Cardiac cath as an IR

[badasshairday]

So I am very drawn to IR because you can market yourself as a disease specialist. For instance, one can specialize in liver cancers, or vascular disease. What about cardio-vascular disease. I'd love to be able to do arteriole work AND coronary work. Maybe Vascular surgery would be a better route? But I also like the rest of IR as well, it is very versatile.

Also, I understand that Charles Dotter, MD, Interventional Radiologist, was the first to do cardiac cath. It only seems natural as cardiology invades IR turf, IR should invade cardiology turf. I've seen some pretty ridiculous things in the Cards forum on here that only confirms this.

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[hartbot]

I'd say go for it.

The problem is that the cards guys do self-referral, or get a lot of referrals from other specialties so I imagine this is why it's hard to get the caths for the heart

 

[badasshairday]

Cardiology fellow:

The field has and will continue to adapt too... Already seeing most groups move into peripheral endovascular areas traditionally addressed by vascular surgery and VIR. With all the endovascular procedures comes all the imaging (carotids, venous duplex, arterial duplex, AAA, renals/mesenteric) which groups can add with little to no overhead given most already have echo machines. Cardiology is well placed to gather up much of the business in these areas as we are self referring where as VIR and vascular surgery need the outside referrals... Take one look at the presentations from All That Jazz or VIVA and you can see just how far the net is being cast in these arenas including intracranial/vertebral/acute stroke team interventions... Basically the full transition of the interventionalists wire skill sets to other areas (many of which pay MUCH better than the coronary interventions because the radiologists have been much better organized in terms of their lobbying, e.g. a 15min IVC filter implantation nets the operator as much as a multi-vessel PCI... the billing codes for peripheral interventions are also cumulative and it isn't uncommon to have 18 or so for a complex peripheral case whereas coronaries are grouped DRG codes with maybe a slight modifier for the hardest cases... in short... these other procedures net more revenue for less work) I'm sure CMS will level these fields as well, but the point is that the field will adapt with the assimilation of new technology and procedures (didn't even mention all the structural procedures that lie ahead between e-clips, TAVI, atrial appendage occluders, etc)

In short... pretty sure you can count on cardiology to remain both competitive and well reimbursed in relation to the other IM fields.

 

[OHMAN0125]

Cardiology fellow:

It's really sad, that in medicine where there's a buck to be made, there's turf wars. I've recently seen IR's advertising cosmetic services. These weren't just vein work either. We're talking laser treatments and Botox. Haha....it's really getting ridiculous these turf issues.

 

[badasshairday]

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[IRGuru]

It's really sad, that in medicine where there's a buck to be made, there's turf wars. I've recently seen IR's advertising cosmetic services. These weren't just vein work either. We're talking laser treatments and Botox. Haha....it's really getting ridiculous these turf issues.

This has actually been going on for years. From what I understand, there are more and more IRs doing this since you can get trained in a variety of ways and even though it's cosmetic work, one can argue it's fundamentally still minimally invasive therapy. It often starts with patients coming in for cosmetic vein treatment and since there are usually excellent results, patients often ask about other cosmetic treatments. Keep in mind its not just IR that does this. There are FM, IM, gen surg, vascular surg docs all peripherally involved in cosmetic work.

 

[badasshairday]

IR doing coronary procedures

http://www.youtube.com/watch?v=2UJvThqBxTs

 

[nick_carraway]

This has actually been going on for years. From what I understand, there are more and more IRs doing this since you can get trained in a variety of ways and even though it's cosmetic work, one can argue it's fundamentally still minimally invasive therapy. It often starts with patients coming in for cosmetic vein treatment and since there are usually excellent results, patients often ask about other cosmetic treatments. Keep in mind its not just IR that does this. There are FM, IM, gen surg, vascular surg docs all peripherally involved in cosmetic work.

Recently read about this in the SIR newsletter. The column was written by an aesthetic IR doc who says exactly what you did, which is that the specialty is trained in minimally invasive modalities. His website hardly mentions his radiological training and glosses over any reason why he's a good choice for the consumer.

The field has a knack for thinking outside the box, but I think we can all agree a weekend course doesn't qualify anyone to do aesthetic procedures. We should probably pick battles we can win based on honest skills/training.

I sent the author of the column an email to ask why he thinks IR docs are so qualified to do aesthetics, and why he doesn't make a better pitch for the field on his website if he believes in what he says.

Still no response