Dont know which cardiology sub-speciality to do

[cath14]

I am a second year Cards fellow who is in a very big dilemma as to which sub-specialty to pursue. These are my thoughts :

EP: saturated job market, don't personally enjoy it that much.

Imaging: Can give an added skill set as 3D, structural imaging, CT, MRI. Does not add too much burden- maybe will consider?

Heart failure: I did the year long non-accredited fellowship and have seen the good and bad- I like making the cerebral and tough decisions but your are like a surgeon's b**** (unless in a big academic setting) and do the internist work.
But I have heard that there are some interventional HF programs where you can as a heart failure guy do impellas, IABP, peripheral ECMOs, Tandem Hearts etc. in addition of course to RHC, biopsies and TEEs. That is a fairly decent number of procedures. And then there are some programs which will train you to do CRTs and pacers too!!- Is that correct and does anyone know- Though despite this training I wonder who in practice will let you do all the stuff- EP will do CRT and other devices can be out by interventionist.

Interventional (with structural): I don't mind doing, but here is my problem: This is a very aggressive interventional program, where I have seen the ugly side of interventional- dissections, stent thrombosis, TAVR valve embolizations. I question now if it is worthwhile taking so much of stress (and that too in the middle of the night). A lot of my friends from not such aggressive programs have done interventional but that is because they didn't get to see the ugly side. VERY CONFUSED!!!

I would like some help and am curious to see what people have to say.

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[Carbocation1]

Are you not considering General Cardiology?

 

[happymedgrad]

sounds like you want to do procedures but you don't want to do ep.

that makes it a no-brainer for me - interventional. the thing is you can't do it without facing complications. even if you stuck to diagnostic caths dissections and haemotomas are unavoidable. if you're gonna go for it, you need to embrace this aspect of intervention and accept that it comes with the territory. no one wants to see them but the maddening contradiction is that the more of them you see the better you'll be able to deal with them when they occur. you also have to somehow look forward to scrubbing in in the middle of the night for the 89 year old occluded RCA that's bradycardic and cold. It's stressful but can be very rewarding.

structural is a bit of a growth area at the moment too so there should be decent opportunities (i'm thinking as the pendulum swings for valve replacements from high risk to moderate risk surgical candidates, coupled with an aging population).

 

[Shelovesbigdogs]

I did a year of interventional and loved it, but I also liked EP and nukes! I'm older than you, and worked in nyc - Bellevue, nyu, the VA - I loved the VA bc we literally had to do everything, including PPM implants. If I was just starting out, knowing how saturated EP and interventional cards is, I think I'd go with either chf - bc of the aging population, or imaging - bc it's constantly evolving. You also have to think about what kind of life you'll want to have in say your 50s and beyond. Do you enjoy action 27/7? _want a family or maybe travel? General cards is very rewarding bc you get to follow pts long term. Good luck!

 

[Nivakia]

Technically if you do intervention you can still do all the procedures in the other fields you listed except the one unique to EP. You are paid and certified by the procedures right not the fellowship title.

 

[CHF4thewin]

Imaging for the win. Lifestyle, still get to be a consultant, easy to publish because you accumulate data just working, and can work till you have your own MI (and probably after). Great field and still growing.

 

[bronx43]

Imaging for the win. Lifestyle, still get to be a consultant, easy to publish because you accumulate data just working, and can work till you have your own MI (and probably after). Great field and still growing.

So CHF4thewin says Imaging 4 the win?

 

[badasshairday]

Yea, he basically said be a radiologist for the win. Lol