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I'm not a cardiologist or cardiac surgeon but as a surgeon of another variety I would say you need to ask yourself how much you love the OR and big operating. The stuff done by cardiologists is small compared to honest to goodness cardiac surgery. If you want the OR, than you might find the smaller procedures in cardiology isn't as satisfying. If you don't think you wouldn't be happy without procedures (as more of a general cardiologist) than cardiac surgery would be a better field, since in theory you could not get an interventional (or even cardiology) fellowship and be stuck going general cadiology or some other kind of IM specialty.

 

Cardiology on the other hand would involve a lot of medicine (cardiology in general, plus regular IM). If you love medicine (the style, the patients, the approach to problems), then maybe you should think about cardiology. 

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During my family rotation, we had rounds where the cardiac surgeon (head of the department) gave a talk on the future of cardiac surgery, and that the family docs should refer their patients with structural heart disease to CV surgeons. He mentioned the "new" approaches to CV surgery, including off-pump surgery (or beating heart surgery), minimally invasive bypass surgery, and many of the procedures you listed above (which are I believe done by both interventional cardiologists and Cardiac surgeons, at least at my centre). So I don't believe that the interventionist's have "locked out" the Surgeons, but I could be wrong.

 

I don't think anyone ever could comment on any job market in 10-15 years, but right now it seems BOTH are pretty saturated (at large centres), with trainee's continuing to come down the pipeline (take that for what its worth). I can't comment on the training or hours. However, the hours from what I've heard and seen from Interventionist's are bad.

 

Since you're just about to enter first year check both of them out. Both are vastly different training styles and mentality. One is surgery, so you have to like being in the OR. The other is through Internal medicine, so if you don't like internal medicine that will be tough to go through to just get to cardiology, especially the first 3 years of IM training with lots and lots of call. But yeah check them out and see which one you prefer and go with that, because superficially in terms of hours, pay, lifestyle they don't seem vastly different, but what do I know.

 

 

Can anyone explain to me more about the future and differences of cardiac surgery and interventional cardiology? From my understanding, CS is a bit of a dying field, there are no jobs currently, long hours, incredibly long training time and you essentially need a PhD in order to get a job and possibly a fellowship on top of that.

 

On the other hand interventional seems to be growing, TAVI, TMVI, TMVR, bio-reabsorbable stents, PAD. It seems as if interventional is the future.

 

Training times on paper seem to be equivalent but I've heard that CS is more rough in terms of hours.

 

I like procedural based cardiology, but I just don't know which path is the most suited towards that. Essentially, I want to manage the heart procedurally in all aspects. Currently its done by CS however interventional seems to be encroaching from all areas except heart transplant.

 

Additionally, i'm interested in academic medicine and i'm willing to do a PhD in order to achieve that but I also have to keep in mind training times, if CS is a proper 13 years of post graduate training I probably would be turned off by that. I've also had a look at the Royal College specialty guide and CS surgeons work an average of 77 hours of week not including on call which i'm not sure includes attendings or not. I don't mind working long hours as a resident but I would prefer something around 60 hours a week + on call as an attending at most.

 

So all in all it seems like I should choose interventional, but something in me feels like I'm missing out and i'm not truly doing heart surgery, just an aspect of it (this might just be me being naive). 

 

tl:dr - what is the future of CS, of IC? Will heart transplants or VADs become common enough that they can provide volume for surgeons in the future? Will CV surgeons ever dabble into interventional, or are interventionalists going to lock them out? As an academic surgeon, will hours be as much if you decide to focus on the research aspect?

- what are the hours really like and what is the training situation right now? I don't think i'm interested in transplant just because the crazy hours are probably too much for me

- what will the job situation be like in 10-15 years time?

 

Thanks everyone!

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The real question here is whether you see yourself as a surgeon or not. If you feel inclined toward technical mastery and fine details of anatomy and relevant pathology and physiology, you may be more inclined to surgery. Cardiac surgeons want to operate and are not satisfied by threading wires and injecting dye into coronary arteries. (Although vascular surgeons do a lot of endovascular work, and there are some cardiac surgeons who do both.) 

 

If you're okay with being away from the OR, managing many patients medically, and doing stress tests and clinics, then I'd suggest that you'd be happy with cardiology. Interventional work could be a large part of your practice - but that would be after a 6 year residency (IM + Cardio) and then one or two fellowships. It's not necessarily a much shorter path than cardiac surgery, though other specializations like electrophysiology or echo would be possible too. 

 

If you can't see yourself doing without the OR and operating, go for the surgical route. I expect this will sort itself more in clerkship once you have more experience. Cardiac surgery isn't really dying, though it has changed - and there are jobs (at least one here anyway!), but it's probably not that much easier to get a job in interventional cardio. 

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I'm not a cardiologist or cardiac surgeon but as a surgeon of another variety I would say you need to ask yourself how much you love the OR and big operating. The stuff done by cardiologists is small compared to honest to goodness cardiac surgery. If you want the OR, than you might find the smaller procedures in cardiology isn't as satisfying. If you don't think you wouldn't be happy without procedures (as more of a general cardiologist) than cardiac surgery would be a better field, since in theory you could not get an interventional (or even cardiology) fellowship and be stuck going general cadiology or some other kind of IM specialty.

 

Cardiology on the other hand would involve a lot of medicine (cardiology in general, plus regular IM). If you love medicine (the style, the patients, the approach to problems), then maybe you should think about cardiology. 

Why do you say this?

 

 "since in theory you could not get an interventional (or even cardiology) fellowship and be stuck going general cadiology or some other kind of IM specialty."

 

 

Also...wouldn't u have to do a residency in diagnostic radiology and then an fellowship in interventional cardiology rather than going through the IM (cardiology) route? 

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Interventional cardiology goes through cardiology and not radiology. But to get into cardiology, you would have to enter the R4 match as an internal medicine resident, for which success is of course not guaranteed.

 

not guaranteed at all - it is a competitive sub-specialty and interventional cardiology is yet another competitive layer as well. They work hard to say the least (I actually work in one of the labs - crazy smart people, very hard working, fun people to do research with though).

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Interventional cardiology goes through cardiology and not radiology. But to get into cardiology, you would have to enter the R4 match as an internal medicine resident, for which success is of course not guaranteed.

 

oddly there are still a couple of rads out there who deploy TAVIs. Ha, medicine is so variable.

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Why do you say this?

 

 "since in theory you could not get an interventional (or even cardiology) fellowship and be stuck going general cadiology or some other kind of IM specialty."

 

 

Also...wouldn't u have to do a residency in diagnostic radiology and then an fellowship in interventional cardiology rather than going through the IM (cardiology) route? 

As people said previously, to get to interventional cardiology, you need to make it through three matches: IM (easy), general cardiology fellowship (possibly competative) and interventional cardiology fellowship (competative). You need to survive three rounds of matching to get to your goal. You could easily fail to secure a spot in one of those matches. For example, you could not get in to cardiology. That means you will be stuck working as some other kinds of IM specialist (GI, rheum, general IM etc.). If you are going that route, you had better be sure that you like all the aspects of internal medicine, since you may end up doing a non cardiology job for the rest of your life.

 

The plus side of cardiac surgery is that it is a direct match (which is probably not competitive, provided you work hard and set yourself up right from a matching POV). You only have one round of matching to go through. After than, you are guaranteed to at least work as a cardiac surgeon in some capacity (provided you can secure a job). It's not like you finish cardiac surgery and then are stuck doing a urology fellowship because you didn't match successfully in a fellowship match.

 

The biggest question you need to answer is whether you want to be a surgeon or not. I'm a surgeon. I love surgery. I dislike medicine (patient population, approach to problems, thought process etc.). I think I would fake my own death (to discharge my debt) and go live in Central America if someone told me I had to be an internist. I'm sure there are lots of internists here who feel the exact opposite.  

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The biggest question you need to answer is whether you want to be a surgeon or not. I'm a surgeon. I love surgery. I dislike medicine (patient population, approach to problems, thought process etc.). I think I would fake my own death (to discharge my debt) and go live in Central America if someone told me I had to be an internist. I'm sure there are lots of internists here who feel the exact opposite.  

 

This is what it comes down to. If you think you want to be a surgeon, but also think you might be doing something else, consider the "else". There's nothing quite like doing a laparotomy (or, for cardiac, a sternotomy), and nothing in cardiology really matches that level of intervention. If you're not sure you need to do that, stick to IM/cardio. No one manages the heart procedurally in all aspects, but cardiologists place temporary pacing wires and permanent pacers and ICDs. And if you like interventions in general, you will find lots in IM even apart from cardio-specific stuff. But there's still a big difference between preferring a procedurally-heavy IM subspecialty and surgery. 

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I'm a cardiac surg resident. I agree with most of the advice you have recieved above. The first thing you need to do is decide if you love the OR. Cardiac surg is technically demanding and it is usually long days in the OR. Often very long days. If you love the OR, then it's the best. If you don't want to spend all that time operating, then it isn't for you.

 

Job prospects are improving in cardiac surg. Training numbers are currently below what will be required to keep up with demand according to recent manpower predictions. Jobs in interventional are actually pretty rare right now but that will probably improve also.

 

Training length is similar between the two. Yup its long and an extra fellowship is necessary. Grad degrees are common.

 

Both specialties will have lots of work in the foreseeable future. Surgeons are still doing lots of cabg, valves, aorta. Surgical volumes are increasing pretty much everywhere so don't worry about that.

 

The type of work done in an average day is quite different between the two. Both work pretty hard and aren't "lifestyle" specialties. But they are very rewarding and gratifying. You need to decide which suits you best. Go do some observerships so you can experience them.

 

Good luck

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I'm a cardiac surg resident. I agree with most of the advice you have recieved above. The first thing you need to do is decide if you love the OR. Cardiac surg is technically demanding and it is usually long days in the OR. Often very long days. If you love the OR, then it's the best. If you don't want to spend all that time operating, then it isn't for you.

 

Job prospects are improving in cardiac surg. Training numbers are currently below what will be required to keep up with demand according to recent manpower predictions. Jobs in interventional are actually pretty rare right now but that will probably improve also.

 

Training length is similar between the two. Yup its long and an extra fellowship is necessary. Grad degrees are common.

 

Both specialties will have lots of work in the foreseeable future. Surgeons are still doing lots of cabg, valves, aorta. Surgical volumes are increasing pretty much everywhere so don't worry about that.

 

The type of work done in an average day is quite different between the two. Both work pretty hard and aren't "lifestyle" specialties. But they are very rewarding and gratifying. You need to decide which suits you best. Go do some observerships so you can experience them.

 

Good luck

 

Thanks for the responses everyone, I really appreciate it. dh79, do you know how competitive it is to match to cardiac surgery these days? 

 

I will do some observerships to see which one suits me more, but i've read on this forum that cardiac surgery residencies are the type that want to see you be interested in CS from day one and will leave their spots empty if they don't feel you are the right candidate. 

 

Not sure if anyone knows much about research in the field and academic cardiology/cardiac surgery. I know a bit more about interventional which is really exploding in terms of publications but i'm not as sure about cardiac surgery. 

 

The reason I was thinking that interventionalists may be pushing cardiac surgeons out of some fields was because TAVI initially started off with 2 interventional cardiologists, 1 cardiac surgeon, 1 cardiac echocardiographer and 1 cardiac anesthesiologist in a hybrid cath lab/OR. However this is starting to move towards just 2 interventional cardiologist doing the procedure with sedation in a cath lab. 

 

For PCI, they are taking another crack at CABG by using fractional flow reserve and 2nd gen drug eluting stents in multivessel disease. https://www.clinicaltrials.gov/ct2/show/NCT02100722

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Thanks for the responses everyone, I really appreciate it. dh79, do you know how competitive it is to match to cardiac surgery these days? 

 

I will do some observerships to see which one suits me more, but i've read on this forum that cardiac surgery residencies are the type that want to see you be interested in CS from day one and will leave their spots empty if they don't feel you are the right candidate. 

 

Not sure if anyone knows much about research in the field and academic cardiology/cardiac surgery. I know a bit more about interventional which is really exploding in terms of publications but i'm not as sure about cardiac surgery. 

 

The reason I was thinking that interventionalists may be pushing cardiac surgeons out of some fields was because TAVI initially started off with 2 interventional cardiologists, 1 cardiac surgeon, 1 cardiac echocardiographer and 1 cardiac anesthesiologist in a hybrid cath lab/OR. However this is starting to move towards just 2 interventional cardiologist doing the procedure with sedation in a cath lab. 

 

For PCI, they are taking another crack at CABG by using fractional flow reserve and 2nd gen drug eluting stents in multivessel disease. https://www.clinicaltrials.gov/ct2/show/NCT02100722

 

The numbers for matching to cardiac surgery can potentially be misleading because there is a small number of positions and usually a small number of applicants.  A small change in the number of applicants can have a large change in the matching percentage.  Typically though, in the last few years most applicants who have pushed hard for cardiac surgery are matching to it.  Doing observerships and getting good reference letters from surgeons goes a long way.  However, I suspect pretty much all programs would rather go unmatched than take a candidate they are not happy with. 

 

There are tons of research opportunities in both cardiology and cardiac surgery.  Getting involved in either is good.

 

The practice of both surgeons and interventionalists will continue to evolve for years to come.  There will always be a role for both and there will be roles for both PCI and CABG.  Go spend some time with surgeons and you'll see there is no shortage of patients needing surgery.

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  • 10 months later...

Years wise

 

CV surgery is 6 plus potential fellowship PhD, searching for jobs etc.

 

IC is 6 + at least 2 of IC but most do additional training/research to develop 'novel' interventional techniques before landing any jobs

 

both are pretty bad with # of years to pursue in the field and you'd have to become very academic to succeed after fellowship for jobs etc.

 

The only thing is with life there may come a point when you might just want to start working and living the life. CV surgery has no backup option (it's all-or-nothing) whereas for IC at least you have general cardiology or even internal medicine as back-up. You'd have to love afibs/heart failure and clinic work though.

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