 In 2022, I finished residency and took my first job as a full-time internal medicine hospice. But just a few months later, I decided to apply and go back to training to be a cardiologist. And after months of applications and interviews, I thankfully was accepted to my number one choice for cardiology fellowship. And here's ultimately why I chose to go into the field of cardiology. Let's break it down. Hey friends, welcome back to the channel. In case you're new here, my name is Lux, I'm an internal medicine physician. And as of last year, I took my first job as a full-time hospice. But as you saw, I've now made the transition to go into the field of cardiology, which I'll be starting in just a few short months. Now in the past, I've made several episodes of why I love the field of internal medicine. You guys can check those out down below. I still love the field. But today, I want to break down exactly the reasons that I ultimately made the switch to pursue cardiology for the rest of my life. So number one is intellectual attraction. Now to explain exactly what this means, quick story time. Now when I was a young upper level resident, my second year of residency, I was doing an overnight shift in the cardiology ICU. And at 3am, I got a call from my attending, which usually doesn't happen. But they told me on the phone, Lux, there's a 94 year old in the emergency room that they just called me about that they're concerned of having a heart attack. Can you go please take a look at her? Now again, it's not normal for your attending to call you. So it's clear that people are concerned about what was going on with this patient. So I quickly made myself down to the emergency room and see this very sweet lady who's clearly in a lot of discomfort. But to avoid getting biased by the story of having a heart attack, I took a quick look at her EKG, and I quickly noticed that she was actually in complete heart block. This is basically where the top and the bottom chambers of the heart aren't talking to each other and cause a lot of discomfort, including start replicating things like chest pain, which is why everyone was concerned about a heart attack in the first place. But because I was thankfully able to identify that this patient was in complete heart block and less so of a new heart attack, we're able to put in the right steps, including having the emergency room, putting in a temporary pacer to get our heart functioning back to normal, as well as having the electrophysiology team aware of her ready to come in the morning and putting in a permanent pacemaker for this patient. And sure enough, I was able to come see this patient on my next night shift and notice that she was feeling 100% better with her new pacemaker and her heart back to normal. Now this story for me is exactly what intellectual attraction means. Every field is going to have their bread and butter cases. You're going to have heart failure, you're going to have heart attacks, you're going to have arrhythmias, in other fields, for example, like pulmonary, you're going to have COPD exacerbations, you're going to have ILD exacerbations, you're going to have asthma exacerbations, lots of exacerbations. And you have to feel comfortable of saying, out of these fields, which ones am I okay of seeing on a daily basis and still not getting bored of? For me in cardiology, there's always intellectual attraction to those bread and butter cases. I love taking care of patients with heart failure exacerbations arrhythmias patients who come in with chest pain and being able to work them out but ultimately making them feel better. Even though those are bread and butter cases are relatively pretty routine, it's something that could easily see myself doing for the rest of my life and still being intellectually attracted to. Number two is the sheer amount of data that can be translated to patient improvement and care. Now every field, every specialty does research to better help manage their patients and diagnose them. But in the field of cardiology, not only is there a large amount of research, there's also a good amount of data that can easily be translated to patients at the bedside. So for instance, if I admit somebody with a heart failure exacerbation, I know from the data the best dose of diuretics to give them based off of their weight or their prior dosages that they may have taken at home. I also know what the data says about continuously giving them a drip of infusion of diuresis or kind of intermittently giving them throughout the day and that there's no difference based off of the data that we have. And so the beauty of cardiology is that there's so much data out there that you can simply say, is this better for this patient or is this a better option? Or is either of them something I should consider? You can look at the data and say, actually, this is the best option for this patient in this setting. I'm able to basically personalize my care for this patient. And once I identify that this actually did help this patient, it made them feel better from their overload, their volume overload, the heart failure, I can then translate it and use that for future patients that I have. And we'll talk about this later in the episode about research within cardiology is by no means stagnant. If anything, it's increasing exponentially where we're asking better and more questions, have more data, ultimately to better help diagnose and manage our patients. Number three is job site flexibility. Now it's a better highlight why I enjoyed the flexibility within cardiology. I'm going to actually explain the flip side of my lack of flexibility currently as a hospice. And keep in mind, I have nothing of being a hospice actually really enjoy what I do. But the thing about being a hospice is that you're pretty much confined to working in the hospital on a certain schedule that somebody sets for you. So for me right now, it's seven days on seven days off. But if I decide in the future when I'm 45, when I'm 55, when I'm 65, and I still ideally want to practice medicine, then maybe I don't want to go seven days in a row or 12 hour shifts in the hospital and show up at seven a.m. What are my options? Usually in the field of hospice medicine, it's usually transitioning to either working less, thus making less money, or it's transitioning to a more admin heavy role, which is not something that I'm personally very interested in. But on the flip side in cardiology, the life that I can create can be pretty flexible. For example, they're cardiologists that will work on a weekly basis where they may do a few days of clinic and see their own patients. They may do a few days of consults over the month and go see patients in the hospital that other medicine positions are asking them to see. In addition, they may do procedures or read images on certain days or half days of the week. You can see how your weekly and monthly schedule can now have this little bit of variety. If you're doing imaging on one day, doing procedures on another, doing consults on a certain part of the month, seeing your patients in a clinic, you're always kind of moving through the field of cardiology that you enjoy without having to do too much of something that maybe still may not be your favorite. And for the sub-specialties within cardiology that are very procedure heavy, for example, somebody who's an interventional, somebody who does with valvular abnormalities, somebody who does with congenital or somebody who does electrophysiology, there's still a nice bit of variety and flexibility because you can do procedures on certain days, seeing patients in clinic that you just operated or did a procedure on on another. And again, the weeks and the months now have a little bit of variety and diversity to what you do. Number four for me is the most attractive, which is the teaching component. Now, the main reason I got interested in cardiology in the first place is I was a young fourth year medical student on the cardiology ICU service. And it was a very hard field to learn, EKGs, echoes, chest pain, heart failure. But thankfully for me during that June to July period, I was able to learn the pearls, the lingoes from some of these amazing residents, amazing physicians, and amazing fellows. Now, the reason that that was so important is that I had three weeks at advance before the new interns were brand new first year doctors joined the cardiology service and the month of July. By no means was I smarter than any of these first year doctors, but I did have three weeks within this cardiology rotation of learning how to better master echoes, EKGs, etc. So I found myself actually working with my interns and teaching them the things that I had just learned a few weeks prior. And I could see that I really enjoy when somebody was able to teach me something, I was able to teach somebody else something, and then see them better take care of their patients. And as I went through residency, the more pearls I was able to learn within the field of cardiology, the more attracted I was to try to pass that down to my interns and my other residents and being able to see again, them better able to take care of their patients. Because again, the field of cardiology is not easy, EKGs, echoes, looking at CAP images, managing all these disorders, there's lots of data, and this is lost forever, lots of little nuances to keep in mind while better taking care of your patients. And so when you can take a hard concept, better learn it for yourself, pass it down to somebody else. One, it sticks better with you, but then you can see tons of people, whether they go into the field of cards or not, better be able to manage their patients. And that's just one half of the teaching component. While I can teach other trainees to again selfishly get better at cardiology myself, the other half is I love teaching my patients about cardiology. Even as a hospice today, if I have a patient that comes in with heart failure or chest pain or arrhythmias, I'm always finding myself drawing things on the board, explaining them to the little nuances of why this medication is on board for them, because it's really life changing when you get these diagnoses and you never knew that you had heart failure in the first place. Being able to walk through your patient of A, B and C, what's going on, what they need to do is really satisfying for me and watching that light bulb happen when they understand that this doctor understands what the heck that they're talking about, and thus they're able to better manage their care. That is truly gratifying. And so I'm excited as both the cardiology fellow and then eventually as a cardiology attending, when my knowledge of cardiology will even be even better to be able to use that to better teach and educate my patients. Now, number five is the future outlook. Now, unfortunately, cardiovascular disease is one of the leading causes of death worldwide. And unfortunately, I don't see that changing anytime soon. But the attractive part about cardiology is that there's always going to be a need for my services. In addition, the technology that's going to advance with more data and information that we talked about earlier is so exciting. Now, often people talk about technology take over the jobs of people in healthcare, including cardiologists, but I actually think technology is going to just aid me doing my job better. For example, I see AI technology better being able to assess something like an EKG or a chest x-ray or a pacemaker or an echo reading and being able to best allow me to say, let me see what this is saying versus what can I do for this patient. And something else that I'm really excited about is as the research within cardiology increases, I think that the future of medicine is really having personalized medications. Sometimes, for example, we know patients have heart attacks and so we put you on a plethora of medications. But there's often a difference between why this patient has coronary artery disease versus why this patient and why their medications help while it didn't help this patient. Same thing for heart failure. This patient with heart failure may have a completely different pathophysiology on what actually led them to have heart failure and that sustained heart failure. And the future, which is exciting, is to be able to look at somebody's genetic and pathophysiology and finding medications that then can address those specific problems. We're already starting to see signs and research and medications that are coming tailored to be for a specific subset of patient populations within something that used to be just everybody take these subsets and that's. And so I'm excited for the future of being able to see a patient in my clinic and saying, well, these two patients have the same disorder based off their genetic and lab abnormalities. Here are the best forms of treatment for them. And here's the best form of treatments for this patient. Again, you can personalize that care and I'm really excited for what that can mean for the future of cardiovascular disease and for those individual patients. Next is having a career in cardiology that aligns with my goals. Now again, nothing against being a hospitalist. I really enjoy what I do. I promise. But one let down honestly of the field is that I'm hoping when I discharge somebody that I never see them again. But I don't know if that means that that patient is doing well based off my treatments, my recommendations, my education, or maybe they went to another hospital or maybe they've already been taken care of by one of my colleagues. And I just didn't know that they were re admitted to the hospital. You just don't know what happens to these patients once you discharge them. But on the flip side, the field of cardiology allows me to have that long term continuation of care with the patient or maybe their families. So I can see them from their initial diagnoses or chief complaint all the way to being able to manage them ideally for years to decades. In addition, one thing that's really important to me, which fits into the idea of long term continuity of care is the idea of prevention and progress. I'm really big and running managing my health managing what I eat my fitness and being able to translate that to my patients of saying this is what the data says that these should be the best things that you eat to lower your risk of cardiovascular disease, particularly in patients who have family histories or have had a personal history of heart attacks or heart disease, being able to say these are the best preventative things that you could do based off the research based off my experience and really being able to use that love for education to again tailor the care for a specific patient. I don't always get that as a hospice and I'm really excited to have that in the field of cardiology. And in similar fashion to something we talked about, I get to have a career that is focused on education. Every time I have a patient have the opportunity of understanding what do they understand and where can I fill in my own lack of knowledge and cardiology understand that better and thus be able to better take care of my patients. And then also having that ability to work with future trainees, whether it's an intern or a medical student, a fellow or other attendings that are young in their career. Ideally, when I'm in my late 40s and 50s and 60s, I'm able to pass down those pearls that I've picked up throughout my decades and time in medicine. And then finally, as a flip side of something I'm really excited not to do anymore, as a hospice, again, nothing against the field, but one thing that your job is very focused on is disposition or discharging a patient. In the field of cardiology, it's just taking care of whatever their cardiovascular complication is. As a hospitalist, I may be taking care of a patient in the hospital five to seven days, but maybe a majority of them are not spent on the medicine. I may make them feel better in two or three, and then those last four or five, maybe trying to get them to a rehab or to a skilled facility. That last part is not as interesting. And so whenever you have several of those patients on your daily list, while it's easy to take care of them medically, it may not be the most intellectually attractive like we talked about earlier. And thus on some days, it makes it feel like where you don't actually want to go to work. And then finally, I don't think I would be doing this episode justice if we didn't talk about salary. Now for me, being able to take care of my family and doing it long term is very important, which is why there's an attractive component financially of being a physician. You can easily have a salary that you know is going to be able to take care of yourself, your expenses and your family and then your future family like your kids. And so while I get paid well as an internal medicine, I make about 250k currently in central Texas. The field of cardiology gives me the options of making even more, again, being able to take care of those long term future goals that my family and I have. So as a reference here is the Doximity Report from 2021. Now these numbers can vary from the true salary for tons of reasons. Geographic locations, demand, exactly what you do. So for example, internal medicine, it says here that you make 295,000. That's actually significantly higher than what I make now in central Texas, but it may be significantly lower compared to somewhere else in the country. But if we look at the field within cardiology, we see that here in the U.S., it's actually one of the highest paid specialties at an average of $537,000. Now there's a few nuances to this number. One, it includes people who do interventional as well as somebody who's non-invasive. So somebody who is doing, you know, a lot of cats and stents and valve repairs and electrophysiologists, for example, will make a little bit maybe more than this. And then thus people who are non-invasive, somebody who is a general cardiologist, prevention cardiologist, somebody who is reading images or doing consults, may make less than this. And this is what brings the average there. So I expect my salary to be in probably the $400,000 range. I'm not sure. It just depends again on where you live, the demand for what you have, how many patients you see, how busy you are, how the group works. There's tons of things that go into this number. But this number again just serves as a reference that cardiologists are well paid for what they do. But those friends are the big reasons that I ultimately made that transition to go into the field of cardiology. I'm really excited to start my fellowship in just a few months from the making of today's episode. So if you want to follow me in that transition, my life as a fellow, my life as a cardiology attending, when that time comes, make sure you hit that license arrive and follow on whether it's YouTube or podcast, wherever you're listening. And if there's anything in this episode that I didn't answer about my decision to go into cards or specific questions you may have, make sure you drop them in the comment section if you're watching on YouTube. I'd love to use those as ideas on episodes I can make future in this kind of series I will do about my life going into cardiology. So make sure you hit that follow, like and subscribe. Now if you're interested in learning what my life looks like right now as a full-time hospitalist, check out this episode right here where I break down exactly what the field means, what my salary, what my job, my hours look like. And then this episode right here on me taking you on a typical day of being a hospitalist. But as always my friends, thank you so much for being a part of my journey. Hopefully I was just a little help to you guys on yours. Let me know what questions you have and I'll see you guys in the next