By Srihari S. Naidu, MD, contributor to the Journal of Invasive Cardiology.
As we enter the interviewing season for interventional cardiology training, there seems to be no dearth of ready, willing and able physicians eager to join our ranks. Competition remains fierce, and the talent exceptional. Yet, I remain at times conflicted on where our field is going and whether we need more or fewer of us due to forces that have seemingly conspired against us. Let’s lay them out.
First, coronary volume nationally has declined, some say as much as 20% over the past several years. Second, there is the attack on reimbursement, with this year alone seeing a nearly 20% drop in payment for our most important family of codes: coronary stenting. And, this was despite the fact that both SCAI and ACC worked tirelessly to prevent far steeper cuts. Third, innovation and technology is fleeing the United States and moving to Europe and Asia. To wit, TAVR has been readily utilized in Europe for years, only reaching commercial availability in 2012 here, and we are just now ready to start the bioabsorbable stent trials while Europe has already been implanting them.
And finally, the job remains more stressful than ever, with door-to-balloon time mandates, additional value-based-purchasing and PCI readmission rate limits, long hours even when we’re not on call, high-risk of malpractice litigation, and the increasingly complex subsets of patients we now see on a daily basis.
So, why enter a field where you will undoubtedly feel persecuted, the salary is decreasing, and where you can’t even get the new tools and techniques on time? What can we do to get interventional cardiology back on track? I believe there are several things we can do by getting involved and working together.
I’m writing this editorial because I think we’re at a potential inflection point. We can cower and go quietly into the night, or we can stand up for what we believe to be true based on our day-to-day interaction with real-world patients. If we rally together, find the evidence we need, talk to our patients and politicians, donate to SCAI political action committee, self-govern our quality, and stand behind our Society 100%, we may be able to preserve our field and even grow. Yes, I believe we can and should grow the interventionist pie, and not just in structural and peripheral intervention, but also in coronaries.
Dr. Srihari S. Naidu is Director of the Cardiac Catheterization Laboratory, Interventional Cardiology Fellowship Program and Hypertrophic Cardiomyopathy Treatment Center at Winthrop University Hospital on Long Island, and Associate Professor of Medicine at SUNY – Stony Brook School of Medicine. He is a Trustee of the Society for Cardiovascular Angiography and Interventions (SCAI) and Appointed Member of the American College of Cardiology Cardiovascular Leadership Institute (ACC-CLI) and Interventional Scientific Council (ACC-ISC).
Additional resources for interventional cardiologists:
Interventional Cardiology 2013: 28th Annual International Symposium, starting March 24, 2013
Consensus Statement on Ad Hoc PCI Is SCAI’s Latest Effort to Ensure Excellence in Patient Care and Quality Improvement in Interventional Cardiology