Cardiac Fellowship

[miamidc]

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I havn't seen any recent threads in regards to Cardiac fellowships lately. Bout to graduate and got an offer to do a Cardiac fellowship at my institution. I had actually applied for the following year because I was planning on working for a year and then completing it, but a spot opened up and I was on the next to call list if I was interested. My question to all you PP guys out there. IS it worth it? Will it make me more marketable in a large city? Will the double board really make a difference? and I heard there is legislation going through that would eliminate getting paid for TEE if you are not Board Certified, so given I cannot get boarded without a fellowship nowadays, is this an important factor for us graduating 2010 or later? Any insight would be greatly appreciated.
Thanks.

 

[AmericanMD]

Hey guys, M1 here. We had a lecture today about CT surgery as a career, and the lecturer said demand for CT surgeons is going to explode in the years to come. He said a good chunk of CT surgeons are retiring in the near future, coupled with increasing demand for cardiac surgeries. So, does it follow that cardiac anesthesiologists will also be in demand in the future? Thanks for your input.

 

[miamidc]

We've been doing a bunch of hearts lately. Only one out of five of us has a cards fellowship. You don't need a cards fellowship to do hearts, obviously. Your residency should train you to do this. All things being equal, it adds something to your CV though. At least in the PP world I'm in, a hardworking individual with a enjoyable personality is more desirable than someone without those traits plus a cards fellowship.

When I was finishing residency, I was most interested in a cards fellowship. So far, I'm very happy I didn't do it.

On that note, what if this legislation goes through and TEE only gets reimbursd by those who have board certification? Would I be wrong to assume that the gasspasser with the cert would be very sought after? All the older guys would be able to get boarded because they are grandfathered in and really only have to pass the exam, still painful but doingable ,but my class and on will have to have completed an ACGME fellowship to be able to sit.Have you heard anything to this regard?

I think beyond the experience, in ten years if your not boarded you are not doing hearts because your group won't be getting that revenue, and that willo hike up the base pay. I could be way off. Another thing I'm thinking about is that in a highly competetive area, that board cert will be the difference bw two people who are both hardworking with two good personalities. ??

Did you do a TEE course or you were all residency training?

 

[coprolalia]

I've said it before and I'll say it again, Cards and Peds are the only two fellowships worth doing. In my humble opinion. If you can afford to do it (in every sense of the word "afford"), then go for it.

👍

-copro

 

[veetz]

Do any or all of you tell the surgeon that the patient doesn't need a valve, or that the valvular repair is adequate?

Our attendings perform all the intraop TEE's.

We had a patient scheduled for a MVR secondary to severe MR. Pt was put to sleep and lined up in standard fashion. However, once my attending took a look at the mitral valve with TEE, he concluded the MR was not as significant as previously thought. He showed the surgeon, who agreed. The surgeon talked about getting cards to take a look, but ended up canceling the surgery without further evaluation by cardiology.

 

[periopdoc]

We do not typically make the determination whether or not to do the repair based on the intraop TEE. The loading conditions under anesthesia are so different from normal that the pathology can be markedly better or worse. We do tend to guide the surgeons as to what type of repair/ replacement might be optimal in a given patient. This seems to be something that the cardiologists are either unwilling or unable to do with their exams. However, the majority of the data in determining whether to surgically address pathology is in unanesthetized patients and it should be applied with skepticism intraop.

One time we did see new pathology, even called in the cardiologist to have a look and help us decide whether repair of the pathology was indicated as it had nothing to do with why we were in the OR. Long story short, I wish we hadn't repaired it. I will be very careful in the future about making major changes to the surgical plan based on intraop echo findings.

As far as "legislation" requiring certification for billing .

What body would issue that legislation? What does legislation have to do with our billing? Of course any of us can bill for anything, the question is what will the payers pay for.

3rd party payer policy determines what we get paid for things like this and so far I haven't heard of a 3rd party that differentiates between certified and non-certified.

Say worst comes to worst and a policy of declining TEE bills for non-certified anesthesiologists comes to pass (it is more likely to see them decline payment for ALL anesthesiologist performed TEEs)... So what.

Just go in and do your anesthesia however you want to. Bill for the stuff you can bill for and do a focused TEE exam that you don't get paid for. Make a note of your findings in the anesthetic record and skip the formal report. It just becomes another monitor. We could still likely get paid for placement of the probe into the esophagus.

Sucks to lose out on the money, but like I say it is more likely that they would decline for all anesthesiologists than differentiate between certified and non-certified.


- pod

 

[miamidc]

We do not typically make the determination whether or not to do the repair based on the intraop TEE. The loading conditions under anesthesia are so different from normal that the pathology can be markedly better or worse. We do tend to guide the surgeons as to what type of repair/ replacement might be optimal in a given patient. This seems to be something that the cardiologists are either unwilling or unable to do with their exams. However, the majority of the data in determining whether to surgically address pathology is in unanesthetized patients and it should be applied with skepticism intraop.

One time we did see new pathology, even called in the cardiologist to have a look and help us decide whether repair of the pathology was indicated as it had nothing to do with why we were in the OR. Long story short, I wish we hadn't repaired it. I will be very careful in the future about making major changes to the surgical plan based on intraop echo findings.

As far as "legislation" requiring certification for billing .

What body would issue that legislation? What does legislation have to do with our billing? Of course any of us can bill for anything, the question is what will the payers pay for.

3rd party payer policy determines what we get paid for things like this and so far I haven't heard of a 3rd party that differentiates between certified and non-certified.

Say worst comes to worst and a policy of declining TEE bills for non-certified anesthesiologists comes to pass (it is more likely to see them decline payment for ALL anesthesiologist performed TEEs)... So what.

Just go in and do your anesthesia however you want to. Bill for the stuff you can bill for and do a focused TEE exam that you don't get paid for. Make a note of your findings in the anesthetic record and skip the formal report. It just becomes another monitor. We could still likely get paid for placement of the probe into the esophagus.

Sucks to lose out on the money, but like I say it is more likely that they would decline for all anesthesiologists than differentiate between certified and non-certified.


- pod

Thanks, very helpful. I think if I can manage to suppliment my salary I will do it. If I can't suppliment, I can't afford it and I won't do it. I guess tesamur status would suffice in the private practice world?

 

[periopdoc]

Thanks, very helpful. I think if I can manage to suppliment my salary I will do it. If I can't suppliment, I can't afford it and I won't do it. I guess tesamur status would suffice in the private practice world?

Why do you even need Testamur status? SCA boasts over 6000 members. As of March 2009 there were 2975 folks with either NBE Testamur or Certification Status in Periop TEE.

Don't get me wrong, I am not bashing doing a CT fellowship. There are a ton of great reasons to do it, not the least of which is spending an entire year doing nothing but the cases you want to do. I just don't buy the myth that is perpetuated that you need the fellowship and/ or the certification and/ or the testamur to practice and bill for cardiac anesthesia and perioperative TEE, or that there is some legislative body with the power to make cert mandatory.

Credentialing determines what you are and are not allowed to do in the hospital and 3rd party payer policies generally determine whether you will be paid or not.

To be fair, the certificate will let prospective employees know that you are more proficient than average with TEE. That may be enough to get you the interview over the next guy. After that, it just depends on what they think of you during the interview. It is unlikely that there will be two individuals who interview identically and are only differentiated by a TEE cert.

Word to the wise. Be sure and read the moonlighting clauses carefully and specifically ask them for all documentation on moonlighting approval. Keep a copy of all of that info. Sometimes there are restrictive moonlighting policies that come to light after you have signed on the dotted line.

- pod