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Re: [echocardiography] Lifestyle and career progression of an echocardiographer

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  • Gerson Lichtenberg
    So Doug, you ve asked a very wide range of questions. My first impulse is to say, Whoa, slow down fella! You ve made many of your questions sound very
    Message 1 of 4 , Aug 1, 2009
      So Doug, you've asked a very wide range of questions. My first impulse is to say, 'Whoa, slow down fella!' You've made many of your questions sound very specific, but in fact their answers depend on where you are, where you will be and when this will all happen.

      Let me start with saying that it is good that you are going to go to what sounds like an academically based program (check the archives of this list for the many debates that have gone on about different programs), but I have no idea of what part of the world OCC is in and whether this is an accredited program. And I mean accredited by a body whom the ARDMS and CCI will recognize.

      So some answers for you are:

      1) Job market depends totally on where you luck and what the supply/demand ratio is like at the time you graduate. Nobody can predict. Some good programs have trouble placing graduates in their area for years after graduation, some people get jobs because they know how to turn on the machine.

      2) Again, salary varies with where you are. And the meanng of the salary varies with the cost of living in that area. So when you become a student, join the SDMS at the student rate and go to the link that you will find  at http://www.sdms.org/search/search.asp to their 2008 salary survey for this information. Your numbers are probably in the general ballpark, but you'll find a great deal of variability with region and with work situation (hospital, private office, government, etc.)

      3) Call again is totally variable. I have worked in hospitals with no call, because the Cardiology Fellows and Attendings were responsible for night-time echoes. I've had call for 3 weeks out of the month in a small hospital because the reasons for being called in were really restricted to true emergencies.

      4) What part of the world do you want to travel to? Getting fully versed in Vascular takes a great deal of time, and it is better if you get the academic background as well.

      5) You are now asking a business question, which is a whole different venture. For instance, how many TEE's would you have to do to pay for a $25,000 TEE probe and make a profit? Who would do the TEE's, and why would they not already have equipment that they can use? What do you know about what it takes to get a Provider Number and do billing to the various insurance payors? What are the current laws (at the time that you do this) enabling you to get paid in your state? Who will read the echoes? There are many issues to learn about to be dealt with before you take on such a project.

      6) It is not the technologist performing the test who gets a higher fee, but the entity responsible for all the costs of performing the echo. This includes cost of equipment, space, supplies, technical staff, report generation, record storage, insurance, etc. Consider also the time it takes to do the echo versus the interpretation time. These fees continue to undergo changes. For instance, some day they might depend on what you have spent on the machine that you use. Or maybe not.

      7) Very variable. Yes, I have taught many fellows a great deal about both performance and interpretation of Echocardiograms. Yet in some programs, you never even see a fellow in the echo lab. Or in some places, those who are interested show up, others not.

      As for your echo questions:

      1) A good CW signal of AI has a somewhat high-pitched, whistle-y sound to it. I don't compare Doppler sounds to stethoscope sounds as they have totally different origins and meanings.

      2) If this is a pre-operative assessment in a patient going for CABG with a high suspicion of significant MR, we often prefer to just do the TEE to guide the surgeon on whether the MV needs intervention. But in the more general situation, we do a TTE, especially for pre-op patients referred from other institutions, to make sure that there are no surprises.

      3) It depends on what operation you are talking about. If the purpose of the TEE is to assess LV function, the surgeon can't tell that from a closed heart. If the operation is a valve repair or replacement, we want to assess the valvular function after the heart is restarted and before the chest is closed. If there is a large leak, for instance, it is much better for the patient to have it fixed then than to have his chest re-opened later on for further repair. In our institution, LV function assessment is done by the anesthesiologists (I believe) but the valve assessment is done by the cardiologist. There is no technologist assistance in either case.

      I hope this helps. Glad to hear your excitement. Pace yourself a little bit, and you will get there eventually.

      Best wishes,
      Gershom Lichtenberg, RDCS
      Echocardiographer
      Rambam Healthcare Center
      Haifa, Israel




      On Fri, Jul 31, 2009 at 9:45 PM, douglas.pereira31 <protoman2050@...> wrote:
       

      Hi! My name is Doug, and I'm currently on a waitlist to be enrolled in the cardiovascular technology AS degree program at OCC.

      I've developed a strong inteest in echocardiography and other cardiovascular diagnostic procedures ever since I was mentored by a local invasive cardiologist; we'd go out to McDonald's and review echocardiograms, EKGs, MUGAs, and we'd discuss various topics in cardiovascular medicine. (We since had to stop doing this, b/c his employer cut his staff down to one, and made him share that one w/ his interventionalist co-worker). I hope to become either an interventional cardiologist, an electrophysiologist, or an echocardiologist some day.

      My questions are:

      1. How strong is the job market for new grads w/ RDCS
      2. What's the average salary for a newly-graduated echocardiographer, $22.50-$25/hr
      3. How often is call, every 3-4 nights?
      4. Where should I go for cross-training in vascular sonography?
      5. After I get some experience, how difficult would it be to buy my own portable machine, transducer(s) (including a TEE probe), and start my own private practice?
      6. Why does the echocardiographer performing the test collect a much higher fee than the cardiologist interpreting the test?
      7. Do echocardiographers teach cardiology fellows and echocardiology advanced fellows how to perform echocardiograms?

      And some questions about echocardiography itself:

      1. When a regurgitant aortic valve is interrogated with the CW Doppler, and it shows the spectrum w/ a really steep trapezoidal shape above the baseline, I know it's in the audible range, but what does it sound like? Like the holodiastolic decrescendo murmur heard on the stethoscope, or does it sound completely different?
      2. When someone w/ an AMI starts coughing up blood, and MR is suspected, is a TTE or TEE performed to confirm?
      3. Why is interoperative TEE performed? The surgeons have the actual heart in their hands. And does a echocardiographer assist the cardiac anesthesiologist in this?

      Thanks,
      Doug


    • katie bittner
      Hi Douglas,Are you talking about Oakland community College? I didn t know they even had a program. Good luck to you!Katie Bittner, rdcs,cct,fase IF YOU DON T
      Message 2 of 4 , Aug 1, 2009
        Hi Douglas,
        Are you talking about Oakland community College? I didn't know they even had a program. Good luck to you!
        Katie Bittner, rdcs,cct,fase

        "IF YOU DON'T KNOW WHERE YOUR GOING, ANY ROAD WILL TAKE YOU THERE."

        KATIE
         
        <a href="http://www.linkedin.com/in/katherinebittnerrdcsfase" ><img src="http://www.linkedin.com/img/webpromo/btn_liprofile_blue_80x15.gif" width="80" height="15" border="0" alt="View Katherine Bittner, RDCS,CCT,FASE's profile on LinkedIn"></a>
         


        --- On Fri, 7/31/09, douglas.pereira31 <protoman2050@...> wrote:

        From: douglas.pereira31 <protoman2050@...>
        Subject: [echocardiography] Lifestyle and career progression of an echocardiographer
        To: echocardiography@yahoogroups.com
        Date: Friday, July 31, 2009, 11:45 AM

         

        Hi! My name is Doug, and I'm currently on a waitlist to be enrolled in the cardiovascular technology AS degree program at OCC.

        I've developed a strong inteest in echocardiography and other cardiovascular diagnostic procedures ever since I was mentored by a local invasive cardiologist; we'd go out to McDonald's and review echocardiograms, EKGs, MUGAs, and we'd discuss various topics in cardiovascular medicine. (We since had to stop doing this, b/c his employer cut his staff down to one, and made him share that one w/ his interventionalist co-worker). I hope to become either an interventional cardiologist, an electrophysiologist , or an echocardiologist some day.

        My questions are:

        1. How strong is the job market for new grads w/ RDCS
        2. What's the average salary for a newly-graduated echocardiographer, $22.50-$25/hr
        3. How often is call, every 3-4 nights?
        4. Where should I go for cross-training in vascular sonography?
        5. After I get some experience, how difficult would it be to buy my own portable machine, transducer(s) (including a TEE probe), and start my own private practice?
        6. Why does the echocardiographer performing the test collect a much higher fee than the cardiologist interpreting the test?
        7. Do echocardiographers teach cardiology fellows and echocardiology advanced fellows how to perform echocardiograms?

        And some questions about echocardiography itself:

        1. When a regurgitant aortic valve is interrogated with the CW Doppler, and it shows the spectrum w/ a really steep trapezoidal shape above the baseline, I know it's in the audible range, but what does it sound like? Like the holodiastolic decrescendo murmur heard on the stethoscope, or does it sound completely different?
        2. When someone w/ an AMI starts coughing up blood, and MR is suspected, is a TTE or TEE performed to confirm?
        3. Why is interoperative TEE performed? The surgeons have the actual heart in their hands. And does a echocardiographer assist the cardiac anesthesiologist in this?

        Thanks,
        Doug


      • jlcjr5505
        Hi Doug, just answer one of your questions....Why do intra-operative TEE before valve relacement? I once saw a case where the patient was sent in for a MV
        Message 3 of 4 , Aug 1, 2009
          Hi Doug, just answer one of your questions....Why do intra-operative TEE
          before valve relacement? I once saw a case where the patient was sent in
          for a MV replacement....guess what, the mitral valve had trace MR, but
          the Aov had severe AI.
          Its tacky to replace the wrong valve!
          Jim
          --- In echocardiography@yahoogroups.com, "douglas.pereira31"
          <protoman2050@...> wrote:
          >
          > Hi! My name is Doug, and I'm currently on a waitlist to be enrolled in
          the cardiovascular technology AS degree program at OCC.
          >
          > I've developed a strong inteest in echocardiography and other
          cardiovascular diagnostic procedures ever since I was mentored by a
          local invasive cardiologist; we'd go out to McDonald's and review
          echocardiograms, EKGs, MUGAs, and we'd discuss various topics in
          cardiovascular medicine. (We since had to stop doing this, b/c his
          employer cut his staff down to one, and made him share that one w/ his
          interventionalist co-worker). I hope to become either an interventional
          cardiologist, an electrophysiologist, or an echocardiologist some day.
          >
          > My questions are:
          >
          > 1. How strong is the job market for new grads w/ RDCS
          > 2. What's the average salary for a newly-graduated echocardiographer,
          $22.50-$25/hr
          > 3. How often is call, every 3-4 nights?
          > 4. Where should I go for cross-training in vascular sonography?
          > 5. After I get some experience, how difficult would it be to buy my
          own portable machine, transducer(s) (including a TEE probe), and start
          my own private practice?
          > 6. Why does the echocardiographer performing the test collect a much
          higher fee than the cardiologist interpreting the test?
          > 7. Do echocardiographers teach cardiology fellows and echocardiology
          advanced fellows how to perform echocardiograms?
          >
          > And some questions about echocardiography itself:
          >
          > 1. When a regurgitant aortic valve is interrogated with the CW
          Doppler, and it shows the spectrum w/ a really steep trapezoidal shape
          above the baseline, I know it's in the audible range, but what does it
          sound like? Like the holodiastolic decrescendo murmur heard on the
          stethoscope, or does it sound completely different?
          > 2. When someone w/ an AMI starts coughing up blood, and MR is
          suspected, is a TTE or TEE performed to confirm?
          > 3. Why is interoperative TEE performed? The surgeons have the actual
          heart in their hands. And does a echocardiographer assist the cardiac
          anesthesiologist in this?
          >
          > Thanks,
          > Doug
          >
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