“Why Cardiology?” is one of the most common questions I have been asked by friends, family, interns, residents, and even the occasional stranger sitting next to me on a flight. Despite being a simple question, the answer is very complex. I initially started residency thinking I would pursue a career in pulmonary/critical care – I loved the acuity, broad differential diagnoses, and the bond created with families. However, after my first month in the unit, I quickly abandoned this career path for multiple reasons. Shortly thereafter, I did my first rotation on the cardiology wards service with Dr. Matthew McGuiness (who is still one of my closest mentors) and I saw the light.
The month on the cardiology wards service is best described as “finding the missing piece of the puzzle.” I loved the anatomy, physiology, patient population, subtle differences in presentations, and my interactions even as an intern with patients. I also loved the depth of cardiology – including both clinical and basic science research opportunities, advanced fellowships options, and the ability to create my niche in cardiology. I learned cardiologists were pursuing careers in preventative cardiology, cardio-oncology, cardiac critical care, and cardio-obstetrics. I was blown away at the possibilities of a career in cardiology and having the ability to create my perfect dream job.
As I mentioned earlier, I was very interested in critical care when I started residency but did not want to be in the medical ICUs. The cardiac intensive care units were much more interesting to me with advanced hemodynamics, malignant arrhythmias, various mechanical circulatory devices, and seeing how quickly the realm of the cardiac ICUs were changing. The CCUs are no longer filled with patients who have had a STEMI requiring a week-long admission, but rather those with decompensated heart failure/cardiogenic shock requiring mechanical circulatory support (MCS) with LVADs, Impella, or ECMO.
I am now combining all of my loves – cardiology, critical care, and obstetrics (yes, I at one point wanted to go into OBGYN) for my job as an attending. With the help of my mentors, I have been able to combine all my passions into one. I will be attending in the cardiac intensive care unit and have a predominantly general cardiology clinic with a focus on cardio-obstetric patients. And the best part, every cardiology fellow can create his/her dream job.
A few key questions to ask yourself are:
- Do I see myself as someone who enjoys the in-patient or the out-patient setting? This will help focus career options and set the stage for your career.
- Am I a proceduralist or not? For me, I hate wearing lead, so it was a simple decision to not go into interventional or EP.
- What type of patients do I get the most joy of taking care of. In my case, it was the critically ill and women who are pregnant with cardiovascular disease.
- Who is 5-10 years ahead of me career-wise and has my ideal job? This has helped me be more active with research, clinics, conferences, and improve my fund of knowledge. It also gave me a roadmap to follow – no need to reinvent the wheel.
Of course, these are starting points and it’s a vast topic that takes time to explore. My journey of “why cardiology” has been filled with highs and low, but with the help of various mentors I have a clear vision of what I envision for my future career.
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Barinder Hansra, known as “Ricky” to his friends and family, is a physician-scientist-teacher living his best life at University of Massachusetts Medical Center in Worcester, MA. His focus is on cardiac critical care and cardio-obstetrics, and is headed to Stanford University for another fellowship. Follow on Twitter: @rickyhansra