Outpatient Cardiology

[cag & tavr]

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Hi, I am sure you all had great experience in your cardiology training and patient care. After many back and forth discussions with my friends, I am deciding to pursue outpatient cardiology as my forte. People usually prefer inpatient and less aligned towards outpatient. I have received mixed reviews from my friends, some like it (due to continuity of care, more focused patient discussion and long-term career) and some don't (due to in-basket messages, scheduling issues, and biling/coding etc). I want to seek what are your thoughts, and how do you foresee the outpatient cardiology in the near and long-term:

 

[shouldigomd]

That is where the money and lifestyle is at.

 

[winterwarlock88]

At first, I was also hesitant going primarily outpatient. I suspect most training programs have a substandard outpatient experience due to the lack of office support. Once I started working FT, the practice provides you with the staff to help you succeed. The team is my work family and we have fun. In outpatient, I can run the day how I see fit as compared to inpatient where I am at the mercy of the consults, study results, etc. Outpatient cards is the sweet spot for sure.

 

[cards67]

Are you in the US? I don't know if people usually prefer inpatient over outpatient but no one really chooses one or the other and it's not like you really have a choice in the matter anyway. Cardiology is an outpatient specialty. The outpatient demand far exceeds inpatient and I don't see that demand ever slowing down in my lifetime.

 

[cag & tavr]

Money is certainly the icing on the cake. After training and training for decades, I feel like outpatient cardiology can be a good niche.

 

[cag & tavr]

Thanks guys. These are helpful thoughts. Having a good office staff really makes a difference - keeps the workflow going well, making it an enjoyable place and keeps it going. What are the other aspects you guys have looked into for the outpatient practice with respect to building up your patient volume. The practices I talked to keeps mentioning that I will have to build up my own referral basis!

 

[ninjaman22]

I think you will get bored of outpatient only practice. I just started in August and basically do 3 days of clinic, echo, SPECT/PET reads, and monitors, 2 days of cardiac MRI, and 6 weeks/year of inpatient at a major quaternary hospital. I enjoy my week on the inpatient service as you see more acute patients. It also helps you keep diagnostic skills sharpe. You can also get new patients to your outpatient practice from the hospital. When I do my clinic for 1 to 2 months straight, I do get a little bored.

 

[supsupsuppy]

I think you will get bored of outpatient only practice. I just started in August and basically do 3 days of clinic, echo, SPECT/PET reads, and monitors, 2 days of cardiac MRI, and 6 weeks/year of inpatient at a major quaternary hospital. I enjoy my week on the inpatient service as you see more acute patients. It also helps you keep diagnostic skills sharpe. You can also get new patients to your outpatient practice from the hospital. When I do my clinic for 1 to 2 months straight, I do get a little bored.

Disagree. Inpatient is just unnecessarily stressful. You as the new attending will draw the short stick by rounding on holidays, holiday 3 day weekends any all the least desirable shifts. Especially if inpatient there's a primary cardiology team that you have no choice but to physically go in and see and write the note. Even if the primary is a hospitalist, if it's a primary cardiology problem you're expected to write a consult note. And then you will always get new consults on the weekend and holidays. Weekend new consults often can balloon to 20+.

Keeping your "skills sharp" is not worth the inpatient trade off. Clinic is much more relaxed with a defined set schedule. Inbox whatever, you have a good clinic staff and MA and they only route you what you have to deal with. 8-5 or 9-5 hours, no weekends, no holidays no nights. It's better for your lifestyle especially if you have a family and kids.

What really are you going to accomplish with inpatient rounding? Figuring out someone is in cardiogenic shock? It's just more work for you to initiate and coordinate the transfer between hospitalist and CCU/ICU attending. You're not going to Swan or TVP any patient as a general cardiologist. You're not going to put in the impella or balloon pump.

Let the academic mental masturbation go. There's no need to trouble yourself with it any more. Outpatient cardiology is the 100% the way to go.

 

[cag & tavr]

Outpatient is unique in the sense it's for long term cardiology practice. Inpatient has its own appeal, but I feel it is short-lived and burn out can be higher especially it's not under your control and can be unpredictable! In the outpatient, you have to be quick and efficient as visits are timed! What are your thoughts on keeping reference materials handy for outpatient cardiology? Which ones can be good resources?