pediatric cardiology or ophtho?

[grmed]

hi guys. I wanna apply this year for residency and I can't really decide.I really love ped cards but I don't know how the future will be and although money is not the only think that counts with all the debt(student loans) it is a considerable factor. The other specialty I love is ophthalmology which they told me is better as far as lifestyle and money are concerned.
Do you think that interventional ped cards or EP add to the income or are just more years of training? I have family and i'm worried about the lifetyle of a pediatric cardiologist.And last I know a ped cardiologist who told me that makes $500k.Is that possible???
Thanks guys

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[copacetic]

if you are concerned about making enough to pay off student loans, cards will is no problem. note that the starting salaries for cards are higher than starting salaries for optho. most optho folks work 4 or 4 and a half days a week, so the lifestyle is pretty sweet in general. however in-hosptal optho can be as hectec or mor hectec than something like interventional cardiology. the average EP income is about 480K + while the average interventional income is about 550K+, while general cardiology is about 350K + note the these values are net incomes before taxes and expenses. i myself am interested in EP, its a very esoteric field. in some ways more art than science, but its very stimulating. EP lifestyle is better than inteventional cards lifestyle because some of the emrgent cases can wait till morning (a general cards can stabalize the patient till you get there). if you are concerned about lifestyle in cards, you can choose the practice style you want. you can decided to work 4 days a week instead of 5, and still make 400K easily. i am in canada, and i know an interventional guy that does this. its very doable in both the states and canada. do a cards job search. i've seen some people advertising 4 day workweeks and 10 hour days plus call 1:5. the thing about cards is that the people who get into it tend to be workaholics anyways, and really love what they do. so to these guys working 80 hours a week is cool with them. one of my mentors, an academic EP comes in at 5:30 in the morning, but makes sure he leaves around 4:30 so he can get home and see his kids and family. he does family stuff for like 4 hours, then around 8-9 when his kids are in bed (their young) he reads journals, and does what academics do. YOU have to make the effeort whatever specialty you end up in. theres plenty of people in ROAD specialties that end up divorced or not seeing their family because of lack of effort, or bad time management. its all on you. life really is what you make it.

 

[copacetic]

as another note, CT cards is pretty nice lifestylet oo. the guys i know are all out by 5 to get home too. its not like you're gonna be working till 12 or something. maybe during residency, or if you love cards more than your family, but thats up to you

 

[grmed]

Thank you very much for your responses.I'm specifically interested in pediatric cardiology and I was told that the compensation sucks.Do interventional pediatric cardiologists make more? How is the lifestyle?

 

[copacetic]

the only reason why pediatric cardiologists would make more is because you are working with a smaller population size. compare how many younglings have cards problems/issues compared to adults.


Specialty>>

All Physicians

>>Starting

>>Eastern

>>Western

>>Southern

>>Northern

>>RSS


Pediatric Cardiology >>$218,331>> ****>> $191,668 >>$264,915 >>$180,000 >>$249,996>> n/a
source: http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

salary wizard median= 220K

source: http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000322.html

once again i would bet anything the difference is due to the fact that there will be less peds cases. note that the salaries are comparable to optho. in terms of lifestyle:

quote:
"My understanding is that their lifestyle in terms of rough hours and busy overnight calls is that they are approximately the same. There are far fewer peds patients who need to see cardiologists, but those patients who do are very sick and they go to major medical centers that only have one to a few peds cardiologists on staff. So, fewer peds patients plus fewer peds cardiologists adds up to roughly the same number of hours as an adult cardiologist. A pedetrician would be able to answer this question better then I could though."

source: http://forums.studentdoctor.net/showthread.php?t=103089

so lifestyle is pretty comparable to general cardiologist. probably not as bad as interventional though.

 

[copacetic]

sry for the bad formatting...

 

[grmed]

Thank you so so much!!!!!If I knew that a pediatric cardiologist can make as much as an ophthalmologist I would definitely choose it as it is an area I really love.I really believe that in the future things will change and pediatric subspecialties will become more lucrative than now as children will be given much more attention and preference. I would really like to know if becoming an interventional pediatric cardiologist would add more $$ than the regular pediatric cardiologist.

 

[Myostatin]

People in the peds forum might have more accurate answers for you as peds cardiology is a peds speciality Though pediatric cardiology salaries are sig lower than what you would expect from adult cards (unfortunately), you will have no difficulty paying off your loans as a pediatric cardiologist. Optho salaries are probably not as high as billed, especially if you're planning for a 4 day work week and you're in an urban setting - if you're planning on retinal surgery or have a very busy cosmetic practice that's a different story.

I would assume that interventional pediatric cardiologists get paid well for their procedures, but in general there is just not that much volume in pediatric ep/interventional, and I think much of what you do will be general cards.

Other things to keep in mind - getting a peds cardiology fellowship spot is not easy, and many people don't match, from what I've seen, so there is some risk relative to optho, where you'll know right up front if you've matched or not. That being said, pediatric cardiology is about as intellectually interesting as it gets in medicine, if you like using your head....

 

[grmed]

Myostatin your post is amazing. I will ask the pediatricians but your analysis is very interesting and helpful!

 

[oldbearprofessor]

Sorry for closing the duplicate post in pedi, but this one had answers already....

Whenever someone asks about a pedi specialty vs a very different option, I think it's important to decide first about whether you want to be a pediatrician. This is not a trivial issue. No matter how much you may want to be a pedi cardiologist, there is no route to it that doesn't include 3 years of pediatric residency (well, unless you fast track...). Sure you can not like well-child care (I don't), but if you don't want to put up with a pedi residency you won't like the route to any pedi specialty.

As far as lifestyle and salary, I'd point out that pedi cards has both academic and private practice opportunities. There is a huge variation in the practice of different pedi cardiologists across the country and between those in large pedi hospitals and those in smaller hospitals. Furthermore, EP and cath have gradually become, in big children's hospitals, more limited to those with extra training in them.

Bottom line is that it's very hard to generalize. First, do whatever it takes to decide if you want to be a pediatrician or an ophthalmologist and then go from there.

You're welcome to post some specific questions about pedi cards fellowship and practice on the pedi forum as several of the folks there are doing or are about to do pedi cards fellowships.

 

[grmed]

I'm sorry that I posted the same thing in two different sections! I'm so glad you have cleared many things concerning my choice.
First of all I have no problem going through a pediatric residency. I really enjoy it and I prefer it instead of doing IM with the older patients that don't attract me at all.
I feel terrible having to think about money but in real life it is a very important factor. I know that we cannot generalize but I wanna know if as a pediatric cardiologist at least I have the potential by working hard to make the kind of money an ophthalmologist makes.If the problem is that I have to work harder as a ped cardiologist is fine because it is a very interesting specialty and very rewarding. If as a pediatric cardiologist you make the same money as the general pediatrician there's no point to go through 3 more years of training.
Thank you for understanding!!

 

[Myostatin]

Income is a sig consideration in choosing a speciality, its nothing to feel bad about... as long as it doesn't outweigh everything else. You will definitely make more as a peds cardiologist than in general pediatrics, and your loans should not be a major problem... good luck with your decision.

 

[grmed]

Thank you very much myostatin, your advice is really important. I'm so glad that you understand my concerns and I hope I'll make the right decision. As I see (without being an expert) ophthalmology is not in its good old days and eye doctors face a lot of problems along with compensation reduction.

 

[J-Rad]

While it is true that pediatric cardiologists make less than their adult counterparts, they are one of the better compensated pediatric subspecialties. I've seen ranges of 180-220,000/yr as average salaries of a general pediatric cardiologist. Any specialty with lots of procedures can make plenty of money. Even your general peds cardiotron has a lucrative and easy procedure that they can do many times a day: echo. While you can do a fourth year in echo, the vast majority do not, so a fourth year is not a necessity. As OBP stated, interventional and EP these days require a fourth year of fellowship in most places. But my experience is that they are at no loss for business and even smaller to mid-size programs may be quite busy (especially during the summer when less emergent/urgent cases get scheduled). One of my previous attending PICU docs said that pediatric cardiac intensivists (most are dual boarded in cardiology and peds critical care) are highly prized and very well compensated. And in an interesting quirk of the field, pediatric cardiologists see far more adults than any other pediatric specialist (I presume) and definitely see far more adults than IM cardiologists see kids. For that matter they see more adults with congenital heart disease than IM cardiologists do. Not interesting to some, but I actually enjoy adult congenital. So if pediatric cardiology is your passion, go for it-you'll be able to afford to pay off your loans. It's a fantastically diverse field and as others have said, lifestyle can be tailored (though it is generally more intensive a lifestyle than some pediatric subspecialties).

 

[grmed]

J-Rad you just made my day!! But I need to ask you something,why in the summer are there less emergent/urgent cases?
I'm glad interventional and EP guys are busy and well compensated and I don't mind if I have to work more hours in something I really love. Kids are always better patients and make you feel younger! I do agree that congenital heart disease is absolutely fantastic and interesting and will be a hot topic for the next decade.

 

[oldbearprofessor]

What he means is that school-age kids will have their elective cases, caths, echos, etc, scheduled during the summer and holidays so they miss the least amount of school. This is true for lots of things in pedi.

Pedi cardiology fellows and attendings work very hard. We often spend the night with them in the NICU and they are also seeing post-ops...

To the OP: At this point, if you want to discuss details of pedi cardiology as a field per se, why don't you start a thread specifically about that in pedi and we'll let the adult cardiologists get back to their stents!

 

[grmed]

Thanks!I'll do so.
Please guys go back to your stents!

 

[Complications]

Thanks!I'll do so.
Please guys go back to your stents!

So the post in the peds forum and came over ...

I'm a resident doing a month of peds cards at a "major center." The work is incredible. My day today ...

- Diagnostic cath on a fontan
- Balloon across a stenotic aortic valve in a 16 year old, immediate improvement.
- Diagnostic/attempt at intervention on a norwood on ecmo.

Crazy physiology ... really cool procedures. I've seen a lot of adults. Closing a PFO is a really cool procedure, and pretty quick to do. There's also a growing population of adults born with defects, now repaired, who are seen by peds cards.

... and let's face it, eye balls are boring .

Lifestyles seem to suck in fellowship, but not bad as an attending. Good life is dooable.

 

[Terpskins99]

While it is true that pediatric cardiologists make less than their adult counterparts, they are one of the better compensated pediatric subspecialties. I've seen ranges of 180-220,000/yr as average salaries of a general pediatric cardiologist. Any specialty with lots of procedures can make plenty of money. Even your general peds cardiotron has a lucrative and easy procedure that they can do many times a day: echo. While you can do a fourth year in echo, the vast majority do not, so a fourth year is not a necessity. As OBP stated, interventional and EP these days require a fourth year of fellowship in most places. But my experience is that they are at no loss for business and even smaller to mid-size programs may be quite busy (especially during the summer when less emergent/urgent cases get scheduled). One of my previous attending PICU docs said that pediatric cardiac intensivists (most are dual boarded in cardiology and peds critical care) are highly prized and very well compensated. And in an interesting quirk of the field, pediatric cardiologists see far mor adults than any other pediatric specialist (I presume) and definitely see far more adults than IM cardiologists see kids. For that matter they see more adults with congenital heart disease than IM cardiologists do. Not interesting to some, but I actually enjoy adult congenital. So if pediatric cardiology is your passion, go for it-you'll be able to afford to pay off your loans. It's a fantastically diverse field and as others have said, lifestyle can be tailored (though it is generally more intensive a lifestyle than some pediatric subspecialties).

I have a ridiculously stupid question here. Are peds cardiologists typically given hospital privileges (for lack of a better term) to treat the full spectrum of adult cardiology? Do turfing issues come to play with separate IM-only cardiology groups? Or do peds cardiologists only cover certain applicable cases such as adults with late complication of congenital heart disease?

 

[copacetic]

I have a ridiculously stupid question here. Are peds cardiologists typically given hospital privileges (for lack of a better term) to treat the full spectrum of adult cardiology? Do turfing issues come to play with separate IM-only cardiology groups? Or do peds cardiologists only cover certain applicable cases such as adults with late complication of congenital heart disease?

it depends on how you ended up as a peds cards in the first place. if you went to peds, then sub specialized in peds cardio i dont see where in that training you have the relevant training to treat adults. if however, you did the IM route, did a cards fellowship, then a peds fellowship, i dont see why not. you could treat adults 1 or 2 days, and kids 1 or 2 days.

 

[grmed]

I totally disagree.If you go through IM and do just a peds fellowship you don't have enough training to treat kids. In that way a ped cardiologist should do a fellowship of 1 or 2 years in adults and then place stents. I think adult cardiologists have enough work and money to treat adults and leave the kids to ped cardiologists that have the training.

 

[Terpskins99]

it depends on how you ended up as a peds cards in the first place. if you went to peds, then sub specialized in peds cardio i dont see where in that training you have the relevant training to treat adults. if however, you did the IM route, did a cards fellowship, then a peds fellowship, i dont see why not. you could treat adults 1 or 2 days, and kids 1 or 2 days.

No offense, but are there any residents/fellows/attendings that can answer my question?

 

[sacrament]

No offense, but are there any residents/fellows/attendings that can answer my question?

You have to complete a peds residency before you can do a peds fellowship, and you have to complete an IM residency before you can do an IM fellowship. That being said, there are combined IM/peds residency programs that'll cut down the training time a little bit. I think, but don't quote me on this, that there are a couple combined adult/peds cardiology fellowships as well.

 

[grmed]

Combined adult/peds cardio? Interesting but I've never heard something like that except some programs dedicated to adult congenital heart disease

 

[sacrament]

Combined adult/peds cardio? Interesting but I've never heard something like that except some programs dedicated to adult congenital heart disease

A quick Google search reveals the existence of at least one, and probably more if I had looked harder.
"Nationwide Children's Hospital also offers a unique combined Internal Medicine/Pediatric cardiology fellowship for individuals who are dedicated to pursue a career in the field of Adult Congenital Heart Disease. The program expands to 5 years with joint appointment to the cardiology fellowship at The Ohio State University department of internal medicine and the division of cardiology."

 

[grmed]

I wonder if you have to go through IM or pediatrics to do that fellowship

 

[sacrament]

I wonder if you have to go through IM or pediatrics to do that fellowship

As I said previously, I'm fairly certain you would need to do both. A requirement for adult cardiology certification by the ABIM is that you've been certified in internal medicine (which requires completing an IM residency), and I manage it's a similar situation for peds.

 

[Complications]

As I said previously, I'm fairly certain you would need to do both. A requirement for adult cardiology certification by the ABIM is that you've been certified in internal medicine (which requires completing an IM residency), and I manage it's a similar situation for peds.

Here's how it works ...

There are Internal Medicine/Pediatrics trained residents who do combined adult/peds cards fellowship. That's "technically" how it works.

In reality, it's usually a med/peds resident who does a peds cards fellowship. Sometimes it's someone who does peds then peds cards fellowship.

This is a newer field. They don't treat acquired heart disease ... they treat adults with congenital heart disease.

 

[grmed]

How easy is it to find a job as a ped card today??

 

[J-Rad]

I have a ridiculously stupid question here. Are peds cardiologists typically given hospital privileges (for lack of a better term) to treat the full spectrum of adult cardiology? Do turfing issues come to play with separate IM-only cardiology groups? Or do peds cardiologists only cover certain applicable cases such as adults with late complication of congenital heart disease?

No, unless they are the rare bird who has done the Med-Peds to IM/Peds cardiology fellowship route. Pediatric cardiologists see plenty of adults, but generally deal with the congenital aspect of their heart disease. The pediatric cardiologist is not going to be in charge of their coronary disease and if an adult needed a cath for CHD (say pre-surgical) and wanted a look at her coronaries for risk assessment, then quite often the services of an adult cardiologist would be requested in the lab to help out with this part of the procedure (since they look at coronaries all the time). The pediatric cardiologist will (in conjunction with the CT surgeons for surgery) make the decision for a corrective surgery or interventional cath on an adult, but if the patient has adult CV disease or other systemic disease, adult subspecialists will help co-manage. For example, while doing a resident rotation in Peds Cards recently I saw an adult patient who, through looking through the chart, had both hematologic and renal issues that would affect the operative and post-operative management. We obviously sent the patient to adult H/O and nephrology. While she will be admitted to the adult ICU post-op, Peds Cards, Peds CT Surg, adult H/O and Nephro will consult. The patient will also get a pre-surg cath by the peds interventionalist.

And to the OP, it's quite easy to find a job as a pediatric cardiologist if you've got the training.

 

[Terpskins99]

For example, while doing a resident rotation in Peds Cards recently I saw an adult patient who, through looking through the chart, had both hematologic and renal issues that would affect the operative and post-operative management. We obviously sent the patient to adult H/O and nephrology. While she will be admitted to the adult ICU post-op, Peds Cards, Peds CT Surg, adult H/O and Nephro will consult. The patient will also get a pre-surg cath by the peds interventionalist.

Interesting, how old was the patient and what procedure did they perform?

 

[J-Rad]

T99:
I PMd you.

 

[howelljolly]

it depends on how you ended up as a peds cards in the first place. if you went to peds, then sub specialized in peds cardio i dont see where in that training you have the relevant training to treat adults. if however, you did the IM route, did a cards fellowship, then a peds fellowship, i dont see why not. you could treat adults 1 or 2 days, and kids 1 or 2 days.

Dude! At least see what the googlegods say before you make post things. Peds cardiologists don't see anyhwhere near the amount of compensation that adult cardiologists get. Average starting salary for an attending peds cardiologist is 145K, which is less than an adult internist's salary.

Yes, pediatric cardiologists treat adults with congenital heart disease. They are masters of congenital heart diseases and are well suited to follow these patients into adulthood. Only relatively recently are these patients even showing increased long term survival rates. Adult cardiologists are more experienced with acquired heart disease, and have not had much experience with this patient population.

 

[J-Rad]

145 is not the average starting salary of a pediatric cardiologist.

 

[howelljolly]

Well thats what the googlegods said.

 

[J-Rad]

That's funny; my googlegods put this link at the top of my list (search query: "pediatric cardiology salary"):
http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000322.html

According to the above, the 25%ile is significantly above your 145. I'd do it for 145, but your average general pediatrician can also make 145. You'd probably see the competetiveness of the field go way down if your stats were true given the lifestyle of a lot of peds cardiotrons.

Now you must bow, and convert to my googlegod, or I will have to send flying monkeys your way

 

[howelljolly]

Oh, my googlegods sent me this link:
http://www.allied-physicians.com/salary_surveys/physician-salaries.htm.

I have seen the light!

 

[J-Rad]

Bless you my child. You are forgiven.

 

[AfternoonT]

one of my mentors, an academic EP comes in at 5:30 in the morning, but makes sure he leaves around 4:30 so he can get home and see his kids and family. he does family stuff for like 4 hours, then around 8-9 when his kids are in bed (their young) he reads journals, and does what academics do. YOU have to make the effeort whatever specialty you end up in. theres plenty of people in ROAD specialties that end up divorced or not seeing their family because of lack of effort, or bad time management. its all on you. life really is what you make it.[/QUOTE]

Copacetic,

I am peds fellow in the United Kingdom, starting Pediatric Cardiology in 2010, probably in the US.
Someone mentioned Canada to me as a place for training, i) where are the ped card centres in Canada ii) I am interested in your academic mentor..I too like EP.

 

[Vandyfellow]

I am the spouse of a fellow at Vanderbilt and I would say that for those of you with spouses who work, think very carefully about your spouses ability to find a job in the market in which you are looking. We came from a large city to Nashville. I started my job search the day of the match and no luck over a year later. It turns out that because we are not from Nashville there are really no opportunities for "outsiders." I was basically told from a rather successful person in my feld that I was unemployable in Nashville due to my lack of ties to the community. I was also told that Vanderbilt will not get involved in offering assistance to spouses because they are concerned about "tit for tat." Programs will pay a lot of lip service to "asisting the family" but when push comes to shove, they won't be there.

Just be very wary and do not rely on the program director or any other individual on this issue in choosing where to do your medical training.