Cardiology vs. GIM w/ "special interest in cardiology"

[TheCat'sMeow]

I'm an IM resident trying to figure out what I want to do when I grow up (again!).

 

I recently ran into a friend who was really interested in cardio (as I am now) who eventually chose to match to GIM b/c he felt that the job situation was better and that he could do most of the things a cardiologist could do.

 

Any thoughts on this?

[cheech10]

In GIM, you can techinically do whatever you like, especially in outpatient practice. The question is, will other docs refer patients to you for problems on the fringe of your scope of practice? You can set up an echo lab and get accredited, set up a Holter lab and a stress test lab, and see patients for these and get paid, but if there is a cardiologist in the community who has reasonable service (sees patients promptly, communicates with referring MDs appropriately, etc) don't expect to get too many referrrals. Similarly, don't expect hospital privileges for these, or space/funding to run these in a hospital, unless there aren't any cardiologists around. These "GIM+" practices mainly work in rural areas where there are few specialists.

[Scholastica]

I'm in the same boat as well.

 

I really enjoy cardiology, but love the diversity and portability of GIM practice. If I become a general cardiologist in a community though, truly interesting and complicated cases will eventually be dealt with by the academic cardiologists in a tertiary centre. But, if I stay a GIM physician in a city/suburb, I should probably not expect to deal with bread-and-butter cardiology stuff since there are so many cardiologists out there. Should I be an academic cardiologist then? But I'm not sure if I'm ready to put in another decade long training/research, etc only to limit my scope of practice to one single problem. I'm really torn.

[cheech10]

Don't expect much cardiology to come your way if you do GIM in a moderate sized city or suburb, aside from the CHF cases that no one wants to touch.

 

Aside from adult congenital, EP, or really difficult interventional work, community cardiologists do see a lot of the same cases the academic guys do.

[Handsome88]

I'm in the same boat as well.

But I'm not sure if I'm ready to put in another decade long training/research, etc only to limit my scope of practice to one single problem. I'm really torn.

 

A decade? What...? Isn't cardiology 3 years? And if you want to do masters on top of that (not sure why) that would be 1-2 extra years?

Also, who said only academic cardiologists get interesting cases?

 

 

I know of one internist in the GTA who does scopes in community centres, so I don't think it's uncommon. Not sure if this would be the same for cardio procedures though.

[Handsome88]

 

Aside from adult congenital, EP, or really difficult interventional work, community cardiologists do see a lot of the same cases the academic guys do.

 

Do interventional cardiologists have to be academic? And does that mean they need to do research years before/after they can get an interventional fellowship?

Say I want to work as an IC in a suburban community, would I be able to do that with just a fellowship year?

[cheech10]

I'm pretty sure there are community guys that do some interventional work, but there's a spectrum of difficulty here, and the harder stuff including percutaneous valve work is mostly done in academic centres (and often with cardiac surgery available in case something goes horribly wrong).

[Guest copacetic]

what im about to say applies to pretty much all specialists and especially subspecialists in canada. If you want to work in a major city, you WILL need extra credentials. Its not enough to simply have the clinical training and certification. Because all the training programs in canada are affiliated with Universities (unlike the states where you can have community training programs) this means that there is a heavy slant towards academically inclined trainees especially if you want to work in a major urban centre. so lets say you want to do Interventional, youll have to do 3 years GIM+ 3 years cardio+ at least 1 year interventional. but then these days alot of interventional programs are turning into 2 year programs (and thats just for the clinical stuff). Getting a job at a major centre is gonna require additional academic credentials such as a research fellowship which would turn your IC training into a 2-3 year ordeal, or masters or PHD training. Right now im doing a research rotation at U of T, and ive met ALOT of fellows doing PHDs at the same time. If you want to work in a major centre, get comfortable with the idea of academia.

[cheech10]

So true. But I'll just add that there are plenty of community hospitals in major cities as well, that see a very interesting case mix, and where multiple fellowships or research degrees are not needed. At least 75% of grads end up in community positions, so academic medicine is not the only route to go if working in a big city is your goal.

[Guest copacetic]

So true. But I'll just add that there are plenty of community hospitals in major cities as well, that see a very interesting case mix, and where multiple fellowships or research degrees are not needed. At least 75% of grads end up in community positions, so academic medicine is not the only route to go if working in a big city is your goal.

 

this is largely true, and has been true for a long time, but times are changing, slowly. It used to be the case 5 years ago that community hospitals would be begging for specialists to come and practice there, but now at least in some specialties, the market reversed itself and more and more the cards are in the hands of the community hospitals. now once again, its no where near as bad as major city centres, but its trending in that direction. community hospitals have greater luxuries in scrutinizing who applies to work there and they can choose the best fit for them whereas before they would pretty much accept whoever they could get. alot of people have alot of delusions about what medicine. alot of lay person believe that every doc is a millionaire, and that we all have guaranteed jobs and what not which is not true necessarily. granted you wont be out of a job and taking unemployment cheques like so many unfortunate canadians these days, but you wont necessarily be doing what you want where you want either. Either way keep things in perspective and realize how lucky you are.