Love cardiology. Hate internal medicine.

[Spodermin]

Title pretty much says it all. I don't know if I can stand 3 years of useless BS. Should I abandon cardiology and gun for rads? Or stick it out and hope that I don't end up in hospital medicine, or even worse, nephrology.

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[gutonc]

Title pretty much says it all. I don't know if I can stand 3 years of useless BS. Should I abandon cardiology and gun for rads? Or stick it out and hope that I don't end up in hospital medicine, or even worse, nephrology.

92% of cardiology is internal medicine.

 

[Spodermin]

I certainly don't see it that way. Especially interventional/EP/cardiac imaging.

 

[Moose A Moose]

Title pretty much says it all. I don't know if I can stand 3 years of useless BS. Should I abandon cardiology and gun for rads? Or stick it out and hope that I don't end up in hospital medicine, or even worse, nephrology.

Lol. Pay your dues, boyo.

 

[Doodl3s]

I'm mostly a lurker (now a cardiology fellow), but saw this and had to post because I think there many be many people in OP's shoes.... to whom I want to say: Please do not apply into Internal Medicine at all. Cardiology programs don't want you or your attitude.

Gutonc is right. Much of cardiology fellowship is wading through non-cardiac issues when you're consulted and pointing out missed diagnoses that are non-cardiac. A lot of things cause chest pain or shortness of breath other than the heart...

Many non-cardiac diagnoses in the fields of GI, Rheum, Onc, etc... come with cardiac complications and cardiology itself has heavy overlap to Pulm/Crit care (pHTN, ECMO, etc...)

Lastly, IM is amazing, you are trained to really think about a patient with multiple co-morbid diseases and be a diagnostician. You go from treating the sickest people in a MICU setting to making personal relationships in primary care clinics who hand you hand-written thank you letters when you leave residency for all you did for them.

Don't apply IM.
-FYI, this comes from someone who knew he was applying cards before even going into IM residency.
(OP is so bad, it's setting off my TROLL alarms)

 

[nlax30]

ASSUMING this isn’t a troll post....

What specifically do you not like about IM?

What sort of exposure have you had at this point? Med student rotations? I can certainly see as a med student rounding for 5 hours while a group waxes about a urine potassium value may not come across as representative of an exciting field but once you’re the one managing things just about any field in medicine is enjoyable to some degree.

You will have to deal with a good bit of IM (whatever that means) even in interventional, or EP. I’m EP and on a daily basis still adjusting BP meds, risk stratifying for procedures, counseling on weight loss, starting work ups of other medical conditions, etc....

Obviously once you get to the point of being in EP or interventional cards and out on your own you could choose to not do any of that and strictly deal with only a few direct EP or cath/coronary related issues but for most cardiologists i don’t think that approach serves them or heir patients well.

Yea there are a few instances where I am ok with that, say you’re an EP or IC who is expertly skilled at a very specific procedure.... Ex: epicardial brugada ablation, CTO PCI, etc... then yea you can be more of limited proceduralist with a very specific skill set and set just those patients. For the vast majority of us that’s not the case.

 

[gutonc]

I certainly don't see it that way. Especially interventional/EP/cardiac imaging.

Enjoy Rads.

Also...I totes ROFL'd at "gunning for Rads". These days that's like "gunning for Path".

 

[Spodermin]

Not a troll post at all. And yeah I'm just a student, that's the exposure I've had to IM. But thanks for the input.

 

[Shufflin]

You don't need to gun for Rads these days. Simply knock on the door.

 

[Shams al Deen]

How can you not like medicine, but love cardiology lol. Maybe you mean you don't like a lot of the dispo issues (SNF placement, etc) that the gen med services usually deal with, but you do enjoy the actual medicine?

 

[Vandalia]

I certainly don't see it that way. Especially interventional/EP/cardiac imaging.

Jumping in with a question: have you actually rotated on these services? I am not a cardiologist, but at least here, in the community,even the sub-specialists end up taking general cardiology call and end up with seeing their fair share of what are generally pretty basic consults in the office.

 

[Spodermin]

Jumping in with a question: have you actually rotated on these services? I am not a cardiologist, but at least here, in the community,even the sub-specialists end up taking general cardiology call and end up with seeing their fair share of what are generally pretty basic consults in the office.

Yeah I’ve rotated on IC. And yeah the cardiologist Iwas with did have to take general call.

ASSUMING this isn’t a troll post....

What specifically do you not like about IM?

What sort of exposure have you had at this point? Med student rotations? I can certainly see as a med student rounding for 5 hours while a group waxes about a urine potassium value may not come across as representative of an exciting field but once you’re the one managing things just about any field in medicine is enjoyable to some degree.

You will have to deal with a good bit of IM (whatever that means) even in interventional, or EP. I’m EP and on a daily basis still adjusting BP meds, risk stratifying for procedures, counseling on weight loss, starting work ups of other medical conditions, etc....

Obviously once you get to the point of being in EP or interventional cards and out on your own you could choose to not do any of that and strictly deal with only a few direct EP or cath/coronary related issues but for most cardiologists i don’t think that approach serves them or heir patients well.

Yea there are a few instances where I am ok with that, say you’re an EP or IC who is expertly skilled at a very specific procedure.... Ex: epicardial brugada ablation, CTO PCI, etc... then yea you can be more of limited proceduralist with a very specific skill set and set just those patients. For the vast majority of us that’s not the case.

I hate how most of IM is straightforward and almost mind numbingly boring. And when you actually get an interesting case, you end up calling the specialists in to figure out whats going on.

 

[mszzeta]

Yeah I’ve rotated on IC. And yeah the cardiologist Iwas with did have to take general call.


I hate how most of IM is straightforward and almost mind numbingly boring. And when you actually get an interesting case, you end up calling the specialists in to figure out whats going on.

"hate how most of IM is straightforward and almost mind numbingly boring"

This is what most specialties are about, unless you are practicing in the most top-tier academic center. Isn't looking at CXR for pneumonia boring for radiologist?

 

[nlax30]

I hate how most of IM is straightforward and almost mind numbingly boring. And when you actually get an interesting case, you end up calling the specialists in to figure out whats going on.

To be honest you will encounter this scenario in pretty much any field. Each speciality has its “bread and butter” cases which over time may just become the simple straightforward cases.

Every patient in the ER is not a high stakes trauma, GI is going to do a lot of screening colonoscopies, ENDO a lot of insulin adjustment, Gen Surg taking our gall bladders, and on and on.

In IM the worst aspect IMHO is probably the administrative aspect of inpatient disposition and just trying to arrange for placement/discharge. To be honest though discharge planning (med rec, arranging f/up, etc) is probably one of the more important and critical parts of inpatient care and if you’re good at it and do it well then you may have one of the most important roles in patient care.

For “interesting” cases while you may call in a specialist to handle a specific issue, if your a knowledgeable and respectable internist then you will probably at least have a differential of what may be going on and able to at least start the work up.

 

[IMreshopeful]

If you don’t at least think you can tolerate an IM residency then you should avoid cardiology as well. As others have said there’s a lot of overlap in the practice of IM and cardiology.

To that point, you don’t have to LOVE everything about IM in order to practice cardiology. I certainly didn’t love nephrology, endocrine, or ID. However, I recognized that you need to be decent at managing many of the issues you see that have an overlap with these subspecialties. Cardiorenal syndrome for nephro, endocarditis for ID, cardiotoxic chemo causing CHF, etc etc. Without a reasonably well rounded IM education you will definitely not excel in cards.

To your point re: IC/EP/imaging - most IC guys in practice and many EP folks do general cards in addition to their subspecialty. And likewise you can’t train in isolation. Lot of IC guys deal with immensely sick, critically ill patients who may need to be on ECMO, etc. When you mention your alternative as rads, it seems to me like for cards the main attraction is the $$$ and procedures/imaging - which is again a terrible reason to do IM

So do some soul searching and figure it out

 

[NITRAS]

Yeah I’ve rotated on IC. And yeah the cardiologist Iwas with did have to take general call.


I hate how most of IM is straightforward and almost mind numbingly boring. And when you actually get an interesting case, you end up calling the specialists in to figure out whats going on.

Think IM is boring, but want to go into a speciality that does the same thing over and over most of the time?

 

[IMreshopeful]

Think IM is boring, but want to go into a speciality that does the same thing over and over most of the time?

Hence my guess the motivation being
Cash money $$$
Procedures
Prestige

What he’s forgetting about (as someone going into IC):
Long hours/call
Stressful with sick patients
You need to actually talk to patients and do actual patient care outside of the cath lab

 

[Spodermin]

Thanks for the input. But $$$ is not part of the equation because I have no student debt.
So my motivation is mainly procedures.

 

[gutonc]

Thanks for the input. But $$$ is not part of the equation because I have no student debt.
So my motivation is mainly procedures.

Finally...jeebus...way to bury the lede. This makes the answer much easier.

EM
FM (UC after...or not)
Derm
Integrated IR
PMR (followed by pain, or maybe sports)
Gas (tube, line, Facebook...Facebook is a procedure, right?)
Ophtho

See anything missing in that list?
IM followed by any fellowship (including cards). Also almost any surgical specialty.

 

[IMreshopeful]

Thanks for the input. But $$$ is not part of the equation because I have no student debt.
So my motivation is mainly procedures.

There is room to be a heavy proceduralist in both IC and EP. General cardiology is less procedurally heavy although depending on where you are they do diagnostic cath, TEE, pacemakers, etc. However in all fields of cardiology you still have to take care of patients and talk to them/do actual patient care/see patients in clinic. I do think there’s incredible versatility in cardiology with respect to noninvasive imaging as well if that’s interesting.

Also looking at your other posts - it seems like you think medicine as a whole is formulaic and dull (something to the effect of 95% is CHF and COPD). Even if this were true (its not) there’s a ton of nuance in management of both conditions. So it can be very interesting

If you want to do pure procedural specialty, the only one I can think of is IR. Every surgical field requires clinic, patient care outside of procedures. Same with FM, derm, GI, PM&R, ophtho, etc. Even anesthesia (whose procedures consist mostly of intubation, lines, and TEEs unless you’re doing regional/pain) requires patient care - seeing preops, chronic pain stuff, etc.

 

[MyTachyBradyHeart]

Op sounds like a peach to work with.

If you don't find IM interesting, then you'll be sorely disappointed by cardiology, even interventional/EP. I mean, how many patients with a boring NSTEMI or AF do I have to take care of to know it all? In addition, you'll be a pretty lousy cardiologist if you don't have a strong foundation not only in managing IM patients, but also in recognizing different presentations of mundane diseases.

Best of luck in your future endeavors of doing procedures but not practicing medicine.

 

[Greenberg702]

Enjoy Rads.

Also...I totes ROFL'd at "gunning for Rads". These days that's like "gunning for Path".

You guys are tripping. The average applicant for rads is vastly better than the average IM applicant. Even at the nadir of competitiveness, the average step 1 score was like 242 (and this is with 1,200 spots). The top 25% of radiology applicants who get the best spots are 255+/AOA, etc and easily on par (and probably stronger) than the top IM kids who get cards/GI. Their job market was terrible 5 years ago, but so was yours - neither of you could get a high paying job around any metro area. I don't have a dog in this fight, just saying.

 

[IMreshopeful]

You guys are tripping. The average applicant for rads is vastly better than the average IM applicant. Even at the nadir of competitiveness, the average step 1 score was like 242 (and this is with 1,200 spots). The top 25% of radiology applicants who get the best spots are 255+/AOA, etc and easily on par (and probably stronger) than the top IM kids who get cards/GI. Their job market was terrible 5 years ago, but so was yours - neither of you could get a high paying job around any metro area. I don't have a dog in this fight, just saying.

K bro

 

[nlax30]

You guys are tripping. The average applicant for rads is vastly better than the average IM applicant. Even at the nadir of competitiveness, the average step 1 score was like 242 (and this is with 1,200 spots). The top 25% of radiology applicants who get the best spots are 255+/AOA, etc and easily on par (and probably stronger) than the top IM kids who get cards/GI. Their job market was terrible 5 years ago, but so was yours - neither of you could get a high paying job around any metro area. I don't have a dog in this fight, just saying.

 

[Limvostov]

I didn't care for general IM that much, but subspecialties were pretty much all awesome. I find the depth of knowledge great. Don't apply to IM and only expect a cardiology fellowship. IM has a lot of great options (aside from nephro) and you learn so much awesome stuff in general IM that I personally hope doesn't fade too much. Also, cards isn't all you might think as some have alluded to. You'll spend a lot of time diagnosing non cardiac issues or managing afib. Also, compared to a hospitalist your hours will suck for your whole career.

Lastly, only apply to IM if you think you could be happy doing that. The is no guarantee you'll be fellowship bound. You need to be happy with the outcome at three years.

I'm applying to interventional cards so I'll get to wake up at 2am for eternity, but I'll love what I do in general. Few get that chance.

Maybe apply radiology if you like that...