Should I pursue additional training?

[Dont_know_mind]

To simplify, in year 1-3 of doing extra fellowship, your salary would be ? 60k instead of 400k. Multiply the difference in salary for year 1-3 by 3 and discount back at 5%. So the present value of that is in the order of 900k, assuming difference in salary is 340k/pa. But in after tax dollars this is more as your income will be spread out more efficiently if you start your attending career earlier, even if it has a lower terminal rate. The after tax NPV cost of a 3 year fellowship might be around 650k, assuming your tax rate is 30%. Which you would have to make up for later and so at a 7% rate of return, you would need to make roughly 70k more per year, pre-tax for the rest of a 20 year career (simple, interest 7% on 650k p.a and payback of principle over 20 years), not taking into account the lower tax efficiency of the higher salary later. I am just guessing the numbers there and you would need to calculate that yourself.

Agree with the sentiment to try attending job in what you are due to finish in. The job as an attendee maybe quite different for you than as a trainee. That seems like a free option to me, and if you really don't like it, you can always do more training. Unless for some reason you don't think you would be able to do further training down the track.

[Hatton]

No one knows what will happen with salaries down the road.  I think they will decrease.  If they do not great.  I also think you should give the critical care job a shot.  At some point all of us professional students have to call training done and actually work.  I think you will be fine either way.

[LIFO]

I would question the assertion that cardiology pays significantly more than critical care.  It can, but that doesn't mean it does.  If you do interventional and move to the boonies, then yeah, you write your own ticket.  But if you're general cardiology in a large city, it takes a significant amount of time to get busy enough to support a 500k salary.  Nobody is subsidizing that salary unless you want to be in a place nobody else wants to be.  There are just too many cardiologists around for that kind of nonsense.  Now contrast that with critical care.  You are in a subsidized specialty that is in very very high demand. You make good money out the door any place in the country and you have protected time off.

But more importantly, why cardiology? As an intensivist you're doing 80% of a general cardiologist's job.  Do you love the cath lab?  Do you love echo, nuclear med?  Are you interested in EP?  Unfortunately, all of those are a very long road and require more training beyond a 3 year cardiology fellowship.  Unless you really hate the ICU and now realize you're really meant for outpatient medicine, I would not do this.

 

 

[SValleyMD]

In no way shape or form would I even entertain the thought of doing cardiology if I were you unless it was something you were extremely passionate about (and this is coming from a cardiologist... and FYI passion dies quickly regardless).

I would bet that most critical care docs make more per hour than cardiology. I would also state that a shift work specialty can be a lot easier to pick and choose your effort and income (obviously that isn’t universal)

9 years of training after Med school just to take q4 call with full work weeks .. That would a no brainer heck no for me.!! especially if I had a physician spouse contributing to my retirement accounts..

Nonetheless congrats and good luck

[pulmdoc]

If you do community practice (ie not academic center) after training, you will 100% be wasting one of your fellowships. There just isn't a market for cardiology/CC out there. If you are going back to fellowship to be a cardiologist, it's so that you will be a cardiologist. Keep that in mind.

[Kamban]

CCM wrote:

Annual aggregate post-tax household income: 388k (Pre-Tax = 650k – mine 400k, wife 250k)

Click to expand...

How you manage to invest the after tax from this $650K income will be more important for your wealth in your 50's and 60's than the change to cardiology fellowship and its perceived additional income.

If you can live on your salary of post tax $400K and invest the wife's $250K post tax for 5 years ( or if you can be more frugal and live on her salary and invest yours) you will be so far ahead in a couple of decades that it does not matter what specialty you will be practicing 20 years down the line.

[mxg67]

Do it only if you're very interested in it and can't stand the idea of CCM, hospitalist or even outpatient.  That's the way I viewed it, otherwise I would've done hospitalist shift work, have good job flexibility, be able to dial it back when I wanted and make hay while I still could. As others have stated, future salary is unknown, cardiology has gotten cuts in the past and is possibly trending down.  On a hourly basis, which I think shouldn't be ignored if analyzing finances, it's hard to say which specialty makes more after considering call and such.  Rather than looking at cumulative salary, you should also look at FI number.  If you could potentially reach FI before the breakeven point then that's something to consider.

[loopas]

My husband had similar thoughts in his fellowship, but he is now very happy he stuck to his original field. It is hard to see the big picture right now but trust me, when you are both done you're training, your job will be just one part of your lives.

[pulmdoc]

This may have been mentioned already, but CCM (especially if you are CCM only) is usually shift work, often 7 on/7off schedule. This is significantly easier to schedule life around with kids when you have a working spouse, especially another physician.

[Duckworth]

@ccm what did you wind up choosing?

[IMMD]

Oh boy...I've been thinking hard and long about doing a fellowship. But two fairly demanding fellowships...No...unless I'm very passionate about the second one but then again, as already mentioned, the first specialty will definitely take a back seat in a non-academic setting. Financially, CCM pays more per hour than general cardiology in my area. What did you decide, @ccm?

[Duckworth]

Based on his other replies to threads I think he stayed with crit care!

[CCM]

I ended up sticking with CCM. I'm 6 months into my first attending job. Loving my job and loving the time off. As crazy as it seems, sometimes it feels like I have too much time off. The wife is also extremely happy that I have no plans on pursuing additional training!

Thank you all for your kind and helpful responses.

[jjandjab]

Haha, I was getting ready to toss out my opinons in until I saw the 7/2018 dates. But thanks for coming back to post an update. The gist of my two cents was going to be if your minimum income between the two of you was going to be 650k, then totally just go with CC for a while and use your training. CC, like a lot of medicine can also lead to other opportunities down the line without other training - I have a good friend who did it at a big Boston hospital for a decade and then went into the Biotech business because CC often deals with a lot of high end meds and equipment. And now he loves that even more... Being happy in your job is so important - pleased it worked out for you.

[CM]

There is no way to know what the incomes and job prospects will be for the 2 fields you are considering over the next 30 years. So do what makes you happy.

If you also do cardiology there is a 99% chance that critical care will go by the wayside and that will be 2 years of wasted fellowship. I see people doing pulm + critical care or nephrology + crtical care who do not use the critical care aspect of medicine. But if cardiology makes you happy, pursue it.

My only thought is at age 55-60, would you still like to be doing critical care at 2 AM. Or be in bed with a good night rest.

Don't count on a good night's rest as a cardiologist. :-)

Edit: Just realized this is a very old thread.