With all due respect, you sound very naive and misinformed. Cardiac procedures are very technical, take years to master, and do save lives. Primary PCI for STEMIs and NSTEMIs unequivocally save lives, are done at all hours of the day and night, and require considerable expertise. Diagnostic angiography is the single most valuable tool in cardiology for assessing prognosis in CHD, and despite what the media might want you to think, is more than just placing stents in people who don't need them. Right heart catheterization, usually done in conjunction with coronary angiography, is very useful in evaluating the hemodynamics of valvular heart disease, pre and post cardiac transplant recipients, and for intracardiac shunting of blood. Transesophageal echocardiography is a very challenging skill to master, is an invaluable tool for evaluating valvular heart disease, and for looking for Atrioventricular/interatrial septal defects/aneurysms. Nuclear cardiology is a well validated tool for risk stratification and for assessing myocardial viability. Pacemaker implantation is a very technical skill to acquire, and is clearly very clinically useful. Echocardiography is the most utilized, and frankly useful, test in cardiology. Its value cannot be disputed intelligently. All of the above procedures require skill, take many years to master, and are performed by Cardiologists who have spent an additional 3-5 years post internal medicine residency in training. Certainly these tests are overutilized in today's medical environment, but please do not imply that the cardiologists are the sole factor for this overutilization. Lets not forget that internists/generalists/surgeons/etc represent the majority of referrals for these tests. So while I do believe that preventative medicine is underutilized and very important, to suggest that procedure-related specialties, Cardiology for example, don't earn their keep, and don't make life or death decisions is quite frankly a stupid declaration. Go spend a night in a hospital, and the next time you want an echo to rule out Tamponade in the middle of the night, or an angiogram on an unstable patient, or a TEE to rule out a large ASD on a patient you're treating for a stroke, or are confused by an ECG that says "anterior ST elevation" on the readout, please remember your initial statement. Perhaps you can consult a generalist, who is probably at home sleeping, to discuss the differential diagnosis. So yes, the GI doc who is called at all hours of the night to fix some unstable, acute, upper GI bleed on a dying pt. with alcoholic cirrhosis is, in fact, providing a value above and beyond discussing the CAGE questionaire in clinic. The cardiologist who does an emergent bedside TEE to evaluate suspected acute mitral insufficiency on a patient with flash pulmonary edema, hypotension, and an aggressive predilection towards death, is providing a valuable service, above and beyond that which a generalist is capable. These guys and gals earn their money. If you disapprove, don't consult us.
