Disturbing trends in the heart rhythm clinic — New post up over at theHeart.org

What follows is a short intro to my latest column on theHeart.org | Medscape Cardiology.


The title of the piece is Three Concerning Trends in the Electrophysiology Clinic. I worked on the 750-word piece the entire week. It was hard to get the tone just right. This is because the trends do not reflect well on us–caregivers in the US healthcare system.

These are changing times for cardiology. In my city of 1-million people, cardiologists are now employed by three major healthcare behemoths. Most, but not yet all, of my referrals come solely because I am part of behemoth A. Doctors in my corporation have no choice. They have to send patients to me. Likewise, referral relationships I had formed with caregivers over years were shattered when we were employed by different corporations.

Earning referrals based on merit is essentially dead. That’s not a complaint; it’s a fact. A doctor in behemoth corporation B may send his mother to me, but his patients are going to the electrophysiologist in his corporation. I may have done 800 solo AF ablations but if your cardiologist is in behemoth B, and his electrophysiologist has done 50 AF ablations, you know where you are going. Heck, what am I thinking, all board-certified doctors perform equally, right?

To put it bluntly, this sucks. Cardiologists are a competitive lot. Knowing that your skills, real skills, not box-checking and compliance skills, don’t matter anymore is a joy-killer.

The good news is that, at least for now, some patients–especially those with means–still have a choice.

So one of the trends I am seeing involves patients seeking me out as a second or third opinion. This is new. I used to get an occasional second opinion, maybe one a month, but now I am seeing these types of consults almost daily.

The two other patterns I discuss pertain to how healthcare is delivered in this country. I use heart-rhythm examples, but the patterns extend to all of medical care.

Here is the lead paragraph:

The essence of electrophysiology is pattern recognition. I like to say heart-rhythm doctors are trained observers. What follows are three changing patterns I’ve noticed in my office practice. I write of these patterns because fixing things in medicine first requires seeing the problem.

I hope you want to read more.

If you do, and you don’t mind giving theHeart.org | Medscape Cardiology your email, here is the title and link to the column:

Three Concerning Trends in the Electrophysiology Clinic


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