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why would someone be a non inv card? whats the point in being able to diagnos something only to have to refer to a more trained card? seems like a big waste of tax dollars.
point of non-invasive cardiology?
- Thread starter ThinkTooMuch
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Unlike what you see in House, Scrubs, and Grey's Anatomy, not everything requires invasive intervention. Something you'll learn to appreciate upon arriving to medical school.
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sorry for not qualifying the obvious. im not talking about everything only those things that do. pcp refers to card, card says (in some cases!) sorry you need invasive card...
btw i hate and never watch shows about medicine...other than doogie howser when it was on. 🙂
btw i hate and never watch shows about medicine...other than doogie howser when it was on. 🙂
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There's additional training to be an interventional cardiologist. There are lifestyle disadvantages as well.
And then there's the obvious: some people don't like to do that.
Some people prefer clinic. Some people prefer running the heart failure service. Some people like EP. Some people like reading echos.
And then there's the obvious: some people don't like to do that.
Some people prefer clinic. Some people prefer running the heart failure service. Some people like EP. Some people like reading echos.
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The trend in medicine in general is toward more subspecialization.
So while interventional cardiologists are better at doing caths and potentially putting in stents than noninterventional cardiologists (who may or may not do diagnostic caths but don't put in stents), some noninterventional cardiologists are much, much better at reading echos, stress tests, or managing complex heart failure or transplant patients than the interventional cards guys.
So while interventional cardiologists are better at doing caths and potentially putting in stents than noninterventional cardiologists (who may or may not do diagnostic caths but don't put in stents), some noninterventional cardiologists are much, much better at reading echos, stress tests, or managing complex heart failure or transplant patients than the interventional cards guys.
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There you go again with thinking too much. You bring up a bunch of unrelated points...
Why would someone be a non-invasive cardiologist?
Whats the point of being able to diagnose if you have to refer for treatment?
Tax dollars?
Refer to cardio... cardio refers to interventionalist...
My cardio attending was not interventional. He had a decent lifestyle. He did inpatient consults for chest pain, MI, CHF.... and had his outpatient practice where he followed his own patients (with all sorts of heart problems). He'd spend a few hours a week sitting and reading echocardiograms, by himself, in the dark. Well, I was there too. Anyway. Since joining his current practice, he's only been dragged out of bed once to confirm a case of pericardial tamponade.
The interventionalist I followed spent all day, and some nights standing in the cath lab, covered in lead. He doesn't have time to read echos or 12-leads, even if he wants to. He doesnt talk to patients because they are all knocked out on Versed and Fentanyl. So while his patients are sleeping, he's just been dragged out of bed. He doesnt have a stethoscope. But he loves his job anyway.
To each, his own.
Why would someone be a non-invasive cardiologist? To me, the fascination of cardiology is in the physiology... not the anatomy. While I like working in the cath lab, I'd like to manage heart failure, arrhythmias, MIs, etc. A better question is why would someone want to spend their life just looking at coronaries and placing stents.
Whats the point of being able to diagnose and not treat? The interventionalist I worked with didnt treat dilated cardiomyopathy. He did an intervention so the patient might not drop dead while driving on the highway... but he certainly didnt treat them. That was up to the clinical cardiologist. It was also part of his job to decide which of his cardiac cath patients would benefit from medical management rather than a stent. With properly stratified patients, medical management is equal in efficacy to interventional management. Go read about it.
Forget tax dollars.
Internist refers to cardiology. The cardiologist knows full well whether or not the patient might benefit from an intervention. The cardiologist sends his patient to the cath lab for one hour where the interventionalist works on her. Said patient gets sent back to the cardiologist for treatment of the cardiac pathology, which is now modified, due to improved blood flow, controlled heart rate, or decreased risk of sudden instant death or something. You dont stick a patient in the cath lab and then send them on their merry way.
The interventional cardiologist isnt the one who cures the disease. The interventionalist performs a very complicated, precise, skilled, risky, and very specific diagnostic and theraputic procedure. Thats about the size of it.
Theres a lot more to cardiology than stents and pacers.
Carry on my wayward son.
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you lumped invasive and interventional together. they are not the same, father.
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Is that so?
I dont actually know what an invasive cardiologist is. Do you mean a cardiologist who did a 3 year fellowship in cardiovascular disease, and didnt go on for an interventional fellowship, but continues to do the invasive procedures in their CVD fellowship skillset? And why would one not do those invasive procedures?
In that case, see the above paragraph about my preceptor. To each their own. There isnt enough time in the day to do everything. Someone might be more interested in banging out consults, or reading a bunch of echo's, or interpreting stress tests, in the time it takes to do one procedure. Your practice might put you in a niche that doesnt need for you to do invasive procedures... you might be a clinical specialist in transplant, heart failure, medical management of valvular disease. Your time may be more valuable outside the cath lab. Just thinking about my preceptor's practice. If he went under the radar for an hour in the cath lab, a significant portion of the hospital patients would be dead.
And as usual, read what Dragonfly99 wrote.
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Firstly, recognize that these are general categories and there can be significant overlap. In the real world, when residency, fellowship (and maybe further advanced fellowships) are over, you still have to apply for jobs, go on interviews, and negotiate things like salaries and JOB DESCRIPTIONS.
Noninvasive cardiologist: May be doing anything from consults, to echos, to nuclear reading, to stress tests, to clinics, to CT, to MRI.
Invasive cardiologist: Someone who has completed 3yrs of training in Cardiology, which is adequte for most hospitals to allow someone to apply for privileges to do DIAGNOSTIC Cath in addition to any or all of the above.
Interventional cardiologist: In addition to a 3 yr general cardiology fellowship has received advanced training (add'l 1-2 yrs) to perform balloon angioplasty, stent deployment, IVUS, and pressure wires.
As a side note, there is the question of pacers and ICDs. In the ivory towers of academe, these are almost solely implanted by EP trained (again, 1-2 years beyond standard 3yr cards fellowship), but in private practice these are frequently implanted by people without this additional training.
What about other procedures?
--Heart biopsies required for post-transplant patients?
--Pulm vein isolation for AFib?
--VT ablations??
--SVT, pathway, and WPW ablations??
--Flutter ablations??
So, to get back to the original question...
Why would someone want to be an noninvasive cardiologist?
--The role of the Noninvasive is not just to diagnose. Perhaps you have heard of medical therapy for CAD and hyperlipidemia? Last I checked, there were relatively few invasive procedures that lower cholesterol or blood pressure and even fewer that fix CHF.
--After med school, IM and Cards training, perhaps you are ready to go ahead and get started with a career
--There is PLENTY to be done in cardiology outside the cath lab
--There is PLENTY that even the interventional cardiologists cannot fix, and guess what that requires? Referral to another MD, like a CT surgeon to fix most valves and multivsl CAD or L main disease (there is plenty more to discuss about which specialties should be doing which)
--You are tired of doing cath and don't want to deal with the call schedule (which is HIGHLY variable, but does tend to be more demanding if you are a Cath doc)
--You are interested in academic practice where people rarely do more than 2-3 things and become very specialized in those areas
Just a few reasons, but undoubtedly there are many more.
Noninvasive cardiologist: May be doing anything from consults, to echos, to nuclear reading, to stress tests, to clinics, to CT, to MRI.
Invasive cardiologist: Someone who has completed 3yrs of training in Cardiology, which is adequte for most hospitals to allow someone to apply for privileges to do DIAGNOSTIC Cath in addition to any or all of the above.
Interventional cardiologist: In addition to a 3 yr general cardiology fellowship has received advanced training (add'l 1-2 yrs) to perform balloon angioplasty, stent deployment, IVUS, and pressure wires.
As a side note, there is the question of pacers and ICDs. In the ivory towers of academe, these are almost solely implanted by EP trained (again, 1-2 years beyond standard 3yr cards fellowship), but in private practice these are frequently implanted by people without this additional training.
What about other procedures?
--Heart biopsies required for post-transplant patients?
--Pulm vein isolation for AFib?
--VT ablations??
--SVT, pathway, and WPW ablations??
--Flutter ablations??
So, to get back to the original question...
Why would someone want to be an noninvasive cardiologist?
--The role of the Noninvasive is not just to diagnose. Perhaps you have heard of medical therapy for CAD and hyperlipidemia? Last I checked, there were relatively few invasive procedures that lower cholesterol or blood pressure and even fewer that fix CHF.
--After med school, IM and Cards training, perhaps you are ready to go ahead and get started with a career
--There is PLENTY to be done in cardiology outside the cath lab
--There is PLENTY that even the interventional cardiologists cannot fix, and guess what that requires? Referral to another MD, like a CT surgeon to fix most valves and multivsl CAD or L main disease (there is plenty more to discuss about which specialties should be doing which)
--You are tired of doing cath and don't want to deal with the call schedule (which is HIGHLY variable, but does tend to be more demanding if you are a Cath doc)
--You are interested in academic practice where people rarely do more than 2-3 things and become very specialized in those areas
Just a few reasons, but undoubtedly there are many more.
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for all intents and purposes they are. A cardiologist who reads nucs, echoes, and can do diagnostic caths would never label himself as an invasive cardiologist, unless he's just trying to impress people. Another cardiologist would never consider this person "invasive"
In private practice, an invasive and noninvasive cardiologist basically do the same thing. The invasive cardiologist has an extra skill. So he gets more money. But he's also busier. You can't get something for nothing.
The idea that an invasive cardiologist can just sit in the cath lab and never read echoes, see patients in clinic, do consults, is just wrong.
Even in academics, the "invasive/interventional" faculty still take rotations on the teaching service rounding with residents and on the consult service seeing post-op Afib and troponin bumps.
