Thoughts on superfellowship (EP v. IC)

[Egghead34]

As first year of fellowship winds down, I approach a decision point: do I apply for interventional cardiology? I know that I want to pursue either IC or EP, and have weighed several pros/cons as I understand them...but ultimately the scales come up even. With IC application season approaching, I find myself under more pressure than ever. Here's how I've broken things down:

Training duration:
- IC wins out with 1 year vs. 2 for EP. I know I've invested over a decade to reach this point, but man that 2nd year of training stings.

Competitiveness:
- IC is more competitive, with the last several years of EP having available slots. With that said, we have an in-house program which gives me a leg up. I'm likely top candidate for chief fellow next year, and have been told by the general cardiology PD (also an interventionalist) that among those in my class I'd be the early favorite to match. I'm a US-IMG with an unremarkable CV. If I matched IC it would surely be at home.

Quality of Training:
- I have a theory which may or may not be true. It matters less where you match IC as long as they have sufficient volume, since ultimately (as a tactile skill) volume of case will be your best teacher. My program is strong in volume, but a community hospital with limited teaching rigors. On the other hand, EP (being such a cerebral specialty) requires excellent teaching faculty in addition to volume. I'd have to match at a strong program, which may or may not happen given reports of increased competition for slots.

Lifestyle/Pay:
- in the long run, EP seems to win out. No true EP overnight emergencies. Light weekend call. Patient in complete heart block? Call the interventional guy to float in the transvenous pacer. I'll throw in the permanent on Monday. Compare that to a career of ~1:4 STEMI for the next 30 years. Pay seems to be comparable, or even favorable to EP.

Future developments:
- growing use of CT FFR makes me feel like IC is potentially at risk; losing out the bread-and-butter cases in favor of non-invasive imaging. Meanwhile, an older population favors greater EP involvement. On the other hand, perhaps I can get more heavily involved in peripheral work in IC?

Job availability:
- IC by a long shot. I signed up for doc-cafe and a bunch of other recruitment services to get an idea of where the jobs are. IC seems to be in higher demand and in more desirable locations.

I don't know...I feel such FOMO at the though of not applying for IC. Especially when I've had such strong feedback from faculty. I think I'd fare well with STEMI call, though I wouldn't gladly look forward to it. But I genuinely have thoroughly enjoyed both rotations and would be content with either from a pure job-description standpoint. Any other thoughts or considerations I'm missing?

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[docimg]

You have a refined and mature thought process and are on the right track evaluating pros and cons of both.
Eventually it comes down to what you want to do beyond fellowship.
With IC you may have more flexibility with geography in terms of settling down versus with EP you may have to move away from the area you may be targeting.
Furthermore IC jobs come in many flavors as well, with variable combination of IC, peripheral and structural work. Mostly not difficult to find coronary jobs but if you want to do more of the other two you may again have to move away from Tier 1 locations.

 

[Rocher]

I am starting EP in July but had the same conundrum. I just had my last cath rotation and wondered if I made the right choice, but I the feeling of getting up in the middle of the night to come in for a STEMI and then have to work the entire next day resolidified my desire to do EP haha. Good luck in your decision.

 

[Mad Jack]

As first year of fellowship winds down, I approach a decision point: do I apply for interventional cardiology? I know that I want to pursue either IC or EP, and have weighed several pros/cons as I understand them...but ultimately the scales come up even. With IC application season approaching, I find myself under more pressure than ever. Here's how I've broken things down:

Training duration:
- IC wins out with 1 year vs. 2 for EP. I know I've invested over a decade to reach this point, but man that 2nd year of training stings.

Competitiveness:
- IC is more competitive, with the last several years of EP having available slots. With that said, we have an in-house program which gives me a leg up. I'm likely top candidate for chief fellow next year, and have been told by the general cardiology PD (also an interventionalist) that among those in my class I'd be the early favorite to match. I'm a US-IMG with an unremarkable CV. If I matched IC it would surely be at home.

Quality of Training:
- I have a theory which may or may not be true. It matters less where you match IC as long as they have sufficient volume, since ultimately (as a tactile skill) volume of case will be your best teacher. My program is strong in volume, but a community hospital with limited teaching rigors. On the other hand, EP (being such a cerebral specialty) requires excellent teaching faculty in addition to volume. I'd have to match at a strong program, which may or may not happen given reports of increased competition for slots.

Lifestyle/Pay:
- in the long run, EP seems to win out. No true EP overnight emergencies. Light weekend call. Patient in complete heart block? Call the interventional guy to float in the transvenous pacer. I'll throw in the permanent on Monday. Compare that to a career of ~1:4 STEMI for the next 30 years. Pay seems to be comparable, or even favorable to EP.

Future developments:
- growing use of CT FFR makes me feel like IC is potentially at risk; losing out the bread-and-butter cases in favor of non-invasive imaging. Meanwhile, an older population favors greater EP involvement. On the other hand, perhaps I can get more heavily involved in peripheral work in IC?

Job availability:
- IC by a long shot. I signed up for doc-cafe and a bunch of other recruitment services to get an idea of where the jobs are. IC seems to be in higher demand and in more desirable locations.

I don't know...I feel such FOMO at the though of not applying for IC. Especially when I've had such strong feedback from faculty. I think I'd fare well with STEMI call, though I wouldn't gladly look forward to it. But I genuinely have thoroughly enjoyed both rotations and would be content with either from a pure job-description standpoint. Any other thoughts or considerations I'm missing?

Also don't forget to factor in the cancer risk and health concerns from being in IC, both from the odd schedule and the radiation. May not be huge but IC may shave years off of your life due to the known effects of circadian rhythm disruption in health alone, even neglecting cancer risk

 

[deleted980918]

Or just do general. At least 1 year of opportunity cost, no real emergencies, best job market out of all, narrowing pay difference gap...etc

 

[Egghead34]

You have a refined and mature thought process and are on the right track evaluating pros and cons of both.
Eventually it comes down to what you want to do beyond fellowship.
With IC you may have more flexibility with geography in terms of settling down versus with EP you may have to move away from the area you may be targeting.
Furthermore IC jobs come in many flavors as well, with variable combination of IC, peripheral and structural work. Mostly not difficult to find coronary jobs but if you want to do more of the other two you may again have to move away from Tier 1 locations.

Thank you for your kind words. The dearth of job availability does worry me with non-coronary work. I feel like it may be one of those fields where if you don't incorporate it early into your career you may not have the experience or practice size to support you at a later point. Location is somewhat of an issue, though certainly not city-specific. More like state specific.

I am starting EP in July but had the same conundrum. I just had my last cath rotation and wondered if I made the right choice, but I the feeling of getting up in the middle of the night to come in for a STEMI and then have to work the entire next day resolidified my desire to do EP haha. Good luck in your decision.

haha, well congratulations! I'll have to pick you brain sometime after your first year. Yes, the STEMI call + post-call certainly does sting. Our EP guys live so much more of a relaxed life it seems.

Also don't forget to factor in the cancer risk and health concerns from being in IC, both from the odd schedule and the radiation. May not be huge but IC may shave years off of your life due to the known effects of circadian rhythm disruption in health alone, even neglecting cancer risk

IC may get the high-dosage radiation from cine, but EP cases are much longer. My understanding is that the radiation risk is roughly equal over time, though this is anecdotal.

Or just do general. At least 1 year of opportunity cost, no real emergencies, best job market out of all, narrowing pay difference gap...etc

At this point I won't do general, for the principle reason that I like using my hands too much. Not enough general jobs retain diagnostic catheterization. A life of nucs, ECHO, and TEE simply isn't enough for me. But those are good points.

One additional point that my attendings have made is regarding "untouchability". That is, how protected you are from the scrutiny of fellow physicians. I worked as a hospitalist for a year, and now that I look back through at the experience through the lens of a specialist I can say that I got one thing right: nobody respects the hospitalist. Rather, nobody respects he without a specialty. No matter what I managed, somebody knew more than me about it. My xray reads were scrutinized by radiology, my management of GI conditions scrutinized by the GI folk, my management of rapid afib laughed at by the cardiologists, etc. I felt like i practiced superficial medicine, and although globally I knew more medicine than any of the others, my plans could individually be picked apart by any given physician.

Cue general cardiology, where you are a step removed from a hospitalist. Or even IC, where the general guys always ask why you didn't go after a certain lesion. Everyone is questioned by others who think they know more than them...unless you become hyper specialized like EP. Nobody questions EP because nobody knows EP all that well, even amongst the general guys. When they choose sotalol over dofetilide, nobody asks why. It's a mystery how they poo-poo amiodarone, until they don't and you can't figure out what was different about that patient. some people go right to ablation whereas that patient's twin case is treated medically. EP is shrouded in mystery, and as such feel untouchable. Unlike IC. Don't know if this is reality, but my attendings certainly think so.

 

[NYknicks44]

To the OP, you definitely thought things out well. At the some point, you just have to trust your instinct and go for it. Some random thoughts below:

I am a first year IC attending working in private practice. I do mostly general with coronary work. With IC, unless you are in extremely academic place, you will have to practice general and interventional. With EP, most jobs seem to pure EP work.

Stemi call is a double edged sword. Because they are so many stemi centers and you need people to cover them, there are more jobs for IC and you will have more job security.

A lot of guys transition out of IC into general cardiology as time goes on due to either back pain or call burden. My group has 2 guys who went from IC to general.

The toll of wearing lead is real. If you ever been to SCAI or interventional meeting, and you see the guys sitting on stage, just watch them as they are leaving the stage. Most of them are bent over and walk crooked.

In my humble opinion, general has the best income to lifestyle ratio. You make decent money, and if you are in a decent sized group, the call is very reasonable. There is no true emergencies, as you just call the IC guy. And you can do the job forever.

 

[littlecow]

IC may get the high-dosage radiation from cine, but EP cases are much longer. My understanding is that the radiation risk is roughly equal over time, though this is anecdotal.

Can't you completely avoid radiation in EP if you wanted to (once you're an attending)?

 

[Rocher]

Can't you completely avoid radiation in EP if you wanted to (once you're an attending)?

Only if you’re willing to give up implanting devices

 

[cards67]

I've never really heard anyone bring up "untouchability". I mean I guess it's true but I'm not sure it's even a concern for most cardiologists. But if colleagues were constantly critiquing each other, that sounds like a toxic environment.

 

[shouldigomd]

I think it all comes down to what you enjoy and very few people I feel debate IC vs EP that closely. The fields are so different and require quite a different personality.

EP is much less saturated so finding a job, workforce drama, getting a better fellowship for training .... all favors EP

 

[paki20]

I think it all comes down to what you enjoy and very few people I feel debate IC vs EP that closely. The fields are so different and require quite a different personality.

EP is much less saturated so finding a job, workforce drama, getting a better fellowship for training .... all favors EP

You can get away with just having a couple EP doctors at a hospital..it can be saturated pretty quickly

IC has better job protection just for STEMI call alone

 

[Cardiology4eva]

I think it all comes down to what you enjoy and very few people I feel debate IC vs EP that closely. The fields are so different and require quite a different personality.

EP is much less saturated so finding a job, workforce drama, getting a better fellowship for training .... all favors EP

EP is saturated, hard to find any positions in a large city. Some of the EPs I know are seeing general patients as well. IC is always needed for ACS, PAD, etc and older guys are always wanting to cut back on the amount of call they take.

 

[docak47]

As first year of fellowship winds down, I approach a decision point: do I apply for interventional cardiology? I know that I want to pursue either IC or EP, and have weighed several pros/cons as I understand them...but ultimately the scales come up even. With IC application season approaching, I find myself under more pressure than ever. Here's how I've broken things down:

Training duration:
- IC wins out with 1 year vs. 2 for EP. I know I've invested over a decade to reach this point, but man that 2nd year of training stings.

Competitiveness:
- IC is more competitive, with the last several years of EP having available slots. With that said, we have an in-house program which gives me a leg up. I'm likely top candidate for chief fellow next year, and have been told by the general cardiology PD (also an interventionalist) that among those in my class I'd be the early favorite to match. I'm a US-IMG with an unremarkable CV. If I matched IC it would surely be at home.

Quality of Training:
- I have a theory which may or may not be true. It matters less where you match IC as long as they have sufficient volume, since ultimately (as a tactile skill) volume of case will be your best teacher. My program is strong in volume, but a community hospital with limited teaching rigors. On the other hand, EP (being such a cerebral specialty) requires excellent teaching faculty in addition to volume. I'd have to match at a strong program, which may or may not happen given reports of increased competition for slots.

Lifestyle/Pay:
- in the long run, EP seems to win out. No true EP overnight emergencies. Light weekend call. Patient in complete heart block? Call the interventional guy to float in the transvenous pacer. I'll throw in the permanent on Monday. Compare that to a career of ~1:4 STEMI for the next 30 years. Pay seems to be comparable, or even favorable to EP.

Future developments:
- growing use of CT FFR makes me feel like IC is potentially at risk; losing out the bread-and-butter cases in favor of non-invasive imaging. Meanwhile, an older population favors greater EP involvement. On the other hand, perhaps I can get more heavily involved in peripheral work in IC?

Job availability:
- IC by a long shot. I signed up for doc-cafe and a bunch of other recruitment services to get an idea of where the jobs are. IC seems to be in higher demand and in more desirable locations.

I don't know...I feel such FOMO at the though of not applying for IC. Especially when I've had such strong feedback from faculty. I think I'd fare well with STEMI call, though I wouldn't gladly look forward to it. But I genuinely have thoroughly enjoyed both rotations and would be content with either from a pure job-description standpoint. Any other thoughts or considerations I'm missing?

I'm in the exact same boat. About to complete my first year and have gotten some gentle feelers from PDs of IC/EP about the future path. If you would like we can connect given the like-mindedness. Thank you for putting into words what I've been meaning to ask for over 3 months now!

 

[residentk3]

Do not underestimate market saturation of EP. It’s true you only need a handful to support an entire region. The rule of thumb is 8-10 gen cards to justify one EP position.

I will also say do not go into EP if you are not inherently interested in the topic. The learning curve is extremely steep and the vast majority of gen cards does not apply when you move forward into EP.

IC seems to build on the foundation of gen cards and as the posters above have mentioned, hospitals need IC to cover STEMI call always.

Gen cards has the best lifestyle and market, which was surprised me during my job hunt

 

[Doc mu]

Or just do general. At least 1 year of opportunity cost, no real emergencies, best job market out of all, narrowing pay difference gap...etc

I heard general was dying, don't quote me on that though

 

[aafisahar]

I heard general was dying, don't quote me on that though

General has the best job market of all subspecialties except for maybe CHF since they can double dip (CHF or gen cards).

 

[Doc mu]

General has the best job market of all subspecialties except for maybe CHF since they can double dip (CHF or gen cards).

Yeah but i was more talking about the future of cardiology in the sense that it seems to be going down the path of subspecialization, general ortho used to be the most requested type of ortho back in the day but now upwards of 90% of orthos do fellowship

 

[cards67]

Yeah but i was more talking about the future of cardiology in the sense that it seems to be going down the path of subspecialization, general ortho used to be the most requested type of ortho back in the day but now upwards of 90% of orthos do fellowship

I doubt it. I'm not sure ortho is really comparable. There's plenty stuff that doesn't really need IC, EP, etc. involved and I'm sure they're content not seeing those patients. IC probably wishes there were less interventionalist, more generalists and more cath lab time.

 

[HeartDoc88]

As first year of fellowship winds down, I approach a decision point: do I apply for interventional cardiology? I know that I want to pursue either IC or EP, and have weighed several pros/cons as I understand them...but ultimately the scales come up even. With IC application season approaching, I find myself under more pressure than ever. Here's how I've broken things down:

Training duration:
- IC wins out with 1 year vs. 2 for EP. I know I've invested over a decade to reach this point, but man that 2nd year of training stings.

Competitiveness:
- IC is more competitive, with the last several years of EP having available slots. With that said, we have an in-house program which gives me a leg up. I'm likely top candidate for chief fellow next year, and have been told by the general cardiology PD (also an interventionalist) that among those in my class I'd be the early favorite to match. I'm a US-IMG with an unremarkable CV. If I matched IC it would surely be at home.

Quality of Training:
- I have a theory which may or may not be true. It matters less where you match IC as long as they have sufficient volume, since ultimately (as a tactile skill) volume of case will be your best teacher. My program is strong in volume, but a community hospital with limited teaching rigors. On the other hand, EP (being such a cerebral specialty) requires excellent teaching faculty in addition to volume. I'd have to match at a strong program, which may or may not happen given reports of increased competition for slots.

Lifestyle/Pay:
- in the long run, EP seems to win out. No true EP overnight emergencies. Light weekend call. Patient in complete heart block? Call the interventional guy to float in the transvenous pacer. I'll throw in the permanent on Monday. Compare that to a career of ~1:4 STEMI for the next 30 years. Pay seems to be comparable, or even favorable to EP.

Future developments:
- growing use of CT FFR makes me feel like IC is potentially at risk; losing out the bread-and-butter cases in favor of non-invasive imaging. Meanwhile, an older population favors greater EP involvement. On the other hand, perhaps I can get more heavily involved in peripheral work in IC?

Job availability:
- IC by a long shot. I signed up for doc-cafe and a bunch of other recruitment services to get an idea of where the jobs are. IC seems to be in higher demand and in more desirable locations.

I don't know...I feel such FOMO at the though of not applying for IC. Especially when I've had such strong feedback from faculty. I think I'd fare well with STEMI call, though I wouldn't gladly look forward to it. But I genuinely have thoroughly enjoyed both rotations and would be content with either from a pure job-description standpoint. Any other thoughts or considerations I'm missing?

You and I have very similar training paths. I also did a hospitalist year between IM and Cards fellowship. It was a great year with a 7-on-7-off schedule, but I also knew I would burn out after a few years...mostly because I didn't enjoy the work (at all). Now, I'm about to finish cardiology fellowship and start EP fellowship in July. At your stage in the game, I was really deciding between gen cards and EP. Gen cards because the job market is amazing, the pay is amazing (tons of jobs over 500K), and the lifestyle is amazing. I can tell you that general cardiologists almost never (and I mean never, ever, ever) come into the hospital when they are on call (I've talked to loads of general cardiologists in a variety of practice types). Think about it, any true cardiology emergency is not handled by gen cards (with the rare exception that they have to float a temp pacer because the intensivist doesn't know how). So why not gen cards? Because at the end of the day you have to hustle to see consults, do a lot of clinic, and read echos and nucs. Nothing wrong with that if that's what you like. But it wasn't for me. I'm actually genuinely interested in EP, which regardless of pay/lifestyle I think will sustain me in the long run. I went with my gut, and my recommendation to you is to just go with your gut. The rest of the stuff will work itself out. Plus, like others have posted, if you end up burning out doing STEMI call you can just transition to gen cards.

 

[littlecow]

You and I have very similar training paths. I also did a hospitalist year between IM and Cards fellowship. It was a great year with a 7-on-7-off schedule, but I also knew I would burn out after a few years...mostly because I didn't enjoy the work (at all). Now, I'm about to finish cardiology fellowship and start EP fellowship in July. At your stage in the game, I was really deciding between gen cards and EP. Gen cards because the job market is amazing, the pay is amazing (tons of jobs over 500K), and the lifestyle is amazing. I can tell you that general cardiologists almost never (and I mean never, ever, ever) come into the hospital when they are on call (I've talked to loads of general cardiologists in a variety of practice types). Think about it, any true cardiology emergency is not handled by gen cards (with the rare exception that they have to float a temp pacer because the intensivist doesn't know how). So why not gen cards? Because at the end of the day you have to hustle to see consults, do a lot of clinic, and read echos and nucs. Nothing wrong with that if that's what you like. But it wasn't for me. I'm actually genuinely interested in EP, which regardless of pay/lifestyle I think will sustain me in the long run. I went with my gut, and my recommendation to you is to just go with your gut. The rest of the stuff will work itself out. Plus, like others have posted, if you end up burning out doing STEMI call you can just transition to gen cards.

Doesn't EP have a good lifestyle since it's mostly clinic, esp in private practice?

 

[timpview]

Doesn't EP have a good lifestyle since it's mostly clinic, esp in private practice?

Typically yes (very much so imo).. some EP take general call but that is more rare than common.

basically any specialty has a good lifestyle if you’re not on at night imo.. combine no real call with a typical EP income of 500-850+ and you can see some good jobs.

 

[HeartDoc88]

Doesn't EP have a good lifestyle since it's mostly clinic, esp in private practice?

I think the lifestyle is good. Ideally a couple of days per week in the lab, a couple of days in the clinic. Have NPs see all inpatient consults and round on your post-procedure patients. You generate enough RVUs doing pure EP cases (Devices, Ablations, Watchman) that you have enough leverage in your cardiology group to not have to do much (or any) general consults from the ED.

 

[Natremia]

I think the lifestyle is good. Ideally a couple of days per week in the lab, a couple of days in the clinic. Have NPs see all inpatient consults and round on your post-procedure patients. You generate enough RVUs doing pure EP cases (Devices, Ablations, Watchman) that you have enough leverage in your cardiology group to not have to do much (or any) general consults from the ED.

Or see your own damn consults. Generalists don’t consult to get someone with 1/16 their/ my/ your education

Stop selling out your profession dude

 

[shouldigomd]

Or see your own damn consults. Generalists don’t consult to get someone with 1/16 their/ my/ your education

Stop selling out your profession dude

Half the consults are being placed by NPs / PAs for things that a basic generalists should be able to manage.

 

[Rocher]

Or see your own damn consults. Generalists don’t consult to get someone with 1/16 their/ my/ your education

Stop selling out your profession dude

I used to be in this camp but our NPs see the consults and staff with the EP attendings who then sees the patient as well so the level of care seems very appropriate. efficiency is significantly increased and allows that same EP to see even more consults and do more procedures. NPs/PAs are here to stay and will increase in number whether we like it or not, it’s the momentum of the field.

 

[deleted980918]

The NP and PA are just there to gather the information, the final decision is always up to tbe attending. Our EP ACP note is never finalized until the attending sees the pt

 

[HeartDoc88]

Or see your own damn consults. Generalists don’t consult to get someone with 1/16 their/ my/ your education

Stop selling out your profession dude

Allow me to clarify. NP/PA functions as your resident/fellow. They see the consult, do the note, summarize key findings to you. The EP still needs to staff the patient.

Also, the EP mid-levels that I've worked with are fantastic and definitely know more about EP-specific issues than any hospitalist (and even most general cardiologists). This isn't an insult to other physicians, but a compliment to the mid-levels that I've worked with.

 

[deleted980918]

Allow me to clarify. NP/PA functions as your resident/fellow. They see the consult, do the note, summarize key findings to you. The EP still needs to staff the patient.

Also, the EP mid-levels that I've worked with are fantastic and definitely know more about EP-specific issues than any hospitalist (and even most general cardiologists). This isn't an insult to other physicians, but a compliment to the mid-levels that I've worked with.

Yes I agree. The mid-levels know more about EP specific issues but the ability to take that EP specific knowledge into the context of the bigger picture is what separates physician from mid levels.

 

[IamNOR]

NPs/Mid-level argument seems to find its way into any topic/thread on SDN or Reddit.

 

[perc_surgeon]

As first year of fellowship winds down, I approach a decision point: do I apply for interventional cardiology? I know that I want to pursue either IC or EP, and have weighed several pros/cons as I understand them...but ultimately the scales come up even. With IC application season approaching, I find myself under more pressure than ever. Here's how I've broken things down:

Training duration:
- IC wins out with 1 year vs. 2 for EP. I know I've invested over a decade to reach this point, but man that 2nd year of training stings.

Competitiveness:
- IC is more competitive, with the last several years of EP having available slots. With that said, we have an in-house program which gives me a leg up. I'm likely top candidate for chief fellow next year, and have been told by the general cardiology PD (also an interventionalist) that among those in my class I'd be the early favorite to match. I'm a US-IMG with an unremarkable CV. If I matched IC it would surely be at home.

Quality of Training:
- I have a theory which may or may not be true. It matters less where you match IC as long as they have sufficient volume, since ultimately (as a tactile skill) volume of case will be your best teacher. My program is strong in volume, but a community hospital with limited teaching rigors. On the other hand, EP (being such a cerebral specialty) requires excellent teaching faculty in addition to volume. I'd have to match at a strong program, which may or may not happen given reports of increased competition for slots.

Lifestyle/Pay:
- in the long run, EP seems to win out. No true EP overnight emergencies. Light weekend call. Patient in complete heart block? Call the interventional guy to float in the transvenous pacer. I'll throw in the permanent on Monday. Compare that to a career of ~1:4 STEMI for the next 30 years. Pay seems to be comparable, or even favorable to EP.

Future developments:
- growing use of CT FFR makes me feel like IC is potentially at risk; losing out the bread-and-butter cases in favor of non-invasive imaging. Meanwhile, an older population favors greater EP involvement. On the other hand, perhaps I can get more heavily involved in peripheral work in IC?

Job availability:
- IC by a long shot. I signed up for doc-cafe and a bunch of other recruitment services to get an idea of where the jobs are. IC seems to be in higher demand and in more desirable locations.

I don't know...I feel such FOMO at the though of not applying for IC. Especially when I've had such strong feedback from faculty. I think I'd fare well with STEMI call, though I wouldn't gladly look forward to it. But I genuinely have thoroughly enjoyed both rotations and would be content with either from a pure job-description standpoint. Any other thoughts or considerations I'm missing?

If you don't like the idea of waking up at ungodly hours for STEMI call, don't become an IC. Although frequency of call varies (1:3 vs 1:10). almost all practicing IC take STEMI call both because that's a job requirement and also because most enjoy it. EP is much more life-style friendly, reading your post it seems like life-style a key consideration for you, so I think you should do EP.

 

[Cardiology4eva]

If you don't like the idea of waking up at ungodly hours for STEMI call, don't become an IC. Although frequency of call varies (1:3 vs 1:10). almost all practicing IC take STEMI call both because that's a job requirement and also because most enjoy it. EP is much more life-style friendly, reading your post it seems like life-style a key consideration for you, so I think you should do EP.

Lifestyle will also depend on where you want to live. EP may be challenging to get a job in a large city if that is what you want. If you don't really care about location, then EP is the better option. because work schedule of EP is better due to no real emergencies to cover

 

[timpview]

Not sure what practicing IC doc “enjoys” STEMI call..

If you don't like the idea of waking up at ungodly hours for STEMI call, don't become an IC. Although frequency of call varies (1:3 vs 1:10). almost all practicing IC take STEMI call both because that's a job requirement and also because most enjoy it. EP is much more life-style friendly, reading your post it seems like life-style a key consideration for you, so I think you should do EP.

not quite sure I would state most practicing IC docs “enjoy” taking STEMI call

 

[cardsperson]

Wanted to bump this thread as I have a similar question (first year fellow). I realize the two lifestyles are very different as are the disease states. At this point in my life I feel more attracted to IC (love hemodynamics and structural work as well as ability to be involved with shock teams, love emergencies) but at some point I wonder if I'd prefer a field with regular hours and its own very esoteric language that nobody else understands/can encroach upon.

The other question I have is how important research is. My research so far is not in either field, and the program I'm in is a mid-tier academic program. The program actually has a really favorable superfellowship to general fellows ratio, so I think anyone who wants to do IC or EP has no problems matching at the home program assuming they have no major red flags during general fellowship. The problem is that I don't see myself staying in this location long-term so would prefer moving somewhere else. EP here is very nationally known so it would be easier to get pubs and phone calls, while IC is not. I'm also a bit nervous about having to apply for IC in a year or so from now, it would be nice to have two full years to get stuff done.

Am I thinking about this the wrong way? Does IC care a lot about publications/brand name? Do you guys see a major negative coming down the line for either field?

 

[residentk3]

Go with the field you love. It’ll be miserable if you’re doing something only to react to a possibility in the future.

 

[Ivabradine]

I think if you can do EP, do it. It seems like by far the best subspecialty because of pay and lifestyle. I don't think I'm smart enough for EP but I wish I was lol.

 

[Rocher]

I think if you can do EP, do it. It seems like by far the best subspecialty because of pay and lifestyle. I don't think I'm smart enough for EP but I wish I was lol.

EP isn’t as intellectually difficult as most people make it out to be.

 

[Ivabradine]

EP isn’t as intellectually difficult as most people make it out to be.

For me it doesn't come as easy as some other things in the field. I have to spend more time reading to retain/learn the same amount. I don't find it very practical.

 

[Rocher]

For me it doesn't come as easy as some other things in the field. I have to spend more time reading to retain/learn the same amount. I don't find it very practical.

It’s like learning a foreign language whereas most of gen cards is quickly understandable to anyone trained in internal medicine. Gen cards is really just an extension of IM whereas EP is a different field altogether. Still, once you know the language it’s mostly routine stuff.

 

[deleted980918]

As first year of fellowship winds down, I approach a decision point: do I apply for interventional cardiology? I know that I want to pursue either IC or EP, and have weighed several pros/cons as I understand them...but ultimately the scales come up even. With IC application season approaching, I find myself under more pressure than ever. Here's how I've broken things down:

Training duration:
- IC wins out with 1 year vs. 2 for EP. I know I've invested over a decade to reach this point, but man that 2nd year of training stings.

Competitiveness:
- IC is more competitive, with the last several years of EP having available slots. With that said, we have an in-house program which gives me a leg up. I'm likely top candidate for chief fellow next year, and have been told by the general cardiology PD (also an interventionalist) that among those in my class I'd be the early favorite to match. I'm a US-IMG with an unremarkable CV. If I matched IC it would surely be at home.

Quality of Training:
- I have a theory which may or may not be true. It matters less where you match IC as long as they have sufficient volume, since ultimately (as a tactile skill) volume of case will be your best teacher. My program is strong in volume, but a community hospital with limited teaching rigors. On the other hand, EP (being such a cerebral specialty) requires excellent teaching faculty in addition to volume. I'd have to match at a strong program, which may or may not happen given reports of increased competition for slots.

Lifestyle/Pay:
- in the long run, EP seems to win out. No true EP overnight emergencies. Light weekend call. Patient in complete heart block? Call the interventional guy to float in the transvenous pacer. I'll throw in the permanent on Monday. Compare that to a career of ~1:4 STEMI for the next 30 years. Pay seems to be comparable, or even favorable to EP.

Future developments:
- growing use of CT FFR makes me feel like IC is potentially at risk; losing out the bread-and-butter cases in favor of non-invasive imaging. Meanwhile, an older population favors greater EP involvement. On the other hand, perhaps I can get more heavily involved in peripheral work in IC?

Job availability:
- IC by a long shot. I signed up for doc-cafe and a bunch of other recruitment services to get an idea of where the jobs are. IC seems to be in higher demand and in more desirable locations.

I don't know...I feel such FOMO at the though of not applying for IC. Especially when I've had such strong feedback from faculty. I think I'd fare well with STEMI call, though I wouldn't gladly look forward to it. But I genuinely have thoroughly enjoyed both rotations and would be content with either from a pure job-description standpoint. Any other thoughts or considerations I'm missing?

So……which field did the OP end up applying?