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littlecow

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I think General Cardiology still a very nice field. I personally enjoyed the imaging aspect of it and even if you don't do any additional sub-fellowship most/many general cardiologists still read a lot of imaging studies (echos, nucs) with a lot also doing their own TEEs. Job market wise for general cards still pretty good.

I've known a couple people who did a CC year after gen cards, mostly because they really enjoyed the hospital environment and higher acuity and wanted to primarily practice in a CCU type setting.
 
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littlecow said:
What are the most interesting/exciting aspects of cardiology without these fields?
And thoughts about CCM afterwards?
Click to expand...

Cards is awesome. Lots of variety, echos, nuclears, cardioversion, most programs will get you level 2 in cath, so potential for some cath lab at certain jobs. You can do TEE for procedures as well.

Heart failure might be up your alley if you got the CC itch. I wouldn't do cards /cc as many groups will need someone to cover pulm consults when you are on ICU. Community ICU is usually much lower acuity than in academic places (eg guys 100s/60 with pneumonia may be an ICU admit).
 
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littlecow said:
Can you expand on the variety please?
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For General Cards practice will usually be some sort of mixture of outpatient clinic and inpatient rounding/consults. Most folks will also read their own echos, stress tests (plain treadmill, echo, and nuclear), holter/event monitors, possibly vascular ultrasounds (carotid, peripheral). Inpatient procedures could include TEEs, maybe diagnostic heart caths and a few general cards still out there who implant pacemakers (getting less likely unless in rural area).
 
nlax30 said:
For General Cards practice will usually be some sort of mixture of outpatient clinic and inpatient rounding/consults. Most folks will also read their own echos, stress tests (plain treadmill, echo, and nuclear), holter/event monitors, possibly vascular ultrasounds (carotid, peripheral). Inpatient procedures could include TEEs, maybe diagnostic heart caths and a few general cards still out there who implant pacemakers (getting less likely unless in rural area).
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I echo this. No pun intended.

In the community, I will throw in there that generalists are also now "expected" to do structural TEE and possibly read CT. There's a growing desire for people to read MR as well.

In an academic center, generalists will be less diverse in what they do- clinic, echo reading/TEE's/stress +/- echo, and inpatient rounding/consults. They'll also fulfill whatever niche they fall into.. cardio onc, rehab, structural, research, etc.
 
littlecow said:
What are the most interesting/exciting aspects of cardiology without these fields?
And thoughts about CCM afterwards?
Click to expand...

There are few cards/CCM people out there and if you plan on doing academics, you could carve out a nice niche for yourself. Outside academia it will be challenging (read as near impossible) to practice both, you will likely have to pick one or the other. Most community jobs are for pulm/ccm with an increasing number of places looking for full time CCM folk. I disagree that acuity in the community is always low, considering many of the places I have worked at do ECMO, and complex cardiovascular procedures - where do you think the complications end up and who helps manage these patients when they become critically ill. Having worked as a full time community intensivist for most of my post fellowship life and at various different hospitals, I can tell you there is no shortage of sick as hell patients. Job market is hot in ccm and money is good. I make similar money to my friends who are gen cards. In fact, my starting pay was much higher. I also work much less than my friends as an intensivist given I’m shift based and work 14-15 days out of the month. It’s also much easier for me to change jobs. But as you noted, burnout is a downside to CCM but it depends on what you like. I can’t imagine doing pulm or cards clinic long term, that would burn me out much faster. If I had to see chronic cough or manage chf chronically on a regular basis I think I would kill myself.
 
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Gen cards is a pretty easy gig. A lot easier than plum/cc imo.

With that said I do think you need to focus on imaging and have that be a decent part of your skill package going forward..

Otherwise a strictly general cardiologist is fairly replaceable by the ever present mid level invasion threat.
 
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timpview said:
Gen cards is a pretty easy gig. A lot easier than plum/cc imo.

With that said I do think you need to focus on imaging and have that be a decent part of your skill package going forward..

Otherwise a strictly general cardiologist is fairly replaceable by the ever present mid level invasion threat.
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I don’t know about you but if I want a card consult I wouldn’t call a np or pa...
 
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Noninvasive cardiology is in much higher demand than EP or IC.
 
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timpview said:
Gen cards is a pretty easy gig. A lot easier than plum/cc imo.

With that said I do think you need to focus on imaging and have that be a decent part of your skill package going forward..

Otherwise a strictly general cardiologist is fairly replaceable by the ever present mid level invasion threat.
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Not sure I agree with any of this. Except maybe the bit about Pulm/CC, that’s a tough gig. Spending all your time staying busy seeing consults to keep up production is not easy or fun to me either though. I’d much rather be in a single 5 hour VT ablation case then walk around the hospital seeing 15 new consults but some may not mind that.

NP/PAs May be prevalent but the referring docs still want you to be the one setting the patient or at least making the decision.
 
The beauty of gen cards is the potential diversity. I am a cards fellow and that is really one of the things that drew me to this specialty in the first place. As made clear by the variety of opinions in this thread.... the role is extremely variable between hospitals / locations / practices / cultures. Once you specialize in IC or EP that diversity becomes more limited as more of your time will be focused on procedures.

As a general cardiologist you can do anything from mostly outpatient to performing your own right / left heart cath's / TEE's whilst seeing every consult in the hospital. You can manage CCU's with patients on mechanical support (IABP, Impella, ECMO, etc) or be an imaging guru reading tons of echo's, nuclear's, CT's, etc. You can learn advanced heart failure and manage heart transplants, LVADs, etc. That is far from being "threatened" by midlevels... Most cardiology practices are so busy that midlevels are an immense help dealing with bread and butter "non complicated" cardiology.
 
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tn4596 said:
I don’t know about you but if I want a card consult I wouldn’t call a np or pa...
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It’s not who you want to call it’s who your bosses (admin) want you to call.
 
Gen cards market is booming. Heard from former fellows that alot of places are offering similar salaries to noninvasives and interventionalists. Lots of job opportunities. Nucs and echos are RVU machines.

In terms of how your practice will be, depends on what you want. General cards is pretty versatile but as you move into the community setting you give up some of the "cool" stuff for better lifestyle and pay. Mostly clinic based and imaging, with easy hospital consults. It's a pretty good life, if you ask me. Academics is a lot more interesting, with higher acuity, but less pay. There is obviously a gradient between academic and community and you can find a practice that best fits you.

Honestly, looking at the gen cards offers and then some of the EP offers I'm seeing, sometimes I wonder why I'm putting myself through another 2 year fellowship...

I think call as a gen cardiologist is universally busy though. And I disagree with the sentiment that a gen cardiologist is easily replaceable....gen cards is in high demand both in the outpatient settinf and the inpatient side, as IM finds whatever reason to push to the primary cards inpatient services. Midlevels actually help out quite a bit with this volume.

Critical care cardiology is pretty niche, and I agree with the sentiment that advanced HF may be a better way to go outside of major academic centers.
 
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Makes me wonder why IC is still so competitive with tougher calls, radiation exposure, back injury and equalizing starting pay. Arguments can be made that EP/IC has a higher ceiling but even that is debatable taking into account of extended training and geographical limitations. The IC and gen fellow in my program had the same starting salary but the gen card guy had much better time finding offers.
 
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I think it's about how you want to structure your practice. Some people hate seeing gen card patients in clinic and would rather be cathing all day. Same with EP. But you are right, unless you really love IC or EP, it is probably more advantageous to forego the extra training and go into gen cards, from a financial/health standpoint.
 
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person1987 said:
I think it's about how you want to structure your practice. Some people hate seeing gen card patients in clinic and would rather be cathing all day. Same with EP. But you are right, unless you really love IC or EP, it is probably more advantageous to forego the extra training and go into gen cards, from a financial/health standpoint.
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I agree that if you truly love cath or VT ablation then by all mean go after your passion and don’t worry about the finance sacrifices. Life is short you got do what you truly love. But the truth of the matter is that its near impossible to find a pure IC or EP job these days. In most institutions even the senior IC guys end up doing gen card for good portion of their practice.
 
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Couldn’t agree more with the above few posts. Those going into IC and EP are doing it for the procedures in my opinion and those are the folks that are just not fulfilled or interested in just seeing gen card clinic patients or hospital consults all day every day. Personally I would hate being in clinic every day.

As already mentioned general cards job market is very good. In general IC/EP salaries, even starting, will be higher in a given region (with some exceptions) however there will be many more gen cards spots compared to IC/EP.

If you really love cath or EP then don’t feel bad about spending the extra time with the fellowships, will be worth it.

EP I think is a little different in that it the nature of the field self selects people who are very dedicated to that specific field. Why else would you spend an extra two years in fellowship. Plus if you don’t enjoy EP then an AF ablation procedure would be pretty boring for you. Most EPs I know do very little pure general cardiology work, most ICs I know do a good bit of general cardiology work just due to the overlap.
 
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I agree with the couple of posts above.

Gen Cardiology job market is great. Jobs are available all through out the US (obviously with regional variations in compensation)

IC job market is tougher in big metro areas. Very few “pure” IC jobs. Most new grads have to do a significant amount of General cardiology. Job market is tougher if you want to do structural procedures. For IC that take stemi call, salary is generally higher than general or EP within that group.

Not sure about EP job market. But most EP physicians are almost entirely EP with little general cardiology.
 
IMO a purely general cardiologist is a waste of potential. The interventional route isn't for everyone, but in order to abstain from mid-level encroachment, it would be best if procedures are included in the mix along with clinic-oriented tasks.
 
Jenghiz_Khaan said:
IMO a purely general cardiologist is a waste of potential. The interventional route isn't for everyone, but in order to abstain from mid-level encroachment, it would be best if procedures are included in the mix along with clinic-oriented tasks.
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General cardiologists aren't going anywhere.
Someone has to feed the IC's and the EP's, and you know they won't tolerate referrals from midlevels.
 
disorder said:
General cardiologists aren't going anywhere.
Someone has to feed the IC's and the EP's, and you know they won't tolerate referrals from midlevels.
Click to expand...

To be fair, you're going to spend a major portion of your time referring anyone with more serious issues to the IC's and EP's. Not saying purely general practice can't be fulfilling but many physicians won't feel specialized enough. Midlevels might appear powerless now, but as the future nears there is going to be more and more advancements in both technology and specialization that general cardiology will be extremely watered down to the extent that PA's can get away with treatment if not referrals. Everyone's increasingly after the paycheck.
 
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A general cardiologist will perform office visits, in patient consultation, EKG, Echo, Nuclear, any and all other types of stress testing. You can also do diagnostic catheterizations. For the majority of IC or even EP, unless you are in a super specialized highly academic center, you are still going to practice general cardiology for 50-90% of your time. Our seniors and current recruiters appear to be looking more for general cardiology than advanced training cardiologists with salaries from 280-600k which from what I can tell is purely dependent on how desirable the location is.

Also, there are other advanced specialties as well such as heart failure, cardiac imaging, and cardio-oncology is also growing.
 
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There's nothing wrong with seeing patients, reading echos, stresses, etc. I have little interest in being in the cath lab all day or talking about non-cardiac issues. Gen cards is just fine. It isn't going anywhere. The day midlevels take it over, many other specialties will be in worst shape. Echo generates a ton of revenue. Nevertheless, at least for interventional don't be surprised to have to see gen cards, read echos, etc. EP can vary on this it seems. Gen cards jobs are highest demand within cardiology.
 
drk said:
A general cardiologist will perform office visits, in patient consultation, EKG, Echo, Nuclear, any and all other types of stress testing. You can also do diagnostic catheterizations. For the majority of IC or even EP, unless you are in a super specialized highly academic center, you are still going to practice general cardiology for 50-90% of your time. Our seniors and current recruiters appear to be looking more for general cardiology than advanced training cardiologists with salaries from 280-600k which from what I can tell is purely dependent on how desirable the location is.

Also, there are other advanced specialties as well such as heart failure, cardiac imaging, and cardio-oncology is also growing.
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I never quite understood the point of diagnostic caths as a generalist. If you find stenoses, do you refer to IC for stenting? Do generalists mostly do diagnostic caths in people with low pretest probabilities?
 
WakaFloxacin said:
I never quite understood the point of diagnostic caths as a generalist. If you find stenoses, do you refer to IC for stenting? Do generalists mostly do diagnostic caths in people with low pretest probabilities?
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There is no point. It’s super annoying, inefficient and Poor patient care.
But yes they do the diagnostic and then call an interventionalist out of clinic to intervene on a patient they have never met and know nothing about. There’s zero benefit in it as a diagnostic cath takes an IC ten minutes to do. It’s a cute hobby for the generalist.
 
timpview said:
There is no point. It’s super annoying, inefficient and Poor patient care.
But yes they do the diagnostic and then call an interventionalist out of clinic to intervene on a patient they have never met and know nothing about. There’s zero benefit in it as a diagnostic cath takes an IC ten minutes to do. It’s a cute hobby for the generalist.
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But the hospital gets to bill it twice for facility fee I guess?
 
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No. Still single charge for the facility fee though it gets upgraded if pci is performed (as it normally would).. there is a separate pci charge the IC can charge.

admin doesn’t really like it either- it creates some headaches for them too, but most allow it to placate the general guys.
 
WakaFloxacin said:
I never quite understood the point of diagnostic caths as a generalist. If you find stenoses, do you refer to IC for stenting? Do generalists mostly do diagnostic caths in people with low pretest probabilities?
Click to expand...

Not only that but patient safety and operator proficiency of generalist vs IC.
 
Are you worried about midlevel encroachment in general cardiology?
 
NT42 said:
Are you worried about midlevel encroachment in general cardiology?
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midlevels cant even replete potassium right. no one is going to trust them for anything except writing notes.

general internists barely know cardiology and it's the most heavily tested section on step 1, step 2, step 3, and ABIM.
 
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CCM-MD said:
You think they are just writing the note, they think they are doing everything. Admin will pick the cheaper option.
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Exactly. I constantly hear NPs/PAs suggesting that they do equivalent work to a MD. The Government and admin believe them.

The system is headed towards 1 MD manager overseeing a team of NPs/PAs who will serve the role of a glorified resident (writing notes, putting in orders and daily labs, and making consults) except they won’t have to work the same number of hours as a resident and they get to do on the job training while getting paid 1.5-2x more than a resident. It’s already happening on the general cardiology service and CCU where I work. This is a much cheaper option for admin from a salary perspective and for government from a reimbursement perspective. Mid levels in my hospital can reimburse patients independently even if they run the plan through a physician. The holy grail for hospital administration is for government to reimburse midlevels at the same rate as physicians. It’ll be game over once that happens.
Unfortunately it’s going to drastically drive down physician salaries and job market.
 
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TAVR4life said:
Exactly. I constantly hear NPs/PAs suggesting that they do equivalent work to a MD. The Government and admin believe them.

The system is headed towards 1 MD manager overseeing a team of NPs/PAs who will serve the role of a glorified resident (writing notes, putting in orders and daily labs, and making consults) except they won’t have to work the same number of hours as a resident and they get to do on the job training while getting paid 1.5-2x more than a resident. It’s already happening on the general cardiology service and CCU where I work. This is a much cheaper option for admin from a salary perspective and for government from a reimbursement perspective. The holy grail for hospital administration is for government to reimburse midlevels at the same rate as physicians. It’ll be game over once that happens.
Unfortunately it’s going to drastically drive down physician salaries and job market.
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I agree. At the VA I work at nearly all of my patients' PCPs are independent NPs. It's truly mind boggling how many of them are poorly managed and I end up doing some internal medicine out of a feeling of duty to my patients. The NPs in cardiology are now independent as well and they sign their notes "Full Practice Authority". They still consult with the attending cardiologists but this was a recent change so they don't feel completely comfortable yet.

On the inpatient side at the local university-affiliated hospital, almost all consults are performed by NPs (though they are overseen by MDs). It's only a matter of time before the requirement to have MD supervision is a thing of the past.
 
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Can you expand on mid levels in Cardiology and how you think it I'll affect the field I'm the future? Such as job prospects?
 
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