Rads vs cards

[MaxPower]

I'm currently finishing up my MS3 year and have mostly narrowed my choices to rads vs cards with likely goals of doing interventional subspecialities (IR, IC, or EP).

My situation: MS3 at top 20 MD program in california, 250+ on step 1, honors in 60-70% of preclinical and honors or near honors so far on my rotations. some engineering/orthopedic research for a summer which is currently on hold, resulted in a poster presentation. I feel like I could excel in either field, both personally and from feedback I have gotten from attendings. I have a background in engineering, which is something I'd like to put to use. With cardio, there are stents, fluid mechanics, possible research in stem cells. I don't need to tell you about rads.

So I have looked into some old posts here and over at the cardiology forum, and have gotten some answers about this decision, but it usually degenerates into turf wars, whether they are real or not, "my grades are too good for IM" vs. "I can do your job just as well as you can, plus I'll do something about it", etc. Anyone here have a similar background in engineering who might be able to provide some insight regarding this issue? Some of the other specialties I've liked include CT surg, urology, vascular (endovascular, mostly), pulmonary/crit care, renal (mostly for the thinking)

Some pros/cons that I consider, personally, include the following (in order of importance). I don't believe that IR, diagnostics, cards, or IC are going to go out of business while I am practicing, nor do I worry about starving.
1. intellectual interest. actually I might favor rads here, since cards is pretty limited in terms of scope. EP is pretty interesting, though, and I love almost anything I do with the heart (peds cardio, CT surg). I enjoy the diagnostic aspect of medicine, but so much of it now just comes down to a hunch, and wait for imaging/labs.
2. lifestyle. obviously, cards is generally not as good, though IR I've heard can get pretty busy
3. patient contact. I enjoy talking to patients and hearing their stories, but only to a certain extent. I can still get pretty fed up with patients (waiting for placement etc), and it wasn't so bad on CT surg when I barely knew my patients but felt like we did so much for them.
4. fall-backs. if I go into rads, I can still have a pretty good life reading films even if I don't end up going into IR. cards still requires a fellowship, then another IC/EP on top of that. I don't see that much more in IM that I would do (though there are more options than gen surg).
5. the match. i think I have a very good chance of matching into a very good IM program in california, which would be my preference (though this is a little up in the air). i feel I probably have to be more open to moving if I do rads.

Thanks for any help you can provide. I continue to talk with attendings and residents but obviously everyone has their biases. My faculty adviser was of no help (well, in this specific question - cardio was the last thing he ruled out before choosing IR). I guess a lot of biased information is better than no information at all.

Also, if anyone has any suggestions on 4th year (planning on IM sub-I, some rads/IR rotations, maybe cards/IC as well) it would be greatly appreciated. Anyone know of a good away rotation in new york or boston?

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[nutcancer]

I'm an MS3 in a very similar situation (deciding careers wise). Although I've lost all interest in being a traditional doctor with his own patients, rounding, etc. There are plenty of these discussions that can be found on SDN. I find it interesting so many people, like myself, end up having to choose between these 2 fields. I'm leaning towards radiology and here are my perspectives on your perspectives:

1) Intellectual Interest: This is a toss up but one-sided depending on your tastes, I think. If you like pathology and anatomy, I think it could be stimulating to learn how these two affect each other in radiology. On the otherhand, I think cardiology is a lot more 'functional' and conceptual and in a way reads more like a novel. I personally would pick cards in this category but I can see myself enjoying rads as well. In the end, as a enthusiastic learner, both fields offer opportunities to learn new, interesting things.

2) Lifestyle: Rads blows cards out of the water in this. My free time is important to me (another way of saying I'm lazy) and this is important in my decision-making process. Cards, unless you're lucky enough to do something like EP or echo, is like 60 hrs a week and call. Rads, generally 9-5 with call once a week. Of course, if you want to do interventional rads, you're working surgery hours. For me its a no brainer but everyone's different.

3) Patient contact: Cards blows rads out of the water. This may seem like a reason to do cardiology to some but quite the opposite to others. I found patient care highly unsatisfying, tedious, and frankly annoying. As House said, 'I'd rather treat the disease than the patient.' Rads is mainly disease my friend. To each his own but to me the paucity of patient contact is a perk and a privelige.

4) Fall backs: Rads > cards. There's no need to go through IM and apply for a fellowship. And you're right, plenty of IR docs do both IR and diagnostic. With stats like yours, the kind of ego one can develop can make it difficult to enthusiastically want to enter IM residency and basically go through 3rd year all over again for the next 3 years. If you thoroughly enjoyed IM, this won't be a problem of course.

5) Match: You'll match anywhere you wan't.

Well these are my opinions on your opinions! In the end, I bet you would be great at anything you go into. If you're committed to interventions as a career, I think after you look into it more and ask around more, you'll find that cardiology is the smart bet in today's climate.

 

[Whisker Barrel Cortex]

I had some of the same thoughts that you did when I was in med school.

Here are some of my thoughts on your topics:

1. Intellectual interest: I think this is present for both fields, but in a different way. If you enjoy learning about a wide variety of diseases and anatomy including all ages and all body systems, radiology is obviously better. We have to know a lot about a lot (including management, what the clinician wants to know, what the consequences of our reads will be, and underlying pathophysiology). However, cardiology is also an intellectually demanding field with, but obviously much more focused. Cards is definitely one of the more research oriented fields out there, if that excites you.

2. Lifestyle: This really depends on the type and size of practice you're in. Some radiology practices work very long hours and some IR docs are on call a lot. However, if you steer away from these groups, you'll do fine (but make less income). Cards can be bad, but again, is dependent on the practice. Probably a little harder to find places with better hours in cards than rads.

3. Patient Contact: I think this should be a main focus for you. Especially during residency, your patient contact in rads will be much more limited than cards and you will not have "your patients" for the most part. In private practice, many IRs do a lot of general rads too. If you really like having your own patients who will thank you and give you direct response for your work, I would recommend cards. You will not enjoy radiology if this is important to you. The satisfaction in rads is more indirect in most cases.

4. Fall backs: If you don't end up doing intervention, do you want to read images all day or see patients all day?

5. Match: I think you'll do ok with your stats. You may not get your first choice in Cali for rads, but should do well.

This is a very tough choice and for me as well. I would focus on this main point: think about how much you enjoy the non-procedural aspects of each specialty, reading images versus managing patients. Which one do you like better? How important is it to you to have your own patients and feel "doctorly?"

Good luck. You can't go wrong with either field, in my opinion. As opposed to some of the cards or wannabe cards I see in the cardiology forum, I have the utmost respect for cardiologists and all clinicians.

 

[MaxPower]

Thanks for the great responses. I guess the main issues are how much patient contact I would want, and how much I want to do the "basics" (reading films or cards clinic). My concern regarding patient care is that while I like talking to some patients, I felt it got very tedious toward the end of my 2 months of inpatient medicine. Outpatient wasn't too bad, and I guess I wouldn't mind it if it were specialized, but taking several detailed H&P's every couple days might get on my nerves, as would managing some guy's diabetes while he gets some free IV antibiotics for 6 weeks.

As for reading films vs. managing patients, part of what I like about cardio is that there are very objective measures of treatment effectiveness. I could NOT handle running a pain clinic, but when it is SOB/not, edema better/worse, it isn't too bad. Then again I have always been interested in conferences when a radiologist comes in to discuss films with the surgeons.

I guess this may come down to the wire when I get a chance to do a rads month and an IM sub-I.

On a side note, would it be advisable to do an away rotation at/near the places I might want to go? I have heard different things. Some say that if you are a strong candidate, you are more likely to hurt yourself by doing an away rotation somewhere. However, having been in california my whole life but seriously considering going back east to boston or new york, it would give me a chance to see what life is like over there, and to show that I'm serious about going there.

 

[ScooterBanks]

Max--The solution to your problem is very easy. As a fourth year, go through the Radiology match. At the same time, do a prelim year at a good academic medicine location where you would want to be for residency if you did medicine. Do a cardiology rotation (or two if you use elective time) during your prelim year. Make the decision 9 months into your PGY1 year.

If you decide you want to do medicine, just call the radiology program you matched with and tell them you don't want your spot. The prelim medicine program you are at will have a spot for you as a categorical to continue because there are people every year in large programs that either leave to another program or want to switch out of medicine. No harm to you, you get to do medicine at a good place, and some lucky intern will thank you for the rest of their life for giving up your PGY2 radiology spot.

On the other hand (and this is MUCH more likely), you will decide that cardiology /medicine is not what you thought it was and not what you want to do. It will be ok because there will be a radiology spot waiting for you at the end of the rainbow. The only think you will have cost yourself is a year of your life in a harder PGY1 year than you needed to be in. You will look back at the 4th year medical student version of yourself and wonder what you were thinking and you will thank God every day you are not stuck in medicine for the rest of your life.

Three things to do during your intern year that will make you run to radiology and never look back.
1) Talk to your attendings. Ask them if they could be in any other field, what would it be...or ask them if they had to do it all over again what would they do. 75% will say radiology.
2) Look at what cardiologists actually do. Look at how much actual time is spent doing what you want to do, and how much time is spent on other stuff that you didn't take into account. Look at the hours they work and the amount of call they take and ask yourself do you want to be doing that for the next 30 years.
3) Look at what patient contact really is. Ask yourself how it makes you feel most of the time. Read "House of God" during your intern year for a much better appreciation of what modern medicine and patient care/contact is.

 

[MaxPower]

I actually did consider the fact that my prelim year could be medicine anyway. I didn't realize that it could be so easy to continue on in medicine if I decided to stick with it.

Max--The solution to your problem is very easy. As a fourth year, go through the Radiology match. At the same time, do a prelim year at a good academic medicine location where you would want to be for residency if you did medicine. Do a cardiology rotation (or two if you use elective time) during your prelim year. Make the decision 9 months into your PGY1 year.

If you decide you want to do medicine, just call the radiology program you matched with and tell them you don't want your spot. The prelim medicine program you are at will have a spot for you as a categorical to continue because there are people every year in large programs that either leave to another program or want to switch out of medicine. No harm to you, you get to do medicine at a good place, and some lucky intern will thank you for the rest of their life for giving up your PGY2 radiology spot.

On the other hand (and this is MUCH more likely), you will decide that cardiology /medicine is not what you thought it was and not what you want to do. It will be ok because there will be a radiology spot waiting for you at the end of the rainbow. The only think you will have cost yourself is a year of your life in a harder PGY1 year than you needed to be in. You will look back at the 4th year medical student version of yourself and wonder what you were thinking and you will thank God every day you are not stuck in medicine for the rest of your life.

Three things to do during your intern year that will make you run to radiology and never look back.
1) Talk to your attendings. Ask them if they could be in any other field, what would it be...or ask them if they had to do it all over again what would they do. 75% will say radiology.
2) Look at what cardiologists actually do. Look at how much actual time is spent doing what you want to do, and how much time is spent on other stuff that you didn't take into account. Look at the hours they work and the amount of call they take and ask yourself do you want to be doing that for the next 30 years.
3) Look at what patient contact really is. Ask yourself how it makes you feel most of the time. Read "House of God" during your intern year for a much better appreciation of what modern medicine and patient care/contact is.

 

[nutcancer]

This is exactly what I was planning to do. More to actually learn some medicine and very little bit to really test cardiology.

 

[hans19]

Max--The solution to your problem is very easy. As a fourth year, go through the Radiology match. At the same time, do a prelim year at a good academic medicine location where you would want to be for residency if you did medicine. Do a cardiology rotation (or two if you use elective time) during your prelim year. Make the decision 9 months into your PGY1 year.

If you decide you want to do medicine, just call the radiology program you matched with and tell them you don't want your spot. The prelim medicine program you are at will have a spot for you as a categorical to continue because there are people every year in large programs that either leave to another program or want to switch out of medicine. No harm to you, you get to do medicine at a good place, and some lucky intern will thank you for the rest of their life for giving up your PGY2 radiology spot.

On the other hand (and this is MUCH more likely), you will decide that cardiology /medicine is not what you thought it was and not what you want to do. It will be ok because there will be a radiology spot waiting for you at the end of the rainbow. The only think you will have cost yourself is a year of your life in a harder PGY1 year than you needed to be in. You will look back at the 4th year medical student version of yourself and wonder what you were thinking and you will thank God every day you are not stuck in medicine for the rest of your life.

Three things to do during your intern year that will make you run to radiology and never look back.
1) Talk to your attendings. Ask them if they could be in any other field, what would it be...or ask them if they had to do it all over again what would they do. 75% will say radiology.
2) Look at what cardiologists actually do. Look at how much actual time is spent doing what you want to do, and how much time is spent on other stuff that you didn't take into account. Look at the hours they work and the amount of call they take and ask yourself do you want to be doing that for the next 30 years.
3) Look at what patient contact really is. Ask yourself how it makes you feel most of the time. Read "House of God" during your intern year for a much better appreciation of what modern medicine and patient care/contact is.

Sage advice. Are you trying to take my job?

 

[nutcancer]

wait...

if you match into radiology out of med school, aren't you contractually obliged to do that one year of radiology residency? i realize they can easily find someone to replace you but are there obstacles into going into Medicine PGY2? Do you become a match violator or something crazy like that?

 

[MaxPower]

wait...

if you match into radiology out of med school, aren't you contractually obliged to do that one year of radiology residency? i realize they can easily find someone to replace you but are there obstacles into going into Medicine PGY2? Do you become a match violator or something crazy like that?

I'm gonna try to talk to some people about this. I had the idea before - my concern was being able to continue on in Medicine. Throughout the year I have heard of many people leaving one program, doing something else, etc. so I guess there it not much they can do if you decide not to go into radiology.