I'm a first-year Cardiology Fellow-- ask me anything

[go lakers]

Just started fellowship 3 weeks ago and I wanted to see if anyone had questions about the process leading to or Cardiology fellowship in general.

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[Carbocation1]

What are your thoughts on the state of the field with all the doom/gloom in the Cardiology? Would you recommend IM people to do Hospitalist unless they really love the heart, due to the (alleged) narrowing salary gap?

If you had not done Cardiology, what other specialty would you have gone into? Ever have 2nd thoughts?

Thanks!

 

[go lakers]

I think it's a very exciting time to be in cards, with new medications (LCZ696 and PCSK9 inhbitors both FDA approved this month), interventions (i.e. TAVR), and devices (the rise of VADs); it's a fascinating field that is constantly evolving. That being said, I wouldn't recommend anyone sub-specializing in anything unless they really love the field. You can do very well financially as a hospitalist, but there are tradeoffs, like everything in life.

If I hadn't pursued the heart, I would have gone in to Pulm/CC primarily due to a love for the physiology, ICU environment and high acuity patients. No second thoughts yet, but I'm only 3 weeks in to fellowship

 

[gobigorgohome22]

Rising 2nd year student and also interested in cardiology

- What would you say that the most thing is to get into cards fellowship, which is relatively competitive. I've heard that PD's throw away all applicants that doing come from IM at an academic institute. How true is that?

- I am also an osteopathic student. Have you seen DO's in cardiology? Do you know if there is any bias there?

Thank you!

 

[go lakers]

Rising 2nd year student and also interested in cardiology

- What would you say that the most thing is to get into cards fellowship, which is relatively competitive. I've heard that PD's throw away all applicants that doing come from IM at an academic institute. How true is that?

- I am also an osteopathic student. Have you seen DO's in cardiology? Do you know if there is any bias there?

Thank you!

In no particular order, fellowships care about where you did your residency, how you performed there (your program director's letter and advocacy play a role here), who in the world of cardiology is advocating for you, how productive you were in terms of research and chief year. Bad USMLE scores can hurt you but good scores won't help you. You definitely want to be a strong IM resident and have your program's cardiology division know you and advocate for you.

DOs in cardiology exist, but are in the minority. There is definite bias here as some fellowships will not interview any DOs (or IMGs) as a screening method. My program had 450+ applications and interviewed 70 for a class of <10 first-years. They have to do something to narrow the stack. Your best bet would be to identify early on programs that are DO-friendly historically.

 

[spicysoup55]

Can you describe what a typical day as a cardiology fellow looks like?

I really like the physiology involved in cardiology but it seems like most patients are old with CAD, HTN, HF. Do you feel that it is monotonous at all?

You mentioned an interest in the ICU environment and treating high acuity patients. Are there cardiologists who work only in the CICU?

 

[go lakers]

Can you describe what a typical day as a cardiology fellow looks like?

I really like the physiology involved in cardiology but it seems like most patients are old with CAD, HTN, HF. Do you feel that it is monotonous at all?

You mentioned an interest in the ICU environment and treating high acuity patients. Are there cardiologists who work only in the CICU?

Extremely variable depending on your practice environment (academic vs community) and your role (general cardiologist vs specialist [invasive vs non-invasive]).

Fellows' life is similar to residents' life in that you perform rotations through various fields: imaging, cath, electrophysiology, CCU, consults, etc.

I think from the outside it does look "monotonous" in that every sub specialty has its bread and butter (CAD and its sequelae in cardiology, diabetes in endocrinology, etc.) Yes you're right that your patients are generally older and much of the disease is a result of lifestyle.

But in cardiology there is a lot of depth in each sub specialty; for example in imaging you can choose to learn and perform echo, nuclear, CT, and MRI. In cath, there is general diagnostics and then advanced structural work (ie valves). Electrophysiology has bread and butter pacemakers/ICDs and advanced ablations for VT/AF. Advanced heart failure is not just diuretics and med management but also working with balloon pumps/LVAD/ecmo/transplant patients too. A general cardiologist would do a little of all of the aforementioned but rely on specialists for many aspects.

There are a small portion of trainees that do a fellowship in Cardiac critical care with plans to focus their career in an ICU setting. It is niche and more likely suitable to academics since it's not a common job in community cardiology.

 

[FutureInternist]

Rising 2nd year student and also interested in cardiology

- What would you say that the most thing is to get into cards fellowship, which is relatively competitive. I've heard that PD's throw away all applicants that doing come from IM at an academic institute. How true is that?

- I am also an osteopathic student. Have you seen DO's in cardiology? Do you know if there is any bias there?

Thank you!

Sorry to hijack the thread but you should do your best to get into an ACGME residency since the fellowship directors then know that you rec'd (mostly) adequate training. The variability in AOA residencies combined with them not really having all the rules in place that protect interns/residents will make for a hellish 3 years

It is easier to go from MD residency --> MD fellowship, so make sure you take USMLE step 1&2

 

[cs24]

Fellow hours- better or worse than residency? (in general, I know that it varies with the service you're on)

Do many programs take their own people?

Do you plan on practicing cards or further subspecializing?

 

[go lakers]

Fellow hours- better or worse than residency? (in general, I know that it varies with the service you're on)

Do many programs take their own people?

Do you plan on practicing cards or further subspecializing?

In general, better than residency in terms of hours

Yes many programs take their own. Red (maybe pink) flag if residents don't stay at their home fellowship because they see it first hand as trainees

Probably advances heart failure/transplant cardiology or general cardiology in an academic setting.

 

[Favoritefarm]

Do you find that a lot of people going into cardiology do so after first aspiring to be a surgeon and not wanting to put in the time and effort? Not asking to be rude but that is what I keep seeing and hearing from the few people I know that went into cardiology.

 

[go lakers]

Do you find that a lot of people going into cardiology do so after first aspiring to be a surgeon and not wanting to put in the time and effort? Not asking to be rude but that is what I keep seeing and hearing from the few people I know that went into cardiology.

People's motivations are very diverse. Some are noble and others not as much.

 

[gobigorgohome22]

Sorry to hijack the thread but you should do your best to get into an ACGME residency since the fellowship directors then know that you rec'd (mostly) adequate training. The variability in AOA residencies combined with them not really having all the rules in place that protect interns/residents will make for a hellish 3 years

It is easier to go from MD residency --> MD fellowship, so make sure you take USMLE step 1&2

Definitely agree with you. I'm planning on taking both next summer. I'm also doing research with a top 20 med school's cards program this summer to get experience.

I appreciate the advice! Thank you

 

[Bancrofti]

Did you fall in love with Medicine first or Cardiology first? Asking because I hear so many people talk about how they would love to do Cardio, Gastro, etc. but how they could never put themselves through 3 years of IM. Always wanted to ask someone who maybe had the same mentality whether it was a struggle/monotonous for them during the resident years. (I'm not interested in IM, just wondering).

 

[TBV]

How many publications did you have?

 

[smarts1]

What did you not like about IM residency?

 

[GadRads]

What did you not like about IM residency?

Probably the endless rounds of eternity and super long progress notes.

 

[Mamba824]

Kobe = GOAT

 

[IMreshopeful]

Do you find that a lot of people going into cardiology do so after first aspiring to be a surgeon and not wanting to put in the time and effort? Not asking to be rude but that is what I keep seeing and hearing from the few people I know that went into cardiology.

PGY-3 here. I know a couple of residents who were interested in surgery and subsequently went into cardiology. However, the idea that you won't be putting in time and effort is ludicrous. IM residency is not a joke if you're at a good program, and fellowship is probably harder from what I've heard. The time commitment is pretty long too (3 years IM + 3 years gen cards +/- 1-2 years of fellowship), which is comparable to doing a full general surgery residency (5+/-2 years of gen surg + 2-3 years of fellowship).

 

[go lakers]

Did you fall in love with Medicine first or Cardiology first? Asking because I hear so many people talk about how they would love to do Cardio, Gastro, etc. but how they could never put themselves through 3 years of IM. Always wanted to ask someone who maybe had the same mentality whether it was a struggle/monotonous for them during the resident years. (I'm not interested in IM, just wondering).

Cards first, but for personal (loss of a loved one) reasons. I loved learning medicine too and it was not monotonous for me. I also do not like the idea of being a specialist who is blind to the rest of the body, so I took internal medicine seriously

 

[go lakers]

How many publications did you have?

A lot (double digits) -- which is much more than necessary. It opened doors to certain very research oriented fellowships (duke, Ucsf, etc) but I wouldn't let research get in the way of trying to be a strong resident first.

 

[go lakers]

What did you not like about IM residency?

I enjoyed it in general and actually enjoy rounds/rounding.

Continuity clinic was not my favorite but others who are interested in primary care loves their experience.

 

[jdh71]

Why do you always think it's the lungs?

 

[go lakers]

Why do you always think it's the lungs?

Low BNP?

 

[olivarynucleus]

Just started fellowship 3 weeks ago and I wanted to see if anyone had questions about the process leading to or Cardiology fellowship in general.

How is the job market for cards?

 

[go lakers]

How is the job market for cards?

Good question. I haven't fully engaged with this process yet but i hear it is competitive in major markets especially in the world of EP and interventional. If willing to life in a smaller market, not too bad.

 

[TBV]

How many cards fellowships did you apply for? Interview in?

 

[go lakers]

How many cards fellowships did you apply for? Interview in?

Applied to ~25 and went to 10 of my interviews.

 

[Jabbed]

Was there anything in particular that pushed you to cards over pccm?

 

[HelpPleaseMD]

did most of your publications come from work as a resident?

 

[go lakers]

did most of your publications come from work as a resident?

60% residency and 40% before but were all cardiology-related

 

[Kaustikos]

Why do you always think it's the lungs?

Man,
You must LOVE EM consults.

 

[witzelsucht]

What is fellowship schedule like? What do you guys do all day? My CCU and tele fellows would always run in to the unit, round for an hour and bounce. Can you get into a low-end community fellowship from a medium-tier academic IM program with minimal research? Is there a promising future in general cards if you don't have the inclination to subspecialize? How much does "I like learning EKGs and cardiac physiology" translate to "I like cardiology fellowship/practice?"

 

[jdh71]

Low BNP?

The guy smokes, has diabetes, high cholesterol, and a brother who fell over dead at 47. And the CT of the chest and lung exam is clear. Could you at least stress the guy?? Before telling him it's his *definitely* lungs?

 

[Microshaft]

that's really cool
but why do u want to wake up at 3am for a STEMI tho

 

[The Buff OP]

People's motivations are very diverse. Some are noble and others not as much.

On a related note (kind of). If someone is interested in interventional cardiology and doesn't really want to do IM, would you still recommend them to go through the traditional route or just go for a vascular surgery integrated residency instead?

What is the difference with interventional cardiology and vascular surgery (besides the obvious routes)?

Do a lot of people that want to become cardiologist dread having to go through an IM residency and will there ever be an integrated pathway to cardiology medicine?

 

[jdh71]

On a related note (kind of). If someone is interested in interventional cardiology and doesn't really want to do IM, would you still recommend them to go through the traditional route or just go for a vascular surgery integrated residency instead?

What is the difference with interventional cardiology and vascular surgery (besides the obvious routes)?

Do a lot of people that want to become cardiologist dread having to go through an IM residency and will there ever be an integrated pathway to cardiology medicine?

I've never heard or seen a single vascular surgeon doing interventional cardiology.

 

[The Buff OP]

I've never heard or seen a single vascular surgeon doing interventional cardiology.

I meant as like if you want to do cath lab procedures. They do have that in common, right?

 

[jdh71]

I meant as like if you want to do cath lab procedures. They do have that in common, right?

Yes. The vascular surgeons own the endovascular domain outside of the heart and brain. Though the cardiologists do occasionally do some stenting outside the heart. There is also over lap with some aggressive IR types vascular peripheral stents. And anything done in the brain is often reserved as well to neurosurgeons and IR.

 

[The Buff OP]

Yes. The vascular surgeons own the endovascular domain outside of the heart and brain. Though the cardiologists do occasionally do some stenting outside the heart. There is also over lap with some aggressive IR types vascular peripheral stents. And anything done in the brain is often reserved as well to neurosurgeons and IR.

Cool.

 

[Psai]

cardiologists have been encroaching on leg stents where i'm at. i've seen several patients who have had stents placed in incidentally found blockages. no rest pain, no leg ulcers, no claudication, no lifestyle changes beforehand

 

[Jabbed]

cardiologists have been encroaching on leg stents where i'm at. i've seen several patients who have had stents placed in incidentally found blockages. no rest pain, no leg ulcers, no claudication, no lifestyle changes beforehand

"Well, seeing as we already got the cath set-up..."

 

[jdh71]

cardiologists have been encroaching on leg stents where i'm at. i've seen several patients who have had stents placed in incidentally found blockages. no rest pain, no leg ulcers, no claudication, no lifestyle changes beforehand

I knew a guy (cardiologist) who would stent carotids and renals. Though I think most prefer not to venture too far afield as it's not strictly standard - complications could lead to an awkward conversation with a vascular surgeon.

 

[go lakers]

cardiologists have been encroaching on leg stents where i'm at. i've seen several patients who have had stents placed in incidentally found blockages. no rest pain, no leg ulcers, no claudication, no lifestyle changes beforehand

It's cardioVASCULAR medicine and turf wars exist in many parts of medicine. It's part of the environment.

 

[Psai]

It's cardioVASCULAR medicine and turf wars exist in many parts of medicine. It's part of the environment.

Yeah except that they dont know much about the vascular part so when the stent becomes occluded its all oh lets call vascular surgery

 

[go lakers]

Yeah except that they dont know much about the vascular part so when the stent becomes occluded its all oh lets call vascular surgery

Neither does interventional radiology. That's part of medicine.

 

[Instatewaiter]

Why do you always think it's the lungs?

Perhaps you should stop consulting us when it Is the lungs.

 

[jdh71]

Perhaps you should stop consulting us when it Is the lungs.

I don't consult cardiology.

 

[Instatewaiter]

I don't consult cardiology.

Except when it's clearly the lungs.

You know that 70 year old with a 100 packyear history, on 4l oxygen at home with an fev1 of 0.6.

 

[jdh71]

The only time I consult cards is if I think maybe they should consider cathing a guy soon.

Outside the academic ivory towers, sick hearts that can't be immediately cathed get handled by the intensivist. So I barely call a cardiologist anymore.