Advanced Cardiac Imaging CV anesthesiologists

[Modanq]

The future is Now. CV anesthesiologists should be all over this especially for cath Lab imaging. We should be at the forefront. Heads up 3D googles for hemos and Imaging fusiin of CT and ECHO.

Houston Methodist |

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[AdmiralChz]

Unless the payment structure changes for TEE (unlikely), this is dead in the water in my opinion.

Also, if things do change (and they probably should) I predict cardiologists will suddenly come out of the woodwork to corner that market. Just look at cardiac MR and they were rapid to take charge and mostly displace radiologists out of their own field!

I know that sounds very defeatist, but I have been totally disillusioned with echo, reimbursement and honestly it’s day-to-day application as a young attending. Outside of academics the uses are really pretty straightforward and the esoteric parts are a total afterthought.

 

[Modanq]

Employing fusion imaging to identify the residual mitral regurgitation relative to currently placed MitraClip. Edward Gill on Twitter

Sure the paynent is one thing. I am just trying to highlight the future tech that is out there. I think there is no harm in posting about the future directions. Sometimes there is too much doom and gloom out there. We will see this in the near future.
See link above.
We have alot of tech driven people in anesthesiology and I was getting sick of the midlevel threads.

 

[T-burglar]

this is an area where motivated anesthesia groups will capture a good chunk of extra money.

The way things are reimbursed now though, anyone doing a dedicated interventional imaging day will have to have their workday subsidized. That subsidy can come from the hospital (that's what our group has worked out).

I love this stuff and would rather do more of this personally than more anesthetics for gall bladders. I wouldn't mind if most of general anesthesia fell to the nurses (sorry generalists) so i could do more of this.

 

[Modanq]

this is an area where motivated anesthesia groups will capture a good chunk of extra money.

The way things are reimbursed now though, anyone doing a dedicated interventional imaging day will have to have their workday subsidized. That subsidy can come from the hospital (that's what our group has worked out).

I love this stuff and would rather do more of this personally than more anesthetics for gall bladders. I wouldn't mind if most of general anesthesia fell to the nurses (sorry generalists) so i could do more of this.

To your point we need to figure out how to incorporate further imaging into our fellowship training such as Flouro and ICE. The other aspect is to have a downward pressure to incorporate surface imaging and TEE in anesthesiology residency including vascular access and regional. That way when our residents get to their fellowship training they will be working on CT, fluoro and advanced TEE type topics.
We can def seriously truncate general anesthesiology training. You dont need 3 years of gallbladders to do anesthesia. Just my two cents.

 

[DocVapor]

I love this stuff and would rather do more of this personally than more anesthetics for gall bladders. I wouldn't mind if most of general anesthesia fell to the nurses (sorry generalists) so i could do more of this.

We can def seriously truncate general anesthesiology training. You dont need 3 years of gallbladders to do anesthesia. Just my two cents.

I came in here to try and see something cool only to find drivel like this. Of course the nurses are going to win when our own people say these things on a public forum for anyone to see.

 

[Modanq]

I came in here to try and see something cool only to find drivel like this. Of course the nurses are going to win when our own people say these things on a public forum for anyone to see.

Fair point. But what's the right approach then?

 

[T-burglar]

That’s just how I feel bro

I’d rather supervise nurses doing the CA1 cases (majority of private practice) so I can focus on doctor stuff

 

[Modanq]

I came in here to try and see something cool only to find drivel like this. Of course the nurses are going to win when our own people say these things on a public forum for anyone to see.

Plus im not saying we shouldnt be doing those cases or anything like that. I think they are essential to training and practice. What Im saying is we dont need our residents doing three years of general surgery rooms and sacrificing other disciplines. They need to truncate training for simple cases. We have CA3 sitting podiatry cases or 8 hour flap cases. Seriously? Maybe we should have residents start and stop cases and train for the essential parts of the case? Just a random idea and I am open to criticism...thoughts.

 

[vector2]

Plus im not saying we shouldnt be doing those cases or anything like that. I think they are essential to training and practice. What Im saying is we dont need our residents doing three years of general surgery rooms and sacrificing other disciplines. They need to truncate training for simple cases. We have CA3 sitting podiatry cases or 8 hour flap cases. Seriously? Maybe we should have residents start and stop cases and train for the essential parts of the case? Just a random idea and I am open to criticism...thoughts.

If you have CA3s sitting podiatry cases then it sounds like it's a problem with the training site(s) case mix, not the duration of anesthesiology training.

 

[Lawpy]

The future is Now. CV anesthesiologists should be all over this especially for cath Lab imaging. We should be at the forefront. Heads up 3D googles for hemos and Imaging fusiin of CT and ECHO.

Houston Methodist |

events.houstonmethodist.org

This is pretty cool and interesting stuff. Thanks for sharing

 

[deleted875186]

If you have CA3s sitting podiatry cases then it sounds like it's a problem with the training site(s) case mix, not the duration of anesthesiology training.

At my hospital even CA3s get **** general cases here and there.

 

[DocVapor]

Plus im not saying we shouldnt be doing those cases or anything like that. I think they are essential to training and practice. What Im saying is we dont need our residents doing three years of general surgery rooms and sacrificing other disciplines. They need to truncate training for simple cases. We have CA3 sitting podiatry cases or 8 hour flap cases. Seriously? Maybe we should have residents start and stop cases and train for the essential parts of the case? Just a random idea and I am open to criticism...thoughts.

What residency program is out there where residents do 3 years of general surgery rooms? And just because a person is a CA-3 doesn't mean there's no value in sitting one of those simple cases every once in a while. It can be refreshing after a while of complex stuff to come back and work on things like efficiency and self-sufficiency in some simpler, higher-turnover rooms. That's when getting sloppy and not paying attention because you think you're a rockstar that's above "nursing stuff" can get you into some really hairy situations. Especially if someone is going into a solo generalist PP gig. Now if that's all a CA-3 is doing, then yes, that sounds more like a problem with the site. I'd say even maybe the last 2-3 months of residency, if someone is going into a job where they'll be supervising, then give them some experience being the "supervisor" for a CRNA or junior residents while the true attending stands in the corner of the room. Also, of course, there should be time to get exposure to this cutting-edge technology too.

I highly respect anyone that wants to go through the extra training and truly focus on that stuff, and they certainly do their part to advance the field. I will listen and learn from any of you. But for the subspecialists to then turn around and stick their noses up in the air and publicly announce that the foundation of their career is not even "doctor stuff" anymore is heartbreaking.

 

[dchz]

During my fellowship, I tried get the training for mitraclips. It's not like I didn't know how to drive the probe or do live 3D. I just wanted to get official training from the company.

Man what a huge mess did that cause... The cardiologists were like wtf is an anes fellow doing trying to get on our turf??! My vice chair had to pull me aside and tell me to cool it with trying to learn MitraClip.

We have a lesson or two to learn from the cardiologists about protecting our turf.

 

[nimbus]

To your point we need to figure out how to incorporate further imaging into our fellowship training such as Flouro and ICE. The other aspect is to have a downward pressure to incorporate surface imaging and TEE in anesthesiology residency including vascular access and regional. That way when our residents get to their fellowship training they will be working on CT, fluoro and advanced TEE type topics.
We can def seriously truncate general anesthesiology training. You dont need 3 years of gallbladders to do anesthesia. Just my two cents.

It’s not a universal skill set. It would be a challenge to find people who are capable and WILLING to teach this. And I don’t know if it can be taught within a 1 year ACTA fellowship.

 

[nimbus]

During my fellowship, I tried get the training for mitraclips. It's not like I didn't know how to drive the probe or do live 3D (I passed my advanced PTEexam before starting fellowship). I just wanted to get official training from the company.

Man what a huge mess did that cause... The cardiologists were like wtf is an anes fellow doing trying to get on our turf??! My vice chair had to pull me aside and tell me to cool it with trying to learn MitraClip.

We have a lesson or two to learn from the cardiologists about protecting our turf.

That’s too bad. I’m sure it varies from program to program.

 

[T-burglar]

That does suck. Clearly the cardiologists had a sweet subsidy they were trying to protect. Again, it is possible to the anesthesia group to be the one that gets the subsidy