Cardiology scope of practice

[JPSmyth]

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I originally posted this in the cardiology thread but nobody seems to be posting in there lately, and I'm a med student so maybe I will be better off here...

I have been searching the internet and these forums specifically but I haven't been able to find a straightforward answer to my question.

It is my understanding that the main types of cardiology are: non-invasive, invasive, interventional, and EP. Non-invasive doesn't work in the cath lab at all, invasive does imaging in the cath lab, interventional places stents and fixes things via cath, and EP does implants and other procedures. Is this somewhat accurate?

My main question is that after an IM residency -> 3 year cardiology fellowship, can one practice as an invasive cardiologist? or solely non-invasive? Non-invasive and invasive are the two fields that interest me more so than interventional or EP with their extra fellowships.

Let's say a resident completes 3 years IM and 3 years cardiology fellowship (2 clinical and 1 research year I think is standard of most programs), will he/she be able to practice as either a non-invasive or an invasive cardiologist? And what might their scope of practice look like?

Thank you!

 

[SterlingMaloryArcher]

Mostly commenting to follow, but I'm pretty sure IM+Cardiovascular Disease=Clinical Cardiologist and to be an invasive you would have to do a fellowship on top of that, not a different one right out of IM.

 

[Redpancreas]

I originally posted this in the cardiology thread but nobody seems to be posting in there lately, and I'm a med student so maybe I will be better off here...

I have been searching the internet and these forums specifically but I haven't been able to find a straightforward answer to my question.

It is my understanding that the main types of cardiology are: non-invasive, invasive, interventional, and EP. Non-invasive doesn't work in the cath lab at all, invasive does imaging in the cath lab, interventional places stents and fixes things via cath, and EP does implants and other procedures. Is this somewhat accurate?

My main question is that after an IM residency -> 3 year cardiology fellowship, can one practice as an invasive cardiologist? or solely non-invasive? Non-invasive and invasive are the two fields that interest me more so than interventional or EP with their extra fellowships.

Let's say a resident completes 3 years IM and 3 years cardiology fellowship (2 clinical and 1 research year I think is standard of most programs), will he/she be able to practice as either a non-invasive or an invasive cardiologist? And what might their scope of practice look like?

Thank you!

I've never heard of a noninvasive vs invasive cardiologist who's just a general cardiologist. I always assumed interventional was another word for invasive.

Interventional Cardiology is PGY-7/8 depending on whether you want to just do peripheral stents or structural stuff too but I'm not positive if that's the only difference between pgy 7 vs. 8.

 

[DrWhozits]

.

 

[JPSmyth]

I've never heard of a noninvasive vs invasive cardiologist who's just a general cardiologist. I always assumed interventional was another word for invasive.

Interventional Cardiology is PGY-7/8 depending on whether you want to just do peripheral stents or structural stuff too but I'm not positive if that's the only difference between pgy 7 vs. 8.

MGMA lists the types of cardiology as 1. Non invasive 2. Invasive 3. Interventional 4. EP

A bit confusing

 

[FindMeOnTheLinks]

MGMA lists the types of cardiology as 1. Non invasive 2. Invasive 3. Interventional 4. EP

A bit confusing

There are also super-fellowships for cardiac imaging, heart failure, congenital, and probably others as well

 

[JPSmyth]

There are also super-fellowships for cardiac imaging, heart failure, congenital, and probably others as well

That's just how MGMA breaks it down, but yeah I'm sure there are many others

 

[cellsaver]

MGMA lists the types of cardiology as 1. Non invasive 2. Invasive 3. Interventional 4. EP

A bit confusing

It is a good question so thanks for asking. Yes it is confusing. I attend a state university and there are 4 Cardiology Fellowship offered: Cardiovascular Disease Fellowship, Clinical Cardiac Electrophysiology Fellowship, Interventional Cardiology Fellowship, Advanced Heart Failure and Transplantation Fellowship. Other state universities might offer a 5th Fellowship (Cardiovascular Imaging). I think it largely depends on what you wish to pursue and then you choose accordingly.

MGMA is a good source but when it comes to training, you'll want to stick with the accrediting bodies. You might want to review the Journal of American College of Cardiology website for their core training guidelines:

Evolution of Training Recommendations for Specialists in Adult Cardiovascular Medicine​

Core Cardiology Training Symposium (COCATS)

The ABIM subspecialty board on cardiovascular disease requires 3 years of cardiology fellowship training. Additional training beyond the standard 3-year general cardiology fellowship is required to sit for certification examinations in clinical cardiac electrophysiology, interventional cardiology, advanced heart failure and transplant cardiology, and adult congenital heart disease. As outlined in this document, additional years of training are also recommended for trainees who desire advanced expertise in specialized areas, those who want dedicated time for basic and/or clinical research training, or both.​

 

[JPSmyth]

It is a good question so thanks for asking. Yes it is confusing. I attend a state university and there are 4 Cardiology Fellowship offered: Cardiovascular Disease Fellowship, Clinical Cardiac Electrophysiology Fellowship, Interventional Cardiology Fellowship, Advanced Heart Failure and Transplantation Fellowship. Other state universities might offer a 5th Fellowship (Cardiovascular Imagine). I think it largely depends on what you wish to pursue and then you choose accordingly.

MGMA is a good source but when it comes to training, you'll want to stick with the accrediting bodies. You might want to review the Journal of American College of Cardiology website for their core training guidelines:

Evolution of Training Recommendations for Specialists in Adult Cardiovascular Medicine​

Core Cardiology Training Symposium (COCATS)

The ABIM subspecialty board on cardiovascular disease requires 3 years of cardiology fellowship training. Additional training beyond the standard 3-year general cardiology fellowship is required to sit for certification examinations in clinical cardiac electrophysiology, interventional cardiology, advanced heart failure and transplant cardiology, and adult congenital heart disease. As outlined in this document, additional years of training are also recommended for trainees who desire advanced expertise in specialized areas, those who want dedicated time for basic and/or clinical research training, or both.​

Thanks for this info!

So in today's climate are there people doing 3 year fellowship and then beginning to practice? Or do most do additional training on top of the 3 year cards fellowship to subspecialize? Not sure if there are any attendings or current fellows on this board to chime in

For example in rads the residency is 5 years but it seems like everyone does a fellowship on top of that. Wondering if cards is the same

 

[FindMeOnTheLinks]

Thanks for this info!

So in today's climate are there people doing 3 year fellowship and then beginning to practice? Or do most do additional training on top of the 3 year cards fellowship to subspecialize? Not sure if there are any attendings or current fellows on this board to chime in

For example in rads the residency is 5 years but it seems like everyone does a fellowship on top of that. Wondering if cards is the same

Yeah, if you want to be an interventional cardiologist it's another fellowship after cardiology. Same with EP, heart failure, imaging, etc. Not everybody does an additional fellowship after cards but many do

 

[takeurmeds02]

Well..just crossed cards off the list. I knew this but reiteration is a btch and I'm not getting any younger

 

[mxg67]

Typically you do 3 years of IM followed by 3 years of cards, after which you can go out and practice as either a non-invasive or invasive non-interventional cardiologist. The non-invasive doesn't cath at all, either by choice or because they didn't train enough in it. The invasive non-interventional does diagnostic caths, but not interventional procedures. You can tack on year(s) of extra training for interventional, heart failure, EP, imaging, etc.

For a clinical cardiologist, the scope of practice can vary greatly depending where/how you trained. On one end of the spectrum you can train to do diagnostic caths, read echos, nucs, etc. and just general cardiac care, on the other end you may only be able to provide general cardiac care, and then there's everything in between.

 

[JPSmyth]

Yeah, if you want to be an interventional cardiologist it's another fellowship after cardiology. Same with EP, heart failure, imaging, etc. Not everybody does an additional fellowship after cards but many do

I'm referring to non-interventional cardiology.

Typically you do 3 years of IM followed by 3 years of cards, after which you can go out and practice as either a non-invasive or invasive non-interventional cardiologist. The non-invasive doesn't cath at all, either by choice or because they didn't train enough in it. The invasive non-interventional does diagnostic caths, but not interventional procedures. You can tack on year(s) of extra training for interventional, heart failure, EP, imaging, etc.

For a clinical cardiologist, the scope of practice can vary greatly depending where/how you trained. On one end of the spectrum you can train to do diagnostic caths, read echos, nucs, etc. and just general cardiac care, on the other end you may only be able to provide general cardiac care, and then there's everything in between.

Thank you this is exactly what I was looking for!