Is it possible in non-invasive cardiology private practice to see a majority of cases of arrhythmias and to a lesser extent ischemic cardiomyopathies?

[Mark1999]

Hello everyone,

I am a medical student and I am wondering about my future specialty. I really like non-invasive cardiology and I would like to work in the future in private practice. The subject I am passionate about is arrhythmias and less so myocardial infarctions. My question is: is it possible in private practice to see a majority of cases of arrhythmias and to a lesser extent ischemic cardiomyopathies?

Thanks in advance

Mark

---

Members don't see this ad.

 

[Davidfromcali]

Check out Electrophysiology. It's an additional fellowship after general cards.

 

[cj_cregg]

Perhaps you know this already, but you can do an electrophysiology fellowship after training in cardiology which would essentially allow you to focus on arrhythmias. Our local guy does place pacemakers and so there is a procedural component I suppose.

 

[Redpancreas]

You may very well have advanced knowledge in Cardiology relative to others, but I’d still advise you to start IM residency before you start thinking 6+ years down the line. Life is a winding path sometimes and it’s best sometimes to focus on what’s directly ahead of you. PGY1 may change your outlook altogether. If I said that 6 years of Cardiology isn’t suitable for running a clinic with mainly arrhythmias, what would that make you do? Shoot for GI? Not IM altogether? Radiology? There is a cardiology forum to discuss this sort of stuff as well and I’m sure fellows and attending will give good opinions. You may not get the best answers here.

Lastly, to give my uninformed two cents, I’m not a Cardiology fellow/attending but I would say that you’re probably not going to be able to build a practice of exclusively arrhythmias and maintain a revenue stream expected of Cardiologist unless you’re willing to see bread and butter stuff too or run a low volume clinic. Also, EP trains two additional years for a reason so why would someone see you when they can see EP. At that point, you may as well do the fellowship. That said, if you're really seeking an answer to this now, I'd take the opinion of a Cardiologist in a Cardiologist forum.

 

[Lawpy]

You may very well have advanced knowledge in Cardiology relative to others, but I’d still advise you to start IM residency before you start thinking 6+ years down the line.

This is the most important point. I really think SDN greatly underrates IM to the point where people by default view it as a stepping stone to a fellowship and nothing else. IM is really important and quite frankly builds the basis of what’s needed to be a good subspecialist, including in cards

 

[Redpancreas]

This is the most important point. I really think SDN greatly underrates IM to the point where people by default view it as a stepping stone to a fellowship and nothing else. IM is really important and quite frankly builds the basis of what’s needed to be a good subspecialist, including in cards

I'd like to think all of what I said was important, thank you very much.

 

[Redpancreas]

This is the most important point. I really think SDN greatly underrates IM to the point where people by default view it as a stepping stone to a fellowship and nothing else. IM is really important and quite frankly builds the basis of what’s needed to be a good subspecialist, including in cards

Agreed.

I think unfortunately think there has been a "frame shift" on the "medical student-fellow spectrum" where at many institutions fellows are performing the resident role sans procedural fields, the resident is doing what's traditionally the interns role, the intern is the subI, and the medical student is shadowing. I think this feeds forward and creates a cynicism where students perceive IM as glorified consulting machines which in some cases they are. I think this "frame shift" is due to several factors including 1) the increased subspecialty nature of medicine given the expanding volume of information 2) increased stakes/transparency with evolution of media/patient expectations. Gone are the days where it's sink or swim to learn something if the attending is not there. That's good for patients, but in many ways not as good for trainees. While I don't think patient care and learning are 100% mutually exclusive, I do think the previous generations of physicians gathered more clinical experience from mistakes that our generation misses out on due to a shorter leash.

I think this is why more than half of the IM residents come in thinking GI or Cards and there are threads on here lobbying for GI and Cards to be separate residencies from premeds who are using Medscape Physician salary reports to drive their field of interest. I think SDN is also skewed because I suspect most join this site as pre-meds already thinking they're going to do XYZ field and have an (understandably) severely underdeveloped understanding of what Internal Medicine or even medicine as a field even is.

I also think that other fields particularly surgeons (by nature of the limited time they have) see IM as a dumping ground. They consult medicine for pre-op if they have any comorbidity unless a patient has a modicum of a cardiac issue, in which case they'll call cards) and put their patients with surgical issues on our services to babysit. I once saw a retired subspecialty surgeon for non-purulent cellulitis that failed 1/2 a day of outpatient therapy with a clear inciting cause and he demanded an ID consult because he didn't think I knew what I was doing. He proceeded to dictate his care with outdated medicine dogma.

I have learnt not to underestimate any of the commonly dumped on fields whether it's IM, EM, General Surgery, Psychiatry, PM&R, Endocrine etc.

 

[Mark1999]

Perhaps you know this already, but you can do an electrophysiology fellowship after training in cardiology which would essentially allow you to focus on arrhythmias. Our local guy does place pacemakers and so there is a procedural component I suppose.

Thank you so much for your good advice.
I started my cardiology rotation last week and even got to shadow an EP cardiologist. It was a fascinating experience that exceeded my expectations. I think electrophysiology could be a perfect fit for me!!!

Have a nice day,

Mark