General Cardiology

[HarrryMaguire]

Can general cards read echo's, do stress tests, and diagnostic caths in the community? 

[Bluberblubo]

Internist not a cardiologist, so take this with a grain of salt. But any internist can do stress tests if you're comfortable with it. For echos as a cardiologist you graduate with level 2 echo training so you CAN read normal echos, just need to find a place that is hiring, which I heard from my colleagues can be tough. To read TEEs you need level 3, which is more training. I'm fairly certain that for caths you need some extra training because the job market is tight, but I could be wrong about that...

[ACHQ]

23 hours ago, HarrryMaguire said:

Can general cards read echo's, do stress tests, and diagnostic caths in the community? 

Yes, yes, no (for the most part now a days). (in the hospital anyways)

the vast majority of my friends/colleagues that did cardio in the last 10 years have a fellowship in something (echo, HF, Interventional, EP), so that makes space and job market tight for those that don't have a certain fellowship to do certain things (i.e. caths).

For example: we have 2 cardiologists that are not interventionalists, that do/did diagnostic caths. They do them extremely seldomly now. All of our cardiologists that do hospital call read echos regardless of whether they have a fellowship in echo. If you have your own clinic (or join a group) that has a diagnostic cards facility available (i.e. stress tests, holters, echos) you will likely read those diagnostic tests.

Hospital resources are thin and hard to come by, so finding a job without something extra would be difficult, especially if *everyone* has it. If you can find a clinic group that has that capability and take you are then there is nothing stopping you as a general cardiologist to do those above diagnostics (with the exception of caths)

 

[HarrryMaguire]

Thanks @skyuppercutt @ACHQ . It seems that the majority of cardiologists seek/find hospital employment despite the call burden & need for fellowship training. Is the (post-overhead) remuneration that much better than a busy, efficiently run diagnostic outpatient practice with a group of general cardiologists? Or, is there another driving factor?

[Edict]

7 hours ago, HarrryMaguire said:

Thanks @skyuppercutt @ACHQ . It seems that the majority of cardiologists seek/find hospital employment despite the call burden & need for fellowship training. Is the (post-overhead) remuneration that much better than a busy, efficiently run diagnostic outpatient practice with a group of general cardiologists? Or, is there another driving factor?

The driving factor apart from better pay from what i've heard is developing a patient base when starting out. Most cardiologists want to do inpatient work because it pays well, but also because the patients they see in hospital can then be followed up by themselves and become their patients. It may be slower to start a practice if you just start outpatient. 

Fellowship training on top of cardiology is becoming more and more common, the norm to land a GTA community hospital job is 2 years now, usually a year of echo and a year of HF. There will be people who do more or less but its a tight market depending on where you want to land. 

[HarrryMaguire]

Makes sense, thanks! Can outpatient cardiologists (not staff) pick up CSU/Ward call on nights/weekends (if they have hospital privileges)? 

[Edict]

10 hours ago, HarrryMaguire said:

Makes sense, thanks! Can outpatient cardiologists (not staff) pick up CSU/Ward call on nights/weekends (if they have hospital privileges)? 

Not sure, but if it is a lucrative thing you'll need to put in your dues in some way to get access to those shifts, or there will just be so much competition that you'll have to have that extra training to stay competitive. CCU is increasingly requiring ICU fellowship. Most hospitals have internists who admit the patients overnight and on weekends and call cardiology the next morning, so cardiology call may not generate that many referrals. It may be possible, if you are willing to do the shifts no one else wants to do, they may offer you it.  

Generally speaking, the good stuff requires more training, simply because everyone wants to do it, sometimes because you actually need the training to do it. 

[hero147]

10 hours ago, Edict said:

Not sure, but if it is a lucrative thing you'll need to put in your dues in some way to get access to those shifts, or there will just be so much competition that you'll have to have that extra training to stay competitive. CCU is increasingly requiring ICU fellowship. Most hospitals have internists who admit the patients overnight and on weekends and call cardiology the next morning, so cardiology call may not generate that many referrals. It may be possible, if you are willing to do the shifts no one else wants to do, they may offer you it.  

Generally speaking, the good stuff requires more training, simply because everyone wants to do it, sometimes because you actually need the training to do it. 

Wow CCU requiring an ICU fellowship? What has medicine come to...

[ACHQ]

3 hours ago, hero147 said:

Wow CCU requiring an ICU fellowship? What has medicine come to...

Not really requiring. *Most* large community CCU's don't have intubated patients (these patients go to our ICU) so they can easily be managed by the general cardiologist. Most general cardiologists are comfortable with sick cardiac patients (as long as the respiratory issue confounded by infection/airways disease/ARDS). Some of my colleagues do a Cardiac-Critical Care fellowship, which is a 1 year fellowship, not a true ICU fellowship. This isn't enough to work at a large ICU that requires formal FRCPC ICU training. I'm not sure how much of it is useful for a community CCU, but probably required for a job at a large academic centre (in the GTA- TGH, Sunnybrook, St Mikes), which have intubated patients in their CCU.

[ACHQ]

23 hours ago, HarrryMaguire said:

Makes sense, thanks! Can outpatient cardiologists (not staff) pick up CSU/Ward call on nights/weekends (if they have hospital privileges)? 

most outpatient cardiologists don't want to do this, or can't get privileges due to saturation issues. Some will locum here and there though. TBH building an outpatient referral base is definitely better/easier to do if you work at a hospital, but if you are apart of a large practice, you can easily get enough referrals from the community from family doctors and internists/subspecialists for cardiac assessments.

 

imo, if I was just an outpatient cardiologist (I'm far from it, just a lonely GIM in an acute care hospital). I would just do GIM ER shifts to make money, and at the same time build a referral base cause you can easily just have those cardiac patients referred to your outpatient practice once they leave hospital/discharged. A large chunk of our admissions on any given day are cardiac in nature (CHFe, CAD/ACS, Arrythmia's, Syncope etc...)

[Chogoz]

On 7/21/2023 at 4:35 AM, Edict said:

Not sure, but if it is a lucrative thing you'll need to put in your dues in some way to get access to those shifts, or there will just be so much competition that you'll have to have that extra training to stay competitive. CCU is increasingly requiring ICU fellowship. Most hospitals have internists who admit the patients overnight and on weekends and call cardiology the next morning, so cardiology call may not generate that many referrals. It may be possible, if you are willing to do the shifts no one else wants to do, they may offer you it.  

Generally speaking, the good stuff requires more training, simply because everyone wants to do it, sometimes because you actually need the training to do it. 

Hi, just saw a post you made like 7 years ago (in 2016) about gen surgery vs cardiology. I am in the same dilemma, don't know what to chose among cardiosurgery, general surgery and cardiology. Would like to ask, what did you choose at last and why? Can you share your experiences if you don't mind

[HarrryMaguire]

Any estimate on the billing difference for a partner of a cardiology diagnostic clinic (echo, stress, holter, etc.) vs a physician that works at the clinic (and pays overhead)? 

[bearded frog]

5 hours ago, HarrryMaguire said:

Any estimate on the billing difference for a partner of a cardiology diagnostic clinic (echo, stress, holter, etc.) vs a physician that works at the clinic (and pays overhead)? 

Assuming they were doing the same thing, they would bill the same, the difference would be that the employed doc would then pay a X% overhead fee, and the partner would pay the costs of the practice, which one would assume is <X% of their billing, and make a profit of whatever the difference in the other doc's overhead fees and actual costs.

Say that both docs bill 1000$ a day, and the cost to run the clinic is 400$ a day. Overhead fee is 25%. Employed doc goes home with 750$ and pays the partner 250$. Partner pays the costs and goes home with 850$. The benefit for the employed doc is that if costs go up, the partner is on the hook for the higher costs.

[futureGP]

Hospital work has no overhead, hospital premium but not as efficient.

 

Clinic work has overhead + administrative burden if you’re the owner. But you may make more because you take T fees if you own the clinic. May make less if you work for someone as they may take a cut of your P fees (or not - i think depends on the clinic)

 

in general when you’re young and starting out you’ll do more hospital work. Once you have a stable outpt practice, you may prefer to stop hospital work in your older years.