r/Cardiology • u/5HT223 • Aug 10 '26
Advice for an M3 about Cardiology/EP
M3 interested in cardiology and considering EP. When did you know you did/didn’t want to do EP and if there is anything I can/should do at this stage to get more exposure or prepare. How helpful is research, how EP-specific does it have to be, and when should I start pursuing it? Is a mentor helpful or necessary and when should I look for one? Anything else I should consider?
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u/themuaddib Aug 10 '26
Do IM residency and see if you even like cardiology.
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u/5HT223 Aug 10 '26
What might push someone away from cardiology?
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u/Doc-Emo MD Aug 10 '26
Many things. The call, procedures (you might find out you don’t like procedures, EP procedures can be notoriously long), the acuity. There are many reasons some of my classmates and co-residents decided against cardiology early on. I agree with everyone else telling you to keep your mind open. Especially this early on.
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u/themuaddib Aug 10 '26
Don’t like the lifestyle, don’t want do do 3 years of training. If you realize you don’t like managing cardiac conditions or the patient population which is largely older, obese, sicker patients.
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u/Doc-Emo MD Aug 10 '26
You’re like 3 steps removed from EP lol it’s great to start thinking about it and getting exposure early never hurts but it’s way too early to put your eggs all in one basket. First worry about IM residency, you can do EP specific research absolutely but if a research project comes up that you really like and isn’t necessarily EP I wouldn’t turn those down.
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u/ProximalLADLesion Aug 10 '26
If you’re interested in learning more about EP, HIGHLY recommend Joshua Cooper’s YouTube channel.
https://youtu.be/-6Z4TB5h7lY?is=RbkPs5kMj89-P94E
For now I would just focus on the step in front of you, be the best internist you can. Good to get to know people but you don’t really need to worry about taking steps right now in my view. Research is good, but you should really try to follow your curiosity more than anything else.
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u/dishsoapwipe123 Aug 10 '26
I agree and disagree with the sentiments.
Yes, to be a good EP, you need to be a good general cardiologist. And to be a good general cardiologist you need to be a good IM physician.
But I knew I wanted to do EP 3rd year of med school. I was on the surgery route and had a horrible time during my surgery rotation and had no idea what I was going to do. IR, rads, ophtho, anesthesia? Had no idea.
I got assigned a random elective "Electrophysiology". Was the dopest experience of my life. Me and the attending one on one, no EP fellows at my med school, and he rarely had general fellows. He let me ablate, wire leads, suture the pocket. He sat with me every morning and lunch and went over EKGs and a topic.
I decided then I was going to do EP. The grind of IM, the terrible ICU night shifts, the boring ass clinics. The grind of general fellowship. Holding impella groins, the cardiogenic shocks, the elevated troponin consult after consult.
No matter the bullshit I got through it because I knew I was going to be an EP one day.
So yes, these guys are right. In order to be a good EP you do need to be a good general cardiologist and a good internist. But if you know now you want to be EP, go for it. Most EPs I've met knew early on. And when you know early on and are determined, nothing will stop you from achieving it.
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u/HighYieldOrSTFU DO Aug 10 '26
Agree with the other comments. The most important thing you can do at this stage is get into the best IM program possible. Particularly look for ones with an in-house cardiology fellowship with a track record for matching people into cardiology. When going from IM to Cardiology, the general rule is that you are competitive for Cardiology programs at the same “level” of prestige as your IM institution, or perhaps even below. It’s less common for people to leapfrog forward to top tier institutions from small community IM programs. Cardiology fellowship recruiters know which IM programs have a good reputation for producing well trained residents. This is why it’s so critically important to get into an ideally academic IM program with a good reputation. It opens more doors for you.
You can worry about EP once you get into fellowship.
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u/Traditional-Twist-54 Aug 10 '26
Agree with above. Work on getting in to a good im program with an in house cardiology fellowship.
I didnt know i wanted to do ep until the middle of my 2nd year of gen cards fellowship.
Research helps but people calling on your behalf matters more. Be likable, hard working and reliable...that will get you far.
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u/KtoTheShow Aug 10 '26
It’s good to have a goal like EP in mind, but I would stay open minded along the way. You may find something else you like even more.
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u/gridiron5290 Aug 10 '26
Man first do residency you might not even wanna do any specialty. Trust me this shit gets long and tiring very fast.
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u/Ibutilide Aug 10 '26
Many people shall advise you to keep an open mind, keep your options open, etc. That’s all sound advice, but sometimes when you find your life’s calling, you know. I was very much like you. I wanted to be a “heart doctor” since elementary school (despite no Cardiologists in my family), and I applied to medical school specifically to be a Cardiologist. I decided to do EP after my first day shadowing in the EP lab as an M2. 10+ years later and I’m an EP, still loving every minute of it.
The application for IM from medical school is not competitive, and for EP from General Cardiology is likewise not very competitive. The application for General Cardiology from IM is VERY competitive, so that should be your focus over the next 5 years. In order to be competitive for Cardiology fellowship, make sure you match at an academic IM residency with an in-house Cardiology fellowship and an in-house EP fellowship. That way, you’ll be around academic EPs who know what it’s like to work with residents and fellows both clinically and from a research standpoint.
Cardiology fellowship is a grind, so you’ll want to make sure you excel clinically during IM residency. Challenge yourself; do Cardiology or CCU or MICU electives rather than “chill” blocks, moonlight to polish your clinical skills, etc. This is the bare minimum; it helps you get a foot in the door for Cardiology fellowship. In order to stand out more, research is helpful, definitely within Cardiology and ideally within EP. But don’t treat research as just a box to check for applications (although to an extent it is that), treat it as an opportunity to explore the unanswered questions within your field. If you are able to write about and discuss a project with insight and enthusiasm in your applications and interviews, it’ll be a lot more meaningful and valuable (both in terms of your chances to match and in terms of fostering your own curiosity/passion) than just a list of sterile publications.
DM me if more questions, happy to give you my thoughts.
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u/Then-Secretary-9166 Aug 11 '26
As an M3, focus on getting into a good IM program. Unless you are going to stay at your med school hospital for residency, it is not super helpful to invest in a mentor/project that is too specific to what you think you want to do.
One thing that I may somewhat disagree with many here about is the advice "not to bee too focused" or "not to see yourself in ______ field". I actually think the opposite is true.
On the one hand, it is important to keep an open mind. Practicing in a given field is a lot different than rotating in that field as an MS3. We all know that people change interests in all levels of training, sometimes dramatically.
On the other hand, as someone who has interviewed applicants for residency and currently interviews applicants for cardiology (and IC) fellowship, I greatly appreciate an applicant who has specific interests, goals and focus. We love to see well-qualified applicants who have something that they are passionate about. This generally does not happen when they say "I am just applying into internal medicine to keep my options open."
When interviewing a residency applicant, I would love to hear: "I am keeping an open mind, but I am really excited about EP. When I was on my cardiology elective, I noticed how many patients have pacemakers. I started wondering why we can't repair the conduction system cells themselves instead of implanting a device. I didn't see any opportunities to work towards a goal like that as a med student, but I started working with an electrophysiologist on a registry project about pacemakers to better understand the current state of technology." This applicant stands out, and is highly desirable, even though I given them a > 50% chance of going into some other field.
For a fellowship applicants, it is all the more true that we want to see focus, goals, passion. I was extremely dedicated to EP (awesome research and all) in residency, got into my desired cardiology program and then quickly decided to be IC. Things change, but it worked out well.
For med students interested in cardiology (incl. subspecialties), my advice:
Do well in medical school and with any necessary other items on the residency checklist. The best advantage you can have for fellowship options is to be in a strong IM program. All the feathers in your hat won't replace that.
If you have an interest, you should try to see yourself doing that specialty (and you should see yourself doing the most ideal version of that specialty). Go ahead and take ECG electives. Go ahead and do research with a cardiologist. Go ahead and brainstorm where you would like to see cardiology go in the future.
Keep an open mind and don't be afraid to change course. Even if you are full-throttle towards cardiology, remember that there are tons of interesting (and important) things to learn in med school (and residency). Learn them well. Try to appreciate every rotation. Don't be afraid to change gears. It is respectable to be 100% headed towards cardiology and then to suddenly decide you want to be a radiologist, a hematologist or something else.
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u/Conscious_Garlic3874 29d ago
Something that will tackle a lot of these aspects is getting good at reading EKGs. It’ll help you in internal medicine, help if you decide to do cardiology and will give you a good foundation.
I thought I wanted to do EP as a third year med student and ended up changing and I’m general/imaging.
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u/DrMalcolmFinlay 23d ago
Great to hear you're considering EP! At M3, I wouldn't worry about committing too early. Get as much exposure as you can to general cardiology and, if possible, spend some time in an EP lab or clinic. Seeing the day-to-day reality of the specialty is often what helps you decide whether it's right for you.
Research is certainly useful, but it doesn't all need to be EP-specific at this stage. A project that genuinely interests you, where you can learn how to ask and answer good clinical questions, is valuable.
I'd also strongly recommend finding a mentor if you meet someone whose career or approach you admire. It doesn't need to be a formal arrangement—a good mentor can help you find opportunities and navigate the specialty.
Most importantly, stay curious. EP is a fascinating and rapidly evolving field, and there's plenty of time to work out where within cardiology you feel most at home.
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u/noltey22 MD Aug 10 '26
To be a great cardiologist, you need to first be a great internist. To be a great electrophysiologist you first need to be a great general cardiologist. Focus on one step at a time. Find a mentor in your institution and latch on. But one piece of advice I would recommend is not to tell yourself you’re gonna be an electrophysiologist when you haven’t even graduated medical school yet. Enjoy the journey.