 It's now been four months into my cardiology fellowship and today I wanted to do a deep dive into how it's going, the positives, the tough points, my schedule, my current goals, and if I ultimately think that I made the right move going from being an attending all the way back to training. Let's get into it. Hey friends, welcome back to channel. In case you're new here, my name is Lux. I'm a board certified internal medicine physician and currently a brand new cardiology fellow. Now this definitely has the potential of being a longer video and episodes. If you're interested in a specific part that we'll talk about, I'll link those down below in description. But as a little bit of a background in case you're not familiar with my story, I graduated medical school back in 2019 and then did three years of internal medicine residency. Then after my three years of residency, I basically had a choice. Do I go to further training to be a sub-specialist like a cardiologist or do I go ahead and just work as a general internal medicine doctor as something like a hospitalist? Ultimately where I was doing medical school and where my family and my wife are from are two different cities. We made the choice of moving back home just to be close to family and making a decision while I worked as an internal medicine hospitalist for one year. If you wanted to see what my day in the life as a hospitalist looked like or why I picked the field of internal medicine in the first place, I'll link down below those episodes down below. But during my first few months of being a hospitalist while I enjoyed the job and the schedule because I would have every other week off, I also realized that it wouldn't be something that I would be able to do for 10, 15, 20 years and come to work with the same level of excitement. And so that's why with the support of my wife, we made that decision to go ahead and apply for fellowship, which is what I did back at the end of 2022. And right around this time in November of 2022, I figured out that I matched or basically got into the program of my choice to become a cardiologist. Now at this point in November, I knew I was going to start fellowship but it wouldn't start until all the way until July of 2023. So I went ahead and worked the remaining months between November and June to still be an internal medicine hospitalist. And then come July of 2023, I ultimately transitioned from being an attending where I was making all the decisions myself without any supervision to now being back to the trainee as a cardiology fellow. Now while it sounds fancy, a cardiology fellow is basically somebody who's training to be a cardiologist. Cardiology fellowship is three years. And this is my first of my three. And it basically means that on every rotation on every patient that I take care of, there's always a board certified cardiologist who's working with me and overlooking my decision making. And if I have any questions, that's who I go to. So that was back in July. And now as I'm making of this episode, we are officially in November or four months into fellowship. So I'm going to break down essentially what I've done so far, what my schedule looks like, what my role has been on all these rotations, my upcoming schedule, and then also talk about some of the pros, some of the cons, as well as ultimately, if I feel like they made the right move of going from being an internal medicine hospitalist to now becoming a cardiology fellow. So first, let's talk about my schedule for my first four months. So my first month as a cardiology fellow was actually a mixture of an orientation and a boot camp. Now this format of having a boot camp for a month is actually not typical at all. Usually when you start fellowship, particularly a cardiology fellowship, you may do a week of getting your badges and getting credentialed at various hospitals and clinics you have to work at. And then they just kind of throw you in. So you may be within your second week of fellowship, working in the cath lab or seeing consoles as a cardiology fellow for us at our program, they actually nicely ease this through and that each week had its own theme. The first week was made to do admin kind of credentialing. The second week was meant to just learn basic things in ICU. Third week was meant for cath lab. And the fourth week was meant to learn some skills in the echo lab. Now again, this is usually not typical, but I did appreciate this kind of system that my program created because it allowed you to jump into fellowship without the nervousness that usually comes with it. And while I was excited to go through this boot camp, I knew that my wife at that point who was about 36 weeks pregnant could be due at any point. And while we were originally expecting her to come at the first week of August, she actually came a few weeks early, essentially two and a half weeks into my cardiology fellowship. Now thankfully my program allowed me to make some adjustments to our schedule, especially because the boot camp wasn't as essential. And I was able to go on a paternity leave slash elective research rotation. So during that last two weeks of July, I was essentially at home learning cardiology to the best of my knowledge while enjoying time with my brand new daughter. So as a month of July, now we go into the month of August, which was my official first month as a cardiology fellowship. I'm coming back from paternity leave and I don't know anything. I feel like I've been missing out because all of the other fellows have gotten experience to the echolab, the cath lab. I don't feel like I know any cardiology. So my first rotation was actually in the congestive heart failure rotation, which is the CHF rotation. This is something that I felt like I did before in residency. Often you're taking care of patients who come in with what we call bread and butter heart failure. This is the people who are short of breath because their heart doesn't squeeze very well. So they tend to accumulate fluid in their lungs and the rest of their bodies. Now pretty much any medicine doctors should feel comfortable taking care of heart failure exacerbations. But in addition, in the CHF rotation, we're also taking care of more complicated patients such as patients who have had a recent heart transplant or patients who have things and devices such as LVADs. Now an LVAD stands for left ventricular assist device. Essentially in heart failure, a left ventricle, which is the muscle that is made to do all the pumping from your heart into the rest of your body. If for some reason it's not working and you're not eligible for something like a heart transplant, an LVAD is basically a pump that sticks to that bottom part, the apex of that heart essentially will take blood out through a vacuum and send it to the rest of the body so that pump doesn't have to work as hard. Now being familiar with these devices as well as the complications that come with them really takes a little bit of training. Thankfully I had some exposure during residency to these devices. So during this rotation, I was also managing patients with LVADs. Now we get into my second official rotation, which is the month of doing echoes. This probably felt like the most cardiology thing I had done at this point because when you read echoes, especially as an internal medicine hospitalist or resident, you're usually kind of looking at the report or the basic images that you're just kind of taught to look at. But now as a cardiology fellows, I was actually submitting the report in addition with my attending on things like their heart function, their valve function, and more information. So all the things on the report are things that I was doing. Now usually the way this rotation was set up is that the first half of the day was really meant for me to read independently and at my own pace. So the echo text would be scanning patients across the hospital. It'd give me a text when a next patient was ready. And I would go ahead and start reading through the report and submit kind of a preliminary that my attending would then see in the afternoon. This is where I got a lot of my numbers in terms of reading echoes by myself. And then every afternoon there would be a different attending assigned to read echoes for that hospital. And then together we would go over the echoes that I read earlier parts of the day as well as the new ones that came in the afternoon. This was honestly such a cool experience. It definitely felt like more like a radiology elective or rotation because we weren't dealing with patients directly, but just learning the nuances of the measurements and how to look at the pictures that have been used to doing for the past four years. But now truly as a cardiologist again really made me feel like, okay, now we're making a different career move before I was taking care of heart failure patients that I did as a hospice. This definitely felt like a different element of clinical medicine that I've never been exposed to before. Next is my third rotation, which is also the next behemoth of cardiology, which is working in the cath lab. Now working in the cath lab is the field of interventional cardiology. Imagine if somebody comes in with a heart attack and somebody puts in the stent. That's what an interventional cardiologist does. But often we also do things like diagnostic left-hard cast or coronary angiography, which is essentially just fancy words for saying, let's look to see how your heart vessels, those important arteries of your heart, if they're open, if there's any blockages, if you're having chest pain, if a blockage is explaining that or if they're completely open, then we need to look for different causes. Now this rotation specifically had me really nervous. One, I had missed a lot of the initial boot camp and the introductions that other fellows had gotten, so I already felt like I was starting behind the eight ball. And you would often show up and not only do you not really know these procedures, you've never done them before, but every attending has their own styles of what catheters they use and how they do their own procedures to ultimately get their same results. It's my first week on the rotation, I really felt like a complete noob not knowing how to get access, how to use certain things, how to just kind of behave in the cath lab, because it's almost like surgery where everyone's gowned up, you have to keep yourself clean, you kind of have to know where your hands need to be, how to make sure you're taking care of the patients, and avoid obviously not causing any complications. But after my first week kind of understanding how to do the step by steps of all the procedures that everyone would be doing, I finally started to get the hang of it, I think, and by the end of the rotation, I was able to do procedures like a left-hard cat and definitely like a right-hard cat without my attending really being involved at all. If you're interested in me diving more into these procedures, let me know in the comment section down below. But a left-hard cat is probably one of the procedures that you do the most in the cath lab, often you'll have patients who are admitted in the hospital for things like chest pain, maybe they have a shraponin, which is an enzyme that usually represents some kind of heart stress or heart damage, and then you may be getting a referral to do a left-hard cat in that patient. Often we'd go either to the wrist or the artery in the groin and you would get access either through an ultrasound or sometimes blind. That was cool, learning how to do that anatomically, and then after you got access by advancing a catheter, you would then use that access point to advance wires and catheters all the way down the sending aorta right above the heart, and you would use those to engage the coronaries, the left as well as the right. And this is honestly probably one of the hardest parts of the rotation, is you just have to memorize these tiny steps that ultimately lead you to doing the entire procedure. What goes in when you flush, which catheter you use for what, and again for you to be able to do it independently, you have to just finally get the flow and that just comes with our petitions. The second hardest part is what we call engaging the coronaries. Once you get your catheter there, the idea is for you to be able to shoot contrast while the catheter is in the left coronary artery or the right coronary artery, so you can get pictures like this. But as you can imagine, these arteries are not big and you can't see them under the x-ray or fluoroscopy that you're using in the cath lab. So you're using a combination of both experience and anatomy to maneuver and rotate the catheters in certain orientations where you think the left or the right coronary may be. And when I first started, I by no means had the experience to really understand how to make these small movements, but again by the end of this rotation, I was overall able to get into the left coronary, get into the right coronary for most of my patients. Now just to give you some idea of how involved I was as a fellow, this rotation was four weeks, but one of them for me was a week of vacation. So for three weeks in the cath lab, I easily scrubbed in and participated in over 60 procedures. Most of them, which I was pretty hands-on. And they're my first year as a fellow. We spend anywhere from two to three months in the cath lab, so they'll easily lead to 100 to 200s of cases and again extrapolate that over the span of two to three years of fellowship. I'll definitely get my repetition and bearings in the cath lab. And that finally brings me into my current rotation, which is a month of cardiology consults. Now this is basically a month of me working one-on-one with the attending, taking consults from the teaching team so whenever they feel like they have a cardiology patient that they would like us to help them make decisions on, they would let us know through a text or an email, and then the next morning we would see those subsets of patients. And during a typical day, I'll see a combination of patients that'll come in for chest pain, shortness of breath, bread and butter, heart failure, arrhythmia, as well as a lot more. And overall this month has probably been the most similar to my life as an internal medicine hospitalist, where again, the patient comes in with a specific complaint and my job as a cardiologist now is to help with that specific complaint. It's also been a good month for me to just flex my cardiology muscles as well as identify things that I just don't feel comfortable with using the help of my attending. Now the hardest part of this rotation has simply been the coordination aspect. As a cardiology fellow, at least in my program, our role is really making sure if somebody needs a procedure, then my job is to make sure it's coordinated, understand what time it's done, make sure all the orders for that patient as well as their consults are in, and that's just a lot to do in addition to all the notes you have to write for the consult, plus all the rounding you have to do with your attending as well as that teaching team. Now that's a breakdown of the four months that I've gone through so far, but let's quickly talk about my upcoming schedule for the rest of my first year fellowship. Now after this month of consults, an exportation that I'll do will be a month of doing nuclear imaging, so that includes just kind of looking at things like stress tests for patients who come in with chest pain. After my month of nuclear medicine, I'll be doing a month in ICU where I'll basically be managing the units of patients who are super sick with things such as post-transplants, cardiogenic shocks, arrhythmias, bradycardia, syncope, you name it, as well as patients on really complicated advanced supports. People who are on balloon pumps and pelas, ECMOs, there's a lot that'll go into it and I'll definitely make a different episode on that all together once I get there. After my month of ICU, I follow that up with another busy month in the cath lab and then lighter month on doing echoes. And then I'll wrap up the year by doing a month of electrophysiology or arrhythmias of the heart, and finally another month of ICU to wrap up my first year of fellowship. Next I want to talk about my average daily schedule using those first four months and those rotations as an example. Now the individual scheduled will vary depending on the rotation, so in cath lab I was showing up at seven o'clock because sometimes the first cases were at seven thirty, but usually my start time will be anywhere from seven to eight a.m. in the morning. And in terms of when my day will end, usually average is from four to five p.m. and most of these rotations that we talked about also have weekends off, which is super, super nice. Now finally as a cardiology fellow, we do one overnight in-house call in the ICU. This basically means that if I'm on call like I am this week on Tuesday, I would do my rotation in consoles throughout the day and then come forward at five o'clock. I would take over for the day ICU fellow. I would stay in the hospital, we have a call room that we can use, and I basically make sure that if there's any new patients that get admitted to the ICU, those would come to me. If there's anything that happens to one of the day patients, I am basically responsible for that call and managing them. And I basically stay overnight to make sure that there is at least some cardiologist there to take care of these sick patients. And the next morning when the day team comes, I'll make sure I tell them about the old and the new patients, and then I get to go home. Now initially I was nervous about this format of having an in-house call, especially having a new baby at home, feeling a little guilty of leaving my wife with her now four month old. But overall it's worked really nice because the day that I go home, I have that rest of that day off. So if I managed to get any sleep during the night, I can usually just push through that rest of the day and enjoy time with my daughter and my wife. Now while most rotations will have the weekends free, there are some rotations like the cath lab or ICU at my institution where your call day will be on those specific days and thus you'll work an average of six days a week instead of the average of five. And then finally the only other aspect of my schedule is every Monday afternoon I have an afternoon of continuity clinic. This is basically patients that I have added from panels from prior fellows as well as patients that I may see in the hospital saying, how about you just follow up with me? My clinic is closer, if you don't have insurance, but we take your insurance. I basically follow these patients for the duration of my three years. Now if you enjoyed that breakdown of my daily schedule and you want to see what my morning routine looks like as a cardiology fellow, especially as having a brand new baby in the house, go ahead and check out the episode which I'll link down below with my full morning routine. And then finally to close off this episode, let's just talk about my experience, the good and the bad, especially the most important question, which is, do I feel like I've made the right decision? Now number one, I realized that I just absolutely love cardiology knowledge-wise. Like I really can see the practicality of what I learn with matching with my interest. I wasn't always the case as a hospice where I'd be learning about things like inhalers or medications or rheumatology, when those wouldn't be in the fields I was necessarily interested in, but I would have to learn it to take care of a patient better. Number two, I really did feel like I selected a great program, obviously a fit geographically to being close to our families, but I do feel like I'm in an environment where I don't feel like I'm in a toxic environment. The people and the program leadership and the tendings that I work with really do see me as somebody they want to teach and kind of mold into a better cardiologist. My co-fellows are amazing, very laid back, and again I come to work feeling like I'm a better cardiologist without the pressure of being a cardiology fellow. I really do appreciate that. Number three is I'm surprised at how much exposure and autonomy I've gotten just four months in. I was really nervous about, especially when you're a brand new cardiology fellow, it's really normal, especially when you're in med school and residency where people at the top, the intending in particular, they will say, well let's not let the med student or the resident do that. But as a cardiology fellow, I felt more often that I've gotten a lot of permission or green light to just make calls and let's see what happens, especially when I'm in-house in the ICU, if there's a patient who's crashing, a lot of times I will make a decision, a lot of that also comes from my ability to feel comfortable doing that as a hospice. And in text my sending saying this patient was not doing so well, these are the things that I did or the orders or tests that I've ordered. And often my attending will kind of give me a text message with a thumbs up and maybe some additional thoughts that they feel like I missed something. But those messages and response and just the ability of making a call allows you to have some confidence in terms of taking care of patients. If the decision you make may not happen, the best one that you'll learn through that experience and then be able to do that better for a future patient. Number four is I've been surprised that the schedule has been much nicer than I expected. Now this is definitely going to change when I work in the ICU in about a month or two or I'm going to be working long hours and also working six days a week, that one's going to be rough. But more often than not, I've been surprised of having my weekends off like I do right now. I've been surprised of how early and not as late as I was expecting to come home and just having that balance of being a dad, being a husband and also being a cardiology fellow while creating content for you guys. It is definitely harder compared to being a hospice where I had every other week off. I don't find it as hard as residency, which is what I was expecting. Number five, the teaching that I've gotten from my attendings, my co-fellows, where a few years ahead of me has been just amazing. A lot of the format at our specific program is really one-on-one. So it's me and the attending, me and the attending of the cath lab and the echo lab. There's just a lots of learning that they fill in, the gaps of knowledge that I may have and I have tons of them, but I don't feel like I'm competing for their attention as I may have to as a multitude nor a resident. So the amount of learning that I've gotten in a short amount of time has just been extraordinary. And then finally, number six is probably the only, it's not even a con, but it's the biggest surprise that I've had in terms of the negative is that self-learning in terms of self-learning cardiology has been a lot harder than I imagine. Big shift from residency where there's always education going on and there was surprising enough time to just learn new medicine. As a cardiology fellow, especially as a being a new dad, and I think that's a big part of it, is I show up to work, I do the clinical duties, I try to learn as much as I can for the gaps that I have, but there's not like this 20, 30 minute slot where I can read about the next topic in cardiology to where I can just feel like a better fellow. There'll definitely be a requirement for me to build better systems on a weekly basis where I'm going and reading journals or listening to podcasts. I'm definitely adapting those, but I was expecting to have more time on a weekly basis to kind of expose myself to the next topics in cardiology that I still haven't mastered. Right now it's kind of been feeling like learning on the job, which again is completely okay and completely normal, but has been the part that's just been the toughest to adapt to. So now the final question, am I happy with my decision to leave a full-time pay and schedule as a port certified internal medicine hospitalist where I was working every other week compared to now as a cardiology fellow where I'm making significantly less because I'm back in training, I'm working more hours, and life is definitely more hectic. And the answer is 100% yes, for a few reasons. For one, the company that I left where I was working as a hospitalist has since had a lot of turnover at their old job, so I already can start to feel like I made the right decision because other people have left for other reasons. Number two is I am actually enjoying coming to work. Being a fellow is not necessarily easy, but I feel like I can actually come and enjoy taking care of the patients that I'm taking care of because all the information and all the things I'm taking care of are in the field of cardiology. I'm not having to take care of inhalers or cirrhosis. Those are diseases that are important, but don't necessarily interest me. And so now I'm managing just the heart and cardiovascular diseases, which again I love. Number three, I feel like there's actually an end goal. Every time I come to work and I'm looking at an echo and I'm seeing a patient, I'm actually asking how can I store this information, the learning pearls to be a better cardiologist three, five, 10 years from now when I'm seeing patients in clinics. So fellowship really feels like a practical version to help me become a better attending three years down the line. Compared to when I was an internal medicine hospitalist, that was not the point at all. I was showing up for shifts. I was taking care of patients. I was trying to be as efficient as possible because we were really busy, but I wasn't always entirely focused and this is me being brutally honest of being a better doctor. I was just trying to get to the next patient, the next note, because we were again always busy. As a fellow, I have the opportunity of saying me taking care of these patients better, me understanding how to evaluate this echo, this cath lab image better will all help me better take care of these patients. Number four, I'm just four months in. So I'm really starting to just get the hang of what I need to know, but still know there's tons of gaps, but I know in a year from now and six months from now that information that knowledge is going to be so much more refined. I'll be able to walk in not just as a newbie, but somebody who actually knows how to make these decisions based off of data, based off of research, based off the pearls and my attendings and my patients have taught me. So just being able to see where I'm going to be able to transform to just from a year from now. And again, compared to my life as a hospice, I likely would have been a very similar clinician two to three years after my first year as being a hospice. That's not the case when I start my fellowship. And finally, although my schedule and my salary are nowhere as nice as what it used to be as a hospice and my life can definitely be busy again with a busy four-month old at home, I think ultimately I could see myself doing this career 20 plus years. That was not the same as me working as an internal medicine hospice, nothing against the field in itself. I've always seen made episodes of how much I actually enjoyed the job and I found something that I enjoyed better and I'm happy I made that move. I'm happy I made that leap. So if you guys have enjoyed this episode and you have more questions about my life as a fellow, my life as a cardiologist, go ahead and add them in the comment section down below if you're watching on YouTube. If you did enjoy this episode, if you enjoyed the breakdown, go ahead and hit that like button, that subscribe button definitely supports the channel. The listing is a podcast, go ahead and hit that follow and subscribe on your favorite listening platform. If you did enjoy this episode, check out this episode right here as my life as a full-time cardiology fellow as well as this episode right here on my morning routine as a cardiology fellow. Hopefully you guys enjoyed these. As always, my friends, thank you so much for joining me on my journey. Hopefully I was a little helped to you guys on yours. I'll see you guys in the next one. Peace.