CardioExchange Archive

Several Cardiology Fellows who are attending ACC.12 this week are blogging together on CardioExchange.  The Fellows include Tariq Ahmad, Bill Cornwell, Megan Coylewright, Jeremiah Depta, and John Ryan (moderator). Read the previous post here. Read the next one here.

One decision all fellows-in-training (FIT) will face is whether to pursue a career in academics or in private practice. At the first of many FIT sessions, a panel very effectively reviewed the pros and cons of the two options. The overarching theme seemed to be that there are unavoidable stressors regardless of a chosen career path.

Let’s take private practice as an example: you have to deal with the job market. Some interesting statistics regarding jobs for new graduates: in 2005, there were 2,500 jobs available for the ~800 graduates of US cardiology fellowships; the “stenting revolution” was well underway and the ICD implantation was on the rise. In short, it was a great time to enter the job market. Now in 2012, we have seen changes in CMS rules and policies, reductions in reimbursement rates for services rendered, and an overall “cooling” of the job market.  Are jobs out there? Of course they are, but there are no guarantees that the dream-job is yours for the taking, as it might have been a few years ago. Compromises include less than ideal locations and lower salaries.  And who will be your employer? In private practice, it seems there are three options: a hospital, an independently owned group, or yourself.  In the hospital-owned cardiology groups, cardiologists are protected from many business and policy-making decisions, such as changes in reimbursements (they are salaried employees), hiring of staff, equipment selection and EP/cath lab operations.  However, this necessarily implies that cardiologists are sacrificing a great deal of autonomy. So, while a hospital-owned model may spare cardiologists from many anxieties, there is certainly the potential for a whole new set of stressors brought on by a lack of control.

The panelists offered some great advice to help in the decision-making process.  Firstly, it is important to define your career goals – what do you want to achieve in the next five years, and what do you hope to accomplish in the next thirty years? What are you good at? What are you not good at?

It seems obvious should all consider these questions when starting our careers, and yet the panelists emphasized that new graduates really are not taking sufficient time to consider these questions and weigh options accordingly. Throughout our medical training, our goals were always defined for us: in medical school and residency our paths were already paved. In fellowship, we now have the opportunity, for the first time, to define what our goals are and to begin a process that will shape our careers. With this in mind, the decision about academics vs. private practice should not focus as much on matters like reimbursement and autonomy.  Throughout our careers, the market is-certain to change time and time again; fulfillment will only come by focusing on accomplishing short and long term goals, and doing what you are passionate about.