Interventional cardiology after practicing general cardiology for several years?

[Apply Pressure]

I enjoy work as a general invasive cardiologist (3 years out from gen cards fellowship) but a part of me wonders if I would be happier and of greater value as an interventionalist. I deferred on interventional training out of fellowship because I enjoy the diversity of practice that cardiology offers, and was concerned about being mostly stuck in the cath lab. I also initially deferred on interventional because of work hazards-- radiation exposure, back discomfort, potential hair loss etc. It was less about call.

Now that I am more seasoned (and somewhat healthier due to improved lifestyle habits), it seems nice to add interventional skills on board as a means to further take care of my patients. I am okay with the real world of most ICs in desirable areas having low PCI volume-- in fact, I would welcome it if it means I can keep up the diversity of my non-cath lab cardiology skillset. Would be great to add some structural to the mix of course (e.g. TAVR) since that is where the field is now but would not have to be a primary focus.

Has anyone made the jump to interventional cardiology fellowship and practice after several years of general cardiology practice? If so, what was your experience? Trying to figure out if I'm experiencing a "grass is greener" phenomenon or not. Thanks for the opinions.

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[cards67]

Probably very few people have gone down this path. I know of one years ago. If you like the cath lab and want to do PCIs, go for it. The health hazards are still there. Having that skillset won't hurt you and may increase your marketability. But it might be a red flag for PD's as far as cath lab skills and proficiency, especially if you didn't do a whole lot in fellowship or the past few years. Probably easiest place to start is your old program, especially if they have in-house IC fellowship. Personally I can't relate and don't think it's worth it but ymmv.

 

[timpview]

Chances you actually do structural in the real world is probably less than 10-20% unless you’re extremely committed… so I woukdnt bank on that.

So it’s likely just coronaries. But then volumes are pretty low for the most of us and the tough calcified patients are only increasing, Most private practice jobs are 90% general, 10% interventional in my neck of the woods, so the days of just hanging out in the cath lab all day are harder to find imo

so 1-2 years of your life as a fellow, lost income for those years, required job change after, increase STEMI call for the rest of your life, increase malpractice and job stability risk from complications , increase stress from killing someone, increase scrutiny from admin on cath lab metrics, radiation, back pain, etc all for 10% more pay (likely not enough to make up for 1-2 years of lost pay as a fellow) and possibly more job satisfaction woukd be a tough sell for me

I would trade jobs with my general cardiology partners yesterday if I could.. the small concern I have is job security or options in 5-15 years but I think that’s overblown and they’ll always be fine - but voluntarily giving up a skill set takes some courage too

 

[Apply Pressure]

Thank you both for the honest replies-- It's helped me realize that I have it pretty good in my current situation. I don't think I have a current visceral desire to become an interventionalist and rather, I'm experiencing fleeting moments. I'm fortunate to have the ability to cath without shouldering the additional liabilities /responsibilities that interventionalists have to take on. I also appreciate being on the imaging side for structural cases-- especially for MitraClip where that role is pivotal.