The Complicated Rise of Interventional Cardiologists

August 9, 2018
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Cardiac surgeons and cardiologists are at war. In one corner stands the surgeons, representing the traditional approach to heart health. In the other corner stand the interventional cardiologists, doctors who are striving to bring a newer, less-invasive strategy to the mainstream.

Contemporary medicine isn’t a stable field. Exciting new developments are rapidly occurring. As medicine advances, there’s been a deliberate shift toward less invasive treatment methods. Why cut someone open when you don’t have to?

The shift is especially significant in cardiology. The Western diet is riddled with food that’s been proven to have extremely negative effects on the heart. As people become heavier, they become prone to developing heart conditions.

An interventional cardiologist wants to address serious heart issues without resorting to major surgery. Surgeons, obviously, want to protect their own jobs. Not from purely egoistic motives, but because they genuinely believe that’s the best option for their patients.

“There used to be more than enough work for everyone, so turf issues weren’t so important,” Robert Rosen, the director of interventional radiology and endovascular surgery at New York University Medical Center, told New York Magazine.

“Usually, there was agreement among doctors about what procedure was best for the patient. But now it’s like putting rats in a box that is getting smaller and smaller. Things have gotten tighter, and reimbursements are less, and doctors are getting paranoid about their practices.”

Differences Between Invasive, Non-Invasive, and Interventional Cardiology

A cardiologist deals with everything related to your heart except for surgery, which is performed by cardiac surgeons. When confronted with a patient with a heart problem, there are multiple ways to treat it. Cardiologists choose their specialty after medical school and receive intense training in one of the following areas.

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Invasive: These procedures are minor, minimally invasive surgeries used to treat conditions like angioplasties.

Non-invasive: This a non-surgical procedure that doesn’t require anything more than external tests. Generally, it means that the skin will not be broken. Using a stethoscope counts as a non-invasive procedure.

Interventional: Interventional and invasive cardiology are similar. The cardiologist performs a non-surgical procedure using a catheter to treat her patient.

They might treat conditions like coronary artery disease or peripheral vascular disease.

Cardiologist vs. Interventional Cardiologist

Interventional cardiologists receive a lot more training than their counterparts. A regular cardiologist might even end up referring their patient to an interventional one for extra treatment.

That’s where the squabble with cardiac surgeons comes into play. There are many conditions where a good doctor could reasonably refer her patient to a surgeon or to an interventional cardiologist.

“If I do the procedure, I get the fee,” interventionalist Alejandro Berenstein told NYU magazine. “If you do the procedure, you get the fee.”

Money concerns shouldn’t be mixed up with patient care but the reality is that doctors are human beings just like everyone else. They want to take care of their patients but they also want to take care of themselves.

Cardiologists

Cardiologists complete a normal hospital residency after graduating medical school. Once their residencies are over, they spend two years in a cardiology fellowship where they specialize in non-invasive, invasive, or interventional medicine.

Interventional cardiology training is more intense. In addition to everything listed above, these cardiologists spend three years training to learn interventional methods. Their work is so successful that they’re beginning to apply their strategies to other branches of medicine.

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“Interventional cardiologists are saying, ‘If I can put a catheter in someone’s coronary artery, I can certainly put one in an artery someplace else in the body’—like kidney vessels or the femoral artery, which before would have been done by a vascular surgeon or an interventional radiologist,” Stephen G. Baum, chairman of medicine at Beth Israel, said.

Should You See an Interventional Cardiologist?

If you suffer from serious heart problems, there’s a chance that you may be referred to an interventionalist. Some patients may feel nervous about the change because it’s so new. However, interventionalists are achieving great results.

Every year there are multiple interventional cardiology conferences scattered across the globe. One of the largest ones, CRT, takes place in Washington, D.C. It’s become such a big event that at the 2018 meeting former President Barack Obama was one of the keynote speakers.

Obama’s presence should provide encouragement to people who are hesitant about seeing an interventional cardiologist rather than a traditional surgeon.

What’s Next in Interventional Cardiology

Interventional medicine is just beginning to take off. Its advance has been slowed by resistance from others in the medical community. Change in medicine is almost never accepted wholeheartedly until it’s been around so long that it’s no longer new.

Surgery is a risk. If a patient can be helped by using a less invasive technique than it should be explored.