Cardiac imaging and PP

[RobertSacamano]

Looking for perspective from recent fellowship grads regarding cardiac imaging and the job market. Wondering how marketable being a 'cardiac imager' in CT/MRI is for PP (would entail 4 years of fellowship) and if there is any associated pay bump.

Also, wondering on using this skill as a way of giving a boost as a general cardiologist, given the increasing involvement of APPs in general cardiology practice and need for a more discrete skill set outside of clinic.

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[shouldigomd]

There is no "boost" needed for general cardiologists so I wouldn't think of it that way. I would focus on what you want to do. Job searching in my opinion as a generalist is simpler with overall more opportunities than most sub-specialists (definitely at least for me as an interventional cardiologist). That being said being an imager is definitely in demand but if it isn't really what you want .... it can be a struggle. For example: If you get hired as an imaging cardiologist than you may be expected to be the "imaging guy" for structural cardiology cases which sucks.

 

[cards67]

Agree with above. CT/MRI has poor rvu/reimbursement so I wouldn't expect a pay bump either. A general cardiologist does not need a boost over an APP. Patients want to see doctors and other doctors want to work with doctors.

 

[IcedAmericano19]

Looking for perspective from recent fellowship grads regarding cardiac imaging and the job market. Wondering how marketable being a 'cardiac imager' in CT/MRI is for PP (would entail 4 years of fellowship) and if there is any associated pay bump.

Also, wondering on using this skill as a way of giving a boost as a general cardiologist, given the increasing involvement of APPs in general cardiology practice and need for a more discrete skill set outside of clinic.

General cardiology is white hot. The threat of APPs is limited in cardiology because the breadth of knowledge in cardiology is vast. In addition, decision making is life and death. A CT surgeon is not going to take an APP's opinion on how severe the aortic stenosis/mitral regurgitation/etc is or when to take a patient to the OR. In addition, no interventional cardiologist is going to Cath somebody based on a stress test interpreted by an APP. Ultimately, you need someone who can do/interpet TEEs, read ECGs, stress testing, Zio monitor, echo, nuclear. This is the bread and butter of cardiology. CT is a plus, most general fellows graduate with Level II and are eligible to sit for boards.

As for advanced imaging, cardiac MRI is becoming increasingly utilized. But the job market remains limited to high-volume centers. It is useful if you want to take a job at an academic or hybrid place, but it is not going to boost your income. It takes about 1-2 hours to fully perform and interpret a CMR. In that time, the general cardiologist has read 10-15 echos, done two TEEs, and a cardioversion.

 

[timpview]

No pay bump.
Might help you land a job at a tertiary center.
Chances are higher than not however that it limits your job opportunities if it’s something you want to read (due to radiology controlling it at most centers).

 

[scrub08]

I am a general cardiologist with an imaging focus (boarded in ct, echo, nuc, mri). I work in a community hospital with a busy cardiology and cardiac surgery service line. I am not reading mri in practice but do everything else. Typically have 2.5-3 days of clinic. The rest of my time I spend reading echos, tee, ct, spect, pet. I enjoy the variety. Plus I think having a strong foundation in imaging makes you a much better cardiologist. I highly recommend getting trained in pet as it is superior to spect (and more rvu).

 

[marcolino]

I am a general cardiologist with an imaging focus (boarded in ct, echo, nuc, mri). I work in a community hospital with a busy cardiology and cardiac surgery service line. I am not reading mri in practice but do everything else. Typically have 2.5-3 days of clinic. The rest of my time I spend reading echos, tee, ct, spect, pet. I enjoy the variety. Plus I think having a strong foundation in imaging makes you a much better cardiologist. I highly recommend getting trained in pet as it is superior to spect (and more rvu).

What about your salary ? How high is it compared to ur general cardiology colleagues ?

 

[scrub08]

My salary is comparable or higher to other gen cards at my hospital. I am 100% rvu and my per rvu reimbursement is the same as gen cards. Ct is the most time intensive thing I do. A standard ccta takes me 30 min to read. My annual rvu are 11k+. If someone is going to read mri I recommend negotiating for hourly rate while reading mri (and not per rvu) as mri is even more time intensive.

 

[Athlete’s Heart]

I did a CT/MRI fellowship and while searching for jobs it was definitely in demand, particularly MRI since a lot of people already do CT. However, the drawback is that not every hospital can really do advanced imaging at a reasonable rate so you have to find a bigger hospital for the most part but there are plenty of those big, non-academic hospitals around. Regarding pay bump, there really wasn’t.. I did it more for hopes of a better long-term quality of life but maybe you can try to get a higher salary than general non-invasive cardiologists.

With that said.. it was by far the worst year of my training. I was at a big institution/imaging center and there were malignant attendings, scut work, and poor teaching. I have met others who also did imaging fellowships elsewhere that had similar experiences, so this seems to be a cultural problem in the imaging world. They’re taking a “chill speciality” and using it as an opportunity for cheap labor. I wondered if this is due to imaging being non-ACGME accredited, but I don’t know how other non-accredited fellowships are so I can’t speak on it. I just know imaging fellowships are a nidus for abuse, and they will absolutely get exposed one day.

My advice to anyone who wants to do imaging is get in contact with the current/past fellows.. and hope they tell you the truth. The only reason I stayed was because I found a job that I really liked that wanted me as an advanced imager. If I could go back in time there is absolutely no chance I would do the fellowship again. Almost everyday I woke up asking myself “what the hell am I doing?”.

On one hand you have a very high chance of a MISERABLE year and on the other you have hundreds of thousands of dollars waiting for you as a general cardiologist.. that’s the decision you have to make. It’s a good field with a promising future, but the current gatekeepers (attendings) are ruining it. Hopefully, a new generation comes through the ranks and changes things.

 

[Sapien3]

My salary is comparable or higher to other gen cards at my hospital. I am 100% rvu and my per rvu reimbursement is the same as gen cards. Ct is the most time intensive thing I do. A standard ccta takes me 30 min to read. My annual rvu are 11k+. If someone is going to read mri I recommend negotiating for hourly rate while reading mri (and not per rvu) as mri is even more time intensive.

11k+ RVUfor Gen Cardiology +Imaging is quite high. How is your work week spread out? do you also to diagnostic angio? DM if ok. Thanks