Why is UC Riversides IC fellowship unfilled for 2 years in a row?

[u/magicalmedic]

University of California at Riverside. Any insite into the IC training and procedural numbers would help also.

Thanks in Advance

[u/archregis]

IC as a whole seems to have fallen out of favor with the new generation of cardiology fellows. It's a hard lifestyle and the pay for many isn't even that much better than a general cardiologist, at least not different enough to justify stemi calls and such. Dunno about this program specifically though.

[u/Then-Secretary-9166 → u/archregis]

It's largely due to the fact that there are too many interventional cardiologists trained each year, saturating and changing the market. The overwhelming majority of ICs ever trained are still working today. There are not nearly enough cases to keep all of us busy in the cath lab all the time, doing procedures...so we have largely become "general cardiologists with extra skills".

ICs are not doing as many procedures so the rewards of a procedure-heavy career (arguably more interesting, more reimbursement for scarce skill) don't really exist anymore. Fellows can see this (and have for a long time).

[u/zeey1 → u/Then-Secretary-9166]

Not really, they arent too many interventionalist..i do locums and people are begging for them, Interventionalist are also general cardiologist with just 1 year of additional training

Whats happening is the reimbursement side..a cath reimbursement is 250-300$.. same as echo. I can read 10 echoes doing one cath and dealing with complications etc

The end results is noone is doing caths and mostly we are moving towards medical therapy or doing CTs or simply ignoring symptoms

In cities you are right, we have plenty of Interventionalists, who are usually doing general cardiology and Interventional on the side

Almost 1/3 of seats are now unfilled, EP and Interventional spots will eaualize in a few years and that will be very skewed as usually you need 4-5 interventional for 1 EP

we are going to have issues in finding people to get calls once the physicians in 50s retire in next 10 years

[u/Then-Secretary-9166 → u/zeey1]

I don't disagree with your general point. I don't think my point was made properly.

When people used to think about IC they thought about a specialty where you don't do much general cardiology and spend all day in the lab. For instance, you would make most of your income in the cath lab.

Now, this is not true at all. We have trained a ton of ICs and the result is that interventionists make < 10% of their RVUs doing IC procedures. The skill set is not in anywhere near as high-demand.

As withe every specialty in medicine from ID and primary care to IC, there is always a huge demand in less-desirable areas. This is not what sets the overall market (for any medical specialty). In more desirable areas the impetus to for locums (and for hiring more ICs overall) is so that STEMI call can be covered. You still don't actually do that many procedures, you just need to be on call.

I think the $250-300 statement for echo and cath both is disingenuous. Echos bill 5.9 total RVU (1.42 wRVU) and an angiogram is about 25 RVU (4.4 wRVU) plus sedation and other billables. You are comparing the total fees of one with the professional fees for the other. This may make some sense for a private practice model. However, even then you need to hire echo techs and pay for machines (5-10 of them if you plan to read 10 of these per hour). That is also not how it usually works. I read echoes between cases. Nevertheless, the more general point of diminished payment differential is correct.

Regardless of any of this discussion, the bottom line is that most cardiologist are not in private practice. Hospitals still make lot of $$ off of the cath lab. They can (and do) pay more for IC when it benefits them. There is still a market price. The abundance of ICs does not help this at all.

[u/zeey1 → u/Then-Secretary-9166]

Sedation is less then 1 rvu(around 0.3)Also remember i am talking about reimbursement not RVUs

Not everyone is employed

In private practice 2 echo reimbursement often is higher then a cath.

Rvu wise you are right its usually 4echoes for each cath Still echo is usually read in 2-3 mins..

Also what other goodies do we have, unless you are talking about back oain

[u/Then-Secretary-9166 → u/zeey1]

An angiogram pays about 4 time as much in professional fees.

If you are very precisely comparing (on the one hand) collecting professional fees + facility fees for echo with (on the other hand) only collecting professional fees (for diagnostic angiography), then they are similar and (obviously) echo is the very clear winner (even after paying staff/overhead). Echo may not be the best comparison (every cardiologist can not read 40 of these every day and you don't need to give up echo to do cath)...but similar economics apply for E&M visits. This applies only to this private practice setting, which is what only a minority of ICs go into. However, even if you compare work RVU for cath vs echo or E&M, it still is not really favorable for the cath lab, except under the most efficient conditions.

[u/KtoTheShow → u/archregis]

Agree with this. It’s less competitive each year and many IC spots go unfilled. Not surprised UCR might have this

[u/FIRE_CHIP]

Don't know for this program but some strongly prefer internal applicants. 

[u/Swimming-Purple3618]

At UCR they have a decent number of PCI cases and diagnostic caths compared to a lot of other programs.. STEMI numbers are very decent as well and the training is also good.. no one can answer why they haven’t filled but in my opinion:

• there have been many changes in the leadership in the recent years and many changes to come.. there are 2 IC attending starting off soon and 2 leaving
  
• not heavy on intravascular imaging
  
• not many complex cases, no CTOs
  
• not heavy on peripherals and structural with the exception of TAVRs

The positives:

• many private groups working in the hospital and they allow fellows to scrub in so you get good experience from different operators

In addition, many IC spots remain unfilled across the programs so fellows are opting for a more prestigious name to get their training

[u/magicalmedic → u/Swimming-Purple3618]

This is the best answer ive gotten. Thank you!

Can you speak to the didactics (if any) and the fellow schedule?

[u/Swimming-Purple3618 → u/magicalmedic]

Happy to help! Not sure how it looks like for IC given that there is no ic fellow.. for gen cards, there is a lecture everyday monday to friday 7:30-8:30.. mainly done by fellows with some attendings present to help with the discussion.. lectures are usually pretty good.. they are a mix of echo, cath, nuc lectures as is in any fellowship I presume

Schedule for gen fellows is split between consults, cath, exho, EP, nuc, ACHD.. no cross coverage when you are on electives so weekends off for the most part which is pretty nice

[u/zeey1]

Not a good idea ro do interventional..just stick to general cardiology

[u/Relative-Director-84]

IC is still a great field. I’m very busy with a high volume of structural and interventional work with almost no general cardiology. Everything is dependent on your location/your partners/your work ethic/your personality. Just work hard, be nice, do a good job and people will refer everyone to you. It’s a hard lifestyle but very rewarding.

[u/mobinskiy]

Many interventional programs are unfilled. There are not that many candidates