What You Should Know Before Selecting Your Interventional Cardiology Attending Position

When you’re finishing up your interventional cardiology fellowship, the path to your attending physician role is an exciting yet pivotal decision. As a resident, you honed your skills and gained experience under guidance from other doctors. In your fellowship, you gained training in an interventional cardiology subspecialty. Now that you’re looking toward the horizon at your attending position, there are a lot of factors to consider to ensure a job is the right fit.

“For me, a great attending job offers an awesome work-life balance, excellent compensation, and the ability to do as many procedures as I want to,” said Jasdeep Dalawari, MD, interventional cardiologist and Regional Chief Medical Officer at VitalSolution.

Details You Should Consider Before Accepting an Attending Position

Depending on what your personal and career needs are, you should consider the following:

1. Procedural volume: A role that has too high (or too low) a procedural volume can impact how well you become proficient in interventional cardiology. Too many procedures, and you won’t have time to focus and improve as you move quickly from case to case. Too few procedures, and you could find your skills lapsing while you wait to practice them.
2. Mentorship availability: While attending physicians are considered independent, you can greatly benefit from an official mentorship in your next role. The best mentors for those in cardiology can facilitate learning opportunities in the specialty. “Mentors can talk through cases with you, determine what equipment is better suited to what anatomy, and just give you a bird’s eye lens of your standing and progress,” notes Dr. Dalawari.
3. Location: Do you wish to live near family now that you are done with your fellowship? Do you need to think about where your spouse or partner will work or where your children will go to school? It would be best if you also considered the financial and social obligations of living in a large urban environment or a smaller suburban setting. You also should factor in financial needs like student loan repayment costs into your budget. A more rural or smaller city location could also allow you to lead in smaller cardiology departments as opposed to large hospital settings that are typical of major city medical centers.
4. Schedule considerations: Ask how many cath lab days are typical in the attending schedule versus clinic or non-invasive procedure days. This could impact how you structure your training as an attending, as well as how often you get to meet with patients who are considering an interventional procedure.
5. Structure of a typical day-in-the-life: Ask several current attending physicians (not just HR representatives) how their typical day is structured. They will have the best idea as to what is expected in the role (which doesn’t always meet what is ideal on paper).
6. Team makeup: Make sure you know how many other cardiologists make up the group. Too many or too few could greatly impact the workload and could lead to quick burnout.
7. Referral sources: Where are patients coming to the cath lab from? Are they referred from inside a larger medical system, or from outside the hospital through other means, like advertising and marketing efforts or even word-of-mouth? If the position includes a bit of “rainmaking” and drumming up business, will you enjoy that or will it be a problem?

Most of all, you should ensure that your job choice is right for all of your needs, not just one or two aspects.

“The biggest factor is to consider what is most important to you,” said Dr. Dalawari. “If you have to live in a particular state due to family reasons, then that becomes your most important priority.  If having a tremendous amount of procedural volume is the most important thing for you, then you must go to a high-volume place (likely a place where you are being fed by multiple noninvasive colleagues).”

Why Your First Year Might Be Your Worst Year: Location, Location, Location

A study published in 2012 found that over 50% of attending physicians polled had left their first job after just five years, and more than half of that number had left after just one or two years. The study found that factors that seemed of utmost importance while conducting their job searches were aspects that ultimately proved to be the most unagreeable to the doctors.

“When embarking on their critical first job hunt, it’s beneficial for interventional cardiology fellows to entertain the idea of multiple locations, instead of hyper-focusing on just one city or facility,” said Sean Ebner, President of Physician Services at Ingenovis Health. “If applicants consider a variety of different sized cities, towns, and urban centers, they may be surprised by the wealth of opportunities and options they will have to choose from for that first job.”

Admittedly, the search for an attending job often falls to the last few frantic months of a physician’s residency years. And finally untethered to a strict educational regimen, there might be too many options that could create trouble down the road. In a small medical program and you’re pining for the big city That could create financial or social temptations that could negatively impact your job performance as an attending. Too close to family who now expect you to have plenty of free time to spend at gatherings? You might create tension where all you wanted was a little (not a lot) of face time with your loved ones.

“Most doctors leave their first job,” noted Dr. Dalawari. “Mainly because, despite trying to find the best fit, they tend to not know themselves and not know enough about the job to find the right fit the first time. So, it is ok to have to leave your first job.”

Don’t Skip Learning the Business of Medicine

Another factor you might not consider until you’re in the midst of your attending job is the role that any doctor plays in the financial health of the hospital itself.

“[You must learn] social and business acumen,” said Dr. Dalawari. “Healthcare is a business. Physicians cannot extricate themselves from the business meetings and finances of their jobs/organizations.”

A 2022 JAMA article noted that coming out of the COVID pandemic, many physicians and medical teams were feeling the effects of burnout after being in crisis mode for years. Hospitals, too, were struggling to adjust after years of financial shortcomings when elective procedures dried up. Medical teams pulled into COVID care were noted as burning out at a higher rate and many left the profession altogether. Meanwhile, budget cuts in non-critical areas led to staffing shortages in other non-emergency areas of the hospital.

A recent study by KaufmanHall which surveyed American hospitals and health systems, published in October 2023, saw encouraging numbers emerging post-pandemic. The vast majority of the more than 100 respondents (nearly 98%) noted they were utilizing several recruitment and retention strategies to hire and maintain a happy workforce. They also were raising starting salaries or their minimum wages for support staff. Still sorting through the modern challenges of a post-pandemic medical system, they are also seeing some signs of system stabilization after an unprecedented amount of chaos. Respondents agreed that what hospitals are heading for is a “new normal,” not back to the way things have been done in the past.

Big or Small, Hospitals and Cardiology Jobs Can Benefit Everyone

While location (and often resulting hospital size) can impact your happiness in your interventional cardiology job, understand that each option can have its pros and cons. How you are impacted is a matter of personal taste.

Factors that come with a big medical center job: 

• A big hospital usually has the latest and greatest and most modern equipment and facilities.  
• They generally will have the most subspecialties available. 
• There will be many colleagues around to bounce ideas off of. 
• They will likely be a tertiary referral center where patients are shipped to from smaller hospitals.
• They are generally busier.

Factors that come with a small medical center job: 

• A small hospital may be more like a family.  
• Everyone knows one another.  
• You will have more “bread and butter” patients and procedures.  
• You will likely not be able to do structural interventional work such as Transcatheter Aortic Valve Replacement (TAVR) or mitral clips.  
• You will most likely have a better work-life balance.

The Lifelong Learning of a Medical Employee

Finally, no matter how in demand you may be as an interventional cardiologist, remember that you’re always learning how to be a good doctor and a good employee. That learning never ends.

“It is easy to find a job,” said Dr. Dalawari. “It is harder to find the right job. It is even more difficult to find the right career path.”