While I concur with Ross and colleagues that the increasing burden of cardiovascular disease poses a significant human resource challenge that must be addressed, I’m dismayed that the solutions continue to focus exclusively on modifying formal, entry-level cardiology training programs. Making more spots available may not help, particularly if one assumes that there may be only a fixed proportion of residents interested in cardiology at any given time, given the workload issues mentioned in the article. Many other physicians are interested in cardiovascular disease, and they constitute a under-used pool of cardiovascular medical practitioners. As a general internist with an interest in cardiology, I believe that there is no means for official recognition of this skill, so the expertise gained working alongside cardiologists is often not portable from institution to institution.
There is limited opportunity for additional skill development, and in Canada, re-entry for formal training is essentially impossible.
Once again, while much ado is made on paper, there seems to be little movement in implementing practical solutions in the ‘real world’. Indeed, changes in training programs move at a glacial pace, essentially maintaining the status quo. In my experience, some are, in fact, reluctant to embrace help when it is offered, causing skills to wane. I suppose we should ask whether we need to train more cardiologists for the sake of training them or try to help improve the skill set of those with an interest in cardiology, chiefly internists but also potentially cardiac surgeons, to care for cardiac patients, and thus also provide opportunity for meaningful career development. Such initiative would also potentially be more flexible because skills could be acquired faster than waiting for someone to complete the formal training process. I agree with Dr Eldon Smith that novel solutions are required. I would further submit that the solution may already be available, but that opportunities are being wasted.