Why can't CT Surgeons do the job of a Cardiologist?

[GobindSingh]

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Why are CT surgeons so dependent on Cardiologists? Can't they also do the diagnostic and evaluatory aspects of Cardiology?

Wouldn't this eliminate CT surgery's dependence on Cardiology?


If I was in CT surgery, I would just tell FPs and GPs to send their patients to me for cardiac evaluation. Why can't a CT surgeon diagnose, stent and prescribe meds for cardiac patients in addition to doing CABGs and other operations?

Thanks!

 

[Eidolon6]

Tack on another 2-3 years onto a CT surgeon's training.....including diagnostic cath time, heart station time, internal medicine training in non-ischemic cardiac disease, and arrhythmia training...and you might have a CT surgeon who does both...otherwise, its unlikely to be a feasible option. Diagnosis is part of the cardiologists art....that is not usually extended to CT surgery training.

 

[Mirror Form]

I don't know for sure, but one of my professors (a urologist) told me that CTS used to do a lot more of the diagnostic stuff, but they gave up that turf willingly b/c they had this "God gave me my hands to cut" attitude. Well, ask ye shall receive! Now it's coming back to haunt them. Although, that could have just been part of his pitch for why urology is the best field.

 

[GobindSingh]

Eidolon--

I don't buy all that for a second. Most of the training that goes into Cardiology is already a part of CT surgery but it seems surgeons have just relinquished it.

There's nothing a Cardiologist can do that a CT surgeon can't - in my opinion.

 

[adude]

There are many aspects of cardiology that I can't imagine would ever be included in CT surgery training. For example long term management of congestive heart failure, electrophysiology, etc. I suppose the CT surgeons could learn that stuff if they wanted to take the time and effort, but so could a urologist or dermatologist, it's just not part of their specialty.

 

[droliver]

They don't really have to learn the field of cardiology as a whole, but rather just the interventional techniques. They're already pretty fluent in the indications so its really just getting time in the angio suites

 

[ESU_MD]

Any surgeon CAN do the job of the assoc medical counterpart- the fact is most just dont want to.

If I wanted to manage HTN and blood sugar I would have went into medicine. Its easier just to get consults and let the pill pushers deal with these mundane tasks while I concentrate on the OR.

 

[Goofyone]

Originally posted by GobindSingh
Why are CT surgeons so dependent on Cardiologists? Can't they also do the diagnostic and evaluatory aspects of Cardiology?

Wouldn't this eliminate CT surgery's dependence on Cardiology?


If I was in CT surgery, I would just tell FPs and GPs to send their patients to me for cardiac evaluation. Why can't a CT surgeon diagnose, stent and prescribe meds for cardiac patients in addition to doing CABGs and other operations?

Thanks!

What's the matter, 80-hour weeks aren't enough for you?

 

[Whisker Barrel Cortex]

I would like to differ with ESU's assertion that any surgeon could do the medical management of their medical counterpart. Its simply not true. You have not done a medical internship and residency and do not realize how much more an intern in medicine knows about medical diagnosis and treatment than a surgical intern. I did an internship in medicine prior to starting radiology and one of my collegues did a surgical internship. While his knowledge of surgical disease is obviously better than mine, his knowledge of medical management is rudimentary compared to anyone who has done just a year of medicine.

There is much more to medicine than the basics that surgery residents are required to know.

 

[droliver]

Actually, if you've followed recent well publicized studies in the news, I believe less then 50% of Internists, FP's, and Medical subspecialists were following recommended treatments and medical management for all of the indexed medical conditions (diabetis, HTN, CHF, etc...) they studied.

By the time you finish most Surgery residencies you're pretty fluent in managing most medical comorbidities at least in the short term (short of the Cath Lab or dialysis). I would defer to my Medicine colleagues with their greater experience at MAINTAINENCE therapy of medical problems in the outpatient setting

 

[GobindSingh]

Heck if I went into CT surgery, I would have all the FPs and GPs send me their cardiac patients. I would evaluate and diagnose them. Then stent or CABG them as needed and send them as a referral to a Cardiologist for long-term management.

CT surgeons can def take back much of their business from Cardiologists, they just aren't doing it. All they need to do is do it and it will be done. There's nothing a Cardiologist can do that a CT surgeon can't learn to do either within their fellowship or during practice - and very quickly too.

 

[doc05]

Originally posted by GobindSingh
Heck if I went into CT surgery, I would have all the FPs and GPs send me their cardiac patients. I would evaluate and diagnose them. Then stent or CABG them as needed and send them as a referral to a Cardiologist for long-term management.

CT surgeons can def take back much of their business from Cardiologists, they just aren't doing it. All they need to do is do it and it will be done. There's nothing a Cardiologist can do that a CT surgeon can't learn to do either within their fellowship or during practice - and very quickly too.

You're making some very big assumptions. The first is that the internists will send their patients to you. It's more likely that an internist would detect a problem, refer to cardiology for management. Not every cardiac patient needs surgery; certainly not at the first sign of illness.

Second, for a CT surgeon to spend all that time evaluating patients would mean an enormous amount of time doing thallium stress tests, etc., spending a lot of time in the cath lab,... how the hell would you expect to do all that and also perform surgery 5 or 6 days a week?

It's pretty obvious you are a very naive medical student who doesn't understand how things work. Think.

 

[Eidolon6]

I doubt CT surgeons would want to do the job of a cardiologist....not to mention the training. Cardiologists train for 6-7 years as do CT surgeons...with a distinctly different thrust in training. Cardiologists deal with 90% of the cardiac patients the CT surgeon doesn't and will never see. I don't known any CT surgeons right now who are starving, or aren't busy enough with CABG after CABG and the occasional juice valve replacement.

As for guidelines....unlike droliver's assumption that all medical conditions should be managed in a cookbook approach...I beg to differ. Most accomplished internists apply the guidelines with a respect for clinical judgement and experience. Your data may be true, but look between the lines man. Most of us, surgeons and non-surgeons alike train to be able to navigate variability that exists within medicine...that makes it fun, more interesting, and ultimately makes us more cognizant of the individual patient's pathophysiologic milieu.

I spend a third of my time managing surgical patients and their complications...in an inpatient setting. I accept patients from surgery services when consulted...because I am acutely aware of how much more attention to their acute and chronic problems they will get on my service as compared to an overflowing understaffed surgery service...with docs tucked away in their ORs...seemingly immune to pages. I can say this with a chuckle because I know and deal with this truth daily.

 

[droliver]

Originally posted by Eidolon6
As for guidelines....unlike droliver's assumption that all medical conditions should be managed in a cookbook approach...I beg to differ. Most accomplished internists apply the guidelines with a respect for clinical judgement and experience. Your data may be true, but look between the lines man.

These guidelines were state of the science and well publicized in the literature. It reflects as much upon ignorance & oversite of contemporary treatment as much as it does about "clinical judgement" of the MD's studied.

 

[eddieberetta]

Originally posted by droliver
Actually, if you've followed recent well publicized studies in the news, I believe less then 50% of Internists, FP's, and Medical subspecialists were following recommended treatments and medical management for all of the indexed medical conditions (diabetis, HTN, CHF, etc...) they studied.

droliver, pardon me if I am not understanding your argument, but I don't see how this changes anything... the issue being discussed is whether surgeons should be performing some of the diagnostic roles typically performed by internists. If I were to find a study showing that X percent of surgeons failed to do this or that, would that bolster the idea of internists performing surgery?!?

 

[droliver]

No Eddie,

what it does is undercut the notion that the related medical specialists routinely or by definition have some special set of skills not possessed by their counterparts. The school of thinking that thinking that Surgery is a technical & not clinical field is the notion I'm really poking fun at with the point about deviation from contemporary care by my counterparts in Medcine (of which I might add are my little brother and several cousins). After finishing training with close to 1500 operative cases prior to fellowship and many,many times that in #'s of patient contacts and hospital care, you tend to accumulate a large experience in clinical medicine despite our best efforts to avoid it 🙂

 

[Whisker Barrel Cortex]

droliver,

I am not questioning your ability to manage the general medical problems of your patients in the hospital. However, as someone who has not been through a medical residency I think you definitely underestimate the knowledge necessary to practice internal medicine and its subspecialties. I have not been through a full medical residency but have worked with upper levels whose knowledge base is much broader and better in the medical management of patients, both acute and chronic, than their surgical counterparts. I have also seen many patients mismanaged from a medical standpoint by surgical teams until medicine was consulted.

I think surgeons become supremely confident in their abilities after a grueling residency. However, this confidence must be tempered with the realization that there are limitations to the knowledge of surgeons simply because these issues are not fully taught during surgical residency. I have the utmost respect for the abilities and excellent training of most surgeons to handle all surgical and major medical issues, as long as they stay aware of when they need help.

 

[banner]

Yeah, great idea gobindsingh!

CT surgeons should do cards.! And why not also see derm patients, work in the path lab, and do the anesthesia for their own cases too? In fact, CT surgeons should see all patients including psych cases, rheumatology, and pediatric patients.

Hell, why stop there?

They should be running the ER and teaching the biochemistry class to the first years students, also.

Any why limit CT surgeons to medicine? I'm, sure learning how to operate on the heart definately qualifies one to practice law. So CT surgeons can be our judges and district attornies, as well. Additionally, president Bush should fill all the positions in the Department of Homeland Security with CT surgeons.

Hate to break it to you Gobind, but CT surgeons aren't as omnipotent or powerful as you think they are. They do a great thing and do it well. But greatness in one area does not translate into competence in all areas, no matter how much or how long you suffer during residency/fellowship.

 

[Mirror Form]

Originally posted by banner
Yeah, great idea gobindsingh!

CT surgeons should do cards.! And why not also see derm patients, work in the path lab, and do the anesthesia for their own cases too? In fact, CT surgeons should see all patients including psych cases, rheumatology, and pediatric patients.

Hell, why stop there?

They should be running the ER and teaching the biochemistry class to the first years students, also.

Any why limit CT surgeons to medicine? I'm, sure learning how to operate on the heart definately qualifies one to practice law. So CT surgeons can be our judges and district attornies, as well. Additionally, president Bush should fill all the positions in the Department of Homeland Security with CT surgeons.

Hate to break it to you Gobind, but CT surgeons aren't as omnipotent or powerful as you think they are. They do a great thing and do it well. But greatness in one area does not translate into competence in all areas, no matter how much or how long you suffer during residency/fellowship.

There's no reason to be rude. Gobindsingh has a valid point that CT surgeons probably are qualified (or could get qualified quickly) to do quite a bit of the diagnostic work, in the same manner that urolgoists, ENT, ophtho, etc, do both diagnotistic work and operate.

The real reason CT surgeons don't is all about economics: it would cause them to take a huge cut in their salaries. If the CT surgeons did some of the diagnostic work too, they'd have to operate less and have higher over head costs. It's much easier to just crank out cabg's all day long and make 1 mil per year (or at least it used to be). They made big bucks over the past few decades by giving up all their turf except for the lucrative operations, but now it's coming back to bite them in the arse.

 

[bustbones26]

I suppose one of the big gripes lately is that because medicine trained cardiologist are doing a lot of invasive procedures, this takes from the CTS. Okay, I agree fully. But there will always be a need for CTS. People will still need CABG, maybe not as much now, thanks to stents, but some people will. People are still going to get heart valve defects, people are still going to be born with heart defects, etc. Now, som eof you may aruge that these cases aren't enough to put bread on the table of a CTS and that is why CTS is an endangered specialty. I agree with you to some extent. But here are my thoughts

You had to be a general surgeon before you could be a CTS, right? now, from what I understand, if a general surgeon performs enough thoracic and vascular cases in their residency, and feels comfortable with these cases, when they become attendings, the hospital may very well give them priviliges to do thoracic and vascular cases. Even though they never did a fellowship year in these areas.

So my point is, its called the cardiovascular system for a reason. Cardio +vascular. Lets not forget that a CTS is also well trained for vascular cases, not just cracking chest. So this extends the cases for a CTS to include repairs of aortic aneurysms, IVC filters, carotid endartectomies, and just PVD in general. And how about vascular emergiencies?? I just finished a surgery rotation and met a CTS who does just this. Also, he moonlights on the hospital's trauma service, so he still gets to do gen surg procedures related to traumatic injuries on the side. This guy has enough cases to do per week and believe me, the man is not a starving CTS.

 

[maxheadroom]

Disagree about CTS doing vascular cases. Most CT surgeons don't do CEAs, AAAs, Greenfields, and other vascular cases. They certainly do perform repairs of thoracic aortic aneurysms.

 

[droliver]

Max,

its actually fairly common for the cardiac guys to do vascular cases, especially carotids sometimes simultaneous to doing a CABG. This is a trend coming full circle as the economics of CABG surgery are putting the squeeze on their salaries. Diversification of their practices to include Vascular, vascular access, and thoracic is being preached to present fellows.


Bustbones,

you've never had to technically do CTVS or Vascular fellowships to get privledges to do those operations, you just had to convince the hospital credentialing committees to give you privledges. This varies a lot by location or local historical precedents on how easy you can get privledges for those things (also for ERCP, endoscopy, bronchoscopy, vascular lab, cosmetic surgery, etc...) About 50% of all vascular cases are done annually by general surgeons nationwide. Subspecialty fellowships for these are realtively recent phenomena, and the maintainence of vascular and non-cardiac thoracic areas of expertise are maintained in the Amer. Board of Surgery Mission Statement for General Surgery training.

 

[maxheadroom]

Ollie,

I see General Surgeons doing general vascular stuff all the time. I guess the academics in CTS that I'm exposed to don't do much outside of the chest. Could be just the small exposure that I've had. I still find it hard to believe that many CT surgeons do stuff like fem-pops, axillo-iliacs, and the like. I wouldn't let anybody but a CAQ cert Vascular surgeon do PVD work on me or my family. (not that I intend to ever be in the position of a vascular patient)

And the real vascular guys own Endo-Vasc, which is swiftly becoming the wave of the future. At my current place, the Endo service is huge -- they do stuff that I never dreamt of at my med school. Cool as heck, but it's beyond my skin-loving plastico brain.

 

[droliver]

Max,

you happen to be located at what I'm told (by one of my friends who's a fellow @ Wash U) is one of the top 2-3 programs for the endovascular training part of vascular surgery. Apparently they got a head start on it by about a decade thru some unique historical circumstances and interest of a few of the vascular surgeons there. Your setup is light years ahead of most programs in the integration of the endovascular operating suites with traditional techniques, they often do combinations of both during the same operation I'm told (eg. Illiac stents + fem-pop/distal bypasses)

The interest in vascular by CT has really depended on the practice type the surgeon was in. At Baylor (Houston) for instance (a large & respected fellowship for that), all of the vascular surgeons with the fellowship until recently were heart surgeons. About half of my Vascular staff were CTVS background as well.

 

[maxheadroom]

Ollie,

I did know that we're ahead of the curve on the endo-vasc part. They do some pretty amazing stuff. Fun to hear a WashU guy give us props. One of the current fellows did his general at Baylor -- I'll have to ask him about it sometime. I just enjoyed his stories of DeBakey & Mattox.