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

[jdh71]

---

Members don't see this ad.

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.

Maybe if you a-holes would just optimize his heart he'd feel better.

 

[Roxas]

 

[Instatewaiter]

Maybe if you a-holes would just optimize his heart he'd feel better.

He probably would feel better but unfortunately that would involve an RVAD to overcome that terrible pulmonary hypertension and right heart failure from his primarily lung Pathology. But you know, just blame the hardest working muscle in your body...

 

[olivarynucleus]

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.

How much research do you need for cards and when do you find time to do it?

 

[jdh71]

He probably would feel better but unfortunately that would involve an RVAD to overcome that terrible pulmonary hypertension and right heart failure from his primarily lung Pathology. But you know, just blame the hardest working muscle in your body...

Well. We need to pull out all the stops. Did you read that he just recently stopped smoking meth? He's turning over a new leaf. And besides you haven't don't a right heart cath yet. Get back to me after the vasodilator change before telling me it's all his lungs!!

 

[Instatewaiter]

How much research do you need for cards and when do you find time to do it?

Did you really just change the subject from the lively argument we were having...

Answer- at least one publication which you do by giving up your free time. Just like the right heart gives up in the setting of 3 working alveoli

 

[Instatewaiter]

Well. We need to pull out all the stops. Did you read that he just recently stopped smoking meth? He's turning over a new leaf. And besides you haven't don't a right heart cath yet. Get back to me after the vasodilator change before telling me it's all his lungs!!

Yeah I heard. He's now injecting it. So although he's missed more than 80% of his outpatient appointments in the last year and never takes his meds, and has no job, insurance or respect for the medical profession, I think we'll just list him for heart transplant. Want to do a combined heart lung?

 

[jdh71]

Yeah I heard. He's now injecting it. So although he's missed more than 80% of his outpatient appointments in the last year and never takes his meds, and has no job, insurance or respect for the medical profession, I think we'll just list him for heart transplant. Want to do a combined heart lung?

 

[group_theory]

Yeah I heard. He's now injecting it. So although he's missed more than 80% of his outpatient appointments in the last year and never takes his meds, and has no job, insurance or respect for the medical profession, I think we'll just list him for heart transplant. Want to do a combined heart lung?

Don't forget the liver - otherwise all your hard work will go down the drain thanks to that pesky portopulmonary hypertension and hepatopulmonary symptom

So let's do a heart/lung/liver transplant. Who wants to be primary?

 

[jw3600]

This exchange is glorious. It's like this medical version of this Family Guy skit:

 

[Instatewaiter]

Don't forget the liver - otherwise all your hard work will go down the drain thanks to that pesky portopulmonary hypertension and hepatopulmonary symptom

So let's do a heart/lung/liver transplant. Who wants to be primary?

i say admit to medicine.

 

[jdh71]

Don't forget the liver - otherwise all your hard work will go down the drain thanks to that pesky portopulmonary hypertension and hepatopulmonary symptom

So let's do a heart/lung/liver transplant. Who wants to be primary?

Oh. I think we ALL know who will be "primary" on this mess.

 

[FindMeOnTheLinks]

Don't forget the liver - otherwise all your hard work will go down the drain thanks to that pesky portopulmonary hypertension and hepatopulmonary symptom

So let's do a heart/lung/liver transplant. Who wants to be primary?

And here I was thinking the kidney was the problem. Silly me.

 

[TBV]

All are wrong this is clearly lupus

 

[Microshaft]

it's like the doctors have found their common enemy: the patient

 

[go lakers]

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?"

Fellowship is rotating between various inpatient services, imaging, procedure-oriented rotations, research, and electives.

Fellows have other responsibilities too, including reading ECGs, holter monitors, etc. Maybe they're doing their work or maybe they're just avoiding the team

If you have very strong clinical letters from cardiologists, yes

Yes general cards has a very promising future and job market is less competitive than the subspecialists

 

[Jabbed]

Was there anything in particular that pushed you to cardiology over CCM?

 

[Instatewaiter]

Was there anything in particular that pushed you to cardiology over CCM?

Well you get to do a lot of crittical care in cardiology, so if that is your thing then great. A lot of the heart failure or EP or cath attendings also attend in the ICU. But, unlike CCM, you also get to do cool stufff like caths, ablations, percutaneous closures of ASDs, pucutaneous insertion of valves, peripheral VADs, ECMO and thel like. You don't get that with just critical care. Plus you get the training to critical things in critical care that other specialties don't really get trained in.

 

[jdh71]

Well you get to do a lot of crittical care in cardiology, so if that is your thing then great. A lot of the heart failure or EP or cath attendings also attend in the ICU. But, unlike CCM, you also get to do cool stufff like caths, ablations, percutaneous closures of ASDs, pucutaneous insertion of valves, peripheral VADs, ECMO and thel like. You don't get that with just critical care. Plus you get the training to critical things in critical care that other specialties don't really get trained in.

I do ECMO. Will canulate and everything zomg!! You guys can have the rest.

 

[jdh71]

Was there anything in particular that pushed you to cardiology over CCM?

Just remember you have to do all that other horse**** he talked about.

 

[Instatewaiter]

I do ECMO. Will canulate and everything zomg!! You guys can have the rest.

You canulate for VA ecmo? interesting

 

[jdh71]

You canulate for VA ecmo? interesting

It's not brain surgery. Though only the fems.

 

[go lakers]

How much research do you need for cards and when do you find time to do it?

The more the better for academic programs. Posters, case reports, manuscripts, etc are all helpful.
Research electives & weekends

 

[PL198]

When is kobe going to make the decision to actually help the lakers and retire

 

[go lakers]

When is kobe going to make the decision to actually help the lakers and retire

After this year hopefully

 

[The Buff OP]

Hey @go lakers I know you are a busy fella (fellow =p), but I'm hoping you didn't skip my question. Thanks.

 

[go lakers]

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 would recommend the traditional route because preferences changes and the landscape of practice changes too. Many fellows come in determined to do one subspecialty and find another calling. Although I have heard some interventionalists call for IM residency to be shortened to 2 years to those who are subspecialty-inclined. Not sure if this would happen anytime soon.

The training for IC is 1-2 years focused primarily in the cath lab -- diagnostics, PCI, structural, valves, etc
The training for vascular surgery is somewhat variable (5+2, 4+2, or straight 5 integrated pathway -- their scope tends to be broader than interventional and their foundation is clearly in surgery.

Some people dread IM if they are very focused on subspecialty. However, the best subspecialists were also good at their general training. So it's worth the time spent building up.

 

[deleted158872]

Does my research have to be in Cardiology for it to be considered by Cardio fellowship directors?

 

[go lakers]

Does my research have to be in Cardiology for it to be considered by Cardio fellowship directors?

Not necessarily because programs know residents change interests. The most important part is demonstrating your ability to be productive (abstracts, manuscripts, book chapters). Work specifically in cardiology will always help but not necessary.

 

[Instatewaiter]

Does my research have to be in Cardiology for it to be considered by Cardio fellowship directors?

Not required but helpful

 

[Jabbed]

@Instatewaiter Are you going sub-specialty?

 

[karayaa]

@Instatewaiter Are you going sub-specialty?

he already did...he's in his first year of cardiology. Are you asking about a super fellowship?

 

[Instatewaiter]

he already did...he's in his first year of cardiology. Are you asking about a super fellowship?

Actually in my last year of general cardiology fellowship. And yes I am doing a superfellowship and the same shop.

 

[marstonne]

Do you see it becoming all but required in the future for interventionalists to have peripheral and/or structural training?

 

[Medstart108]

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.

Are there many Canadians in your program? Do you know what the process is like for Canadians interested in doing a Cardiology fellowship in the US?

 

[go lakers]

Are there many Canadians in your program? Do you know what the process is like for Canadians interested in doing a Cardiology fellowship in the US?

Zero in mine
Sorry wish I knew more

 

[go lakers]

Do you see it becoming all but required in the future for interventionalists to have peripheral and/or structural training?

Not necessarily. I think at specialized centers, probably. But a lot of hiring in academic centers seems to revolve around niche. I still think there will be interventionialists who have plenty to do without the additional training. In fact, I think we will be doing more and more PCI of lesions that previously were solely to be bypassed.

 

[deleted158872]

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.

Do you think a DO or a US-IMG (from solid schools in UK/Ireland/Australia) has better chance of getting a Cardiology fellowship?

Do you have family or spouse? If yes, how did they adjust to you moving locations for residency/fellowship?

Say, if after I finish Cardio fellowship and can't find a job in the location I want, can I fall back on being an IM doctor?

 

[JustPlainBill]

What is the terminal velocity of a European swallow? <you said I could ask you anything> Why DID the chicken cross the road and BTW, which came first --chicken or the egg? WTF happened at Roswell and was there a 2nd gunman in Dealey Plaza? and why do women go to the bathroom in packs?

I await your wisdom ---

 

[go lakers]

Do you think a DO or a US-IMG (from solid schools in UK/Ireland/Australia) has better chance of getting a Cardiology fellowship?

Do you have family or spouse? If yes, how did they adjust to you moving locations for residency/fellowship?

Say, if after I finish Cardio fellowship and can't find a job in the location I want, can I fall back on being an IM doctor?

DO

Family and S/O. I've never left southern ca for anything so that helped. But whatever your path, an understanding support system is key.

Yes you can.

 

[deleted158872]

Can one finish IM residency, work as an IM doctor for a few years, then go back applying for a Cardio fellowship? How difficult is it?

 

[go lakers]

Can one finish IM residency, work as an IM doctor for a few years, then go back applying for a Cardio fellowship? How difficult is it?

Yes people take time off but the more time away, will probably be harder to match.

1- it's harder to find motivation to get back in the training rat race
2- programs tend to prefer people fresh or 1 year out of fellowship

 

[StraightOuttaBrooklyn]

In fellowship, is there a, for lack of a better term, "push" to do research? Obviously research in cards during residency is important for building your CV towards cards, but during fellowship, if one desired to focus themselves more on clinical practice and skill-honing than research, is that frowned upon/stigmatized at all?

 

[235009]

In fellowship, is there a, for lack of a better term, "push" to do research? Obviously research in cards during residency is important for building your CV towards cards, but during fellowship, if one desired to focus themselves more on clinical practice and skill-honing than research, is that frowned upon/stigmatized at all?

There are clinically focused programs where research is secondary and no one really expects you to produce much…just dabble a little. Then there are research focused programs where the funding is tied to your success in research and half of your training may be set aside for research. At these programs it's not optional and the reason some people think you "need" research is because these are typically the "strong" academic programs everyone wants to go to and they try to use your prior research experience to determine whether you're actually serious about research or are going to screw them.

 

[go lakers]

There are clinically focused programs where research is secondary and no one really expects you to produce much…just dabble a little. Then there are research focused programs where the funding is tied to your success in research and half of your training may be set aside for research. At these programs it's not optional and the reason some people think you "need" research is because these are typically the "strong" academic programs everyone wants to go to and they try to use your prior research experience to determine whether you're actually serious about research or are going to screw them.

What he said

Some programs are more clinically oriented and some are more research oriented. They make it somewhat clear their goals for you as a fellow. It's best to go to one that actually fits your career goals.

 

[StraightOuttaBrooklyn]

What he said

Some programs are more clinically oriented and some are more research oriented. They make it somewhat clear their goals for you as a fellow. It's best to go to one that actually fits your career goals.

Bumping an old thread here, but can anyone provide some examples of more practice oriented fellowships (as opposed to research centric fellowships)? And going out on a limb here, but anything in NYC, Chicago, Texas / SE US and Midatlantic?

Merci 🙂


Sent from my iPhone using SDN mobile app

 

[psychMDhopefully]

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.

Question about moonlighting in IM/cardiology. Is it possible to moonlight maybe 4 hrs a week pgy2- pgy 6? What's the average hourly pay for moonlighting?

 

[Instatewaiter]

Question about moonlighting in IM/cardiology. Is it possible to moonlight maybe 4 hrs a week pgy2- pgy 6? What's the average hourly pay for moonlighting?

Depends on the residency/fellowship as to whether or not they allow moonlighting. My residency outright prohibited it. My fellowship allows it and has opportunities to moonlight in the same specialty.

On busy rotations it will be impossible. You will also likely be taking q4 call which similarly will make it near impossible unless you really want to do q2. Few moonlighting gigs allow you to do 4 hours at a time. If you want to work an average of 4 hours a week (ie 1-2 overnight shifts per month) that will be doable.

Pay will be based on city, going rate, how competitive it is to get those slots, amount of work required etc. It tends to be $75-150 per hour.

 

[Instatewaiter]

Bumping an old thread here, but can anyone provide some examples of more practice oriented fellowships (as opposed to research centric fellowships)? And going out on a limb here, but anything in NYC, Chicago, Texas / SE US and Midatlantic?

Merci 🙂


Sent from my iPhone using SDN mobile app

Definitely- Texas heart, CCF (closeish to Chicago) come to mind (places where you can get level 2 in everything). Also washington hospital center.

Likely- Emory.

Definitely not: Hopkins, MGH, The Brigham

Mayhaps- Duke, Columbia (reasonably research heavy but can probably get numbers to be level 2 in a lot of things)

 

[Psai]

Why are you guys so obsessed with trials? What ever happened to being a doctor? Nah I need a hundred thousand patient multicenter doubled blinded placebo controlled rct that shows a statistically significant 0.5% vs 0.7% difference in 30 day mortality to determine my practice patterns