• training
• cardiology
• career

Cardiology remains an attractive specialty. In the UK for the 2017 application round, cardiology received the highest number of applications of all the medical specialties. At its peak in 2011, the competition ratio for a UK cardiology training number was 6.46.1 Due partly to an increase in training numbers (from 94 to 136), this has reduced to 2.65 in 2017,2 but it still remains a competitive specialty. What drives people to pursue a career in cardiology? To get a local sample of opinion, we surveyed first-year and second-year doctors at a busy London teaching hospital. As a topic, 64% of the 33 responders (80% female) thought that cardiology was interesting, but only 21% would consider applying to pursue it as a career. When asked to describe their perception of cardiology as a career, the most common descriptors were ‘interesting’, ‘difficult’ and ‘competitive’. To delve into why there might be a disconnect between interest in the specialty and desire to work in it, we asked how 11 factors that could be considered when choosing a specialty were perceived in relation to cardiology. The most positively rated aspects of the UK cardiology training pathway were opportunities for research, followed by fulfilment, earning potential and impressiveness to others. The most negatively rated aspects were competitiveness and inflexible hours.

These sentiments are reflected in national and international data. Questionnaire surveys of all UK medical graduates in selected years from 1974 to 2009 found that between 2.4% and 4.2% of cohorts aspired to cardiology as their first-choice career. Important factors were ‘enthusiasm/commitment’, ‘financial prospects’ and ‘experiences on the job so far’.3 Interestingly, this commitment declined in the years postgraduation (most markedly for women), and only 34% of this group went on to work in cardiology. However, only 24% of practising cardiologists had selected cardiology as their sole first choice in year 1 postgraduation, and there was a weak correlation between early choice and later destination for cardiology, suggesting that it is possible to attract and recruit candidates throughout their postgraduate clinical training, especially when they are able to gain a more practical understanding of what the career path entails.

In the USA, the perception of cardiology among medical trainees was perhaps more negative.4 In descending order of significance, there was a perception of adverse job conditions, interference with family life and a lack of diversity. As with our small sample of trainees, work–life balance (particularly stable hours and family friendliness) was a very important influence on specialty choice for all medical trainees and cardiology was negatively associated with this.

It is clear that cardiology remains an attractive and popular specialty. Trainees desire a career that is enjoyable and fulfilling, and a career in cardiology can certainly provide. While the acute nature of our specialty requires out-of-hours work and procedural competencies demand many hours of practice, we must seek to find a balance so that we can continue to attract the brightest and the best.