Dear Dr. Grines,

I’d like to publish my response to your kind comments on the prior blog post. As an SCAI member, I value my Society and your response. But I would like to point out my specific concerns and some suggestions. 

As a long time SCAI member, it pains me to say that the current activities of the society do NOT reflect my perception of what a professional society for interventional cardiologists needs to be.  In these difficult times, it is becoming increasingly hard to practice as an interventional cardiologist out in the community. With multipronged rivalry from interventional radiologists, cardiac and vascular surgery as well as their strongly supportive professional organizations, many of us face uphill battles as we deal with credentialing and new procedures as medicine evolves. The need of the hour is an advocate for our cause, not a witness for the prosecution.  

While elite operators (read: high volume, academic – not necessarily high quality) prefer that we refer our cases to them – in their cocooned environs – this comes at a cost.

Firstly, the patients often need to travel long distances, and deal with physicians and hospitals they are unfamiliar with. For instance, an 81-year old rural farmer with no family in the city, this is a major issue. On top of that, many of our patients are country folk for whom these large cities and mega hospitals are a forbidding prospect, even prior to their high-risk procedures surrounded by people they don’t know or can’t relate to.

Secondly, as you are well aware, the complexity of disease, driven by aging, obesity and diabetes has only increased. By reducing volume in the community and promoting the “high quality (i.e. high volume) referral center” model, it also means that operators in the community are less confident at dealing with these patients when they present in an emergency at 2AM on Christmas night, when the “referral center” team, tens or hundreds of miles away, is warmly tucked away.

How, then, does taking away procedures from us, the community cardiologists, help the specialty? How does it help our patients? What are the metrics that decide who gets to do what?

Here are my suggestions:

As a former member of the QI and advocacy committees, as well as working with Dawn on the PAC, I am only too keenly aware of how lacking we are in member engagement. These are the concerns that I have heard from my colleagues and in this missive, hope to transmit these to you.

1. SCAI, possibly partnering with industry, needs to take the lead in training operators in the community to enhance the procedures they perform, as well as, engage them in ensuring they have the resources to do these safely. 

2. SCAI needs to find ways to HELP interventionalists negotiate the credentialing processes in their local areas to ensure that they are able to deliver the appropriate and safe care to the patients – IN THEIR COMMUNITY.

3. Rather than focusing on volume metrics, SCAI should help operators in the community with creating QUALITY metrics to enhance the safety and appropriateness of the procedures, because we can do it BETTER than any other specialty. 

4. Mandate that at least 30% of the SCAI leadership, at any given time, consist of community cardiologists (not just academic “leaders”). This will need recruitment and engagement but it is work that needs to be done for the good of the Society and the specialty. 

I do not want this letter to come across as self-serving. I am secure in where I am and am writing to you, out of a sense of alarm, rather than a desire to look for any academic growth. While I am happy to help in ALL the society’s efforts, I do not want to seem like I am angling for a position in this. My only interest is preventing the decline in our specialty and our Society. I remain committed to the ideals of SCAI with the same enthusiasm as I did in 2006 and hope that we can reclaim this lost ground. 

Best regards,

Kartik Mani FSCAI

By Kartik Mani

Widely known for my extremely poor sense of humor, my life revolves around being an interventional cardiologist in the daytime; a molecular and cell biologist, when not placing stents in peoples arteries; a blogger when I get the time; a philosopher, when epiphany strikes; a rangefinder artist, when provided the inspiration and subjects; a car nut of staggering proportions; and Son, Brother, Dad and Husband to the greatest family known to mankind.

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