What is the view of cardiologists.....

[windsurfr]

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Browsing the rads link or SIR I see a lot of complaining about 'turf stealing' of cardiologists. Others claim cardiologists are 'supertechnicians' and not real docs. Has anyone noticed this view around their hospital, or is it just here........

 

[Eidolon6]

Browsing the rads link or SIR I see a lot of complaining about 'turf stealing' of cardiologists. Others claim cardiologists are 'supertechnicians' and not real docs. Has anyone noticed this view around their hospital, or is it just here........

Cardiologists embraced cardiac catheterization and endovascular techniques before the radiologists did and there are a good number of poorly informed people who believe that this only belongs in the realm of the radiologist. Cardiologists are trained to diagnose and treat all diseases of the heart as well as some of those of the vasculature. Coronary heart disease is certainly the most common of these, but certainly not the only disease. Since most atheromatous disease is mediated by the same mechanism, its only natural that cardiologists extrapolate knowledge about cardiovascular disease to systemic vascular disease. Additionally, the skills required to be a good interventional cardiologist, much like surgery, require repetition, practice which can be applied to other anatomy as well. Also, cardiologists are trained internists, meaning they have a greater background in the patient care aspects of their specialty. Similar complaints have been launched against cardiologists by vascular surgeons who perform lucrative, although, marginally beneficial bypass surgeries and many have diversified their practices to cover endovascular techniques.

Unfortunately, radiologists and interventional radiologists have distanced themselves from patient care and frankly would be considered specialized technicians more so than cardiologists. A large complaint about IR is they often perform procedures without the expectations to manage the complications. For example, a cardiologist who performs a renal artery angioplasty w/ stent is much more likely to follow and treat the patient for his/her hypertension than a radiologist who lacks that knowledge. The same procedure is done by either person, but the fact that continuity is established, enhances the care. That being said though, IR has really revolutionized a lot of what we can do for our patients before being relegated to sending them to surgery. With the expanding role of multidetector scanners, virtual imaging, radiologists should have enough "turf" to cover without having to indict the cardiologists.

 

[IMGforNeuro]

ABSOLUTELY
Neurology and Neurosurgery following the same line

 

[avendesora]

Blah... blah... blah...

Everybody bags on everybody else in the hospital -- especially where the high reimbursement procedures cross specialties. I haven't met a whole lot of radiologists who are having trouble feeding their families lately, nor cardiologists. Cardiologists are going to continue to do most of the cardiac and vascular cases simply because they have the first crack at the patients. If a cardiologist has a patient who they have been seeing for CAD, and now the patient has claudication, of course they're going to do the procedure rather than send it out to someone else. This is not 1984 when only radiologists could work under fluoro.

I guess if the IR guys had a clinic, and the cardiologist was sitting outside the door promising to do the procedure for half off or something, then you could say they were "stealing cases". I don't know many radiologists, though, who have clinics or see patients on the floor.

 

[ERMudPhud]

Here is where turf battles get ridiculous. I sent a 24 year old to the cath lab the other day with what appeared to be an acute MI. He also had severe unworked up hypertension for some time(not on coke or speed). I was talking to the cardiologist and said, "oh on the way by you should squirt is renal arteries" He said he would love to but that they were no longer allowed to do, "flyby renal angiograms" because radiology had complained that they shouldn't be credentialled for it. I said, " so he has to get a bunch of other tests which may or may not make the diagnosis and then eventually a repeat angiogram just because radiology is defending their turf. You're going to be right there isn't it better for patient care to just get him the gold standard test now?" He ended up getting the flyby renal angiogram.

 

[Whisker Barrel Cortex]

Cardiologists are very agressive and have taken it upon themselves to continously expand their scope. Not blaming them, just pointing out why some may be bitter. They are doing peripheral angio and stents. The "fly-by renal angio" is a way for them to due the "fly-by renal stent" which is a great money maker, whether it is indicated or not. In fact, some do SMA stents for good measure even if there are no symptoms of mesenteric ischemia. At our hospital, they are now doing some of the IVC filters. The complaint is why do they start doing these procedures (and I am sure hurting a few patients during the learning curve) when there are physicians that are already trained to due them. Is it for better patient care? Not in many cases. Its for income and power.

Same with cardiac imaging. Even with the increase in CTs performed by the ER and MRIs ordered by primary care doctors, the largest percentage of increase in imaging in the past 10 years has come from cardiologists who self refer (there is a study, I'll find it later).

I think cardiologists do a great and difficult job and are by no means technicians. Some of the recent stories (see Tenet in northern california) of cardiologists performing unessecary procedures, referring people for unnecessary bypasses highlight this problem of greed at the expense of patients, not just monetarily, but sometimes to detriment to their overall health as well.

 

[avendesora]

Perhaps if physicians were fairly compensated for challenging and time-consuming tasks like actual patient management, they would not feel the need to perform extra procedures to make money. Cardiologists (and surgeons, and pediatricians, and ophthalmologists, and everyone else) have seen reimbursement for various things decline over the years. It is not reasonable to expect someone to take a pay cut, therefore it should be reasonable to expect them to try to make up the difference however they can.

Discuss...

 

[Fermata]

Perhaps if physicians were fairly compensated for challenging and time-consuming tasks like actual patient management, they would not feel the need to perform extra procedures to make money. Cardiologists (and surgeons, and pediatricians, and ophthalmologists, and everyone else) have seen reimbursement for various things decline over the years. It is not reasonable to expect someone to take a pay cut, therefore it should be reasonable to expect them to try to make up the difference however they can.

Discuss...

What do you think would be a fair salary for the average American cardiologist?

 

[sdude]

Perhaps if physicians were fairly compensated for challenging and time-consuming tasks like actual patient management, they would not feel the need to perform extra procedures to make money. Cardiologists (and surgeons, and pediatricians, and ophthalmologists, and everyone else) have seen reimbursement for various things decline over the years. It is not reasonable to expect someone to take a pay cut, therefore it should be reasonable to expect them to try to make up the difference however they can.

Discuss...

It's one thing to pad lousy insurance with a non-essential in-office ECG--the patient is not put at risk (probably likes the fact that their doctor is so thorough!) and a baseline ECG has some clinical value.

Going on a "fishing expedition" in the cath lab is indefensible, in my opinion. The procedure is not only incredibly expensive, but is uncomfortable and risky for the patient. There are many ways to deal with reimbursement concerns, but putting patients at risk in the process plays into the worst physican stereotypes.

 

[RADRULES]

It is pretty simple. Interventional radiologists innovate and create new and exciting procedures. Cardiologists then come in and try to steal them so they can buy their wife a new Benz, even though she is banging the mailman when Dr. Card is living in the hospital. They then claim that because they "manage patients" they suddenly have the expertise to do peripheral intervention on patients and simply because of the numbers game they get away with it. Of course, in the long run it won't matter, because IR will create new areas of expertise and with superior imaging skills will always be ahead of the game.

Cardiologists will never innovate, only steal from others with much more creativity and novel thought.

 

[avendesora]

Of course, in the long run it won't matter, because IR will create new areas of expertise and with superior imaging skills will always be ahead of the game.

...And will never be bitter about anything, EVER!! 😉

 

[BWG]

Frankly, I feel confident that both IR and Cards can handle these procedures with competence.

But as hinted to above, the docs who see patients in clinic and are on the frontline will always have the final say in who performs what procedure. IR, Anesthesia (non-OR), Surgery (if OR priv didn't apply) all rely on their patients being sent to them by clinicians. If clinicians/cardiology decides they want to keep a procedure for themselves, then IR is simply SOL.

 

[task]

It is pretty simple. Interventional radiologists innovate and create new and exciting procedures. Cardiologists then come in and try to steal them so they can buy their wife a new Benz, even though she is banging the mailman when Dr. Card is living in the hospital. They then claim that because they "manage patients" they suddenly have the expertise to do peripheral intervention on patients and simply because of the numbers game they get away with it. Of course, in the long run it won't matter, because IR will create new areas of expertise and with superior imaging skills will always be ahead of the game.

Cardiologists will never innovate, only steal from others with much more creativity and novel thought.

I have no argument with the fact that many interventional equipment innovations were and are being made by bright and well meaning Radiologists

The first coronary angioplasty was performed by Andreas Gruntzig at Emory in the 80s, a Cardiologist. The real advancements in stenting and peri-stenting management were made by Cardiologists. Percutaneous valvuloplasty and the evolving valve replacement procedures were/are done by Cardiologists. Rotational atherectomy, IVUS to optimize stent deployment -- all innovations by Cardiologists.

I really don't think its practical, correct, or constructive to berate one field compared to another, especially since the reasons for such abuse frankly are not valid. Turf wars exist in multitple fields (GI and Surgery, Neurosurgery and Ortho Spine and PMR and Anesthesia) -- this is the nature of medicine. Who controls the patients and who is the gatekeeper and who is the technician aside, all these MDs are well trained and bright and intelligent practitioners whose innovations in one field that can be applied in another benefits everyone. There will just be more innovations on down the pike later on.

Its the same argument that people who are for outsourcing to other countries employ (to some extent) -- the movement and dissemination of these skills to places outside the US encourages and facilitates the next wave of innovation here in the US -- the same can be applied to said procedural equipment and techniques/technology. (Don't flame me on outsourcing, I'm not sure where I fall in that argument, just trying to clarify a point) 🙂

 

[Eidolon6]

Cheers Task, for keepin' it real!!!

Way to show wannabes not to write checks their knowledge can't cash!

 

[ptanpit1]

Don't you guys ever get tired of complaining about "turf" battles? Can't radiologists and cardiologists just share the work?

 

[RADRULES]

FYI, cardiac cath was invented a long time ago. Angioplasty is a rather recent phenomenon.

http://www.nobel.se/medicine/laureates/1956/index.html

The pioneer is peripheral angio and stenting was Dotter, this point is widely accepted.

 

[Hudson]

It is pretty simple. Interventional radiologists innovate and create new and exciting procedures. Cardiologists then come in and try to steal them so they can buy their wife a new Benz, even though she is banging the mailman when Dr. Card is living in the hospital. They then claim that because they "manage patients" they suddenly have the expertise to do peripheral intervention on patients and simply because of the numbers game they get away with it. Of course, in the long run it won't matter, because IR will create new areas of expertise and with superior imaging skills will always be ahead of the game.

Cardiologists will never innovate, only steal from others with much more creativity and novel thought.

Radrules,

Explain to me how IR docs are so much more qualified to perform these peripheral interventions than cardiologists who you say "suddenly have the expertise to do peripheral interventions". General cardiology fellowship usually includes at least 3-4 months of interventional cardiology and more for those choosing to pursue subspecialty fellowship in interventional cards. They then do a full year of Interventional subspecialty training that consists of almost all arterial interventions(both peripheral and coronary).

This is compared to an interventional radiologist who does some IR during residency and then 1 year of IR that consists of arterial interventions only part of the time. Most of IR is not peripheral arterial interventions-most of it is angiograms/venous studies/Picc/PEGs/TIPS/Biliary tubes/Chemo-embo etc. IR docs do tons of cool stuff, but I would be interested to see who has done more peripheral arterial interventions at the completion of their training, an IR doc or an interventional cardiologist. I bet the cardiologists have pulled ahead, and one can then argue that this generation of interventional cardiologist are better trained in peripheral arterial interventions than the IR docs.

If anyone has concrete #'s I would be interested to see them.

Also keep in mind that medicine is an enterprise of patient care. Until IR docs choose to manage their patients, both referring docs and patients are going to choose cardiologists and vascular surgeons to perform these interventions because of the better follow-up care. A decade ago the ball was in IR's court and they dropped it by not expanding their skills to include peri-procedural management of complications, and at least attempted longterm management of the initial disease process at hand.

The statement that "Cardiologists never innovate" simply exhibits your ignorance to the realm of percutaneous intervention for many cardiac lesions. I'll let you research this yourself in hopes of taming your arrogance.

 

[p53]

It is pretty simple. Interventional radiologists innovate and create new and exciting procedures. Cardiologists then come in and try to steal them so they can buy their wife a new Benz, even though she is banging the mailman when Dr. Card is living in the hospital. They then claim that because they "manage patients" they suddenly have the expertise to do peripheral intervention on patients and simply because of the numbers game they get away with it. Of course, in the long run it won't matter, because IR will create new areas of expertise and with superior imaging skills will always be ahead of the game.

Cardiologists will never innovate, only steal from others with much more creativity and novel thought.

Actually these "single" women are banging guys like me that have accounts on Match.com, eharmony.com, and myspace. What do I care if they are married? This just means that they are only in it for fun. Just like me. 😀

 

[Qtip96]

How many friends do you have (not counting the strangers you know on the internet) ?

hmmm... i should probably ask the same about you...🙄

Actually these "single" women are banging guys like me that have accounts on Match.com, eharmony.com, and myspace. What do I care if they are married? This just means that they are only in it for fun. Just like me. 😀

thanks for proving to everyone that your query only reflects your own pathetic lifestyle...

 

[Hudson]

Just realized I replied to a thread from 2 yrs ago. Did not mean to revive a topic so distantly discussed, however still interested to hear thoughts on the qualification and development of peripheral intervention skill sets compared by fellowship/training environment (IR, Int Cards, Vasc Surg) respectively.

 

[p53]

hmmm... i should probably ask the same about you...🙄


thanks for proving to everyone that your query only reflects your own pathetic lifestyle...

Where have you been? The players hang and swooch up hoochies on myspace and match.

For the record, I never ask if they are married (even though 1/4 are married). It kills the seduction. I always assume they are single since they have it on their profile.

The point I was making is that attractive wives are on the internet getting their groove on.

 

[Mr. McDuck]

Just as a side note, a bypass graft procedure is only going to be more lucrative than a percutaneous angioplasty/stenting if the latter is billed horribly wrong. Using national fees, not locality fees, for the two procedures done in a hospital, a fem-pop bills $1310.12, whereas a percutaneous angioplasty and stenting of the superficial femoral artery bills at around $2471.67*. Most of the time, you're also ballooning and/or stenting the iliacs as well, so it would be well over $3000 in reality.

*I say around, because it can vary depending on how you bill it.

 

[Param Jeet Rana]

Hey guys,
what money one makes when one gets into a cards fellowship ?
if I M right then its juz a lil above what an IM resident gets. Thats too low considering that one has family by now & this amount is too little to raise kids decently. Are fellows allowed to moonlight ?