With the rapid rise of TAVRs has come a concomitant explosion in inpatient pacemakers due to the amount of conduction disturbances we see. If you’ve done this long enough you’ve also been burned by delayed heart block (or worse Brady dependent torsades) caught on monitor, so even borderline cases often end up with a pacer.

How is your institution handling this massive volume? We are being totally stretched thin, cases in the ep lab routinely going until 8 or 9 to accommodate all these patients. And then we hear about it if we have to push the patient off lest we have all our staff quit on us.

It’s getting to the point where they are asking us to cancel ablations, which is not fair to our outpatients who already have to wait months to get their procedures. And also, we would all much rather be doing ablations.

The hospital refuses to scale EP at the same rate they scale TAVRs, it’s like that don’t understand the connection.

Any creative solutions to this problem? I’ve heard from multiple colleagues and also experienced this at multiple institutions.

I’m currently an IC fellow, and lately I’ve been feeling pretty discouraged about the state of the field and questioning whether I should just pursue general cardiology.

Between the workload, call burden, lifestyle sacrifices, and especially the direction of reimbursement, I’m starting to wonder whether the procedural side of things is worth it long term. It feels like we’re taking on more risk, responsibility, and lifestyle sacrifices with compensation not that significant from gen cards.

I enjoy the procedures, which makes the decision harder, but I sometimes wonder whether I’d be happier practicing general cardiology with a more predictable lifestyle

Any people who have been in the same boat? Thoughts? What’s the best way to handle this coming from IC fellowship?

Not sure how other programs do it but when we’re on imaging rotations like nuclear or echo there’s no structure to our day. We sometime reach out to the readers to go over cases but if we don’t reach out no one contacts us. Is this how it is at every program? Just curious how you all fill your time on these rotations.

I’m planning to take the Echo Boards (ASCeXAM) and noticed that I was given the option to take the exam online through Pearson VUE OnVUE instead of going to a testing center.
I honestly didn’t even realize taking the Echo Boards from home was an option.
Has anyone actually taken the exam this way? If so, how was your experience?
Were there any issues with the proctoring, technical setup, or exam itself? Would you recommend taking it at home, or is it better to just go to a testing center?
Would appreciate any feedback from people who’ve done it!

I know this gets posted constantly, but I’m curious what people actually think the timeline looks like for AI to substantially change the demand for general cardiologists.

Structural/EP/IC presumably have a longer runway given the procedural component, but AI integration into general cardiology seems inevitable. That could also expand what NPs can manage independently, especially if they focus on a specific niche. At some point, using it may become an expected part of practice. I could imagine malpractice arguments eventually invoking AI “You missed XYZ, which a readily available AI tool would have flagged.” Whether that actually becomes part of the standard of care is another question.

As a fellow, I mostly use it as a differential check to see whether there’s something I haven’t considered. It’s useful, but there’s obviously a big jump from that to independently managing patients. Should I would love AI integration as far as trends, data aggregation, etc. all as a means to improve my interpretation rather than relying on ChartLore without any primary sources, acknowledging it's not perfect.

I know we’re all armchair experts trying to predict a future nobody really knows, but for those who follow this closely, when do you think we move from “helpful tool” to one cardiologist overseeing substantially more patients, potentially reducing hiring or affecting compensation? 5yrs? 10? 20? Does unmet demand absorb those gains, or are we underestimating how different the job could look by mid career?

I feel like it says something that, as a new fellow, this scares me more than a refractory NSTEMI spiraling into cardiogenic shock, near-PEA, and emergent bedside ECMO cannulation. At least with that, there’s a problem in front of me and something I can do about it.

I also realize that if we reach the point where cardiologists are broadly replaceable, a lot of other professions will probably have gotten there first. By then, my individual job outlook may be a pretty small part of a much bigger problem.

Anyway, this is just me letting out my sunday scaries to run away from tomorrow’s responsibilities.

I've been tasked with starting a preventative cardiology clinic. Looking for recommendations, advice, experience, etc.

I'm general non-invasive and a few years out of fellowship. I'm in a sizable rural cardiology group with a laaaaarge catchment area. We're a very busy group with solid volumes. I've been there a few years now and have a large patient panel of gen cards patients. I trained heavily in lipids in fellowship and I've kept up with it, so very capable.

When I initially joined the group, they knew my interest in preventative cardiology. We're finally in a place to get the program started, so admin asked to sit down and figure out what I need. And I've come to the realization I'm very capable of managing lipids, but have no experience or frame of reference for how to start up a program. And I have no idea what I should be asking for from admin, so I'm reaching out to the community.

I already have an office, an NP and an MA for my general cards patient panel. I figure one of my gen cards clinic days would just be swapped out for a lipid day.

For those of you in this niche, what range of conditions are you accepting into your preventative cards clinic? My passion is mainly lipids and risk management, so thinking I would limit it to that. I don't really want to open it up to HTN because then that would be literally all I would ever see.

Hi all, I'm a 2nd year general cardiology fellow and I'm planning to apply EP. Initially I was thinking of applying this coming July like most people but given financial reasons and family obligation, I'm now leaning towards working 1 year as general cardiology after graduating.

I know EP has gotten a lot more competitive in the last few years, so I wanted to hear from people who did this or PDs/faculty who have been on the selection side on how do programs actually look at applicants who are already out in practice? Neutral, red flag, or does it depend on the reason?

Also, anyone take the 1 year and end up not going back? Any regrets either way?

If anyone has done this before, would you consider locum vs signing a regular job and leaving after a year, what did you do and what would you do differently?

Appreciate any advice, thanks!

I am an EP fellow, and I use electronic calipers multiple times per day every day. I was dissatisfied with the existing tools. I had a phone app that I thought was okay, and worth the $2 I paid for it, but I still wanted some different features. I made these apps for myself really, but realized I could just turn it into a website for other people to use.

I hope others find it helpful, and please let me know if anything does not work as expected. You can DM me or leave feedback via the Feedback link on the website.

title. whats the likelihoods? where? money? peocedures? etc?

I’ll be graduating from general cardiology fellowship soon and am considering an offer from a large academic medical center in a midsize Midwest city. The compensation is $550K annually plus a $50K signing bonus. The expected schedule includes 8 weeks per year of inpatient service and 38 weeks of a mix of outpatient clinic and imaging (echo and nuclear). During the outpatient weeks, I would be expected to do 5 half-days of clinic per week, with a minimum of 10 patients per half-day, 4 half-days of imaging, and 1 half-day of administrative time. For those working in academic cardiology or familiar with similar positions, does this seem like a reasonable compensation package for the expected workload? Is the clinic and imaging volume manageable, particularly when factoring in documentation, inbox management, call, and other responsibilities outside scheduled hours? Would you consider this a competitive offer straight out of fellowship, or would you expect higher compensation for this workload? I’d appreciate any insights on typical salaries and contract details.

Hi does anyone have access to free anki decks to help study for echo, nuc, CT, and general boards? Much appreciated, thank you!

General cardiology fellow here. I initially came in passionate about interventional structural, but have been spooked by job market saturation and do not want to compromise geographic flexibility. While I like coronaries, I do not feel like I am passionate enough about them to accept the associated call, lead, and lifestyle. I thought about structural imaging, but I enjoy the procedural side of cardiology too much.

So... I am thinking to pivot to EP. I don't particularly love AFib ablation, but it's bread and butter. I enjoy VT ablation, tracings, and a good svt study. I find devices enjoyable. I think it will allow me to stay procedural, with perhaps better lifestyle and without the severe market constraints in structural.

However, I can't shake this feeling that down the line, I will regret not following my heart. Would love to hear general perspectives and advice. I am having a really hard time between just picking the specialty I most enjoy versus deciding based on the overall job (ie factoring in lifestyle, market opportunities). Curious if others found themselves in a similar position and how they weighed things.

TLDR; passionate about structural but spooked by the job market and thinking about pivoting to EP. Worried I may regret not following my heart down the line.

Hey guys,

I was curious what the EP job market is looking like these days. i’m currently a first year EP Fellow that’s looking to settle down in the Midwest, ideally the Twin Cities (Minneapolis/St. Paul) or within 1 hr radius.

Whenever I go to conferences or talk to reps, I keep getting told how EP is a hot market nowadays and everybody is looking to expand. However, when I look at the job market, most of the positions I seem to find are way out in rural areas that pay pretty similar to general cardiology gigs in those same areas. I’ve also heard that a lot of EP jobs are not necessarily advertised. I’m not sure what to believe.

Would love to hear any insight from people who have more recently been involved with the EP job search. Also, when is a good time to start looking?

Thank you!

I am debating whether or not to rank KP SF as my first choice other options I have aren’t great. I just liked the faculty.
Anyone knows how is the program like?

Hello, are there any out of match fellowships including cardiac echo and TEE that I can apply for if I don’t match cardiology as an IM graduate ? Thanks

Hey everyone,

I’m currently an IM resident applying to cardiology fellowship and trying to figure out which programs would best set me up for a career as a non-invasive cardiologist. I’d especially appreciate input from people involved in hiring cardiologists. I’m leaning more towards private practice currently if that helps.

I’m trying to get a better idea of what actually makes someone more competitive when applying for jobs after fellowship. Specifically, I’m curious about a few things:

- Geographic preference: How much does where you complete fellowship matter? If I ultimately want to practice in my home city, would I be better off staying there for fellowship to build connections, even if the training may not be as strong? Or is it better to go somewhere with stronger clinical training and come back afterwards?

- Echo training: Does COCATS Level 3 in echo make someone meaningfully more competitive for general/non-invasive cardiology jobs, or is Level 2 generally sufficient?

- Additional imaging training: Does having COCATS Level 2 in multiple modalities (echo, nuclear, cardiac CT, etc.) make someone more marketable, or do most employers primarily care about echo competency?

- Networking and connections: How much of a role do fellowship connections, mentors, and local reputation play in getting hired? Would training in the city where you want to work give you a meaningful advantage?

- Overall clinical training/fellowship name: How much weight do employers put on the reputation of the fellowship program versus the actual skills and experience you gain during training?

- Academic vs community: it seems that some of the community cardiology programs offer more autonomy and more volume than academics. Does the academic name still reign supreme despite possible better training at a community program?

- Other factors: Are there other things you look for when hiring a new grad that applicants might not realize are important?

Ultimately, I’m trying to decide how to weigh the strength of clinical training, imaging exposure, networking, and geographic preference when making my fellowship rank list. Again, I’m leaning towards private practice and independent groups, but I’d appreciate hearing different perspectives.

Thanks in advance!

Hello,

I hope everyone is well! I am a 4th year medical student who is interested in going into cardiology after having exposure during 3rd and 4th year. I know this is still too early since I am not a resident yet, but just like applying to competitive speciality from medical school, I wanted to set myself early on so that I can become a strong cardiology applicant in the future.

I know that during my time in residency I can collaborate with the in-house cardiology team, but I was also wondering currently and as a resident next year if there would be benefit to cold emailing cardiologist to try and get research opportunities as a way of having my name out in the field, outside of the hospital I end in during residency. If cardiologists here in this subreddit have also done this or something similar when they were a student/resident, I would greatly appreciate your insights and how you approached this when you were once an aspiring cardiologist.

Thank you all for your time!

I'm currently an IC fellow at a major academic center, coming from a research-heavy background. As I explore job opportunities, I'm struggling with the decision between academic and non-academic practice.

The compensation difference is substantial. However, what I'm having trouble figuring out is whether that difference translates into a meaningful difference in workload, lifestyle, and overall job satisfaction.

I enjoy research and have built a profile that would allow me to pursue an academic career, but I'm not entirely sure that's what I want long-term. Part of me worries that leaving academia now would mean giving up opportunities I've spent years building toward. On the other hand, I'm concerned that staying in academia could mean significantly lower compensation while still having a demanding clinical schedule.

I'd particularly appreciate hearing from IC who have worked in both settings.

I'm trying to understand whether the academic pathway offers enough tangible benefits to justify the compensation difference, particularly for someone who enjoys research but isn't necessarily committed to making it the central focus of their career.

Would appreciate candid perspectives, especially from those who've experienced both sides.

STEMI in young patients with heavy thrombus is a difficult scenerio. How do you approach a proximal large vessel occlusion with heavy thrombus ? Do you POBA the vessel and leave on antithrombitics ? Aspiration ? Or intracoronary lytics ? How often do you leave the vessel alone if there is no significant residual lesion after POBA ?

Cards fellow at a large academic center. A few attendings have told me call gets way more tolerable as an attending, even without fellows, and you generally aren't getting called at 2am for stable afib with nothing else going on.

I want to believe that lol but with the amount of BS consults and random overnight calls we get, it's hard to picture. Someone still has to field those calls, and if there's no trainee, isn't that just you? I expected this, but not quite to this degree..

For attendings without trainees, what does call actually look like from 5pm to 8am or over an entire weekend? Do APPs take calls first? Are stable consults held until morning? How often are you waking up or coming in, and are you working a full day afterward?

How many hospitals are you covering, and does that include CCU patients and outpatient calls? How many nights/weekends a month?

Curious how this varies between larger systems and community hospitals. Would love to hear from APPs/hospitalists too if ya checkin out here. I know there's huge variation, which is what I'm trying to understand. How good can a good setup be, and how miserable can a bad one get? What should you ask before signing, and how did what you were promised compare with reality?

Second year fellow and new parent here. Anyone have any advice on how to find the time/energy to read or watch Mayo/board videos? I just don’t have the energy in me to come home and study when I’m working all the time. I’m sure I’m not the only fellow who has dealt with this issue.

what a mess of a test this is…walked out the testing center today feeling like crap and questioning how I could have prepared even more for this. The images for the most part in EKGs were okay, but the echo and cath films were a hit or miss (Majority were a miss).

i would love to hear your thoughts as well on this experience and if you had taken it previously, if you can offer advice or honestly some things to cheer me up.

fingers crossed for everyone that they pass!

I came into fellowship pretty set on interventional. Then I actually did my cath lab rotation and honestly it just didn't do much for me.
The diagnostic part I liked. Getting access, maneuvering the catheter was cool. But the PCI itself kind of lost me. Cases ran forever, so many wire exchanges, and I'd just get bored (obviously I’m second out third operator at that point). Even the fancy equipments didn't really do it for me.
The other thing is I really like teaching. Working with residents/fellows and students is a big part of what I want my career to be, and interventional doesn't seem to leave much room for that.
Because I want to give back, I want to go back to my home (and developing) country from time to time , that would mean having real procedural skills. I still want something hands on. I've been looking at EP, and I'm just wondering if it might be a better fit. I like the cognitive side of it but my EP rotation isn’t till the end of 1st year. I also don’t have a great back with all the lead lol (I know leadless is catching up in a few places though)

So am I jumping the gun here? It's one rotation. Anyone have a rotation flip a plan you were pretty sure about? And for the EP people, does it leave room for teaching?

Also maybe I don’t mind non-invasive but it appears I have an irrational fear of AI making it less appealing in decades to come (or sooner)