We read with great interest the comments by Dr Agarwala. The authors agree that there should be a mechanism in place to allow physicians to re-enter training programs during their careers. These individuals have the capacity to be excellent cardiologists and should receive credit for training already completed. However, as mentioned by Dr Agarwala, this option is not widely available, and where it is available, it is often based on a specific candidate. Why? Many factors may influence cardiology training programs’ acceptance of such individuals, including funding issues (Departments of Health), sheer numbers, large competition for the few spots available, ‘match rules’ and, in a few cases, obstacles in recognizing previous training from the Royal College of Physicians and Surgeons of Canada.
As mentioned in our article, we support the two-track approach supporting internal medicine (three years) and cardiology (two years) for those wishing to practice in the community and a two-year plus three-year internal medicine and cardiology program for those interested in academic cardiology. In addition, designing a four-year general internal medicine (GIM) residency with a final year that focuses on cardiology, designed jointly by GIM and cardiology to ensure that training meets the Canadian Cardiovascular Society standards (eg, nuclear cardiology, echocardiography), could be developed for individuals intending to practice in a community centre. This does not exist at present, in part due to the lack of funds for extra training and perhaps due to the reluctance of some GIM programs to allow residents to extend their time in one area, especially if they are lost to the GIM call schedule within the core GIM four-year program. In addition, in certain areas, cardiologists may wish to protect billings and work sources.
Because of the epidemic of cardiovascular disease in Canada, it is imperative that the status quo is revisited and that innovative ideas are developed to try to achieve an appropriately trained cardiovascular community that can meet the increasing patient demand.