Acknowledging the decrease in coronary bypass surgery, opinions expressed in a recent CMAJ news article included the possibility of broadening the clinical focus of cardiac surgeons into critical care as well as changing resident training programs to facilitate the practice of both cardiac and vascular surgery.1
Darly Kucey and colleagues make the valid point that a standard level of competency must be ensured during training for any specialty. Examination and certification is the domain of the RCPSC. Although the need for quality assurance is incontrovertible, the current eligibility requirements for certification are redundant and needlessly prolong training.2
The RCPSC established a direct-entry cardiovascular and thoracic specialty in 1964.3 As volumes and complexity grew, the RCPSC separated thoracic and vascular surgeries into independent subspecialties in 1976 and 1980 respectively, with General Surgery residency completion being a pre-requisite. Nonetheless, cardiac residents were eligible to sit either exam, given the significant overlap in training. The direct-entry cardiac program was re-established in 1995.
Currently, vascular or thoracic surgery certification requires 2 years in addition to certification in cardiac care. Cardiac certification encompasses research, thoracic, vascular and cardiac rotations. Credit for completion of these rotations can eliminate 15 of the 24 months required for examination and certification eligibility. Unfortunately, the RCPSC exempts cardiac residents from up to 6 months if they pursue thoracic certification, but zero months toward vascular training. Conversely, recently revised critical care requirements acknowledge the integration of related specialty rotations; cardiac residents receive credit for up to 1 year of the 2-year critical care program.
Many aspects of the practice of interventional cardiology, cardiac surgery, interventional radiology and vascular surgery are converging. Integration is not only sensible from a training perspective,4 but mirrors how cardiovascular health care is evolving and may facilitate more efficient and enhanced management of cardiovascular disease for Canadians.