Ditto!! to Julie's comment, I too am one of the lucky ones that had a preventive cardiology team that cared enough to have kept me alive and help me to find a quality life the past thirteen years since by CABG4 at 51.  As the daughter of a general practioner who healed others in the 50's & 60's, I understand the importance of a medical home for patients. Cardiologists both interventional and preventional need take be proud of the work that they do to give patients a second chance to live a healthier lifestyle and live a longer more producive life. I am grateful for the opportunity to embrace the frailties of my physical being and to use the expertise and knowledge that  my caridologist has been willing to share with me. I will be 64 at the end of this month; thank you to all of you who have helped so many of us.

Claire Blocker, President                                                                            HeartBright Foundation                                                                                   

Dear Dr. Walton-Shirley,

This is the year to take back medicine and in our case, Nuclear Cardiology.  While the Government continues to try to tell those of us trained in Medicine, what to bill for and how; this will be the year we show them how we do it "downtown."  It's time the Government quit attaching our collegues and let us worry about when and how to do something.  RMF

Diane,

thanks so much! I know your cardiologist colleagues must really appreciate you! I appreciate your post. 

Ssaith, We must approach it in a multi-pronged fashion:  Inform the public by utilizing local media outlets.  Make appointments to discuss the issues with your local congressmen and women. Discussion + dedication = attention.

Melissa

Dear Melissa,

   Rock on!   I'm a private solo cardiologist in Texas and I have seen over 1/2 of the cardiologists in town become employees because of the threats of cutting reimbursement and hospitals throwing their weight around trying to get marketshare with doctors and patients.   Someone needs to tell these "Non-Profit" religious-affiliated hospitals that high quality,  compassionate care for patients is supposed to be the primary goal and mission.  These hospitals are flush with cash and are more concerned about dominating healthcare than serving patiients in the community.    As you clearly point out, I have had to become extremely efficient while maintaing excellent service to our patients and the referring doctors.  You have the most compelling blog representing cardiologists and doctors.  You are are a "rock" and I hope you continue to lead the way with your message which always seems to be right on point.

EST

Eric,

Thanks so much for reading and thanks for the encouragement as well.  Hold fast! I think the private sector will be better off in the long run.  I am acutely aware of the risk that many private physicians can incur when they come under the auspices of someone who is not adept at navigating the very rocky economics and demographics of a  medical environment. If one utilized a cookie cutter approach to running a hospital and uses a template for a tertiary center to pattern their maneuvers for a smaller hospital, the community loses. At this point, there have been many atrocities committed against private practice communities of physicians.  When derision and division are instigated, everyone loses but most especially the patients.  

Keep up the faith! Hope you have a FANTASTIC year in practice!

Melissa

As the Clinical Coordinator for Pharmacy at a 300 bed hospital I know all to well the good, bad and ugly of our health care system. The point that you make that I bet will get overlooked/underappriciated by most readers is  "Become a leader in entities like smoke-free-ordinance movements, previously owned medication repositories, health fairs, and public forums, and generally make it easier to get cardiovascular information and services to our local communities. Champion antiobesity campaigns and focus on fitness" As a 47 yo male that has completed several marathons and a few Ironman triathalons I have made fitness the cornerstone of my own health. As a Pharmacist I get a very global view of sick people and lack of fitness is ubiquitous. I think that ALL practioners within healthcare have to do a better job promoting healthy living rather than continuing to just increase doses or add another drug. The vast majority of the people that work at this hospital could not pass a basic physical fitness test. How can we expect our patients to heed the "diet and excercise" advice when the person giving it is 50 lbs over weight themselves? What kind of message are sending to our COPD/cardiac patients by having a smoking area on hospital property? For a group(heathcare workers) that is supposed to be so smart, we sure have done a lot of dumb things.

Mervyn,

Without knowing the structure or recent changes in structure of your program I can't really answer with certain accuracy, but there are potentially multiple factors that can impact the number of bypasses performed at an institution. It could simply be that a new surgeon is available who increases referrals and procedures. The timing of new data release (some of which suggest that CABG is a more optimal choice for multivessel CAD in diabetics),  it can also have a transient or permament impact on referrals.  Glad you enjoy the Heartfelt series! Thanks for reading.

Bryan,

I completely agree. In South Central Kentucky, there is a constant parade of tobacco addicts who stil run to the cancer shack to run up the cost of their health care programs.....er.....to smoke I mean.  Though it's not as bad as it used to be because unfortunately, some of those folks whom I have loved over the years are certainly sickening and dying.  This "thinning of the herd" is a horrible end result of raising children in an area without a smoke free ordinance and with one of the  lowest tobacco tax rates in the country.

Congratulations to you for your dedication to health. If all Americans were like you, we'd be wondering what on earth to do with all the spare cash.......perhaps give it to folks who CAN NOT help themselves instead of folks who WILL NOT help themselves. 

Melissa

Bryan, I agree with your excellent points as well.  As a Mayo Clinic-trained* heart attack survivor, women's health advocate, and frequent speaker on the subject of women and heart disease, I've been occasionally invited to do my Mayo presentations to health care professionals (in mental health, E.R., cardiology, etc).

When I was asked last fall to do a one-hour talk as part of the hospital's annual 'Cardiology Day' staff training, I told event organizers that, although I was thrilled to be invited to speak, by the time a heart patient gets brought upstairs to the Cardiology unit, the damage has already been done. Cardiologists see their patients for the first time long after the salient fact.

My audience on Cardiology Day included staff at our world-class Heart Institute (a solid educational and research reputation). But no matter how good our local cardiology team is, they are not miracle workers and cannot PREVENT the damage that patients have been self-inflicting, sometimes for decades. That's where Dr. Melissa's goal to "make it easier to get cardiovascular information and services to our local communities" comes in. That is my main focus during my own community presentations and on my HEART SISTERS blog - www.myheartsisters.org - these days.

But I am just one person, merely a patient who's survived a heart attack, and not a health care professional. I wish all docs (cardiologists included, whose credible voices in their home communities are heeded simply by virtue of the fact they wear the letters M.D. after their names) would join Bryan's challenge:  ".. ALL practitioners within healthcare have to do a better job promoting healthy living rather than continuing to just increase doses or add another drug..."

Thanks Dr. Melissa for this compelling essay - and good luck in 2011!

      * 7th Annual 'WomenHeart Science & Leadership Symposium For Women With Heart Disease' at Mayo Clinic in Rochester, Minnesota - October 2008

I am a very successful solo cardiologist in Raleigh, NC. I enjoy my work and come home happy. However the past 12 months most of the cardiologists in the area (95% of them) were bought by the two major health systems. Without even realizing, I am constantly worried - will I be the loner and looser, if I do not make a move and joint them? Will I be left out in the field with an empty office not knowing what to do? I worked very hard all my life and I continue to do so. As many cardiologists, I am very self confident and believe in myself and a bit stubborn too. I consider myself a failure if I give up my autonomy and joint a hospital system. However I have to bend my head if I have to - as I have a family to feed and parents to take care of. Any one to relate to me and advise me ?

Dear Healthy Heart,

Yours is a question that many are asking right about now. I just answered a comment on another blog with similar issues. I think the answer depends on a lot of things:

1.  Can you get cross coverage and particpate in call sharing? If not, staying solo will kill you. You can't work every weekend and every night so this issue is key.

2.  As long as you have a healthy practice and keep seeing your patients coming back, you it is a sign that you are surviving. 

3.  Can you trust your hospital administration to know how to navigate the current medical climate?  An acquaintance of mine was "bought" and is now being handed over to another "For profit" entity. Things are quite what he seemed. He's still on the hampster wheel and his extenders salaries are coming out of his pocket, so it was exactly the Land of Oz that he was told it would be.  

4. My partner always says it's important to remain autonomous. For now, we are still doing what we always do while the hospital army continues to be amassed.   The economy took a horrible downturn and it caused a lot of anxiety. Some had no choice but to close their doors to make a "deal with the devil" so they had to do what it took to remain in their communities. I feel the hospitals by and large took advantage of this downturn and in the long run, I am afraid they may be regretful of their new allegiance, especially if you are being "handled" by an inexperienced CEO or one that is not savvy, it can be disastrous.

5. IMHO, I think I'd only consider going in with a hospital personally if I were at the end of my career and didn't really care to deal with the day to day management of the office issues. However, you must do what is right for you, your family and your patients.  If you get the sense after 2-3 years that your friends have a better deal, you can always approach the hospital. I will warn you though that a neighboring town has already been there and done that and it seems the hospital nor the docs found the relationship to be what they thought it would be and disappointment abounds.  You might talk with those you trust and get the low down on it before you make any firm opinions.

GOOD LUCK! You seem like a caring person and a good doc and I wish the best for you. Please let know how it is going and what your decision making process entails.

Melissa

I agree with Mellisa's comments except for possibly point 2.  Physicians have always prided themselves on being ok if they take excellent care of patietns but that may not be the case inthe unknown future.

We are considereing an educational session at ACC stay tuned.