Pediatric Cardiology??

[medstud2ndyr]

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[heartdoc345]

Peds cardiology is very different from adult cardiology. The three biggest differences:

1) Congenital heart disease is a major part of the training and practice of pediatric cardiology
2) Ischemic heart disease is uncommon in pediatrics and not emphasized in pediatric cardiology training (so if you do pediatric cardiology you won't cath coronaries unless you are an uber-specialist in Kawasaki's disease)
3) Pediatric cardiologists make a lot less money than adult cardiologists

Adult cardiology is primarily concerned with coronary artery disease, although there are a lot of docs who specialize in heart failure, valvular disease, advanced imaging, electrophysiology (specialists who implant pacemakers, defibrillators, and who ablate arrhythmias in the cath lab), and preventive cardiology.

Obviously, you have to be board-eligible in pediatrics to specialize in pediatric cardiology, and you have to finish an internal medicine residency in order to specialize in adult cardiolgy. If you do med/peds you can apply to either or both fields. There are a handful of programs that "fast track" you into adult cardilogy and exempt you from your 3rd year of IM training, which would let you finish cardiology 5 years after med school instead of 6 years out. I may be wrong about this, but I believe that you can re-certify your boards in adult cardiology every 7 years without re-certifying in medicine, but you can't stay boarded in pediatric cardiology if your general pediatrics board-certification lapses.

In both adult and pediatric cardiology, it is becoming more common to do a 4th year of fellowship to get advanced training in a niche. The major subspecialties are interventional, EP, echo, CT/MRI, preventive, and ICU. Each has different advantages/disadvantages in terms of lifestyle, salary, and job satisfaction. You can structure your career so that you are in clinic all day and reading EKGs or stresses to "risk stratify" patients for future heart attacks, or you can be in the cath lab all day with very little clinic time. Or you could essentially be a radiologist who only looks at hearts.

I will be training in BOTH adult and pediatric cardiology, which is very unusual since it requires a lot of extra training - 9 years total instead of the usual 6. (5 years of fellowship after 4 years of residency). For me, congenital heart disease has always been fascinating, and there is no other group of patients I would rather take care of. Peds cardiologists, by default, end up taking care of a lot of adult patients with congenital heart disease, because adult cardiologists don't learn much about congenital heart disease (and most don't care to learn about it since they are very busy with coronary disease, which is much more lucrative).

Although congenital heart disease is a very important part of pediatric cardiology, there are several other areas of interest, such as syncope, arrhythmia, exercise physiology, and preventive cardiology. Pediatric cardiologists learn to distinguish functional from pathologic murmurs by physical exam, perform and read echos, read EKGs, and take care of children after heart surgery in the ICU during their training. There are about 50 pediatric cardiology training programs in the US.

A private practice physician in pediatric cardiology will likely spend the bulk of his/her time in the office seeing patients with chest pain (which is almost never cardiac in kids), syncope, and for evaluation of murmurs, plus reading lots of echos. Most pediatric cardiologists who do invasive interventional cath cases work at major children's hospitals. Congenital heart disease is very much a surgical disease, and the bulk of the anatomic palliation is surgical, but there are many things pediatric cardiologists can do in the cath lab, such as closing holes such as ASDs, PDAs, VSDs, and stenting stenosed pulmonary arteries, balooning open valves, etc. Plus, the congenital cardiologist has a major role to play in terms of using the cath lab, MRI, or other tools to determine which children need surgery and what type of surgery migh be beneficial.

I chose to do both adult and pediatric cardiology because adults with congenital heart disease is a growing population. Surgeries have gotten so much better over the last 50 years (for a good website with pictures of congenital heart lesions check out www.pted.org). 95% of congenital heart babies born today are expected to reach age 18. There are actually more adults than kids with congenital heart disease, and they are rapidly "outgrowing" their doctors. Most congenital heart patients, even in their 30s, 40s, and 50s, follow up with pediatric cardiologists, since adult cardiologists are generally uncomfortable taking care of them.

I hope this gives you a general overview of the different specialties and helps you decide what you like!

 

[medpedsdoc]

i am in Med/Ped private practice and finished my combined residency in 2004 and now i am applying for pediatric and adult cardiology programs as i like congenital heart disease and their interventions. I have applied to 25 programs across country for peds cardiology .
any suggestion will be appreciated.

Thanks

 

[jeesapeesa]

Peds cardiology is very different from adult cardiology. The three biggest differences:

1) Congenital heart disease is a major part of the training and practice of pediatric cardiology
2) Ischemic heart disease is uncommon in pediatrics and not emphasized in pediatric cardiology training (so if you do pediatric cardiology you won't cath coronaries unless you are an uber-specialist in Kawasaki's disease)
3) Pediatric cardiologists make a lot less money than adult cardiologists

Adult cardiology is primarily concerned with coronary artery disease, although there are a lot of docs who specialize in heart failure, valvular disease, advanced imaging, electrophysiology (specialists who implant pacemakers, defibrillators, and who ablate arrhythmias in the cath lab), and preventive cardiology.

Obviously, you have to be board-eligible in pediatrics to specialize in pediatric cardiology, and you have to finish an internal medicine residency in order to specialize in adult cardiolgy. If you do med/peds you can apply to either or both fields. There are a handful of programs that "fast track" you into adult cardilogy and exempt you from your 3rd year of IM training, which would let you finish cardiology 5 years after med school instead of 6 years out. I may be wrong about this, but I believe that you can re-certify your boards in adult cardiology every 7 years without re-certifying in medicine, but you can't stay boarded in pediatric cardiology if your general pediatrics board-certification lapses.

In both adult and pediatric cardiology, it is becoming more common to do a 4th year of fellowship to get advanced training in a niche. The major subspecialties are interventional, EP, echo, CT/MRI, preventive, and ICU. Each has different advantages/disadvantages in terms of lifestyle, salary, and job satisfaction. You can structure your career so that you are in clinic all day and reading EKGs or stresses to "risk stratify" patients for future heart attacks, or you can be in the cath lab all day with very little clinic time. Or you could essentially be a radiologist who only looks at hearts.

I will be training in BOTH adult and pediatric cardiology, which is very unusual since it requires a lot of extra training - 9 years total instead of the usual 6. (5 years of fellowship after 4 years of residency). For me, congenital heart disease has always been fascinating, and there is no other group of patients I would rather take care of. Peds cardiologists, by default, end up taking care of a lot of adult patients with congenital heart disease, because adult cardiologists don't learn much about congenital heart disease (and most don't care to learn about it since they are very busy with coronary disease, which is much more lucrative).

Although congenital heart disease is a very important part of pediatric cardiology, there are several other areas of interest, such as syncope, arrhythmia, exercise physiology, and preventive cardiology. Pediatric cardiologists learn to distinguish functional from pathologic murmurs by physical exam, perform and read echos, read EKGs, and take care of children after heart surgery in the ICU during their training. There are about 50 pediatric cardiology training programs in the US.

A private practice physician in pediatric cardiology will likely spend the bulk of his/her time in the office seeing patients with chest pain (which is almost never cardiac in kids), syncope, and for evaluation of murmurs, plus reading lots of echos. Most pediatric cardiologists who do invasive interventional cath cases work at major children's hospitals. Congenital heart disease is very much a surgical disease, and the bulk of the anatomic palliation is surgical, but there are many things pediatric cardiologists can do in the cath lab, such as closing holes such as ASDs, PDAs, VSDs, and stenting stenosed pulmonary arteries, balooning open valves, etc. Plus, the congenital cardiologist has a major role to play in terms of using the cath lab, MRI, or other tools to determine which children need surgery and what type of surgery migh be beneficial.

I chose to do both adult and pediatric cardiology because adults with congenital heart disease is a growing population. Surgeries have gotten so much better over the last 50 years (for a good website with pictures of congenital heart lesions check out www.pted.org). 95% of congenital heart babies born today are expected to reach age 18. There are actually more adults than kids with congenital heart disease, and they are rapidly "outgrowing" their doctors. Most congenital heart patients, even in their 30s, 40s, and 50s, follow up with pediatric cardiologists, since adult cardiologists are generally uncomfortable taking care of them.

I hope this gives you a general overview of the different specialties and helps you decide what you like!

just happen to run into your post. great info that many don't know about, thanks! good luck.

 

[medpedsdoc]

I am applying to both adult and Peds cardiology but NRMP wont let me register for both in same year. How did you manage to get combined cardiology position. i have submitted my application to 170 adult cardiology programs and 30 peds cardiology programs.

Thanks

 

[impedsdoc]

I applied to Adult Gastroenterology and Pediatric Gastroenterology and it seems that I will not be able to apply for both matches together. Any thoughts or suggestions? Medpeds doc, did you find out anything?