Least competitive cardiology subspecialties

[Madhatter]

What are the least competitive cardiology sub fellowships that still have a decent job market?

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[Instatewaiter]

heart failure

 

[Madhatter]

I heard heart failure is getting more competitive? How about imaging?

 

[sacrament]

I don't have any actual evidence to support this, but I have a hard time imagining that heart failure is more competitive than imaging at most centers. Imaging is relatively laid-back whereas heart failure just sucks.

 

[P Diddy]

I don't have any actual evidence to support this, but I have a hard time imagining that heart failure is more competitive than imaging at most centers. Imaging is relatively laid-back whereas heart failure just sucks.

That's true. It sucks to have evidence based therapies that actually improve mortality instead of mind-numbing stents, which improve...target vessel revascularization. Oh I'm sorry, I forgot about the invigorating 90+ year old TAVR population...what fun!

Plenty of people love heart failure. To each his/her own.

It is true that HF is less competitive than imaging , which is a combination of an increase in positions (VADs = need for more HF trained physicians = more jobs) and laziness (people prefer imaging, the ROAD of cardiology, which is less labor intensive).

p diddy

 

[Trifling Jester]

I really don't see much of a benefit to doing either fellowship... that's just my opinion.... I'll no doubt get flamed away now on a website with such an academic bias like this one lol

 

[hotshotdoc]

Is there any role of cardiac imaging fellowship trained peeps in the private world? specially in bigger cardiology groups that are doing Mitral clips and TAVRs? hows the reimbursement for them?

 

[P Diddy]

I really don't see much of a benefit to doing either fellowship... that's just my opinion.... I'll no doubt get flamed away now on a website with such an academic bias like this one lol

the only benefits of doing either fellowship are to be more competitive for jobs and to get better at doing something.

currently one doesn't need to do a subspecialty fellowship to get a job in cardiology to read imaging studies or treat patients with heart failure. but you can get a better job by being heart failure or imaging trained, and not just in academia.

it could be the difference between practicing in Nebraska or somewhere more desirable, or in getting better pay.

p diddy

 

[P Diddy]

Is there any role of cardiac imaging fellowship trained peeps in the private world? specially in bigger cardiology groups that are doing Mitral clips and TAVRs? hows the reimbursement for them?

No different reimbursement given for board certification in imaging (yet) - a TEE is a TEE. That said, as I mentioned above, special skills will get you a leg up in the hiring process, even in private practice. As cardiology hyperspecializes, not everyone will be able to perform a meaningful TAVR/COAPT TEE, among other procedures.

How important this is in hiring will vary across and within private practices and academia. As you can see from this list, we're not even close to the point where specific skills within imaging are _required_ for all imaging jobs:

http://www.nejmcareercenter.org/jobs/cardiology/

p diddy

 

[sacrament]

That's true. It sucks to have evidence based therapies that actually improve mortality instead of mind-numbing stents, which improve...target vessel revascularization. Oh I'm sorry, I forgot about the invigorating 90+ year old TAVR population...what fun!

My comment was in reference to the lifestyle. I've never known a HF specialist who didn't work like a frickin' dog.

 

[P Diddy]

My comment was in reference to the lifestyle. I've never known a HF specialist who didn't work like a frickin' dog.

Sorry, that wasn't clear.

Do you think HF specialists work harder than interventionalists? In hours I think it's fairly even, but for interventional the lead wears on you over the years, as does STEMI call. It also depends on how big the group is.

Certainly I agree that HF works harder than imaging. But it's also more fun...just like interventional is.

p diddy

 

[harrypotter7]

The only problem with CHF is that its a cancer of cardiology. You end up becoming a primary care physician for the patient, taking care of their back pains and constipation esp VAD/Transplant patients. If you miss medicine and love cardiology and would like to stay away from competitiveness, CHF is the way to go. If you want to be in control, be a leader (not that in CHF you wont be a leader, I admire Dr. Yancy a lot myself), and are ADHD, then Interventional is the way to go. Finally if you just want to sit in a dark room, and wanted to be a radiologist, and by mistake ended up in medicine and cardiology, imaging is the way to go. Its all about what you like and not what jobs are! You will be an interventionalist, CHF specialist or imaging specialist whatever u want, there are fellowship spots available for everything!!

 

[EPADHA]

Heart failure physicians tend to take ownership of their patients and pretty much deal with a lot of stuff. The specialty is not competitive as it is quite labor intensive (more than interventional at many places).

"you want to be in control, be a leader (not that in CHF you wont be a leader, I admire Dr. Yancy a lot myself), and are ADHD then Interventional is the way to go".. this is blown up BS. Some of the worst 'cardiologists' I have seen were interventionalists- they were good plumbers though. Besides I would not want some one who is ADHD doing my angioplasty- as that is when bad things happen..I hate to guess but harrypotter7 is probably doing interventional. The blown up ego comes with the territory 🙂

"Finally if you just want to sit in a dark room, and wanted to be a radiologist, and by mistake ended up in medicine and cardiology, imaging is the way to go"...more BS..

 

[harrypotter7]

I guess my post was misleading to Epadha.
And NO, I am not going to be an interventionationalist. But I am sure you are aiming for CHF.
I am going for General cardiology. Apologies if any misleading comments. Didnt want to misguide the forum. Its just my perspective. Nothing to do with the ego.
Thanks

 

[nope80]

Heart failure physicians tend to take ownership of their patients and pretty much deal with a lot of stuff. The specialty is not competitive as it is quite labor intensive (more than interventional at many places).

"you want to be in control, be a leader (not that in CHF you wont be a leader, I admire Dr. Yancy a lot myself), and are ADHD then Interventional is the way to go".. this is blown up BS. Some of the worst 'cardiologists' I have seen were interventionalists- they were good plumbers though. Besides I would not want some one who is ADHD doing my angioplasty- as that is when bad things happen..I hate to guess but harrypotter7 is probably doing interventional. The blown up ego comes with the territory 🙂

"Finally if you just want to sit in a dark room, and wanted to be a radiologist, and by mistake ended up in medicine and cardiology, imaging is the way to go"...more BS..

How are the jobs for cardiologist imagers structured? I guess it depends on academia vs private practice but in general how many days are devoted to reading imagers vs seeing patients? Are imaging jobs really structured where one is acting like a radiologist and reading images all day, 5x/week?

 

[Instatewaiter]

The only problem with CHF is that its a cancer of cardiology. You end up becoming a primary care physician for the patient, taking care of their back pains and constipation esp VAD/Transplant patients. If you miss medicine and love cardiology and would like to stay away from competitiveness, CHF is the way to go. If you want to be in control, be a leader (not that in CHF you wont be a leader, I admire Dr. Yancy a lot myself), and are ADHD, then Interventional is the way to go. Finally if you just want to sit in a dark room, and wanted to be a radiologist, and by mistake ended up in medicine and cardiology, imaging is the way to go. Its all about what you like and not what jobs are! You will be an interventionalist, CHF specialist or imaging specialist whatever u want, there are fellowship spots available for everything!!

I do think it's funny that Interventional is "competitive" right now. It makes little sense since the job market is pretty terrible... unless you want to move to Northern Montana or to Nowhere, Nebraska.

There are pros and cons to each specialty. An argument could be made that in interventional you are essentially a technician. Quite frankly, there is no need to go through IM and 3 years of cards to be an interventionalist. You could do a year of IM, a year of Cards and an interventional fellowship and be done. Plus there is a lot of funny business going on in interventional these last few years with unnecessary stenting and the new approrpiate use criteria. There is definitely a target on the back of interventional cards. With those who are structural minded, who knows what's going to happen with TAVR with more Gov't oversight. The argument could be made (and has been made) that TAVR'ing a 90 year old demented grandmother in a nursing home is irresponsible and not worth the $100K cost when you're keeping grandma alive another 6 months but now with a dense hemiplegia.

CHF similarly becomes the primary care of the cardiology world and is uncompetitive. A lot of us fled primary care for good reason. However, the job market is great and if you like the work, perfect. Furthermore, if you want, after the HF training you could very easily run a CCU for much of your practice (as you could as an interventionalist). The pay seems pretty reasonable as well. The highest paying offers for the superfellows at my hospital apparently came from heart failure fellows last year, not interventional. Plus the HF fellows choose where they want jobs, not just pray that they will be workingnext year

 

[Madhatter]

What are the typical jobs like after HF fellowship? I don't see many openings on nejm career center.