Love cards but not IM?

[tiger2011]

Does anyone out there really like cardiology but generally dislike the rest of internal medicine? I love the procedures, love the physiology, find the diseases fascinating, but the rest of medicine just doesn't do it for me.

It would be comforting to know whether there are any cards fellows or IM residents pursuing cardiology who feel the same way as I do, before I choose to bite the bullet for an intense 3 years of mostly stuff I don't enjoy.

Thanks!

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[KaLiMaN]

Does anyone out there really like cardiology but generally dislike the rest of internal medicine? I love the procedures, love the physiology, find the diseases fascinating, but the rest of medicine just doesn't do it for me.

It would be comforting to know whether there are any cards fellows or IM residents pursuing cardiology who feel the same way as I do, before I choose to bite the bullet for an intense 3 years of mostly stuff I don't enjoy.

Thanks!

Well, everyone is different, but I would say, I have enjoyed every single rotation of IM with very few exceptions. I do know, however, people who have done Radiology just to become neuro-intervensionists, and some of these people even hate diagnostic radiology. I'd assume you're probably most intereted in interventional or EP cardiology right ?. I don't really see anything wrong with that. Just don't say it during your IM and Cardiology fellowship interviews.

 

[wellchild]

Does anyone out there really like cardiology but generally dislike the rest of internal medicine? I love the procedures, love the physiology, find the diseases fascinating, but the rest of medicine just doesn't do it for me.

It would be comforting to know whether there are any cards fellows or IM residents pursuing cardiology who feel the same way as I do, before I choose to bite the bullet for an intense 3 years of mostly stuff I don't enjoy.

Thanks!

There's always peds cards...

 

[KRichards62]

Does anyone out there really like cardiology but generally dislike the rest of internal medicine? I love the procedures, love the physiology, find the diseases fascinating, but the rest of medicine just doesn't do it for me.

It would be comforting to know whether there are any cards fellows or IM residents pursuing cardiology who feel the same way as I do, before I choose to bite the bullet for an intense 3 years of mostly stuff I don't enjoy.

Thanks!

My advice would be to proceed with caution. While cardiology can be very subspecialized, the foundation is rooted in internal medicine. The best cardiologists are well trained in the basics - history and physical exam, patient interaction, firm understanding of comorbid conditions such as diabetes, HTN, hyperlipidemia, renal disease, pulmonary disease, infection, etc. The more time you spend taking care of cardiac patients, the more you will realize how integral other internal medicine topics are.

On a more practical note, it is important to understand that cardiology is a very competitive fellowship. You will only spend a few months of your 3 year residency doing cardiology specific rotations. The rest of the time you will be doing rotations you don't like. This is a recipe for a bad/unhappy resident. Bad IM residents don't get good fellowships.

 

[tiger2011]

Thanks for the honest responses. The truth is, I quite enjoy the intellectual nature of internal medicine, and therefore enjoy reading about the pathophys/diagnosis/treatment of various disease processes (AKI, GI bleeds, electrolyte abnormalities, etc). The problem is that when it comes to medicine in practice, I really don't have much of a stomach for the typical patient admitted to a general medicine floor who has 50 medical problems and stays in the hospital for a week for largely social issues (nursing home placement, etc). Meanwhile the medicine team is responsible for managing the insulin, htn meds, and so on.

As for cards, I understand that the heart is connected to the rest of the body, and that organs other than the heart need to be considered in cards patients. I embrace this. I just really don't want to have to be the guy to figure out how much insulin to give him, or (shudder) spend my entire day trying to figure out how to coordinate his home nursing care.

And yes, you're right- I was thinking interventional or EP. But that doesn't mean I don't like general cardiovascular medicine either. I guess I just don't see myself as a generalist at all.

Thoughts?

 

[1986]

right there with you

 

[BGriffin]

Thanks for the honest responses. The truth is, I quite enjoy the intellectual nature of internal medicine, and therefore enjoy reading about the pathophys/diagnosis/treatment of various disease processes (AKI, GI bleeds, electrolyte abnormalities, etc). The problem is that when it comes to medicine in practice, I really don't have much of a stomach for the typical patient admitted to a general medicine floor who has 50 medical problems and stays in the hospital for a week for largely social issues (nursing home placement, etc). Meanwhile the medicine team is responsible for managing the insulin, htn meds, and so on.

As for cards, I understand that the heart is connected to the rest of the body, and that organs other than the heart need to be considered in cards patients. I embrace this. I just really don't want to have to be the guy to figure out how much insulin to give him, or (shudder) spend my entire day trying to figure out how to coordinate his home nursing care.

And yes, you're right- I was thinking interventional or EP. But that doesn't mean I don't like general cardiovascular medicine either. I guess I just don't see myself as a generalist at all.

Thoughts?

I'm not sure there are a lot of people who enjoy dealing with the social issues of gen med that you speak of. I'm sure even hospitalists hate it. Dealing with insulin/DM, AKI, etc however is definitely important in managing cards patients (and also good just for general knowledge since a huge proportion of your future patients will have them, regardless of your specialty). This is coming from a guy who pretty much does not like most areas of internal medicine outside of cards. If you have decent research, come from a strong IM program, and don't piss anyone off while you're a resident, you should be able to get into a decent cards program; you don't necessarily need to be in love with gen med.

 

[dragonfly99]

If you really hate IM, you could try getting into one of those "short track" IM to cards programs. You'll only have to do 2 years of IM then. You will have to do a couple of years of research, but you may prefer that the pain or a 3rd year of IM.

 

[tiger2011]

If you really hate IM, you could try getting into one of those "short track" IM to cards programs. You'll only have to do 2 years of IM then. You will have to do a couple of years of research, but you may prefer that the pain or a 3rd year of IM.

I've actually thought about this a bit, but I think it would be a hard sell, since all of my research so far has been in an unrelated field (went into med school thinking something surgical). From my understanding the people who do the fast track programs are research all-stars and/or MD/PhDs with the intent to enter academia, no? I enjoy research as a trainee but I'm probably headed towards private practice, so probably not much chance I'd get a look from any fast-track programs. I wonder if it helps to have stellar grades/AOA/step1?

 

[KaLiMaN]

I've actually thought about this a bit, but I think it would be a hard sell, since all of my research so far has been in an unrelated field (went into med school thinking something surgical). From my understanding the people who do the fast track programs are research all-stars and/or MD/PhDs with the intent to enter academia, no? I enjoy research as a trainee but I'm probably headed towards private practice, so probably not much chance I'd get a look from any fast-track programs. I wonder if it helps to have stellar grades/AOA/step1?

What about thoracic surgery? You mentioned you wanted to be a surgeon, or you don't feel like doing general surgery either? It seems to me you have a more surgical profile.

 

[tiger2011]

What about thoracic surgery? You mentioned you wanted to be a surgeon, or you don't feel like doing general surgery either? It seems to me you have a more surgical profile.

Considered that, but it's definitely not my thing. I'm all for working hard, but I'm not a masochist. Just wish there was a better streamlined path to cards.

 

[dragonfly99]

Half those people who do research tracks will probably end up in private practice. I think you could get a look from research track programs if you have good grades and USMLE scores and some kind of research background.
It just depends what kind of pain you want...potential pain of indentured servitude in someone's lab versus pain of 2 upper level internal medicine years.

 

[Friendly]

Half those people who do research tracks will probably end up in private practice. I think you could get a look from research track programs if you have good grades and USMLE scores and some kind of research background.
It just depends what kind of pain you want...potential pain of indentured servitude in someone's lab versus pain of 2 upper level internal medicine years.

No they won't. You really think two years of a clinical fellowship is enough time to get class 2 in nuclear and echo and to gather all the trimmings private practice is going to want? I don't.

 

[tiger2011]

bump- anyone else in this boat?

 

[IRGuru]

bump- anyone else in this boat?

I didn't HATE medicine...but I just couldn't get myself to be excited about it and I REALLY REALLY didn't like note-writing/too often being a social worker. I always thought that would end up grinding on me...as a result, I chose IR

 

[BigRedBeta]

, I really don't have much of a stomach for the typical patient admitted to a general medicine floor who has 50 medical problems and stays in the hospital for a week for largely social issues (nursing home placement, etc).

Thoughts?

To be honest...this makes peds cardiology sounds much more up your alley, assuming you can handle kids. The heart kids are usually the most complicated ones in the entire hospital, but they don't compare to the train wrecks you see on medicine floors.

Plus, I'd argue that the physiology of congenital heart disease is way more fascinating than adult disease, and there are plenty of opportunities for doing interventional procedures.

Lastly, if you want to really make a difference for your patients, there's nothing you can do that beats pediatrics. You do your job, and a child who would have otherwise never made it past 6 months lives into adulthood and often has an extremely normal life. Way better than prolonging the life of the patient who won't take their meds, won't stop drinking or smoking, and flatly refuses to change anything about their diet or lifestyle yet expects you to fix them...

Just some thoughts.

 

[dragonfly99]

No they won't. You really think two years of a clinical fellowship is enough time to get class 2 in nuclear and echo and to gather all the trimmings private practice is going to want? I don't.

That's actually a good point, although I don't think all "short track" programs only allow 24 months clinical cards, do they? What they all generally do is cut off/truncate the IM residency so that one only has to do two years. The reality is that once a cards fellowship has taken someone, they are generally committed to training the person and would probably allow more clinical rotations if someone needed or wanted them (even if only 2 clinical years were technically required). they may not let him out of any of the lab and/or other research time, though.