2 scope of practice scenarios for a cardiologist

[Scean]

Two quick questions that may seem a little strange; but I wonder if they would be feasible as a practicing cardiologist.

Many attendings at my medical schools "rotate" through the general medical floor at our public hospital doing 2-3 month long blocks per year running a team. The two I've interacted with specifically include a sports medicine/primary care physician and a double boarded med/psych attending. My question is - could a cardiologist ever do this? It would be kind of refreshing to face all aspects of internal medicine now and again over the years.

My second question relates to the first - it would seem the only cards attendings able to do this might be interventionists who do not care for a large number of patients in their own clinic continuously - or do they? My question being- do interventionalists also run a clinic where they follow patients continuously adjusting medications and attending to changes in their patients' course whether they have ever been "intervened" on or not?


Cliff version- Could I ever be an interventional cardiologist who also follows a number patients in a preventative/long term clinic setting and in addition - also act as a floor attending in general medicine from time to time?

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[supp-2]

1) No: most likely you'll be a salaried employee of a hospital where they'll want to utilize your Cardiology skills or you'll be in a private practice (if those exists in the future) where you'll have to meet overhead, ect. You still see plenty of internal medicine as a Cardiologist.

2) Yes: Interventionalists do plenty of general cardiology and you could be as busy as you want adjusting BP meds

 

[AZhopeful]

1)actually, yes. At my institution we still have a few of our inpatient gen med teams run by specialists. There has classically been a team always run by a nephrologist, and up until last year there was a team run by a pulmonologist, and a team run by a cardiologist(this year that has shrunk down to one team split between those two specialties). The rest of the teams are run by generalists/hospitalists. You end up with specialists coming back to their roots of general medicine and then being able to offer their specialized expertise if something up their alley is admitted.

This was actually the way a lot of academic centers had their gen med teams organized in the old days, but it's a dying breed. The reason is financial: if a specialist admits the patient as a generalist, he has to bill as a generalist; furthermore, he can't double-bill for any specialist-type stuff that he might do for the pt(i.e. the nephrologist can't bill for his specialty service if he writes his patient's dialysis orders while being their general medicine attending). The hospital, and the doc, lose out on the extra money gained through having a generalist admitting the patient and then calling a consult. So it's great for learning and even a bit of fun, but financially not the best model. Just one more example of why our healthcare system can't have nice things.

2)see above poster. Interventionalists can do as much general cards as they want or need, but for reasons similar to #1 there's an incentive to do more interventional stuff.