Why would anyone go into cardiology today?

[daelroy]

I fail to see the appeal of cardiology. Cardiology fellowship doesn't offer the great lifestyle the other IM fellowships offer like allergy/immunology and GI. Cardiology fellowship for all intensive purposes is an extension of IM. It's not much better than general surgery in regards to lifestyle. And now interventional training is practically a requirement if you seek to join a cardiology group in a large city so you can tack on 1 more year to that total. That's right, most large groups are not interested in a non-invasive cardiologist since they are limited by their inability to perform procedures.

Salaries have been significantly hit hard in the past 4 years as insurance reimbursement has significantly dropped for procedures and office visits. It's tough for a cardiologist to earn in excess of 400K these days. That's a lot of money but for the amount of training and stress you undergo there are better options like radiology and anesthesiology.

Finally, their lifestyle after residency is less than pleasant with the amount of call and patient management they undergo. Yet cardiology seems to be this great buzzword and I just have to laugh. I can understand the appeal of cardiology 10 years ago when they were earning a lot more money and had the prestige back then but today the field seems to fallen significantly.

---

Members don't see this ad.

 

[Aesculapius]

Not everyone does it for the lifestyle and the money. Maybe some of them like the heart Also, 400k, no matter how you spin it, is plenty enough to live on.

 

[Whisker Barrel Cortex]

They do it for the money and the prestige.

 

[ChiefToma]

where did you find all of that information about cardiologists?

 

[daelroy]

Not everyone does it for the lifestyle and the money. Maybe some of them like the heart Also, 400k, no matter how you spin it, is plenty enough to live on.

In reality, most people enjoy several fields and then narrow their choice to one based on factors outside of pure interest such as lifestyle. Most cardiologists probably considered GI or other fields as well. Regardless, you have to be intelligent to get a cards fellowship so most cards fellows could have their pick of what they want to do. I fail to see why they would select cardiology unless they were absolutely just fascinated with everything related to the heart.

 

[ny skindoc]

Salaries have been significantly hit hard in the past 4 years as insurance reimbursement has significantly dropped for procedures and office visits. It's tough for a cardiologist to earn in excess of 400K these days. That's a lot of money but for the amount of training and stress you undergo there are better options like radiology and anesthesiology.

All fields have been hit hard financially,and radiology is no doubt a target for future cuts.With the baby boomers just starting to hit 60,the demand for cardiologists in the next 30 years is going to be very strong.
Considering what general internists make ..400k is pretty good.As for stress,thats very personal.For some people specializing in field they dont want to be in is stressful and Anesthesiology is not a low stress specialty.

 

[doc05]

huh? what's wrong with cardiology?....

some people actually want to work hard and help people who have real pathology. let's face it, no matter how good the lifestyle, many of us would be miserable in fields like allergy or derm.

 

[LuckyMD2b]

You sound really obnoxious in your previous posts; so in a similar spirit do I reply to your inquiry

Cardiology fellowship for all intensive purposes is an extension of IM.

First of all, I believe that what you meant to say is: Cardiology fellowship for all intents and purposes is an extension of IM.

Most importantly maybe many people choose Cardiology as a career because they find Cardiovascular Disease interesting.

And I don't know; maybe heart disease is just the number one cause of morbidity and mortality in the country. Who knows, a cardiologist may even be able to HELP a large number of patients with life or death illnesses.

 

[jdaasbo]

I am not sure why so many people want to become cardiologists. Money surely has something to do with it. Lifestyle may be a secondary consideration for many.

I don't think that cardiology is unique in terms of the recent decline in reimbursement. All medical specialties are being hit hard. Primary care (FP, IM or Peds) is poorely remunerated for the number of hours that are required (which is actually not less than Cards, GI, or Pulm/CCM).

Cardiology is also not unique in terms that it is, at least in theory, an extension of internal medicine. That is why you still have to do three years of internal medicine before fellowship (even for allergy and immunology!).

What is (relatively) unique is the job security in the field. The demand for cardiologists is astounding. Cardiovascular disease is the number one cause of death in the US. Yes it is true that if you want to practice interventional cardiology in downtown Chicago, New York, Boston or LA the market is somewhat tight. On the other hand, areas of high population density aside, the demand is quite high. I have not even started my fellowship and already I have physician recruiters sending me letters and emailing me. Circulation (in March?) this year (past) published a series of editorials by Robert Bonow, Valentin Fuster, and others discussing the shortage of cardiologists predicted and how to meet this shortage.

I decided to go into it for a variety of reasons, most notably that cardiovascular medicine absolutely fascinates me.

 

[PsychMD]

Just a general comment re. recruiters mailing you. Everyone starts getting junk mail recruiting around the time when they start to appear listed in several databases (available free for anyone who looks), such as medical licensing boards, the Specialty Board Certification site, hospital privileges staff lists, even final year resident rosters which are available on many programs' websites.

I wouldn't encourage anyone to pick a job pitched by a recruiter who has your name from a database and has no clue who you are and what you want. Plus, of course, they will all tell you that the "market" is pretty tight in the major cities, because most major hospitals in most major cities do not even go through these recruiters; they have their own in house recruiters, or recruit staff through internal networking; they have where to pick from. Look for a job based on where YOU want to live and where YOU are familiar with the local medical scene. Do your homework well. Lots of jobs picked through recruiters are jobs that are not already filled locally for a variety of reasons, not all of them good, in many cases.

All that aside, there are some rural area jobs that are GREAT, and the only reason they don't get filled is their more remote location. For someone who doesn't have a lot of pre-existent family obligations (such as a spouse who also needs to find work in a non-medical field), or are just starting their families, and do not mind being 1-2 h. away from a major airport or other larger city amenities (nowadays a lot of stuff can be available on line anyway!), some of these jobs are true gems.

(This pertains to all specialties, not just cardiology.)

 

[rtk]

daelroy;

Your argument that cardiology doesn't offer the same financial rewards that it used to applies to all fields of medicine. Most replies to your post have said this. In fact, unless a congressional amendment is passed this year (as has been done each year for the past several years), the balanced budget act will start decreasing Medicare physician reimbursement 5% per year for the next ten years. That'll be 50% reimbursement from 1997 levels (PS: that affects all physicians, not just cardiologists). Most third-party payers follow Medicare reimbursement trends... This is the reality of medical reimbursement.

I'm finishing my cardiology fellowship in July, so I feel I can address your comments regarding reimbursement. I have interviewed at several midwest practices and 400K as a starting salary is about right. The partners in these groups double and sometimes triple this amount. Their salary is in no small part attributable to their capital investment in the group (ownership in the facility and equipment). Reimebursement for facility charges then is collected by the group and parlayed to the partners after expenses. In fields such as cardiology and GI, where many procedures and imaging studies are performed, this opportunity exists. This revenue stream is not available to non-procedure oriented specialties (ie: allergy/immunology).

The other reality of cardiology is the vast number of job opportunites. For every graduating fellow in '05, there are atleast 4 positions available. This is true all over the country. The pausity of available cardiologists is in part due to the length of training required (limiting interest in the field by physicians such as yourself) and the demand for services by an aging population with increasing incidence heart disease (thanks to the western diet and lifestyle). And not everyone does a interventional year. There is a great demand currently for non-invasive and general cardiologists. Cardiac imaging (nuclear, echo, MRI CT) is growing dramatically.

And finally, as several people have already pointed out, an interest in the field of cardiology is the driving force to pursue this additional training. It is a demanding field, but, there is no other area in medicine as fascinating as cardiology. Where else in medicine does what you do so directly impact the health of your patient? I can think of no other field (except, perhaps trauma surgery) that what you do in 20 minutes in the interventional lab determines life or death of a patient. If you have the opportunity to watch an acute intervention on a patient suffering a huge anterior MI, do so... You'll cange your mind about cardiology.

 

[daelroy]

daelroy;

Your argument that cardiology doesn't offer the same financial rewards that it used to applies to all fields of medicine. Most replies to your post have said this. In fact, unless a congressional amendment is passed this year (as has been done each year for the past several years), the balanced budget act will start decreasing Medicare physician reimbursement 5% per year for the next ten years. That'll be 50% reimbursement from 1997 levels (PS: that affects all physicians, not just cardiologists). Most third-party payers follow Medicare reimbursement trends... This is the reality of medical reimbursement.

I'm finishing my cardiology fellowship in July, so I feel I can address your comments regarding reimbursement. I have interviewed at several midwest practices and 400K as a starting salary is about right. The partners in these groups double and sometimes triple this amount. Their salary is in no small part attributable to their capital investment in the group (ownership in the facility and equipment). Reimebursement for facility charges then is collected by the group and parlayed to the partners after expenses. In fields such as cardiology and GI, where many procedures and imaging studies are performed, this opportunity exists. This revenue stream is not available to non-procedure oriented specialties (ie: allergy/immunology).

The other reality of cardiology is the vast number of job opportunites. For every graduating fellow in '05, there are atleast 4 positions available. This is true all over the country. The pausity of available cardiologists is in part due to the length of training required (limiting interest in the field by physicians such as yourself) and the demand for services by an aging population with increasing incidence heart disease (thanks to the western diet and lifestyle). And not everyone does a interventional year. There is a great demand currently for non-invasive and general cardiologists. Cardiac imaging (nuclear, echo, MRI CT) is growing dramatically.

And finally, as several people have already pointed out, an interest in the field of cardiology is the driving force to pursue this additional training. It is a demanding field, but, there is no other area in medicine as fascinating as cardiology. Where else in medicine does what you do so directly impact the health of your patient? I can think of no other field (except, perhaps trauma surgery) that what you do in 20 minutes in the interventional lab determines life or death of a patient. If you have the opportunity to watch an acute intervention on a patient suffering a huge anterior MI, do so... You'll cange your mind about cardiology.

rtk

Thanks for the classy, thorough, and informative post. However, you are practicing in the midwest where pay is generally higher for all fields of medicine. And you have not addressed it's stresfull lifestyle like the fact that you will be on call a lot. And the training isn't easy by any means. 7 years after medical school is a long time. And unlike GI, cardiology fellowship is not relatively chill. As an example, GI fellowship is far more relaxed. And as a GI, you will take far less call while still doing a variety of procedures.

 

[daelroy]

I am not sure why so many people want to become cardiologists. Money surely has something to do with it. Lifestyle may be a secondary consideration for many.

I don't think that cardiology is unique in terms of the recent decline in reimbursement. All medical specialties are being hit hard. Primary care (FP, IM or Peds) is poorely remunerated for the number of hours that are required (which is actually not less than Cards, GI, or Pulm/CCM).

Cardiology is also not unique in terms that it is, at least in theory, an extension of internal medicine. That is why you still have to do three years of internal medicine before fellowship (even for allergy and immunology!).

What is (relatively) unique is the job security in the field. The demand for cardiologists is astounding. Cardiovascular disease is the number one cause of death in the US. Yes it is true that if you want to practice interventional cardiology in downtown Chicago, New York, Boston or LA the market is somewhat tight. On the other hand, areas of high population density aside, the demand is quite high. I have not even started my fellowship and already I have physician recruiters sending me letters and emailing me. Circulation (in March?) this year (past) published a series of editorials by Robert Bonow, Valentin Fuster, and others discussing the shortage of cardiologists predicted and how to meet this shortage.

I decided to go into it for a variety of reasons, most notably that cardiovascular medicine absolutely fascinates me.

All medical fields have job security. You won't have trouble finding a job as even a family practice physician. But I understand what you were getting at. The supply of cardiologists is so low that the demand for your services is high. And areas of small population density show a demand for all fields let alone cardiology.

The thing is you guys work hard even outside of fellowship. You work much longer hours than family, peds and IM guys in general.

 

[Idiopathic]

The thing is you guys work hard even outside of fellowship. You work much longer hours than family, peds and IM guys in general.

Yeah, for about twice the money

 

[Filter]

The thing is you guys work hard even outside of fellowship. You work much longer hours than family, peds and IM guys in general.

Yup,

They work hard, perform life saving procedures, oftentimes get to watch others leave the hospital while they continue to work, and are altogether amazing docs. Its not for everyone, which is why some people choose to do it, and others go into fields like AI, endocrine, GI, etc. Its a choice and a calling, just like going into a highly demanding surgical field. I'm sure there is an element of ego involved, but i think that most people enjoy being respected and valued by thier peers and the public in general. I'm just a lowly fourth year student, but after doing some cards rotations and research, my respect for these guys is immeasurable. Its both intellectually and technically challenging, and is one of the few fields where you can effect change immediately in a patient's life. And although the compensation may be declining, i have yet to hear a cardiologist complain about income. So, if you are not interested daelroy, please don't go into it......leave the spot open so that maybe ill have a shot if i decide to do it .

 

[novacek88]

I think this is a very informative thread and am glad it was posted. Cardiology is an amazing field but it isn't for everyone. I'm glad some of the negative aspects of the field were touched upon because many people have the wrong idea about cardiology. They don't realize that it is a very demanding field. People think that once you are finished with your internal medicine residency, cardiology fellowship and practice is a breeze. Yes, in other IM fields like allergy, endocrine and GI, fellowship offers a signficantly easier lifestyle when compared to a medicine residency. And the real world practice of these fields can afford one a very relaxed lifestyle. People think cardiology is the same way because it's another IM subspecialty. Cardiology is more like a surgical subspecialty because of the hours and stress. However, cardiology is very cutting edge and many people absolutely love the field because of this aspect. So I don't think one can do cardiology for the income and prestige alone, because they will find themselves working much harder for those aspects when they could have received the same from other fields with a better lifestyle.

Like another poster mentioned, there are other fields of medicine that can afford similar or greater compensationand a much better lifestyle so don't go into cardiology for the wrong reasons. And not all cardiologists start at 400K particularly on the coasts and other densely populated areas. 400K to start can be found in the midwest and the south. However, it's not uncommon to find radiologists and GI's starting at 400-500K in these areas as well. A good friend of mine is a cardiologist in Phoenix and his starting salary was 275K so you be the judge. And Phoenix isn't LA, Chicago, New York or SF.

 

[scrub monkey]

at my residency, i have to say the gi fellows probably work even harder than the cards fellows. (there are a lot more cards fellows than gi fellows, and the volume for gi is outrageous). while endocrine and allergy fellowships may be cushy, i wouldn't say the same for gi.

as for cards, i think there is great respect both among the lay public and the medical community for cardiologists. many of the smartest, most talented docs are cardiologists. even in med school and residency, i think some of the brightest people i've met are the ones planning on going into cards. and it should be that way. if anyone in my family has heart disease, i'd want the smartest, brightest doc taking care of them. it wouldn't make much of a difference if their dermatologist or allergist was a bone-head, bottom of the class physician (though usually these specialists are top-of-their-class). but i would hope their cardiologists are top-notch.

cards docs work hard, save lives, are paid well, as they should be, and are well respected all around. i think these are good reasons people are still interested in cards.

 

[novacek88]

A good point that has been made is that cardiologists are practically required to do an interventional fellowship these days. Most job listings require an interventionalist. For those of you who were pursuing interventional cards, this is a non-issue. But for those who wanted to finish after 3 years of fellowship, you might want to reconsider since the interventional tag is almost a requirement. 4 years of fellowship is quite lengthy so make sure you are going into cards for the right reasons. After 7 years of residency, the money and prestige may not matter as much as it did when you were in medical school.

 

[SmallTownGuy]

I am under the impression that after completing a 3 year fellowship, one has to apply all over again for an interventional fellowship. I think that it is very competitive. A local institution at my school trains 6 cardiac fellows a year, but only accepts one person per year for interventional training. Given the last post, would I be screwed if I did not match in interventional?If there are so many less spots offered in interventional, what are all the non-interventional fellows who don't match do?

 

[novacek88]

I am under the impression that after completing a 3 year fellowship, one has to apply all over again for an interventional fellowship. I think that it is very competitive. A local institution at my school trains 6 cardiac fellows a year, but only accepts one person per year for interventional training. Given the last post, would I be screwed if I did not match in interventional?If there are so many less spots offered in interventional, what are all the non-interventional fellows who don't match do?

It depends where you choose to live. If you want to practice in a small town or a smaller city, you wouldn't have any trouble finding a position as a non-interventionalist. I know a non-invasive cardiologist who didn't want to go the intervential route, however, he is also moving to a small town in North Carolina. But it would be tough to join a partnership in a large city as a non-invasive cardiologist. Think about it. You bring less value to the firm if you can't perform procedures which is what brings in the money. And partnerships in large cities have no problem receiving applications from interventionalists so why would they hire a non-inverventionalist?

The non-invasive guys are the ones who practice in less dense areas and make a killing doing a large volume of stress tests. But if you plan on living in a metropolitan area(city+suburbs) with a population exceeding 1.5- 2 million people, I would strongly encourage you to go interventional. Even in these cities, there will be opportunities for non-interventionalists but you will be a much more marketable candidate as an interventionalist.

 

[SmallTownGuy]

Thank you for info! I do plan on doing interventional (provided that I can get in). The area that I am from is small (can you guess that from my name??), but I intend to live there and practice in a bigger town about 10 minutes from there. My mom is on the board at a hospital there, and there is NOT A SINGLE CARDIOLOGIST, believe it or not, in the whole area (drawing population of over 200,000). This is because the hospital is small and can not afford to get one (they are currently offering 300k and being refused).
My main concern was not being able to get into a interventional fellowship because there are so few spots. Since I plan on practicing in a medium size town or small town, your post gives me some hope that I can still pay the bills even if I can't get the interventional spots.

 

[fatsal]

Why would one go into cardiology? MONEY!

It's not uncommon for a cardiologist in the midwest in a smaller city to earn close to a million dollars. In large cities, cardiologists still earn 400K on average. Yeah it requires additional training but it's only a year longer than many other fellowships with a much higher potential for income. And if you hate taking call, just go into non-invasive cards and you will still earn a lot of cash doing stress tests etc.

 

[rtk]

Novacek88;

Actually, there is a greater demand right now for non-interventional and even non-invasive cardiologists. THat's because of the demand for imaging services (i.e.: echo, nuclear , CT and MRI).

I'm doing a year of interventional training next year because of my interest in this area, but I've been told by many recruiters that there are more positions available for non-invasive cards.

It is possible to be level 2 certified in both echo and nuclear after three years of fellowship training. Level 3 certification in these areas usually requires more training beyond fellowship. And many cardiologists read these studies even without certification (although that'll change in the near future with reimbursement trends through Medicare).

 

[TXMSIV]

I like this thread. Definitely positives and negatives to the field. I'd like to hear from any cards fellows that can shed light on the EP pathway. What does it entail, and is there demand for it? I find the field to be quite fascinating.

 

[jdaasbo]

EP is an additional two years after general cardiology.

The demand is currently quite high for EPs and is expected to become only higher due to the all the new indications for devices as well as EP studies/ablations.

 

[LubDubLubDub]

edit

 

[Stormreaver]

EP is an additional two years after general cardiology.

The demand is currently quite high for EPs and is expected to become only higher due to the all the new indications for devices as well as EP studies/ablations.

Correction: 1 year.

 

[jdaasbo]

Correction: 1 year.

To recieve full training in EP it is two years.

Trust me. I am not interested in a pissing contest.

 

[v-tach]

To recieve full training in EP it is two years.

Trust me. I am not interested in a pissing contest.

Please. No "micturition competitions"!

 

[cardiologydude]

EP fellowship lasts 1 year, regardless if you piss or if you are anuric.

Albert Einstein College of Medicine Program
Identifier: 154-35-21-042
Specialty: Clinical Cardiac Electrophysiology (IM)



Basic Information
Last updated: 10/12/2004
Survey received: 07/09/2004
Program Director:


John D Fisher, MD
Montefiore Med Ctr
111 E 210th St
Cardiology Arrhythmia Offices N2
Bronx, NY 10467 Tel: (718) 920-4291
Fax: (718) 547-2111
E-mail: [email protected]
Web Address:


Person to contact for more information about the program:

John D Fisher, MD
Montefiore Med Ctr
111 E 210th St
Cardiology Arrhythmia Offices N2
Bronx, NY 10467 Tel: (718) 920-4291
Fax: (718) 547-2111
E-mail: [email protected]




Accredited length 1
Required length 1
Accepting applications for 2005-2006 Yes
Will be accepting applications for 2006-2007 Yes
Program start dates July
Participates in ERAS 2005 No
Participates in ERAS 2006 No
Affiliated with US Government No


New York Presbyterian Hospital (Cornell Campus) Program
Identifier: 154-35-23-048
Specialty: Clinical Cardiac Electrophysiology (IM)



Basic Information
Last updated: 10/12/2004
Survey received: 07/09/2004
Program Director:


Steven M Markowitz, MD
New York Hosp Cornell Med Ctr
525 E 68th St Starr 4
New York, NY 10021 Tel: (212) 746-2655
Fax: (212) 746-6951
E-mail: [email protected]
Web Address:


Person to contact for more information about the program:

Steven M Markowitz, MD
525 E 68th St Starr 4
New York, NY 10021 Tel: (212) 746-2158
Fax: (212) 746-6951
E-mail:




Accredited length 1
Required length 1
Accepting applications for 2005-2006 Yes
Will be accepting applications for 2006-2007 Yes
Program start dates June
Participates in ERAS 2005 No
Participates in ERAS 2006 No
Affiliated with US Government No




New York University School of Medicine Program
Identifier: 154-35-32-049
Specialty: Clinical Cardiac Electrophysiology (IM)



Basic Information
Last updated: 10/12/2004
Survey received: 09/27/2004
Program Director:


Larry A Chinitz, MD
New York Univ Med Ctr
560 First Ave
New York, NY 10016 Tel: (212) 263-5656
Fax: (212) 263-0730
E-mail:
Web Address:


Person to contact for more information about the program:

Larry A Chinitz, MD
New York Univ Med Ctr
560 First Ave
New York, NY 10016 Tel: (212) 263-5656
Fax: (212) 263-0730
E-mail:




Accredited length 1
Required length 1
Accepting applications for 2005-2006 Yes
Will be accepting applications for 2006-2007 Yes
Program start dates June
Participates in ERAS 2005 No
Participates in ERAS 2006 No
Affiliated with US Government No

 

[rtk]

EP fellowship lasts 1 year, regardless if you piss or if you are anuric.

Albert Einstein College of Medicine Program
Identifier: 154-35-21-042
Specialty: Clinical Cardiac Electrophysiology (IM)



Basic Information
Last updated: 10/12/2004
Survey received: 07/09/2004
Program Director:


John D Fisher, MD
Montefiore Med Ctr
111 E 210th St
Cardiology Arrhythmia Offices N2
Bronx, NY 10467 Tel: (718) 920-4291
Fax: (718) 547-2111
E-mail: [email protected]
Web Address:


Person to contact for more information about the program:

John D Fisher, MD
Montefiore Med Ctr
111 E 210th St
Cardiology Arrhythmia Offices N2
Bronx, NY 10467 Tel: (718) 920-4291
Fax: (718) 547-2111
E-mail: [email protected]




Accredited length 1
Required length 1
Accepting applications for 2005-2006 Yes
Will be accepting applications for 2006-2007 Yes
Program start dates July
Participates in ERAS 2005 No
Participates in ERAS 2006 No
Affiliated with US Government No


New York Presbyterian Hospital (Cornell Campus) Program
Identifier: 154-35-23-048
Specialty: Clinical Cardiac Electrophysiology (IM)



Basic Information
Last updated: 10/12/2004
Survey received: 07/09/2004
Program Director:


Steven M Markowitz, MD
New York Hosp Cornell Med Ctr
525 E 68th St Starr 4
New York, NY 10021 Tel: (212) 746-2655
Fax: (212) 746-6951
E-mail: [email protected]
Web Address:


Person to contact for more information about the program:

Steven M Markowitz, MD
525 E 68th St Starr 4
New York, NY 10021 Tel: (212) 746-2158
Fax: (212) 746-6951
E-mail:




Accredited length 1
Required length 1
Accepting applications for 2005-2006 Yes
Will be accepting applications for 2006-2007 Yes
Program start dates June
Participates in ERAS 2005 No
Participates in ERAS 2006 No
Affiliated with US Government No




New York University School of Medicine Program
Identifier: 154-35-32-049
Specialty: Clinical Cardiac Electrophysiology (IM)



Basic Information
Last updated: 10/12/2004
Survey received: 09/27/2004
Program Director:


Larry A Chinitz, MD
New York Univ Med Ctr
560 First Ave
New York, NY 10016 Tel: (212) 263-5656
Fax: (212) 263-0730
E-mail:
Web Address:


Person to contact for more information about the program:

Larry A Chinitz, MD
New York Univ Med Ctr
560 First Ave
New York, NY 10016 Tel: (212) 263-5656
Fax: (212) 263-0730
E-mail:




Accredited length 1
Required length 1
Accepting applications for 2005-2006 Yes
Will be accepting applications for 2006-2007 Yes
Program start dates June
Participates in ERAS 2005 No
Participates in ERAS 2006 No
Affiliated with US Government No

Cardiologydude;

It's hard to argue w/ FRIEDA, but if EP is not listed as 2 years yet, it soon will be. The vast majority of EP fellowships are now 2-years. This is due to the vast number of procedures performed in EP, particularly Afib ablations...

I was considering EP but opted for Interventional in part because every program I contacted (despite what the FRIEDA web site stated) was 2-years. In fact, many interventional programs are going to 2 years as well...

 

[Stormreaver]

That may be true. Interventional is increasingly moving to two years. Our own cardiology program extended interventional to 2 yrs. However, they have one of the foremost EP programs in the country, and that is still 1 year.

 

[jpro]

With the baby boomers just starting to hit 60,the demand for cardiologists in the next 30 years is going to be very strong.

Don't forget the rapid increase in obesity especially among children. Not only is cardiology going to be in high demand but IM in general.

 

[TommyGunn04]

...Cardiovascular disease is the number one cause of death in the US...

I was recently told that this isn't entirely true anymore (as of just a few months ago). Cancer has now surpassed cardiovascular disease as the #1 cause of death in the US for those under age 85, according to the American Cancer Society (here's one of many stories about it; they were all over the news in January http://my.webmd.com/content/article/99/105264.htm). From what I gather, cardiovascular disease remains the leading cause of death overall though, if you take out the "under 85" qualification. This is consistent with what I've found on the CDC's website. Their most recently released data (Feb 28, 2005) still suggests that cardiovascular disease is the leading cause of death (but these are figures based on 2003-collected data). (http://www.cdc.gov/nchs/pressroom/05facts/lifeexpectancy.htm)

Anyway, I point this out not to be contrary, but rather to make sure we're all on the same page and because I thought it was interesting (no desire for a micturition contest here! ).

This is a great thread!

 

[jgar26]

I fail to see the appeal of cardiology. Cardiology fellowship doesn't offer the great lifestyle the other IM fellowships offer like allergy/immunology and GI. Cardiology fellowship for all intensive purposes is an extension of IM. It's not much better than general surgery in regards to lifestyle. And now interventional training is practically a requirement if you seek to join a cardiology group in a large city so you can tack on 1 more year to that total. That's right, most large groups are not interested in a non-invasive cardiologist since they are limited by their inability to perform procedures.

Salaries have been significantly hit hard in the past 4 years as insurance reimbursement has significantly dropped for procedures and office visits. It's tough for a cardiologist to earn in excess of 400K these days. That's a lot of money but for the amount of training and stress you undergo there are better options like radiology and anesthesiology.

Finally, their lifestyle after residency is less than pleasant with the amount of call and patient management they undergo. Yet cardiology seems to be this great buzzword and I just have to laugh. I can understand the appeal of cardiology 10 years ago when they were earning a lot more money and had the prestige back then but today the field seems to fallen significantly.

Well, I think I will weigh in on this issue. Cardiology is probably the HARDEST specialty for recruiters to fill jobs for clients (i.e. practices) today. There are easily 5 to 10 high paying jobs for any graduating Cards fellow. Whether you are invasive, interventional, or non-invasive, jobs are very plentiful. It is not "hard" to make 400K dollars in Cardiology. Granted it is probably easier to do in other specialties. People do NOT do Cardiology for the money.....At least I hope not, because that is an unwise thing to do. I am a current cardiology fellow and thus have a "real" perspective on this.

The lifestyle of a Cardiologist is defintely harder than most IM specialties, but it depends how you define "hard". Cardiology is exploding in growth and demand for a Cardiologist is out of control. I am a 2nd year Cards fellow and have recieved 4 job offers already (starting salary ranging from 250K-300K/year with bonuses, relocation, and 401K added on). The demand FAR OUTWEIGHS the supply. You are wrong when you say that one needs to do an Interventional year to be marketable.. NOT TRUE AT ALL. Many non-interventional cardiologists can actually bill more than an interventional cardiologist. One can read 10 Nuclear studies (that are reimbursed at about 1000K/study) in the time it takes someone to do a technically difficult angiplasty reimbursing 3000K. Trust me, there is no problem finding multiple job offeres for a Cards fellow today. This is probably unprecedented. The future only will get better. The supply of Cards grads is just not able to keep up with the demand.

NOw don't get me wrong, the work is tough and YOU WILL WORK hard. The Cards fellowship is tough and is stressful. I do not think there is one specialty in the hospital that ALL specialites rely on as much as Cards (at least it seems that way). As a private practice Cardiologist, you can easily expect to work 55 hours +. The pay is great but I have been told by many cards docs that they have never worked harder in their lifes. The demand for our services is out of control. The technology and legal climate have been a boom to us, but along with this comes more hours and stress. You can make 500K a year very easily,,,BUT you will be working hard for that. Noone is gonna pay you that money to work 9-4 and drink coffee all day. You will need to do many consults, see pts at a referring docs whim, read Echos, do Nucs, read Holters, and possibky do an emergency angiogram all in a day. Unlike most other IM specialties, you cannot "sit tight" and watch the pt. The pts need to be seen NOW. Chest pain or Coronary Artery Disease frighten all docs and they WILL call you to see these pts.

If one wants to make a good income and not be burdened with as much stress, etc...go to GI. They make very good money and have a considerably better lifestyle (in general). The stress in Cardiology can be overwhelming. You will be called by Surgery all of the time b/c they can't read EKG's and want "clearance" for someone they plan to operate on. You will be called by the ED for everything as those guys are so damn afraid of their shadows that they will ask for a consult for a 20 year kid with a rib fracture if he complains of chest pain. If you do Cardiology you better be ready to deal with the extreme ineptitude of Emergency Medicine Doctors. Yeah, that may be controversial to say on here, but it is the f-ing truth. You will get 10 consults a day for what amounts to "tranfer of risk from me to you". You better be ready to deal with stat Echos for post CT/CABG pts who await your read and study to decide if they need to go back to the OR. You better be ready to do a STAT 4 am TEE after a Radiologist reads a CT scan and uses the infamous "Cannot rule out"....looking for a dissection. You better be ready to do curbside EKG reads at ALL TIMES because in reality most docs in the hospital (including IM) don't "really" know how to read an EKG. YOu better be ready to deal with ED docs asking for a Stat Catherization because they can't get someone with non-cardiac chest pain free with a nitro drip.

I may sound a little jaded, but what I say is reality. Cardiology IMO is the best specialty in Medicine. The respect of every specialty is there (except probably radiology as we have pushed them around with cardiac imaging in the distant past and there is a turf war of immense proprtions brewing). YOu will directly be able to save lives, and be truly on the "front" lines of medicine. Please don't go into Cardiology for the lifestyle or "money". It is not worth it. It is a hard specialty that can come with a steep price. In my 1st year of felllowship I worked often from 7 am to 8 pm. I missed my son's second year of life essentially. I often slept on the couch away from my wife b/c the pages I got all night kept her up. Even with all of this, I would NOT do another specialty. I love this job.

This is just my opinion on this topic, take it for what you want.

 

[glc549]

Are there any statistics on how many people apply to this awesome fellowship and do NOT get in?

 

[Jattdoc]

_________________________

Hey Dr. Jassbo, and Dr. Rtk, Dr. Jgar26, …thanks for keeping us up to date on the forum…

I was wondering, with the need for additional 2 years or more for EP, Inteventional, Imaging or other training, on top of standard 3-year cardiology fellowship, is there or are there any future plans for fast tracking or other ways to speed up you training…or maybe incorporating the procedures/advances into the standard 3-year curriculum. Anything in the works at the national/regional/university/etc level.

…thanks…

 

[usmlestep12]

I was recently told that this isn't entirely true anymore (as of just a few months ago). Cancer has now surpassed cardiovascular disease as the #1 cause of death in the US for those under age 85, according to the American Cancer Society (here's one of many stories about it; they were all over the news in January http://my.webmd.com/content/article/99/105264.htm). From what I gather, cardiovascular disease remains the leading cause of death overall though, if you take out the "under 85" qualification. This is consistent with what I've found on the CDC's website. Their most recently released data (Feb 28, 2005) still suggests that cardiovascular disease is the leading cause of death (but these are figures based on 2003-collected data). (http://www.cdc.gov/nchs/pressroom/05facts/lifeexpectancy.htm)

Anyway, I point this out not to be contrary, but rather to make sure we're all on the same page and because I thought it was interesting (no desire for a micturition contest here! ).

This is a great thread!

Now if CDC or anyone else says that Cardiovascular is no longer a leading cause of death...that means heart disease doesn't kill many people anymore...that indirectly means a lot more and more are surviving with it now...and that leads to an even greater demand for cardiologists (all-invasive,non invasive etc) to take care of those millions now surviving with heart disease...
did anybody thought of this fact...
dudes...the bottom line is that...both Coronary and Cancer are natural part of aging in todays life...every other person (I would say everyone of us) is bound to get either one or both of it...and the more you live ..the more chances you have to get it...
and with the increasing of geriatric population you have an increase in demand for both....
so both are going to prosper for the time being....
that's my 2 cents on it.....

 

[TommyGunn04]

Now if CDC or anyone else says that Cardiovascular is no longer a leading cause of death...that means heart disease doesn't kill many people anymore...that indirectly means a lot more and more are surviving with it now...and that leads to an even greater demand for cardiologists ....

very good point! These stats can be deceiving...it's quite likely that death from cardiovascular disease is decreasing in incidence because medical interventions are working, not because the incidence of cardiovascular disease itself is dropping (in reality it's probably RISING given the obesity problem and increasingly sedentary lifestyle, adding to the problem of a growing number of uninsured Americans with little or no access to preventive care).

I think a similar situation goes for oncology...cancer is now known to kill many more people today 1) because we're much better at detecting it, but also because 2) people are living longer since they're not dying from other things (like cardiovascular disease!) I bet oncology will keep on growing too!

 

[glc549]

There are 173 cardiovascular fellowship programs with roughly 706 slots available each year. Does anyone know (or have a reference to) how many people applied this year for those coveted slots?

 

[RADRULES]

Radiology will win the turf battle for CT/MRI because cardiology is a victim of its own greed.

The self-referral by cardiologist is absurd and all of those footing the bill have come to this understanding.

Too many unnecessary caths and stress tests to make payments on the new Benz...

In fact, it really is not even a turf battle.... CT/MRI is the domain of the radiologist and will stay that way. The Nucs docs are soft and gave it up like a cheap hooker, but I doubt that will happen again.

There is a lot of information on a CT or MR of the chest besides the heart.

Cannot rule out dissection?? You must be at a ****ty hospital...

As for resepct, several of the IM docs I know tell me that cards try to steal their patients.... start handling all their medical care following a referral... great way to keep that respect level high...

 

[usmlestep12]

Radiology will win the turf battle for CT/MRI because cardiology is a victim of its own greed.

The self-referral by cardiologist is absurd and all of those footing the bill have come to this understanding.

Too many unnecessary caths and stress tests to make payments on the new Benz...

In fact, it really is not even a turf battle.... CT/MRI is the domain of the radiologist and will stay that way. The Nucs docs are soft and gave it up like a cheap hooker, but I doubt that will happen again.

There is a lot of information on a CT or MR of the chest besides the heart.

Cannot rule out dissection?? You must be at a ****ty hospital...

As for resepct, several of the IM docs I know tell me that cards try to steal their patients.... start handling all their medical care following a referral... great way to keep that respect level high...

Here are my answers for you.....

"Radiology will win the turf battle for CT/MRI because cardiology is a victim of its own greed."

Cardiology is not anyone's victim so far...in fact Radiology is a victim of Cards greed...

"The self-referral by cardiologist is absurd and all of those footing the bill have come to this understanding"

Rarely is there any speciality or sub-speciality in hospital that does not do referrals to Cards...so they really don't have time for self-referrals...

"In fact, it really is not even a turf battle.... CT/MRI is the domain of the radiologist and will stay that way. The Nucs docs are soft and gave it up like a cheap hooker, but I doubt that will happen again"

CT-MRI may be the domain of the radiologists...but the Arteries and The heart definitely are not...

"Too many unnecessary caths and stress tests to make payments on the new Benz... "

Those caths and stress tests are not unnecessary when you consider the amount of money Cards docs pay to the Malpractice insurance companies...

"There is a lot of information on a CT or MR of the chest besides the heart"

I agree that that is a lot more in the chest besides Heart...but my dear...Heart is more important than all those other stuff in the chest...

"As for resepct, several of the IM docs I know tell me that cards try to steal their patients.... start handling all their medical care following a referral... great way to keep that respect level high"

Many of the Cards docs that I know told me that IM docs (and every other speciality docs..ED being notorious in this respect) dump their patients on Cards to avoid liability..so Cards docs are really not stealing anything from anyone...

 

[abu barney]

Don't mean to be cynical but the popularity of any given specialty across the board is proportional to the amount of money made and inversely proportional to the amount of work needed to make that money. Cards is no exception. However if you want a chill lifestyle, do cards imaging and just analyze stress tests from 9-4 and then drive home in your aston-martin convertible. Stress tests in themselves are of dubious value especially when done as part of the pre-op eval.

My beef with cards is that I think cardiologists have no idea whatsoever what they are doing outside of treating STEMI. The past 30 years of studies of coronary disease has been based on cardiac cath being the "gold standard" and now there is the pink elephant in the room saying whether cardiac cath is of any value at all in "stable" CAD.

My 2 cents.

 

[Pili]

Don't mean to be cynical but the popularity of any given specialty across the board is proportional to the amount of money made and inversely proportional to the amount of work needed to make that money. Cards is no exception. However if you want a chill lifestyle, do cards imaging and just analyze stress tests from 9-4 and then drive home in your aston-martin convertible. Stress tests in themselves are of dubious value especially when done as part of the pre-op eval.

My beef with cards is that I think cardiologists have no idea whatsoever what they are doing outside of treating STEMI. The past 30 years of studies of coronary disease has been based on cardiac cath being the "gold standard" and now there is the pink elephant in the room saying whether cardiac cath is of any value at all in "stable" CAD.

My 2 cents.

I have a Q: those guys reading heart stuff and then driving home in the rolls, are the ones that do cards, rads, or straight nuclear medicine? (the least competitive where you just do 2-3 years after graduating) I heard that straight nuclear medicine is a ruin and there are no jobs. Is that true?

 

[chameleonknight]

Attended a talk by the Cards fellowship director here a few days ago; he said they receive about 400 applications for 4 slots every year (!) He was saying the quality of applicants goes up every year, and that even if they set the USMLE cut off level at 250, there would still be dozens of applicants left.

So, I think they are PLENTY of people that want to go into cards today, and personally, I don't think it's all about the money (though it doesn't hurt). Cardiologists to me seem like intellectuals who are practical and hands on.

Interesting that with all this demand, why don't they increase the number of fellows?

 

[colforbinMD]

Many of the Cards docs that I know told me that IM docs (and every other speciality docs..ED being notorious in this respect) dump their patients on Cards to avoid liability..so Cards docs are really not stealing anything from anyone...

Wandered in from my EM pen here on SDN. Someone left the door open and now I'm loose.
Now let me, before I start my rant, just ask. ARE YOU FREAKIN SERIOUS????? Do you understand how medicine is practiced and the precious and key role that EM plays in this practice? Have you ever been in an ED? Do you know what they are there for? Are you that sel.............wait, [DEEP BREATH kp, you promised you wouldn't rant, calm down, don't let the monster out just yet.................] phewww!! Close one.... Anyway seriously now. ARE YOU FREAKIN SERIOUS?

 

[Whisker Barrel Cortex]

"The self-referral by cardiologist is absurd and all of those footing the bill have come to this understanding"

Rarely is there any speciality or sub-speciality in hospital that does not do referrals to Cards...so they really don't have time for self-referrals...

"In fact, it really is not even a turf battle.... CT/MRI is the domain of the radiologist and will stay that way. The Nucs docs are soft and gave it up like a cheap hooker, but I doubt that will happen again"

CT-MRI may be the domain of the radiologists...but the Arteries and The heart definitely are not...

"Too many unnecessary caths and stress tests to make payments on the new Benz... "

Those caths and stress tests are not unnecessary when you consider the amount of money Cards docs pay to the Malpractice insurance companies...

"There is a lot of information on a CT or MR of the chest besides the heart"

I agree that that is a lot more in the chest besides Heart...but my dear...Heart is more important than all those other stuff in the chest...

Cardiologists self refer (or refer to their partners) for nuclear cardiac stress tests all of the time. The volume of these studies and of echocardiography has increased exponentially in the past 10 years. You would think that this increase in non-invasive testing would decrease the number of invasive cardiac catheterizations. In fact, cardiac caths have gone up at the same time. Many studies have shown that the number of imaging studies performed increase from 2 to 8 fold for the same type of patient when a clinician is self referring as opposed to when they refer to a radiologist.

The attitude that the heart is more important is the exact attitude that is dangerous in having cards primarily interpret cardiac CT/MRI, my dear (wtf is that). Do you think lymphoma, pulmonary embolus, lung cancer, lung mets, bone mets are unimportant? Studies have shown that 10-15% of cardiac MRI and cardiac CT have clinically significant non-cardiac findings. I think that the best patient care in the future will be to have cardiologists interpret the angiogram portion of the examination with the radiologist intrepreting everything else.

 

[gwen]

would anyone agree that a lot of these sentiments here could be arising from jealousy between subspecialties? cards vs rads vs heme/onc etc.? i'm just an outsider...going into the low-paying rheum field, so don't yell at me. this is just my observation.

 

[RADRULES]

Sorry, but I do not think Cards is needed to interpret any part of Cardiac CT/MRI.

One of my former faculty members did one of the first cardiac caths in the US, and helped pioneer cardiac angiography. He used to give us excellent lectures on the subject, and let me tell you a secret, it is not hard.

Any radiologist worth his salt will be able to the get all the important information from cardiac CT/MRI. More importantly, since we understand the imaging physics and protocols, we can tailor the study for the clinical question.

I would like to see cardiologist try to wrap their greedy brains around gradiant FFSE or triple IR MR pulse sequenced... what a joke.

 

[ReMD]

Radiologists are just jealous and worried about other specialties, specifically Cardiology, taking over they're business. Slowly but surely, radiology will become a more narrowed field as other specialties expand their scope of practice and as technology advances. Cards will continue to do more and more imaging and "whole body" vascular intervention. Gastro/hepatology, vascular surg, neurology, pulm, etc, are all in the process of expanding their procedural services and image diagnostic capabilities. These fields are already reading their own imaging studies accurately. There's no sense a patient should be billed twice for a radiologist reading unless the primary doc refers it to rads. I read CXRs all the time and feel very comfortable with my accuracy. Why should a rads doc read it unless I have a question. This is the same for Cardiology and cardiac CT/MRI, for Vascular surgeons and arteriograms, etc, etc, etc.
Bottom line is that whoever primarily cares for the patients, are the ones that control the outcome of these turf battles. Radiology is just not in an optimal position to challenge these issues, unless they learn how to manage patients clinically over a potentially long period of time.