u/BridgeQueasy1551

Going to be starting cards fellowship soon. Ultimate goal is starting my own practice. I already have a group of 5-6 friends going into cards also wanting to start their own thing. Since we are so early in the game, I wanted to ask what resources/conferences/networking opportunities I should pursue to give myself the best foundation to eventually open my own PP?

Plan is for all of us to negotiate first attending job aggressively for the best non-compete agreement we can find in a market like Texas, Florida etc to build patient base, save aggressively to get capital, and build reputation in community. My goal is ultimately have a set up where we have 2-3 general guys, 1-2 Interventional, 1-2 EP with ASC/OBL ownership and imaging equipment.

The biggest challenges I see to this plan are the following:

1. Negotiating payment agreements with insurance companies without leverage at the beginning. Possible solution is using a PE company that has negotiating power already but they take 25-35% of gross revenue. Is it better to start with less optimal payer agreements and renegotiate as practice builds? Or is the hassle not worth it?

2. Finding a geographic location that doesn’t already have a chokehold on the area (e.g. giant PE backed groups or big hospitals)

3. Medical billing: how difficult is it to learn how to do this optimally in house instead of outsourcing to a medical billing company that takes a large percentage?

4. Ramp up timeline : obviously we can’t build out an entire cath lab and ASC with millions of dollars of imaging equipment at the beginning. From my understanding it seems most logical to start with cheaper modalities like ultrasound and build out as practice grows. Not sure how this would work and what IC and EP guys would do in the meantime before building out cath lab other than taking STEMI call, rounding on hospital patients and doing mostly Gen cards work for the first couple years

What other roadblocks should I anticipate? What skills do yall recommend I focus on or things I should study up on during fellowship to make my dream a reality?

How feasible would it be to start a practice from scratch with our own capital?

Bear with me because there are a lot of unknowns and variables here.

Starting PGY1 at a T20 IM program with 400k in student loans. My fiancée is a soon to be 4th year medical student applying anesthesia with 250k in loans.

I am planning on going into Cardiology (most likely EP). With the trend towards more and more cardiac procedures being done in ASCs Id ideally like to either spend a few years building a patient base and setting up shop on my own with a few partners or joining a privately owned group. Obviously this is nearly a decade away and things change, but no matter what I’d like to never work academics or in a setting where I don’t have ownership of some kind. I know GI is probably a better bet for this but I simply can’t scope buttholes for a living and I love cardiology. I also know EP Is rolling out fast track programs at a lot of sites where I’d likely be competitive so training would (in a perfect world) be 7 years instead of 8 and my fiancée would (again in a perfect world) be an Anesthesiology attending well before then.

My question is do I PSLF and bite the bullet on working a non-profit for less money for a few more years post training instead of deferring my loans entirely and using that time to get on a partnership track where by the end of the 2-3 years I’d likely be in a much better position financially?

With interest my loans will be 650-700k total and PSLF would be a huge burden off my back but I’m factoring in the opportunity cost of being on a partnership track instead of wasting time at a job I wouldn’t want to stay at long term.

Cardio EP jobs are paying at least 750 from mentors I know and many clearing 7 figures in private practice. I’d assume non-profit jobs are Significantly shittier with less freedom and less pay (500-600?).

Any advice, please help me. This is quite literally a million dollar decision for me and I have no clue what to do.

Hi guys. I’m a DO incoming PGY1 at a T20 IM program. Step 2 score 265.

I have seen that my program has historically matched >15 people per year into pretty prestigious cards programs, but most of them seem to be MDs. I am not sure whether this is a reflection of less DOs applying to these places or bias against DOs who do apply. (Prob both?)

My question is: is this just survivorship bias or am I actually fucked if I wanna do cardiology not in the middle of nowhere? I would really like to be in a major coastal city for fellowship because I did medical school in the middle
of nowhere and my IM residency is in a decent sized city but not what I’m used to. (I grew up in NYC).

If I do some research and get some good mentors what’s my chances of matching at a decent cards program in a coastal city?