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ON THE JOB

They Put Heart Into Their Work

September 15, 1997|KATHLEEN DOHENY | SPECIAL TO THE TIMES

The Job:

Heart docs

The History:

In 1940, only 1,000 American physicians viewed themselves as heart specialists--and few of them had received any formal cardiology training. At that time, only four official residency programs were available in cardiology.

Today, 18,998 physicians claim adult cardiology as their specialty; 16,275 are board-certified--15,257 men and 1,018 women. About 1,300 are pediatric cardiologists.

The Sub-Specialists--what they do and what they earn doing it (incomes are for 1996):

* Cardiac surgeons: specialize in heart operations.

--Annual income: $545,431

* Interventional cardiologists: use balloons, stents and other techniques to reverse effects of heart disease.

--Annual income: $353,769

* Vascular-thoracic surgeons: specialize in treatment of veins and chest, excluding the heart: $308,750.

* Noninterventional cardiologists: diagnose and manage heart problems medically.

--Annual income: $247,133

* Pediatric cardiologists: diagnose and manage childhood heart problems medically.

--Annual income: $168,151

The Need:

* In the U.S., almost 17% of the adult population has some type of cardiovascular condition.

* About one-fifth of total hospital charges are related to the diagnosis and treatment of cardiovascular problems.

* In 1992, Medicare alone paid cardiologists almost $3 billion.

* Cardiovascular disease is the leading cause of death in the U.S.

Membership:

Cardiologists do not have to belong to the American College of Cardiology. However, 90% of U.S. board-certified cardiologists do. Other heart specialists join a variety of other organizations, such as the Society of Thoracic Surgeons and the American College of Surgeons.

Getting There:

Here is the path traveled by Dr. Alfredo Trento, 47, chairman of cardiothoracic surgery, Cedars-Sinai Medical Center:

After obtaining his medical degree from the University of Padua in Italy, Trento came to the United States to complete his residency in general surgery at the University of Massachusetts from 1976 to 1982.

Next, he was accepted for a residency in cardiothoracic surgery at the University of Pittsburgh, which he completed in 1985 at the age of 35. He stayed on as a faculty member at the university, focusing on transplants and pediatric cardiac surgery.

In 1988, he came to Los Angeles to start the heart transplant and pediatric cardiac surgery programs at Cedars. In July 1996, he was named to his present position.

The Milestones:

* 1902: An electrocardiograph (a machine to record the heart's electrical activity) was first used.

* 1924: The American Heart Assn. was launched.

* 1925: The American Heart Journal was launched.

* 1945: World's first diagnostic cardiac catheterization lab was organized at Johns Hopkins University.

* 1953: The first successful open-heart surgery using a heart-lung machine is performed.

* 1954: Echocardiography (use of ultrasound waves to visualize heart structures) first used to image the heart.

* 1958: Modern coronary angiography technique (use of radiopague substance to visualize blood vessels) was developed.

* 1958: First internal pacemaker placed.

* 1960: First successful long-term mitral valve replacement with a caged ball valve.

* 1960s: Coronary care units become common in hospitals.

* 1967: First human heart transplant.

* 1977: First angioplasty (inflation of a catheter to compress plaque against vessel wall) performed.

* Early 1980s: Thrombolytics ("clot-busting" agents) come into widespread use.

* Researcher Scott Wilson of The Times' library contributed to this story.

Sources: Merritt, Hawkins & Associates, Irving, Texas; Cejka & Co., St. Louis; the Wilkerson Group, New York; Medical Group Management Assn., Englewood, Colo.; American College of Cardiology; "American Cardiology: The History of a Specialty and Its College," Dr. W. Bruce Fye (The Johns Hopkins University Press, 1996).

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