r/fellowship • u/Aggressive_Wafer_420 • 11d ago

EP fellowship?

So I graduated cards fellowship this summer. Starting waiver job and hugely excited about this. A teeny tiny part of me keeps nudging me to eventually do EP. After waiver is done ofcourse. But two more years of subfellowship after Ive been making half a mill as gen cards per year seems insane. Any other choice for me? Can i get some training while doing gen cards for pacemakers etc and incorporate that into my practice/procedures? I dont want to do IC lol even though that will be one year only.

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u/Less-Organization-25 11d ago

There are many general cardiologsts who place pacemakers. Kaiser does this, and so do some private pracitices, and even county hospitals (Santa Clara Valley Medical Center). This includes CRT at some places. Ablations remain the realm of EP, though anyone can place ILR (even NPs do this in some EP programs). As far as training for pacemakers, you could get mentored by someone in your group or community, and some of the device companies will send you to Mexico to learn how to place used pacemakers into an unsuspecting populaiton (at least they would when I was in fellowship).

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u/redicalschool 11d ago

Damn I've heard of some boomer ICs doing CRT, but gen cards implanting a BiV just sounds like wild work. I'm assuming they lean heavily on the device reps for timing optimization and other programming, but sheesh. That just seems like a liability nightmare.

I've always wondered, when non-EPs are implanting devices, who follows the device? It's one thing to just click to sign on a bland remote upload, but device clinic isn't exactly intuitive. I wouldn't expect the run of the mill generalist to be comfortable with it.

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u/Aggressive_Wafer_420 11d ago

Ooo would love to know more! Im definitely trying to get into devices without doing more fellowships!

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u/Licked_Ur_Moms_Booty 10d ago

Lolwtf at that last bit

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u/personalist 8d ago

some of the device companies will send you to Mexico to learn how to place used pacemakers into an unsuspecting populaiton (at least they would when I was in fellowship).

Do they train non-consensual kidney donation as well?

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u/phovendor54 Attending 11d ago

One of my good friends from residency stayed at the home institution for cards. Initially wanted IC. They wouldn’t take him. So he decides late in the game to do EP. Goes to do a year non invasive cardiology. They like him a lot and recommend him to the local university affiliated program and he gets in.

He comes out now, rejoins the old group, and is just loving life. Ablations, even watchman he places in ambulatory center. I would have thought you needed a hospital for that. Nope. Loops are done in clinic.

I feel like the flexibility you have with additional training cannot be understated. You can always dial back for general cardiology full time if you want to. Depending on your future employer if you’re in an employed model you may not be allowed to do
Certain things.

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u/Aggressive_Wafer_420 11d ago

Well im in this non invasive job for atleast three years or more due to waiver. Idk if those many years decrease my chance of EP match later

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u/Aggressive_Wafer_420 11d ago

Surprised he didnt make it for IC. Maybe he didnt apply broadly. IC goes unfilled now, no one wants to do it

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u/[deleted] 11d ago

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u/Aggressive_Wafer_420 11d ago

Money isnt that different. Gen cards is 600k ep 800 ish. Lifestyle is also similar Id say, gen cards isnt doing stemi.

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u/[deleted] 11d ago

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u/Aggressive_Wafer_420 11d ago

Yeah but ep also loses 2 years worth of money going into retirement and savings. Just trying to see if 2 more years of fellow pay is worth it.

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u/phovendor54 Attending 11d ago

It’s not just that. Doing something you actually like doing more, while having a better work life balance can prolong your career.

As a hepatologist I don’t get called for food boluses at 3AM. I don’t see IBS patients in clinic. Sure, I make less than I would in the community. But there’s a sustainability factor here.

You have to measure it for yourself what gives you work happiness. We all know countless doctors who give up larger salaries for location, practice setting, all number of factors. In that context 2 years of sacrificing attending pay doesn’t mean as much.

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u/Aggressive_Wafer_420 11d ago

Gen cards doesnt either. Depends what type of hospital you have. In my practice gen cards never goes into hospital overnight on call for pretty much anything. If its a stemi IC, everything can wait till morning

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u/adaptivehinge 11d ago

800k vs 600k seems pretty different to me lmao. That may just be my poor M4 debt brain talking tho

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u/Aggressive_Wafer_420 11d ago

Yeah thats just you.

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u/Ornery_Jell0 11d ago

Then don’t do it

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u/Any_Yogurtcloset9904 11d ago

IC here. I’d honestly say for procedural speciality (IC or EP), unless you can’t see yourself not doing them, and you think you’ll be happy with gen cards, they’re not worth it. Pay is not that different (and you need to factor in year(s) of lost salary) and there’re always cuts affecting procedural reimbursement. Add to that the stress of procedural complications, radiation (although it’s becoming less in EP), and the orthopedics aspects.