Cardiology fellowship electives if going into EP (electrophysiology)

[HeartDoc88]

Hello all,

I'm currently a 3rd year cardiology fellow and just submitted my application for EP.

My program has a ton of flexibility in the 3rd year (11 months elective time), which is great, but I'm starting to develop a little analysis-paralysis. Mostly concerning what I should get level II training in.

As it is now, I'm going to get Level II in ECHO, Nuclear, and Cath. Besides ECHO, Nuc, Cath, I'm taking electives in CV anesthesia, CMR, vascular US, and 3 months EP.

If anyone out there is a current EP fellow or EP attending, I'd be interested to hear what you would do if you could do 3rd year cardiology fellowship over again and what level II training you think is useful. I plan on going into private practice or community employed group practice. Don't plan on staying in academics.

Thanks for whatever insight you can share

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[nlax30]

Do you want to or anticipate doing a lot of general cardiology once out?

I wouldn’t bother trying to get level II cath. Same with Nuc. If I did it over I wouldn’t have bothered taking nuc boards.

I’m glad I did echo. I enjoy that modality, use intracardiac echo a lot and still do TEEs.

 

[HeartDoc88]

I would like to be nearly 100% EP, but like you I also enjoy ECHO as a modality and would like to keep reading when I'm out practicing.

My only hesitation with not having Nuc is that I've heard of jobs where new EPs will have to build their practice up to 100% EP, and in the meantime do a lot of general cards (mostly cover inpatient consults -- read echo and nuc in the hospital). This may be less of an issue now since EP procedures (notably AFib ablation and WATCHMAN) are really picking up and seems like there is more than enough volume to keep EPs busy without needing to do any general cardiology.

Pretty much everyone has told me I don't need Nuc, but it seems like a crucial modality if I end up doing a couple of years of mixed EP-Gen Cards before I can be 100% EP.

 

[person1987]

I've talked to a few private EPs and a bunch at ACC etc. and asked them this question. All of them told me not to do nuc if I don't want to (its not necessary).Seems like the privates supplement with echo, holters, EKGs, device stuff, etc. I think if you take that off the plate of general people you can definitely earn your keep. Personally, I hate nuc...but to play devil's advocate from what I hear it is very lucrative in RVU based practices. I just can't bring myself to do it, and it seems most EPs feel the same way.

 

[nlax30]

I think there’s enough even in just the EP “realm” where not also covering nuc won’t be a problem. It’s even tough, if not impossible, at this point to be competent in all areas of even just EP between ablations (AF, VT - endo and epi), devices (Pacers, ICD, CRTs, conduction system pacing), and extractions. To expect an EP then to also read echos and nucs is not practical, feasible, or a good use of our time.

 

[HeartDoc88]

Very good points. Thanks

 

[CardioKid84]

Very helpful discussion. I'm approaching my third year of fellowship with elective opportunities and want to make best use of time . What do people think about the value of the following rotations as prep for EP? If you could repeat general fellowship. Which of these electives would you find useful for an EP?

1. Cardiac MRI
2. Cardiac CT
3. Vascular Ultrasound
4. Congenital
5. CV Surgery
6. Community EP rotations

 

[aafisahar]

mri: no

ct: +/-

vascular: no

congenital: no

CV surgery: depends on what you mean

community EP rotations: depends on the type, are you scutted out seeing garbage consults or are you spenidng time in the labs doing devices/ablations; if the former, no, latter, yes