Future competitiveness of cardiology

[Handsome88]

With all this talk about Cards having 40% decrease in salary. Many other specialties will have a better pay and lifestyle and thus a lot will find cards "not worth it" (not my opinion). What will happen to it's competitiveness 3-4 years down the road?

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[josephf1]

certain procedures (ECHO, nuckes) are getting phased in cuts o f30-40% but OVERALL Compensation is expeted to fall 15%. Thats still alot more than anything else in IM pretty much. But as the compensation gets closer to hospitalist work for @200K+ for 14 shifts a month, fewer will pursue unless they do it out of love or IMGS with no loans. also, expect all MD salaries to fall porportioanlly

 

[k96tw01]

The field has and will continue to adapt too... Already seeing most groups move into peripheral endovascular areas traditionally addressed by vascular surgery and VIR. With all the endovascular procedures comes all the imaging (carotids, venous duplex, arterial duplex, AAA, renals/mesenteric) which groups can add with little to no overhead given most already have echo machines. Cardiology is well placed to gather up much of the business in these areas as we are self referring where as VIR and vascular surgery need the outside referrals... Take one look at the presentations from All That Jazz or VIVA and you can see just how far the net is being cast in these arenas including intracranial/vertebral/acute stroke team interventions... Basically the full transition of the interventionalists wire skill sets to other areas (many of which pay MUCH better than the coronary interventions because the radiologists have been much better organized in terms of their lobbying, e.g. a 15min IVC filter implantation nets the operator as much as a multi-vessel PCI... the billing codes for peripheral interventions are also cumulative and it isn't uncommon to have 18 or so for a complex peripheral case whereas coronaries are grouped DRG codes with maybe a slight modifier for the hardest cases... in short... these other procedures net more revenue for less work) I'm sure CMS will level these fields as well, but the point is that the field will adapt with the assimilation of new technology and procedures (didn't even mention all the structural procedures that lie ahead between e-clips, TAVI, atrial appendage occluders, etc)

In short... pretty sure you can count on cardiology to remain both competitive and well reimbursed in relation to the other IM fields.

 

[youngdoc8205]

I'm sorry I had to butt in. Full disclosure i am a former rads resident switched into surgery and going to do breast surge onc so I have no dog in this fight. What I do take issue with is these posts where the interest is clearly in financial gain and not patient safety. A cards w one year interventional fellowship will hardly have enough practice and case volume to do coronary interventions and EVARs and lower extremity stents to have lower complication rates than a surgeon or a VIR who does only one type of thing. As a testament to that in one month on vascular we had to bail a cardiologist out 4 times. On the other hand a cardiologist who only does peripheral stuff and no cardiac intervention would be quite good. But if you only want to treat vascular disease why do cardiology?

Also the self referal for imaging is a cash cow that will drop off based on the cracking down of the Stark law (there is an article in a recent washington post) Even IRs who do UFE and transarterial or percutaneous oncology which require imaging follow up cannot bill for interpretation of MRI and CT (under any circumstances ) and cant have imaging done at facilities where they have a financial stake even though an argument can be made they are the most qualified to do so. You don't see breast surgeons reading or owning mammograms or urologist reading CT urograms.

I mean what is really to stop an IR or vascular surgery from certifying themselves in coronary intervention and to just go "take a look" at the coronaries while they are mucking around the aorta for some reason like cards have certified themselves to do certain things?

As someone who switched fields trust me do not pick a field based on potential rewards if you don't live it. Training is long and hard and if you don't come out loving what you do you will hate your life.

 

[Taurus]

You mean this editorial?

Why other states should adopt Maryland's law on doctor self-referrals

I would also like to add that under Obamacare physicians will increasingly abandon private practice and become hospital employees, albeit grudgingly. There are several threads on Sermo of private practice cardiology groups having trouble staying profitable after the reimbursement cuts in nucs, echo, and interventional. Many groups will simply sell out to hospitals. So what happens when all of these physicians including cardiologists become hospital employees paid on a salary? It will remove a huge significant financial incentive to do extra.

 

[youngdoc8205]

yeah that's the one;

not sure if this was in the article, but allegedly this group of physicians is now lobbying the state legislature to get the Stark Law reversed.

 

[IRGuru]

I'm sorry I had to butt in. Full disclosure i am a former rads resident switched into surgery and going to do breast surge onc so I have no dog in this fight. What I do take issue with is these posts where the interest is clearly in financial gain and not patient safety. A cards w one year interventional fellowship will hardly have enough practice and case volume to do coronary interventions and EVARs and lower extremity stents to have lower complication rates than a surgeon or a VIR who does only one type of thing. As a testament to that in one month on vascular we had to bail a cardiologist out 4 times. On the other hand a cardiologist who only does peripheral stuff and no cardiac intervention would be quite good. But if you only want to treat vascular disease why do cardiology?

Also the self referal for imaging is a cash cow that will drop off based on the cracking down of the Stark law (there is an article in a recent washington post) Even IRs who do UFE and transarterial or percutaneous oncology which require imaging follow up cannot bill for interpretation of MRI and CT (under any circumstances ) and cant have imaging done at facilities where they have a financial stake even though an argument can be made they are the most qualified to do so. You don't see breast surgeons reading or owning mammograms or urologist reading CT urograms.

I mean what is really to stop an IR or vascular surgery from certifying themselves in coronary intervention and to just go "take a look" at the coronaries while they are mucking around the aorta for some reason like cards have certified themselves to do certain things?

As someone who switched fields trust me do not pick a field based on potential rewards if you don't live it. Training is long and hard and if you don't come out loving what you do you will hate your life.

Testify brother

 

[RickyBobby23]

I'm sorry I had to butt in. Full disclosure i am a former rads resident switched into surgery and going to do breast surge onc so I have no dog in this fight. What I do take issue with is these posts where the interest is clearly in financial gain and not patient safety. A cards w one year interventional fellowship will hardly have enough practice and case volume to do coronary interventions and EVARs and lower extremity stents to have lower complication rates than a surgeon or a VIR who does only one type of thing. As a testament to that in one month on vascular we had to bail a cardiologist out 4 times. On the other hand a cardiologist who only does peripheral stuff and no cardiac intervention would be quite good. But if you only want to treat vascular disease why do cardiology?

Also the self referal for imaging is a cash cow that will drop off based on the cracking down of the Stark law (there is an article in a recent washington post) Even IRs who do UFE and transarterial or percutaneous oncology which require imaging follow up cannot bill for interpretation of MRI and CT (under any circumstances ) and cant have imaging done at facilities where they have a financial stake even though an argument can be made they are the most qualified to do so. You don't see breast surgeons reading or owning mammograms or urologist reading CT urograms.

I mean what is really to stop an IR or vascular surgery from certifying themselves in coronary intervention and to just go "take a look" at the coronaries while they are mucking around the aorta for some reason like cards have certified themselves to do certain things?

As someone who switched fields trust me do not pick a field based on potential rewards if you don't live it. Training is long and hard and if you don't come out loving what you do you will hate your life.

Just want to remind you that it's called cardioVASCULAR medicine

 

[fibonacci011]

I'm sorry I had to butt in. Full disclosure i am a former rads resident switched into surgery and going to do breast surge onc so I have no dog in this fight. What I do take issue with is these posts where the interest is clearly in financial gain and not patient safety. A cards w one year interventional fellowship will hardly have enough practice and case volume to do coronary interventions and EVARs and lower extremity stents to have lower complication rates than a surgeon or a VIR who does only one type of thing. As a testament to that in one month on vascular we had to bail a cardiologist out 4 times. On the other hand a cardiologist who only does peripheral stuff and no cardiac intervention would be quite good. But if you only want to treat vascular disease why do cardiology?

Also the self referal for imaging is a cash cow that will drop off based on the cracking down of the Stark law (there is an article in a recent washington post) Even IRs who do UFE and transarterial or percutaneous oncology which require imaging follow up cannot bill for interpretation of MRI and CT (under any circumstances ) and cant have imaging done at facilities where they have a financial stake even though an argument can be made they are the most qualified to do so. You don't see breast surgeons reading or owning mammograms or urologist reading CT urograms.

I mean what is really to stop an IR or vascular surgery from certifying themselves in coronary intervention and to just go "take a look" at the coronaries while they are mucking around the aorta for some reason like cards have certified themselves to do certain things?

As someone who switched fields trust me do not pick a field based on potential rewards if you don't live it. Training is long and hard and if you don't come out loving what you do you will hate your life.

Ummm. if you want to treat patients.. why do radiology? and isn't IR just a 1-year fellowship as well. What is that makes you think so highly of radiology (diagnostic) that it equips you with great technical skills? You don't have to read a CT slice when performing an interventional procedure.

I also notice you rads guys have no issues with the vascular surgeons. They're "vascular" surgeons and these guys are "cardiologists". You go out of your way always to attack the medicine guys and pretend the surgeons are your colleagues. the only thing you 2 had in common were exceptionally good step 1 scores 7 years ago. get over it.

 

[IRGuru]

Ummm. if you want to treat patients.. why do radiology? and isn't IR just a 1-year fellowship as well. What is that makes you think so highly of radiology (diagnostic) that it equips you with great technical skills? You don't have to read a CT slice when performing an interventional procedure.

I also notice you rads guys have no issues with the vascular surgeons. They're "vascular" surgeons and these guys are "cardiologists". You go out of your way always to attack the medicine guys and pretend the surgeons are your colleagues. the only thing you 2 had in common were exceptionally good step 1 scores 7 years ago. get over it.

I just explained to you ad nauseam in the IR forum how much clinical training a clinician IR actually gets...It's not just one year. As I told you, by the time I'm done, I will have had 4 years of clinical medicine and three years of dedicated imaging...Those who won't do a vascular medicine fellowship post-IR will still get 3 years of clinical care with 3 of dedicated imaging...What part of that don't you understand?

 

[fibonacci011]

I just explained to you ad nauseam in the IR forum how much clinical training a clinician IR actually gets...It's not just one year. As I told you, by the time I'm done, I will have had 4 years of clinical medicine and three years of dedicated imaging...Those who won't do a vascular medicine fellowship post-IR will still get 3 years of clinical care with 3 of dedicated imaging...What part of that don't you understand?

"Clinician IRs". lol. most of the current IRs just did a 1-year fellowship after radiology. so you're part of what the first class of "Clinician IRs". im guessing those IR attendings that are trying to run these new clinical IR models aren't even trained as clincian IRs.

Right now the majority of IR programs are 1-year post-diag rads fellowship. but keep stressing "Clinician IR" by all means

 

[IRGuru]

"Clinician IRs". lol. most of the current IRs just did a 1-year fellowship after radiology. so you're part of what the first class of "Clinician IRs". im guessing those IR attendings that are trying to run these new clinical IR models aren't even trained as clincian IRs.

Right now the majority of IR programs are 1-year post-diag rads fellowship. but keep stressing "Clinician IR" by all means

Will do

 

[davidjones]

The majority of the guys who practice clinical model of IR now were either trained by dotter or his trainees and have been practicing that way for decades. In those places ir is the primary provider of pad. I.e miami,UVA, Brown, Peoria etc. Meaning the model. Works
Not sure why you are complaining about a more clinical IR practice when the biggest complaint of the referers was not enough clinical follow up.

For the record neither cardiology nor vascular surgery have any problem splitting overnight PAD work with IR and only want to do elective cases during the day.

 

[badasshairday]

You don't have to read a CT slice when performing an interventional procedure.

Actually some procedures are CT guided. I saw a novel procedure performed in front of my eyes. A CT guided screw placement and osteoplasty for a pelvic ramus fracture. Pt suffered the injury due to hx of gyn cancer that was subsequently radiated, causing weakening of her pelvic ramus. Pt went home the very next day, with no pain, and was able to ambulate without assistance. This is why imaging is important. To create novel minimally invasive procedures, one must understand imaging.

 

[ucladukes]

I'm sorry I had to butt in. Full disclosure i am a former rads resident switched into surgery and going to do breast surge onc so I have no dog in this fight. What I do take issue with is these posts where the interest is clearly in financial gain and not patient safety. A cards w one year interventional fellowship will hardly have enough practice and case volume to do coronary interventions and EVARs and lower extremity stents to have lower complication rates than a surgeon or a VIR who does only one type of thing. As a testament to that in one month on vascular we had to bail a cardiologist out 4 times. On the other hand a cardiologist who only does peripheral stuff and no cardiac intervention would be quite good. But if you only want to treat vascular disease why do cardiology?

Also the self referal for imaging is a cash cow that will drop off based on the cracking down of the Stark law (there is an article in a recent washington post) Even IRs who do UFE and transarterial or percutaneous oncology which require imaging follow up cannot bill for interpretation of MRI and CT (under any circumstances ) and cant have imaging done at facilities where they have a financial stake even though an argument can be made they are the most qualified to do so. You don't see breast surgeons reading or owning mammograms or urologist reading CT urograms.

I mean what is really to stop an IR or vascular surgery from certifying themselves in coronary intervention and to just go "take a look" at the coronaries while they are mucking around the aorta for some reason like cards have certified themselves to do certain things?

As someone who switched fields trust me do not pick a field based on potential rewards if you don't live it. Training is long and hard and if you don't come out loving what you do you will hate your life.

I agree with much of what you said - just some food for thought

1) Anybody who can do a coronary stent - can do an IVC filter

2) After 5 years of reading films, I doubt I would trust a radiologist with 1 year of procedural training (VIR) more than a cardiologist with 1 year of procedural training. A radiologist is rarely skilled enough to handle critically ill patients when stuff hits the fan (as a cardiologist is not able to appreciate some of the finer nuances of tomographic imaging, or appreciate the physics, etc, of imaging.

3) I agree - those who can manage complications, should do the procedures. At our institution, the vascular surgeons and cardiologists work as a single service.

4) Most cardiologists that want to do extensive peripheral work, need to do additional training these days, beyond 1 year. Anything more than coronary interventions is starting to move towards 2 years.

 

[ucladukes]

I just explained to you ad nauseam in the IR forum how much clinical training a clinician IR actually gets...It's not just one year. As I told you, by the time I'm done, I will have had 4 years of clinical medicine and three years of dedicated imaging...Those who won't do a vascular medicine fellowship post-IR will still get 3 years of clinical care with 3 of dedicated imaging...What part of that don't you understand?

I'm confused. Where are these 3 clinical years coming from? Pushing contrast, consenting patients, standing in the lab does not constitute patient care.

Is there ever regular PRIMARY responsibility for ICU patients?
Is there ever arrhythmia management (those squiggly lines mean something)
How many codes have you run?
How many dieing patients have you cared for.
Have you ever managed a ventilator?
Do you remember how to interpret blood gases?

Most cardiologists proceeding to interventional training, have already done 6-12 months in the cath lab and are expected to be fully independent in diagnostic cath by the start of their interventional training. We have already seen most of the vascular complications of our procedures.

Who would you rather have standing there when you code - a interventional radiologist, or a vascular surgeon or cardiologist. Most rational people would choose the cardiologist and surgeon first - and I cannot imagine a single person ever picking the radiologist. There is ZERO way a radiologist can make the case that cardiologists doing procedure compromises patient safety more than a radiologist picking up a needle.

 

[dragonfly99]

I agree that it's best for an interventional cardiologist who wants to do much peripheral work to do a 2 year interventional fellowship. That is what they do at my institution and they are quite good. There is quite a bit of interaction among the vascular surgery trainees and attendings and the cardiology peripheral attendings and interventional cardiology fellows. Sometimes the attendings even swap trainees for certain cases.

By the way, radiology, including interventional radiology, frequently calls in cardiology to help them take care of a sick (or not so sick) patient on their table for a procedure. I think it's fine because they didn't do 3 years of internal med plus 3 years of cardiology fellowship. They just aren't used to taking care of sick and/or dying patients. They did little if any ICU training and they just aren't comfortable with sick patients and often don't know what to do with them, honestly. There might be institutions where this isn't the case, but the vast majority of IR folks I have seen came out of diagnostic radiology, which is basically a 1 year clinical internship followed by 4 years of reading images the vast majority of the day, with very little, if any, contact with unstable patients.

 

[NDESTRUKT]

I'm confused. Where are these 3 clinical years coming from? Pushing contrast, consenting patients, standing in the lab does not constitute patient care.

Is there ever regular PRIMARY responsibility for ICU patients?
Is there ever arrhythmia management (those squiggly lines mean something)
How many codes have you run?
How many dieing patients have you cared for.
Have you ever managed a ventilator?
Do you remember how to interpret blood gases?

Most cardiologists proceeding to interventional training, have already done 6-12 months in the cath lab and are expected to be fully independent in diagnostic cath by the start of their interventional training. We have already seen most of the vascular complications of our procedures.

Who would you rather have standing there when you code - a interventional radiologist, or a vascular surgeon or cardiologist. Most rational people would choose the cardiologist and surgeon first - and I cannot imagine a single person ever picking the radiologist. There is ZERO way a radiologist can make the case that cardiologists doing procedure compromises patient safety more than a radiologist picking up a needle.

Great post. Very honest too. Radiologists, though good at what they do, are hardly the physicians you want to depend on for any unstable patient. The majority of them probably don't even know the doses to the most common medications (or even the most common medications in that case!)

 

[Taurus]

Who would you rather have standing there when you code - a interventional radiologist, or a vascular surgeon or cardiologist. Most rational people would choose the cardiologist and surgeon first - and I cannot imagine a single person ever picking the radiologist. There is ZERO way a radiologist can make the case that cardiologists doing procedure compromises patient safety more than a radiologist picking up a needle.

Lol. Spoken like a true med student.

You should spend some time seeing what IR's do and you probably will change your tune.

Regarding coronary stents, everyone knows and multiple studies have confirmed this that many unnecessary stents are placed. That's why interventional cards are being put under a microscope and the govt is cracking down on it. Drastic reimbursement cuts for stents are no doubt in the near future. Remember what the govt did with the cardiac imaging reimbursement cuts this year.

 

[Radonkulous]

I am a senior cardiology fellow going on to an interventional fellowship - so consider my biases as you proceed.

1) Where government is the biggest payer - reimbursement will ALWAYS go down - cash business (Lasix, Plastics, etc) will survive health care reform because they do not depend on Medicare/aid payments. I am doing cards cause I LOVE going to work every day - but show me a cardiologist in 10 years making a million a year - probably doing something shady - its gonna change and cardiology is a major target of health care reform (the cardiologists of the 80s and 90s screwed the pooch royally for us)

2) Yes you do have to be smart to be a cardiologist (and an opthalmologist, and a GI, and a Rheum, etc) - whoever posted otherwise is mistaken. That was just a dumb comment.

3) GI does not have the "lifesaving" satisfaction to the extent that a poster above suggested - if you require that satisfaction, only Cardiology and PCCM( (of the medical subspecialties) enjoy that satisfaction as a matter of bread and butter. The GI fellowship at the 2 institutions I trained worked waaaaay harder than the cards fellows - FYI.

4) I suspect many people feel the same, but I went into medicine knowing I was gonna work hard, but that everyday would be a change of scenery and have meaning - it was the opposite of cubicle life - so consider that 80hrs doing something you love, can seem much shorter than 40hrs doing something you hate.

5) Just my personal experience - the reasons I said I liked fields in my senior year of med school, turned out to all be B.S. Be honest with yourself, and don't let the tree-huggers/Koom-baya (sp?) MDs of the world make you feel bad for considering, income, prestige, bad-ass-edness, etc, they shouldn't be sole motivators, but they are not wrong. I personally needed to be in a field where I can come in and save the day - that was important to me, therefore, Geriatrics - a very noble and necessary field (my dad and sis) - wasn't gonna cut it for me. Good luck to all you students figuring this all out.

6) Cardiology is best field EVER!

ummm.................I think he is a cards fellow.

 

[badasshairday]

3) I agree - those who can manage complications, should do the procedures. At our institution, the vascular surgeons and cardiologists work as a single service.

At my instituation it is VS and IR who work together. And by saying "those who can manage complications, should do the procedures", then only Vasc Surg should be doing them... and it should really be CT surg doing cardiac interventions. Also, a lot of people interested in IR are doing surgical intern years or DIRECT programs which require 2 surgical or internal med years. You think an IR can't run a code? If cards learn to do highly sophisticated procedural techniques (started by IR), PA's and NP's can run codes, than you can be damn sure a radiologist can run a code. BTW, pt's code in CT scanners often, guess who responds to it? I'm not saying radiologist deal with codes constantly like cards, but I'm just saying the amount of complications an interventional cardiologist can deal with is about the same that an IR can deal with... both are NOT surgeons. Who is cards going to call for a retroperitoneal hemorrhage? The same person as IR will.

4) Most cardiologists that want to do extensive peripheral work, need to do additional training these days, beyond 1 year. Anything more than coronary interventions is starting to move towards 2 years.

Respect. Cardiologist are badass dudes. I seriously considered it and am sometimes very envious of there position as it is a jugarnaut and I'm glad we can have competition between physicians in the peripheral vascular arena. They basically run many hospitals. However, people should keep in mind that IR, despite starting PVD interventions, has much more to offer than just that, which is what drew me to IR.

 

[badasshairday]

\
1) Anybody who can do a coronary stent - can do an IVC filter

Anybody that can coil a cerebral aneurysm or select hepatic tumor with a microcathetor to deliver chemo - can do a coronary stent. How would you like other specialties trying to invade your turf? Actually it is already happening, although in small doses rather than a full on onslaught that cards has done on PVD. Interventional Radiology at Miami Cardiac and Vascular Institute are doing structure interventions such as percutaneous PFO closure and valve replacement.

 

[davidjones]

I've been wondering how to respond to this if at all, but I feel like there is a great deal of misconception about what it is exactly IR does and the changes in the training

1)IR doesn't take care of critically ill patients:
--Crashing GI bleeders and Cirrhotics who need TIPS are very frequently unstable, and often are turfed straight to IR by GI (who has had the apparently pre-requesite 3 years of IM needed to take care of these patients)

2)Cards has to come bail IR out:
--I am at a very heavy IR program, we do 5-6 big cases (TACE, EVAR, Y90, ablations, etc) and I have never seen cardiology in our angio suite
I have seen a cardiologist ask us to do a thrombectomy, because they "were too far away" from the hospital, why is the on-call cardiologist too far away to respond to an emergency at 3 in the afternoon? (note the place I am at is also a heart and vascular center)

3)Many of the things the cards claims they should be doing instead of IR, isn't exactly indicated in critically ill patients: IVC filters, PAD, even dialysis stuff and endovenous ablations, hardly the stuff of emergencies; PAD, fine, whatever, call it cardiovascular disease and learn to do the procedures, much of this centers on reimbursement, and these are highly re-imbursed procedures. I am half-epecting some cardiologist to open up a fibroid clinic, or to try to do a uterine artery run after putting in a coronary stent just because they are "already there"

4)Clinical medicine, particularly as it applies to pre, peri, and post-operative management is hardly the most difficult thing to learn; I choose to do my electives in Heme/Onc, surge oncology and GI as it directly pertains to me, I've done about 3 months, during my radiology residency, with room to do 6 more months before I finish, and after a few days I can run circles around the so-called "clinicians", I may forget the finer points of sodium and potassium correction, but I can certainly recognize surgical and medical emergencies, and if not able to deal with them, call in someone who can.

If you want to talk about people only being half-trained, look at the cards who read cardiac CTAs and miss liver and adrenal lesions, or the ones who read myocardial perfusion and miss the uptake of sestamibi in the breast

5)IR can't take care of their own complications, only in the most dire of circumstance, i.e avulsing an artery, in fact most complications arising from IR procedures have to be treated by IR



The new clinical pathway for IR is dual-certification in IR and DR, 6 years, 2 of which will be 100% clinical, surgery or medicine, (2 of the same) and 4 years of IR and DR, with IR involving admissions, clinic, etc. While IR is relatively broad, that pathway will more than adequately prepare someone to take care of their patients. Additional training available for people wanting to do more focused oncology or pediatrics

If people stopped bickering with each other, and started working together, I think they would find a much more pleasant place to be around; If I can find a place with IR, Cards and Vascular who actually have respect for one another a la Miami that's the place I would want to practice.

 

[k96tw01]

Wow. Haven't looked in on this in 8 months and look at the firestorm... FYI. I am an interventional cardiologist doing my PGY8 year of training in a Vascular Medicine/Peripheral Endovascular fellowship so I am indeed seeking out the additional training to be fully proficient in all the aforementioned procedures. My initial comment was to point out how cardiology groups were adapting to financial pressures and a changing reimbursement climate, nothing more. I welcome anyone with the skill sets to the same table and to that point our institution has combined conferences where IR, IC, and vascular surg all bring their endovascular cases to review/discuss/learn from. That being said I see the national trend of squeezing IR out of peripheral endovascular intervention continuing, especially as cardiology/CTS/Vascular surg groups start forming these Cardiovascular Institutes (often breaking away from IM and Surg departments respectively). The control of the referral base that this sets up is the decisive factor here ( not skill sets for good or bad)... This isn't me stating anything more than an observation and trying to make sense of market forces and the business side of our profession, not a commentary on anyone's training or talents.

 

[badasshairday]

Interesting, especially the comment about cardiovascular institutes. I feel that it is more regionally dependent. I know cards is doing most of the peripherals on the east coast. However, out here on the west coast, IR is doing more peripherals than V-surg and Cards does very little. In a lot of the desirable California metros, IR private practices have hired Vascular Surgeons as well to form mixed groups. I know a super successful group in the Bay Area started by 2 IR's trained in VIR and NIR who hired a vascular surgeon, a CT-surgeon w/ wire skills, and another VIR or two, who are dominating the south Bay Area market. They do this by providing full scope of endovascular care including interventional oncology, neuro-IR (including acute stroke), venous interventions, dialysis access, men's health, women's health, pain interventions, arterial interventions and surgery.

Wow. Haven't looked in on this in 8 months and look at the firestorm... FYI. I am an interventional cardiologist doing my PGY8 year of training in a Vascular Medicine/Peripheral Endovascular fellowship so I am indeed seeking out the additional training to be fully proficient in all the aforementioned procedures. My initial comment was to point out how cardiology groups were adapting to financial pressures and a changing reimbursement climate, nothing more. I welcome anyone with the skill sets to the same table and to that point our institution has combined conferences where IR, IC, and vascular surg all bring their endovascular cases to review/discuss/learn from. That being said I see the national trend of squeezing IR out of peripheral endovascular intervention continuing, especially as cardiology/CTS/Vascular surg groups start forming these Cardiovascular Institutes (often breaking away from IM and Surg departments respectively). The control of the referral base that this sets up is the decisive factor here ( not skill sets for good or bad)... This isn't me stating anything more than an observation and trying to make sense of market forces and the business side of our profession, not a commentary on anyone's training or talents.

 

[deuist]

BTW, pt's code in CT scanners often, guess who responds to it?

At my institution, it's emergency medicine. The most frustrating thing about dropping what I'm doing in the ED to run across the hospital to the CT suite is that the radiology reading room is next door to CT and usually has 6 rads residents and attendings hiding in there.

 

[taurus70]

At my institution, it's emergency medicine. The most frustrating thing about dropping what I'm doing in the ED to run across the hospital to the CT suite is that the radiology reading room is next door to CT and usually has 6 rads residents and attendings hiding in there.

At my institution, all codes not in the ER and even some there are managed by the Internal Medicine house Staff with Pulm/Critical Care or Cardiology Fellow assistance IF Needed. The MICU resident/ senior IM resident always carry the code pager. The ER never responds unless it is in the ER, (sometimes). I have never seen an IR resident anywhere near a code even if they are in the CT scanner room.