimately the part of gen surg I liked the least was sacral decubitus ulcers and EC fistulas. In vascular I strongly dislike maggots in feet and wet gangrene.

The latter takes me roughly 15 seconds to take off with a gigli, while the sacral decubitus ulcer is the gift that keeps on giving.

 

[onamission!]

I’m surprised no one has said this yet- don’t do either of these.
Both of these specialties will suck the life out of you from a physical/mental/emotional wellbeing. And to say to only look at attendings lifestyle or happiness when both of these routes will take at minimum 5-9 grueling years is laughable and not good advice in my humble opinion. Training years matters. 5-9 years in indentured servitude where you have minimal rights and time off as a trainee is like a prison sentence. Not to mention that a lot of things could happen during that period, people get sick and die, children could be born, you might get diagnosed with incurable cancer, etc. And even after all that training, orthopedic surgeons and interventional cardiologists are not exactly lifestyle friendly specialties.
OP, if your own well being is a major factor for you more so than what you enjoy doing, I advise that you keep an open mind and look to other specialties for a more balanced work-life in medicine.

 

[LucidSplash]

I’m surprised no one has said this yet- don’t do either of these.
Both of these specialties will suck the life out of you from a physical/mental/emotional wellbeing. And to say to only look at attendings lifestyle or happiness when both of these routes will take at minimum 5-9 years is laughable and not good advice in my humble opinion. Training years matters. And even after training, orthopedic surgeons and interventional cardiologists are not exactly lifestyle friendly specialties.
OP, if your own well being is a major factor for you more so than what you enjoy doing, I advise that you keep an open mind and look to other specialties for a more balanced work-life in medicine.

We need people in every specialty. If we continually advocate for people not to do specialties that have longer or relatively more arduous training pathways, we won’t have anyone to do those things. Especially someone who has expressed an interest in those specialties. While I think it’s equally ridiculous to try to convince someone who is, say interested in FM, to do a surgical specialty, I think it is highly inappropriate to try to talk a student out of a training pathway they are interested in because it is relatively longer. I did 9 years of training and it was hard. But life doesn’t stop while you’re in training and I’m on the other side in a time-intensive specialty. I like my life. I wouldn’t trade it for a shorter training path. The time in training is fleeting in the grand scheme of a 40-year career and the amount of call one takes in training should not influence an entire career if the student is interested in that specialty.

 

[gutonc]

I’m surprised no one has said this yet- don’t do either of these.
Both of these specialties will suck the life out of you from a physical/mental/emotional wellbeing. And to say to only look at attendings lifestyle or happiness when both of these routes will take at minimum 5-9 years is laughable and not good advice in my humble opinion. Training years matters. And even after training, orthopedic surgeons and interventional cardiologists are not exactly lifestyle friendly specialties.
OP, if your own well being is a major factor for you more so than what you enjoy doing, I advise that you keep an open mind and look to other specialties for a more balanced work-life in medicine.

What will suck the life out of you is spending your career in a specialty you hate. Training sucks no matter what you do (ask a derm resident how much they love residency) but it's finite. Once you're done you can tailor your practice to suit your lifestyle preferences.

 

[dozitgetchahi]

I’m surprised no one has said this yet- don’t do either of these.
Both of these specialties will suck the life out of you from a physical/mental/emotional wellbeing. And to say to only look at attendings lifestyle or happiness when both of these routes will take at minimum 5-9 years is laughable and not good advice in my humble opinion. Training years matters. And even after training, orthopedic surgeons and interventional cardiologists are not exactly lifestyle friendly specialties.
OP, if your own well being is a major factor for you more so than what you enjoy doing, I advise that you keep an open mind and look to other specialties for a more balanced work-life in medicine.

I don’t disagree, but I will say that I’ve encountered orthopedists and general cardiologists that seem to have reasonably good lifestyles after training (of course, they’re not going to work bankers hours like derm or allergy etc). But compared to some of the really crappy lifestyle specialties (neurosurgery, renal, OB/GYN, etc), these aren’t so bad.

That said, I’ve been very happy with choosing a true zero call, 100% outpatient specialty.

 

[LucidSplash]

I don’t disagree, but I will say that I’ve encountered orthopedists and general cardiologists that seem to have reasonably good lifestyles after training (of course, they’re not going to work bankers hours like derm or allergy etc). But compared to some of the really crappy lifestyle specialties (neurosurgery, renal, OB/GYN, etc), these aren’t so bad.

That said, I’ve been very happy with choosing a true zero call, 100% outpatient specialty.

I think people get the wrong idea about call even in busy specialties. I take 1:3.5 call on average. I am obligated to take 1:3 but anything over that I am paid extra for and I am not obligated to do it. They find coverage and pay whoever else the group volunteers. Our call pool covers 3 hospitals, one of which pays us extra for taking calls there 100% of our calls as it is not in our system.

Even in vascular, as a surgeon at a non-trauma center hospital, I would say I have an after-hours consult that I feel I need to go in and see maybe twice a month on a weekday call. Maybe once a month I operate after hours. Weekends sometimes I do a case or two and sometimes I do nothing except round. Every once in awhile I do a true emergency, something like a guillotine or a cold leg or get called to an OR because a non-vascular surgeon got into a vascular structure on accident. Ruptured AAA and dissections are shipped to the Level I center because of hospital resources, mostly our blood bank and ICU capabilities.

Most of the time, I might have a couple people admitted overnight to the hospitalist service or get a “see in the morning” consult for someone already admitted to the hospitalist service, like a gangrenous toe or a dialysis access malfunction.

So even in vascular, I have chosen not to practice big fancy aortic surgery (I do aortic surgery but elective AAA mostly) and there is a place for that. And it significantly cuts down on what I do on call. We are busy as heck during the workday, but I think most of us want that? And then I go home by 5-6pm on a weekday most of the time. Every once in awhile you have a bad weekday or weekend call. But it’s honestly not that common. You can choose to find a job like this, there are plenty out there. You just have to know what you want and what is important to you.

This is what we mean when we say that after training you can tailor your practice and your life more. Yes I do have a call obligation but for vascular this is very manageable. I work far less than I did in residency.

 

[GolDRoger]

I think people get the wrong idea about call even in busy specialties. I take 1:3.5 call on average. I am obligated to take 1:3 but anything over that I am paid extra for and I am not obligated to do it. They find coverage and pay whoever else the group volunteers. Our call pool covers 3 hospitals, one of which pays us extra for taking calls there 100% of our calls as it is not in our system.

Even in vascular, as a surgeon at a non-trauma center hospital, I would say I have an after-hours consult that I feel I need to go in and see maybe twice a month on a weekday call. Maybe once a month I operate after hours. Weekends sometimes I do a case or two and sometimes I do nothing except round. Every once in awhile I do a true emergency, something like a guillotine or a cold leg or get called to an OR because a non-vascular surgeon got into a vascular structure on accident. Ruptured AAA and dissections are shipped to the Level I center because of hospital resources, mostly our blood bank and ICU capabilities.

Most of the time, I might have a couple people admitted overnight to the hospitalist service or get a “see in the morning” consult for someone already admitted to the hospitalist service, like a gangrenous toe or a dialysis access malfunction.

So even in vascular, I have chosen not to practice big fancy aortic surgery (I do aortic surgery but elective AAA mostly) and there is a place for that. And it significantly cuts down on what I do on call. We are busy as heck during the workday, but I think most of us want that? And then I go home by 5-6pm on a weekday most of the time. Every once in awhile you have a bad weekday or weekend call. But it’s honestly not that common. You can choose to find a job like this, there are plenty out there. You just have to know what you want and what is important to you.

This is what we mean when we say that after training you can tailor your practice and your life more. Yes I do have a call obligation but for vascular this is very manageable. I work far less than I did in residency.

Thank you so much for your input - this is a great perspective - by no means would
i consider cards or ortho lifestyle but I do want to be able to tailor my practice to not have to work 65+ for the rest of my life. Some months I’m fine with doing 65+, some I want a more cush time

 

[SpineMD14]

Just to put this in perspective, I was in your same situation many years ago. I applied IM (only for cards) and Ortho. I ended up not interviewing at any IM programs but I truly loved cardiology. I am very happy I did ortho and I am now about 5 years out of training and practicing in a PP group. My call is 100% optional and paid extra. I take call because I enjoy it. I am home most clinic days by 4p and most OR days by 5p. I have 2 young kids and I have all the time in the world for them and I am training for a marathon so I have a lot of time for myself as well. I make an excellent salary despite living in a high cost of living state. No complaints - the practice you are looking for is out there if you're willing to look for it.

 

[Dral]

"Another thing is losing all the medical knowledge I've accumulated - part of me wants to be able to treat my kid when I'm sick and I feel it would be difficult for me to do that in ortho."

Just really not an issue. I am double boarded in fields where I hung up my stethoscope long ago. I mourned that for all of 3 seconds. Sick kid? Do you think you're going to forget how to Rx antibiotics? Much more than that and you start to get into areas where you probably shouldn't be treating a family member to begin with anyway.

 

[GolDRoger]

Just to put this in perspective, I was in your same situation many years ago. I applied IM (only for cards) and Ortho. I ended up not interviewing at any IM programs but I truly loved cardiology. I am very happy I did ortho and I am now about 5 years out of training and practicing in a PP group. My call is 100% optional and paid extra. I take call because I enjoy it. I am home most clinic days by 4p and most OR days by 5p. I have 2 young kids and I have all the time in the world for them and I am training for a marathon so I have a lot of time for myself as well. I make an excellent salary despite living in a high cost of living state. No complaints - the practice you are looking for is out there if you're willing to look for it.

Thank you so much for your input. Really great to hear someone else had the same thoughts as me. Honestly your life sounds exactly what I would love to have if I pursued ortho. Would you say it is feasible to have kids in residency and be able to spend an adequate amnt of time with them, and was residency as tough as everyone makes it out to be even if you love ortho? Also and sorry for all the questions here - do you find yourself exhausted most days after OR or not really

 

[gutonc]

Thank you so much for your input. Really great to hear someone else had the same thoughts as me. Honestly your life sounds exactly what I would love to have if I pursued ortho. Would you say it is feasible to have kids in residency and be able to spend an adequate amnt of time with them, and was residency as tough as everyone makes it out to be even if you love ortho? Also and sorry for all the questions here - do you find yourself exhausted most days after OR or not really

I won't speak for ortho, but I (a dude) had a kid at the end of IM intern year. I spent as much time with her as possible, but no, it wasn't enough time. I made sure the time I did spend with her was quality, but I would have loved more. That said, towards the end of my fellowship and from the beginning of my attending career, I tailored my schedule in a way that allowed me to spend more time with her. It's only in the last 2 years, when she's a high school junion/senior (with a car, a job, friends and hobbies of her own), that I've even worked close to full time.

Bottom line...you'll never have enough time with your kids. But you can have great time with them, enjoy them and raise solid citizens and cool people.