By Becky Nicholson MRCVS
Cardiology is a much-needed sub-discipline of veterinary internal medicine. Auscultation of the heart should be performed on every clinical examination. From puppies and kittens to geriatric patients, heart disease happens. Correct and early diagnosis is vital in preserving patients’ lives and quality of life. General practice vets, understandably, have limits to their expertise, hence the high demand for veterinary cardiologists at the referral level.
Training to be a cardiologist is competitive. There are currently relatively few specialist cardiologists to meet demand, but with limited opportunities in recognised cardiology training programmes, completing postgraduate qualifications can be tricky. However, if cardiology is your area of interest, the cases are there, jobs are available, and there is a clear path you can follow. If you’re interested in learning more about available Cardiology jobs, why not register with The Vet Service and explore your options? If you are not yet a specialist, we provide a range of options, including graduate vet jobs.
So, how do you become a cardiologist?
Becoming a Specialist Cardiologist
The highest tier of qualification in veterinary cardiology is to become a board-certified specialist. Achieving this status has a clearly defined path.
Those aspiring to cardiology specialist status must be veterinary surgeons (somewhat obviously). The next step is to complete an internal medicine internship. This is usually a one-year commitment, rotating departments in a reputable institution, preferably a university (although a large, private, multidisciplinary hospital may be acceptable).
Following successful completion of an internship, candidates must obtain a place on a cardiology residency programme. The residency must be recognised by either the European or American College of Veterinary Internal Medicine (ECVIM or ACVIM, respectively). There is no separate specialist college for cardiology in the US or Europe, so it is recognised as a specialist discipline under the banner of internal medicine.
Places on cardiology residencies recognised by the ECVIM or ACVIM are extremely competitive. Completion of a PhD or research year before applying for a residency is desirable to gain an advantage at the application stage.
Residencies are usually 3 years, but some recognised by the ACVIM are 2- or 4-year courses.
After two years on a residency programme, candidates will be required to sit the ECVIM or ACVIM general internal medicine exams. On successful completion of these exams and the remainder of the residency, candidates are close to being ‘board-eligible’. Candidates must also satisfy additional criteria – published research, a minimum set time spent on clinical work, and completion of other non-clinical commitments – to be fully ‘board-eligible’. The board-eligible status allows individuals to sit the specialist college exams in cardiology and, on successful completion, become ‘board-certified’.
Due to the difficulty of obtaining a place on an ECVIM recognised residency programme, it is possible to apply for an ‘Alternative Residency’. This is a “postgraduate training programme that has been tailor-made and approved for an individual” (as described by the European Board of Veterinary Specialists (EBVS)). At present, any Alternative Residency must satisfy the same criteria as a pre-approved residency programme in terms of time spent under the supervision of a specialist, research, and non-clinical learning. The application process is probably easiest when conducted through an academic institution.
Obtaining approval for an Alternative Residency can be challenging and takes time. The EBVS recognises the demand for veterinary cardiologists and the lack of supply – so is, therefore, trying to make Alterative Residencies more accessible. A more modular route to specialisation with less direct supervision is being discussed. However, the ECVIM are yet to vote on this proposal, so there are no guarantees it will become a reality anytime soon.
The ACVIM Is not currently offering Alternative Residencies as a route to specialisation – perhaps with a higher number of academic institutions offering ACVIM-recognised residencies, an alternative is less obviously required.
Advanced Practitioner Status in the UK
The Royal College of Veterinary Surgeons (RCVS) in the UK introduced the accreditation status of Advanced Veterinary Practitioner (AVP) in 2014. It is possible to become an AVP in cardiology. This is a middle tier between veterinary surgeons and board-certified specialists. This tier of training and recognition allows vets to demonstrate a more in-depth level of understanding than their non-AVP colleagues, without meeting the full expertise and requirements of a specialist.
Applicants for AVP must have a minimum of 5 years of clinical experience and a relevant postgraduate qualification. Relevant qualifications include the RCVS’s CertAVP, the ‘old style’ RCVS certificate – awarded up to 2012, postgraduate clinical qualifications awarded by universities or recognised awarding bodies, or relevant clinical postgraduate master’s degrees.
Once practising as an AVP, individuals must complete 250 hours of Continuous Professional Development (Veterinary CPD) with at least half of those hours being in their designated field.
The AVP status makes it possible to practice veterinary cardiology to a high standard and make this a key focus of your career, without pursuing specialist status. Most referral centres will seek to employ specialists as clinical leads, but CertAVP holders and AVP status vets are employed widely in top-end cardiology practices accepting referral cases.
The main path to a career as a veterinary cardiologist is clearly defined at present, with little flexibility – internship, approved residency, specialist college exams.
Due to the competitive nature of approved residency places, some post-internship time spent in relevant research or in completing a PhD is a wise (and possibly necessary) addition.
Any preparation undertaken pre-internship can only help lubricate the pathway to a residency place. For example, completing externships in academic centres or large hospitals with good cardiology credentials could provide useful contacts in the field of cardiology and demonstrate a certain level of commitment.
If approved-residency placements are too tricky to obtain, applying for an individualised ‘Alternative Residency’ is also an option via the ECVIM. This process may become more flexible and accessible in future.
If specialist status proves too tricky, the middle-tier status of AVP, offered in the UK, is a great way to focus your career as a cardiologist and practice to a high standard in your chosen field.
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