On SCAI.

The society for coronary angiographers and interventionalists is a medical professionals group that portrays itself as a representative for the interventional cardiology community – both in the US and abroad. Things could not be further from the truth. As a card-carrying member of the organization, I would like to bring to light exactly how bad things are. Even if you are not an interventional cardiologist, you may want to read this, just to see how a “professional society” devolves from high ideals to petty protectionism and selfish elitism.

I joined SCAI as a wide-eyed interventional cardiology trainee in 2006. I was dazzled by the camaraderie and focus on quality. A determined effort to maintain high procedural quality and an academic approach – alone – even in the face of strong commercial and industry influence taking over many others. Over the years, as a member, subsequently a Fellow and committee member, I have seen with dismay as the society has devolved into an elitist club, focused more on pet agendas of “leadership” as well as promoting their own, with no emphasis on trying to honestly represent the large body of interventional cardiologists in the community.

For years SCAI has pushed an agenda portraying themselves as representing the interests of patients’ as purveyors and guardians of procedural quality. While this may have held true in yesteryear, the present sings a different story. Most present “multi-society” documents, no longer include SCAI, partly because of their vanishing relevance. Whether in discussion of outpatient surgery centers, high risk coronary procedures, valve procedures, the society is lead by individuals who believe that they are the only people capable of doing these procedures. Akin to royalty, they do dole out permissions to the humble average board certified interventional cardiologist out there, but the paying procedures (that the SCAI fights for expanded reimbursement using society money at the national level) should be preferentially sent to “quality” operators (per their own self affirming guidelines).

Take for instance the most recent”competencies” document they have generated.

https://onlinelibrary.wiley.com/doi/abs/10.1002/ccd.29229?campaign=wolearlyview

In this wondrous piece of work, the authoritarian authors promulgate that training for high-risk PCI be driven by numbers that would result in less people available to do these procedures than are currently out there. Without delving into details, their guidelines are clearly likely to benefit the authors of the document. Rather than focusing on improving the standards of procedures performed in the patient’s neighborhood by focusing on education and engagement of the society’s membership, the statement is to put unrealistic numbers to prevent “low-volume” operators. Of course this is put out in the guise of a training document, i.e. applicable to training of new operators, but it is a short hop from these becoming standards that hospitals use to determine privileges and renewal thereof in existing operators. For example they recommend 150 CTO procedures at a minimum to be considered competent. The number of such centers that do 150 CTO procedures nationally is tiny. Then, they insist on technical aspects to further limit access. What broke the camel’s back was the fact that in order to qualify as a “high risk operator” a physician had to be reckless enough with at least 15 patients to have to demonstrate competence in rescuing a ruptured coronary artery with injecting fat or a plastic covered metal coil or a possibly dangerous heart support device (where significant safety questions have been raised by 2 independent non-industry funded studies).

In all of this, where is the patient, you ask? Nowhere, there are no mentions of outcome metrics with these procedures. There is no mention of metrics to ensure that appropriate medical therapy is ascertained. There are no metrics of procedural followup of these patients. It makes me wonder why the focus is only on things which can be billed for?

Is this what we have become? Is this who we are? As an interventional cardiologist and a Fellow of the Society, it pains to me to see this. I could quit the Society. But how would that help. No. The society won’t be rid of me that easy. I will stay and fight. I will be the thorn in their side, till every last one of them cries uncle. I will be there until the best outcome for the patient and the MAJORITY of interventional cardiologists, is back at the center of the discussion.

Why the majority?

Most interventional cardiologists, unlike the ivory tower elitists running the society, are regular folk. They are part of the continuum of the patient’s life. They have to live with their decisions WITH their patients, unlike the elite who deign to touch the patients and return to eliteland, never to see the patient again. The regular interventionalist knows his patient, their families and their social fabric. These elite don’t.

And yet, the elite are the one’s making decisions on how the regular interventionalist cares for his patients. In other words, they are trying to take away the patient’s own decision making by substituting their own.

This has to stop.

I may be one voice. I may be shunted aside. But it will not be for a lack of trying. Join me. Retweet this. Share this. Email this. Print this and post on your notice board.

We will not be silenced.