Too many years?

[spyyder]

The average residency seems be about 4-5 years, but it seems like cardiology, a program that could easily be its own residency is six years (3 IM, 3 Cards). Anyone feel this is too long for an internal medicine field. Doing a fellowship adds at least one more year, making it nearly as long a Neurosurgery (without the wonderful compensation). I am curious is it common for someone in cards to do more than one fellowship, like both interventional and nuclear. Any possiblility Cards in the future might become its own specialty (not a subspecialty of IM). Which fellowships are better "lifestyle" suited? I am considering cards, but am kinda put off by the years, because other non IM specialties are much shorter. Also does a turf war exist btwn radiology and nuc cards. Sorry for all the questions, just trying to get perspective.

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[AJM]

Really the vast majority of IM subspecialties require a total of at least 5 years (residency plus fellowship). Cards, Pulm/cc, and GI are all 3-year fellowships, and a growing number of the academic programs are even requiring their fellows in these specialties to do 4 years. The rest of the fellowships are 2 years (or more). Considering that I'm doing a fellowship that takes 4 years, and will likely do a sub-subspecialty fellowship after this, I think doing just a 3-year fellowship sounds pretty sweet....

Sure, your residency may be a touch shorter if you go into a non-IM field, but things always seem to even out -- every specialty has their own fellowships or hidden research years, so unless you do a 3-4 year residency with no additional specialty training and no extra research years, you're going to be spending about the same amount of time training in any specialty, give or take.

I don't know if cards programs have been thinking about creating their own residency, but I don't think it'll happen. Cardiology relies too much on an IM base for them to cut out the IM training completely. The closest I could see them coming is for them to cut the IM years down to 2 instead of 3. I can't imagine any cardiology program willing to have their trainees only do an IM prelim year.... you just don't learn enough medicine in that one year to be at all useful as a cardiology fellow/trainee.

 

[spyyder]

Thanks for the explanation. I was also wondering of anyone knew anything about nuclear cardiology vs. nuc Radiology. Is there a job market for nuc. cards or any advantage going one way or the other? Future outlook?

 

[novacek88]

I don't think it is long at all. 3 years is pretty standard for an IM fellowship. In fact, you would be hard pressed to find many 2 year fellowships left. Rumor has it that Allergy/Immunology will become 3 years. Pulmonology by itself is a 2 year program but there aren't many of those in existance considering most programs have done away with them by incorporating critical care into them which makes it 3 years. I think Endocrinology is 2 years.

Considering the responsibility cardiologists have, I think 7 years is appropriate. It could be worse. And internal medicine isn't that bad of a residency. Yes, the intern year is bad but years 2 and particularly 3 are not bad at all. Compare that to a 5 year general surgery residency in which even years 4 and 5 are still grueling. And then fellowship offers an easier lifestyle than IM residency. So technically it's 7 years but it's not like 5 years of general surgery and 2 years of a difficult fellowship. You can't just look at the total numbers of years and make any type of assessment about it. You have to examine the quality of years.

And lastly, cardiologists are not exactly underpaid. If you look at most salary surveys, their income ranges from 300-400K and those are conservative estimates. Many cardiologists who have been working in private practice for a few years are earning in upwards of 500K so there is a light at the end of the tunnel. It's not like endocrinology and rheumatology in which you will earn just a little more than you would as a generalist after fellowship.

If you are interested in lifestyle fields this early on then I would ask that you seriously start looking into Rheumatology, Endocrinology, Allergy, Pathology, PM&R and Radiology. Cardiology is not a lifestyle field. You will have to work hard and if you are questioning lifestyle this early in your career then it's likely you don't have the personality for cardiology and you will later regret your decision. Cardiology isn't like a lot of other fields. I know several people who go into radiology and could care less about the field. But those in cardiology genuinely seem to love their field and would still do it if they were being paid less. I don't see that in a lot of fields but in cardiology I see it. You really have to like it deep down otherwise you will be miserable It's not for everyone.

I agree that lifestyle is important but there is a reason certain fields medicine are paid so well. These fields come with a major cost: your time! It's kind of funny because a lot of physicians don't stop to think about lifestyle. There are several fields where you could earn between 200-300K and have a much better lifestyle. Aside from living the life of P Diddy, you could afford everything you wanted in life at that salary except you would actually have TIME to enjoy those things.