Interested in cardiology, but have my qualms about it

[KaratCake]

Hi SDN,

Currently partway into my preclinical years, have sort of been bouncing around in terms of specialty interest. Cardiology really caught my eye, but I have a few worries. Namely the fact that it's a good 6 - 8 years training post-med school and the hours are unforgiving.

Guess my question is how worried should I be about the massive training required and the unforgiving hours (not to mention a pretty nasty call schedule). For every "no you'll be fine" I hear I receive another "you've got to think about the lifestyle!" On the other hand, how worried should I be about not being a plastics worthy applicant given mediocre grades and decent extracurriculars (I'm somewhat involved with research and leadership). Thank you, and please don't quote!

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[Gilakend]

Clinical year will sort a lot of this out for you in terms of your interests. I would be very surprised if at the end of clerkships someone was between IM and plastics. As to cards specifically, even if you did IM you still have a long ways to go until fellowship applications. You'll get lots of experience before then to make your decision and see how much people in each field are at the hospital.

 

[mrbreakfast]

Don't worry too much about deciding between fields as a preclinical student. That's what clinicals are for. You don't even know what you don't know yet. The main things to determine during clinicals are a) whether you like seeing patients, b) whether you like procedures, c) whether you love the OR, d) whether you like emergencies, and e) whether you prefer clinic or inpatient. Once you have even some of those answers, you can pick your field easily.

In terms of lifestyle, there is a lot of variability in almost every specialty. But you can do cardiology and still have a practice where you aren't on call every week (or at all). It's up to you.

If you are seriously considering plastics or ophtho, you should focus on getting your grades up and getting some research/focused extracurriculars in. Average students don't match into those fields, and while you can do plastics through general surgery, you don't seem to be the kind of person who would want to take that grueling path (which is totally fine, I wouldn't either).

My general advice is to go into clerkships with an open mind and find the specialty that excites you the most, or bores you the least. Worry about the lifestyle later, as for most fields you can make of your career what you want.

 

[ortnakas]

Cardiology and plastics have very few similarities. While you’re in rotations figure out what you actually would enjoy on a daily basis, not just what sounds cool.

 

[Med Ed]

Hi SDN,

Currently partway into my preclinical years, have sort of been bouncing around in terms of specialty interest. Cardiology really caught my eye, but I have a few worries. Namely the fact that it's a good 6 - 8 years training post-med school and the hours are unforgiving. I'm also somewhat interested in plastics (met some really cool reconstructive plastics docs), but I don't think I have what it takes to cut it (marginally below average student, fake P/F system which counts towards our class rank, see other students who are able to do far better than I am). I also met a really cool oculoplastic surgeon, but I suppose the same idea would apply with plastics.

Guess my question is how worried should I be about the massive training required and the unforgiving hours (not to mention a pretty nasty call schedule). For every "no you'll be fine" I hear I receive another "you've got to think about the lifestyle!" On the other hand, how worried should I be about not being a plastics worthy applicant given mediocre grades and decent extracurriculars (I'm somewhat involved with research and leadership). Thank you, and please don't quote!

So you're interested in cardiology, but hesitant about the 6+ years of training and long hours. And your other current interest is plastic surgery, a field with... 6+ years of training and long hours.

It is perhaps useful to consider the saying "choose a job you love an you'll never work a day in your life." While not literally true for the vast majority, it does underscore the fact that work isn't exactly torture if you find it engaging and fulfilling.

 

[Lawpy]

So you're interested in cardiology, but hesitant about the 6+ years of training and long hours. And your other current interest is plastic surgery, a field with... 6+ years of training and long hours.

It is perhaps useful to consider the saying "choose a job you love an you'll never work a day in your life." While not literally true for the vast majority, it does underscore the fact that work isn't exactly torture if you find it engaging and fulfilling.

IM can be a torture though if someone’s interested in procedural stuff

 

[Melchizedek]

Hi SDN,

Currently partway into my preclinical years, have sort of been bouncing around in terms of specialty interest. Cardiology really caught my eye, but I have a few worries. Namely the fact that it's a good 6 - 8 years training post-med school and the hours are unforgiving. I'm also somewhat interested in plastics (met some really cool reconstructive plastics docs), but I don't think I have what it takes to cut it (marginally below average student, fake P/F system which counts towards our class rank, see other students who are able to do far better than I am). I also met a really cool oculoplastic surgeon, but I suppose the same idea would apply with plastics.

Guess my question is how worried should I be about the massive training required and the unforgiving hours (not to mention a pretty nasty call schedule). For every "no you'll be fine" I hear I receive another "you've got to think about the lifestyle!" On the other hand, how worried should I be about not being a plastics worthy applicant given mediocre grades and decent extracurriculars (I'm somewhat involved with research and leadership). Thank you, and please don't quote!

Rather than thinking about specialties and lifestyle, also try to consider your day to day.

Would you rather be doing more medical management of your patient, with a little bit of echo and EKG reading? Cardiology can be very procedure heavy (IC, floating pace makers as gen cards, lines etc) or if you just want to manage outpatient heart failure you can go that route. It comes down to how you build your practice.

Are you more looking for working with your hands all day, using visual and artistic sense. Younger population, elective surgeries for the plastics or you can even do trauma reconstruction (everyone forgets that there’s a “reconstruction” side to plastics and reconstruction).


I was in a similar spot and considering plastics or cards. I put aside the training length because it’s pretty much the same between the two. The thing that helped me decide was even with good stats, I was always advised to take a research year in school in order to be somewhat competitive for plastics, and I suspect the same would be true for you. The other thing was the retiring/aging with the job thing. In IC you can be in the cath lab and do hands on procedures, do a lot of cool interventions like stents and now newly shockwave lithotripsy type procedures to break up lightly calcified vasculature, do TAVR’s for valve repair, lots of options while I’m just getting into the field. After a couple of years of being on my feet doing stuff I can always pivot my practice to do more ICU time for high acuity, or try to do more outpatient gen cards for a slower pace. I am biased though and prior experience in cards before school and 3rd year rotations helped solidify that.

 

[KaratCake]

So you're interested in cardiology, but hesitant about the 6+ years of training and long hours. And your other current interest is plastic surgery, a field with... 6+ years of training and long hours.

It is perhaps useful to consider the saying "choose a job you love an you'll never work a day in your life." While not literally true for the vast majority, it does underscore the fact that work isn't exactly torture if you find it engaging and fulfilling.

I guess I should rephrase, the training itself isn't so much of an issue (especially because their lengths are easily comparable). It's more so the call schedule and hours. From what I understand (and I'm aware that it can very well be inaccurate given I'm only a medical student), call is a major contribution in physician burnout (in the sense that it messes up your schedule flexibility and stability). That, followed by the long hours. Otherwise I agree, interest in the job will be the saving grace and what I should prioritize.

 

[Med Ed]

IM can be a torture though if someone’s interested in procedural stuff

IM as a career or IM as a 3-year bridge to a procedure-rich medical subspeciality?

 

[Matthew9Thirtyfive]

IM can be a torture though if someone’s interested in procedural stuff

Every cardiologist I met on rotations was an IM doc at heart.

 

[Matthew9Thirtyfive]

I guess I should rephrase, the training itself isn't so much of an issue (especially because their lengths are easily comparable). It's more so the call schedule and hours. From what I understand (and I'm aware that it can very well be inaccurate given I'm only a medical student), call is a major contribution in physician burnout (in the sense that it messes up your schedule flexibility and stability). That, followed by the long hours. Otherwise I agree, interest in the job will be the saving grace and what I should prioritize.

No one can answer this for you. The obgyn docs where I rotated took in-house 24 hour call every 4 days. I would rather do that for the rest of my career than be a dermatologist and never take call again. How much the lifestyle matters will be unique to you and how much you like each specialty. As a preclerkship student, you just aren’t ready to answer that question. But you will be.

 

[Drrrrrr. Celty]

Every cardiologist I met on rotations was an IM doc at heart.

General cardiologists often are. The interventionalists and EP docs tend to be less so in my experience.

But honestly it's an important point. IM is not just a jumping point to better and greater things. It's the train that gets you to fellowship. If you're going to complain about every sodium patient you need to work up then you're probably going to be bitter and miserable by the time fellowship interviews come.

 

[FindersFee5]

I think there are very few fields more opposite than cardiology and plastic surgery. Cardiology has some of the best studies in medicine. Most of their landmark studies are RCTs with n's of thousands. Therefore, a lot of the decision making in cardiology is extremely data driven and knowing the latest guidelines is considered of paramount importance.

Plastics, in my opinion, has some of the least extensive and encompassing literature of any field. There are problems associated with the literature in surgery by its very nature: randomization and blinding are more difficult, many techniques are surgeon dependent, and familiarity with a certain technique often outweighs absolute benefits of another technique which will only be realized with time (see early laparoscopy vs open chole/appy data). Plastics is often even more creative and open-ended than other surgical fields, so these issues are magnified.

 

[Drrrrrr. Celty]

I think there are very few fields more opposite than cardiology and plastic surgery. Cardiology has some of the best studies in medicine. Most of their landmark studies are RCTs with n's of thousands. Therefore, a lot of the decision making in cardiology is extremely data driven and knowing the latest guidelines is considered of paramount importance.

Plastics, in my opinion, has some of the least extensive and encompassing literature of any field. There are problems associated with the literature in surgery by its very nature: randomization and blinding are more difficult, many techniques are surgeon dependent, and familiarity with a certain technique often outweighs absolute benefits of another technique which will only be realized with time (see early laparoscopy vs open chole/appy data). Plastics is often even more creative and open-ended than other surgical fields, so these issues are magnified.

Well, I'm medicine but I find there's very little better evidence of plastic surgery working than when they seal up a gaping debridement wound after nec fasc.

I mean I jest, but it kind of crystalizes the issue of comparing surgery to a field that is still at heart medicine driven.

 

[Espressso]

OP, as others have mentioned, both training paths cards vs plastics includes around 6 years or so of training. I used to fret about that during med school. Now I'm an IM intern and see why that's all meaningless. Once you're in training, it's a job. And you go in and learn every day. Sure for many you get to a point where you want to just make money and start attendinghood, but if you feel as if being a GI doc or a cardiologist is the path that will make you the happiest in your career, than the time to get there doesn't matter as much. The trick is to really understand do you like surgery or non-surgery. Because plastics and cardiology are very different lol.

 

[KaratCake]

OP, as others have mentioned, both training paths cards vs plastics includes around 6 years or so of training. I used to fret about that during med school. Now I'm an IM intern and see why that's all meaningless. Once you're in training, it's a job. And you go in and learn every day. Sure for many you get to a point where you want to just make money and start attendinghood, but if you feel as if being a GI doc or a cardiologist is the path that will make you the happiest in your career, than the time to get there doesn't matter as much. The trick is to really understand do you like surgery or non-surgery. Because plastics and cardiology are very different lol.

I've definitely come to realize that, thanks. I still can't figure out that surgery versus non-surgery question even with all the shadowing I've done on both sides. Guess that'll be the question to focus on in the meanwhile.

 

[Matthew9Thirtyfive]

I've definitely come to realize that, thanks. I still can't figure out that surgery versus non-surgery question even with all the shadowing I've done on both sides. Guess that'll be the question to focus on in the meanwhile.

You’ll find out pretty quick when you start rotations.