Cardiac Rhythm Management - Industry Advice

Understandable. CRM and especially EP reps are not going away any time soon, but if for some reason they do... CRM/EP are undoubtedly the most challenging and technical areas of the device industry. If you succeed and prove yourself here, you can easily switch to any other device industry.

Every single day is different. But a very rough example would be...

  • 7:30 - get to hospital, check the boards for add-ons, etc.
  • 7:45 - set up room with our mapping system.
  • 8:00 - patient on the table, nursing staff prepping the patient. Review chart, get an idea of what the arrhythmia is and patient's history.
  • 8:30 - ablation start. Ablations can take an hour and they can take 4 hours, depending on what it is. AVNRT ablations are usually short, a fib ablations can be long. We run the mapping system while the EP manipulates the catheters. Using the catheters we create a shell of the appropriate chamber, can create a timing map of the arrhythmia to show what it is, and then assist with the burning of the appropriate area (very rough description). Sounds easy, but the level of understanding of EP and competency on the system to be able to do this successfully are far beyond what you would ever expect. And some EPs rely heavily on the mapper to help with the case.
  • 11:00 - ablation over, break down system.
  • 11:30 - leave for pacemaker implant at another hospital.
  • 11:32 - get called back to the last hospital to check a patient's pacer on the floor.
  • 11:45 - check patient. they were in for stomach pain but we had to check the device anyway. everything looks fine.
  • 12:00 - get back to car and leave for pacer implant. now running late and stressing about getting there on time.
  • 12:15 - stuck in traffic.
  • 12:40 - get to hospital, throw a bunch of pacemakers and leads in your bag, run into the hospital. patient is already on the table. quick get changed into their scrubs, grab programmer and go into the room to program the pacer.
  • 12:41 - realize it's an ICD not a pacer. run out to car and get ICD product.
  • 12:45 - doctor scrubbing, run into room, program device, set up dictation sheet on computer, hand off appropriate product, case starts. in device implants your role is to assist with the placement of leads by testing that they are in a good location, you program the patient's device specific to their needs, and then do all device-based testing after the device is connected. The level understanding to be able to do this successfully is also beyond what you would expect.
  • 2:00 - case over.
  • 2:30 - grab a quick lunch.
  • 3:00 - get called to hospital 40 minutes away for a pacer check.
  • 3:45 - check patient, all good, leave printouts in the chart.
  • 4:45 - get to gym.
  • 4:46 - get called to another hospital for pacer check.
  • 5:30 - finish checking patient.
  • 6:30 - get back to gym.

Well that escalated quickly. But that's the extreme of what the days feel like sometimes. Other days you have one case or just a few checks and you can have the rest of the day to get administrative stuff done - but those days are infrequent. I'm on a team of around 15 people in a midwest city. Some territories are small with not much driving, some are huge with hours of driving. All the doctors are staff tend to be very nice if you know what you're doing. If you don't know what you're doing or screw up big in a case, you may be asked to not come back to that lab.

How often you are on weekend call depends on how many people are on your team. Some weekends you get pounded all weekend, and others you don't get a single call.

If you didn't get the impression yet, this is a stressful but hugely rewarding industry. At the end of every day I feel like I put in a good day's work and helped improve people's lives.

/r/Cardiology Thread Parent