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there is a whole bunch of threads already on this question but all of them are like "i think the difference is this or that"...does anyone know exactly what the difference is?
difference between invasive and interventional cards?
- Thread starter ThinkTooMuch
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Invasive can do diagnostics caths i.e. inject dye into the coronaries to look for blockages.
If a blockage is found, they may call the interventionalist to stent it as invasive cards don't put stents in.
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My impression is that "invasive" means that the person is trained to do diagnostic caths, but does not necessarily imply that the person is trained to place stents.
"Interventional" definitely implies that the person is trained to place stents as well as being able to do diagnostic caths.
"Interventional" definitely implies that the person is trained to place stents as well as being able to do diagnostic caths.
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Hmmm...just read the entire thread.
So Tibor, are you saying that "invasive" should = the same thing as "interventional" or that it really does (in current usage/procedure)? For example, I've seen a lot of ads advertising for invasive cardiologist but I think they were just looking for someone who could do diagnostic caths (at least at minimum). Are you just saying that the terms should be interchangeable and are just being misused currently, or I am just totally wrong and the two terms really are synonymous?
So Tibor, are you saying that "invasive" should = the same thing as "interventional" or that it really does (in current usage/procedure)? For example, I've seen a lot of ads advertising for invasive cardiologist but I think they were just looking for someone who could do diagnostic caths (at least at minimum). Are you just saying that the terms should be interchangeable and are just being misused currently, or I am just totally wrong and the two terms really are synonymous?
Invasive implies diagnostic cath Intervention well is self explanatory. ---------------- Listening to: Van Halen - You Really Got Me via FoxyTunes
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i r more confused now, lol.
this recruiting site makes a distinction so thats why i asked:
http://www.physicianrecruiting.com/jobfinder.php?jobclass=Card&jobstate=CA&action=2
btw im really digging these 450k starting positions for non invasive cards, although they are in states like KY and SD. 😀
this recruiting site makes a distinction so thats why i asked:
http://www.physicianrecruiting.com/jobfinder.php?jobclass=Card&jobstate=CA&action=2
btw im really digging these 450k starting positions for non invasive cards, although they are in states like KY and SD. 😀
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So after your three year Cardiology fellowship are you able to do any procedures? If so, what procedures can you do?
Or, do you have to do the 1-2 years of invasive/interventional after the Cardiology fellowship to do procedures?
Thanks.
Or, do you have to do the 1-2 years of invasive/interventional after the Cardiology fellowship to do procedures?
Thanks.
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it kind of depends on where you are and what kind of back up you have/your contract/how big your stones are. In general, you can do diagnostic caths but not stents if you don't have the interventional training. Other procedures (rt heart cath, cardiac biopsies, etc) will still be on the table though.
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Can someone break it down: non-invasive vs. invasive vs. interventional?
3 yrs cardio fellowship: non invasive. Consults, ECHO, stress test, nuchs, outpatient
3 yrs cardio fellowship plus enough electives in interventional to log the required caths to be Level II - no stenting, just R/L Heart Diagnostic Cath = invasive
3 yrs cardio + 1 or 2 yrs extra in intervetional: Level III in cath, stenting, IVUS, rotablader, PFO/ASD closure, HOCM
Additional year to do peripheral stenting (Carotids, aorta, renal, legs, subclav)
Additional year to do structural (valve replacement)
3 yrs cardio fellowship plus enough electives in interventional to log the required caths to be Level II - no stenting, just R/L Heart Diagnostic Cath = invasive
3 yrs cardio + 1 or 2 yrs extra in intervetional: Level III in cath, stenting, IVUS, rotablader, PFO/ASD closure, HOCM
Additional year to do peripheral stenting (Carotids, aorta, renal, legs, subclav)
Additional year to do structural (valve replacement)
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That's a good question. I guess it depends upon the context.
If a cardiologist can do diagnostics but not inteventions, he could market himself as an invasive cardiologist.
BUT if a job says they want an invasive cardiologist, I would assume they want somebody who can do it call, i.e. interventions.
I do not believe the term invasive cardiologist carries much meaning. If you can only do diagnostics, I guarentee you that the bulk of your time/RVU's will be in noninvasive work - consults, clinic, echo, nuclear. Diagnostic caths alone won't get you much - especially since you will only cath patients who you think are low risk. You won't cath patients with STEMI, ACS, non-STEMI, etc.
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Thanks for the clarification everyone. The extra one-year of interventional seems to be a great marketing tool for one's CV. A stressful tool, but a nice one to have 🙂
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noninvasive = does consults, reads echo, does clinic, often reads nuclear studies (plus maybe coronary CT, and MRI but only if you got extra imaging training, usually extra year fellowship)
invasive = you do your own diagnostic caths but you're not an interventionalist who does stents. I disagree a little w/Tibor on this. I know 2 fellows from my program who got hired last year as invasive...meaning they do diagnostic caths but they don't do interventions. If you are in a big hospital network/sytem and/or some academic centers, it's not that uncommon, although probably becoming less common. There are a lot of diagnostic caths in the world and they aren't all going to be done by interventionalists. It probably depends on the market/city and hospital system you are in. Any fellow in my program with any ambition at all can graduate with enough diagnostic caths to get Level II certified (which means you'd be allowed to do diagnostic caths in private practice).
interventional = you did 1-2 extra years of fellowship beyond the usual 3 years, and you got training in how to do coronary stents, probably closing ASD and PFO's, and perhaps with doing peripheral (i.e. aortic and lower extremity) interventions.
invasive = you do your own diagnostic caths but you're not an interventionalist who does stents. I disagree a little w/Tibor on this. I know 2 fellows from my program who got hired last year as invasive...meaning they do diagnostic caths but they don't do interventions. If you are in a big hospital network/sytem and/or some academic centers, it's not that uncommon, although probably becoming less common. There are a lot of diagnostic caths in the world and they aren't all going to be done by interventionalists. It probably depends on the market/city and hospital system you are in. Any fellow in my program with any ambition at all can graduate with enough diagnostic caths to get Level II certified (which means you'd be allowed to do diagnostic caths in private practice).
interventional = you did 1-2 extra years of fellowship beyond the usual 3 years, and you got training in how to do coronary stents, probably closing ASD and PFO's, and perhaps with doing peripheral (i.e. aortic and lower extremity) interventions.
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I guess we'll have to agree to disagree. I've worked in 2 big academic centers and there was nobody who did caths who couldn't do interventions.
The fact is that if you cath somebody, and then find a blockage that needs fixing, you have to call somebody else. This somebody else is probably going to be doing something else....i.e. his own caths.
Which means you will only cath patients who have a greater than 90% chance of not needing a stent....very low risk patients..and those who are pre-surgery (i.e. left heart cath in a patient undergoing AVR). This isn't that big of a population.
Where might it be useful? In certain hospitals, you can do diagnostics, but not interventions because there is no CT surgery backup. So, a group can stick one of their non-interventional invasive guys there to cath low risk patients. If it abnormal, you keep the sheath in and transfer them to the cath hospital.
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FWIW I've seen cardiologists in both private hospitals and academic centers who do only diagnostics.
-The Trifling Jester
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I know docs who work @Kaiser who just do diagnostic caths. There are always going to be more patients who need diagnostic caths than patients who need interventions. I know there are multiple VA hospitals also that do caths (diagnostic) but not interventions, and some of the attendings are not interventionalists (but only do diagnostics). I think it depends on your practice environment. I don't doubt that there are a number of academic-type places where there are so many interventionalists that it's totally unnecessary for them to have invasive cardiologists who don't do interventions.
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Invasive/Non-interventional and Interventional cards are in fact different.
When asking this question, whether one is considering Academic or Private practice is an important distinction.
Private Practice:
Non-invasive: inpatient consults, CCU, echo (some do TEE), treadmill stress testing, nuclear cardiology, +/- CT angiography, outpatient clinic. When on-call, if a cath is required will call in the interventionalist. Does not take STEMI call.
Invasive non-interventional: everything that non-invasive does, but can do right heart catheterization with complex hemodynamic assessment, TEE, coronary/bypass angiography, LV angiography/Left heart catheterization, pericardiocentesis, intra-aortic balloon pump, permanent pacemaker implant (if skill was acquired as a fellow), ICD implantation (typically not BiV). When on call, if a cath is required, they do it. If a stent is called for, the interventionalist comes in. They can do intra-aortic balloon pumps and can do a pericardiocentesis if needed. In some places, they DO take STEMI call. They will shoot the diagnostic part prior to the interventionalists arrival. Furthermore, when on call, if a patient with unstable angina or NSTEMI requires a cath, the invasive non-interventionalist will do the diagnostic procedure, and only call the interventionalist if stenting is required.
Interventional: typically does not do TEE, many do not read nucs, still read echo, have a clinic, inpatient consults, treadmill stress testing, coronary stenting, +/- peripherals, IABP, pericardiocentesis. They typically do not do permanent pacemaker or ICD implants. Takes STEMI call. Some do balloon valvuloplasty, ASD closure, alcohol septal ablation, and now TAVI.
In the majority of Academic Institutions, though certainly not all (A lot of VAs for example have non-interventionalists doing diagnostic caths and RHCs), all cardiac catheterizations are done by Interventionalists, and all EP procedures are done by electrophysiologists.
In private practice, the interventionalists don't just sit and wait to do caths. They have their own clinics, and function as general cardiologists as their non-interventional colleagues. In fact, some EP physicians must also take general cardiology call.
So, those who are arguing that there is no difference between an invasive cardiologist and an interventionalist are simply misinformed. As someone said before, most cardiac catheterizations do not end in stenting. Cardiac catheterization is a broad term that encompasses right heart catheterization, coronary/bypass angiography, and left heart catheterization (generally entering the LV via a retrograde approach through the aortic valve to measure LVEDP, determine LV/AO gradients in AS, and to perform LV angiography to measure LV volumes and ejection fraction). Perhaps some of the differences can be confusing to non-cardiologists, but there are many indications for cardiac catheterization that have nothing to do with coronary stenting.
As a reflection of the above stated distinctions, when one is applying for cardiology jobs following fellowship (mostly in private practice), he or she will notice that jobs are offered for non-invasive, invasive non-interventional, and interventional. They are in fact different.
When asking this question, whether one is considering Academic or Private practice is an important distinction.
Private Practice:
Non-invasive: inpatient consults, CCU, echo (some do TEE), treadmill stress testing, nuclear cardiology, +/- CT angiography, outpatient clinic. When on-call, if a cath is required will call in the interventionalist. Does not take STEMI call.
Invasive non-interventional: everything that non-invasive does, but can do right heart catheterization with complex hemodynamic assessment, TEE, coronary/bypass angiography, LV angiography/Left heart catheterization, pericardiocentesis, intra-aortic balloon pump, permanent pacemaker implant (if skill was acquired as a fellow), ICD implantation (typically not BiV). When on call, if a cath is required, they do it. If a stent is called for, the interventionalist comes in. They can do intra-aortic balloon pumps and can do a pericardiocentesis if needed. In some places, they DO take STEMI call. They will shoot the diagnostic part prior to the interventionalists arrival. Furthermore, when on call, if a patient with unstable angina or NSTEMI requires a cath, the invasive non-interventionalist will do the diagnostic procedure, and only call the interventionalist if stenting is required.
Interventional: typically does not do TEE, many do not read nucs, still read echo, have a clinic, inpatient consults, treadmill stress testing, coronary stenting, +/- peripherals, IABP, pericardiocentesis. They typically do not do permanent pacemaker or ICD implants. Takes STEMI call. Some do balloon valvuloplasty, ASD closure, alcohol septal ablation, and now TAVI.
In the majority of Academic Institutions, though certainly not all (A lot of VAs for example have non-interventionalists doing diagnostic caths and RHCs), all cardiac catheterizations are done by Interventionalists, and all EP procedures are done by electrophysiologists.
In private practice, the interventionalists don't just sit and wait to do caths. They have their own clinics, and function as general cardiologists as their non-interventional colleagues. In fact, some EP physicians must also take general cardiology call.
So, those who are arguing that there is no difference between an invasive cardiologist and an interventionalist are simply misinformed. As someone said before, most cardiac catheterizations do not end in stenting. Cardiac catheterization is a broad term that encompasses right heart catheterization, coronary/bypass angiography, and left heart catheterization (generally entering the LV via a retrograde approach through the aortic valve to measure LVEDP, determine LV/AO gradients in AS, and to perform LV angiography to measure LV volumes and ejection fraction). Perhaps some of the differences can be confusing to non-cardiologists, but there are many indications for cardiac catheterization that have nothing to do with coronary stenting.
As a reflection of the above stated distinctions, when one is applying for cardiology jobs following fellowship (mostly in private practice), he or she will notice that jobs are offered for non-invasive, invasive non-interventional, and interventional. They are in fact different.
I will briefly summarize what is correct and has already been stated:
noninvasive: no invasive procedures whatsoever, only does diagnostic testing (echo, stress, nucs, possibly ct/mri) and sees patients
invasive (non interventional is implied when saying invasive): does diagnostic left heart caths, right heart caths, places IABPs and TVPs, but does not do any type of angioplasty/stenting/intervention. Must call an interventionalist to do angioplasty and stenting. Also likely to do much of the work noninvasive does as there
Interventional: does everything an invasive cardiologist does as far as procedures, plus does angioplasty stenting of coronaries and may also do angioplasty stenting of carotids, renals, peripheral arteries
*** One thing nobody has stated though, is in a lot of jobs in the midwest/west/south when they say invasive non interventional they may also be looking for a non ep trained doc who can place ppms and aicds. (there may be a shortage of ep docs in these areas).
noninvasive: no invasive procedures whatsoever, only does diagnostic testing (echo, stress, nucs, possibly ct/mri) and sees patients
invasive (non interventional is implied when saying invasive): does diagnostic left heart caths, right heart caths, places IABPs and TVPs, but does not do any type of angioplasty/stenting/intervention. Must call an interventionalist to do angioplasty and stenting. Also likely to do much of the work noninvasive does as there
Interventional: does everything an invasive cardiologist does as far as procedures, plus does angioplasty stenting of coronaries and may also do angioplasty stenting of carotids, renals, peripheral arteries
*** One thing nobody has stated though, is in a lot of jobs in the midwest/west/south when they say invasive non interventional they may also be looking for a non ep trained doc who can place ppms and aicds. (there may be a shortage of ep docs in these areas).
