Most people with heart failure are treated by either an internist or a cardiologist. Who you choose to be your treating physician depends on many factors. These factors might include:
- The doctor’s training, board certification, and experience
- The proximity of the medical office to your home
- The doctor’s participation in your insurance plan
- The doctor’s reputation in the community
- Your ability to build a trusting relationship with the doctor
- The doctor’s ability to speak your native language or understand your culture and customs
Although many of these issues do not necessarily bear on a doctor’s clinical abilities, patients will often choose a doctor by what is most important to them. It may be helpful to understand the difference between an internist and a cardiologist before you choose your physician. An internist is a man or woman who has at-tended 4 years of college, 4 years of medical school, and at least 3 years of a medical residency.
During that residency, the internist studies the diagnosis and medical treatment of a wide variety of diseases of the human body, with emphasis on the heart, lungs, digestive tract, and the neurological (brain and nerves) and endocrine (e.g., thyroid, pancreas, and pituitary glands) systems. After completing the residency, the physician is invited by the American Board of Internal Medicine to take an examination to demonstrate his or her understanding of internal medicine.
This is a grueling 2-day examination, the successful completion of which entitles the physician to be called board certified or a diplo-mate of the American Board of Internal Medicine. The American Board of Internal Medicine created the certification process to assure the public that a medical specialist has successfully completed an approved educational program and an evaluation, including a secure examination designed to assess the knowledge, experience, and skills requisite to the provision of high-quality patient care.
Certification requirements include:
- Completion of a course of study leading to an M.D. or D.O. (doctor of osteopathy) degree from a recognized school of medicine or school of osteopathy
- Completion of required training in an accredited residency program
- Assessment and documentation of individual performance from the residency training director or from the chief of service in the hospital where the specialist practices
- An unrestricted license to practice medicine
- Passing a certification examination
A board-certified internist is capable of rendering excellent care to patients with congestive heart failure. A cardiologist is a physician who has all the training of an internist, including the 3-year residency, but then undergoes an extra 3 to 4 years of training that focuses on the heart. This training period is called a cardiology fellowship. The cardiologist spends years of in-depth study learning about the diseases that affect the heart. After successfully completing this fellowship, the cardiologist is invited to sit for an examination by the American Board of Internal Medicine in cardiologic diseases.
If he or she passes the test, the cardiologist is referred to as being a board-certified cardiologist or a diplomate of the American Board of Internal Medicine, Cardiology. As a general rule, the cardiologist will have more training and experience in the area of heart failure.
There have been many studies comparing the care rendered to CHF patients by internists and cardiologists. In these studies, patients treated by cardiologists were significantly more likely to be admitted to an intensive care unit; receive chest X-rays, electrocardiograms (EKGs or ECGs), nuclear medicine tests, cardiac catheterizations, and stress tests; and have their weight monitored daily than were patients treated by noncardiologists.
This more intensive level of care rendered by cardiologists may result in improved symptoms and fewer visits to the hospital by the CHF patient. However, this more intensive management resulted in significantly greater costs than those of patients of generalists. Interestingly, both cardiologists and internists did poorly when adhering to medication guidelines. The majority of patients with CHF who were eligible for an ACE inhibitor,a beta blocker, or an aldosterone antagonist did not receive these medications, regardless of the treating physician.
Victoria’s comment: When I was first diagnosed with CHF, I was being treated by an internist. He was a good doctor, but told me that my condition was getting more serious and more complicated. My internist referred me to a cardiologist. I’ve been seeing my cardiologist for 8 years. I still see my internist for colds and my arthritis, but I see my cardiologist for my heart problems.