I received an article from a good friend today from the New York Times. He's a liberal New Yorker (pronounced yakker) so he considers the the Times the equivalent of the Bible, Talmud or the Koran. The article comments on a recently published JAMA paper on complications with defibrillator implantation. It finds that patients who underwent defibrillator placement by a cardiologist subspecializing in electrophysiology (EP) have lowere complication rates compared when to implantations performed by non EP cardiologists, thoracic surgeons and others.
"Most implant procedures, about 70 percent, were performed by electrophysiologists, the study reported. The remaining implants were done by other types of cardiologists or other kinds of doctors, including thoracic surgeons. The study found that the highest rate of serious complications, about 2.5 percent, occurred when the implant was done by thoracic surgeons, who accounted for only 1.7 percent of the procedures reviewed.
In recent years, the question of how much training doctors receive before they start implanting heart devices has taken on added importance because of the growing number of people getting defibrillators. The units send out electrical jolts to disrupt potentially fatal heart rhythms. "
New York Times exerpt
There remains a lot of controversy about various specialty turf wars and who should be doing what procedure. This gets into areas like credentialling, training, industry relationships and hospital politics. This area of EP would seem to be a little more clear cut than, lets say peripheral arterial interventions where one sees cardiologists, vascular surgeons, interventional radiologists and now even interventional nephrologists competing.
One of the least debatable parts of this discussion is the fact that institutions have to define a minimal level of training to become credentialed for an area of procedures. The credentialling should be evidence based to include representation from various involved specialties. Furthermore, the literature is clear that their is a direct relationship not only with physician volume but with hospital volume and better outcomes. I dont care who does the procedure, if they have been trained well and currently perform a high volume, then they are likely to better outcomes.
Im encouraging various specialists to share their turf battle stories with www.vasculardeviceforum.org . It's an interesting topic that is not soon to go away.
Comments