We arrive at a time where a diminishing number of us are prepared to describe ourselves as a ‘general’ cardiologist. Indeed there is probably no such recognised entity as a general cardiologist. The reasons for this, we may discuss, are many.
Our training and career structures now suggest that we must have subspecialty training in the field – we must be an EP, an imaging or an interventional guy or girl – in order to find a successful path. Perhaps more importantly, the medico-politico-industrial complex has swung firmly away from drugs (that might have been prescribed by anyone) and firmly in the direction of device therapies and high tech imaging infrastructure (which may only sensibly be utilised by those with appropriate sub specialist training in their use).
Some of this, of course, makes a lot of sense but it also ignores a lot of truths.
Several facets of the specialty are all but ignored by the current direction – where is the place for cardiac genetics, grown-up congenital heart disease, screening for heart disease, primary prevention, acute rheumatic heart disease, heart disease in pregnancy in the prevailing structure – it’s hard to see. All of these are real, day-to-day issues in my part of the world and indeed in my hospital with many of them increasing in importance.
Finally, the current structure also ignores some fundamental political, geographic and demographic problems. Namely, that our populations are ageing and that a large proportion of us, probably the majority, live isolated, either by distance or politics, from the provision of the advanced cardiovascular medicine and interventions that we are striving for.
I think that you can see where I am heading with all of this…