Cardiologists Ask for a Board of Their Own

Update: This article was corrected to include the AHA in the board proposal coalition.

A coalition of cardiovascular organizations, including the American College of Cardiology (ACC), American Heart Association (AHA), Heart Failure Society of America (HFSA), Heart Rhythm Society (HRS), and Society for Cardiovascular Angiography & Interventions (SCAI), has joined in a call to establish a new board for cardiovascular medicine under the American Board of Medical Specialties (ABMS).

If approved by ABMS, the new board would be called the American Board of Cardiovascular Medicine.

MedCentral spoke about the proposed board with Jeffrey Kuvin, MD, chair of the department of cardiology at Northwell Health in Manhasset, NY, and president of the board of directors of the proposed board, and with Omar Baqal, MD, who in July will begin a cardiology fellowship at Mayo Clinic in Scottsdale, AZ.

Why do cardiologists need their own board?

Dr. Kuvin: As a profession, cardiology has clearly distinguished itself as a separate specialty from internal medicine. We have evolved tremendously over the last few decades, to the highest levels of technology, taking care of a huge array of patients with a variety of diseases. As a result, we now have clear-cut, evidence-based guidelines.

Further, we've developed sub-specialties and sub-sub-specialties within cardiology. We have training programs in each and every area, along with a huge repository of data, clinical trials, competency statements, training statements, and more. We really have carved out a separate specialty.

Dr. Baqal: Cardiology is potentially the largest specialty in terms of representation across professional organizations. We need a board that understands what we need as cardiologists.

In the past, some cardiologists, particularly members of SCAI, have registered complaints about certain policies of the ABIM. Was this a factor in the call for a new board?

Dr. Kuvin: This is not a response to the way cardiologists – and by the way, any people within ABIM – have been treated, or about maintenance of certification. It really isn't. It is because cardiology has evolved into its own specialty, and it needs to be governed by its own specialty.

So this board will be by and for cardiologists alone?

Dr. Kuvin: Correct. It’s going to allow cardiologists to govern cardiologists. We believe very strongly that cardiologists have to maintain a certain level of competency. It’s important for our profession – and it’s really important for our patients – that we have proven we are competent to take care of them. But what that level of competency is, how that bar is set, how one is evaluated for their level of competency, and in which areas of practice it pertains to are really important. I think that should be determined and governed by those who know this best: cardiologists.

Other than being managed by and for cardiologists, how will this board be different?

Dr. Kuvin: We believe in the American Board of Medical Specialties, and they have specific guidelines for how they determine whether someone is sufficient or competent in any of a variety of areas. Some of this, especially at the end of training, is likely going to continue with high-stakes examination.

But the ABMS continues to evolve, and cardiology has evolved with them. One area is the concept that, as a lifelong learner, it’s more than just taking a test. Rather, it’s understanding what you need to know in your specific practice. And also understanding what you don’t know and how to fill in your knowledge gaps. You don’t have to do that through high-stakes testing. You can do that through a variety of mechanisms that acknowledge that you might have a knowledge gap, show you how to fill that knowledge gap, and document that you’ve filled that knowledge gap.

Dr. Baqal: The hope is that we as cardiologists find a more efficient way, a more transparent way, of maintaining certification without it adding any undue stress or strain on the already difficult schedule and commitments that physicians have to balance.

Cardiovascular medicine has evolved in recent decades, where do you see it headed in the coming years?

Dr. Kuvin: The world [of cardiovascular medicine] has been absolutely revolutionized in terms of how we take care of patients. If you had a heart attack 30 years ago, the treatment was bed rest for a week in the hospital with really nothing else to offer. And unfortunately, about a third of patients died from their initial heart attack.

Now we take care of patients with heart attack very quickly. We put stents in their arteries, we open up blockages as quickly as possible, and patients leave the hospital within 2 days. Mortality has been cut by an incredible amount. So that’s one example, but an important example, of how technology, medical therapies, devices, and evidence-based guidelines and medicine have really evolved in cardiology. I would say it has outpaced any other area.

The future of cardiovascular medicine is incredibly bright. We have come a long way and exciting new therapies and technologies will continue to evolve aimed at decreasing the risk and burden of cardiovascular diseases. However, we need to continue to reinforce the basics, including healthy lifestyle, risk factor reduction, medication compliance, “knowing your numbers”, and staying connected to health care providers. A new Cardiovascular Medicine Board will help ensure that our patients are followed by competent cardiologists and the field of cardiovascular medicine is governed by cardiologists.

Dr. Baqal, what would this new board mean for you as an early career physician headed into cardiology?

Dr. Baqal: I’ll be starting my fellowship in a few months, and then I want to do electrophysiology after that. So to me, it’s going to be quite interesting to see how all this evolves. There are a lot of promises being made right now. They promise to be big advocates for cardiovascular professionals. So my hope would be that they truly stand up for our rights and meet that promise to advocate for us. And the fact that there’s no one entity that’s overpowering or dominating the discussion really speaks volumes in terms of the hope that cardiologists have for a unified front where we all advocate for our rights and for safeguarding this specialty as it continues to evolve.

The application for the new board has been submitted and is under review. An open comment period began on April 24 and will last until July 24, 2024. If you’d like to submit a comment to the ABMS, click here. You don’t have to be a cardiologist to comment.