So you want to be a cardiologist.
You’ve come to the right place. In this third episode of So You Want to Be, let’s talk about what it means to be a cardiologist, how to become one, and some of the hidden perks and downsides of being a heart doctor. Dr. Jubbal, MedSchoolInsiders.com. Welcome to the next installment of our
So You Want to Be series, where we highlight a specific specialty within medicine, and help you decide if it’s a good fit for you. You can find the entire list on our So You Want To Be playlist. If you wanna help us decide which specialty or healthcare professional to cover next, drop a comment down below with your request. A lot of you asked for cardiology in the last video, so that’s what we’re going to do here If you like to see what being a cardiologist actually looks like, check out my second channel, Kevin Jubbal, M.D., where I do a second series in parallel titled A Day in the Life. We may even be doing A Day in the Life with our cardiologist guest from today’s episode. Stay tuned. The heart is comprised of 4 chambers, two atria and two ventricles. The right side of the heart pumps blood to the lungs to oxygenate it, so that the left side of the heart can pump the oxygenated blood to the rest of the body. Cardiology is the specialty of medicine dealing with the heart and some specialized circulatory pathologies. If you like medicine and find physics and fluid dynamics interesting, cardiology may just be for you. It was personally one of my favorite blocks we studied in medical school. Cardiologists are also one of the few doctors that can actually save your life during an in-flight emergency. Obviously, cardiologists are the go-to doctors for heart attacks, the technical term for which is myocardial infarction, but they also handle many other pathologies such as high blood pressure, known as hypertension, high cholesterol, known as hyperlipidemia and irregular heart rhythms, known as arrhythmias. It’s not a surgical specialty, but it’s also not a traditional medical specialty. Cardiology is unique in that it’s more procedural than the average medicine specialty. Cardiologists have several cool non-invasive tests like electrocardiograms, or ECGs, and echocardiograms or cardiac CTs and MRI’s. But invasive tests are also part of the job such as coronary angiography, catheterization, and electrophysiology studies. To become a cardiologist, you don’t go to cardiology residency. There’s actually no such thing. First, you complete 3 years of internal medicine residency. This is actually the number one most common residency that med school graduates pursue. Think of it as the default. However, after internal medicine residency, you can choose to subspecialize, and that’s where fellowship comes in. Cardiology is one of the most competitive internal medicine fellowships and requires another 3 years of training to complete. In total, you’ll be spending 6 years in addition to medical school to become a cardiologist. If you want to subspecialize further, such as interventional cardiology, or electrophysiology, tack on another 1 or 2 years on top. If you want to do pediatric cardiology,
that’s a slightly different process. Rather than internal medicine residency, you’ll do three years of pediatrics, and then three years of pediatric cardiology fellowship. Becoming a cardiothoracic surgeon is an entirely different process. At its core, CT surgery is a surgical specialty, and therefore, it makes sense that you have to do a surgical residency rather than a medicine residency. There are two main paths. First, you can do 5 years of general surgery residency, plus 2 to 3 years of cardiothoracic surgery fellowship. Or second, do a 6 year integrated cardiothoracic surgery residency. Rather than telling you what it’s like to be a cardiologist, I’m gonna hand it over to my friend, Dr. Rohin Francis. Not only does he have an awesome YouTube channel, MedLife Crisis, which you should definitely check out, but he’s also a practicing cardiologist in the U.K. Without further ado, here is Dr. Francis. Cardiology is the best of both worlds specialty. A fantastic tunable combination of acute and chronic medicine, satisfying those who like fast-paced critical illness while still allowing the long term relationships with patients and disease that make medicines so rewarding. It also combines the best of medicine and surgery; multi-system disease processes and diagnostic challenges alongside increasingly complex and essentially surgical interventional procedures. Cardiology can be divided into a few broad areas. Intervention – which involves invasive procedures such as coronary angioplasty and valve implantation. Sometimes we’re referred to as “The orthopedic surgeons of medicine” which is a little unfair, but only a little. Heart failure – which can range from managing an outpatient to a community-based service for patients with impaired hearts right through to running a cardiac intensive care, specializing in mechanical support and transplants. They are the specialist generalists. Electrophysiology – the management of rhythm disorders with medications and invasive ablation procedures. ECG nerds. Devices – the management of heart rhythm disorders with medications and by implanting pacemakers and defibrillators. Also ECG nerds. Imaging – these are cardiologists experts at the non-invasive scanning techniques like CT, MRI, and echo. They are the glue that sticks cardiology together. And of course, there are other fields like adult congenital heart disease, women’s and obstetric cardiology, sports cardiology, and preventive cardiology. The choice of specialty hugely affects the typical working day, but with ever-increasing levels of heart disease and an aging population, all cardiologists are busy. I am an interventional cardiologist so a typical week for me might be a couple of days in a cardiac catheter lab, performing a combination of emergency and elective procedures, a half-day in clinic, daily coronary care unit, and general ward rounds. In my case, I also have a half-day reporting and performing echocardiograms and MRI scans, and some time set aside for research. Cardiology is a very academic field with many physician-scientists, but it is not mandatory. However, It is the most evidence-based specialty there is, so a thorough understanding of research is essential. On calls are invariably busy – 30-40% of emergency room admissions are cardiac – from chest pain to loss of consciousness and breathlessness. Intervention is not a subspecialty to choose if you don’t wish to have to come in most nights on call. I don’t want to perpetuate the cliché that Cardiology is not conducive to having a normal personal, and social life. Of course, we all know type A personalities that live and breathe their work but there are many cardiologists who enjoy their free time and an increasing recognition that we need to improve working lives if we want to attract a diverse workforce. But it certainly is a specialty that attracts the top performers and as such is consistently one of the most competitive specialties to enter. Cardiologists are paid well in comparison to other doctors, in pretty much all countries. In the UK and the USA, they are consistently in the top 3 earning specialties overall. Those that can bill for scans or procedures are best remunerated and there is ample scope for involvement with the pharmaceutical or lucrative device industry, If that’s what inflates your balloon. Check out the link above to learn more. In addition to the aforementioned selling points of cardiology, I tend to emphasize a few factors that I believe make it so great: Results are immediate. The heart has stopped, restart it. The arteries blocked, unblock it. The patient is in tamponade and grey, drain the fluid, they’ve got a blood pressure and they’re pink. But If you enjoy the slow application of time and tinkering, that’s available as well. It appeals to those that might dither between medicine and surgery. I thought I would be a cardiac surgeon for years, but I’m very glad I made the right choice. I still use my hands every day and will be refining my manual dexterity skills my whole career. I love the logical physiology where it’s more about understanding concepts than learning lists of microbes or molecules. One can combine critical care when managing patients in cardiogenic shock, with an interest in the power of exercise in daily life. You can manage the heart health of a 100-year-old or help a 21-year-old with dilated cardiomyopathy become a mother. It is endlessly adaptable. Some of our treatments are phenomenal.
Heart transplants and artificial hearts capture the imagination like little else. We now have pacemakers the size of jelly beans. And there have been few leaps forward in medicine as dramatic as primary percutaneous coronary intervention or primary PCI. Older doctors will recall that patients with large hearts attacks were just tucked into bed with a cup of tea, in fairly recent memory. Thrombolysis or the administration of clot-busting medication helped, but caused a host of new problems as well. The advent of Primary PCI sent death rates from ST Elevation MI (STEMI) plummeting, saving millions of lives. One of the most exciting treatments in cardiology now is transcatheter aortic valve implantation (TAVI, or TAVR). The latest evidence suggests that TAVI will overthrow the surgical aortic valve replacement for the majority of patients, in the same way that coronary stenting decimated coronary artery bypass numbers. In just a few years, we will come to regard opening up someone’s chest to replace their valve as a barbaric relic of the past. The workload can be intense and this has created a perception that cardiology will consume your life, which has some truth to it but is certainly not ubiquitous. It is not regarded as family-friendly and has one of the lowest ratios of women to men. This is slowly changing but there’s a long way to go. Cardiology attracts hypercompetitive people, so one should be mindful of how you will interact with your colleagues. We have a reputation for ruthless pimping and intimidating behavior. This is also changing – and we need nice, normal people to join our ranks. In these days of super-specialization, the general cardiologist is becoming a thing of the past as people focus on smaller areas of interest – a trend reflected across medicine. What kind of person should go for cardiology? A budding cardiologist is likely to enjoy caring for complicated, sick patients, and be willing to work hard. You probably were more fond of maths and physics than you were of chemistry. Physiology was your favorite pre-clinical science. You like action and are decisive. I personally don’t think intelligence correlates with how good you are as a cardiologist, but simply due to the high bar for entry into the specialty, you are likely to have excelled academically. If you want to avoid the high rates of burnout in cardiology, which is not too far behind emergency medicine, you will maintain a healthy work-life balance. If you’re considering other acute medical specialties like intensive care, respiratory or gastro, remember cardiology involves almost no exposure to disgusting bodily fluids. And that might well have been the main selling point for me. When you’re in your 20s with no kids, an onerous on-call schedule and sleep deprivation seem like a walk in the park but do try to think ahead about what area you want to spend 30 or more years of your life, you might be less enthusiastic about a 4am angioplasty when you’re 50 years old. Because so many more people are surviving heart attacks now, there is falling mortality but rising morbidity and the real growth areas within cardiology are heart failure and imaging. If you’re considering it, chat to as many cardiologists as you can, spend some time shadowing them and start giving your resumé an acute medical flavor early on by getting involved with audits and research within the specialty. If you think cardiology is the place for you, look past its reputation and carve your own path. I guarantee you won’t find a more rewarding specialty. Massive thanks to Dr. Francis for sharing his expertise in cardiology in this video. He’s a hilarious and knowledgeable guy, so again, please check out his channel, Medlife Crisis. Which specialty should we cover next in our So You Want to Be series? Let me know with a comment down below. Thank you all so much for watching,
and I will see you guys in that next one.