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.