What I do

I get a lot of questions about what I do. It's understandable - many people aren't exactly sure what a "cardiology fellow" is, or if there is a difference between a resident or fellow.

First, the training structure:

College (Bachelor's) > Medical School (M.D.) > Residency (to practice medicine in the US you have to complete a residency) > Fellowship (specialized training after residency, in my case, cardiology).

Second, what is "cardiology"?

Cardiology, or "cardiovascular medicine" or the "study of cardiovascular disease" is a subspecialty of Internal Medicine. It is where I learn to diagnose and treat cardiovascular disease. The 3 most common cardiology conditions are 1) Coronary Artery Disease (aka blockages in the heart, which cause heart attacks), 2) Heart Failure (damage or dysfunction of the heart), and 3) Atrial Fibrillation (a common rhythm problem that makes your heart beat fast and irregular. Of course, there are many many more conditions:

- coronary artery disease
- arrhythmias (and the study of them, called "Electrophysiology"; they also place pacemakers and defibrillators)
- valvular heart disease (disease of the valves)
- adult congenital heart disease (heart problems you are born with)
- heart failure
- cardiac imaging (echocardiography, nuclear cardiology, CT, and MRI)
- interventional cardiology (the docs who place stents)
- preventive cardiology (the study of preventing heart attacks and heart failure)

Notice that what is not included is cardiac surgery. Cardiologists do not perform cardiac surgery - instead, "cardiothoracic surgeons" do. The decison to become a surgeon or not actually happens in medical school - when you apply to residency, one of the main distinctions is choosing a surgical or a non surgical residency, and thus, to become a surgeon or not to become one. These surgeons do cool things - bypass surgery, valve repair and replacements, correction of congenital malformations. Their specialty though, is not to diagnose and study...their specialty is to cut. Who decides if the patient needs a cutter? The cardiologist does.

So...my cardiology fellowship is 3 years long, and I've finished about 5 months of it. I do a different rotation every month, learning all the various disciplines and skills within cardiology that I listed above. Here is my schedule this year:

July: Heart Failure
August: Inpatient/Consults
September: Consults
October: Consults
November: Electrophysiology
December: Nuclear cardiology
January through March: Cardiac catheterization (learning to put plastic tubes "catheters" into the heart to look for blockages, or to make measurements, or to take certain xrays of the heart)
April: MRI
May: Echocardiography
June: Electrophysiology

I really enjoy what I do. The key to Internal Medicine, and to a subspecialty like Cardiology, is that I get really good at diagnosing patients, and learning the skills to do various tests to help diagnose them. Then, I decide what treatment they need and how to get them better. And there are many procedures I can do to help them...everything except surgery! It is fascinating and there is always so much to learn. The only drawback is...the extra 3 years it takes to get through this!

Hope everyone is having a happy holiday season! This will be almost 5 years since I started this blog!

Alan