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deleted980918
I heard that the average intervnetionalist in NY and CA does about 30-40 PCIs a year. Shouldn’t the ACGME or ACC cut down the IC spots to prevent a supply>demand situation like nephro?
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They want you to be a commodity. If you start becoming too independent or stop saying yes to your nurse administrator overlord, they will replace you with a fellow who will take half the salary to stay in New York and won’t rock the boat.
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That is nuts. Our guys do that many per week.
Anecdotally seems like an oversupply. Most IC folks seem to have a tougher job market compared to gen cards, and often requires doing some gen cards as well. Mostly anyone I know says that their hospital/group has no shortage of IC. Having said that it also seems most older guys slow down with PCIs or really should stop altogether and the workforce is getting older.
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Should IM residents jump ship to GI? pls tell me now
Agree with some of the comments above.
1) While it is not difficult to find an IC job, it comes in variety of flavors. Majority of IC work is office based general cardiology with very small number of PCIs per operator, especially on coasts.
2) The whole thing about 'older' doctors retiring and the projected shortage for new grad IC is overrated. Similar projections were made for nephrologist demand and we know how it panned out.
1) While it is not difficult to find an IC job, it comes in variety of flavors. Majority of IC work is office based general cardiology with very small number of PCIs per operator, especially on coasts.
2) The whole thing about 'older' doctors retiring and the projected shortage for new grad IC is overrated. Similar projections were made for nephrologist demand and we know how it panned out.
An IC’s “value” is in coverage not production. The proliferation of more and more hospitals wanting 24/7 STEMI coverage means that in general the demand of an IC will likely always be there..
No one (or very few) care or want the high volume PCI operator of the 99-00s. Hospitals are making millions without them. Hospitals and admin don’t want to deal with their perceived attitudes or demands, their potential higher pay as compared to their colleagues or general cardiologist (which causes strife) and the complications that just come with volume
get a guy that doesn’t pipe up in meetings, who gets his flat 600k without whining about more, who has limited complications because he’s not taking on high volume or high risk cases abd who’s available for his 24 hr call shift and that guy will have the most job security of any doc in the hospital
No one (or very few) care or want the high volume PCI operator of the 99-00s. Hospitals are making millions without them. Hospitals and admin don’t want to deal with their perceived attitudes or demands, their potential higher pay as compared to their colleagues or general cardiologist (which causes strife) and the complications that just come with volume
get a guy that doesn’t pipe up in meetings, who gets his flat 600k without whining about more, who has limited complications because he’s not taking on high volume or high risk cases abd who’s available for his 24 hr call shift and that guy will have the most job security of any doc in the hospital
interventional cards is like 25% of cardiology
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deleted980918
Demand is fine imo
New fellows are the hottest commodity out there (outside of perhaps the year 2-5 year out attendings). They come in cheaper, are more use to being subservient to the corporation and don’t carry baggage that comes with time (which is just inevitable if one does this long enough). Obviously still market dependent but it’s really not that hard to get a decent gig (at least in my neck of the woods).
I don't think it's like EM. IMO, we can't really compare to EM anyway for a variety of reasons. Yet there's something like 25k cardiologists in the US, so 1000/yr may be slightly aggressive. However, with increased technology and therapies expanding our scope, and an aging population, demand will hopefully still be ok. Have to consider midlevels too but I tend to be less pessimistic about that. We'll see but I tend to think making a career/specialty decision based on something that may or may not happen 5, 10, 20yrs from now to be somewhat fruitless.
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Yes. Cardiology is one of the fastest expanding specialties, maybe second only to autoimmune disorders and oncology. 10 years ago, TAVR was still experimental, now it's relatively rare that someone over 70 gets a surgical AV unless they have another indication. Mitral valve disease, especially in cardiomyopathy patients, is headed that way and they used to be only for hail Marys as it was high morbidity/mortality via surgery. Likewise, tricuspid interventions are where TAVRs/Mitraclip were 10-15 years ago. Left atrial appendage occluders were surgical only until the last 10 or so years. Amyloid was a death sentence up until tafadamis came out. CMRI is exploding. LVADs didn't really exist 15-20 years ago and now thousands are placed yearly.
Cards is blessed with common diseases and ever expanding technology. It's one thing to have another fancy mumab for your rare autoimmune disease, but demand is limited due to the rarity of disease. Cardiology has no such issues. They control the patient pipeline entirely. It takes less effort to get consults as cards is the gatekeeper to advanced diagnostics.
Also, it's the best field in medicine. Better than digging through **** for money.
I am aware that lots of new interventions have decreased surgical demand for CTS. All these procedures you listed need extra 1-2 fellowship after cardiology. But I keep seeing everywhere there is great demand only for general cardiology and interventional/structural market is kind of saturated as they are mostly done in higher centers. So there is less scope for general cardiology without EP/HF/Imaging/Interventional in 10 - 20 yrs ?
I think the lack of demand for interventionalists despite all these new procedures and devices is due to the fact that structural heart disease is not a board requirement or an ACGME fellowship. More importantly, when a new device comes out, they will go to the current IC who have been doing anything from coronary to TAVR for the last 5-10 years. When a hospital wants to start a TAVR program or any device, they just go to their coronary guy and say "listen, we have 20 patients who need a TAVR, xxx company will let us start a program with that number and will fly in a proctor for your required certification. We will pay you an extra 50k."
There is no need to hire someone new. The other benefits of percutaneous based procedures that don't really take that long is you can do this til you're 100 years old and the basic tenets of it are the same. Access, catheter, device position, balloon, done. I'm not saying there is no skill, but the basics tenets of percutaneous based procedures means the old guys are going to be around forever.
There is no need to hire someone new. The other benefits of percutaneous based procedures that don't really take that long is you can do this til you're 100 years old and the basic tenets of it are the same. Access, catheter, device position, balloon, done. I'm not saying there is no skill, but the basics tenets of percutaneous based procedures means the old guys are going to be around forever.
Someone has to accurately diagnose and follow those patients, on top of all the other standard cardiology stuff, plus read the echos, TEEs, nukes, etc etc. There's more than enough work to go around for all subspecialties. A general cardiologist is what makes a practice thrive.
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deleted980918
I do think that the early generation of interventionalist are on the verge of retiring. In my institution alone, the most active ICs are in their late 50/early 60 range who have enjoyed 7 figure income for a few years and made a killing on the stock/real estate front. While no one will walk away from a routine job that will still pay them well, I do get the sense that they are walking away from acute cases and give the younger generation a chance.
The main issue is that all fellows want to do structural whereas 90%+ of the interventional jobs in the communuty just want a run of the mill coronary guy who basically has a general cardiology practice that intermixes 50-125 PCIs a year and covers STEMI call.
plus another issue is a lot of structural guys I know have a pretty Cush set up where they’re not chasing rvus or seeing 30 pts in clinic a day and are just focusing on their handful of cases per week. They tend to have huge support teams which makes their life easy. Then most programs only need 1-2 of them. Maybe volume increases some but most of these guys seem far from overwhelmed and seen very content not doing their old busy IC jobs. So there’s not a ton of turnover there
So fellows who naturally want to do the latest and coolest are quickly realizing there’s not a ton of places where they can come in and day 1 use or develop that structural skill set.
so there are basically 2 different job markets for interventionalists depending on whether you are trying to do structural, which sometimes can be confusing for fellows.
plus another issue is a lot of structural guys I know have a pretty Cush set up where they’re not chasing rvus or seeing 30 pts in clinic a day and are just focusing on their handful of cases per week. They tend to have huge support teams which makes their life easy. Then most programs only need 1-2 of them. Maybe volume increases some but most of these guys seem far from overwhelmed and seen very content not doing their old busy IC jobs. So there’s not a ton of turnover there
So fellows who naturally want to do the latest and coolest are quickly realizing there’s not a ton of places where they can come in and day 1 use or develop that structural skill set.
so there are basically 2 different job markets for interventionalists depending on whether you are trying to do structural, which sometimes can be confusing for fellows.
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So you're saying that structural is oversaturated while coronary is not?
Yes. Significantly so in my region. Assume that is pretty consistent elsewhere
I could get a coronary IC job in 10 hospitals/cities that I know about in my region or basically anywhere I want.
maybe 1 of those would I be able to do structural and it would be low volume facility with me as the 2nd or 3rd guy
but just one persons perspective
Structural pays.
Stents do not. STEMI call sucks.
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What are the pay differentials like for structural vs coronary?
Really? I've heard differently. Other than TAVRs, structural doesn't pay as well as standard interventional work.
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There is no question that there is (and has been) an oversupply of interventionalists with far too many low volume operators out there doing <50 PCI/year (many at "top institutions").
However, there will be no decrease in supply any time soon due to demand for fellow labor (inpatient cardiology is labor intensive at academic centers) and seemingly limitless GME funding (see below).
Many procedural advanced fellowships are sponsored by industry.
Ultimately industry wins when there is an oversupply of proceduralists due to provider-induced demand.
The same is true for EP.
The field of Cardiology in general is heading towards oversupply but this is especially true for EP/IC.
I am glad I secured a job in a great location and good salary but not sure this will be possible in 5 years (most partners are young in group).
However, there will be no decrease in supply any time soon due to demand for fellow labor (inpatient cardiology is labor intensive at academic centers) and seemingly limitless GME funding (see below).
Many procedural advanced fellowships are sponsored by industry.
Ultimately industry wins when there is an oversupply of proceduralists due to provider-induced demand.
The same is true for EP.
The field of Cardiology in general is heading towards oversupply but this is especially true for EP/IC.
I am glad I secured a job in a great location and good salary but not sure this will be possible in 5 years (most partners are young in group).
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Do you recommend IM residents to jump ship for GI?
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Figure out what you want to do for a living.
GI and cardiology are completely different specialties.
I would do GI over cardiology...
1. easier call. Too sick to scope or scope in the am.
2. hospitalists for whatever reason seem a lot more willing to do all admits. It’s been a while since I’ve seen GI having a primary service
3 GI is still slightly under the radar with hospital politics. You don’t get the heavily scrutinized deaths as often. You’re not “costing” the system as much in certain models. Mostly speculating there.
4. GI seem to utilize midlevels a lot more. Where I’m at they don’t seem to get as burdened with the chronic stuff as much.. though I’m sure that’s institution dependent.
5. Shorter fellowship
but all just one persons limited exposure to the field as well as ones biased view who thinks real world cardiology sucks. So take it with a grain of salt.
1. easier call. Too sick to scope or scope in the am.
2. hospitalists for whatever reason seem a lot more willing to do all admits. It’s been a while since I’ve seen GI having a primary service
3 GI is still slightly under the radar with hospital politics. You don’t get the heavily scrutinized deaths as often. You’re not “costing” the system as much in certain models. Mostly speculating there.
4. GI seem to utilize midlevels a lot more. Where I’m at they don’t seem to get as burdened with the chronic stuff as much.. though I’m sure that’s institution dependent.
5. Shorter fellowship
but all just one persons limited exposure to the field as well as ones biased view who thinks real world cardiology sucks. So take it with a grain of salt.
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Do you regret doing cardiology?
Yes and no. I regret doing medicine in general and I’m sure I would regret GI the same.. so I wouldn’t make any decisions based on random internet people
But at the same time the grass isn’t always greener and cardiology has created a great life for my kids at least.. so I can’t complain too much
But honestly the only thing that is borderline unbearable for me is call and sooo much of that is dependent on the job you take.. so I’m partly to blame for chasing dollars abd being in a high call frequency/burden place.
it’s the places that have frequent general call that the worst. Taking er nurse calls, patient calls all throughout the night is the killer.
cardiology can be fine abd perhaps great for some. Just be careful in your job selection.
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Yes and no. I regret doing medicine in general and I’m sure I would regret GI the same.. so I wouldn’t make any decisions based on random internet people
But at the same time the grass isn’t always greener and cardiology has created a great life for my kids at least.. so I can’t complain too much
But honestly the only thing that is borderline unbearable for me is call and sooo much of that is dependent on the job you take.. so I’m partly to blame for chasing dollars abd being in a high call frequency/burden place.
it’s the places that have frequent general call that the worst. Taking er nurse calls, patient calls all throughout the night is the killer.
cardiology can be fine abd perhaps great for some. Just be careful in your job selection.
Could you please elaborate on what it is about frequent general call that irks you?
Is it that you prefer STEMI call? Were there only jobs with frequent general call available in your area?
Job selection is key. Salary, procedures, etc. are just one of the many factors. Patients, support, call setup, culture, colleagues, etc. are important, maybe even more so for career longevity and happiness. Cardiology isn't always primary btw. There's some good gigs out there.
