What is happening with general cardiology?

[FIT2011]

Currently I am still in training with one of the general cardiology fellowship programs in the south. After I am done with my fellowship I am planning to move to the northeast .I am wondering if practicing general cardiology with level 2 in cath,echo,nuclear,CT would make me a competitive candidate in the job market. Sometimes I think ,a fourth year in Interv or EP is a must .But what is happening with the good old model of general cardiologist who is placing pacers/ICD and doing diagnostic caths. I am really confused.

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[famdoc83]

Also interested in hearing some noninvasive cardiologist point of view on this.

 

[Dreemer005]

At the last ACC, the FIT meetings actually stated that the highest demand is for general cardiologists right now. The EP market is saturated and the EP docs at my current institute state that there are mostly complex VT ablations left since most people who needed ablations or devices got them done, unless new indications come along. The interventional market also seems saturated. For imaging, it still hasn't really caught on despite the massive hype cardiac CT/MRI received about 5-6 years ago.

I'm curious to hear feedback from others. I know that for people applying from my program and ones around me, their experience has confirmed the openings for general cardiologists, as well as the saturation for EP/interventionalists, at least over the last couple years.

 

[k96tw01]

Currently an interventional fellow in the Northeast... will be doing a peripheral endovascular intervention / vascular medicine year as well.

Market in the NE is pretty saturated all the way around this year. Much of this is not because of all the needs being served (across subspecialty or general cards) but because many groups have a hiring freeze on while they negotiate group mergers or selling of practices to hospitals. My colleagues looking for jobs are finding demand is in Northern New England or much further south down the Atlantic Coast. For the non-invasive guys, the ones that had more opportunities all had lvl 3 in some NI modality. My interventional colleague had some more bites because of having just enough peripheral numbers + his RPVI in vascular u/s. This is just not the year to come out into practice... EP guys had it the hardest in finding jobs.

will be interesting to see how much the market changes as these groups sell and then, possibly, a wave of retirement starts from senior partners that sold especially if there is further stock market (ala retirement investment) recovery

 

[timpview]

These are my thoughts:

- From what I've heard the Gen Cards market is actually decent in comparison. Many groups where I live have stocked up on subspecialists and don't have as many gen cards guys doing the leg work in clinic for the referral base.

- I think interventional will continue to do alright as the shift to more hospital based employees continues. They provide STEMI call and still are huge revenue boosters for their hospitals.. Plus I think the real future of cardiology is the structural stuff (unless AF ablation makes a U turn)

- I think EP would make me most nervous. There was thought to be a lack of EP physicians in the early 2000s and w/ the hype of AF ablation, new device guidelines at the time, there was a huge push to increase EP numbers. I think that saturated the market.. These guys are also younger in comparison w/ interventional/general guys, so there's not going to be a wave of old-timers retiring. To me, the future of EP is 90% on AF ablation. But w/ 1st and 2nd time procedure rates still iffy at best and no super solid mortality data AND with the uncertain economic reimbursement questions in the future, AF ablation makes me nervous. I believe there will always be a role, but don't know how big of a role going forward..

So, I actually think Gen Cards guys will do be okay - Their main questions would be is imaging reimbursement cont to drop.. will midlevels ever encroach on their clinic territory in the next decade - will there be more restrictions on who can read echo's, nucs, ect.. basically a required imaging fellowship that would limit Gen Cards guys access -

 

[famdoc83]

Interesting...So are we able to say that general noninvasive cardiology will have an upswing in the next couple years when the subspecialty market is more saturated?
I'm not sure I understand why reimbursement for noninvasive procedures is dropping. Intuitively I assume noninvasive tests are more affordable than invasive. Why wouldn't health care reform reflect this?

 

[dragonfly99]

familydoc,
reimbursements for the nuclear imaging studies used to be pretty darned high...the bureaucrats/gov't noticed this and honed in on it as an area where costs could be trimmed.

I feel like it is hard to train as a general cardiologist currently. Most academic attendings are looking to make someone in their own image...for example cath lab guys are most interested in teaching a guy who wants to go do interventional fellowship, EP docs are most interested in letting a trainee participate in procedures (like placing pacemakers, etc.) if the person is going to continue to EP fellowship. This is analogous to the way residents and medical students in IM @the more top/academic places are often discouraged from doing primary care or hospitalist careers. I think the way we train people is not the way most patients/the public would want us to be trained. But that's probably a discussion for another day.

 

[famdoc83]

So I guess the question for the fellows out there is: are you or any of your colleagues going into noninvasive cardiology? If so, are you're job prospects good and will you be able to sustain you're interest in the field in the face of the changes? Less importantly but still an issue:Will reimbursement make a recovery for noninvasive cardiology?

 

[Dreemer005]

So I guess the question for the fellows out there is: are you or any of your colleagues going into noninvasive cardiology? If so, are you're job prospects good and will you be able to sustain you're interest in the field in the face of the changes? Less importantly but still an issue:Will reimbursement make a recovery for noninvasive cardiology?

From my program, most graduates the last few years have gone into noninvasive or invasive (but not interventional) practices. The job prospects seemed much better than the options for EP and interventionalists, who mostly stayed on as faculty.

Reimbursement for general cardiology seems okay from feedback from people looking for jobs this year, and doesn't seem much decreased from prior years. I think the difference is that most people are moving into jobs at HMO type institutes or groups affiliated with major hospitals or academic centers, rather than the older private practice or community models. These HMO and group affiliated jobs tend to offer equally competitive reimbursement to start, but the ceiling for growth is going to be much lower than what the private groups used to have.