Cardiologists and Other Barbarians

Posted on November 12, 2009
Filed Under Cardiology Topics |

Here’s a Podcast of this post:

 
icon for podpress  Cardiologists and Other Barbarians [10:41m]: Play Now | Play in Popup | Download (211)

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Beginning in about 300 A.D., at the height of the Roman Empire, great masses of barbarian peoples - Ostrogoths, Visigoths, Vandals and others - were displaced by the invading Huns from their ancestral homes in northern and eastern Europe, and began  moving south. It was the so-called Great Migration. The vaunted Roman legions proved a poor match for these desperate but robust barbarians, and the Roman frontier gradually gave way. Finally, Rome itself was sacked in 410 by Alaric and his Visigoth hordes.  So much for the once-mighty Roman Empire.

DrRich is put in mind of this most interesting chapter in the history of Western Civilization as he observes the behavior of the modern American Cardiologist in these desperate times.

It appears that the reduction in Medicare reimbursements to cardiologists (cuts of up to 40% for certain procedures), discussed here earlier by DrRich, are going to happen after all - despite a full-court-press lobbying effort by the American College of Cardiology (ACC) and their very good friends in industry. All the lobbying got them was a “phase-in” of the cuts, rather than having to suffer their implementation all at once. To many cardiology practices, these cuts threaten a true catastrophe. Many simply will not be able to offer certain cardiac services any longer (at least, not to Medicare patients), because it will cost them far more to provide those services than they can be legally paid to perform them. These soon-to-be-economically-unfeasible cardiac services are not only important to many patients, they are also vital to the survival of many cardiology practices.

And so, we have the Feds (the Huns in this little analogy, themselves activated by powerful, unseen forces), invading the territory of the well-entrenched cardiologists (the Visigoths, say, heretofore enjoying their happy and robust - if unsophisticated - way of life), and forcing them to make a choice. The cardiologists can stay where they are, in their old homelands, and live out their lives in a reduced, subjugated, penurious manner - or they can, like their barbarian forebears, strike out for new territory.

DrRich, being a cardiologist himself, knows what they will do. And his message to the other, less robust medical specialists, whose territory lies to the south, is simply this: Repent! The end times are nigh! The barbarians are at the gate! Gather your women and children, and what possessions you can carry on your backs, and flee, while there is still time!

And don’t say DrRich didn’t warn you.

Just in the week or so since the Medicare payment cuts to cardiologists have been made more-or-less official (for what acts of Congress are ever really final?) DrRich has already received solicitations from entrepreneurs offering to help.  Numerous enterprises, it happens, propose  to assist him in “expanding” his cardiology services to areas not traditionally occupied by cardiologists. (DrRich retired from active medical practice nearly a decade ago, but since he still belongs to the ACC, and writes the heart disease website for About.com, he remains on all the cardiology mailing lists.)

For instance, DrRich received in the actual physical mail a very well-produced, multi-coloured and very glossy pamphlet from a certain company offering to set up for him a practice in “bariatric medicine,” specifically designed to be integrated into his practice of cardiology. Intrigued, DrRich went to the website of said company, and found a fully-fleshed out business plan laid out for him, promising to produce an additional $20,000 to $40,000 of revenue per month (in the attractive form of cash) for his cardiology practice.

Among many similar offers he received, all wishing to supplement his cardiology practice with novel revenue streams, specifically marketed as replacements for the revenue stream being taken away by the Huns, was one for a turnkey “sleep medicine” service.  Had DrRich actually been concerned with replacing his lost revenue  (instead of bemusedly observing, from some distance, the Great Migration of his former colleagues), it appears that his choices would have been truly manifold.

Now, no doubt the endocrinologists and the pulmonary medical specialists are scoffing at the idea that mere cardiologists (a backward people who ream out clogged arteries for a living, like medical plumbers operating FDA-approved Roto-Rooters) can navigate the complexities of medical weight loss, and of sleep medicine - specialties for which they (the endocrinologists and pulmonary specialists) had to undergo years of special training. Why, the thought’s absurd.

That, friends, is just what the complacent Roman Senators said about Alaric, even as his barbarians swarmed down the great peninsula, ravaging and raping the countryside.

Let DrRich remind you of a couple of things.

It was the cardiologists who brought the mighty cardiothoracic (CT) surgeons - the King of the Beasts - to their knees. A mere 25 years ago, all a cardiologist could do was squirt some dye into the coronary arteries to visualize the blockages, then send the patient to their imperious CT surgeon colleagues for a bypass operation. Today the cardiologists are treating those blockages themselves, and they throw the now-underemployed CT surgeon only those rare cases they deem are too risky for their own tastes. Ask any CT surgeon today (you’ll find they have plenty of time to chat) whether you ought to scoff at the cardiologists, once they set their minds on some territorial takeover.

And more to the point, there’s metabolic syndrome. Metabolic syndrome was invented by endocrinologists, and taken up as a great cause, and subsequently heavily promoted, by the American Diabetes Association (ADA). All was well for a time. But then the cardiologists noticed metabolic syndrome - a series of risk factors centering around obesity and insulin resistance, that, taken together, produces a substantial increase in the risk for cardiac disease - and took it up themselves. The next thing you knew, people recognized as having metabolic syndrome were being referred to cardiologists instead of diabetes specialists or endocrinologists.

Astoundingly, the ADA reacted by suddenly disowning metabolic syndrome altogether, asserting publicly that there’s actually no such thing after all (and so please disregard our strenuous decade-long public campaign to the contrary).  Rather, there’s a condition called “pre-diabetes” that (remarkably) has the same features of metabolic syndrome, but, obviously, given the name, would require a patient to seek the counsel of a diabetes specialist.

Too late. The relatively tiny ADA stood no chance against the great ACC and American Heart Association, both of which continued to promote metabolic syndrome (as a “pre-cardiac” condition) with great vigor, and which ridiculed the ADA’s lame attempt to “cure” the metabolic syndrome problem by denying its existence. Subsequently, metabolic syndrome has flourished - if it actually exists, up to 40% of American adults have it - and so have the cardiologists.

DrRich’s point should be obvious. The cardiologists are remarkably predatory, and have proven adept at invading the turf of other medical specialists - even powerful ones - and making that turf their own.

And the cardiologists are on the march. They are being displaced by an even more irresistible force than themselves - the Feds - and are seeking new turf. They will not be stopped.

DrRich reminds his friends in other medical specialties that the board certification document carried by cardiologists declares them to be  specialists in “Cardiovascular Medicine,” and not merely in cardiology. DrRich reminds his friends that the vascular system, of which cardiologists are certified experts, extends to the very essence of every organ in the body.  Any of you are fair game.

Nobody is safe.

Hide the women and children.

Comments

9 Responses to “Cardiologists and Other Barbarians”

  1. Dr. Wes on November 12th, 2009 9:13 am

    And cardiologists are boarded in Internal Medicine, too… The march continues…

  2. pheski on November 12th, 2009 9:27 am

    ROTFL. (Right after I hid the women and children.)

  3. james gaulte on November 13th, 2009 8:37 am

    DrRich,
    This is off topic but I did not know how to contact you otherwise.I am struggling to understand why AMA,ACP etc, etc all favor the health care reform bill(s) in the house and Senate.It must be more than a blind (IMHO)allegiance to a social justice imperative.Or is it? I would love to hear your views on that. Thanks.

  4. Mike K on November 13th, 2009 11:06 am

    As a former (and retired) CT surgeon, I attest to your veracity. Cardiologists are not to be disregarded when they are in migration mode. I noticed during my annual visit to the American College of Surgeons, a similar migration to obesity surgery about ten years ago which seems to be ebbing a bit.

    For those who wonder about the AMA, all I can say is “follow the money.” Mind you, I’m not referring to the members, who are fleeing if they haven’t already, but the Board of Trustees who are, no doubt, seeking jobs in the new bureaucracy they expect to see rising in a couple of years.

  5. Liz on November 13th, 2009 11:55 pm

    Where there is an organ being perfused, there is an artery waiting to be stented.

  6. DrRich on November 14th, 2009 11:13 am

    Dr. Gaulte,

    Here’s how I see it.

    What the AME gets by supporting the healthcare bill is the continued government’s imprimatur as the organization that represents American doctors (which it clearly does not). So, this is simply a continued partnership between the AMA leadership and the government - and we’ve both written about the travesties that flow from this partnership.

    The ACP, in my opinion, is buying all the palaver about how the administration wants to support PCPs - so they are supporting the bill as good for their membership. This is a more noble goal than that of the AMA. But it is no less misguided. The healthcare bill actually goes a long way toward accelerating the purposeful destruction of American primary care doctors.

    By the way, Dr. Gaulte, my direct e-mail address is: DrRich (at) covertrationingblog (dot) com.

    Rich

  7. DrRich on November 14th, 2009 11:15 am

    Liz,

    I find it disturbing that you are so willing to disclose the secret cardiology passphrase.

    Rich

  8. james gaulte on November 16th, 2009 9:38 am

    DrRich,

    Thanks for your thoughts.I cannot disagree.Also maybe some at the AMA really believed that the bill would contain abolition of the SGR mess.

  9. Cardiology Jobs on February 5th, 2010 4:44 pm

    :-) I needed something to smile about today.

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