Cardiac CT Level 2 - Should I do it?

[SpyGuy]

Hi guys,
I want to know if it's work pursuing Level 2 Cardiac CT.
Numbers were recently (as of today) increased to 250 minimum cases interpreted. I would have met level 2 requirements from 2020, but its 2021 now and they have made changes, hence the question.
I'm also not super interested in it though I can ready decently which adds to the dilemma.

Plan is private practice interventional (predominantly coronary work) and maybe in the future a predominantly clinical academic job.
Would you bother with pursuing Level 2 Cardiac CT?
Yes, why? No, why?

Thank you for your input!

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[timpview]

No question. I regret I didnt

it’s a 1000x easier to get it in training than when you’re done.

stress testing is basically worthless imo (obviously debatable) and it’s amazing imo that cardiology hasn’t moved past it all together (mostly nuclear) in favor of anatomical testing- obviously a lot of financial/traditional factors in play.

now there’s a good chance local politics or culture will prohibit you from reading in your future job but there’s an equally good chance that it will be an ongoing revenue source for you.

 

[disorder]

yes, do it.
read with both your radiologist and your cardiologist at your institution.

 

[cards67]

If you have nothing else better to do, sure, won't hurt and gives you options but I don't think it's a big deal if you don't either, especially if you have no interest or don't care to have it part of your practice. CT is still niche around here, either level 3 or rads doing it with no one else really yearning to get into it. I doubt you'll miss many job opportunities for not doing it. If the plan is to use it in the future, then you still have to maintain competency and proficiency. If you find a job doing it, you may end up being the "CT guy" for the group. Reimbursement isn't terribly great either.

 

[drk]

No question. I regret I didnt

it’s a 1000x easier to get it in training than when you’re done.

stress testing is basically worthless imo (obviously debatable) and it’s amazing imo that cardiology hasn’t moved past it all together (mostly nuclear) in favor of anatomical testing- obviously a lot of financial/traditional factors in play.

now there’s a good chance local politics or culture will prohibit you from reading in your future job but there’s an equally good chance that it will be an ongoing revenue source for you.

There is nothing amazing about it. A nuclear camera can be set up in your clinic, be read in less than 5 minutes, and reimburses 800-1200 dollars. A CTA is generally not ideal for just cardiac purposes, reimbursement for reads/facility fee is less. Money drives the field just as much if not more than evidence based medicine.

Stress echo perfusion has also been shown to be incredibly sensitive and specific. Why did that never take off despite the ease, feasibility, and obvious cost/radiation advantage? No one is going to give up nuclear reimbursement. Probably doesn't help that so many doctors are hospital employed now and facility fees for nuclear are obviously significantly higher than other stress modalities.

 

[disorder]

There is nothing amazing about it. A nuclear camera can be set up in your clinic, be read in less than 5 minutes, and reimburses 800-1200 dollars. A CTA is generally not ideal for just cardiac purposes, reimbursement for reads/facility fee is less. Money drives the field just as much if not more than evidence based medicine.

Stress echo perfusion has also been shown to be incredibly sensitive and specific. Why did that never take off despite the ease, feasibility, and obvious cost/radiation advantage? No one is going to give up nuclear reimbursement. Probably doesn't help that so many doctors are hospital employed now and facility fees for nuclear are obviously significantly higher than other stress modalities.

I think the real point here is if you have the opportunity to get level 2 during fellowship, then do it because it's easier than when you get out.
Reimbursement aside, clinically the CT is and will continue to be more clinically relevant- prevention, chest pain/coronary anatomy (also use of CT FFR), structural planning.

Not every lab does stress perfusion (actually, by not many, I mean very very few). Nor is it an FDA approved use of contrast. You're right, I don't think nuclear will go away anytime soon. I just think it's a crappy test.

 

[Sam1987]

Just do it if you can ..

 

[pkex008]

Stress echo perfusion has also been shown to be incredibly sensitive and specific. Why did that never take off despite the ease, feasibility, and obvious cost/radiation advantage? No one is going to give up nuclear reimbursement. Probably doesn't help that so many doctors are hospital employed now and facility fees for nuclear are obviously significantly higher than other stress modalities.

How does the facility fee play into whether nuclear will be utilized more? Do cardiologists get paid part of the facility fee?