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To do hearts in private practice?
Is a Cardiac Fellowship necessary?
- Thread starter DrRobert
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most residencies no longer can provide cardiac training like they used to, due to the drop in case load. And the main reason why some specific places are looking for "cardiac" trained anesthesiologists is to take advantage of the TEE training....
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Why are heart cases dropping? With the aging baby-boomer population, you would think heart cases would be increasing, not decreasing.
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Conditions that used to be routinely sent to CVT surgeons are more and more being treated through interventional cardiology. What remains are mostly refractory heart disease, failed interventional cases, and redo hearts, along with transplants. Most of these cases are going to be medicare cases on top of that. You will generate at least 40 points/units of pay for those cases but mostly at medicare rates of $18/point.
In some groups, fellowship training is not absolutely necessary. One of the best groups in Dallas, PAP, has many members who do the 1,400 hearts at Baylor Dallas who have never had fellowship training yet have had more cases in one year than almost any fellowship could provide them with.
TEE training will become an interesting point of debate in the future. As I understand it, the ASA and SCA (Society of Cardiovascular Anesthesiologists) have come to an agreement on forming future rules that would mandate a CV fellowship in order to receive TEE training for basic and advanced certification to utilize TEE intraoperatively. From now until 2008, those who get TEE certified without doing a fellowship will effectively be grandfathered into the system while those afterwards will be forced to do a fellowship.
In some groups, fellowship training is not absolutely necessary. One of the best groups in Dallas, PAP, has many members who do the 1,400 hearts at Baylor Dallas who have never had fellowship training yet have had more cases in one year than almost any fellowship could provide them with.
TEE training will become an interesting point of debate in the future. As I understand it, the ASA and SCA (Society of Cardiovascular Anesthesiologists) have come to an agreement on forming future rules that would mandate a CV fellowship in order to receive TEE training for basic and advanced certification to utilize TEE intraoperatively. From now until 2008, those who get TEE certified without doing a fellowship will effectively be grandfathered into the system while those afterwards will be forced to do a fellowship.
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I hear heart cases are dropping due to the amount of stenting done by interventional radiologist, interventional cardiologists, and vascular surgeons.... Im not sure how true this is however...
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That is unfortunate. I find cardiac anesthesia to have some of the most interesting and challenging cases.
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That is a little disturbing. I find cardiac anesthesia the most interesting and challenging. So are cardiac anesthesiologists starving? Is it possible to do well only performing heart cases?[/QUOTE]
It's possible, but you have to have good-great patient demographics in the hospital(s) you practice in. Even a 40:60 ratio of private insurance:medicare would be acceptable. Multispecialty groups would allow you to do both hearts and non-cardiac cases where you could bolster your income or have blended reimbursement rates that would definitely benefit you if you do the hearts for that group.
Is it a money maker like it once was? Definitely no, but the interest level keeps a lot of anesthesiologists there.
It's possible, but you have to have good-great patient demographics in the hospital(s) you practice in. Even a 40:60 ratio of private insurance:medicare would be acceptable. Multispecialty groups would allow you to do both hearts and non-cardiac cases where you could bolster your income or have blended reimbursement rates that would definitely benefit you if you do the hearts for that group.
Is it a money maker like it once was? Definitely no, but the interest level keeps a lot of anesthesiologists there.
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hate to say it - but that article is a fluff article (some info for the lay public at the time of the clinton cabg).
nationally CABGs are trending down - the only thing that is unchanged is valves and congenital stuff. assist devices are becoming a bit more commong. But the bread and butter CABGs are disappearing
nationally CABGs are trending down - the only thing that is unchanged is valves and congenital stuff. assist devices are becoming a bit more commong. But the bread and butter CABGs are disappearing
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I just read a few of the beginning posts, but here are my views as a graduating CA-3 in June. I am doing a pain management fellowship next year, and have no interest in hearts, although I have done more than enough (4 months in tristate referral center that is the flagship hospital of my program), so I can give you a somewhat objective and experienced opinion.
1. cardiac anesthesiologists will never "starve" b/c if you can do a heart, then you can also do anything else in anesthesia. That is, they can easily do the general cases. The heart is the most important organ followed by the brain for anesthesiologists. so, cardiac anesthesiologists will always be in high demand in the OR world, simply b/c they can take are of sickest patients (i.e. patients w/ terrible heart disease).
2. its true that the number of routine cabg's are declining and that Cardiac surgeons are probably going to have trouble in the future, but see #1 to understand why cardiac anesthesiologists will not be affected. more and more cases are now valves.
3. many if not most private groups do not require a fellowship to do hearts. most of my CA-3 graduates are going into private practice and doing hearts some of the time. many routine cabg's where the patient is not all that sick do not require TEE. when they do, a cardiologist can come in and do it. many community hospitals simply have in a central line and at most a swan for the harder heart cases. TEE would be provided by the cardiology dept or a general anesthesiologist who "learned on the job". if I was going into private practice, I would be VERY CONFIDENT to do most hearts in the community hospitals after my four months of cardiac rotation. my hospital had some of the sickest hearts and most of them were valve cases. i know how to do a basic TEE exam and would learn more by trial and error as a practicing anesthesiologist.
4. many, many general anesthesiologists do not like doing hearts simply b/c its more stressful. they are some of the more challenging cases. thus, that's why the young attendings, freshly out of residency, end up doing them.
Hope this helps.
1. cardiac anesthesiologists will never "starve" b/c if you can do a heart, then you can also do anything else in anesthesia. That is, they can easily do the general cases. The heart is the most important organ followed by the brain for anesthesiologists. so, cardiac anesthesiologists will always be in high demand in the OR world, simply b/c they can take are of sickest patients (i.e. patients w/ terrible heart disease).
2. its true that the number of routine cabg's are declining and that Cardiac surgeons are probably going to have trouble in the future, but see #1 to understand why cardiac anesthesiologists will not be affected. more and more cases are now valves.
3. many if not most private groups do not require a fellowship to do hearts. most of my CA-3 graduates are going into private practice and doing hearts some of the time. many routine cabg's where the patient is not all that sick do not require TEE. when they do, a cardiologist can come in and do it. many community hospitals simply have in a central line and at most a swan for the harder heart cases. TEE would be provided by the cardiology dept or a general anesthesiologist who "learned on the job". if I was going into private practice, I would be VERY CONFIDENT to do most hearts in the community hospitals after my four months of cardiac rotation. my hospital had some of the sickest hearts and most of them were valve cases. i know how to do a basic TEE exam and would learn more by trial and error as a practicing anesthesiologist.
4. many, many general anesthesiologists do not like doing hearts simply b/c its more stressful. they are some of the more challenging cases. thus, that's why the young attendings, freshly out of residency, end up doing them.
Hope this helps.
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I just finished two months of elective CV as part of my CA-3 year. It was the busiest two months of my entire residency. Now granted our CV surgeons do vascular cases as well, but I did so many hearts it was unreal.
While the old days of a 50 y/o otherwise healthy male having a CABG for single vessel disease are gone, they are being replaced with tons of older patients with complex multi-vessel CAD, and valvular dz. No to mention that the surgeons are starting to do the minimally invasive CABG's and MVR's with the robot. And as long as people are stupid enough to keep smoking, there will always be tons of thoracic cases.
The major reason to do a CV fellowship would be to get TEE certified. All the docs in our heart group are, and the surgeons really look to them for their interpretation of the echo exams. I was hoping to pick up some skills during this year, but it is just impractical when the OR's are buzzing.
While the old days of a 50 y/o otherwise healthy male having a CABG for single vessel disease are gone, they are being replaced with tons of older patients with complex multi-vessel CAD, and valvular dz. No to mention that the surgeons are starting to do the minimally invasive CABG's and MVR's with the robot. And as long as people are stupid enough to keep smoking, there will always be tons of thoracic cases.
The major reason to do a CV fellowship would be to get TEE certified. All the docs in our heart group are, and the surgeons really look to them for their interpretation of the echo exams. I was hoping to pick up some skills during this year, but it is just impractical when the OR's are buzzing.
