I'm a rising third-year medical student and I've found that I really enjoy studying the cardiovascular system. I'm not interested in CT surgery, however. At least not at this point.
I know that both adult cardiology and pediatric cardiology are six year processes, but I don't know much about the differences between the two.
I know that pediatric cardiology involves three years pediatrics residency and three years pediatric cardiology fellowship, whereas adult cardiology is three years internal medicine and three years of cardiology fellowship. And as I understand it, there are one-year interventional fellowships in both fields. I also know that pediatric cardiologists tend to follow their patients throughout adulthood.
These points are all correct. In both adult and peds cardiology, there are also fellowships in: electrophysiology, heart failure/transplant, preventive cardiology, and imaging. I know there are adult cardiac intensivists who are trained from the cardiology pathway, but know little of this pathway. There are formal training programs for training pediatric cardiac intensivists (with some variations on the path). There are adult congenital heart disease 4th-year fellowships, however, in my brief exploration, they are more geared for adult cardiologists (which makes a sort of sense given that pediatric cardiologists already have a great deal of familiarity with CHD in both children and adults.
Beyond that, what is the difference between the two?
Hours? Similar and highly dependent on the setting (PP, academic, size of center) and superspecialty (generalist, interventionalist, etc.)
Income? Decidedly (and undreservedly, IMHO) less on the peds side of the house. Pediatric cardiologists are paid a fair amount less than their adult counterparts, although I would say that they are about the second-best paying specialty in pediatrics (behind neonatology). Across the country I believe avg. salaries to be between 190-220K/yr (academic jobs paying much less than PP jobs. The univeristy system I am in publishes salaries for everyone on the payroll and I have seen a low of ~135K/yr on staff [our adult guys, while better paid, aren't paid that great either]. One of our local PP guys apparently makes ~300+)
Lifestyle? It's really the same answer as two above.
I'm going to add an obvious point to your distinctions list: disease processes are different, with some exceptions. The majority of pediatric cardiologists will have a great deal of their practice dealing with congenital heart disease. And, yes, because of this, they tend to follow their patients for life. There is a distinct lack of interest amongst adult cardiologists to learn about and deal with antyhing but simple CHD (like ASDs, VSDs, bicuspid aortic valves. And depending on the center, the pediatric cardiologists still may take care of the vast majority of those cases). Both sets of cardiologists will deal with acquired heart disease such as cardiomyopathies (famailial or not) and age will be the sorting factor (although a quirk of where I am is that one of our child neurologists [dual trained as a geneticist] sees a lot of the neuromuscular disease patients, even when diagnosed primarily as adults and she sends them to us for evaluation and treatment of cardiac complications associated with their disease pretty often). There is a lot of overlap in electrophysiologic issues (long QT, pacemakers, SVT) though there are more common mechanisms of, say, SVT in a given age group. Also peds EPs will do many cases on structurally abnormal hearts. I know some adult guys will do repaired TETs, but the geometry of the heart isn't that much different than normal. Doing a trans-septal across the baffle of a Mustard palliation for D-TGA or a Fontan is a different story. Dextrocardia/L-TGA-fun times! And repaired and palliated complex CHD is frequently a substrate for atrial arrhythmias (IART frequently) or, for Tets, ventricular arrhythmias.
Adult cardiologists are going to deal with vastly more coronary artery disease and lifestyle-induced heart and vascular disease (pediatric cardiologists will see almost none of the former and very little of the latter, most of which will be in the adult patients and a rare teen). Both fields deal with a fair amount of syncope from both benign and malignant causes and we both see a lot of chest pain (although in my world chest pain induces a lot more yawns and groans than in adult-land)
Superspecialties will have some specific differences as well. Imaging from both fields can entail echo, 3D echo, and cardiac MRI/CT. Only pediatric cardiologists are going to learn fetal echocardiography.
Do pediatric cardiologists sometimes (or frequently) compete directly with adult cardiologists for patients? Probably only very rarely. The lack of interest in CHD amongst the adult folk is probably going to prevent this. We had a parent of one of our EP patients request that our peds EP folks do their repeat ablation; a request that was accomodated. But beyond that, I haven't seen too much in the way of competing for patients. The peds folks don't want anything to do with CAD, which is the stock-in-trade of adult cardiology.
Are pediatric cardiologists "looked down upon" by specialists the way pediatricians are?
First, as a pediatrician, I've never found the field to be "looked down upon". As a resident, I functioned as a consultant to our ED, and they were always appreciative of and respected our service. I also took care of multiple physicians' children in residency and now in fellowship. I've never sensed anything other than respect. Children of all ages make many doctors uncomfortable, even those that routinely encounter or care for them (such as FPs and Emergency docs). A pediatrician who demonstrates their capability in settings from the clinic to the NICU and PICU and can reassure parents with their words, demeanor, and competence is highly respected amongst their colleagues. There is always a little inter-specialty ribbing, but I have always found this "pediatricians are looked down upon" to be built more on myth than fact in my experience.
But as to pediatric cardiologists specifically-definitely not. Think kids in general make a lot of docs nervous? Try being the ED doc with the toddler with a hetertotaxy and a Glenn in your ED or having the Mustard with a pacemaker. They always seem to be very happy to talk to us. We exist in one of the most esoteric and least understood worlds in medicine and I feel like we are very well acknowledged and appreciated for that. And we now have, for the first time, more adults with CHD alive than children with CHD and the first generation of palliated single ventricles have grown into adulthood and the IM resident in the MICU always seems to appreciate our advise when one of these folks shows up there.
Are there any specific advantages or disadvantages to one or the other?
Other than the pay differential? Not really. The disease processes in the pediatric world are infinitely more intersting to me, but that's just a personal preference thing.
Any input would be much appreciated.
