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Matters of the heart

Marge Overs
Med J Aust
Published online: 6 August 2012

Cardiology is a growing specialty that can be tailored to your skills and lifestyle

From the adrenaline rush of saving a life in the wee hours to the satisfaction of building relationships with patients over years, cardiology offers the best of acute and chronic medicine

Professor Len Kritharides, head of cardiology at Concord Hospital in Sydney, has enjoyed this diversity, which includes growing opportunities for procedural work.

“Cardiology also has a strong evidence base, which gives us a good foundation on which to continually develop our management of patients based on prognosis.”

However, this mix of medicine has its challenges, he says, as it takes time to maintain procedural skills while keeping up academic and clinical activities.

Diversity is also a key attraction for Professor Derek Chew, whose many professional hats cover clinical and interventional cardiology, research and administration.

Professor Chew is a clinical and interventional cardiologist at Flinders Medical Centre; director of cardiology for three hospitals in the Southern Region of Adelaide; a clinical researcher at Flinders University; and chair of the State Clinical Network in Cardiology.

“My roles show the opportunity for diversity and variety in cardiology, and that’s been a big attraction for me”, he says, adding that his roles often interact with each other.

“If I struggle with an issue clinically, I can explore it through research. When I need to take that research and turn it into practice again, it’s both a policy and administrative issue.”

Professor Chew says young doctors considering a career in cardiology need to have strong people skills and enjoy interacting with patients.

“You are helping people to make difficult choices — because not all outcomes are good.”

It is also important to be quantitative and to look critically at your own practice. “Cardiologists often portray themselves as knowing the right answer, but so often we don’t, and the ability to be critical about the data or your own perceptions of that data and the ability to translate that into practice will become increasingly important”, he says.

The misconceptions

Professor Chew says one misconception is that all cardiologists have a heavy after-hours and emergency load.

“We have enough acute-end cardiologists and in some respects we don’t have enough consultative cardiologists”, he says. “There is such a great need for consultative cardiology that those who want to work 9–5 can do so. We need more thinkers than we need doers.”

While much of the after-hours work for cardiologists is procedural, there are also growing opportunities for non-procedural cardiologists, he says.

Another misconception is that it can be difficult to secure a training position in cardiology, but in recent years it has become harder to find enough trainees, he says.

Cardiology has a growing workload and clinical need, Professor Kritharides says. “While people have talked for many years about how many cardiologists we need, the workload is only increasing, so it’s a busy specialty with lots of growth ahead.”

The big issues

Professor Kritharides says developments in electrophysiology and electrical devices are transforming the specialty.

Percutaneous treatment of structural heart disease is also a growing area, which will increase the availability of treatments for valvular heart disease to the ageing population, he says. Cardiologists and cardiac surgeons are collaborating to choose patients who should have open-heart operations or percutaneous procedures, all of which are expensive and carry risk.

For Professor Chew, a critical issue is making appropriate decisions about the use of new technologies and treatments.

“There is a lot more that we can do, but we are still learning how to do it well”, he says. “Many of the treatments are invasive and associated with risk, and our populations are getting older and our ability to cause harm is increasing.”

Training as a cardiologist

Doctors first need to complete the first part of the fellowship of the Royal Australasian College of Physicians, which includes the clinical exam and written exam. The cardiology training program then involves three years of core training, after which some doctors will choose to do a fellowship in a subspecialty or a higher degree, or both.

The inside story

What are the insider tips for doctors wanting to train in cardiology?

Professor Kritharides is on the specialist training committee of the Royal Australasian College of Physicians (RACP) in cardiology and coordinates the matching process for selection of advanced trainees in NSW.

He says that while different training centres may vary, all would look for people with strong clinical skills who are committed and are prepared to work well in a team.

The appointments are considered very carefully, he says, because people are choosing an advanced trainee who will not only work closely with them for the next three years but, in many cases, will maintain affiliations with their department as a junior colleague and consultant in the years ahead.

“So when people make these appointments, it’s an assessment of the person and their potential to contribute to the quality of clinical service in the department during their training, and to the practice of cardiology as consultants in the long term.”

Professor Kritharides says the RACP’s cardiology training program also looks at academic achievement, evidence of self-directed learning, teaching and initiative in doing research.

“The people who stand out are those who have broad clinical experience, including as residents in cardiology, so they understand the specialty”, he says. “They are very strong clinicians who are compassionate, committed to high-quality patient care, work well in a busy teaching hospital environment and who show initiative and energy.”

Once established in the specialty, Professor Chew urges young cardiologists to cast their net widely. He suggests they find opportunities to link their clinical practice with experiences that broaden their knowledge and contribution, but are not necessarily related to patient care. “As you do that, not only does it improve your care of the patient, it improves sustainability in your career.”

  • Marge Overs


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