Credentialling in peripheral

[Limvostov]

So, I'm sure I'm not the first interventional cardiologist with peripheral vascular training that is having trouble getting credentialing due to "turf" issues. Any ideas of how to navigate this situation or do I need to start looking for employment elsewhere if I want to continue peripheral? I thought about moonlighting but I don't know how many opportunities there are for moonlighting in peripheral vascular. Any thoughts or advice would be great. I honestly like just about everything else about my current position and the location is essentially perfect for my family so leaving would be rather difficult for personal reasons.

Just for an example, I tried to book my first peripheral procedure (diagnostic abd lower extremity run off) and was met with total resistance including a meeting with the chief of medicine stating that vascular surgery refused to monitor my case for credentialling as they were concerned that if I started peripheral procedures I would "dilute their experience". I was told to keep working on building my cardiology practice and to revisit the idea of peripheral vascular interventions in 6 months.

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[paki20]

So, I'm sure I'm not the first interventional cardiologist with peripheral vascular training that is having trouble getting credentialing due to "turf" issues. Any ideas of how to navigate this situation or do I need to start looking for employment elsewhere if I want to continue peripheral? I thought about moonlighting but I don't know how many opportunities there are for moonlighting in peripheral vascular. Any thoughts or advice would be great. I honestly like just about everything else about my current position and the location is essentially perfect for my family so leaving would be rather difficult for personal reasons.

Just for an example, I tried to book my first peripheral procedure (diagnostic abd lower extremity run off) and was met with total resistance including a meeting with the chief of medicine stating that vascular surgery refused to monitor my case for credentialling as they were concerned that if I started peripheral procedures I would "dilute their experience". I was told to keep working on building my cardiology practice and to revisit the idea of peripheral vascular interventions in 6 months.

That means you're not going to be doing PV. Really need backing of chief of cardiology and chief of Medicine to fight for it. Seems like at your institution vascular surgery is going to fight this and you alone can't win this battle if you don't have support of own chairs.

 

[cards67]

That's how it goes, not just peripheral either. But that's always been the risk with something like peripheral. Could wait it out or move. Though was this not discussed before you took the job? It all depends what's important to you. There's rarely a perfect job out there. And it's not just inter-departmental turf but intra-departmental turf.

 

[Limvostov]

I did know there would be challenges with doing peripheral vascular procedures because vascular does them all here. Even IR is excluded. I'm hoping that will change in the next few months. Finding other sources of peripheral experience will be difficult. The rest of the job is great. Guess I could have it worse. Just disappointing, I wanted some sprinkles on my ice cream sundae career. I'll try to stay positive.

 

[AirplaneFruit]

As an IM resident, what are the reasons why you want to do peripheral procedures? Are they fun/lucrative/add diversity to your workload?
And then, will Medicine/Cardiologists eventually win these turf wars just by sheer persistence?

 

[paki20]

As an IM resident, what are the reasons why you want to do peripheral procedures? Are they fun/lucrative/add diversity to your workload?
And then, will Medicine/Cardiologists eventually win these turf wars just by sheer persistence?

Interventional cardiologists are already doing peripheral procedures. It's just institution dependent.

 

[timpview]

1. No one will “win” the turf war. Depends on institutions but if you want to do peripherals you can do peripherals. Just often not as the same place that wants to employ you for coronaries.

2. I’ve found IC guys that do them are often the types that just love to be in the lab. Peripherals are more the Wild West as the coronaries were in 90s/00s. Can be aggressive. A little more industry interaction. Obviously the guys that benefit in production contracts are incentivized as they can be huge money makers. Not bundled payments. Repeat procedure galore. Also potential for ownership in outpatient labs.

3. With that said with the current trend of hospital employment for cardiologists I see more IC giving up or not wanting to deal with it. It’s a sick patient population that results in complications. Admin hates complications so that’s a headache. Hospitals in my region care more about budget than profit. There’s often not a huge carrot to chase for more production. They require a lot more work/time/hassle. So you might get support but you often don’t. Often it’s all in addition to your full time general cardiology and coronary work. Then as u alluded to you have your institutional turf wars.

The ones that I’ve seen do it are trying to capture the facility fees of their own outpatient lab or have 100% hospital support to really create a church and burn practice. In my area that is basically non-existent. Many hospitals aren’t willing to commit the resources or energy to do that .. especially if it pisses off their IR or vascular guys. The few IC guys I see do them almost do it exclusively now (basically all they do) but they’re at random small hospitals and are able to carve out their niche..

But I’m not in the south or a heavy peripheral area so just one perspective.