One comes across so many types of doctors, at times with similar sounding credentials. It's not difficult to confuse one with another, and at times assume a famous doctor to be good at everything. This article aims to breakdown various sub-specialties that deal with heart diseases. This should help you identify which doctor is best suited for the care you need.
After MBBS, future heart doctors chose one of the two paths which essentially define what they will be doing for rest of their careers. Few chose 'Medicine' (or 'Internal Medicine') and specialize in 'Cardiology'. They are the typical cardiologist in the community. They should be the first line doctors to patients who are suffering from heart disease. Many patients suspected of having heart disease are first seen by 'General Physician' (MBBS >> MD Medicine) and then referred to 'Cardiologists' for further evaluation and treatment.
Certain cardiologists specialize further to define their area of expertise further. Cardiologists who focus mainly on invasive interventions like Coronary Angioplasty, Valvuloplasty etc. are labelled as 'Interventional Cardiologists'. They are MBBS >> Medicine >> Cardiology >> Interventional Cardiology. Few cardiologists expertise in electrophysiological aspect of the heart (dealing with electrical system of the heart). They deal with arrhythmias (abnormal heart rhythm) and are experts in pacemakers or defibrillators. They are labelled as 'Electrophysiologists, or EP'. They are MBBS >> Medicine >> Cardiology >> Electrophysiology.
Similarly cardiologists who specialize in heart issues of children are called 'Pediatric Cardiologists'. At times, cardiologists focus their work in imaging (CT, MRI, Echo), or in advanced heart failure.
Specialized section of cardiology has emerged lately whose expertise is in a particular technique like structural interventions. They are Interventional Cardiologists who have additional expertise in very specific interventions like TAVR (Transcatheter Aortic Valve Replacement), TMVR (Transcatheter Mitral Valve Replacement), Balloon Aortic Valvuloplasty or Mitral Valvuloplasty. These terms will be discussed in different article of this blog. These cardiologists are MBBS (5.5 years) >> Medicine (3 years) >> Cardiology (3 years) >> Interventional Cardiology (1 year) >> Structural Interventionists (6 months to 1 year). As you can see, many of these experts spend more than 12 uninterrupted years of training to reach beginning of their careers.
After MBBS, few doctors chose to become surgeons. They take up General Surgery after which specialize in Cardiothoracic and Vascular Surgery (CTVS). They are the doctors ('surgeons' to be more accurate) who specialize in heart surgeries. They are typically called in by cardiologists (or cardiology sub-specialties as described above) to perform heart surgeries of a particular nature. These surgeons are MBBS (3 years) >> General Surgery (3 years) >> CTVS (3-5 years). Surgeons are typically brought in only when heart surgery is being considered or requested. Surgeons manage the patients around the surgery period following which patients revert back to their cardiologists for long term care. CTVS surgeons further focus their area of expertise in the field of 'Coronary Artery bypass surgery', 'valve repair and replacement', 'heart transplant', or 'novel procedures like TAVR'.
As you can see, doctor diverge as physicians or surgeons immediately after MBBS. Expertise of physicians can't be replaced by surgeons and vice versa. Choosing the right kind of doctor is more important than choosing a famous or best local doctor since the imparted expertise is not inter-changeable. Also, among physicians, focused sub-specialty expertise leads to better outcomes. So, heart disease of a child is best taken care of by a Pediatric Cardiologist rather than an Adult Cardiologist. Rhythm disorders are best taken of by EP cardiologists, and heart interventions like stents or TAVR are best done by Interventional Cardiologists. Certainly an Adult Cardiologist can reasonably manage most of cardiology needs if sub-specialists are not available.
In India, majority of doctors attach degree abbreviations to their names. A basic understanding of those letters will also help identify who is who. Here is a common list:
MBBS: Medical graduate, entry level community doctor.
MD or DNB: Post-graduate after MBBS in medicine field. Most commonly identified as 'General Physican', MD is also awarded to other physicians like Dermatologist (skin doctor), Psychiatrists, Neurologists, Pathologists, Microbiologists etc.
DM or DNB: These doctors have done additional specialization after MD. They can be Cardiologists, Nephrologists, Endocrinologists, Rheumatologists, Pulmonologists etc.
MS or DNB : Post-graduate after MBBS in surgery field. Most commonly identified as 'General Surgeon', MS can have their focused area of work. MS is also awarded to other surgeons like Ophthalmologists, Gynecologists, Orthopedics, ENT etc.
MCh or DNB: They are surgeons who have done additional training post MS in specific sub-specialty. They can be CTVS, Urologists, Neurosurgeon etc.
So, you see, identifying specific kind of doctors help you chose who will be best suited for the care you need. While it is best to first consult to a General Physician who can guide you to appropriate 'type' of doctor, now you can also do some homework to be better prepared and ask correct questions. Also, as a patient/caregiver, you can tailor your questions as per a doctor's expertise. For example, an Adult Cardiologist may not be able to answer specific questions regarding open heart surgery. Similarly, a CTVS surgeon may not be able to provide specific information on types of coronary stents.
I am sure I didn't address all questions that one may have related to this topic. Feel free to contact me for any related question and I will be happy to help.
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