Interventional Cardiologist Lifestyle

[magnetto84]

This may have been discussed before, but can some practicing interventionalists give their side of the story. What is the truth. How is the lifestyle as compared to your non invasive colleagues. Who is happier overall.

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[francisco84]

This may have been discussed before, but can some practicing interventionalists give their side of the story. What is the truth. How is the lifestyle as compared to your non invasive colleagues. Who is happier overall.

I get to go in and fix stemi's and have people thank me for saving their lives. On the other hand I have to go in to fix stemi's at any hour and have people die.

I don't know anyone (I'm sure they exist) who doesn't love being a interventionalist. There is some self selection but the thrill of the job is addictive.

There's probably a lot more work to do as a non invasive. More patients to see in clinic, more echoes to read etc. But I don't know the last time I saw a non invasive in the hospital in the middle of the night.

 

[timpview]

There’s no question general guys have a significantly better quality of life.. by a pretty wide margin in most cases.

never underestimate the additional stresses of any procedure or surgery based specialty. Especially when people die.

not only is there the stress of perhaps killing a previously living soul but it also comes with a handful of things you don’t think about as a trainee.. specifically the oversight of hospitals, administrators and fellow docs.

Complications,outcomes, case reviews, cms penalties. All that noise adds up but you put a lot of other peoples money at risk. Add to that the stress of high risk cases in sleep deprived states and potential things that go wrong or be misinterpreted by techs or nurses and you out your own self at risk more than any doc in that hospital. One bad interaction with a nurse and or 2-3 bad cases that go wrong (even if not your fault) and you can be out of there.. and go luck finding a new job after that.

A general guy typically doesn’t worry about that. See some consults, read some echos or nucs, see clinic patients.
With that said the one true protection going forward that you can do that no one else can do and the thing hospitals need more than anything is STEMI coverage.

so in a way your job is more at risk given the environment you work in but at the same time if things change going forward your job is also more protected.,

 

[timpview]

People also don’t understand that for a lot of interventionalists in the community, we are basically general cardiologist that happen to do interventions. 90% of my RVUs are general cardiology. I would rank in 90%th plus for general cardiology production.. then you add on the interventions and interventional call. So those type of set up are the worse.

There is a shift to “interventional” only practices in hospital employed systems with more lifestyle protection (not taking general call) so many interventionalist are getting better q of life set ups.. with some I would argue having better q of l than their general colleagues. These are situations when IC is paid for coverage rather than production.

I would argue that anything that requires GENERAL call in a frequent rate is the absolute worse for quality of life, especially when you are the primary admitting service

so find a job where you are consulting only, have mid levels to do your rounding and only get called for true emergencies. Nights are what will ruin your life

 

[magnetto84]

Thank you to all the posters. For the first time, I have seen very informative comments on this topic on SDN. If other practicing interventionalists can chime in, and maybe practicing generalists too, we will have a wider opinion

 

[magnetto84]

And we probably need to think about differences in academic and private setups. And about other things little talked about such as hazards of radiation, prolonged standing and lead weight etc..

 

[nlax30]

I’m not interventional, but EP and so I’ll echo some the comments that were mentioned above in regards to a heavy procedural base field.

The stress is real on that one wrong move of a catheter could seriously change that patient’s life. Certainly in the beginning of my career that aspect is very stressful, I’m assuming it gets a little better with time but will always be hanging over me.

The hazards to your body are real. At least in my field we’re minimizing fluoro use but just about every IC or EP I know who’s been practicing a while has had some sort of ortho issue.... back, neck, shoulders, hands, etc.

 

[Mdinfo]

There’s no question general guys have a significantly better quality of life.. by a pretty wide margin in most cases.

never underestimate the additional stresses of any procedure or surgery based specialty. Especially when people die.

not only is there the stress of perhaps killing a previously living soul but it also comes with a handful of things you don’t think about as a trainee.. specifically the oversight of hospitals, administrators and fellow docs.

Complications,outcomes, case reviews, cms penalties. All that noise adds up but you put a lot of other peoples money at risk. Add to that the stress of high risk cases in sleep deprived states and potential things that go wrong or be misinterpreted by techs or nurses and you out your own self at risk more than any doc in that hospital. One bad interaction with a nurse and or 2-3 bad cases that go wrong (even if not your fault) and you can be out of there.. and go luck finding a new job after that.

A general guy typically doesn’t worry about that. See some consults, read some echos or nucs, see clinic patients.
With that said the one true protection going forward that you can do that no one else can do and the thing hospitals need more than anything is STEMI coverage.

so in a way your job is more at risk given the environment you work in but at the same time if things change going forward your job is also more protected.,

Am not sure how” one wrong interaction with a nurse” can affect an IC? I know admin always supports the RN , but one rn can fire u is little scary

 

[redlined1]

Timpview is spot on. Very difficult to find quality RN/RT to work in the lab. They will frequently make mistakes which will exponentially raise the IC stress level. Say anything to anyone and you will be in trouble. Admins do not support docs. Admins support RN's as many times hospital is run by RN's

 

[pkex008]

Timpview is spot on. Very difficult to find quality RN/RT to work in the lab. They will frequently make mistakes which will exponentially raise the IC stress level. Say anything to anyone and you will be in trouble. Admins do not support docs. Admins support RN's as many times hospital is run by RN's

Unfortunately pretty much true - RN/RT's mistakes are always on the MD, and admin will always support RN and even when you complain, you're always the scapegoat. Have seen many situations where RN judgement was poor, angering the interventionalist/EP, and in the end the IC/EP is the one that gets disciplined.

 

[onconc]

Admins do not support docs. Admins support RN's as many times hospital is run by RN's

Can confirm this as a HemOnc as well. Hospital admin is disproportionately made up of former (or even current) nurses.

 

[NewYorkDoctors]

People also don’t understand that for a lot of interventionalists in the community, we are basically general cardiologist that happen to do interventions. 90% of my RVUs are general cardiology. I would rank in 90%th plus for general cardiology production.. then you add on the interventions and interventional call. So those type of set up are the worse.

There is a shift to “interventional” only practices in hospital employed systems with more lifestyle protection (not taking general call) so many interventionalist are getting better q of life set ups.. with some I would argue having better q of l than their general colleagues. These are situations when IC is paid for coverage rather than production.

I would argue that anything that requires GENERAL call in a frequent rate is the absolute worse for quality of life, especially when you are the primary admitting service

so find a job where you are consulting only, have mid levels to do your rounding and only get called for true emergencies. Nights are what will ruin your life

just wondering do you have your own nuclear machine? i know that's probably one extra board to worry about.

I refer patients to a two different interventional cardiologists who also do general. but of the workup pattern I noticed there really is not much in the way of nuclears being done by them. perhaps that has to do with logistics, buying the machine, maintaining it, and maintaining the board certification and all the radiation stuff? Moreover if equivocal treadmill stress just go to CCTA followed by LHC is the preferred way to go for the interventionalist? just curious learning how how other subspecialties run their shops.

 

[timpview]

Depends..

My personal take is stress testing is nearly worthless, completely over-utilized and just a reflex test that many of us (especially now APPs) do to make it look like we’re taking the patient and whatever concerns they have seriously (silly chest pain, sob, fatigue). I do find some value as a “d dimer” type test to reassure low risk patients and their doctors that everything looks fine.

I find CCTA more useful in those patients where I think we can get good images, but no doubt the lack of direct cards reimbursement has slowed its uptake- plus it’s annoying to now have to deal with radiology depts.

Since the majority of cardiologists are hospital employed now (>90% in my area) that financial incentive to utilize those nuclear scans has decreased. And although they are easy rvus many of these employed gigs don’t even have production incentives so that’s kind of a mute point.

But obviously a lot of ways to skin it. Stress testing/nuc will likely always be around.

My take is if I’m actually concerned I cath. Moderate concern I try and get a ccta. And if I need to appease people I stress

 

[NYknicks44]

I like treadmill nuclear stress tests. I think it gives a tremendous amount of information that is useful. It tells me how many METS they achieved, if their symptoms correlated with exertion, if they are concerning EKG changes, and if the degree of ischemia ( small or severe) and localizes the ischemia to the artery (helpful when you cath them). You do need to have good reader that gives you the above information

I don’t find CCTA that helpful unless it is completely normal. A lot of them reads hedge significantly between moderate and severe disease. Having calcium on arteries, ckd or Afib (which is a lot of our patients) makes CCTA non diagnostic.

It is hard to get insurance approval for direct LHC as an outpatient. If I am concerned about unstable angina, I send them to the hospital.

 

[NewYorkDoctors]

don't forget those incidental lung findings on CCTA that you have to refer out to. i don't mind when I get those. easy consultation.

addendum: without bumping:

I have noticed in some places (like the tertiary care hospitals) the CCTAs have a cardiologist report and a radiologist lung window report

At a private practice radiology center chain that does CCTA, I sometimes see the radiologist doing the cardiac and full CT chest report

I suppose radiologist COULD do this but the cardiology division has to exert political influence in a hospital setting?