Lifestyle of Interventional Cards variable???

[Firebird]

Is it possible for an interventional cardiologist to choose not to do emergent cases? This would help to alleviate the bad lifestyle that everyone talks about, but still allow the physician to practice as an interventionalist. I think doing procedures like interventionalists do would be great, but I think I would be miserable with the long hours and call. I am sure someone is thinking about telling me that I need to pick a specialty based on what I like to do, rather than the call schedule and amount of time spent in the hospital...but I would just like a straight forward answer to the original question. Thanks!

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[chanx314]

I don't think you quite understand how hospitals work. In order to do interventional procedures, you need a hospital(unless you have the cash for a stand alone surgicenter, in which case you need a rich clientele because some insurers will not pay for procedures done in a surgicenter). In order for a hospital to grant you admitting priveleges, you enter with them into a mutual contract whereby you agree to take call for certain periods of time. One ways to lesson such call is to work for a group because a group can split the call amongst themselves making the workload easier.

 

[Firebird]

You're right, I don't understand how hospitals work. That is precisely why I was asking the question. Thanks for the info, though!

 

[novacek88]

While you are it, why don't you ask if you can become a neurosurgeon yet avoid all cases related to head trauma and emergencies.

 

[Firebird]

Thanks for the comments, even if they weren't meant to be constructive or helpful. Lifestyle is important to me, as is picking a specialty that I enjoy. I want to explore the possibilities of different specialties, including the idea of not doing emergent interventional procedures. I am sure somewhere there is someone who has this sort of deal. But clearly your comment, albeit sarcastic, is evidence that it would be a rarity.

 

[TBforme]

there are options other than interventional cards if you like procedures but want a better lifestyle. GI is better than cards in this respect. the beautiful paradox of the GI bleeder: the patient is stable in which time it can wait until the morning or the patient is unstable in which case stabalize him and wait until the morning or call surgery. interventional rads is also an option. the hours can be long like a surgeons, but probably less emergent cases than interventional cards.

 

[novacek88]

Thanks for the comments, even if they weren't meant to be constructive or helpful. Lifestyle is important to me, as is picking a specialty that I enjoy. I want to explore the possibilities of different specialties, including the idea of not doing emergent interventional procedures. I am sure somewhere there is someone who has this sort of deal. But clearly your comment, albeit sarcastic, is evidence that it would be a rarity.

No, there is no deal in which someone does interventional cardiology not relating to emergent cases. That very notion is an oxymoron and thus the question is rather silly. Do you think people say: "I think I will schedule my MI at 1 PM so my doc doesn't have to wake up in the middle of the night."

If lifestyle is important to you then interventional cardiology is probably not your best option. I feel like all medical students go through this growing up period where they realize they CAN'T have their cake and eat it too. I know so many who loved surgery and would have gone into surgery but lifestyle took precedence over that and they made the mature decision and avoided it. Likewise, I know people who desired a great lifestyle but made the sacrafice so that they could practice the field they love. You need to grow up and realize that you can't have it both ways. Figure out what is more important to you and then choose based on that. So no, you won't be able to be an interventional cardiology and avoid emergent cases. I will be a GI fellow and while it's lifestyle is considerably better than cardiology, it's still more strenuous than many fields of medicine. I wouldn't go into GI for lifestyle.

 

[Firebird]

I was unaware that interventional cardiology was emergency cases only. I was under the impression that they could place stents in, for example, stenosed popliteals. Further, a great number of caths are in fact scheduled. If the pt needs a stent, they're not going to wait until the pt has an MI.

Your friend who avoided surgery because of lifestyle should have looked at it more closely. There are breast surgeons who work 9-5 and do not take general surgery call. ENT, Urology, Plastics, etc. all have good lifestyle. Even beyond that, a general surgeon can do ok in a big practice and not work as hard as a general surgeon used to.

 

[novacek88]

I was unaware that interventional cardiology was emergency cases only. I was under the impression that they could place stents in, for example, stenosed popliteals. Further, a great number of caths are in fact scheduled. If the pt needs a stent, they're not going to wait until the pt has an MI.

Your friend who avoided surgery because of lifestyle should have looked at it more closely. There are breast surgeons who work 9-5 and do not take general surgery call. ENT, Urology, Plastics, etc. all have good lifestyle. Even beyond that, a general surgeon can do ok in a big practice and not work as hard as a general surgeon used to.

Yes, but those patients that are scheduled to have a stent often have "emergent" complications that would require you to intially see them outside of normal business hours before scheduling the stent. That would interfere with your lifestyle. A patient rarely walks into a cardiologists office and says; "You know I have a family history and I fear I might have an occlusion. Could you check it out so that we can schedule placing a stent" Also, do you think patients that have procedures don't suffer from future complications? Also, there are procedures that are not emergent but what fraction of any successful cardiology practice do you think that encompasses. Did you really think you could make a living solely addressing stenosed popliteals for example?

Perhaps, you should examine those fields more closely like my friends. The fields of surgery you mentioned can offer reasonable lifestyles however that lifestyle come after training. It's easy for any medical student to simply discount 5-8 years worth of residency/fellowship but when you are approaching your 4th year of medical school, reality starts to dawn on you. You will realize that extensive training period isn't somthing you can ignore. Furthermore, the breast surgeons and others who established the 9-5 didn't do so immediately following residency. It takes time to establish that type of practice so it requires initial years that encompass much longer hours than the ones mentioned.

 

[Dr. J?]

Ah, yes....the voice of reason. So often not heard on SDN. Good post Novacek88.

 

[Firebird]

I am well aware that patients don't walk in and talk about their occlusion and how they want a stent. But they do often walk in and say, "You know, I just can't walk much more than a block without my legs cramping up...but as soon as I sit down, the pain goes away." These pts can undergo bypass. But I suspect in the future, the standard of care will be the less invasive stent placement, rather than cutting holes in arteries and sewing things together.

At any rate, it is a mistake to allow the intensity of a residency to interefere with your choice of your specialty. You'll be practicing medicine for 30+ years and so why allow a tough 5 years to keep you from doing what you want to do for the rest of your life?

 

[Fascia Lata]

No, there is no deal in which someone does interventional cardiology not relating to emergent cases. That very notion is an oxymoron and thus the question is rather silly. Do you think people say: "I think I will schedule my MI at 1 PM so my doc doesn't have to wake up in the middle of the night."

Correct me guys if I'm wrong, but I read somewhere (Kaplan notes for USMLE step 2 CK) that only 25% of US hospitals are able to provide primary PTCA (in acute MI setting). This is because 1ry PTCA needs a ready OR so that if anything goes wrong (e.g. rupture of the coronaries), the surgeon would take hand.

Can I assume that NOT every hospital with a cath lab does provide 1ry PTCA?? Actually this is why they still use thrombolytic therapy. To avoid the waiting time if they refer a patient to another center, which may take up to 2-3 hours.

Just a thought.

 

[HiddenTruth]

this is somewhat unrelated, but you can always do INVASIVE cardiology (which is not necessarily interventional). From what I understand, an invasive cardiologist is one who has undergone general/clinical cardiology training that chooses to perform diagnostic cath's, but no interventions of course. So, by that regard, you would NOT be the person running into the hospital at 3AM if someone walks in with ST elev. But, you can still spend time in the cath lab during business hours. Just a food for thought.

I am curious though, are invasive card's really needed anymore though, since a pt can be referred directly to an interventionalist who can then perform angioplasty during a diagnostic cath procedure, if needed rather than having to re-cath them if something was found during a diagnostic cath, by an invasive cardiologist?

Also, I briefly researched this, and from what I understand, interventionalists are not making much more, if anything more, than general cardiologists. Is this accurate?

Thanks.

 

[Saabdriver]

At any rate, it is a mistake to allow the intensity of a residency to interefere with your choice of your specialty. You'll be practicing medicine for 30+ years and so why allow a tough 5 years to keep you from doing what you want to do for the rest of your life?

Sure don't let 5 tough years from your chosen career, except if you're thinking of interventional cardiology its more like 8 at years of training post MD.

As far as lifestyle the prevalance of interventional cardiologists is already shifting the workload from emergency to business hours as more and more patients who would end up in the ER with a STEMI are being diagnosed and treated electively. Obviously getting up in the middle of the night throughout your career is not fun, but what other specialty gives you the opportunity to intervene in a situation that just 50 years ago had a 50% mortality rate, it's often cliched to say that any physician really saves someone's life but primary PCI comes awful close.

 

[Firebird]

I thought the interventional fellowship was only 1 year. But I have been wrong before

Anyway, I thought that this might be the case...early diagnosis (as in the case I mentioned with the stenotic pop) leading to elective stenting rather than emergent.

 

[P Diddy]

I thought the interventional fellowship was only 1 year. But I have been wrong before
QUOTE]

it is usually one year. it is also usually one year of hell. at my institution the interventional fellows are Q2 for 1 year. they split it up by taking call a week at a time.

p diddy

 

[Firebird]

Yeah that sounds pretty rough...like a surgery internship...or worse. A week at a time wouldn't be that bad, though. I would rather do that than be q2. It would be a bad week, but after that you'd at least have the rest of the month to relax after business hours (or thereabouts).

 

[uclabruins47]

Yeah that sounds pretty rough...like a surgery internship...or worse. A week at a time wouldn't be that bad, though. I would rather do that than be q2. It would be a bad week, but after that you'd at least have the rest of the month to relax after business hours (or thereabouts).

what you're describing is a Q4 call with 7 calls/months. Q2 means 14 call days/month so you wouldn't have the REST of the month off. it's more like a week of no call then another week of call

 

[Firebird]

Yeah you're right, obviously. I guess I was thinking that the program had, say 4 fellows, 2 of which would be on call each night splitting the work. Instead they chose to be on alone and took call one week a month. I have no idea why I thought that, rather than the obvious.

 

[P Diddy]

what you're describing is a Q4 call with 7 calls/months. Q2 means 14 call days/month so you wouldn't have the REST of the month off. it's more like a week of no call then another week of call

exactly. have fun divorcing your wife/husband!

p diddy

 

[HiddenTruth]

aren't most interventional -ships, now 2 years?