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Interventional Cardiology Vs General Surgery (Sub Spec)?


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Hi everyone! Im having trouble deciding between a few specialties and am looking for some advice on it. 

 

I've done rotations where I've observed or assisted in ccu, cardiology, interventional cardiology, cardiac surgery, general surgery and GI. In terms of systems I like the heart the most followed by GI second and maybe OB third. I really like the heart because it is a vital organ, it is a pump and conceptually easier to understand and yet its a very common source of disease and I feel like as a cardiologist or interventional cardiologist you can really make a difference to a large number of people. However, when things hit the fan like in trauma/emerg I do like evaluating the patients and "saving their life". I also really enjoy the idea of being able to fix people no matter what and general surgery definitely feels like the kind of one stop shop for all kind of doctor. I know it sounds very hypocritical but I really feel this way about these specialties. 

 

I'm cerebral in that I like to learn and like thinking but incredibly complex things do bore me especially when things become uncertain, i.e. when all the lab values are mixed up in a way that makes a diagnosis essentially impossible. I like learning and knowing a lot though and definitely enjoy being an expert in things.

 

I also enjoy working with my hands and I really enjoy tying, suturing and cutting. I definitely enjoy the feeling of doing something to help someone and being confident that what I am doing is helping them. I also really like new tech and gadgets and new things.

 

I like clinic in my downtime, I wouldn't enjoy being in the OR or cath lab every day of the week. I do like patient interaction but also like being able to sit in a chair and talk about something I know a lot about. I enjoy explaining medicine and talking to patients. 

 

I'm not a very patient person however, and I like doing things and really dislike sitting around while still having to pay attention (aka observing in surgeries that i've seen before). While I enjoy the adrenaline rush of a trauma or an emergency I definitely also like my downtime (i.e. clinic or just chilling at home or sleeping). I'm not one of those people who has constant energy and never seems to be tired. 

 

I considered cardiac surgery and still am to some degree, but I feel like it seems too intense with very little downtime and maybe too specialized while being too tiring and intense. I do like working long hours but i don't think I will enjoy working the hours cardiac surgeons work. 

 

So all this has led me to General Surgery or Interventional Cardiology. 

 

General Surgery pros: 

Satisfies my love of surgery (cutting, suturing, tying) 

I feel like a jack of all trades with my baseline 5 years (part of me would love to travel abroad to do surgery)

I feel like a specialist (since I can do a fellowship)

I can delay my decision on surgical subspecialty 

hours seem perfect for me as an attending (60 ish)

I like endoscopy, i like choles and appys (at least I think i do now)

Research at least in general surgery doesn't seem to be as hot but maybe in a sub-specialty it will be? 

 

cons

I like the cardiac system the most

While I like upper GI and other general stuff a lot I'm not sure I really like colorectal and hemorrhoids so much

 

 

Interventional Cardiology pros:

Satisfies my love of the heart and I get to be an expert at one thing

I already know a lot about the heart

I get to do procedures and do emergency more simple cases that save lives (P-PCI)

New procedures on the way that are more meaty (TAVI, TMVI etc)

Tech heavy

Hours also seem perfect for me (60 ish)

Research in the field seems like it will be insanely exciting for years to come

 

cons

I don't get to do surgery (i.e. I don't get to properly cut, cauterize and suture), wiring catheters sounds a bit to narrow of breadth for me (I would like to do catheters and cut realistically)

I lose the ability to be a generalist surgeon

 

I like procedures that take anywhere from 30 minutes to 3 hours. I would like longer procedures as well but I'm not sure I want to 4 hours procedures only for the rest of my life although for some reason I really like plaques and especially when surgeons are trying to scrape at the coronary during a CABG. Coronaries fascinate me because they are so small and are the source of so much harm (i.e. heart attacks).  

 

I also really enjoy rare pathologies, common stepwise pathologies (like abdo pain differentials), i really like acute things that get me excited. 

 

I understand this may not be the most honorable reasons for liking a specialty, but i'm just being honest here and I believe when it comes to such important decisions honesty is the best policy. 

 

The TLDR is 

 

I'm inpatient (I'm the type to lose attention if i'm made to sit around and listen to something i'm not interested in, i'm the guy whos looking around 30+ minutes into a lecture and asleep by 2 hours)

I love acute and action (I love something rare or exciting or urgent)

I'm a bit hot and cold in the sense of I can get really excited and engaged but after the adrenaline wears off a few hours later i'm tired and just don't care anymore. I'm not one of those stable workers who can sit and study for hours on end without complaint. 

I need my downtime (downtime includes clinic, paperwork, research or just sitting or relaxing around and of course having family time or travel/friends) 

I want to work hard but not insanely hard (ideally I would have days where I work hard but days that are relaxing or at least have time for lunch) 

I do want to end up doing research (i really like the cutting edge clinical research (who doesn't though haha))

I don't mind spending up to 10 years or so in residency/msc/fellowship training but I don't want to spend much more than that. 

 

If there is any other specialty you think I'm suited for i'm open to suggestions

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You keep saying you don't want to do cardiac surgery but everything you're saying screams cardiac surgery.

 

You love the heart and it's physiology, you love acuity, and you love to cut and sew.

 

It's a rewarding field. You have a relationship with your patients if you want to. There's a lot of thinking that goes on when your patient is on the table to satisfy the cerebral requirement.

 

Don't be in denial ;)

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Have you looked into thoracic/vascular surgery? Would fit your interests in surgery and the chest and cardiovascular system with plenty of acuity, not sure about the lifestyle portion.

With regards to interventional cardiology, there are a couple of more steps to get there - not guaranteed to match cardiology after 3 years internal medicine.

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Have you looked into thoracic/vascular surgery? Would fit your interests in surgery and the chest and cardiovascular system with plenty of acuity, not sure about the lifestyle portion.

With regards to interventional cardiology, there are a couple of more steps to get there - not guaranteed to match cardiology after 3 years internal medicine.

 

Thanks for the replies everyone! In reply to quackster, i definitely have been and still am considering cardiac surgery, but really want to look into other fields now as well to find the best fit. 

 

I definitely should look into both. The reasons i haven't looked into thoracics as of yet but am interested is because I wasn't as interested in lungs and wasn't sure I'd like treating smokers, but I think those reasons are not important to me as much anymore. Regarding vascular, it seems very interesting but I feel that while vascular is interesting i just haven't been as interested in it as cardiac or interventional cardiology. 

 

I'll definitely take a look into thoracics though and probably vascular. 

 

A lot of people tell me that I can't just expect to get into cardiology after IM or interv after cardiology. I'm wondering though if i demonstrate interest for so many years wouldn't it be something that I should be able to achieve? Its true that I would probably not be happy if I didn't get into cardiology or at least GI after IM, but I may be able to accept not getting into interventional cardiology after cardiology. Although at the end of the day I might be naive but I feel like when I do apply I would have so much accumulated interest that I should be a competitive applicant for these specialties if I did really want Interventional Cardiology at the end. 

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A large proportion of patients in thoracics, vascular, cardiology and cardiac surgery are smokers, sadly. If it bothers you that much, none of those will work for you, lol.

 

Being interested for a long time isn't necessarily enough. Cardiology is competitive, interventional even more so, let alone finding a job in interventional afterwards.

 

Take time in all the specialties and see what the day to day is like. You have to be happy doing what you're doing everyday for the rest of your life.

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Sounds like you should be a surgeon. 

 

I also really liked gastro and spent a lot of time there, but in the end I can't convince myself it's a good idea to go through 3 years of IM, especially all that CTU and call, just to get into one particular subspecialty. 

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  • 2 weeks later...

I think you guys are right, I'm most probably going to stick with surgery, I do think cardiac will be a great option after having just done a short hepatobiliary surgery rotation I think I am more excited and engaged with things related to the heart and looking at the way research is headed I think surgeons will definitely be involved in the new transcatheter procedures of the heart (except PCI and angiograms) so this would be a good way to also experience the interventional cardiology side of things. 

 

I think 3 years of IM followed by 3 years of cardiology while relaxing and potentially enjoyable just isn't what I want. I think the lifestyle sacrifice i'd make is going to be the same no matter what I go into because I would probably want to get very involved anyways. 

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I think you guys are right, I'm most probably going to stick with surgery, I do think cardiac will be a great option after having just done a short hepatobiliary surgery rotation I think I am more excited and engaged with things related to the heart and looking at the way research is headed I think surgeons will definitely be involved in the new transcatheter procedures of the heart (except PCI and angiograms) so this would be a good way to also experience the interventional cardiology side of things. 

 

I think 3 years of IM followed by 3 years of cardiology while relaxing and potentially enjoyable just isn't what I want. I think the lifestyle sacrifice i'd make is going to be the same no matter what I go into because I would probably want to get very involved anyways. 

I thought 3 years of IM and  3 years of cardiology is pretty tough as well. Is the lifestyle that much more different between a cardiologist (especially interventional) vs a surgeon?

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I think 3 years of IM followed by 3 years of cardiology while relaxing and potentially enjoyable just isn't what I want. 

 

 

Oh it's very relaxing. Especially the call and the codes and managing the CV surgery disasters in CVICU. 

 

I'm sure the exam will be even more relaxing. 

 

I gather from your posts that you're still a pre-clerk (certainly it's late to be this torn about your decisions pre-CaRMS if you're matching in 2017). You need to experience life on real clerkship rotations, even though lifestyle as a clerk isn't reflective of it as a resident (or staff!). 

 

I started clerkship fairly set on surgery, but it wasn't really until neurosurgery (5:45 starts, very mixed outcomes) that this started to change. I really enjoyed the OR and clinics, but it was the atmosphere and morale amongst the residents that gave me substantial pause. One of the off-service residents was a guy who'd switched from gen surg to emerg. Another neurosurg resident was trying to switch out at the same time. 

 

I eventually made the decision that while I enjoyed surgery, that wasn't the same thing as needing to do it. So I didn't and haven't (really) regretted it. 

 

Later on I found out that at least half of the R2s I worked with as a clerk ended up switching to path or anesthesia. A good friend of mine said to me not long ago that she'd never really understood why people switch out... until she become an R4. 

 

Anyway, it's often said that if you can think of anything else you'd be happy doing other than surgery, it's probably best to do that thing. 

 

But if you can't imagine a career without operating, then go for it. 

 

Characterizing something like a cardiology fellowship as "relaxing" is naive and makes you sound ultra-green and inexperienced. 

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If lifestyle is your potential pro in cardiology vs CV surgery, I would just do CV surgery. You won't see a much better lifestyle in cardiology compared to CV surgery.

 

Yeah you won't be spending all your night in the OR doing emergency thoracotomies. But you will be running around the ER and the hospital seeing emergent consults (because no consult is non-emergent in cardiology even if it's a rapid afib) instead.

Life as staff does not get better either and you will be working for your money. The provinces are now cracking down on those shady community cardiology clinics running private echos with no clear indication just for $$$ so don't count on them for your 'lifestyle' jobs either. Cardiologists work hard for their money and well-deserved too given how much they work (and how long they train, 3+3 + fellowship + master's or PhD)

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If lifestyle is your potential pro in cardiology vs CV surgery, I would just do CV surgery. You won't see a much better lifestyle in cardiology compared to CV surgery.

 

Yeah you won't be spending all your night in the OR doing emergency thoracotomies. But you will be running around the ER and the hospital seeing emergent consults (because no consult is non-emergent in cardiology even if it's a rapid afib) instead.

Life as staff does not get better either and you will be working for your money. The provinces are now cracking down on those shady community cardiology clinics running private echos with no clear indication just for $$$ so don't count on them for your 'lifestyle' jobs either. Cardiologists work hard for their money and well-deserved too given how much they work (and how long they train, 3+3 + fellowship + master's or PhD)

There are community clinics doing private echo? In B.C. at least, you can't have echo outside of hospital and can't even bill for the ECG's done outside the hospital (or so I heard).

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There are community clinics doing private echo? In B.C. at least, you can't have echo outside of hospital and can't even bill for the ECG's done outside the hospital (or so I heard).

 

Yes.  Friend of mind did his cardiology training in BC and his ICU training in Ontario.  He has some strong opinions about this...

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Oh it's very relaxing. Especially the call and the codes and managing the CV surgery disasters in CVICU. 

 

I'm sure the exam will be even more relaxing. 

 

I gather from your posts that you're still a pre-clerk (certainly it's late to be this torn about your decisions pre-CaRMS if you're matching in 2017). You need to experience life on real clerkship rotations, even though lifestyle as a clerk isn't reflective of it as a resident (or staff!). 

 

I started clerkship fairly set on surgery, but it wasn't really until neurosurgery (5:45 starts, very mixed outcomes) that this started to change. I really enjoyed the OR and clinics, but it was the atmosphere and morale amongst the residents that gave me substantial pause. One of the off-service residents was a guy who'd switched from gen surg to emerg. Another neurosurg resident was trying to switch out at the same time. 

 

I eventually made the decision that while I enjoyed surgery, that wasn't the same thing as needing to do it. So I didn't and haven't (really) regretted it. Later on I found out that at least half of the R2s I worked with as a clerk ended up switching to path or anesthesia. A good friend of mine said to me not long ago that she'd never really understood why people switch out... until she become an R4. 

 

Anyway, it's often said that if you can think of anything else you'd be happy doing other than surgery, it's probably best to do that thing. 

 

But if you can't imagine a career without operating, then go for it. 

 

Characterizing something like a cardiology fellowship as "relaxing" is naive and makes you sound ultra-green and inexperienced. 

 

I used the wrong word without even thinking about it, i certainly don't think cardiology or IM is relaxing!! What i meant to say was that compared to surgery, medicine would have slightly shorter hours and probably be less physically tasking and busy during the day than surgery. Medicine is very hard work and long hours. 

 

And I know that cardiology is a very demanding job, since the majority of heart related emergencies are going to be dealt with by a cardiologist rather than a cardiac surgeon, an interventionalist on call is much more likely to be called in to do a PPCI than a surgeon is to do any kind of procedure these days.

 

The reason I used the word relaxing at all was because I had done a cardiology rotation where I felt like the pace was enjoyable especially mid day when the work load was less and I was able to have time to talk to some of the residents etc. whereas on surgery I didn't have time to even talk to the resident for more than 5 minutes in 3 days. 

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Just two points I think are worth considering from someone who has seen a loved one gone through the whole journey:

  1. Many are turned off by the training involved in Sx subspecialties, but I think it's important to remember the bigger picture. Sx training including fellowship is lets say 7-10 years, which in comparison to your entire career is not as big as you think. Lets say you finish all your training (at the latest) by 40, and you retire at 65. That's still 25 years you have to practice. I know this is simplistic view and easier said than done, but I think there is some merit to looking at this big picture. Isn't it the same reason many of us study/studied so hard and sacrifice things to get into medicine? So is it worth saving that 1 or 2 additional years of gruesome training for a career that ends up being a high paying job to pay for your lifestyle, family and hobbies? I can't say as that's for you to decide.
     
  2. As a student, everything new looks fascinating. The PCI's, and appendectomiess and cholecystectomies, all look exciting the first 10 times, maybe even 100 you see it/do it. But you have to remember that this novelty will eventually wear off and you'll be doing these bread and butter cases 1000's of times throughout the rest of your career. The question is, how much do you mind doing these bread and butters? Even trauma surgeons have to do tons of elective appendectomies and cholecystectomies throughout their career to make a living. During your clerkship, if you find it boring to watch another appendectomy or a cholecysteomy, or even close cases, general surgery may not be for you. This applies to any bread and butters in all subspecialties.

 

addendum to 1. Same idea applies to hating the atmosphere. Yes learning environment is important as a toxic and hostile environment can make an already difficult training that much worse. However remember that when you finish your training, you will get to choose where you work and what kind of work environment you want. And as I stated before, I know it's easier said than done, but it has been done by many before.

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