The morphing of cardiovascular specialists.

e read with interest the insightful and balanced perspective put orth by Dr. DeMaria concerning the collective futures of specialsts involved in the care of patients with cardiovascular disease (1). lthough we agree that as new technologies are introduced and ecome incorporated into the care of patients there will be a ontinued blurring of traditional boundaries between specialists, e also believe that the root problem stems from the limitation of raditional training paradigms to adapt to a rapidly evolving pecialty and that the ultimate solution to limiting “turf battles” ill be to devise new cross-specialty training pathways. Much attention is being focused on how practicing specialists an “retrain” and obtain procedural and cognitive skills outside heir traditional scope of practice (i.e., vascular surgeons learning atheterization techniques and cardiologists becoming more inolved in the treatment of peripheral vascular disease). Traditional ractice patterns are rapidly becoming nontraditional. However, ittle is being done to address how we train and produce the ardiovascular specialist of the future. Existing organ-based trainng paradigms most likely will not be able to accommodate the urrent and future needs of cardiovascular physicians. The next ave of disruptive innovations in cardiovascular medicine, beyond ndovascular procedures and advanced imaging, will likely involve olecular therapeutics such as tissue engineering, nanotechnology, iogenomics, and pharmacogenetics. Therefore, we believe that he cardiovascular specialist of the future will 1) possess intensive urgical training in cardiovascular disease, 2) be interventionally rained in catheter-based skills, 3) have expertise in advanced adiology imaging, and also 4) be a tissue engineer. It is unrealistic to expect even the most motivated specialist hysician to spend 6 to 10 years training in a traditional residency athway and then, upon graduation, immediately spend another ear (at a minimum) “retraining” to acquire another set of ross-specialty skills necessary to become a comprehensive cardioascular specialist. No specialty can single-handedly “morph” its xisting training curriculum to encompass the diverse requirements f a multifunctional cardiovascular specialist. The American Board f Internal Medicine, American Board of Surgery, American oard of Radiology, and American Board of Thoracic Surgery hould cooperatively create a joint task force empowered with the esponsibility to develop an innovative hybrid training pathway hat would potentially involve a six-year training program after edical school, with rotations in internal medicine, cardiology, adiology, general surgery, vascular surgery, and cardiothoracic urgery. After completing this newly proposed Cardiovascular esidency, residents would then be able to obtain joint certificaion, which would be recognized by each of the individual specialty oards. It is important that training issues relating to new technologies nd procedural interventions in cardiovascular surgery and mediine are addressed sooner rather than later in order to train the next eneration of physician leaders adequately. The model of the uture with regards to achieving success in medicine is cooperation nd collaboration, not isolation and confrontation. Just as our atients deserve the best and most innovative technologies for the 1 reatment of their cardiovascular medical problems, our medical tudents and residents should have access to new and innovative raining pathways—the future of our “specialty” depends on it.