It is a fascinating and challenging specialty that appeals to those who want to make a difference. Most congenital heart conditions are treatable and the majority of children treated will survive to adulthood. It appeals to those who like using practical skills, needed for echocardiography and catheter intervention treatment and there is the opportunity to work in a high intensity multidisciplinary team. Longitudinal care from fetal life to adulthood also results in a high level of job satisfaction and it is just great to work with children.
Positive attributes that are helpful in Paediatric Cardiology include:
- good team working and "people" skills
- enthusiasm for the specialty
- an enquiring mind
- an ability to work under pressure
Paediatric cardiology is unusual in that trainees may enter the specialty from adult medical training or from paediatric training. Entry is therefore at ST4 level i.e. after 3 years of core paediatric training (ST1-3) or after 2 years of CMT training followed by acquisition of ST1 paediatric competencies, which usually takes a further year. It is advantageous for paediatric training to be undertaken prior to application for paediatric cardiology training by undertaking locum paediatric posts (LAT). For those who have not been able to gain this experience prior to application, some Postgraduate Medical Education (PGME) regions may be able to offer this training prior to commencement of paediatric cardiology training. However, this will delay entry to training and may be disadvantageous at interview or job application.
Paediatric Cardiology training takes 5 years with an initial 3 years of core training followed by 2 years of training in one or more special interest areas. These special interest areas are:
- cardiac catheterisation and catheter intervention
- cardiac pacing, electrophysiology and ablation
- fetal cardiology
- adolescent and adult congenital heart disease
- advanced echocardiography
- transplantation cardiology
- pulmonary hypertension
- advanced imaging (MRI and CT)
There are therefore many different paths that a trainee may take before becoming a consultant in paediatric cardiology and there are opportunities for everyone to find their "niche" that they enjoy with a suitable job prospect. Nationally there is a need to continue recruiting paediatric cardiologists as consultant numbers remain below optimum levels and there is a move to develop a smaller number of larger specialist surgical centres.
Applications to paediatric cardiology are managed by Wessex PGME.
Dr Robin (Rob) Martin, previously Training Programme Director
Paediatric and adult congenital (sometimes known as grown up congenital heart or GUCH) cardiology.
Current job title and grade?
Consultant Paediatric and Adult Congenital Cardiologist.
Bristol Royal Hospital for Children and Bristol Heart Institute for adult work.
What influenced you/made you decide to choose your specialty?
I became interested in cardiology as a medical student. It is always difficult to pin down why something interests you but I do remember being fascinated by heart murmurs and enjoyed the practical skill of working out what was wrong by using the stethoscope and other aspects of clinical examination. I also admired the approach of a senior cardiologist and he became an early mentor for me.
I initially trained in adult medicine and then concentrated on adult cardiology, moving to Harefield Hospital near London. I enjoyed the practical aspects of cardiology related to coronary work and pacemaker implantation but also faced a new challenge as the cardiology registrars were expected to look after the paediatric cardiology patients as well. I had no previous experience of looking after children so had never considered this as a career option but I quite quickly realised that paediatric cardiology was a fascinating specialty and I decided to change my course and formally train in the specialty. It was therefore serendipity that resulted in me ending up as a paediatric cardiologist.
What was your first experience in your specialty like? Did you hit it off immediately?
My first experience was as a medical student but at that stage I was not considering looking after children. As a cardiology registrar, having trained in adult medicine, my first practical encounter with paediatric cardiology was pretty daunting as I had to look after sick infants after cardiac surgery. I found this scary initially but as I became more accustomed to the smaller size of the patient I found the range of conditions that I was evaluating and treating to be fascinating.
When did you decide to change course?
I changed course at registrar level.
If so, what was your reason for changing your career path?
I enjoyed the challenge of the specialty. Each child presenting with heart disease is a diagnostic puzzle that needs to be solved. It is possible to diagnose quickly using a combination of clinical skills and investigations such as echocardiography. I enjoyed the problem solving aspects of the specialty and the hands on practical skills needed to undertake echocardiography and cardiac catheterisation.
It is also a privilege to work with children and their families and for most conditions effective treatment is possible. There is nothing better than seeing these children later develop their characters after going through a difficult and risky period when they were being treated. This contributes to the high levels of job satisfaction that can be gained in this specialty.
What rotations did you do in your training? What did you find helpful?
Paediatric cardiology has a 5 year training programme and is based in one of the teaching hospital children's heart centres. I trained too long ago for my training to be relevant for current trainees but I did manage to work in 3 different centres and this helps broaden experience. It is more difficult to train in different centres now but we do encourage trainees to obtain experience overseas and in research.
What training do you have to do to get in to paediatric cardiology?
Most trainees entering paediatric cardiology training do so after 3 years of core paediatric training i.e. entry is at ST4 level. We do also accept trainees from CMT (Core Medical Training ST1 and ST2) but they need to undertake a year in paediatrics before starting paediatric cardiology training at ST4 level.
Applications are accepted at ST3 level after 2 years of CMT but the paediatric experience needs to be gained (equivalent to ST3) before undertaking cardiology, so either the trainee will need to arrange this themselves in paediatric LAT posts or the PGME office may be able to offer it locally. However it is best for the trainee to obtain this paediatric experience before applying as the delayed start to paediatric cardiology training puts them at a disadvantage.
For those that want to train in adult congenital heart disease entry to training can be via years 4 and 5 of either paediatric cardiology or adult cardiology training.
Do you work closely with other specialties?
Team working skills are vital in paediatric cardiology. There is a very close relationship with congenital cardiac surgeons, paediatric intensivists and cardiac anaesthetists as the care of complex heart problems requires attention to detail and a clear understanding of each other's role.
There is also a need for close collaboration with cardiac radiologists, adult cardiologists and fetal medicine consultants and because children may have problems in other areas also with other paediatric specialties.
In what ways is your job satisfying?
It is great to work with children and one of the great pleasures of the specialty is that you look after patients from fetal life through to adulthood. One of my greatest pleasures is to see one of my patients towering over me when they come to my adult clinic and what I can remember is looking after them when they were a very sick infant.
Being in a small specialty is also satisfying because it is like being in a family and everyone seems to know everyone else and this is also the case for colleagues around the world.
What are the possibilities for your future career progression?
I have been a consultant now for 23 years so have already progressed my own career to a level where I am President Elect of our national specialist association. For those coming into the specialty there is plenty of opportunity to progress your career through clinical excellence, education and training and research.
What are your typical working hours? Are they sociable/family-friendly hours?
It is a high intensity specialty and paediatric cardiologists work long hours compared to some of the other medical specialties. Personally I start work soon after 8 and typically finish between 7 and 8. On call/ on service work is onerous with the occasional sleepless night dealing with a sick admission or post-operative case.
Others may be better at juggling their commitments than I am, but I do manage some family and sociable down-time. When you work in a high intensity specialty you do need to recharge your batteries from time to time to avoid burn out.
How much annual leave do you get?
Six weeks per year.
Are there opportunities for travel?
We encourage our trainees to gain experience overseas and many will undertake training in Canada, Australia or New Zealand. Those with USMLE may choose to spend time in the USA.
As a consultant there is ample opportunity to travel to international conferences, both in Europe and further afield. Every 4 years there is a World Congress which tends to be held in pleasant settings (next one in South Africa and previously Australia, Toronto and Argentina). Many centres also undertake charitable work in less developed countries, for instance in my own centre we visit Kenya, Trinidad and Syria on a regular basis.
Are there opportunities for teaching or lecturing?
Education has to be an important part of a consultant paediatric cardiologist's role as all centres are in large University Hospitals and there is always a need for local and international meetings.
Are there opportunities for research?
Again, being within a large University Hospital there is ample opportunity for research. Many trainees opt to spend a period in research to undertake and MD or PhD. In my own centre we have a nationally funded Biomedical Research Unit which undertakes a wide range of cardiovascular research.
What changes have you seen in your paediatric cardiology during your career?
We have all become more subspecialised and this means that you can concentrate on areas that particularly interest you. For instance, my main special interest is in interventional catheter procedures in children and adults with congenital heart disease and there have been major developments in the technology involved so that we can now close holes and replace heart valves without needing to open up the chest.
What is the required mix of skills for paediatric cardiology?
Good team working and communication skills are important. Many subspecialty areas are very practical and require good hand-eye coordination akin to a surgical specialty. You also need to be adaptable and resilient as this is a highly intensive specialty both from a physical and mental perspective.
Do you work closely with other healthcare colleagues or groups?
The cardiac team includes specialist nurses, cardiac physiologists, radiographers and psychologists, all of whom contribute to the holistic care of the patient.
Do you establish long term relationships with your patients?
Inevitably with the cradle to grave care that we offer you establish long term relationships with patients and their families.
Are there typical patient groups? What are they like?
We look after a very diverse population of patients and over a wide range of ages so nothing is typical in this specialty.
Does your job involve decision making?
Being a high risk, high intensity specialty it is very important to be decisive. One of the important attributes that is needed is the ability to synthesise complex diagnostic and management problems and then make a decision regarding the optimal management plan.
What are the best aspects of working in paediatric cardiology?
Every child is different and every day is different. I enjoy working in a large team of individuals who have mutual respect.
What are the main challenges of working in your specialty?
The challenges include the intensity of the work and the emotional challenge if treatment does not have the expected result and the child succumbs or has major incapacity.
How competitive have you found working in paediatric cardiology?
It is a competitive specialty to get into and I think most paediatric cardiologists are ambitious and competitive.
Is there a typical location for working in your specialty?
What other jobs, roles, societies, charities and working parties have you been involved in?
Many and varied including the British Congenital Cardiac Association, The British Cardiovascular Society, The Royal Colleges of Physicians and Paediatrics and Child Health, the Association of European Paediatric Cardiologists and the Children's Heart Federation.
What are your broader interests and pursuits?
I enjoy nature related tourism, gardening and quizzing.
What advice would you give to someone considering a career in your specialty?
Work hard and play hard.
What would you like to see in your junior doctors?
I like to see enthusiasm and interest.
What makes being a physician better than being a surgeon, GP or other career?
Paediatric cardiology has many similarities to a surgical specialty so is not a typical physicianly specialty. I would not want to put any other specialties down as all will have their own attractions.