Hans, have you ever thought that maybe cardiologists are motivated by becoming the best provider of cardiovascular care and maybe trying to become a one stop for many patients ( not all of course) is the best for the patient??
I see how many of your posts seem to be motivated by the same thing you say day after day that is what motivates cardiology: money. You always say how cards stole this and that from IR.
Just my take on this issue.
You are absolutely right, it IS about money. Just as you have seen in my other posts, I can't stand it when its clear an applicant is only interested in the money and lifestyle of radiology.
When I talk about certain interventional cardiologists and their peripheral ventures, it absolutely has to do with money. I have a problem when they treat 'an opportunity to help patients' as an excuse to print money.
But before I continue, I want to say that radiologist owned cash-only screening 'body scans' are just as deplorable. Fortunately most of these centers have gone under.
Anyways, as patient advocates, we should do whats best for the patient, not necessarily whats best for your pocket book.
The problem with the cardiologist set-up you describe is the inherent conflict of interest and a set up for unbridled self-referral. Would you be more inclined to Stent the renal arteries for a mild stenosis if there was $2500 extra to be made from each one, knowing that in the majority of cases the cause of the hypertension is essential and medicine is a better option? You, LGMD, may not but for others it might be a little tempting. I don't have a problem with a cardiologist stenting, if he/she can do it SAFELY and WHEN its indicated. My problem is with cardiologists have a tendency to stent everything like its going out of style, for some of the most dubious indications. Drive-by-stenting is really happening. What patients don't realize and some cardiologists don't want to admit iis that stents have a certain life span before intimal hyperplasia occludes the stents. STENTS STENOSE over time! Stents also limit future surgical anastomoses. When all you have is a hammer everything looks like a nail, especially when there is a huge financial incentive.
This conflict of interest also exists when a clinician owns a share of an imaging center to which he refers patients.
Let me give you an example: 30 year old with worst headache of his life - the clinician (who is also an investor) orders a $2000 brain MRI. If you suspect an a ruptured aneurysm with bleed the indicated study is a non-contrast head CT which is faster, but also happens to be about 1/4th cheaper. If you actually see a bleed then consider a CTA of the brain. Instead he orders the most expensive test. If you are really worried, why not send the patient to the ED instead of your imaging center!
15 year old kid with back pain but no focal neurologic defect order a $1500
L spine MRI (the pretest probability is virtually nil without focal defect).
Its no different from certain GI docs, insisting that every patient be scoped first from above and below, before they will be seen -- 'just to be sure'. Though this is a much less common occurence.
As other posters have alluded to, there are very unscrupulous business practices going on out there, which I am bringing to light. If you can't understand whats going on, then the problem might be with you and not me.
Best
PS.
LGMD trust me you don't want a carotid stent if you can tolerate a CEA instead. And thats something best left to a vascular surgeon... not a cardiologist... and not even an IR!
