The Role Of A Cardiologist
Cardiologists diagnose and treat adult patients with cardiovascular pathologies. Cardiologists engage in the management, and primary and secondary prevention, of cardiovascular disorders using medical and minor surgical modalities and clinical pharmacology, cardiac imaging and interventional skills. Examples of conditions managed by cardiologists are arrhythmias, cardiomyopathies, atherosclerosis, and myocardial infarction.1
Cardiologists jobs are typically based in hospitals – on coronary care units, general cardiology wards and out-patient clinics. They operate in conjunction with a multi-disciplinary team comprising, for example, specialist nurses, radiologists, and cardiothoracic surgeons. They liaise with primary care professionals to address comorbidities and rehabilitation. Personal skills requisite for cardiologists include communication, problem-solving, decision making, coping with pressure and managing uncertainty. The specialty benefits from extensive evidence base and pioneering preventative, diagnostic, and therapeutic approaches.2
Cardiologists may be employed by the NHS, private institutions, universities, armed forces, or other government departments. Additionally, there is significant opportunity for clinical research. In 2017-18, 13% of consultants in cardiology were women.1 Although cardiovascular diseases are prevalent, recently, job prospects in this specialty have been impacted by a surplus of trainees.
The specialty of cardiology is distinct from cardiothoracic surgery. Cardiothoracic surgeons perform major operations on the thoracic organs. Paediatric cardiology is another separate specialty.
A Typical Week
In a standard week, 75% of the activities performed by a consultant cardiologist centre on the clinical care of patients – such as ward rounds, outpatient appointments, and procedural lists – and laboratory work. This includes on-call duties, which are regularly undertaken at weekends by almost 70% of consultant cardiologists.
For example, an on- call pattern of 1:6 weekdays and 1:8 weekends may be followed. Other activities include liaising with primary care colleagues, teaching and clinical research.3 On average, cardiologists work no more than 48 hours per week, according to ‘Working Time Regulations 1998’.
The Route To Cardiology
The route to cardiology commences after successful completion of a medical degree and two years of foundation training. Subsequently, general medical training is attained. This can be Internal Medicine Training (IMT) stage 1 or Acute Care Common Stem (ACCS), which are three-year programmes. Both programmes feature several rotations across a variety of medical specialties; ACCS facilitates increased focus on acute medicine, emergency medicine, anaesthetics and critical care medicine in the initial two years. Application to these is through a form examining entry requirements, for example, core competence, clinical reference, and details of achievement in various areas – and an interview.
Entry to specialty training in cardiology is very competitive – in 2019, 426 applications were received for 127 posts available for cardiology ST3 in England.4 Trainees apply after passing the Member of the Royal College of Physicians of the United Kingdom (MRCP (UK)) examination.2 Specialty training in cardiology is typically completed in five years. Entry to this is competitive – the competition ratio for ST3 cardiology was 2.33 in England in 2016.1 Consequently, it is highly encouraged to pursue research towards attainment of an MD or PhD qualification. This increases the duration of the training period by a minimum of two years. The initial three years of specialty training are core training in cardiovascular medicine which facilitate the acquisition of acute medical and core cardiological skills.2
Subsequent to successful completion of a computerised knowledge-based assessment (KBA) in cardiovascular medicine – the European Examination in General Cardiology (EEGC) – trainees complete advanced specialist area modules in the successive two years. The choice of courses includes interventional cardiology, electrophysiology, non-invasive imaging, adult congenital heart disease and heart failure.2 Entrance to these modules may be via a competitive selection process. Finally, trainees are awarded a certificate of completion of training (CCT) by the General Medical Council. Applications for consultant posts can be made six months subsequent to attainment of a CCT.
Medical students interested to pursue a career in cardiology can attend cardiology conferences, join the British Cardiovascular Society (BCS) as student members and choose relevant topics for research projects. An associate group of the BCS is the British Undergraduate Cardiovascular Association which aims to support medical students interested in cardiology. An early decision on specialty choice may be of use and can be aided by careful observation and enquiries on clinical placements. Foundation trainees should attempt to secure full placements in cardiology or, if unfeasible, apply for taster experiences. It is useful to partake in audits and research.
Obtaining research experience is also beneficial for core and specialty trainees. Additionally, specialty registrars can join the British Junior Cardiologists’ Association (BJCA). BJCA also offer starter memberships for foundation and core trainees.1
Cardiologists may specialise in general cardiology however, increasingly, a sub specialised team model is employed. Jobs are often advertised for a consultant cardiologist with a special area of interest. Stroke medicine is a subspecialty with a distinct CCT.1 The five main cardiac subspecialties are interventional cardiology, adult congenital heart disease, cardiac imaging, electrophysiology and device therapy, heart failure management and interventional cardiology.
Adult congenital heart disease is a growing subspecialty in accordance with increased life expectancy of congenital heart disease diagnoses. It offers diverse cases, prolonged involvement in patient care and the opportunity to apply an array of approaches in cardiovascular disease management. Presently, job prospects are promising but may be restricted to specialist centres.5 There is increased on-call work – a consequence of smaller clinical teams. Cardiac imaging is a developing subspecialty which benefits from extensive investment. Cardiologists working in this subspecialty are proficient in imaging modalities. The workload and variety of cases differ between establishments.5 Electrophysiology and device therapy is a stimulating subspecialty which utilises problem-solving and interventional skills.
High quality practice is facilitated by a strong base in electrophysiological concepts and novel mapping, ablation and device modalities. Recently, this specialty has expanded in response to increased demand, however, job prospects are likely to plateau.5 Training is extensive and competitive. A postgraduate degree is requisite and subspecialty training may exceed two years. Heart failure is a gratifying subspecialty which allows practitioners to combine a range of disciplines to deliver complete management of cardiovascular pathologies, from diagnosis to end of life care.
There is opportunity to work in the community alongside secondary care roles. Job prospects are good and are predicted to improve. Lastly, interventional cardiology combines practical and decision-making skills to provide life-saving care and benefits from pioneering technologies and research. Contrastingly, on-call work is extensive which can severely impact work-life balance. Postgraduate research may be compulsory and an additional year of training subsequent to two years of subspecialty training may be completed. Jobs are very competitive.5
Other emerging subspecialties include inherited conditions, and cardio-oncology.1 Many cardiologists choose – and are offered opportunities – to progress research careers.
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849.6 Salaries can be further enhanced with NHS excellence awards.
Many cardiologists conduct private work alongside NHS jobs. There is major earnings potential in private practice; earnings may match or exceed the NHS salary. In 2018, on average, private cardiologists generated a revenue of £161,000, which is £105,000 after deduction of expenses.7 Only orthopaedics and radiology have greater private practice earnings potential on average.
The recommended starting salary of accredited consultants in the British Army is similar to that in the NHS. In 2017, this was £80,527.6
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The primary society for all professionals in the field of cardiovascular care and research is the BCS. BCS is affiliated with nineteen societies, for example, British Congenital Cardiac Association, British Cardiovascular Intervention Society and British Society for Cardiovascular Research, and three groups.
Additionally, alongside the British Medical Journal, BCS co-owns Heart – an international peer-reviewed journal. Key journals in cardiac and cardiovascular systems are European Heart Journal, Circulation and the Journal of the American College of Cardiology.
Additionally, numerous conferences are organised annually, including by the European Society of Cardiology and the American College of Cardiology. A key textbook is the ESC Textbook of Cardiovascular Medicine written in conjunction by over 1000 preeminent specialists and complemented by a digital version that is regularly updated.
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February 2020]. Available from: https://www.gmc-uk.org/education/standards- guidance-and-curricula/curricula/cardiology-curriculum
4. Working life (cardiology) [Internet]. Health Careers. [cited 28 February 2020].
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England; 2019 [cited 28 February 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%20201 9_1.pdf
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cardiology BMJ 2015; 351:h4485
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8. Independent Practitioner Today