What happens if I renege on my cards fellowship spot?

[Onemoretry]

So I matched into cardiology and I'm supposed to start in a few months. But I'm seeing a field that has been ravaged with reimbursement cuts. Everyone has sold their practices. People are working for big corporations (albeit non-profits) and the morale could not be lower. That is not what I signed up for and I'm having some very serious second thoughts about going in. I will likely just go on to be a hospitalist.

Can anyone comment on the fallout if I were to renege now? I realize that I would be screwing over the fellowship program and creating a bad rep for my current IM program, but I would rather do it now than in the middle of my fellowship (as I have heard of people doing).

Can anyone comment on how this is gonna reflect on my future? Will it impede me trying to get a hospitalist job? Will this follow me in my medical career?

Thanks ahead of time.

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[EPADHA]

So I matched into cardiology and I'm supposed to start in a few months. But I'm seeing a field that has been ravaged with reimbursement cuts. Everyone has sold their practices. People are working for big corporations (albeit non-profits) and the morale could not be lower. That is not what I signed up for and I'm having some very serious second thoughts about going in. I will likely just go on to be a hospitalist.

Can anyone comment on the fallout if I were to renege now? I realize that I would be screwing over the fellowship program and creating a bad rep for my current IM program, but I would rather do it now than in the middle of my fellowship (as I have heard of people doing).

Can anyone comment on how this is gonna reflect on my future? Will it impede me trying to get a hospitalist job? Will this follow me in my medical career?

Thanks ahead of time.

From a technical standpoint, per NRMP you have to start the fellowship or else you are commiting a match violation which would flag you in the NRMP system.

I still see hope in cardiology. At least in the southeast there are non invasive jobs that start at about 325-400,000 and interventional tend to start at about 400,000 depending on how big of an area you are in ( all this is contingent on whether you wd like to leave in the south). We will never make the ridiculous amounts people made a few years ago. Some of graduates from my fellowship were offered 550K as late as 2004 for non invasive!

I dont think you will be screwing up your fellowship program if you apply for a waiver, as I am sure they will find some one rather quickly to fill your spot. But I would recommend going through NRMP to make sure YOU dont get flagged. Now you can always join and leave after a few months.. That may reflect poorly on you, and you may be asked later on to comment on why you joined and left during interviews (I think as time will pass it will not be a big deal). However you may be closing doors of competitive subspecialties for later on if u do this.

I was in your spot two years ago, and was faced with doubt. I decided to do the fellowship for a year. In my program the first year turned out to be passage through hell. This year is pretty chill. I do moonlight for hospitalists. I am glad that I dont have to deal with some of the issues they have to deal with. I think that managing a service of 15-20 patients with multiple medical problems is not a piece of cake if you want to provide quality care.

If you have made up your mind, before u contact your program, talk to your residency program and let NRMP know. Any unofficial deal between u and ur fellowship program may get u both in to trouble if it gets reported.

Good Luck!

 

[EPADHA]

So I matched into cardiology and I'm supposed to start in a few months. But I'm seeing a field that has been ravaged with reimbursement cuts. Everyone has sold their practices. People are working for big corporations (albeit non-profits) and the morale could not be lower. That is not what I signed up for and I'm having some very serious second thoughts about going in. I will likely just go on to be a hospitalist.

Can anyone comment on the fallout if I were to renege now? I realize that I would be screwing over the fellowship program and creating a bad rep for my current IM program, but I would rather do it now than in the middle of my fellowship (as I have heard of people doing).

Can anyone comment on how this is gonna reflect on my future? Will it impede me trying to get a hospitalist job? Will this follow me in my medical career?

Thanks ahead of time.

After looking at your previous posts, i gather that you have business background. If you are enterpreneurial enough, you could still make a lot of money in cardiology as there is too much disease (if that is what attracted you to cardiology). We do need more MBAs and physician-executives in cardiology!

 

[Onemoretry]

I'm in a fairly dense metropolitan area on the west coast and really cant see myself going down south (never been too far from here and I surf). My concern is not the hellish part of fellowship as I'm fully prepared for that. What upsets me is seeing newly minted cardiologists working as peons for a large multi-tiered machine for a few dollars and many hours more than hospitalists. The guys who work in private practice need to see 30-40 patients/day (if their partners are lucky to have such census) and they end up working horrendous hours as their partners can exploit them by paying them a little more than the hospital. Im also being told that partnership tracks no longer exists either...

I still like cards very much and see some of the smartest people going into it, but I think that's still inertia and it will change soon. I guess I still have some time to figure things out...

Thanks for the advice

 

[bronx43]

I'm in a fairly dense metropolitan area on the west coast and really cant see myself going down south (never been too far from here and I surf). My concern is not the hellish part of fellowship as I'm fully prepared for that. What upsets me is seeing newly minted cardiologists working as peons for a large multi-tiered machine for a few dollars and many hours more than hospitalists. The guys who work in private practice need to see 30-40 patients/day (if their partners are lucky to have such census) and they end up working horrendous hours as their partners can exploit them by paying them a little more than the hospital. Im also being told that partnership tracks no longer exists either...

I still like cards very much and see some of the smartest people going into it, but I think that's still inertia and it will change soon. I guess I still have some time to figure things out...

Thanks for the advice

I mean... this is all true, but not limited to cardiology. Health care overall is trending towards corporatization, as there are fewer and fewer private practices being able to sustain themselves. Reimbursements are getting cut pretty much across the board for specialists, and will likely continue to do so. Personally, I don't think being a practitioner will yield great financial results in the years to come. There are likely still good business opportunities available if you keep your eyes open (you should be prime given your background in VC). Creation of value and risk are pretty much the only ingredients to success.

 

[academicalias]

What are the estimates for regional variation for starting academic cardiology positions?

Northeast
Southeast
Midwest
Northwest
Rocky Mountain West
California

 

[reventon2]

Here's a link to 2011 cardiology compensation across the country: http://www.medscape.com/features/slideshow/compensation/2011/cardiology
Northwest - 477k
Northcentral - 450k
Southcentral - 400k
Great lakes area - 375k
Southwest southeast - 350k
Northeast, midatlantic, california - 275k

Btw, this is all cardiologists in general. Tough to find just for academic alone. Although, as shown in the survey median academic salary is around 200 - 250k across the country. I would think the the regional variation above applies to academics as well. Let's also not forget that high end ivy league institutions pay much much less.

 

[IMDoc607]

Here's a link to 2011 cardiology compensation across the country: http://www.medscape.com/features/slideshow/compensation/2011/cardiology
Northwest - 477k
Northcentral - 450k
Southcentral - 400k
Great lakes area - 375k
Southwest southeast - 350k
Northeast, midatlantic, california - 275k

Btw, this is all cardiologists in general. Tough to find just for academic alone. Although, as shown in the survey median academic salary is around 200 - 250k across the country. I would think the the regional variation above applies to academics as well. Let's also not forget that high end ivy league institutions pay much much less.

What is wrong with these numbers? I think moving out of the northeast, midatlantic, and California is the best bet. You'll make a lot of money if you don't live there.

Simple

 

[reventon2]

What is wrong with these numbers? I think moving out of the northeast, midatlantic, and California is the best bet. You'll make a lot of money if you don't live there.

Simple

Might be easy to say based on these numbers, but I think a lot of people prefer the extrinsic perks of Northeast or California living (cultural diversity, weather, etc) rather being stuck in middle of nowhere Kansas making twice the money

 

[shark2000]

You can have a decent life making 300K in California or NE.
After reaching a certain point, other factors are more important in your quality of life.
There is a reason (and a good reason) that the income in NE or Cali is lower than other places.
Most people feel happier making 250-300K in NYC or near the beach in cali than making 500K in the middle of nowhere.

Just one point: Doctors have one of the most stable job markets and are on average the highest paid educated groups. On average doctors income easily surpass any other groups (forget about one or two HFs or lawyers who make 2 mil /year) AND surprisingly they are the most obsessed and insecure group among other groups. If 300K does not make you happy, 350 K also won't make you happy and the lack of happiness has its roots in other factors (hating your job, not having a stable network of friends and family ,. . ..).

 

[arfu]

I am already in cards fellowship and think the same, it gets even hard to quit once into fellowship.

 

[Socrates25]

So I matched into cardiology and I'm supposed to start in a few months. But I'm seeing a field that has been ravaged with reimbursement cuts. Everyone has sold their practices. People are working for big corporations (albeit non-profits) and the morale could not be lower. That is not what I signed up for and I'm having some very serious second thoughts about going in. I will likely just go on to be a hospitalist.

Can anyone comment on the fallout if I were to renege now? I realize that I would be screwing over the fellowship program and creating a bad rep for my current IM program, but I would rather do it now than in the middle of my fellowship (as I have heard of people doing).

Can anyone comment on how this is gonna reflect on my future? Will it impede me trying to get a hospitalist job? Will this follow me in my medical career?

Thanks ahead of time.

I dont understand. I'm going in to peds cardiology and we get paid less than half what the adult cards guys get, yet I cant imagine quitting and going to general peds or hospitalist or whatever. Surely the job market cant be THAT bad, unless your only sense of being happy is to work as a cath jockey in Manhattan and make 500k per year.

If the option is to do general adult cardiology and make 350k per year vs making 250k as a hospitalist, thats a complete no-brainer to me.

 

[reventon2]

I dont understand. I'm going in to peds cardiology and we get paid less than half what the adult cards guys get, yet I cant imagine quitting and going to general peds or hospitalist or whatever. Surely the job market cant be THAT bad, unless your only sense of being happy is to work as a cath jockey in Manhattan and make 500k per year.

If the option is to do general adult cardiology and make 350k per year vs making 250k as a hospitalist, thats a complete no-brainer to me.

This is the reason why adult cardiology will continue to be competitive in the future regardless of these reimbursement cuts. There are enought people who'd rather train 3 more years even if they were getting paid the same salary instead of dealing w/ all the issues of a hospitalist.