Cardiology fellowship training programs.

SPECIAL REPORTS 139 Pre-existing policy and opinion have suggested that the maldistribution of specialists should be addressed by greatly increasing the number of trainees. Current projections suggest that a substantial excess of cardiologists will develop over the next few decades. Presently, in several sectors of the U.S., a surplus of cardiologists exists. It is our consensus that the training of practitioners will become excessive, and yet, maldistribution will not be eliminated. Thus, the overall training of future cardiologists should be reduced. A second challenge to manpower needs relates to the significant fall in the number of cardiologists involved in research. Concomitanfly, a dramatic rise in the relative number of Ph.D.s in cardiovascular research is evident. Thus, despite decreasing projected manpower needs in the private sector, a continued need in the academic sector will persist. The impact of failing to recognize changing manpower needs will prove a burden on society in several ways. Increased health care costs to government will result. Similarly, health care costs to patients and third party carriers will increase, perhaps dramatically. Increased competition within and between specialties will result, affecting real earnings, as well as potentially depriving academic centers of patients needed for physician training and research. Ethical considerations may become problematic regarding the application of technology. Lastly, basic and clinical research is likely to decline as the involvement of the M.D. wanes. A direct result may be fewer medical advances in future decades. In responding to changing manpower needs, the following recommendations are presented: 1 ) A decrease in the relative number of cardiologists will be needed. This decrease should be primarily in the private sector, among practitioners. The point of easiest regulation is at the Fellowship level. Thus, a decrease in the actual number of Fellowship trainees appears to be appropriate. Institution of three-year training programs with increased emphasis on academic training ( including a significant emphasis on research beginning in the first year ) should encourage an academic orientalion. Training programs without academic potential should be eliminated and new programs prevented. 2 ) To provide necessary clinical and teaching resources in academic centers, increased involvement of the private sector is encouraged. Such arrangements should be mutually beneficial. Increased flexibility within the universities and active courting of appropriate individuals in the private sector will be necessary. 3) Increased inducements must be provided to obtain and retain young academic faculty. Financial return for young academic faculty members must be improved and more professional business management practices instituted. Increased institutional support must be provided for the young academician, so that secretarial, technical, space, equipment and time needs are met. Improved career planning and guidance by senior faculty are a must. A concentrated effort must be made to provide ready access to and support by the various funding agencies. Craig January, M.D., Ph.D.