Rheumatology switch to Non-invasive Cards

[PacificDrift]

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Hello,

I'm a PGY-5 Rheum fellow thinking about a switch to cardiology. I'm a USMD and was a good IM resident with some cards research during residency.

I originally wanted to pursue cardiology since med school but had a brutal CCU rotation intern year and my home program was quite malignant, which pushed me towards Rheum. Fellows/staff in rheum were super chill and lifestyle is pretty amazing.

I don’t hate being a rheumatologist, some of the diseases can be rewarding to treat and patients are generally thankful, but I deplore the fibro/undifferentiated pain patients, non-specific testing, low prestige, lower pay, and significant overlap with other specialties (renal biopsies, pulm for ILD, derm for psoriasis, ortho for joints). A lot of it feels like being the PCM/quarterback for the specific diseases. I know the pay can vary significantly and some rheums pull more than gen cards, but averages are averages for a reason.

Cardiology was my original passion in medicine and non-invasive cards looks better on paper: hot market with most salaries in all locations being 500K+, more central in medicine, definitive testing/treatments, only piggy backing between IC/EP & CTS. I know the downsides are a heavy inpatient consult service/call, working nights/weekends, revolving-door admissions, sometimes doing procedures on patients who may not really benefit, plus more training.

I'm planning to try attending rheum lifestyle for a year or two before deciding to reapply. I still have some strong cards connections from residency, pretty much all my friends went cards. Age is a consideration as well, but I went straight through for everything so I’d be about 37-38 y.o. when finishing gen cards if am able to successfully match and retrain. I know some cardiologists who did 2-4 years of IM between fellowship so that's not too far off/unheard of.

For those in non-invasive Cards:
- Are you happy with your call burden, patients, hospital grind?
- Do you find it fulfilling long-term, or just as repetitive as other IM subspecialties but with more stress?
- If you could go back, would you still pick Cards over a lifestyle field like Rheum, allergy, endo (no call, nights, weekends, inpatient)?

Looking for honest takes, which I know the cardiologists here will be able to provide.

 

[IcedAmericano19]

yes, the pay is good. But lifestyle considerably worse than rheumatology. I work harder as an attending than as a fellow, and I worked pretty damn hard as a fellow. You can find clinic heavy gigs, but most places want you to cover the hospital (especially if you want higher end pay). And in a large hospital, you will be extremely busy (where you have all subspecialties and CTS). At least once or twice per week, you have to make life or death decisions for sick patients. The stress is much higher than rheumatology. On top of seeing 20-30+ patients in the hospital per day, you read imaging (echos, nuclear, stress, and ecgs) and do TEEs. The pay is good but the hours and volume can be brutal. I'm still glad I chose cardiology because I think it is a fun specialty and I see all types of cool stuff everyday.

 

[cards67]

I'd absolutely choose it again, no question. I think you overstate the downsides of cardiology. Any specialty's lifestyle is gonna be heavily driven by job choice. There's little reason gen cards has to be worse than any other specialty. I'm gen cards at a smaller hospital and I don't have heavy inpatient service, heavy calls, work nights/weekends or revolving door of admissions. I'm on call 1x/wk, never go in after hours or woken up by a call, and rarely go in on weekends. I don't do much procedures but I'd only do it on those who need it. I'm just in clinic a majority of the time. It's certainly repetitive like anything else, but I find it fulfilling because it's what I'm interested in and like talking about all day everyday, especially the bread and butter stuff.

 

[bronx43]

I'm a salty rheumatologist. I hate the specialty for all the reasons you listed - pain/fatigue/malaise nonsense with nonspecific testing and no ability to improve the quality of life for these patients, who themselves are already at their wits' end by the time they make it to a rheum clinic.

However, the pay can be very good if you work in a rural/semi rural location. Lifestyle is also amazing, as most people only work 4 days a week and call is nonexistent. I worked in a major metro area before and wouldn't wish it on my worst enemy. Now, I practice in semi rural location and the pay is very solid. I won't be doing this job for that much longer, since I'm just saving and investing every penny I make.

Even with my rheum hatred, I still wouldn't go back and do a cards fellowship. It's simply not worth it financially or from a work life balance perspective. You're going to set yourself back another 5 years.

The goal is to make money then GTFO. I wouldn't recommend delaying freedom from medicine for any reason at this point.

 

[NYknicks44]

I am an IC. I think non invasive cardiology is a great gig. It will involve clinic, hospital work and imaging. My partners are busy. They work hard but they have a good work life balance. Their compensation is great and non invasive cardiology is great demand and there are jobs everywhere. With non invasive, you can find a job that suits your taste for acuity.

Do you want to go back, be a fellow and do cardiology? Only you can answer that. I have partners who are still practice after 40+ years (two are in mid 70’s and work part time). If your time horizon is that long, then you have to do what you enjoy.

 

[shouldigomd]

Agree with the good posts above. I am an IC and gen cards is probably the best gig right now with the most flexibility in terms of what you want for lifestyle.

 

[dozitgetchahi]

Hello,

I'm a PGY-5 Rheum fellow thinking about a switch to cardiology. I'm a USMD and was a good IM resident with some cards research during residency.

I originally wanted to pursue cardiology since med school but had a brutal CCU rotation intern year and my home program was quite malignant, which pushed me towards Rheum. Fellows/staff in rheum were super chill and lifestyle is pretty amazing.

I don’t hate being a rheumatologist, some of the diseases can be rewarding to treat and patients are generally thankful, but I deplore the fibro/undifferentiated pain patients, non-specific testing, low prestige, lower pay, and significant overlap with other specialties (renal biopsies, pulm for ILD, derm for psoriasis, ortho for joints). A lot of it feels like being the PCM/quarterback for the specific diseases. I know the pay can vary significantly and some rheums pull more than gen cards, but averages are averages for a reason.

Cardiology was my original passion in medicine and non-invasive cards looks better on paper: hot market with most salaries in all locations being 500K+, more central in medicine, definitive testing/treatments, only piggy backing between IC/EP & CTS. I know the downsides are a heavy inpatient consult service/call, working nights/weekends, revolving-door admissions, sometimes doing procedures on patients who may not really benefit, plus more training.

I'm planning to try attending rheum lifestyle for a year or two before deciding to reapply. I still have some strong cards connections from residency, pretty much all my friends went cards. Age is a consideration as well, but I went straight through for everything so I’d be about 37-38 y.o. when finishing gen cards if am able to successfully match and retrain. I know some cardiologists who did 2-4 years of IM between fellowship so that's not too far off/unheard of.

For those in non-invasive Cards:
- Are you happy with your call burden, patients, hospital grind?
- Do you find it fulfilling long-term, or just as repetitive as other IM subspecialties but with more stress?
- If you could go back, would you still pick Cards over a lifestyle field like Rheum, allergy, endo (no call, nights, weekends, inpatient)?

Looking for honest takes, which I know the cardiologists here will be able to provide.

I am a rheumatologist, and I will add that I’m a pretty satisfied rheumatologist overall.

I think you need to get out in the real world and see what it’s like to practice outside of fellowship/tertiary care/academia. By the end of fellowship, I was ready to go crazy…I was tired of dealing with the BS of academic medicine, as well as the way they forced us to practice as fellows, the fact that I was chronically broke because of the **** pay of medical trainees in this country, etc.

But in the real world, things are lot different for a rheumatologist. You can filter consults. You can tailor your practice, and go OP only (I hated dealing with inpatient consults as a fellow). As an attending, I see a very minimal amount of fibro and other BS, and I am able to quite efficiently discharge those types of patients from the clinic.

Prestige? Hate to break it to you honey, but out in the real world, the “prestige” thing counts for a lot less than you think it does. Nobody outside (or even inside?) medicine will really give a **** whether you are a rheumatologist or a cardiologist. No, seriously. (And if for whatever reason they DO claim to care, you won’t actually care at that point. I promise you.) And the lifestyle of cardiology is way way worse. No way would I trade working 4.5 days a week, zero call, zero hospital rounding, etc for the BS the cardiologists in my practice have to put up with.

Interacting with other specialties? I think this is part of what makes rheumatology so interesting. And out in the community, what you’re going to find is that a lot of those specialists regard your opinion as worth its weight in gold - because they usually don’t know how to manage these rheumatologic issues well. Community pulms generally suck at managing ILD. Community renal docs suck at managing lupus nephritis. Community opthos suck at managing uveitis. All of these folks will be looking to you for your treatment strategy on these issues. It’s actually pretty cool. You’re going to find yourself driving the bus more often than you think.

Compensation? I’m in a PP and I made about $750k last year. On track to beat that slightly this year. If I worked a full 5 days a week, I could probably make $850k+. But I don’t want to. Hospital rheumatology gigs suck by and large, but *good* multispecialty PP jobs will have you making way more than you ever thought possible as a rheumatologist.

Frustration? You already alluded to the fact that you’re aware that this exists in cards too. “Definitive treatments”? Please discuss the definitive treatments available for, say, severe CHF. LVADs have a whole lot of issues, and heart transplants are hard to get - never mind all the issues associated with the transplant process, and whether or not rejection happens etc. There is some of this in every specialty. I’m mostly happy that rheum patients don’t (generally) die suddenly, and if they do, it almost certainly isn’t because of something I did.

There is no freaking way in hell that I would be going back for more training after the end of rheumatology fellowship. Just let yourself be done with training, and go carve out your niche in the real world. Get away from academia, get a decent PP job where they’re going to treat you fairly, and see how you feel in a couple years. I promise that you won’t want to be going back for a brutal cardiology fellowship.

PM me if you want. Rheumatology ain’t bad. I’ll gladly smile though the occasional fibro/fatigue/garbage consult in exchange for the upsides of being a rheumatologist.

 

[Green_Goose]

I'd absolutely choose it again, no question. I think you overstate the downsides of cardiology. Any specialty's lifestyle is gonna be heavily driven by job choice. There's little reason gen cards has to be worse than any other specialty. I'm gen cards at a smaller hospital and I don't have heavy inpatient service, heavy calls, work nights/weekends or revolving door of admissions. I'm on call 1x/wk, never go in after hours or woken up by a call, and rarely go in on weekends. I don't do much procedures but I'd only do it on those who need it. I'm just in clinic a majority of the time. It's certainly repetitive like anything else, but I find it fulfilling because it's what I'm interested in and like talking about all day everyday, especially the bread and butter stuff.

Just curious - what kinds of procedures do you do as a general cardiologist? TEE?

 

[PacificDrift]

I'd absolutely choose it again, no question. I think you overstate the downsides of cardiology. Any specialty's lifestyle is gonna be heavily driven by job choice. There's little reason gen cards has to be worse than any other specialty. I'm gen cards at a smaller hospital and I don't have heavy inpatient service, heavy calls, work nights/weekends or revolving door of admissions. I'm on call 1x/wk, never go in after hours or woken up by a call, and rarely go in on weekends. I don't do much procedures but I'd only do it on those who need it. I'm just in clinic a majority of the time. It's certainly repetitive like anything else, but I find it fulfilling because it's what I'm interested in and like talking about all day everyday, especially the bread and butter stuff.

Thanks for the insight. This seems like a great gig and I have found other posters say similar things on places like reddit.

In your experience or when you were looking for jobs, have you seen general cardiologists cover the CCU? Obviously the patients are wickedly sick, especially the STEMI/Cardiogenic Shock patients.

I would presume that most cover inpatient consults. At least for the hospital I'm affiliated with, they are both extremely busy services. It's a low-tier academic/big city community hospital with fellows but just skimming the notes, they're both oversigning notes at 9 -11 PM.

 

[cards67]

Just curious - what kinds of procedures do you do as a general cardiologist? TEE?

I do TEE and RHC occasionally, but really one could get by without doing any procedures.

Thanks for the insight. This seems like a great gig and I have found other posters say similar things on places like reddit.

In your experience or when you were looking for jobs, have you seen general cardiologists cover the CCU? Obviously the patients are wickedly sick, especially the STEMI/Cardiogenic Shock patients.

I would presume that most cover inpatient consults. At least for the hospital I'm affiliated with, they are both extremely busy services. It's a low-tier academic/big city community hospital with fellows but just skimming the notes, they're both oversigning notes at 9 -11 PM.

I can't speak for every job out there, it can vary greatly. In my gig I'm never primary, and I never want to be. Consult volume can vary by hospital size but also culture. Some hospitals consult for every damn thing.

 

[Cardiac Amyloidosis]

I couldn’t see myself doing anything in medicine other than cardiology, and overall it’s a great specialty. BUT I wish I liked an “easier specialty” and pursued that or even better did something like derm or radiology lol. The busyness and constantly taking work home sucks big time. I can’t even fathom working 4 days with no call or inpatient rounding, I wish I could do that.


Doing a second fellowship sounds like a crazy idea btw, I would suggest just finding a good rheum practice and making some money. Being a trainee is absolute garbage.

 

[Dr. HWS]

I couldn’t see myself doing anything in medicine other than cardiology, and overall it’s a great specialty. BUT I wish I liked an “easier specialty” and pursued that or even better did something like derm or radiology lol. The busyness and constantly taking work home sucks big time. I can’t even fathom working 4 days with no call or inpatient rounding, I wish I could do that.


Doing a second fellowship sounds like a crazy idea btw, I would suggest just finding a good rheum practice and making some money. Being a trainee is absolute garbage.

I totally agree with this. I love cardiology and can't see myself doing anything else, but if I liked rheumatology, I'd have 100% done it and never looked back. Grass is always greener on the other side.