In medical school and starting to think more deeply about what specialty to choose? To help you make an informed decision, we interviewed board-certified pediatrician and pediatric cardiologist, Arthur S. Pickoff, MD about his career. He explained the best parts of cardiology, the worst parts, tips and tricks to develop resiliency when faced with career-related stress, and more.
What Do You Do in a Career as a Cardiologist?
Career Focus: Cardiology section in the Medical Student Core
Both adult and pediatric cardiologists diagnose and treat disorders of the heart and blood vessels. In general, pediatric cardiologists care for patients from prenatal life to 21 years of age, and adult cardiologists care for patients from age 21 and beyond. There is an interesting and relatively new field that has evolved called Adults with Congenital Heart Disease, in which both adult and pediatric cardiologists often provide care side by side.
What Do Adult Cardiologists Treat?
Conditions treated by adult cardiologists include ischemic heart disease and myocardial infarction (which represent a large portion of the adult cardiologist’s practice), heart failure, cardiomyopathy, acquired conditions such as myocarditis, and a host of rhythm disturbances, with atrial fibrillation being the most common.
What Do Pediatric Cardiologists Treat?
The spectrum of disorders treated by pediatric cardiologists is somewhat different. The pediatric cardiologist rarely sees ischemic heart disease or myocardial infarction. Instead, the pediatric cardiologist often evaluates and treats neonates, infants, and children with congenital heart disease, including septal defects (such as ventricular septal defects), cyanotic heart disease (such as tetralogy of Fallot), and obstructive lesions (such as coarctation of the aorta). Like the adult cardiologist, pediatric cardiologists diagnose and treat patients with heart failure, cardiomyopathies, certain acquired heart conditions (such as rheumatic fever), and cardiac rhythm disturbances.
Within both adult and pediatric cardiology there are cardiologists who subspecialize in various fields within cardiology. Interventional cardiologists employ sophisticated tools in the cardiac catheterization laboratory to open and stent blocked coronary arteries (adult cardiology), to use balloon catheters to open up stenotic, narrowed pulmonary and aortic valves (pediatric cardiology), and even implant artificial cardiac valves without the need for surgery. Cardiac electrophysiologists place specialized electrode catheters within the heart to determine the mechanism of a cardiac rhythm disturbance and use specialized catheters to burn or freeze critical areas of the heart that are responsible for the abnormal rhythm. They also implant pacemakers in patients with severe bradycardias and, when necessary, automatic internal cardioverters/defibrillators in patients at risk for severe ventricular arrhythmias. There are other cardiologists who specialize in cardiac imaging, including echocardiography and cardiac MRI. Another specialty, preventive cardiology, exists within both adult and pediatric cardiology and aims to prevent or mitigate the development of severe atherosclerotic heart disease through various interventions, including diet, exercise, and the pharmacologic treatment of hyperlipidemias.
How To Start a Career as a Cardiologist
Career Focus: Cardiology section in the Medical Student Core
After completion of either a residency in internal medicine or pediatrics, those interested in becoming a cardiologist enter a fellowship training program that generally consists of three years of training. After fellowship, those interested in one of the subspecialties (e.g., interventional cardiology, electrophysiology) often complete another year or two of additional specialized training.
Hear What a Career as a Cardiologist Is Like From Dr. Pickoff
We interviewed Dr. Pickoff about his career as a Cardiologist
What is your specialty and why did you choose it?
"I am a board-certified pediatrician and pediatric cardiologist. I really wanted to be involved in the care of children as the focus of my professional life. Then the question became, do you want to be a general pediatrician or a subspecialist? I decided to become a subspecialist and took several electives in the 4th year of medical school in various pediatric subspecialties. It was during my pediatric cardiology elective that I felt a true connection and “fit” with this specialty. I liked the focus of the specialty, the tools used to diagnose children with heart disease, and the various treatment strategies. I liked that as a pediatric cardiologist you can spend time in the clinic, time in the hospital and ICU, time performing invasive cardiac procedures, and time performing noninvasive imaging studies."
What do you like best about your specialty?
"Helping neonates, infants, and children with suspected or known heart disease that is the absolute best part of being a pediatric cardiologist! And to be clear, we are now able to help, even cure, the vast majority of even the most severe forms of congenital or acquired heart disease. When I was a pediatric intern, there was nothing that could be offered to babies with a severe form of left heart obstruction called hypoplastic left heart syndrome. In today’s world, there are a number of options available to help palliate these babies, including performing a series of surgical procedures (the Norwood procedure) and even cardiac transplantation. I still, now and then, get cards from patients I treated for this disorder, who are now entering college, the job market, or getting married. It is very gratifying!"
What do you dislike the most about your specialty?
"Honestly, the only 'downside' to this specialty is the fact that while we can help the vast majority of our patients navigate through a difficult cardiac condition, not everyone survives or survives without a significant disability. So, the specialty can be sad at times. But the community of pediatric cardiologists is committed to continually improving the care provided to children with congenital and acquired heart disease."
Stress is a huge issue for doctors. Do you have any suggestions for how I can develop better resiliency to career-related stress?
"You must work hard but also play hard. Don’t bring work-related stress home with you. Cultivate a network of friends, in addition to family, with whom you can openly discuss issues such as work-related stress. And here is another little trick that I have told countless residents who are about to embark on their career: Choose the type of practice you are going to enter carefully. For example, increasingly, many physicians are employed by a hospital or hospital system. In this setting, the stress of many administrative hassles, such as billing and collecting, compliance, etc. is done by others, not you. Also consider the size of the group you are joining. If you are signing onto a job to be the 2nd pediatric cardiologist in a practice, you will be on call every other weekend! On the other hand, if you are coming on as the 8th pediatric cardiologist, it is likely that your on-call duty will be much less, perhaps even once every month or so. Choose wisely."
One cool feature of the Medical Student Core is the Career Focus section at the beginning of each topic. These sections present an overview of the specialty, as well as an interview with a specialist, that paint a clear picture of what your future holds should you venture down that path.
Start studying with the Medical Student Study Strong System now to see the entire Cardiology Career Focus section. We’ve taken 30 years of expertise in helping Internists and Pediatricians ace their boards and crafted the revolutionary Medical Student Study Strong System. This comprehensive learning system combines focused content with evidence-based learning techniques to ensure you truly LEARN the foundations of medicine as you work toward your goal of becoming an awesomely competent doctor.
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