They don't need any backup. So I'm confused why cardiology is going to need to branch out while vascular surgery will apparently always have patients. Students who searched for Cardiologist vs. Cardiac Surgeon found the links, articles, and information on this page helpful. The drudgery is diagnostic radiology work, which I actually enjoy as well. Who knows? Thank you for your reply. All three fields have a bad lifestyle. How do I choose and what do you think would be the best in the long term? So, the training and subsequent job you get will likely determine your case mix more than your specialty. Vascular surgery seems to have a similar reputation but has apparently gone down in terms of hours. My question is brief, although I am quite aware this is an extensive topic/debate. Our fellows care for patients with complex cardiovascular disease including peripheral arterial occlusive disease, complex venous thromboembolic disease, and insufficie… Will the leaders in Vascular Surgery push for complete control over this system, and if so, will they obtain it? If you're in a smaller hospital without access to vascular surgery, though, IR may very well still be the big dog for intra-arterial work. before finding a way to get it done. IC seems amazing but every IC doctor I've met has no life and works 90+ hours a week. Also, how are the salaries--I have A LOT of student loan debt :(? Division of Vascular and Endovascular Surgery Louisiana State University Health Sciences Center ... Vascular Surgery IR Int Cardiology IR +35.2%. My two cents is that cards and vascular will squeeze IR out of femoral/carotid work. My question is, what really defines the current unique scope of IR? They'll probably reach an equilibrium between the two as far as who takes what cases (higher risk to vascular who have more experience with salvage of dead limbs). For me, IR is great because there's so much variability. Certain procedures will always belong to certain fields: coronary work will always belong to cards, interventional onc work will always go to IR, and EVARs/critical limb will almost always go to vascular (unless you're in the middle of nowhere and the cath lab may be able to step in for EVARs). But, if they don't enjoy listening to old ladies with pain everywhere, they'll be miserable as rheumatologists. Cases that were accepted at the center with visiting on‐site cardiac surgery were those with insurance status that permitted hospital choice and allowed the performance of the procedure at an institution with a visiting cardiac surgeon. By using our Services, you agree to our use of cookies.Learn More. Both, the cardiac surgery and interventional cardiology … All three fields involve significant (often official final reads) interpretation of imaging with IR having the widest scope. It's not just STEMIs that get cathed, it's also the NSTEMIs and UAs and stable anginas, not to mention heart failure and lots of other random chest-related complaints. I'm really interested in interventional radiology, vascular Surgery, and interventional cardiology because of the minimally invasive procedures, but I can't really decide or figure out which one I like better. IR is really what I am most interested at present. You're focusing way to narrowly too early in your career. Well, I've been giving this serious thought since year 1. In his example, people go into allergy/rheum wanting to work with complex immunodeficiencies. if they gain the ability to admit patients and handle referrals, what's stopping them from gaining a significant amount of power in the future? A rheumatology attending told me that too many docs choose a field based on the most exciting or coolest thing that they do. They even often tend to see the same patients with similar pathology. I've worked for Vascular surgeons for 4 years and the most likely the ir or ic will only maybe do angiography or occasional angioplasty if they don't have much of a vascular team at that particular hospital other than that we get all the evar, cea, amps, dialysis access, angioplasty, stenting, wound healing, etc. The specialty evolved from general and cardiac surgery, and includes treatment of the body's other major and essential veins and arteries. Journal of Interventional Cardiology Volume 31, Issue 2. Knowing what a specialist does and does not do can help you choose the right provider for your specific health needs. All of the services in the hospital are supposed to work like a team. Each of the three specialties you've asked about will have practices with case mixes that include a high level of endovascular work. 4 DISCUSSION. Directly addressing the unique barriers cited by women in interventional cardiology may provide the most impact in reducing gender imbalances in the field, according to a study published Jan. 16 in JACC: Cardiovascular Interventions.. Based off an online survey of cardiovascular Fellows in Training (FITs), Celina M. Yong, MD, et. APDVS Annual Meeting On Behalf of the Resident and Student Recruitment Committee Overall, those interested in mastering endovascular work can do so via training in vascular surgery, interventional radiology, or interventional cardiology. Interventional cardiologists spend three years completing a fellowship in interventional cardiology after they have graduated from medical school, finished a residency in … Do you want to be on call with 20 minute response time for STEMI's? With all of that given in my field you have interventional neurologists, endovascular neurosurgeons, and interventional neuroradiologists doing the exact same procedures on the exact same problems on the exact same anatomy with nearly the same years in training sharing a call schedule and going to the same conferences. They decided to centralize surgical specialties activities, including major trauma, neurosurgery, interventional neuroradiology, interventional cardiology, cardiac surgery, and vascular surgery, creating a Hub/Spoke system to concentrate their resources for COVID‐19‐related cases. As much as I love cardiology, it's hard for me to imagine being stuck in one body system for my entire career. IC seems amazing but every IC doctor I've met has no life and works 90+ hours a week. Not in any of those three but here's my American take: Certain procedures will always belong to certain fields: coronary work will always belong to cards, interventional onc work will always go to IR, and EVARs/critical limb will almost always go to vascular (unless you're in the middle of nowhere and the cath lab may be able to step in for EVARs). So you're saying that from your experience, Vascular Surgery has a strong hold on the arterial work? Besides diagnosis & angioembolization, what other skills can IR offer in the setting of trauma? With the new IR residency, will IR continue to branch into varying fields, drastically altering turf? Or when they embolize a plaque during carotid stenting, and do a cerebral angiogram for retrieval of embolus. Thanks for your response. So IR has a pretty strong presence in the setting of trauma? Really just comes down to what you want to do on a daily basis. Covered stents can do a lot as a temporizing measure as well. They do have the advantage of being more "adventurous" in some ways than the other two. So, for me, IR was a great fit. I fell in love with Vascular Surgery early because of my love for the vascular system and the fact that their procedures are not confined to one body system. Do you know if the new IR residencies will qualify people to do interventional neuro-radiology? Do you want to spend your time between procedures reading CT's (or... bleh... mammo's)? Sometimes health specializations can be as confusing as medical terms. I suspect that some of the procedures that were originally developed by IR's and taken by other specialists will gravitate back. I went to medical school sure I wanted to be a neurosurgeon. Endovascular Surgery. There are three main types of cardiology: invasive, non-invasive, and interventional. They're not running out of patients any time soon ('Murka). You're not wrong that cut downs are occasionally needed for a case that's planned to be PCI only. Thank you for your response. Illustrating the differences between urgent interventions and interventions performed to manage chronic conditions the authors present the chapters in a consistent template for ease of use covering; background, indications, evidence review, device description, procedural techniques, follow-up care, and complications. I can't seem to find any numbers for IR and VS. Interventional Radiology, Vascular Surgery, and Interventional Cardiology. Is Vascular Surgery destined for outpatient venous work, amputations, and the less common (but still relatively high-volume) EVARs, CEAs, bypasses, and high-end emergency hospital case? Seems like that would be fewer years in training than the other pathways, and be more appropriate for someone who doesn't want to have something non-procedural as a fallback. In 38 (28%), vascular surgery alone is the service enrolling CLI patients. Cookies help us deliver our Services. So even with IR becoming its own field and own integrated residency, you don't think that their ability to handle patient admits and referrals will grow? One other thing: The reimbursement model will be what drives the case mixes of various specialties when you go beyond maybe a 5-year time frame. Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries, veins and lymphatic circulation, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. A LOT of EVAR's and PAD cases are done by cardiologists and IR's The same is true for carotids, etc. The more than $1.8 million renovation will allow CMH to perform minimally-invasive interventional cardiology, vascular surgery, and interventional radiology procedures to … All three involve long training and competitive residency/fellowships. Sometimes, vascular surgeons perform hybrid open and endovascular cases. Cardiology certainly has the taste to pick up femoral/carotid stenting, and they also have the referral base (better positioned than any of the others). ... and had a high to intermediate risk for cardiac surgery reflected by a logistic EuroSCORE of 17 ± 17% in the suture and 14 ± 11% in the closure device group. You generally do not see IR called to evaluate critical limb ischemia. New comments cannot be posted and votes cannot be cast. The turf is more well defined than it used to be at least in the centers I have been in. However, I was unaware that other fields utilized endovascular techniques in their procedures until MS3. Vascular is a great specialty and I feel like the doctors I work for are not lacking in work, they are constantly busy and saving lives. A cardiologist is involved in testing and other procedures. Does IR still have a strong presence in vascular interventions in the U.S., or is their work more cut out for interventional oncology and traumatic angioembolization? As the US moves towards a single payer system, and the incentives for doing procedures (likely) decrease relative to more cerebral activities, I think that specialties will go back to focusing on their historic core competencies -- cards sticking to the heart, nephrologists doing less interventional work (nobody else has brought up interventional nephrology to my knowledge), etc. As others have already said, you always need backup. Endovascular treatment by specialty in BEST-CLI vs national Medicare claims is as follows: vascular surgery, 55% vs 51%; interventional cardiology, 17% vs 13%; interventional radiology, 16% vs 25%; and other, 2% vs 10%. So, you have to look at the 'drudgery' of a field as at least as important as the exciting stuff. Press question mark to learn the rest of the keyboard shortcuts. First, I'll pass on what I think was the most insightful career advice I received in med school. Others specialize in adult cardiology. I'm an interventional radiologist, and, like others who have commented, I have biases and experiences that shape my opinions. Clinical and serial computed angiographic imaging outcomes were followed by a retrospective chart review. Often, I'm looking at a scan with a surgeon or other doc, thinking "How the hell am I going to do that?" Cardiologists VS Vascular Surgeons Tuesday, September 25th, 2018 | Written by Premier Surgical Staff Cardiologist vs. Vascular Surgeon. Press J to jump to the feed. I would say case selection would prevent most of this. Equally long training. Do the IR dominant procedures benefit from a background in imaging, or are they held by IR because OB, general surgery, and other IM subspecialties haven't gotten into image guided procedures? Vascular Surgery Training–Independent Fellowship (5+2 pathway) • 5 years of general surgery residency (+/- ADT) • Followed by a 2 year vascular surgery fellowship • Previously, the most common training pathway •Vast majority of VS trained this way •2018 - 96 fellowship programs (121 spots) • Allows for ABS certification in both: •General Surgery (primary certificate) Lots of clinic time vs lots of OR time. Methods: In our community hospital setting, between September 2005 and November 2007, we included all patients who underwent EVAR by interventional cardiologists, with available on‐site vascular surgical support. There are always exceptions, but you generally do not see vascular surgeons called to evaluate chest pain with dynamic EKG changes. Please read the rules carefully before posting or commenting. To cut to the point I am getting at, let's completely remove lifestyle and training out of the picture and only focus on the actual endovascular presence of Vascular Surgery, IR, and Interventional Cardiology. An alternative to traditional open surgery, endovascular surgery is an innovative, less invasive procedure that offers advantages such as small incisions, shorter hospital stay, less pain and quicker return to normal activities. Interventional cardiology is a unique medical discipline with a knowledge base of internal medicine and cardiology coupled with physical skill and analytic thinking common to surgical subspecialties. The question of which field picks up which "peripheral" work really has to do with the future of each field. This is a highly moderated subreddit. Vascular will always have the advantage of being able to offer the full scope of peripheral procedures, plus they have their own hospital service, so extensive endovascular work is fairly straightforward for them. You get to feeling like MacGyver at times. The hospital works best when everyone is trying to just do what's the best thing for the patient. Sometimes I'm reading the trauma CT, telling the surgeon where the patient is bleeding, and how I'll fix it, before going into the angio suite and doing the embo (that was my call last night, actually). Yup, like when a vascular patient gets an MI on the table. Interesting. In EVEREST II patients with significant mitral regurgitation were randomly assigned to MitraClip or cardiac surgery. IR is the most screwed from both patient referral and hospital/clinic presence points of view. Also, the endovascular work truly fascinated me. The CLCD Council supports AHA objectives in clinical cardiology, promotes excellent clinical care, and fosters professional development and education for clinical cardiologists. Cardiac surgery was performed in 7 patients. For each of these fields, what are we looking at in terms of the future (ie, 5 years from now)? Now I'm loving life as an EM doc because someone told me to keep an open mind. I'm really interested in interventional radiology, vascular surgery, and interventional cardiology because of the minimally invasive procedures, but I can't really decide or figure out which one I like better. However, the amount of time in clinic, and following patients with chronic diseases is not something that I'd enjoy. I like interventional cardiology because of the catheter work, but it's completely confined to the heart. The need for interventional cardiologists is driven by the same 'Murkan lifestyle that drives the need for vascular surgeons. /r/medicine is a virtual lounge for physicians and other medical professionals from around the world to talk about the latest advances, controversies, ask questions of each other, have a laugh, or share a difficult moment. 95 The primary efficacy end point was the combination of freedom from death, surgery for mitral valve dysfunction, and presence of grade 3 or 4 mitral regurgitation. For example the vascular surgeons who I know that focus on outpatient venous work do so as a choice, in order to have a more controllable lifestyle. A good friend who's an IR works in a wound clinic every week, and does a ton of CLI cases. A cardiac surgeon, who requested anonymity, just performed triple-bypass surgery on a 51-year-old diabetic, formerly the patient of an interventional cardiologist. IR seems to be the best for me due to hours and type of work but online it states IR is constantly in turf wars and IC and VS keep taking IR procedures and the idea of getting a lot of radiation exposure kind of scares me. And, some days, I spend the whole day just reading films, which can be dull or a nice break, depending on my mood. I loved being in the OR, and considered vascular surgery or ortho. Patient Interaction. Interventional Cardiology and Vascular Care Heart and vascular diseases remain among the top causes of death for adults in the United States. Or not. I know these are very bland, superficial, and seemingly naive statements about the bread and butter of each field, but I'm strictly focused on endovascular interventions. Some cardiologists specialize in pediatric, or children’s, cardiology. Surgery vs Medicine. al, assessed FIT perspectives regarding subspecialty choices. This is a great answer, and I think the most important part comes at the end. Coronary work is still enough to keep most cardiologists (who tend to be conservative) happy, but as AMI becomes less and less frequent, they will definitely begin looking elsewhere. 0 50 100 150 200 250 300 350 400 450 Vasc Int Card IR. This really intrigues me. All the dickwaving and specialty stratification as to which kind of doctors are "best" is done by two types of people: (1) assholes and (2) people without the requisite clinical experience to get that fact. ... and vascular surgery. Will cardiology continue to delve into endovascular interventions (ie, angioplasty) and squeeze Vascular Surgery out of the picture because of their reign over consults? Vascular / Interventional Cardiology Services Watchman Implant Device The FDA-approved WATCHMAN implant device is a safe and effective alternative to blood thinners for patients diagnosed with Nonvalvular Atrial Fibrillation (NVAF). Then vascular stents their coronaries. ORIGINAL INVESTIGATION. So, do you want to have a clinic full of chronically ill patients? Do you want to be a surgeon who operates on hearts or a heart doctor who does catheter based treatments. Don't pigeonhole yourself too early on. Interventional radiologists treat both healthy and sick patients of all ages. Presumably, in addition to patient access, IC and vascular surgery guys do benefit from their knowledge of the relevant systems, and medical/surgical management. With the new IR residency, I think the future of IR will be more clinician-esque than it has been in the past 15 years. Vascular surgery includes treatment of all vessels outside the heart and brain. As an aspiring "interventionist," what are the pros and cons of each of these fields and, if I choose one over the other what, can I expect in terms of my type and volume of cases 5-10 years down the line? You do not see cardiologists called to stop large volume hemorrhage with a uterine source. The Vascular Medicine and Intervention Fellowship program provides training for up to two fellows every year preparing trainees for board certification via the American Board of Vascular Medicine in vascular medicine and in endovascular medicine as well as the ARDMS certification as a registered physician for vascular interpretation (RPVI). The routes of training are quite different, and the exact problems they are called to answer tend to be quite different. The thing that the Vascular Surgeons have that IR and IC don't: if/when shit hits the fan, the vascular surgeon can open up the patient and fix the problem. A cardiac surgeon is a different specialist who performs the actual physical heart surgery. And does not do can help you choose the right provider for specific! A team squeeze IR out of patients any time soon ( 'Murka ) but you generally do see... Now ) a plaque during carotid stenting, and following patients with significant mitral regurgitation were randomly to. 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