Cardiovascular Imaging: Radiology vs. Cardiology. Turf

[badasshairday]

Found some old articles. The 2003 article shows Radiologist doing 98.6% of Cardiac CT's and 91% of Cardiac MRI. How have things changed?

http://www.jacr.org/article/S1546-1440(05)00298-X/abstract

http://www.ncbi.nlm.nih.gov/pubmed/17411922

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[Radonkulous]

Bro, go into Interventional Cards. You seem very concerned about the ongoing turf war, which clearly cards has the upper hand in (unless you're interested in IO and other non-vascular procedures). No matter what anyone says, Cardiologists have control over both coronary and peripheral interventions as well as a lot of cardiac imaging. Plus, they have the patients.

 

[badasshairday]

Bro, go into Interventional Cards. You seem very concerned about the ongoing turf war, which clearly cards has the upper hand in (unless you're interested in IO and other non-vascular procedures). No matter what anyone says, Cardiologists have control over both coronary and peripheral interventions as well as a lot of cardiac imaging. Plus, they have the patients.

Not really that concerned, just interested in finding out more. CT and MRI of the CV system is pretty cool stuff.

 

[badasshairday]

(unless you're interested in IO and other non-vascular procedures).

Non-vascular procedures? Tell these IR's that. www.endovascularsurgery.com
Don't forget IR does a huge amount of PVD these days as long as you have a clinic like these guys. They do it all at programs like Miami Cardiac and Vascular Institute. Old school IR is over. Make way for the new generation.

I'd definitely do IO and PVD as the meat of my practice if I end up doing IR. And I'd definitely do a cardiovascular imaging fellowship interested me.

Anyways my interest in turf probably has something to do with my prior interests in other fields which have much worse turf issues than radiology.

 

[badasshairday]

(unless you're interested in IO and other non-vascular procedures).

Non-vascular procedures? Tell these IR's that. www.endovascularsurgery.com
Don't forget IR does a huge amount of PVD these days as long as you have a clinic like these guys. They do it all at programs like Miami Cardiac and Vascular Institute. Old school IR is over. Make way for the new generation.

I'd definitely do IO and PVD as the meat of my practice if I end up doing IR. And I'd definitely do a cardiovascular imaging fellowship if that interested me.

Anyways my interest in turf probably has something to do with my prior interests in other fields which have much worse turf issues than radiology.

 

[Radonkulous]

I remember you posting a graph once which showed cards did 50% pvd, rads 40%, and vs 10% or something similar to that. I like vascular disease in general so I'm having a tough time deciding which route I should take (I especially like cerebrovascular disease but it seems NSG have a lot of control over that).

 

[badasshairday]

I remember you posting a graph once which showed cards did 50% pvd, rads 40%, and vs 10% or something similar to that. I like vascular disease in general so I'm having a tough time deciding which route I should take (I especially like cerebrovascular disease but it seems NSG have a lot of control over that).

That chart was in 2006. In 5 years a lot changes, especially with VIR. I haven't found much new data but at my (academic) program they do all PVD. In private practice there are tons of busy IR practices who do a lot of PVD such as the link I shared above. In fact an orthopedic surgeon from the San Francisco Bay Area told me to do VIR over Vascular surgery because IR is taking over all of the PVD. It depends on the market, depends on the practice style. If you are going to be the IR of the old days waiting for people to send you good stuff, then say good bye to your PVD turf because Vascular Surgery and Cards will be all over that. Start a clinic, heck, hire/partner/work with vascular surgeons in your practice like those guys above to provide full scope PVD care including open surgery if needed. Those guys at endovascularsurgery.com are in the SF bay area and they both are trained in VIR/NIR and have a vascular surgeon (with wire skills) and a cardiothoracic surgeon (with wire skills) on staff.

Cerebrovascular is open to neuro/neurosurg/neurorads, just depends on which way you want to go. Same thing is true for NIR as it is for VIR, depends on location and the way you set up your practice.

 

[Radonkulous]

But don't you think cards has a distinct advantage of seeing the patient first, especially if the patient has PVD?

For example, how do you think this scenario would play out? An Interventional Cards guy enters the market where there is already a well-established IR practice that does a lot of arterial work. Do you the IC would begin to make a serious dent in the IR's practice?

 

[badasshairday]

But don't you think cards has a distinct advantage of seeing the patient first, especially if the patient has PVD?

For example, how do you think this scenario would play out? An Interventional Cards guy enters the market where there is already a well-established IR practice that does a lot of arterial work. Do you the IC would begin to make a serious dent in the IR's practice?

Of course there would be competition. But like I said, I'll refer to the endovascularsurgery IR's who are based out of San Jose, California which is a highly desired locale for doctors. There is an oversaturation of doctors in the Bay Area, so plenty of cardiologists, but these guys still have a very busy practice. They established a referral system with PCP's and get the patients straight from PCP's or patient self-referrals. Gvataken, the IR attending who posts on SDN from time to time and some of the other IR attendings (ie. irwarrior) who have posted here in the past have stated as long as you run a clinic you will get patients. It takes time to build a practice but it is doable.

I'm not going to lie, but I have seen a community program where the cards guys are very aggressive in PVD, and have basically taken all the peripheral work from IR. But in those cases the IR guys were not clinical, they did not admit their own patients nor run clinics. They were relegated to venous and other procedures outside the realm of the arterial system.

 

[NappingGuppy]

Cerebrovascular is open to neuro/neurosurg/neurorads, just depends on which way you want to go. Same thing is true for NIR as it is for VIR, depends on location and the way you set up your practice.

FWIW, my faculty mentors have told me that IR's dominate the stroke/neuroIR work in the Bay Area. Apparently SIR wised up and is making it *very* difficult for nsgs and neuro folks to get a certificate in NIR work.

 

[omarsaleh66]

Of course there would be competition. But like I said, I'll refer to the endovascularsurgery IR's who are based out of San Jose, California which is a highly desired locale for doctors. There is an oversaturation of doctors in the Bay Area, so plenty of cardiologists, but these guys still have a very busy practice. They established a referral system with PCP's and get the patients straight from PCP's or patient self-referrals. Gvataken, the IR attending who posts on SDN from time to time and some of the other IR attendings (ie. irwarrior) who have posted here in the past have stated as long as you run a clinic you will get patients. It takes time to build a practice but it is doable.

I'm not going to lie, but I have seen a community program where the cards guys are very aggressive in PVD, and have basically taken all the peripheral work from IR. But in those cases the IR guys were not clinical, they did not admit their own patients nor run clinics. They were relegated to venous and other procedures outside the realm of the arterial system.

Im a senior rads resident at Ole Miss. I was moonlighting in the ED about a month ago. I saw a lady in the ER for hypertensive urgency which I took care of with some BP meds. But when I was getting her history, I always am very thorough, so basically I found out she was suffering from menorrhagia and symptoms related to fibroids. Her Dr is recommending a hysterectomy. Anyways, I gave her my pager number and told her about UFE and asked her to come see me in clinic (really my attending's clinic). So couple days later, she paged me. I referred her to my attending and now we are gonna do the full workup for a UFE. My attending so happy, he let me do a pre- SIR spheres case to show his appreciation, and Im on a msk rotation. haha

Anyways the point it, the patients are out there, its so easy. The services we provide are way better than the alternative. U just have to be clinical and educate the patients and they will come. U can compete with anybody as long as you make an effort and having good bed side manners go a long way.

later

 

[colbgw02]

Im a senior rads resident at Ole Miss. I was moonlighting in the ED about a month ago. I saw a lady in the ER for hypertensive urgency which I took care of with some BP meds.

Whoa. Why are you moonlighting as an ER doc?

 

[badasshairday]

Whoa. Why are you moonlighting as an ER doc?

That is kind of cool. What type of intern year did you do omarsalaeh66? TY, prelim IM, or prelim surg?

 

[omarsaleh66]

Whoa. Why are you moonlighting as an ER doc?

I started ER moonlighting alot during earlier the residency. Now Ive pretty much stopped cuz Im moonlighting as radiology. I just filled in a month ago cuz the ER didnt have anyone to cover that weekend and were really desperate. But the cool thing about ER is I have gotten to refer alot of patients to IR and NIR during those times so as long as you have some kind of clinic or marketing where you can see patients, it will be easier to get the cases.

I did a strong TY year. I also knew I wanted to do ER moonlighting before I started rads so i planned rotations accordingly to be more prepared. Not only did it help for IR but it helped pay the bills before I could start rads moonlighting as a pgy4.

 

[badasshairday]

http://www.appliedradiology.com/Digital-Portals/Hot-Topics-in-Cardiac-CT/Of-turf-and-surf.aspx

 

[hematogone]

I started ER moonlighting alot during earlier the residency. Now Ive pretty much stopped cuz Im moonlighting as radiology. I just filled in a month ago cuz the ER didnt have anyone to cover that weekend and were really desperate. But the cool thing about ER is I have gotten to refer alot of patients to IR and NIR during those times so as long as you have some kind of clinic or marketing where you can see patients, it will be easier to get the cases.

I did a strong TY year. I also knew I wanted to do ER moonlighting before I started rads so i planned rotations accordingly to be more prepared. Not only did it help for IR but it helped pay the bills before I could start rads moonlighting as a pgy4.

Did you spend a lot of time on surgical services? If so, what was your overall approach to the surgical time as an intern, in order to achieve the maximum benefit in terms of clinical knowledge and skill? I'm doing a surgical intern year, and I figure since I know it's going to be rough, I might as well see what kind of experience I can gain to help me later in my Radiology career, whether or not I go into IR.

 

[omarsaleh66]

Did you spend a lot of time on surgical services? If so, what was your overall approach to the surgical time as an intern, in order to achieve the maximum benefit in terms of clinical knowledge and skill? I'm doing a surgical intern year, and I figure since I know it's going to be rough, I might as well see what kind of experience I can gain to help me later in my Radiology career, whether or not I go into IR.

U will probably be seeing consults and floorwork and responding to traumas. Very little OR time. U will learn a ton just from that in terms of clinical management. Alot of these patients will have imaging that u can try to look at and learn some radiology.

If u can, try to get some hands on experience with some procedures like central lines, intubating, codes, I &D, chest tubes.

U can also learn alot from clinic. U can see the patient for followup and see the imaging findings atleast in vascular clinic, that would be alot of CTA, doppler US, vein mapping, etc.. These type of things will help carry over to radiology.

 

[shark2000]

It will not help in general. 3 months of it is good to get familiar with the system and how things work. Otherwise, IMO it is a waste of time for DR. For IR it may help if you obtain the clinical knowledge, but procedure wise probably not.
Internship is 80% about paper work and administrative work.
I did my internship in a community hospital close to my medical school. At least it was good to see what the true practice of medicine is like outside a big academic center.