Your assertion provides no evidence. I have been involved with doctors and cardiology for at least 25 or 30 years. My father had coronary artery disease. My cousins had heart attacks and strokes in their 50s and 60s. Not one single one of them stayed under the care of a primary care physician they all had cardiologists assigned to them. The doctors no longer can spend the necessary time ordering the intensive lab tests that do a deep dive in to the types of lipid panels that make up today’s understanding of coronary artery disease, plaque, and lipids. They no longer can order all the specific tests needed to assay your heart and its arteries. They no longer can take all of the numbers and integrate them so they can predict, track, and care for artery and heart problems at a sufficient level to protect their patients. They can’t keep up with the new medications and the medication cocktails that may be needed. All they can do is a cursory top level essay on what show up in common labs. Tell me, are you a heart patient? If so, have you had ALL of your lipid panels tested? There’s probably six I can think of offhand: HDL, LDL, LPa, APOEA, APOB, And triglycerides? Then would your primary care doctor know how to relate all of those lipid panels or do they just know the top three cholesterol LDL and HDL? Then do they order all of the tests that are required to understand the lipids that may be deposited in your arteries and around your heart? Referring you out to other scans and test and heart monitoring? Can they interpret divergent test results do they track you from year to year for the progress of your heart disease to tell you if you’re getting close to having a stroke or a heart attack and monitor the deterioration of your heart and arteries? I am at one of the world’s best teaching and research hospitals UCSD. And I can tell you that my primary care doctor is only an umbrella and looks at the top level results. last year when I - I found out there was a simple lab for familial vascular disease. I had to ask for it. indeed I inherited it. It is an in the weeds test that my doctor would never have suspected because my cholesterol and physique are slim. But I inherited the familial mutation for heart disease. my doctor is smart, and she sends me out to a cardiologist who is a specialist on ordering all the up-to moment, tests offered to picture my heart and arteries and crunch the numbers. Because I have always paid attention to my health. I was blessed with only one artery being partially blocked--and that was only because I’ve been fastidious about my health all these years and took bio nutrition chemistry in college. However- this means nothing at 68. My father had awesome cholesterol in his 60s 70s and 80s between 169 and 200, he was on statins, yet he had three heart bypass surgeries, and I’ve lost count of the angioplasties. That was all while he was at the heart center of Los Angeles at the time, Los Angeles Kaiser Sunset with an awesome cardiologist. What that meant was the nature of plaque deposit was not controlled even though he religiously took his statin exercised and ate right in his later years. What I know now is there wasn’t enough medical information available to instruct individuals how to not have plaque lay down in their arteries, using statins and nutrition and exercise at the time.
Today, in today’s world if your doctor gives you superficial tests as Medicare allows for and you score well it does not give you the information you need to understand your body sufficiently especially if those in your family are having strokes and heart attacks. You need extra tests even if you score well. The end of my story is that the UCSD cardio consultant assigned me a number of being in the 66 percentile at 68 and took pictures of my heart gave me all the second tier level looks C and interpreted all the second tier level tests and decided I was in good shape. Certainly not the shape at 140 pounds that his 360 pound people are at with worse numbers. However, what he did not do is put me on LEVQIO which I had to ask for (because I can’t take statins) as a protective measure going forward to keep the plaque (hopefully from depositing as I age) with two months lack of cardio, walking my LP a went in the wrong direction! That means I have more plaque in my arteries. My primary care doctor isn’t trained to know what else to do about that and so only now am I getting the regular cardiologist specialist. It’s not up to the doctors anymore. It’s up to us to advocate for what we think we need. They do not deny me at Ucsd because my research is sound. The point is they would’ve dismissed me because I’m a good looking package. But there’s information that’s on the horizon that there’s a lot of other indicators that have to be assessed. In addition to the LPa going in the wrong direction my triglycerides went in the wrong direction while my other cholesterol were amazing. It is incumbent upon me to keep getting tested every three months and get EVERYTHING going in the right direction so hidden plaque isn’t depositing on my arteries and entering my heart area without anyone . My primary care doctor is overcast with workload. She can’t stop for one patient to order all the necessary test. Organize all the information and stay up all night trying to figure out the research. Neither can I. Neither can the cardiologist consultant specialist so now I will go to a cardiologist once a year for all the test That are going to be a progressive look at my heart and arteries aging and to a specialist who is tasked to maintain the latest information on facts and lipids, and how to prolong my lifespan in good quality.
On the other hand, you may be absolutely right! If you are a fit person, young, no family, history of strokes or heart attacks, and all of your lipids have been tested, and your heart and arteries have been looked at in imagery then there’s no reason to worry your PCM doctor is sufficient for your needs.

@mayoclinicuser1 Please accept my apologies for my arrogant and self-righteous response. I was under enormous pressure to get out of town for a baby shower. I always try select my words carefully however I did not adequately make my points. The illustrations I provided were meant as evidence to demonstrate the inadequacy a primary care doctors to discuss comprehensively coronary artery disease with a coronary artery disease patient. So let me try this again: a primary care doctor is equipped to discuss aspects of heart and artery disease. PCM‘s understand anatomy. PCM‘s understand general contemporary theory and medicine PCM‘s are not specialists. what they are equipped to do is discuss labs in a general sense. They can order blood tests and they can tell you what’s in range and what’s out of range. But they don’t understand in depth, the newer, lipid panels, and how the results of these newer, lipid panels impact coronary vascular heart disease; they don’t know how to read the interpretations of the calcium artery tests. They don’t know how to compare the data for familial, inherited heart and artery disease. (which also may include vascular brain issues as well and the potential for strokes.) it doesn’t matter how competent the doctor is. A general practitioner is not educated at the level that a cardiologist or a cardio specialist is. That’s impossible. It’s a dedicated field and a primary care doctor cannot be expected to stay on top of that information. I have a very competent PCM. She would agree with me. I pose questions to her which she can’t answer and I understand why what a general practitioner CAN do is adequately discuss coronary artery disease in patients who present with a profile which is clear and obvious: i.e., patient has high blood pressure, has high LDL low HDL, high triglyceride, and high cholesterol numbers. That is all that a PCM test for if you are a certain age. they will discuss it with you and ask you to bring the numbers in line. They don’t just go and send you to a cardiologist. it’s not necessary when you’re age 40. They can’t send everybody to a cardiologist. We just don’t have enough cardiologists and there’s no reason to if the person can bring their numbers down and they’re not huffing and puffing. only if they find out that you have family members who have died early from heart disease do they take this more seriously and maybe investigate if you have a genetic mutation that predisposes you to plaque buildup on your in your arteries. Then they still don’t send you to a cardiologist they send you to a cardiologist consult, which means that the the cardiologist specialist does a complete work up on you. If they determine at that juncture that you are in a pretty good percentile, and you don’t have much blockage they still don’t send you to a cardiologist. a person like me has to point out that I want to have regular testing and go to a regular cardiologist doctor on an annual basis to have them monitor the progression of my heart disease.
I’m not sure I’m getting the concept across —My dad had really good care. I mean amazing care. With the triple heart bypass and heart attack at 58 he went to a heart valve specialist, AND he went to a cardiologist. Same cardiologist for 20 years. He was on statins. He lowered his cholesterol. He ate well and he exercised. But his body STILL was laying down plaque in his arteries. he had a quadruple heart bypass at 72 and then another triple heart bypass at 80 years of age! (And numerous angioplasties in between) all these doctor visits required many different types of physical, visual and blood tests a person with heart disease gets. This is seriously beyond the scope of what a general practitioner can be responsible for; and there’s no reason they should because that’s what the specialist are there for.
What I’m trying to convey is that there are two different situations: in one situation a person just has bad habits they’re sedentary, overweight, they don’t eat well and then they will acquire heart disease, and so the PCM is sufficient. But for others with coronary artery disease they can’t just get better by fixing their bad habits, they have to go to the cardiologist for individual assessment for which the PCM isn’t equipped. the PCM doesn’t know the types of medications, the types of testing, the types of x-rays, calcium scores, and comparative of analysis that the patient needs. And this cardio field is constantly changing. a primary care doctor can’t keep up with it. I just asked my doctor to ask the specialist why my LPa test went in a bad direction while the APOB went in a great direction, but the cardio consult specialist didn’t have an answer so now I go to a cardiologist. Yes I am frustrated, I am angry (but not at anyone) it’s just upsetting that there is all this new testing available but the doctors don’t know necessarily how to interpret test results with divergent results. It’s all really new medicine and it’s impossible for a primary care doctor to understand what the cardiologists may not quite have a handle on. If you read the research, a lot of it is conflicting. It takes a lot of time for a doctor to figure out what is useful, what has been sufficiently tested and will be useful in treatment. You may be looking at this at a very superficial level, but I am looking at it over many years on behalf of my father and now with me, I stand by my original point that a primary care doctor doesn’t have the capacity nor the time to deal with heart disease in an in-depth way and that it’s better dealt with by the cardiology department.