Competitiveness of landing Cardiology

[medguy5367]

Just how competitive is Internal Medicine --> Cardiology?

 

Can it be compared to the difficulty of Undergrad --> Med school?

 

 

Also, what happens if you don't match into cardiology? Can you apply again next year, and meanwhile work as an internal medicine doctor?

 

Thanks.

[apache]

Cardio is the most competitive internal sub-specialty, followed by gastroenterology. you have to work like a dog for it and network effectively. personally if i was in internal i'd go for endo, nephrology (both are uber interesting, "clean", decent paying and reasonable hours). Cardio is a great specialty but you work like a dog, and life and death is often in your hands... but you're one of those pay and prestige guys right... i can sure as hell tell you i respect cardiologists and they make a lot of money.

 

Just how competitive is Internal Medicine --> Cardiology?

 

Can it be compared to the difficulty of Undergrad --> Med school?

 

 

Also, what happens if you don't match into cardiology? Can you apply again next year, and meanwhile work as an internal medicine doctor?

 

Thanks.

[Dany]

not as competitive as gastro last year, largely due to the cardio job market "overflow"

 

refer to carms site for matching stats

I remember cardio is like 60sh applicants for 60sh spots

vs GI 50sh applicants for like 38 spots

[thebouque]

Cardio is the most competitive internal sub-specialty, followed by gastroenterology. you have to work like a dog for it and network effectively. personally if i was in internal i'd go for endo, nephrology (both are uber interesting, "clean", decent paying and reasonable hours). Cardio is a great specialty but you work like a dog, and life and death is often in your hands... but you're one of those pay and prestige guys right... i can sure as hell tell you i respect cardiologists and they make a lot of money.

 

What do you like exactly about endo and nephro

[aaronjw]

What do you like exactly about endo and nephro

 

endo is pretty complex. When you're dealing with hormones it's a huge ass giant puzzle and changes can have unintended consequences in other areas which make the game of balancing pretty interesting.

[NLengr]

Nephro is very tight for jobs now.

[jordan19]

What about infectious disease as a subspeciality? How competitive is that?

[apache]

this pretty much answered it, i really like cloudiness, nebulosity, i like to come up with my own answers and challenge myself, see how someone reacts, and think how to adjust... which obviously explains the interest in things like psych and neuro... far less treatment algorithms (i.e. high dose lamotrigine would be my first line ahead of lithium in people with bipolar characteristics, the tolerability and side effect profile are just too vastly superior... of course, if a patient didn't respond well i'd go back to lithium, or if they came to me on lithium and we're stable i wouldn't tamper.) i'd scarcely use anti-psychotics except for manic phases with psychotic features, i've seen anti-psychs used first line for bp and i'm just disgusted.

 

 

endo is pretty complex. When you're dealing with hormones it's a huge ass giant puzzle and changes can have unintended consequences in other areas which make the game of balancing pretty interesting.

[apache]

that's interesting, yeah, i hear it's hard to get cardio jobs now at major centres.

 

not as competitive as gastro last year, largely due to the cardio job market "overflow"

 

refer to carms site for matching stats

I remember cardio is like 60sh applicants for 60sh spots

vs GI 50sh applicants for like 38 spots

[thebouque]

That's the thing, people think that endo is vague or nebulous. It's actually very down to Earth with lots of algorithms. Your bread and butter still is diabetes and hypo/hyper T4.

 

As for nephro, yes it's really interesting, but most of the dx for the glomerular diseases (arguably the most interesting diseases in nephro) are done by the pathologist.

[Maxime]

Definitely doable, 2 spots left for second round though all of Canada (Sherbrooke). In terms of competitiveness, it's at the top with gastroenterology. If you have a good application, getting in shouldn't be too hard. As for getting a job, the job market slowed down a bit, but there are some openings (the hospitals are no longer desperate, but they still want you).

 

As for micro/ID, a lot of candidates this year in all of Canada. Nephro is usually intermediate, endo less.

[medguy5367]

Definitely doable, 2 spots left for second round though all of Canada (Sherbrooke). In terms of competitiveness, it's at the top with gastroenterology. If you have a good application, getting in shouldn't be too hard. As for getting a job, the job market slowed down a bit, but there are some openings (the hospitals are no longer desperate, but they still want you).

 

As for micro/ID, a lot of candidates this year in all of Canada. Nephro is usually intermediate, endo less.

 

 

Great post, exactly what I was looking for.

 

 

But why isn't cardiology more competitive? Getting into Internal Med isn't hard, and if IM --> Cardiology isn't hard either, why do people speak of cardiologists in hushed tones like they're rock stars?

 

 

Is the lifestyle so bad that no one WANTS cardiology? I would assume cardiac surgeon would be the horrible lifestyle, not cardiology.

[NLengr]

Great post, exactly what I was looking for.

 

 

But why isn't cardiology more competitive? Getting into Internal Med isn't hard, and if IM --> Cardiology isn't hard either, why do people speak of cardiologists in hushed tones like they're rock stars?

 

 

Is the lifestyle so bad that no one WANTS cardiology? I would assume cardiac surgeon would be the horrible lifestyle, not cardiology.

 

Not to many middle of the night bypasses. Lots of middle of the night PCI and cardio calls.

[medguy5367]

Not to many middle of the night bypasses. Lots of middle of the night PCI and cardio calls.

 

But you have the option to choose how much you work right? If you're willing to take a pay cut?

 

 

Our family knows one young cardiologist who only works 4-days a week, not sure about his overnight-call schedule... He only earns about $450k though, while most of the cardiologists he knows earn much more.

[aaronjw]

But you have the option to choose how much you work right? If you're willing to take a pay cut?

 

 

Our family knows one young cardiologist who only works 4-days a week, not sure about his overnight-call schedule... He only earns about $450k though, while most of the cardiologists he knows earn much more.

 

Only? Was that an attempt at humour?

[medguy5367]

Only? Was that an attempt at humour?

 

No 10char.

[Maxime]

Cardiology is very popular starting internal medicine, but interests often diversify themselves with time, and a lot of people change ideas before the end of their training (I almost did! Very happy in retrospect that I didn't).

 

As for quality of life, it definitely depends on what branch you decide to specialize in. Those who do hemodynamics do get called at night, but it's a very high paying field, so usually they don't mind if a STEMI comes along at 4 am when they're on call. If you go into ultrasound/electrophysiology, then quality of life is pretty good. Gastroenterology also has it's emergencies (upper digestive bleeding, piece of food causing obstruction in the oesophagus...). Pneumology has massive hemoptysis. Nephrology has late night urgent Hemodialysis. Rhumatology and endocrinology get much less calls at night (great quality of life), but also do make less money.

 

You do have the UA/NSTEMI at night, AF, decompensated heart failure and the like, but normally good ER docs are able to manage these until the morning.

[Maxime]

Just to add that interest for medical specialties comes and goes with the years. A few years ago, gastro was not in vogue, or internal medicine (GIM). This year, GIM was very popular, as was gastro. Who knows what will happen next year?

[cheech10]

For most of the conditions listed above, at least in community hospitals, the internist will see/manage/admit the patient overnight and transfer care in the morning to the appropriate subspecialist. For example, at my hospital, the internist sees the NSTEMI and CHF patients overnight, and STEMI get re-routed to a nearby 24 hour cath lab, so the cardiologists don't typically come in to see these patients. They will provide advice over the phone and occasionally come in for a very sick patient, but it's not a very onerous call schedule. Same for GI and Resp (rare that endoscopy can't wait until the AM); Nephro often can call in dialysis orders.

[Maxime]

There's an internist all night doing consults? Interesting.

 

Here in Québec, in community hospitals, there are no internists at night, only ER docs. Internists are on call should the need arise. They do not sleep at the hospital, and will not come in to do this kind of consult for a stable patient. They can give recommendations by phone to the ER doc though. In bigger centres, cardiology sees the NSTEMI/UA/CHF, but again not at night (unless unstable). Of course, in university centres these cases will be seen by the resident on call at night, stable or not.

[cheech10]

Most (maybe all?) of the community hospitals in Toronto have an internist in house overnight for consults. Often it's done in two 12-hour shifts, day and night.

[n00b]

For PCIs/cath, are general cardiologists able to do those, or do you have to be interventional cardiology trained?

 

Also, how common is it to apply to 2 subspecialties? For example, GI doesn't seem like a sure thing at all. What would those unsuccessful R3s do?

[cheech10]

Diagnostic caths are sometimes performed by non-interventional cardiologists, but most of the PCI is done by those with interventional training, at least for new grads.

 

I'd say it's fairly uncommon for people to apply to multiple subspecialties, but it does happen, particularly for cardiology applicants in the past and GI applicants today. It used to be that you were essentially entitled to an R4 spot in IM at your home program if you didn't match, but this may have changed with the move to CARMS and now the new 5 year program. I would ask your PD.

[inspiring-curmudgeon]

Diagnostic caths are sometimes performed by non-interventional cardiologists, but most of the PCI is done by those with interventional training, at least for new grads.

 

I'd say it's fairly uncommon for people to apply to multiple subspecialties, but it does happen, particularly for cardiology applicants in the past and GI applicants today. It used to be that you were essentially entitled to an R4 spot in IM at your home program if you didn't match, but this may have changed with the move to CARMS and now the new 5 year program. I would ask your PD.

 

What 5 year program? For cardiology?

[justletmein]

What 5 year program? For cardiology?

 

5 year program for GIM