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What exactly does a cardiologist do?
What's the difference between invasive/non-invasive, etc.?
What's the difference between invasive/non-invasive, etc.?
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cardiologists can choose to do a lot of different things. Invasive cardiology is generally referring to doing cardiac cathertizations, placing stents, and doing cardiac electrophysiology (eg ablating ectopic rhythms). Non-invasive cardiology includes basic out patient management of patients with CAD, CHF, arrhythmia w/u's, as well as doing things like reading echo's and interpreting ECG's.
Diagnostic cath is going to be obsolete by the time we reach that level b/c of emerging CT angiograms (non-invasive and yet, visualizes the whole coronary artery architecture). Invasive cardiologist takes 1-2 years beyond general cardiology training, for a total of a whopping 7-8 years of post-medical school training (this includes electrophysiology as well). Eletrcophysiology, from what I understand, has a patient on a bed and what you do is sit in front a console for hours trying to "interrogate" the pacemaker/figure out aberrent pathway in a patients heart (kinda like anesthesia in a way). Some people are doing chief year/research year so that 7-8 year easily extends into 8-10 years. Its a long road. But if you like it, it will be worth it.
I just posted about this new CT technology in the radiology forum. I suspect that cardiologists will pick up the technology in a similar manner that they are doing and interpreting all their echo's. It will pay a lot less then doing a diagnostic cath, so I suspect that general cardiologists are worried about it, but ultimately, I suspect that it will be interpreted as a good thing since the complication rate from doing a multi-scan EKG gated CT is much lower then cath-ing of course. Maybe they will eventually incorporate invasive cardiology into the general cardiology fellowship, especially with all of those new studies showing better outcomes with immediate angioplasty over thrombolytics. The only problem with that is that there aren't nearly enough CT surgeons around to cover the number of hospitals that could theoretically be convereted into having privelages of doing angio's.
I wouldn't be so sure about this. Diagnostic cath is now really a more "routine" procedure. The real $$ in cardiology - along with the real risk - comes with interventions. That is, stents and angioplasty. I think people often confuse "invasive" with "interventional". The extra year you do after cardiology fellowship is for interventions. Any graduate of a fellowship these days should be able to do a diagnostic cath.
Also, diagnostic caths don't really pay that much. I've been quoted $600 physician fee at my institution. How much is a radiologist paid to read an MRA? I bet the $$ to hours ratio is much better.
As someone interested in cardiology, I think the advent of non-invasive imaging is a win-win situation. There will always be plenty of bucks to be made. Reading ECHOs pays well, and even reading an EKG pays more than $50. How long does it take a cardiologist to read an EKG? -- not long 🙂
Then there will always be bucks to be made in interventions for those that want it. You're never gonna put a stent in with a spiral CT 🙂
