"Choosing a post-fellowship career between academic or private practice cardiology is quite challenging, especially given the changing environment in either pathway," write Zaher Fanari, MD, and Sandra A. Weiss, MD, in a Fellows in Training and Early Career Page in the Journal of the American College of Cardiology.

They note that "the pursuit of a purely academic career is jeopardized by many obstacles, including prolonged training periods, expanding debt burdens, increasing discrepancies between academic and private practice salaries, difficulty regarding visa requirements for international medical graduates, and significant limitations of government funding for research."

Meanwhile, quality clinical care in the private setting is also "potentially compromised by physician burnout induced by the increasing cost of malpractice insurance, billing issues, increased documentation requirements, reimbursement and financial considerations, and challenges of work/life balance."

In a corresponding response, Spencer King, MD, MACC, writes: “training in cardiology should be pursued with an understanding of oneself, so as to prepare for the career that will be most rewarding. As the new COCATS recommendations aim for competence-based training, fellows should master those basic competencies while also preparing for the career they envision.

In this rapidly evolving health care environment, my advice is to pursue training for the kind of practice desired without excessive concern as to whether it is initially structured within an academic or private practice environment.” Read the full JACC article.