A Day With the PD

[avendesora]

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So, I don't usually read this forum. I am doing a radiology rotation this month, though, and I was lucky enough to spend the entire day with the chair of radiology who is also the PD at my school. This was a very instructive day!

Firstly, the program was making up their ROL the next day, and coincidentally or not, two external candidates called, and two from my class stopped by to talk to him. He basically said these people did themselves no favors by interrupting his working day. Also, he told us of a kid who wanted to come for a 2nd look, and was basically told this program doesn't do 2nd looks. So the kid, under the pretense of "showing his wife the town" shows up uninvited by himself and hangs out in the department. Again, said applicant did himself no favors. Very instructive.

Next, another attending stops by to talk about how the department is gearing up to start doing cardiac imaging (we just recently got a new, fast, hi-res CT, and they are talking about getting a new MRI than can do cardiac angio). Basically the gist of this discussion was that cards had asked rads for a couple of lectures on this stuff, and how they would give the lectures but basically "dumb them down" or make them overly convoluted so cards wouldn't be able to read these studies. While I think this is probably within their rights because it's their scanner, it was interesting to see just how viciously turf is protected. Ultimately, I think this type of isolationism and resistance to sharing of information will slow the adoption of this type of imaging because cards won't refer patients for scans if rads is openly hostile about it.

Lastly, with the new high res CT and 3D reconstructions, this is not exactly rocket science. It seems like there's just not as much subtle interpretive skill needed. Note, this does NOT apply to the other kinds of studies that are being done (CXR, Nucs, etc). Also, I'm amazed at the number of reads that are done on films for which no one will ever look at the report (ortho clinic films, ICU chest films, Neuro clinic stuff -- things where the clinicians look at their own films).

DISCLAIMER -- Not trying to offend anyone -- just my impressions after a few days of rads

 

[avendesora]

Oh -- the other observation I've made is how often the radiologists I've been working with defend the fact that they're "real doctors" and "oh, we really helped someone with that study". I do NOT disagree at all with either one of these statements. Radiologists are most certainly physicians and critical to the operation of the hospital and patient care The observation was just that they keep saying it out loud.

 

[jgar26]

AVENSDORA WRITES:
"Next, another attending stops by to talk about how the department is gearing up to start doing cardiac imaging (we just recently got a new, fast, hi-res CT, and they are talking about getting a new MRI than can do cardiac angio). Basically the gist of this discussion was that cards had asked rads for a couple of lectures on this stuff, and how they would give the lectures but basically "dumb them down" or make them overly convoluted so cards wouldn't be able to read these studies."

You know, being in cardiology myself I find this statemtent by the attending laughable. What Radiologists fail to realize is that they will need the Cardiologists to refer them the pts to read the MRI's. "dumbing it down" for Cards is a joke. At most hospitals, you will see Cardiology being in control. You are nuts if you think Cardiologists will sit by and let rads take over Cardiac MRI. They will buy their own scanner, and hire a rads guy if need be and keep the referals within the system. Cardiology Fellowships by and large have not started teaching Cardiac MRI yet, but it is coming. It all boils down to who controls the patients. IR has lost a lot of ground to Vascular Surgery and Interv Cards in the stenting area and I only see the future with more of Cards protecting their turf and actually invading Rads turf....It goes back to controlling the patients. You're right it is an ongoing problem. I am learning to read nukes now, and in private practice I will never need a Radiologist to read my perfusion scan, but a radiologuist will ALWAYS need me to do the stess portion of their scan. I guess it doesn't matter, you will always have differing opinions on this stuff. I myself am jealous of the radiologist, what a great life.....Work good hours, take no real responsibility for patient care "CLINICAL CORRELATION SUGGESTED" and generally make great money with low stress. Anyone who rips you guys for not being "real doctors" is jealous.......at least I am.

Peace

 

[Goober]

Originally posted by jgar26


You know, being in cardiology myself I find this statemtent by the attending laughable. What Radiologists fail to realize is that they will need the Cardiologists to refer them the pts to read the MRI's. "dumbing it down" for Cards is a joke. At most hospitals, you will see Cardiology being in control. You are nuts if you think Cardiologists will sit by and let rads take over Cardiac MRI. They will buy their own scanner, and hire a rads guy if need be and keep the referals within the system. Cardiology Fellowships by and large have not started teaching Cardiac MRI yet, but it is coming. It all boils down to who controls the patients. IR has lost a lot of ground to Vascular Surgery and Interv Cards in the stenting area and I only see the future with more of Cards protecting their turf and actually invading Rads turf....It goes back to controlling the patients. You're right it is an ongoing problem. I am learning to read nukes now, and in private practice I will never need a Radiologist to read my perfusion scan, but a radiologuist will ALWAYS need me to do the stess portion of their scan. I guess it doesn't matter, you will always have differing opinions on this stuff. I myself am jealous of the radiologist, what a great life.....Work good hours, take no real responsibility for patient care "CLINICAL CORRELATION SUGGESTED" and generally make great money with low stress. Anyone who rips you guys for not being "real doctors" is jealous.......at least I am.

Peace

Actually I agree that cards will take over cardiac MRI. It is just a matter of time. Cards has taken over every imaging modailty related to the heart so I really don't see how MRI will be any different. It will follow the same path as all previous imaging studies such as cardiac Nucs, echo and coronary caths.

First the majority of docs reading cardiac MRI will be radiologists. They will develop the protocols and do all the early work. Slowly but surely cards will start doing more and more. Once they feel comfortable reading they will stop referring cases out. It can't be stopped because they control the patients and they will refer to themselves.

Ever wonder why nucs is exempted from Stark laws? It is because of Cardiologists are politically powerful and could not have nuclear cardiology stopped by Stark. Of course it was ok to stop all other aspects of radiology from self referral🙄

 

[Voxel]

It is because of a specific clause in the Stark Laws. Something that radiologists have been trying to change for years but has not happened.

The battle for cardiac mri is not over. I can envision many specific instances where cardiac mri will still be performed by radiologists. I really don't want to divulge specifics. See you in the trenches.

 

[avendesora]

The battle for cardiac mri is not over.

Ah -- the newest George Lucas epic -- "MRIWars". Pitting the evil Cardiology Empire vs. the Radiology rebels 🙂

That was kind of my original point -- if this thing turns into a huge competition, it will ultimately just slow the adoption of the technology. You guys in rads are ALWAYS dependent on others to send you work, so you might as well play nice. As someone interested in cardiology but not really interested in interventions, this has some personal interest for me. It seems like there should be room for both fields to get a cut of the action. There are radiologists who read nucs, and cardiologists who read nucs, no? Why not have a similar sharing with this new tech?

For Voxel or anyone else -- Is cardiac MRI/CT angio a reality where you are yet? We're just starting it where I am. Are there patients for who it doesn't work? What about patients with previous stents/hardware?

I think ultimately with the aging population there is going to be more than enough work to keep our cardiologists busy. I think for the near future Rads and Cards are both going to remain among the best reimbursed fields.

 

[RADRULES]

Cardiac MRI is really not that great of an exam. It has some useful indication, but really is not the greatest thing since sliced bread as many would have you believe.

I am sure it will be a useful study in the future which both radiologists and cardiologists can read. Not a big deal.

As for VIR.... I am not as worried as some. After seeing countless botched arterial procedures by cardiologists, it is clear to me that eventually clinicians will realize that IR trained guys are just simply better. The truth be told, the best teams for endovascular work is a vascular surgeon and an IR guy... not a cardiologists.

If you ever watch a decent IR guy vs. a cardiologist, you will see a big difference. I am not sure why, but cards guys are just too cavalier with the wire and technique is often really sloppy.

 

[Goober]

Originally posted by RADRULES
Cardiac MRI is really not that great of an exam. It has some useful indication, but really is not the greatest thing since sliced bread as many would have you believe.

I am sure it will be a useful study in the future which both radiologists and cardiologists can read. Not a big deal.

As for VIR.... I am not as worried as some. After seeing countless botched arterial procedures by cardiologists, it is clear to me that eventually clinicians will realize that IR trained guys are just simply better. The truth be told, the best teams for endovascular work is a vascular surgeon and an IR guy... not a cardiologists.

If you ever watch a decent IR guy vs. a cardiologist, you will see a big difference. I am not sure why, but cards guys are just too cavalier with the wire and technique is often really sloppy.

Well that never stopped cards from taking over coronary cath work. In the beginning rads did 100% of coronary angiograms. Now Cards does all of them. Right now Cards are behind rads in IR, but as they get more experience their mistakes will decrease. The main problem is that I don't see Vascular Surg and Cards referring cases out once they feel comfortable doing them.

As for Cardiac MRI, I don't think that its full potential has been realized. If it turns out to be useful and has many indications, than cards will take it over. If it stays at the current state sor progresses very little, I don't think there will be any big fight.

 

[Docxter]

The real turf battle will be mostly in cardiac CT rather than cardiac MR. We now do CT coronary angiography in our ER for patients with chest pain. This exam will be the major turf.

 

[Voxel]

I'm curious as to why you are not impressed by cardiac mri?

Cardiac CT is also very promising.

As for cardiologists and their cavalier techniques: There are many more cases of iatrogenic groin hematomas and arterial wall injuries (non-coronary) from the cardiologists vs VIR. It's amazing and frightening that cardiologists are even allowed/"credentialled" to perform arterial interventional procedures.