cards/CT

[spyyder]

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To what extent is cards eating into the territory of radiology. Is this a trend to be worried about in the future. Seems like radiologist are doing nothing about this. Will the affect radiologist bottom line in the future? I am trying to decide to go the way of nuclear cards vs rads.

 

[p53]

Unfortunately, until radiologists start having patients, the hospital administrators are going to continue to side with the $$$ (Cardiologists bring in the patients).

This trend has been going on for quite a while. Guess who started using cardiac caths and angioplasties. Radiologists are the innovators and the Cardiologists are the pirates of the medical industry.

 

[spyyder]

Perhaps I am just to young to know, but how is that if rads created the procedure, cards uses it. How can they all of a sudden be certified to do it if its was a rads procedure.

To play devils advocate why shouldn't they be allowed to do their own CT's, I mean after all they are trained in cardiology, wouldn't they benefit from it more?

 

[TBforme]

Perhaps I am just to young to know, but how is that if rads created the procedure, cards uses it. How can they all of a sudden be certified to do it if its was a rads procedure.

To play devils advocate why shouldn't they be allowed to do their own CT's, I mean after all they are trained in cardiology, wouldn't they benefit from it more?

A chest CT contains more than just a heart and vasculature, when looking at a chest CT radiologists evaluate:

-adenopathy-mediastinal, axillary, etc
-lung fields-you could write a 6 million page book on this but in brief: nodules (cancer, granuloma, scarring), interstitial diseases, alveolar processes, pleural based disease
-airways-H/N cancer, stenosis, collapse, deviation
-bones-trauma, metastatic disease, degnerative bone and primary bone disease
-soft tissue windows-thyroid, esophagus, subcutaneous tissue, breasts, spinal cord and much more
UPPER ABDOMEN! a chest CT goes to the level of the adrenals/kidneys-you have to read the liver, spleen, adrenals, kidneys, vasculature, stomach and bowel as well

Cardiologists are qualified to read none of these. They are not even qualified to read the heart and vasculature of the chest. Do they know the anatomy of the coronary arteries, yes...but that is where their knowledge ends and training ends.

 

[ironmaiden]

Cardiologists are qualified to read none of these. They are not even qualified to read the heart and vasculature of the chest. Do they know the anatomy of the coronary arteries, yes...but that is where their knowledge ends and training ends.

I disagree with that last part. They are also trained to royally F* up some coronaries 😱 so the Cardiothoracic surgeons can (hopefully) come in and fix them.

Never send your momma to a heart cath lab with no surgeon to fix the aggressive cardiologist's ooops-y.

Cardiologists are wannabe radiologists and wannabe heart surgeons.

They should stick to EKGs and rounding, really.

 

[spyyder]

This sound like a well discussed and debated issue. It also sounds like a real legal and ethical issue, why isn't it being challenged in court. What is allowing this to continue at the cost of patient care. Not to mention cards seem to be milking CT to the bone.

 

[TBforme]

.

 

[hans19]

There are many more knowlegable than me about this but as I see it: Money money money. Cardiologists are greedy. Imaging is highly profitable currently. The have stolen turf from vascular surgeons to the detriment of the patient as well. Cardiologists control the patients so they have bargaining power with hospitals. As i understand it, they have to have split interpretation of the remainder of the study with a radiologist, i could be wrong about this though.

Fee splitting is illegal, but thats what's happening. The sad thing is that there are actually radiologists out there reading the non-coronary portion of the CTA for cardiologists at cut rates. They are short changing themselves as well as the field of radiology, and commiting fraud.

Self-referral for hematology and chemistry labs was a big money maker, but that got slashed ages ago.

Imaging is where the money is now. Insurance companies and medicare put the squeeze on physician reimbursement across the board. So what do physicians do? Instead of organizing and standing together and fighting it, physicians cannibilize each other to make up the difference.
Cardiology, specialty surgeons, neurologists all want to get in on the imaging pie. Self-referral of imaging studies goes sky high!!!
(Look at the numbers- the greatest increase in studies performed has been at the hands of cardiologists. Radiologist imaging has marginally increased.)

Ok so healthcare expenditures go sky high. So what does the government do? They slash spending! They have scheduled a 25% cut in the technical fee for contiguous body parts and now have planned a 16% cut in the professional interpretation fee to be implemented in '07.

That hurts EVERYONE, and puts pressure to read MORE images to make up the difference. More work in less time, means more misses=> the patients will suffer.

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To prospective applicants: I am glad you guys are interested in radiology. IMO its one of the most interesting specialties out there. We really need people who are enthusiastic about the field. But please realize that RADIOLOGY IS NO LONGER THE LIFESTYLE SPECIALTY it used to be. Its actually been that way since the late 90's. Radiology reimbursement WILL GET CUT. People will read more studies and take less time off to make up the difference. Have you been in your local reading room lately? The radiologists read nonstop all day, no down time. There is a constant back log of studies to be read and when we are on call we read all night. Do radiology because you like it, because the money, time off, lifestyle that you've heard of aren't going to be there much longer.

Good luck!