So You Want to Be an Interventional Cardiologist


So you want to be an interventional cardiologist. You love doing procedures and have the ego of a surgeon, but don’t want to go through the hassle of surgical residency. Let’s debunk the public perception myths of what it means to be an interventional cardiologist and give it to you straight. This is the reality of interventional cardiology.


What is Interventional Cardiology?

An interventional cardiologist is a cardiologist who has completed additional training in minimally invasive procedures of the heart. Unlike surgeons, these procedures are typically performed in a cardiac cath lab instead of an operating room and involve live x-rays, contrast dye, and specialized equipment.

Historically, the field of interventional cardiology has been limited to the treatment of coronary artery disease with balloons and stents; however, it has since evolved to include much more. Although coronary artery stenting continues to be the bread and butter of interventional cardiology, their scope is now much broader.

There have been significant advances in the treatment of coronary blockages. Specialized tools now exist allowing interventional cardiologists to break up calcium deposits to improve outcomes and take high-resolution images from within arteries to optimize interventions. There are even a variety of percutaneous mechanical heart pumps now that can temporarily keep a patient alive if the heart is failing from a heart attack or shock.

One of the more commonly used devices is the Impella left ventricular assist device. This device is inserted through the femoral artery into the left ventricle of the heart and uses a motor to pull blood into the ascending aorta. This allows the heart to rest while the device circulates blood to the vital organs of the body.

An intra aortic balloon pump is another less powerful device that sits in the aorta and pumps in sync with the heart. Then there is ECMO, which is essentially an external temporary heart-lung machine used in extreme cases.

Interventional cardiologists’ scope extends beyond coronary artery disease as well. There are a variety of innovative devices and therapies that allow interventional cardiologists to treat a wide spectrum of issues involving the heart and vascular system. They can perform heart valve repairs and replacements, repair structural defects in the heart, and place a variety of other cardiac implantable devices.

It should be noted that interventional cardiologists are not the same as cardiothoracic surgeons. Cardiothoracic surgeons are trained via surgical residencies and perform much more invasive procedures than interventional cardiologists – most notably, open-heart surgeries. That being said, as the field of interventional cardiology has evolved, there are now more collaborative procedures than ever before.

Hospital-Employed vs Academic vs Private Practice

This brings me to an important method of differentiating an interventional cardiologist’s practice: academic versus hospital-employed versus private practice.

Interventional cardiologists working in hospital-employed positions can expect to spend more dedicated time in the cath lab doing procedures and less time doing general cardiology.

Interventional cardiologists working in academia will further split their time between research, teaching, and other academic responsibilities. Large academic centers also tend to have a high volume of specialized and complicated patients such that there is a constant need for the expertise and specialization of an interventional cardiologist.

In private practice, the majority of an interventional cardiologist’s time will be spent doing both procedures and general cardiology as volume and production are what drive private practice revenue.

There are often more general cardiology duties involved in private practice compared to academic or hospital-based positions. This means in addition to procedures, there are often inpatient rounds, office patients, and reading imaging studies.

That being said, the balance between procedure time and general cardiology can vary significantly between practices.

Interventional cardiologists working in private practice tend to have higher average compensation than their colleagues in academic or hospital-based settings.

There is also more of a demand for interventional cardiologists in rural areas as opposed to major metropolitan ones, so the compensation tends to be higher the more rural you get. That being said, as the infrastructure of healthcare continues to change, so do the compensation models.

Misconceptions About Interventional Cardiology

Let’s clear up some of the misconceptions about interventional cardiology.

A common stereotype about interventional cardiologists is that they are all workaholics with very poor work-life balance. Although it should not be considered a “lifestyle” specialty, not all interventional cardiologists work terrible hours or are constantly on-call.

There are many different types of jobs out there where you can have a decent quality of life depending on what you prioritize. The on-call obligations are also highly variable across different hospitals with some being much more relaxed than others.

Another common misconception is that all interventional cardiologists are cocky and have big egos. Although they may not be in their best mood when you wake them up at 3 AM to come in and do a procedure, a lot of interventional cardiologists are much more thoughtful and approachable than you might think.


How to Become an Interventional Cardiologist

To become an interventional cardiologist, you must first complete 4 years of medical school, followed by 3 years of internal medicine residency, 3 years of general cardiology fellowship, and 1 year of interventional cardiology fellowship. Some residents may also choose to do an optional chief resident year after internal medicine residency to increase their competitiveness for cardiology fellowship.

Speaking of competitiveness, cardiology is consistently ranked as the most difficult internal medicine fellowship to get into. High board scores, extensive research, and impressing your seniors and faculty in residency are imperative for those wishing to pursue this career.

As for the type of medical students who typically go for interventional cardiology, they tend to be those that are very studious and ambitious; the ones that are regularly accused of being gunners, overachievers, and workaholics. They also yearn for immediate satisfaction, are excited by cutting-edge technologies, and love working with their hands, although perhaps not as much as surgeon personalities.

They also tend to be the students that thrive in high-stress situations and enjoy the challenge of taking care of some of the sickest and least stable patients in the hospital.


Subspecialties within Interventional Cardiology

For interventional cardiologists who believe that 4 years of fellowship after internal medicine residency isn’t punishment enough, there are a few additional 1-year fellowships to further subspecialize.

Interventional cardiologists desiring further specialization in the treatment of coronary artery disease can complete a year of additional training in advanced stenting procedures and learn specialized high-risk techniques to treat conditions like chronic total occlusion.

Those that want to specialize in valve interventions and repair of structural issues such as atrial septal defects and left atrial appendage closures can complete an additional year of training in structural heart procedures.

Lastly, those that are interested in vascular procedures such as lower extremity revascularization, carotid and subclavian stenting, abdominal aortic aneurysm repair, DVT and PE thrombectomy, and IVC filter placement, can complete an additional year of training in these procedures.

It should be noted that in the US, there is some overlap between interventional radiology and vascular surgery; however, it is still fairly common for interventional cardiologists to perform vascular procedures.

It should be noted that in the US, interventional cardiology has some overlap with interventional radiology and vascular surgery; however, it is still fairly common for interventional cardiologists to perform vascular procedures. That being said, it is less common in other countries.


What You’ll Love About Interventional Cardiology

There’s a lot to love about interventional cardiology.

To start, the bread and butter of interventional cardiology is coronary artery stenting for heart attacks which often offers immediate gratification. You can save the life of someone on your table within minutes by threading a catheter through a tiny hole in their wrist and opening up an occluded artery in the heart. There are few specialties where you can have such a profound life-saving impact in such a short amount of time.

Compensation is also on the higher end of the spectrum. The median salary for interventional cardiologists varies by geography, and lies somewhere between $450,000 to $500,000 per year, with top earners exceeding $750,000. That’s the highest of any non-surgical specialty.

Cardiology is also one of the most heavily researched fields and with all the money and resources poured into it, it’s rapidly evolving.

Another advantage is that as an interventional cardiologist, you are still a fully-trained cardiologist. This means that you can often find a position that balances your desired clinical interests and work-life balance.

If you ever get to the point where you can’t tolerate wearing lead aprons and standing long hours each day performing procedures, you can take comfort in knowing that you can still fall back on general cardiology which is less physically demanding.

Lastly, heart disease continues to be the number one cause of mortality with no sign of slowing down. As unfortunate as this is, it also means that there will always be plenty of demand for interventional cardiologists.


What You Won’t Love About Interventional Cardiology

While interventional cardiology is an awesome specialty, it’s not for everyone.

With a total of 7-8 years minimum of additional training after medical school, depending on whether you opt for an additional chief resident year, becoming an interventional cardiologist is one of the longest training paths in medicine.

The rapidly evolving nature of the field also means that you will have to stay up-to-date on the most current literature and understand how to analyze clinical trials and research papers well. While many love the excitement and innovation of a rapidly evolving field, you might not be as enamored by the work it takes to keep on top of new developments.

In addition, the lifestyle of an interventional cardiologist is often more demanding than most specialties. If you’re on STEMI call, for instance, you will regularly have to come into the hospital in the middle of the night for urgent procedures. Even for the most experienced physicians, being called in at 3 AM on a weekday when you work the next day is always tough.

Interventional cardiology is more physically demanding than many specialties as well. Having to wear heavy lead aprons and stand all day doing procedures can physically wear on you over time.

It’s also a specialty that deals with very sick patients. As such, it is inevitable that you will have challenging cases and complications occur. Despite your best efforts, there will still be times when patients die on you, and those family conversations are never easy.


Should You Become an Interventional Cardiologist?

How can you decide if interventional cardiology is right for you?

If you love practicing medicine and are willing to dedicate the time and effort to treat the most important organ in the human body, interventional cardiology might be for you.

You should be okay with the occasional sleepless night and nontraditional work hours if it means having the opportunity to treat the patients who need you most.

You should thrive in high-stress situations and have the mental fortitude to accept the complications and bad outcomes that come along with treating very sick patients.

You should also have some degree of physical stamina as wearing lead aprons and standing still all day performing procedures can wear on you.

Lastly, if you enjoy working with your hands and doing procedures but don’t want to become a surgeon, interventional cardiology offers a great balance between clinical medicine and procedures.

Are you hoping to become an interventional cardiologist? To get into medical school, match into internal medicine residency, and get into a cardiology fellowship, you’ll need a rock-solid application, not only with test scores but the soft components as well.

As you look at resources and companies to work with, seek out those who are actual M.D. physicians, not Ph.D. or other types of doctors that didn’t go to medical school. Look for those who have achieved stellar results themselves, a track record of success with positive ratings from customers, and a systematic approach so you know you’ll always receive high-quality service. If you decide on Med School Insiders, we’d love to be a part of your journey in becoming a future physician.

If you enjoyed this article, be sure to check out So You Want to Be an Internal Medicine Doctor or another specialty in our So You Want to Be Series.


Leave a Reply