How to work in… Cardiology
Doctors who never miss a beat: Sara Williams gets to the heart of medicine
Every hospital needs a cardiologist’s input and there are plenty of opportunities to practise your skills
What is cardiology? Cardiology is big business; it represents a huge proportion of the medical workload in hospitals, particularly in acute medicine. Around 40% of emergency admissions have cardiovascular-related problems; myocardial infarction, heart failure, arrhythmias and syncope all require a cardiologist’s input. Cardiology contains many subspecialties including interventional cardiology, electrophysiology, device therapy, imaging and specialist heart failure management. Every hospital needs a cardiologist’s input and there are plenty of opportunities to practise your skills and do worthwhile things.
Training
Trainees must complete core medical training (two years) before entering specialist cardiology training (another five years), which now comprises three years of general cardiology training followed by two years of subspecialty training (eg intervention, electrophysiology, imaging). Trainees can also gain experience in acute medicine and there are additional opportunities for those who wish to pursue a career in academic cardiology. The run-through training schemes, introduced by Modernising Medical Careers, drastically reduced the number of opportunities to enter competitive specialties like cardiology, but have now been abandoned in accordance with the recommendations of the Tooke report. Entry to cardiology training will therefore be solely through open competition from 2010 in England and Wales and 2011 in Scotland.
The Specialty Advisory Committee for cardiology hopes to make the system as fair as possible by introducing a national application process, with standardised forms and scoring systems, for use by local appointment committees. Dr Nick Boon is chairman of the Joint Specialty Committee for Cardiology and President of the British Cardiovascular Society. He works as a cardiologist at the Royal Infirmary of Edinburgh, and says that new doctors should not be put off by the competition. “If doctors really want to do cardiology, they must be prepared to demonstrate excellence. Being a good doctor with strong references is not always sufficient and applicants who have done extra things, such as conducted research, travelled, or acquired skills that others at their grade may not have, have a real advantage.”
Working in cardiology
I enjoy seeing the success of targeted therapy and the knowledge that I have something to offer virtually every patient that comes to see me
Cardiology encompasses a wide range of subspecialty pathways for an aspirational physician; these include careers in academia, cardiovascular research, interventional cardiology (angioplasty), electro-physiology (treating arrhythmia using radio frequency ablations), device therapy (pacemaker surgery), and specialised imaging of the heart (echocardiography, nuclear, CT and MR scanning). Cardiologists also deal with the acutely unwell in coronary care units, manage chronic disease patients in the community and supervise preventive health strategies. Cardiology can therefore be as varied as medicine as a whole.
Dr Boon specialises in interventional cardiology and coronary care. “I found cardiology interesting because it had a certain logic and I seemed to have empathy for the circulation and the people who taught me about it. I didn’t opt for cardiology because I saw opportunities, but in the end I was very lucky because almost as soon as I joined the specialty it began to expand and develop very rapidly. When I became a cardiologist you couldn’t do much for most patients; echocardiography was only just beginning and there was no effective therapy for heart attack patients, but we now have a fantastic array of diagnostic tools and evidence-based therapies.
“I enjoy seeing the success of targeted therapy and the knowledge that I have something to offer virtually every patient that comes to see me. I don’t want to run down other specialties, but if you’re a neurologist it must be terrible to see people with horrendous diseases that you can’t do anything about. There are very few situations in cardiac medicine where the cardiologist can’t make a difference and that’s a great feeling. The key to success is to be able to communicate well with your patients, to understand what they are worried about and allay their fears. A lot of my work comes down to dealing with the emotional fear of death; most cardiologists are very good at putting their patients’ fears into perspective and building up confidence.”
Women in cardiology
Cardiology has traditionally been a male domain, possibly because many women are put off by the prospect of emergency work in anti-social hours. However, things are changing; 25% of European cardiologists are now women and in the UK the proportion of female consultant cardiologists has risen from 4% to 9% since the millennium. Moreover, women now account for nearly 50% of cardiology trainees. “Being called out of bed to do an angiogram is not very compatible with family life,” says Dr Boon. “However, there are many areas of cardiology that are family friendly, such as paediatric cardiology, echocardiography and heart failure. There are many cardiology posts that offer a good work-life balance and it is great to see more women entering cardiology training.”
The future
According to Dr Boon, 20 years ago 10% of people who otherwise would have had coronary bypass surgery underwent angioplasty. Now five people are treated with an angioplasty for every one person who has coronary bypass surgery. Evolving techniques, such as those that allow cardiologists to replace valves percutaneously, or treat congenital heart problems without recourse to open surgery, are being used more widely. The diagnosis and treatment of heart disease is changing rapidly and gets better, more efficient and simpler all the time.
How will this affect the demand for cardiologists in the future? Dr Boon says, “It is unlikely that some medical breakthrough will come along and eliminate heart disease altogether; there is bound to be huge demand for specialist cardiac services for the foreseeable future because coronary artery disease is so common and can manifest in so many ways.
“The burden of cardiovascular disease is actually growing. Although age-adjusted death rates are falling, many treatments and prevention strategies only delay the onset of disease or complications. The success of treatment in early life and the increasing number of elderly people in the community mean that there are now more people than ever living with heart disease in the UK. Most of these people need and deserve ongoing treatment by a cardiologist.
“The bottom line is that cardiovascular disease remains the most common cause of death in the UK and the most common cause of emergency hospital admissions. Coronary artery disease is responsible for more healthcare needs than any other disease and there is still a huge amount for cardiologists to do.”
- Personality – Concise coordinator, good communicator, adaptable, committed, confident
- Best bits – Seeing success of prolonged therapy, exciting, rewarding
- Worst bits – Losing sleep on-call, when procedures go wrong and complications occur, long training
- Stress – Active on-call work
- Salary – Well paid, paid for extra sessions, activities and on-call supplements, earnings are amongst highest in private practice
- Competitive – Very competitive, more applicants than specialist training posts specialty feature hospital admissions.
Many thanks to Dr Nick Boon for contributing to this article.