Do Cardiologists only work in big cities?

[Ryan]

I am just starting med school this fall and really I have no idea what I would like to go into, but I have always been interested in the heart. Also I am from BC and would like to return there some day. I am wondering whether or not someone as specialized as a cardiologist (or any other internal subspecialty) would be limited to working in Vancouver. Would Victoria have those kinds of specialists? Any place smaller than that?

[Lactic Folly]

Haven't seen ffp on the boards for a bit.. but certainly you will find general cardiologists, gastroenterologists, etc. in smaller cities. Sub-sub-specialists would be more likely to work in quaternary centres.

 

Not endorsing this site, but it shows you a listing of some places in BC where cardiologists are working:

 

http://www.ratemds.com/social/?q=node%2F28883&country=1&dlname=&dcity=&sid=53&dspecialty=Cardiology+(Heart)&dgender=&zip=&radius=10

[flying kumquat]

In my experience, they don't seem limited, depending on what you want to do. My example isn't from med school, but from the other side of the country from you, so you can take it with a grain of salt.

 

When I was in undergrad, I worked in my small hometown's hospital (Truro, NS, total surrounding pop. 42,000). There were two internists on staff full-time during the summer I worked there; one was a hematologist and one was a cardiologist. Their duties involved running the 6-bed ICU and 6-bed CCU (when it was open), doing consults on the admitted family docs' patients, reading EKGs, running stress-tests, and, of course, being on call. The cardiologist also had his own outpatient cardiology clinic and read echos and some of the nuclear medicine tests. It seemed like a well-rounded practice to me, but that was from my pre-med perspective. Even if he had the training, I don't think that Truro would have been able to support a cath lab, for example.

 

I haven't looked this up, but considering some of the UBC residents do their PGY1 year in Victoria, I would be quite surprised if they didn't have the full complement of internal subspecialists.

[leviathan]

I think you'd definitely see cardiologists, but not interventionalists in small towns.

[Ryan]

Thanks for the fast and informative answers.

 

Another, unrelated question. I also have a pretty big interest in HIV. What would that fall under? Infectious disease? Hematology? Community medicine? All three?

[bayervillager]

It would fall under Infectious Diseases if you are interested in the clinical side of HIV, and Community Health if you are more interested in the public health side.

 

I think it's really great that you are already thinking about what specialty you'd like. A number of my classmates didn't think about it until too late and completely freaked before we had to choose our clerkship rotations this year. My advice would that besides thinking of which disease process or which organ you like, it would be helpful to figure out how you'd answer following questions, because they will really help you figure out what specialty is right for you. Do you like the OR, the ward, or the outpatient clinic more? Do you want to do lots of procedures, or spend your time talking to people? Do you like working on a team with other healthcare professionals? Do you want to take care of chronic diseases, or acute diseases? Long-term doctor-patient relationships or short term? How important is lifestyle and not doing call to you? What's your tolerance for paperwork, patient death and lawsuits?

[crackers]

the subspecialties are usually represented in towns about 20 000 or more... depends on the size of the hospital. Some smaller sites (example, Wingham, ON, about 4000) will have certain capabilities (like an endoscopy suite) that make them attractive to subspecialists to come for a day or two a week/month/quarter and do procedures.

 

There are cardiologists in the community centres --- the sub-sub specialists, like interventionalists/EP (which require expensive equipment and extensive support (like ICU or cardiac surgery)) are only going to be located where there is a lot of capacity --- the major cities and the academic centres. The cardiologists are in higher demand in the community, and the academic subsubspecialty jobs are pretty much unavailable. Hence my decision a few years ago to switch from Cardio to General Medicine, where I am now employed!

 

In the community, general internists and family docs will see and treat a lot of cardiac disease (BP, cholesterol, angina, CHF), but farm out the highly acute or the highly complex to the specialized centres.

 

Everyone from ER docs to internists to cardiologists can give thrombolytics when someone's having an acute MI. But what happens if they don't work, or you get a contraindication? That's where having access to a cath lab in the major centres has the greatest benefit.

[Ryan]

Hence my decision a few years ago to switch from Cardio to General Medicine, where I am now employed!

 

 

By making that switch, to you get paid as a general internist would, or do you keep the same remuneration in your new role? It's amazing to me that someone would train as a cardiologist and then go back to general medicine otherwise.

[Darla]

Another, unrelated question. I also have a pretty big interest in HIV. What would that fall under? Infectious disease? Hematology? Community medicine? All three?

 

HIV studies can be accessed through Family Medicine as a plus 1 at UofT and Mac.

http://www.cfpc.ca/English/cfpc/education/section%20of%20residents/resource/sor3-rdyear/default.asp?s=1

[cheech10]

By making that switch, to you get paid as a general internist would, or do you keep the same remuneration in your new role? It's amazing to me that someone would train as a cardiologist and then go back to general medicine otherwise.

 

General Internal Medicine is a lot more lucrative than you think, especially in the community. Less than cardiology, but you generally work a lot less as well.

 

Also, HIV is usually treated by ID specialists, in large cities where they are available. Some general internists and family docs as well, but fewer in number.

[Halo]

I was wondering.... if one was interested in pursuing a cardiology focused practice in the community, is it even necessary to do a additional 3 year cardio fellowship after IM? What is the advantage of doing a cardio fellowship if your end plan is to work in a community practice? I was under the impression that general internists can also have a cardio focused job in the community. Is it that the only advantage of doing a cardio fellowship is to be able to work in a university centre with cath, imaging, etc facilities?

[cheech10]

A general internist can do whatever IM specialty he wants in his office, but will likely be limited in the following ways if trying to do cardiology (similar caveats for other subspecialties also apply):

 

- won't have access to cath lab

- likely very limited (if any) access to echo lab, holter, stress testing, unless set up through the office (which has a significant capital expenditure)

- will find it difficult to get consults/referrals if there are many cardiologists around with established practices, as long as the cardiologists are seeing referrals in a timely fashion

- may not have admitting/attending privileges in CCU

 

But there's nothing stopping one from seeing cardiac patients in the office and doing chronic care, risk factor modification, periop risk management, etc.