You love doing procedures and have the ego of a surgeon, but don’t want to go through

the hassle of surgical residency.

Let’s debunk the public perception myths of what it means to be an interventional cardiologist

and give it to you straight.

This is the reality of interventional cardiology.

Dr. Jubbal, MedSchoolInsiders.com.

Welcome to our next installment in So You Want to Be.

In this series, we highlight a specific specialty within medicine, such as interventional cardiology,

and help you decide if it’s a good fit for you.

You can find other specialties on our So You Want to Be playlist.

We decide what specialties to cover from our community polls.

If you want to help decide what specialty we cover next, make sure you are subscribed.

If you’d like to see what being an interventional cardiologist looks like, check out my second

channel, Kevin Jubbal, M.D. and our series Day in the Life where we show you what a day

actually looks like for doctors and surgeons of various specialties.

An interventional cardiologist is a cardiologist who has completed additional training in minimally

invasive procedures of the heart.

Unlike surgeons, these procedures are typically performed in a cardiac cath lab instead of

an operating room, and involve live x-rays, contrast dye, and specialized equipment.

Historically, the field of interventional cardiology has been limited to the treatment

of coronary artery disease with balloons and stents; however, it has since evolved to include

much more.

Although coronary artery stenting continues to be the bread and butter of interventional

cardiology, their scope is now much broader.

There have been significant advances in the treatment of coronary blockages.

Specialized tools now exist allowing interventional cardiologists to break up calcium deposits

to improve outcomes and take high-resolution images from within arteries to optimize interventions.

There are even a variety of percutaneous mechanical heart pumps now that can temporarily keep

a patient alive if the heart is failing from a heart attack or shock.

One of the more commonly used devices is the Impella left ventricular assist device.

This device is inserted through the femoral artery into the left ventricle of the heart

and uses a motor to pull blood into the ascending aorta.

This allows the heart to rest while the device circulates blood to the vital organs of the

body.

An intra aortic balloon pump is another less powerful device that sits in the aorta and

pumps in sync with the heart.

Then there is ECMO, which is essentially an external temporary heart-lung machine used

in extreme cases.

Interventional cardiologists’ scope extends beyond coronary artery disease as well.

There are a variety of innovative devices and therapies that allow interventional cardiologists

to treat a wide spectrum of issues involving the heart and vascular system.

They can perform heart valve repairs and replacements, repair structural defects in the heart, and

place a variety of other cardiac implantable devices.

It should be noted that interventional cardiologists are not the same as cardiothoracic surgeons.

Cardiothoracic surgeons are trained via surgical residencies and perform much more invasive

procedures than interventional cardiologists - most notably, open-heart surgeries.

That being said, as the field of interventional cardiology has evolved, there are now more

collaborative procedures than ever before.

This brings me to an important method of differentiating an interventional cardiologist’s practice:

academic versus hospital-employed versus private practice.

Interventional cardiologists working in hospital-employed positions can expect to spend more dedicated

time in the cath lab doing procedures and less time doing general cardiology.

In academia, interventional cardiologists will further split their time between research,

teaching, and other academic responsibilities.

Large academic centers also tend to have a high volume of specialized and complicated

patients such that there is a constant need for the expertise and specialization of an

interventional cardiologist.

In private practice, the majority of an interventional cardiologist’s time will be spent doing

both procedures and general cardiology as volume and production is what drives private

practice revenue.

There are often more general cardiology duties involved in private practice compared to academic

or hospital-based positions.

This means in addition to procedures, there are often inpatient rounds, office patients,

and reading imaging studies.

That being said, the balance between procedure time and general cardiology can vary significantly

between practices.

Interventional cardiologists working in private practice tend to have higher average compensation

than their colleagues in academic or hospital-based settings.

There is also more of a demand for interventional cardiologists in rural areas as opposed to

major metropolitan ones, so the compensation tends to be higher the more rural you get.

That being said, as the infrastructure of healthcare continues to change, so do the

compensation models.

Let’s clear up some of the misconceptions about interventional cardiology.

A common stereotype about interventional cardiologists is that they are all workaholics with very

poor work-life balance.

Although it should not be considered a “lifestyle” specialty, not all interventional cardiologists

work terrible hours or are constantly on-call.

There are many different types of jobs out there where you can have a decent quality

of life depending on what you prioritize.

The on-call obligations are also highly variable across different hospitals with some being

much more lax than others.

Another common misconception is that all interventional cardiologists are cocky and have big egos.

Although they may not be in their best mood when you wake them up at 3 AM to come in and

do a procedure, a lot of interventional cardiologists are much more thoughtful and approachable

than you might think.

To become an interventional cardiologist, you must first complete 4 years of medical

school, followed by 3 years of internal medicine residency, 3 years of general cardiology fellowship,

and 1 year of interventional cardiology fellowship.

Some residents may also choose to do an optional chief resident year after internal medicine

residency to increase their competitiveness for cardiology fellowship.

Speaking of competitiveness, cardiology is consistently ranked as the most difficult

internal medicine fellowship to get into.

High board scores, extensive research, and impressing your seniors and faculty in residency

are imperative for those wishing to pursue this career.

As for the type of medical students who typically go for interventional cardiology, they tend

to be those that are very studious and ambitious; the ones that are regularly accused of being

gunners, overachievers, and workaholics.

They also yearn for immediate satisfaction, are excited by cutting-edge technologies,

and love working with their hands, although perhaps not as much as surgeon personalities.

They also tend to be the students that thrive in high-stress situations and enjoy the challenge

of taking care of some of the sickest and least stable patients in the hospital.

For interventional cardiologists who believe that 4 years of fellowship after IM residency

isn’t punishment enough, there are a few additional 1-year fellowships to further subspecialize.

Interventional cardiologists desiring further specialization in the treatment of coronary

artery disease can complete a year of additional training in advanced stenting procedures and

learn specialized high-risk techniques to treat conditions like chronic total occlusion.

Those that want to specialize in valve interventions and repair of structural issues such as atrial

septal defects and left atrial appendage closures can complete an additional year of training

in structural heart procedures.

Lastly, those that are interested in vascular procedures such as lower extremity revascularization,

carotid and subclavian stenting, abdominal aortic aneurysm repair, DVT and PE thrombectomy,

and IVC filter placement, can complete an additional year of training in these procedures.

It should be noted that in the US, there is some overlap between interventional radiology

and vascular surgery; however, it is still fairly common for interventional cardiologists

to perform vascular procedures.

It should be noted that in the US, interventional cardiology has some overlap with interventional

radiology and vascular surgery; however, it is still fairly common for interventional

cardiologists to perform vascular procedures.

That being said, it is less common in other countries.

There’s a lot to love about interventional cardiology.

To start, the bread and butter is coronary artery stenting for heart attacks which often

offers immediate gratification.

You can save the life of someone on your table within minutes by threading a catheter through

a tiny hole in their wrist and opening up an occluded artery in the heart.

There are few specialties where you can have such a profound life-saving impact in such

a short amount of time.

Compensation is also on the higher end of the spectrum.

The median salary for interventional cardiologists varies by geography, and lies somewhere between

$450,000 to $500,000 per year, with top earners exceeding $750,000.

That’s the highest of any non-surgical specialty.

Cardiology is also one of the most heavily researched fields and with all the money and

resources poured into it, it’s rapidly evolving.

Another advantage is that as an interventional cardiologist, you are still a fully-trained

cardiologist.

This means that you can often find a position that balances your desired clinical interests

and work-life balance.

If you ever get to the point where you can’t tolerate wearing lead aprons and standing

long hours each day performing procedures, you can take comfort in knowing that you can

still fall back on general cardiology which is less physically demanding.

Lastly, heart disease continues to be the number one cause of mortality with no sign

of slowing down.

As unfortunate as this is, it also means that there will always be plenty of demand for

interventional cardiologists.

While interventional cardiology is an awesome specialty, it’s not for everyone.

With a total of 7-8 years minimum of additional training after medical school, depending on

whether you opt for an additional chief resident year, becoming an interventional cardiologist

is one of the longest training paths in medicine.

The rapidly evolving nature of the field also means that you will have to stay up-to-date

on the most current literature and understand how to analyze clinical trials and research

papers well.

While many love the excitement and innovation of a rapidly evolving field, you might not

be as enamored by the work it takes to keep on top of new developments.

In addition, the lifestyle of an interventional cardiologist is often more demanding than

most specialties.

If you’re on STEMI call, for instance, you will regularly have to come into the hospital

in the middle of the night for urgent procedures.

Even for the most experienced physicians, being called in at 3 AM on a weekday when

you work the next day is always tough.

Interventional cardiology is more physically demanding than many specialties as well.

Having to wear heavy lead aprons and stand all day doing procedures can physically wear

on you over time.

It’s also a specialty that deals with very sick patients.

As such, it is inevitable that you will have challenging cases and complications occur.

Despite your best efforts, there will still be times where patients die on you, and those

family conversations are never easy.

How can you decide if interventional cardiology is right for you?

If you love practicing medicine and are willing to dedicate the time and effort to treat the

arguably most important organ in the human body, interventional cardiology might be for

you.

You should be okay with the occasional sleepless night and nontraditional work hours if it

means having the opportunity to treat the patients who need you most.

You should thrive in high-stress situations and have the mental fortitude to accept the

complications and bad outcomes that come along with treating very sick patients.

You should also have some degree of physical stamina as wearing lead aprons and standing

still all day performing procedures can wear on you.

Lastly, if you enjoy working with your hands and doing procedures but don’t want to become

a surgeon, interventional cardiology offers a great balance between clinical medicine

and procedures.

Huge shout out to Interventional Cardiologist Dr. Ali Haider for helping me with the creation

of this video.

Check out his YouTube channel and Instagram - links in the description.

Are you hoping to become an interventional cardiologist?

To get into medical school, match into internal medicine residency, and get into a cardiology

fellowship, you’ll need a rock-solid application, not only with test scores but the soft components

as well.

As you look at resources and companies to work with, seek out those who are actual M.D.

physicians, not Ph.D. or other types of doctors that didn't go to medical school.

Look for those who have achieved stellar results themselves, a track record of success with

positive ratings from customers, and a systematic approach so you know you'll always receive

high-quality service.

If you decide on Med School Insiders, we'd love to be a part of your journey in becoming

a future physician.

Visit us on MedSchoolInsiders.com.

Thank you all so much for watching!

If you enjoyed this video, check out So You Want to Be an Internist, or another specialty

in our So You Want to Be playlist.

Much love and I’ll see you guys there.