Cardiologist

If you'd like to make a positive impact on the health and wellbeing of people whose lives are affected by illness of the cardiovascular system a career in cardiology may suit you

Cardiologists are doctors who specialise in diagnosing, treating and preventing diseases that mainly affect the heart and blood vessels.

You'll work with adult patients to treat ongoing, long-term illnesses or will respond to emergency, potentially life-threatening situations.

Conditions you will encounter include:

• angina
• arrhythmias
• cardiomyopathy
• congenital heart disease
• disease of the arteries
• heart attacks
• heart murmurs
• oedema.

As well as working to improve survival rates and quality of life, you'll also be involved with disease prevention.

Paediatric cardiologists work with children and this is a separate specialty.

Types of cardiology

Cardiologists can specialise in areas such as:

• adult congenital heart disease - managing heart disease or a heart defect you're born with
• cardiac imaging - managing valvular heart disease, aortopathy and cardiac tumours by reading and interpreting cardiac imaging, including echocardiograms, cardiac MRI scans, cardiac CT scans and nuclear cardiac imaging
• coronary disease and intervention - managing coronary artery disease, by performing advanced cardiac procedures such as stent placements in closed or diseased arteries, atherectomy and balloon angioplasty
• electrophysiology and devices - managing irregular heartbeats (cardiac arrhythmias) through medication and cardiac implantable electronic devices
• heart failure - managing disorders of the heart muscle, pericardium (fibrous sac that surrounds and protects the heart muscle) and pulmonary (lungs) vasculature.

If you're more interested in the science behind cardiology, you could pursue academic opportunities in the field of research.

Responsibilities

As a cardiologist you can expect to:

• treat patients by reviewing and understanding their medical backgrounds and examining them to assess their current condition and health
• look at and employ ways of preventing, diagnosing and treating a range of heart-related problems
• carry out tests such as echocardiograms and interpret test results to measure how effectively the heart is working, which will help you to decide on the best method of treatment
• perform specialist procedures, such as cardiac catheterisation, to help diagnose and guide treatment of a variety of heart conditions
• carry out a range of advanced interventional or surgical cardiac procedures, such as coronary artery bypass surgery, stenting or coronary angioplasty
• prescribe medication to patients to help treat a range of cardiac illnesses
• provide ongoing support and advice to patients under long-term care
• work effectively in a multidisciplinary team, collaborating and liaising closely with colleagues
• provide support and advice to colleagues working in other specialities
• practise governance and audits within your department
• complete administration, which can include anything from accurately recording patient interventions and referrals to overseeing budgetary information
• teach and provide educational support and training for junior staff
• carry out clinical research in your area of interest
• be at the forefront of trialling breakthrough treatments and medication developed by pioneering research.

Salary

• As a junior doctor undertaking foundation training, you will earn a basic salary of £29,384 to £34,012.
• Salaries for doctors starting specialist training (early career cardiologist) are between £40,257 and £53,398.
• A speciality doctor can expect to earn a basic salary of between £50,373 and £78,759. Salaries for specialist grade doctors range from £80,693 to £91,584.
• As a consultant cardiologist your basic annual salary will range from £88,364 to £119,133, depending on length of service. Consultants may apply for local and national National Clinical Impact Awards (NCIAs) (England and Wales). You may be paid more for taking on extra management or education responsibilities, for example. You can also supplement your income by working in private practice.

As well as a basic salary, doctors in training earn extra for any hours over 40 per week, a 37% enhancement for working nights, a weekend allowance for any work at the weekend and an availability allowance if they are required to be available on-call.

Figures relate to the pay and conditions of medical doctors within the NHS - the largest employer of cardiologists in the UK. Consultants working in the private sector can expect to be paid more.

Income data from NHS Health Careers - Pay for doctors. For salary figures in Scotland, Wales and Northern Ireland, see the BMA website.

Figures are intended as a guide only.

Working hours

Cardiologists can work long and sometimes unsocial hours, including weekends and nights (usually on a rota basis). Many roles involve being on-call for certain periods.

What to expect

• Working as a cardiologist requires high levels of skill, knowledge and resilience. The work can be pressurised and time-critical in some instances (for example, carrying out surgery or emergency situations), and you'll often work long hours in a busy environment.
• As a practitioner, you'll usually be based in a hospital. Cardiologists following an academic or research career are more likely to be based in a lab environment.
• You'll work as part of a multidisciplinary team, including cardiothoracic surgeons, cardiac physiologists, diabetologists and specialist nurses, as well as staff within nuclear medicine and radiology imaging.
• Organisations such as the British Cardiovascular Society are actively looking to increase the numbers of women training in cardiology.
• Cardiology is likely to take you to some emotional highs and lows. On the one hand, you can be working with patients in some very difficult medical situations such as end-of-life care, but on the other, you can save lives and help people recover from potentially life-threatening illnesses.

Qualifications

To qualify as a cardiologist, you'll first need to complete a degree in medicine recognised by the General Medical Council (GMC). This usually takes five or six years to complete. However, if you've already got a degree in a subject other than medicine (normally a 2:1 or above in a science-related subject), you can apply for a four-year accelerated graduate entry medicine programme (also known as the Graduate Entry Programme). The British Medical Association has further information about applying to medical school as a graduate.

You'll then go on to complete the UK Foundation Programme. This two-year, work-based training programme bridges the gap between medical school and specialty training. During this time, you'll work in hospitals as a junior doctor on a rotational basis in different departments, developing your clinical and professional skills. Try, if possible, to do rotations in areas relevant to cardiology. On successful completion, you'll be awarded a Foundation Programme Certificate of Completion (FPCC).

You must then apply for the first stage of specialty training - internal medicine Stage 1 training. This can be either:

• Internal Medicine Training (IMT) - three-year programme
• Acute Care Common Stem: Internal Medicine (ACCS-IM) - four year programme.

For more information on how to apply, see IMT recruitment.

This training prepares you for managing patients with acute and chronic medical problems in both outpatient and inpatient settings. During this time, you must also achieve MRCP(UK) from the Royal College of Physicians (or equivalent) to show you have the required knowledge and skills.

You will then apply for specialty and internal medicine Stage 2 training. This training consists of five years of dual training in cardiology and general internal medicine. The core cardiology training is organised around five themes and you'll need to train to an advanced level in one of these themes later in your training. As part of specialty training, you must pass the European Exam in Core Cardiology (EECC).

Speciality training is competitive and there may not be enough posts for all applicants, even if they've met the required standards.

At the end of this training you'll receive a Certificate of Completion of Training (CCT) and will be eligible for entry on to the GMC specialist. You can apply for consultant positions six months prior to gaining your CCT.

See hospital doctor for full details on the qualifications and training required to be a doctor.

Skills

You'll need to be:

• calm in stressful situations and able to make effective decisions
• focused on attention to detail in mentally complex situations
• comfortable working in a fast-paced and pressurised environment
• a good problem solver with diagnostic and analytical skills
• an excellent communicator who is able to manage relationships with patients, their families and colleagues
• confident in your skills, knowledge and ability
• assertive and a good motivator and leader
• able to work with a multidisciplinary team
• extremely organised with excellent resource and time management skills
• persistent in the face of challenges
• emotionally resilient when working in challenging situations
• flexible in your approach to work and able to adapt quickly to changing priorities.

Work experience

Before applying to do a medical degree you're expected to undertake work experience, either paid or voluntary, in areas relevant to medicine. This could be through work experience at your local hospital, doctor's surgery, mental health trust or nursing home, or through work shadowing a doctor. This experience shows your commitment to becoming a doctor and provides insight into the physical and emotional demands of working in medicine.

Consider joining your university's cardiovascular student society to keep informed about developments in the field. You could also take a student-selected module, project and elective in cardiology as part of your undergraduate medical degree.

During your two-year Foundation Training as a junior doctor, try to choose a cardiology placement to gain an insight into the work. Also, make the most of networking opportunities by attending cardiology conferences and events.

Find out more about the different kinds of work experience and internships that are available.

Employers

The largest employer of cardiologists in the UK is the NHS, although there are also opportunities in private clinics, universities and academic institutions, the armed forces and national governing bodies.

Academic cardiologists can also expect to find positions within the NHS, universities, academic institutions and the private sector (such as large medical health and pharmaceutical companies.)

As a cardiologist you'll also have excellent opportunities to work abroad.

Look for job vacancies at:

• BMJ Careers
• NHS jobs - England and Wales.
• NHSScotland Jobs
• Jobs.hscni.net - Northern Ireland.

Specialist recruitment agencies also handle vacancies for doctors.

Professional development

You'll be expected to continue learning and developing throughout your career. This is essential given the rate at which medical developments and scientific research lead to changes in all aspects of medicine, and is essential for remaining on the GMC register.

This learning can take many different forms, including:

• taking further training to specialise in procedures such as pacemaker lead extraction or structural and valvular heart disease intervention
• undertaking a piece of relevant research
• attending developmental activities such as conferences, exchange events and workshops.

Further information on professional training and development is available from professional bodies such as the British Cardiovascular Society and the British Cardiovascular Intervention Society (BCIS).

Career prospects

As a recently qualified cardiologist, you'll build on your experience and will continue to develop your chosen area of specialty. There is also the opportunity to specialise in new areas such as cardio-oncology or inherited cardiac conditions. During this time, you will also develop your leadership and management skills.

As you progress, you can expect to receive higher salaries and have more opportunity to take on senior-level management roles within hospitals. Management roles include clinical lead, clinical director and medical director. You will also usually be involved in the training and supervision of medical students and junior doctors.

As an academic cardiologist, you'll have the opportunity to engage with pioneering research, which can have a significant impact in the field (this could be prevention, intervention, medical or surgical). You will develop both your research and teaching skills, with the opportunity to blend academia and education within your portfolio.