cards fellowship?

[amyl]

Anyone have any idea how competitive cards fellowships are? Is TEE certification automatically part of a cards fellowship...if not how long is the training for TEE? Can you be certified for TEE with a cards fellowship?

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[The_Sensei]

Anyone have any idea how competitive cards fellowships are? Is TEE certification automatically part of a cards fellowship...if not how long is the training for TEE? Can you be certified for TEE with a cards fellowship?

1) Not at all competetive
2) TEE part of any cardiothoracic fellowship
3) As long as you do 50 documented cases with TEE, you can sit for the certification exam

 

[urgewrx]

1) 3) As long as you do 50 documented cases with TEE, you can sit for the certification exam

150 Tee's done personally by you, plus 150 reviewed with a MD certified in tee in the same hospital where you have priviliges.

 

[WalterSobchak]

1. I agree, these are not terribly competitive, as they involve a lot more hours than other fellowships. This may change (a bit) as some cards fellowships will be ACGME approved starting in July. This means that you will then have a second board certification as a subspecialist.
2. TEE experience is a huge part of the fellowship. If it isn't DON"T GO to that fellowship.
3. TEE certification is a weird process. Anyone (yes anyone with $895) can take the exam given the last day of the SCA. If you pass this exam, you then become a "Testamur". A testamur can then do the following to achieve certification (As testamur status is not in itself a certification). Basic certification involves personally performing 50 echos, and reviewing 150 more. Advanced certification involves personally performing 150 echos and reviewing 150 more. If any fellowship won't easily get you to perform 150 echos DON'T GO there. Moreover, ALL 200 or 300 of the echos must be overread by someone who already has advanced certification, so this is hard to do in private practice.
4. I forgot one thing - Any echo done in residency does not count toward certification. I thought it would, but I was wrong.

 

[Bertelman]

I have heard that TEE certification may be more difficult in the future, as cardiologists try to get a stranglehold on that business. Will it be as easy to become certified in 4 years?

 

[urgewrx]

Basic certification involves personally performing 50 echos, and reviewing 150 more.

Anyone (yes anyone with $895) can take the exam given the last day of the SCA.

I would like to know where you got this info. I know the National Board of Echo is working on a basic certification, but on their website they don't talk about this.

Correction:
Anyone with an MD/DO, a license to practice medicine, and $895 can take the exam.

 

[urgewrx]

I have heard that TEE certification may be more difficult in the future, as cardiologists try to get a stranglehold on that business. Will it be as easy to become certified in 4 years?

Not true. Cardiologists have welcomed anesthesiologists since the early days. Even the president of the National Board of Echo is an anesthesiolgist.

 

[MD Dreams]

I have heard that TEE certification may be more difficult in the future, as cardiologists try to get a stranglehold on that business. Will it be as easy to become certified in 4 years?

How would a cardiologist perform a TEE reading in the operating room? I've never heard of a cardiologist perform such a function.

 

[WalterSobchak]

You are right, I was thinking of a statement made on TEE guidelines made by the SCA. It is found at: http://www.scahq.org/sca3/tee_guidelines.pdf. The basic and advanced categories are mentioned on page 3 of the pdf. I visited the NBE website, and there is no mention of a basic certification. You are either certified or not (kinda like pregnancy). The NBE requirements for certification can be found at: http://www.echoboards.org/certification/pte/reqs.html. I apologize for the confusion. I confused things that I read as I was getting ready for this test.

Oh, and cardiologists occasionally come to the OR to interepret echo. This is most common in the case of congenital heart defects, as the anatomy is so different from normal as to require a peds cardiologist. The vast majority of adult cases are done just fine by anesthesiologists (this may be institution dependent).

 

[Bertelman]

How would a cardiologist perform a TEE reading in the operating room? I've never heard of a cardiologist perform such a function.

I agree, it does seem unlikely. It's just a rumor I heard, nothing more.

 

[urgewrx]

How would a cardiologist perform a TEE reading in the operating room? I've never heard of a cardiologist perform such a function.

They'll come if you call them. If you don't call them they'll never come. I don't think they like the bunny suit, though.

 

[cchoukal]

How would a cardiologist perform a TEE reading in the operating room? I've never heard of a cardiologist perform such a function.

When I was a medical student rotating at a county hospital in Minneapolis, the cardiologist came into the OR in his bunnysuit and read the TEE pre-op for what I believe was a CABG and valve.

 

[EtherMD]

Cardiologists lose money coming to the O.R. We utilize a TEE certified Anesthesiologist for the toughest cases. Most cases are "read" by those of us with training in TEE (experience but not certified). If you check www.gaswork.com every practice that does hearts would like a TEE certified Anesthesiologist as part of the Group. The TEE certification is what distinguishes you from the rest. Your experience during a 12 month fellowship is far less than most private practice attendings. Hence, the TEE certification/testamur is the key to the fellowship experience.

 

[johankriek]

How would a cardiologist perform a TEE reading in the operating room? I've never heard of a cardiologist perform such a function.

They do it all the time.. easy... they just put on a bunny suit... walk into the OR do the echo.. then they come back and do the echo when they are coming off pump...

cardiologists arent interested because there is not enough money in OR TEE. prolly pays like 50-100 bucks to waste four hours with a surgeon.. plus cardiologist dont do TEE.. they do transthoracic.. I dont know what the indication would be for a TEE instead of a transthoracic in cardiology practice.. maybe they see vegetations better... and for intimal tears in the aorta i think TEE is the modality of choice to diagnose.. much easier than pulmonary angiography..

 

[Darwin]

They do it all the time.. easy... they just put on a bunny suit... walk into the OR do the echo.. then they come back and do the echo when they are coming off pump...

cardiologists arent interested because there is not enough money in OR TEE. prolly pays like 50-100 bucks to waste four hours with a surgeon.. plus cardiologist dont do TEE.. they do transthoracic.. I dont know what the indication would be for a TEE instead of a transthoracic in cardiology practice.. maybe they see vegetations better... and for intimal tears in the aorta i think TEE is the modality of choice to diagnose.. much easier than pulmonary angiography..

They do them all the time, as you said, to get a better view of the valves (eval. endocarditis, cath complications, endovascular valve repairs, etc). Most commonly I think they use it prior to cardioversion to r/o atrial thrombus. Our cardiologists stay pretty busy with TEE's.

 

[amyl]

At my hospital, the cardiologist does the TEEs....bedside in the CCU...I take it this is not at all the norm.

 

[EtherMD]

Cardiologists are trained in TEE and transthoracic Echo. They will come to the O.R. and CVICU on occasion (rare) to do an ECho on THEIR patient.
But, they LOSE money doing this because the time away from their practice costs them several procedures.

Hospitals with well-trained Cardiac Anesthesiologists perform and read their own Echos. A written report is also placed on the chart. THe surgeons have come to EXPECT this level of service at many institutions and request CARDIOLOGY presence for the rare case.

 

[PainNGas]

WHen are you able to bill for your TEE? Do you have to be certified or just a"testamur"? (Agree getting the experience is paramount)

 

[EtherMD]

You are confusing billing with credentialing. Any licensed Physician can bill for a procedure like an Internist doing a stress test in his office. Remember, when you do a procedure and bill you are held to the "standard of care" in that area. Military MD can elaborate more on this concept.