AMERICAN COLLEGE OF CARDIOLOGY NEWS
President’s Page: Should We Reduce Graduate Cardiovascular Training Programs?
Borys Surawicz, MD, FACC In continuing the tradition of the “President’s Page,” I should like to preface it with a word of gratitude to the Editor of the Journal for a rare privilege afforded to the College President, to voice an opinion without being restricted by a subject matter, and without the restraining rigor of the Journal’s peer review mechanism. Most privileges can be readily abused unless guarded by the recipient’s sense of obligation. In this case, the obligation is to say something of interest to the membership and, if possible, to provide the reader with a stimulus for an exchange of views and ideas. I hope that my comments, which express my personal opinion because I have no time or opportunity to check my text in advance with the Board of Trustees or the appropriate committees of the College, will invite responses that I shall either answer personally or summarize within the text of ensuing “President’s Pages.
870
April 1979
The title of this “page” was provoked by the “Statement of Manpower” issued by the Federated Council for Internal Medicine on September 16, 1978.’ The Council represents the prestigious organizations consisting of the American Board of Internal Medicine, the American College of Physicians, the American Society of Internal Medicine and the Association of Professors of Medicine. The limitations of space will permit me to give only a cursory account of this statement, but I trust that I will be able to convey faithfully the opinions of the Council and explain the roots of my negative reaction to their document. I have no objection to the Council’s statement in the preamble that “continuing efforts should be made to ensure that an appropriate number and distribution of internists are available for the provision of optimum medical care for the people of the United States.” This is the reason why the Council has supported the National Study of Internal Medicine Manpower. Although the results of this study are not yet available, the Council is ready to identify the difficulty and make the appropriate recommendations for its solution. What is the actual problem? The National Study of Internal Medicine Manpower has shown that the number of trainees in subspecialty programs increased at a rate of about 11 percent per year during the past 6 or 7 years, and that the present overall 2:l ratio of general internists to subspecialty internists could reverse in the next 20 years if the present numerical trend continues. The Council’s statement does not make it clear how this calamity of substituting the subspecialty internist-who has acquired, in addition to the knowledge and experience common to the general internist, some special skills and interests-will detract from “the optimum medical care for the people of the United States.” On the contrary, the Federated Council for Internal Medicine
The American Journal of CARDIOLOGY
Volume 43
admits in its statement that most subspecialty internists now in practice deliver a substantial amount of primary care and that “delivery of primary care represents a significant proportion of the subspecialists’ professional activities.” Leaving this issue unresolved, the Council presents observations and conclusions concerning “the importance of an appropriate distribution of manpower within internal medicine, including a proper balance between general internists and subspecialty internists.” As an internist, I strongly believe that the profession of internal medicine is challenging, mind-expanding, humanitarian and beneficial to the welfare of the human race. I also expect that members of other medical specialties have similar beliefs about their own professions. But I am afraid that efforts to create “an appropriate distribution” or a “proper balance” between different specialists or subspecialists within a specialty must require some form of coercion or manipulation, which is difficult to achieve without abridging the freedom of personal choice. Unusual circumstances may force society to curtail or suspend privileges of certain groups or individuals, but the Council does not make a good case for such an action in this instance. It claims that “the overall rate of increase in numbers of subspecialty trainees has been excessive” and suggests that “reimbursement levels” for technical procedures “very significantly influence career choices among internal medicine trainees.” This prompts the Council to state that “an increased emphasis on training in general internal medicine would be in the public interest.” These are strange notions, indeed. I wonder who among the Council’s members will summon up the courage to approach a third year medical resident preparing to spend additional (usually at least
COLLEGE NEWS
two) years in a teaching hospital in order to acquire the knowledge and the skill required to practice the specialty of adult or pediatric cardiology, and tell him or her that such action is not in the best public interest because it amounts to seeking higher levels of reimbursement for technical procedures.’ And what might be the reply to the anticipated countering questions: Why is my increased knowledge, experience and competence not in the public interest? Why is it wrong to be motivated by the prospect of higher reimbursement levels? Why should the knowledge and the technical skills remain the undisputed domain of a group limited to few selected competitors? The last part of the Council’s statement entitled “Recommendations” is not surprising, in view of the previously expressed opinions. The Council recommends adjusting the number of clinical subspecialty training positions “to meet health care needs in the United States where appropriate,” and it instructs the chairpersons of departments of medicine and directors of internal medicine training programs to modify, limit or reduce the number of clinical subspecialty slots. At the same time, it states that “the number of general internists should be increased,” and their training “should place reduced dependence on technical procedures and a greater emphasis on bedside skills and clinical judgment.” While the nostalgia for the allegedly vanishing “bedside skills” cannot be dismissed lightly, the methodology of reducing the dependence on technical procedures may pose some interesting logistic problems. For instance, I can envision a scenario in which the resident is denied an electrocardiograph until he figures out from the intensity of the heart sounds whether tachycardia is supraventricular or ventricular, or perhaps is kept away from the echocardiograph before he masters the art of percussing a pericardial effusion. But the impact of technology on medical practice is a separate subject that is beyond the scope of this “page.” The statement of the Federated Council for Internal Medicine ends with a pronouncement that “further data are needed to develop a coherent national policy regarding appropriate numbers of medical
students, general internists and other primary care physicians and “subspecialists of various types.” This is probably the most significant part of the statement because it is an admission of a need for the appropriate data and an expression of hope that some appropriate information will be developed by the National Study of Internal Medicine Manpower. All of us will undoubtedly follow with interest the national manpower study and the results of other future manpower studies, but we must not forget the efforts of the American College of Cardiology to obtain the needed data. In 1973, the College, aided by a contract from the National Heart and Lung Institute and helped by the consultants representing the American Heart Association, American College of Chest Physicians and Subspecialty Board in Cardiovascular Disease, prepared an extensive evaluation of cardiology training and manpower requirements edited by Forest H. Adams and R. C. Mendenhall.* From this report, we learn that in 1973 we had 177 physicians per 100,000 population, while the number of cardiologists averaged 5.6 per 100,000 population. The cardiologists were physicians who estimated that they had spent 50 percent or more of their professional time providing care for patients with cardiac problems. About 50 percent of all cardiologists were certified in Internal Medicine and 10 percent certified in Cardiovascular Disease. Does this represent an adequate number of cardiologists needed in the country? The report wisely does not attempt to answer this question, but provides precise data relating to the number of new trainees needed to maintain the present ratio of about six cardiologists per 100,000 population. The report also lists some of the factors that could contribute to the increasing need for cardiologists. These include improving standard of care, development of new diagnostic and surgical techniques and the recently imposed restriction on numbers of foreign graduates entering the country. We must also consider the possible changes in the prevalence of heart disease. The present estimate is that 24.9 percent of the adult American population have definite or suspected heart disease.2
April 1979
It is obvious that we do not know how many general internists and how many cardiologists are needed for the optimal medical care in this country. My preference would be to see the issue determined by the process of self-regulation based on the laws of supply and demand. When the prospective cardiologists receive word that the previous graduates of cardiology training programs face problems in their practice that require no special skills, they may choose to terminate their own training at an earlier stage and embark on the practice of general internal medicine. It would be a gross oversimplification to assume that pure pragmatism is the sole power motivating human actions. The quest for new knowledge, the intellectual curiosity, the joy and pride in mastering new skills may represent a much stronger motivation than the prospects of marketability or even the prestige of Board certification. In the final analysis, it is as appropriate for the Federated Council for Internal Medicine to be concerned about the status of the general internist as it is appropriate for the American College of Cardiology to be concerned about the status of the cardiologist. However, as citizens and physicians, we all should take under advice the following statement from the Physician Manpower report of the American Medical Association adopted in June 1976: “The public can best be served under an educational system which maximizes the freedom of individuals to choose and develop their career interests and opportunities under normal competitive conditions. This applies to both the selection of medicine as a career and the choice of speciality.” 3 Borys Surawicz, MD, FACC President American College of Cardiology References Statement on Manpower. Federated Council for internal Medicine, Forum on Medicine, November 1978, p 20-21 Report of an Evaluation of Cardiology Training and Manpower Requirements (Adams FH, Mendenhall RC, ed). DHEW Publication no. (NIH) 74-623 Physician Manpower Medical Education, II. A report of the American Medical Association, June 1978
The American Journal of CARDIOLOGY Volume 43
871
COLLEGE NEWS
NEW MEMBERS The following individuals were elected to membership in the American College of Cardiology on November 30, 1978 in the category indicated. FELLOWSHIP AHMAD, Salahuddin, MBBS, Granite City, IL AKIYAMA, Toshio, MD. Rochester, NY ALEXANDER, Charles F., Ill, MD, St. Paul, MN ALOSILLA, Carlos E., MD. Jacksonville, FL ANGOFF, Gerald H., MD, Manchester, NH ARENSBERG, Daniel, MD, Atlanta, GA ATKINS, Floyd L., Jr., MD, Kansas City, KS BADKE, Frederick R., MD, San Antonio, TX BALU, Venkataraman, MBBS, Buffalo, NY BARNES, Robert N., MD, Temple, TX BAUERSFELD, Samuel R., MD, Pittsburgh, PA BEAUCHAMP, Gary D., MD, Kansas City, MO BENNETT, Fredrick A., Jr., MD, Fort Smith, AR BENOUALID, Henri, MD, Ville St. Laurent, Canada BERGER, Robert L., MD, Boston, MA BERNHARDT, Louis C.. MD, Madison, WI BITTAR, Neville, MD, CM, Madison, WI BLACKMAN, Marie S., MD, Syracuse, NY BONKE, Felix I. M., MD, PhD, Maastricht, Netherlands BORNSTEIN, Abraham B., MD, Darien, CT BREINIG, John B., MD, Nashville, TN BRENNAN, John P., MD, Nanticoke, PA BRIEF, George, MD, New York, NY BUCHNESS, Michael P., MD, Salisbury. MD BUDA, Andrew J., MD, Toronto, Canada BURWELL, Douglas T., MD, Santa Ana, CA BYAHATTI, Veerappa G.. MD, South Plainfield, NJ CHEN, Scott H. S., MD, Temple, TX CHHABLANI, Ramesh, MBBS. Chicago, IL CHIAVACCI, Wayne E., MD, Scranton, PA CHIN, Ching-Fong. MD, Huntington Beach, CA CHINOY, David A., MD, Jacksonville, FL COHEN, Willard, MD, Syracuse, NY COOPER, Terry B., MD, Birmingham, AL CRAWFORD, Fred A., Jr., MD, Jackson, MS DICK, Edward W., MD, Tucson, AZ DREW, Denis W., MD, Alameda, CA DREW, Thomas M., MD. Providence, RI DUGALL, John C., MD, Phoenix, AZ DUICK, Gregory F., MD, Wichita, KS ERWIN, Stanley W., MD, Memphis, TN EUBANKS, Donald R., MD, Clearwater, FL FABRE, Carlos E.. MD, Canton, OH FABREGAS, Ramon A., MD, Albany, NY FARUQUI, Azhar M.. MB. BS, Karachi, Pakistan FULEIHAN, Daniel S., MD. Syracuse, NY FURST, Alex J., MD, Miami, FL GAIHA, Vishnu D., MBBS, Evanston, IL GALICHIA, Joseph P., MD. Wichita, KS
872
April 1979
The American
GALLAGHER, John J., MD, Durham, NC GARDNER, Ian R., MB. ChB, South Bend, IN GARMAN. J. Kent, MD, Stanford, CA GENOVESE, Bruce, MD, Ann Arbor, Ml GILLUM, Richard F., MD. Minneapolis, MN GOLDBERG, Samuel D., MD, Rockville. MD GOWDAMARAJAN. R., MD, Kansas City, MO GRADMAN, Alan H., MD, West Haven, CT GRONDIN. Claude M., MD, Montreal, Canada HAFFAJEE, Charles I., MB, BCh, Worchester, MA HANOVICH, Gary D., MD, Minneapolis, MN HARLAN, Bradley J., MD. Portland, OR HAUSER, Andrew M., MD. Royal Oak, Ml HECHT, Harvey S.. MD, Los Angeles, CA HELLENBRAND, William E., MD, New Haven, CT HILL, James D.. Jr., MD, Berkeley, CA HILLIS, Leslie D., MD. Dallas, TX HOFSCHIRE, Philip J., MD, Omaha, NE HOWARD, Paul F.. MD, South Bend, IN HUBBARD, Francis E., MD, Philadelphia, PA HURVITZ. Richard J.. MD, Los Angles, CA HWANG, Ming Hsiung, MD, Hines, IL JACOBS, Benjamin F., Ill, MD, New Orleans, LA JOBIN, Gary C., MD, Artesia, CA KAIMAL. P. K., MD, Cleveland, OH KAWAI, Chuichi, MD, Kyoto, Japan KEELAN. Michael H., Jr., MD, Milwaukee, WI KHEMKA, Mahaveer P., MD, Anaheim, CA KLAUSNER, Steven C., MD, Salt Lake City, UT KORN, Chaihan U., MD, Peoria, IL LEVINER, John L., Jr., MD, Charleston, SC LOCKSPEISER, Lester, MD, Denver, CO LONG, Linda A., MD, St. Paul, MN LYONS, Chalmers J., MD, Albany, NY MADRY, Robert W., Jr., MD, Corpus Christi, TX MANITSAS, George T., MD, Hamilton, OH MARANDA, Claude R.. MD, St. Lambert, Canada MARTIN, Hugh M.. Jr., MD, Tampa, FL MATAR, Adel F., MB, BCh, Portland, OR MILLER, Donald W., Jr., MD, Seattle, WA MOYER, John P., MD, Sellersville, PA MURPHY, Edward S., MD, Portland, OR NANAVATI, Suketu H., MBBS. Dubois, PA NAVIA, Jose A., MD, Buenos Aires, Argentina NELSON, William H., MD, Laguna Hills, CA NICHOLS, Wilmer W., MD: PhD, Gainesville, FL NICHOLSON, Walter J., MD, York, PA NICOLOSI. Gian L., MD, Pordenone. Italy O’GRADY. William P., MD, Spokane, WA ORMAND, Jackson E., Jr., MD, Corpus Christi. TX ORNATO, Joseph P.. MD, Newport News, VA PAREKH. Virender D., MD, Port Huron, Ml PARENZAN, Lucia, MD, Bergamo, Italy PREMSINGH, Narlini G., MBBS, Kansas City, KS
Journal of CARDIOLOGY
Volume 43
PRITCHETT, Edward L. C., MD, Durham, NC PYHEL, H. Jack, MD, St. Petersburg, FL RAO, Aroor S., MBBS, Laurel, MD RICELY, James C., DO, Baltimore, MD RIGGINS, Robert C. K., MD, Seattle, WA RITVO, Arnold S., MD, Hartford, CT ROETH, Charles L., MD, San Antonio, TX ROMHILT, Donald W., MD, Richmond, VA RUBIN, Stanley A., MD, Los Angeles, CA RUBUSH, John L., MD, South Bend, IN SABAPATHY, Shanmugasundaram, MBBS, Joplin, MO SABOM, Michael B., MD, Decatur, GA SAHA, Sibu P.. MBBS, Lexington, KY SARNAT, William S., MD, South Bend IN SASTRY, Pillutla V. N.. MB, BS, Union City, NJ SAW, Eng Chuan, MD, Walla Walla, WA SCANLAN. Edward S., MD, Menasha, WI SCHNEIDER, Eurico, MD, Binghampton, NY SCHULZE, Robert A., Jr., MD, Columbia, SC SELBY, John H., Jr., MD, Gainesville, FL SERRANO-MUNOZ, Jose A., MD, Hato Rey, PR SHAH, Dilip, MBBS, Harvey, IL SHAPIRO, Jerrold E., MD, Chicago, IL SHERROD, Gene A., MD, San Angelo, TX SIMPSON, Paul C., Jr., MD, San Francisco, CA SINGH, Steven N., MD, Washington, DC SLATER. Eve E., MD, Boston, MA SMITH, David E., MD,. Little Rock, AR SMITH, Michael L., MD, Indianapolis, IN SMITH, Richard N., MD, Atlanta, GA SNODGRASS, Richard, MD, Moline, IL STARR, John W.. Ill, MD, Roanoke, VA SWAMY, S. M. Mallikarjuna, MBBS, Pittsburgh, PA SWEET, Stephen E., MD, Boston, MA TAYLOR, William R., MD, Modesto, CA TECKLENBERG, Paul L., MD, Baltimore, MD THOMPSON, Paul D., MD, Pawtucket, RI VARELA, Sergio V., MD, Mexico City, Mexico VASUDEVAN, Gopalan, MBBS, Greensburg, PA VEITH, Gary E., MD, Bay Shore, NY WAMPOLD, David B., MD, Roseville, CA WEISFOGEL, Gerald M., MD. Highland Park, NJ WHIPPLE, Robert L., Ill, MD, Atlanta, GA WILSON, Donald D., MD, Rockford, IL YAP, Vicente U., MD, Madison, WI YOU, Kwang-Duck. BM, Munster, IN ADVANCE
TO FELLOWSHIP
AMIRPARVIZ, Firouz, MD, Oak Brook, IL ASKENAZI, Joseph, MD, Chicago, IL ATALLAH, Pierre C., MD, Rochester, Ml BALIGADOO, Soorianarain. MB, BCh, Paris, France BARDACK, Richard A., MD. Marietta, GA BERGER, Marvin, MD. New York, NY BERKOWITZ, Cary E., MD, Glenview, IL BISHOP, Richard L., MD, Worcester, MA BLUMENTHAL, Jerome B.. MD, Marietta, GA CARALIS, Dennis G.. MD, Baltimore, MD
COLLEGE NEWS
CARLSEN, Andrew B., MD, Amarillo, TX CARVER, Joseph R., MD. Philadelphia, PA CHMIELEWSKI, Chester A., MD, Providence, RI CHRISTIAN. Fredric V., MD, Providence, RI CURRAN, Robert L., MD, Providence, RI DAMANI, Prabodhkumar M., MB, BS, Trenton, NJ DAVIS, David H., MD. Aurora, IL DORROS, Gerald, MD. Milwaukee, WI FIALLOS-MEDINA, Pedro, MD, Tegucigalpa. Honduras FUERTES, Antonio, MD, Madrid, Spain GELLER, Kenneth A., MD, Menasha, WI GLADSTONE, Julian L., MD, Broomall, PA GOLDENBERG, Edward M., MD, Wilmington, DE GOLDSTEIN, Marvin, MD. Scottsdale, AZ GORWIT, Jeffrey I., MD, Escondido, CA GOTZOYANNIS, Stavros E., MD, Athens, Greece HALLETT, Robert V., MD, New York, NY HALLORAN, Randolph M., MD, Richmond, VA HENNING, Robert J., MD, Los Angeles, CA HEWLETTE, Frederic C., MD, Denver, CO INGLESSIS, George, MD, Merida, Venezuela JAMAL, Nasiruddin M. K., MB, BS, Johnson City, NY JAUME-ANSELMI, Francisco, MD, Mayaguez, PR JENIKE, Frank T., MD, Cincinnati, OH KANSAL, Santosh Sood, MD, Birmingham, AL KANTER, Lawrence J.. MD, Jacksonville, FL KITZES, David L., MD, Providence, RI KLEIMAN, Jay H., MD, Chicago, IL LAMBERT, Mark E., MD, Houston, TX LONGO, Edward A., MD, Middletown, CT LUBOW, Lawrence A., MD, Morristown, NJ MACMILLAN, Robert M., MD, Philadelphia, PA MANCINI, James R., MD, Providence, RI MARKIEWICZ, Walter, MD, Haifa, Israel MARTIN, M. Herbert, Jr., MD, Dubuque, IA MITAL, Mohan S., MD, Johnstown, PA NYE, Glenn C., MD, Norfolk, VA OLAZABAL, Francisco, Jr., MD, Hato Rey, PR ORTH, Donald W., MD, Haddonfield. NJ PAES, Mauro M., MB, BS, Chicago, IL PATEL, Mehmood, MB, BS, Lafayette, LA RITTER, William S., MD, Kansas City, MO RODRIGUEZ, Gaston R., MD, Jackson, MS ROITMAN. David I., MD, Birmingham, AL SAPPINGTON, Joseph B., MD, Hartford, CT SEHAPAYAK, Georgina B. K., MD, Fort Worth, TX SPYROU, Panagiotis G., MD, Stratford, NJ STRUVER, Gerd P.. MD. San Francisco, CA TUCHINDA, Jalit, MD. Pittsburgh, PA VAL-MEJIAS, Jesus E., MD, St. Louis, MO VAWTER, Michael H., MD, Phoenix, AZ VETROVEC, George W., MD, Richmond, VA WHEELING, James R., MD, Fort Sam Houston, TX ZELDIS, Steven M., MD, New Hyde Park, NY
ASSOCIATE
LINDAU, Warren, MD, South Miami, FL MARDELLI, Talaat J., MB, BCh, Philadelphia,
FELLOWSHlP
ALBONI, Paolo, MD, Ferrara, Italy ANDERSON, Jeffrey L., MD, Ann Arbor, MI ANDREADI$, Nicholas A., MD, Auburn, WA ARKIN, Barry M., MD, Brockton, MA BARDSLEY, William T., MD, Rochester, MN BESCAK, Kenneth J.. MD, Omaha, NE BREEN, Dennis R., MD, Sacramento, CA BRISKIN, Jonathan G., MD, San Mateo, CA BURNETT, William C., MD, Tulsa, OK CASSEL, John J., MD, Allentown, PA CERETTO. William J., MD. San Diego, CA CHAUDHERY, Shaukat A., MBBS, Perth Amboy, NJ CHUN, Duck S., MD, St. Louis, MO CLARKE, Janice, MD, Cincinnati, OH COOK, John R., Ill, MD, New Orleans, LA COTE. Pierre, MD, Montreal, Canada CROUCH, John A., MD, Columbia, MO DANG, Surinder, MBBS, Fountain Valley, CA DE COCK, David G., MD, Long Beach, CA DERRIDA. Jean-Paul, MD, Paris, France DESSEN, Alan J., MD, Phoenix, AZ DHANANI, Shiraz P., MB, BS, Madison, WI DOSHI, Nitin C., MBBS. Bloomfield Hills, MI EBERZ, Dennis A., MD, Pittsburgh, PA FAULKNER, Dale A., MD, Houston, TX FERNANDES, Hilaire L., MBBS, Plantation, FL GARCIA-GREGORY, Jorge A., MD, Houston, TX GARD, Joseph Robert, MD, Lincoln, NE GENETOS. Basil C., MD, Fort Wayne, IN GOLDSCHER, David A., MD, Randallstown, MD GREEN, Richard M.. MD, Agoura, CA GRODAN, Paul J., MD, CM, Los Angeles, CA HABIB, Ahmad M., MD, Paterson, NJ HALLAM, Clifford C., MD, Indianapolis, IN HAMMAD, Abdul-Rahman H., MB, ChB, Pontiac, Ml HARPER, William K., MD, Columbus, GA HAYAT, Sultan A., MBBS. University City, MO HEGER, Joel W., MD, Pasadena, CA HERSH, Steven H.,’ MD, Wheeling, IL HESS, Michael L., MD, Richmond, VA HICKMAN, Horace 0.. Jr., MD, Beech Grove, IN HSUEH, John T. L.. BM, Flushing, NY ITELD, Bruce J., MD, New Orleans, LA JAIN, Dharam P., MBBS, Milwaukee, WI JAYAKRISHNAN, Chemmale. MBBS, Luling, LA JUDSON, Preston L., MD, Virginia Beach, VA KENNETT, Jerry D., MD, Baton Rouge, LA KLEIN, Richard C., MD, Sacramento, CA KO, Thomas Y., MD, Oxon Hill, MD KOCHAR. Mahendr S., MBBS, Milwaukee, WI KOROTKIN, Steven M., MD, Southfield, Ml KUNSMAN, William E., MD, Pittsburgh, PA LASLETT, Lawrence J., MD, Sacramento, CA LEDIS, Jeffrey E., DO, Flint, Ml
April 1979
PA McCLENDON, James E., MD, Temple, TX MCCLELLAN, Joseph R., MD, Pittsfield, MA McGREEVY, Martin J., MD, La Mesa, CA MISSRI, Jose C., MD, Madisonville, KY MORALES-BRICENO, Eduardo, MD, Caracas, Venezuela NAHORMEK, Patricia A., MD, Houston, TX NAINI, Mansoor G., MD, Livonia, Ml NAIR, C. K., MD, Omaha, NE OH. Keun C., MD, Batavia, NY OLIVER, David C., MD, New Bern, NC ORZAN, Fulvio, MD, Torino, Italy PASSO. Thomas C., MD, Danville, IL PATTERSON, F. M. Simmons, Jr,, MD, Durham, NC PIETRO, Daniel A., MD, West Roxbury, MA PINSKY, William W.. MD, Houston, TX POLLOCK, Michael L., PhD, Milwaukee, WI RAJFER, Sol I., MD, Washington, DC ROMANO, Antonio, MD, Parma, Italy SELVAN, Arthur, MD, Irvine, CA SCHICK, Edgar C., Jr., MD, Boston, MA SCHROEDER, David P.. MD, Anniston, AL SICHERMAN, Harlan Jay, MD, New Brunswick, NJ SILVERMAN, Ralph I., MD, Bronx, NY SIPOWICZ, Manuel E., MD, Anaheim, CA SLACK, John D., MD, Lexington, KY STERN, Mark A., MD, Highland Park, IL STUTTS, Baldwin S., Ill, MD, San Antonio, TX SUAREZ, Florentino, MD, Staten Island. NY SULBARAN, Tulio A., MD, Maracaibo, Venezuela TERRY, Richard F., MD, Wheeling, WV TOBEY, Martin A.. MD, Fort Worth, TX TRILLOS. Donaldo, MD, Houston, TX VOGELBACH, Karl-Heinrich. MD, Pasadena, CA WARDE. Donal A., MB, BCh, Pittsburgh, PA WARSHALL, Steven L., MD, Lake Park, FL WEINSAFT, Malcolm H., MD, Brooklyn, NY ZAKS, Jeffrey M.. MD, Southfield. Ml ADVANCE
TO ASSOCIATE
FELLOWSHIP
AHMED, Tajuddin, MBBS, Springfield, OH ALOAN, Leslie A., MD, Rio de Janeiro, Brazil MUNDALL. Stanley L., MD, Portland, OR AFFILIATE ALI. Muhammad, MBBS, Chicago, IL BHOOTRA, Radha K., MD, Bombay, India BONILLA, Victor O., MD, Chandler, AZ CHESTER, Howard A., MD, New York, NY CONRAD, Gary L., MD, Baltimore, MD CONTINO, John A., MD, Broomall, PA DEFILLO, Fernando E., MD, Ponce, PR DELMASTRO. Patrick R., MD, Tampa, FL DODD, Halbert B., II, MD, Union City, TN HARGUS, Edward P., MD, San Diego, CA
The American Journal of CARDIOLOGY
Volume 43
973
COLLEGE NEWS
INDRA. Djon, MD, Hilo, HI KANADE, Ashok, MBBS, New Orleans, LA KHAN, Majid K., MD, Edison, NJ MONDRAGON, Gustav0 A., MD, Winnipeg, Canada
SY. Albert0 0.. Jr., MD, Sidney, NY TEMPLE, Kimball B., MD, Keene, NH YAMAMOTO. Noriaki, MD. Hamamatsu, Japan YOUNAN, Kivarkis Y., MD, Parlin, NJ
PALETTA, Frank, MD, Creve Coeur, MO PULIDO, Jose Ignacio, MD, Caracas, Venezuela REYNS. Philippe Y., MD. Phoenix, AZ RIVERA-DIAZ, Don R., MD, Cayey, PR
LEARNING CENTER: PROGRAM CALENDAR ._
The American College of Cardiology’s newest department, the Learning. Center, located at the College’s Bethesda, Maryland headquarters, began operations last October with the offering of its first continuing medical education program for physicians with a specialty or an interest in cardiovascular medicine. The purpose of the Learning Center is to support the professional commitment to quality patient care by providing
a new standard of excellence in cardiovascular continuing education. For additional information concerning the programs listed below or for a complete schedule of programs through December 1978, contact Program Coordinator, Learning Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20014. Telephone (301) 8975400.
APRIL 1979 THROUGH JULY 1979 Course Director
Month/Dates
Title of Program
April 2-4
Samuel Kaplan, MD, FACC
Non-invasive Pediatric Cardiology
April 5-7
John A. Spittell, Jr., MD, FACC
Peripheral Vascular Disease
April 9-l 1
Keith E. Cohn, MD, FACC
Exercise Testing
April 18-20
J. O’Neal Humphries. MD, FACC
Coronary Care Units-15
April 23-25
Arthur E. Weyman, MD, FACC
Cross-sectional Echocardiography
April 26-26
Robert G. Tancredi, MD, FACC
Pulmonary, Renal and Electrolyte Considerations In Cardiovascular Disease
May 3-5
Daniel S. Berman, MD, FACC
Nuclear Cardiology
May 7-9
Leonard S. Dreifus, MD, FACC
Cardiac Rehabilitation:
May 14-16
Louis Lemberg. MD, FACC Agustin Castellanos, Jr., MD, FACC
CCU Update for Nursing Supervisors
May 21-23
James E. Doherty, Ill, MD, FACC
Clinical Cardiovascular Pharmacology: Rational Approach to Drug Therapy
May 24-25
Joseph K. Perloff, MD, FACC
The Fundamentals of Echocardiography: A Practical Course for Cliniclans
Ira H. Gessner, MD, FACC
The Principles of Pediatric Cardiology: A Fundamental Approach
June 4-6
G. Charles Oliver, MD, FACC
Ambulatory Monitoring and Sudden Death
June 11-13
Shahbudin H. Rahimtoola, MD, FACC
Valvular Heart Disease
June 20-22
Michael S. Gordon, MD, FACC
Cardiac Auscuttation
May 30-June
674
1
April 1979
The American Journal of CARDIOLOGY
Volume 43
Years Later
Principles and Techniques
COLLEGE NEWS
CALENDAR OF EXTRAMURAL
PROGRAMS
The aim of each program is to increase the theoretical and practical knowledge of the normal and abnormal function of the cardiovascular system in man. Most of the programs are pertinent to direct care of patients with heart disease. The need for such programs increases with the ever increasing amount of scientific and clinical data, the constant changes in technology and methodology, and the greater availability of therapeutic options. Today most cardiologists, internists and family practitioners feel the need of supplementing their professional reading by direct contact with the authors, research workers and leaders in the field. To solve these problems the Committee selects each year series of carefully super-
vised programs which are usually preceded by extensive consultations with the program directors recruited among the foremost specialists educators and scientists in the field of clinical cardiology and allied basic science disciplines. Although each program director is personally responsible for the choice of faculty, and the structure of the program, the National Committee of Continuing Education assumes the overall responsibility for the caliber of the postgraduate education and the relevance to the practice of cardiology. This is accomplished by the processes of meticulous scrutiny of the objectives, analysis of the educational methods, and studying the impact of each course on the knowledge and attitudes
of the participants. These progarns shoukl help each physician to keep up with the new knowledge, to put into practice the new advances and to retract gracefully from the obsolete and useless practices. An effective practitioner must learn and relearn, listen to new ideas, share past experiences and observe the work of his peers. The National Program Committee for Continuing Medical Educatii of the American College of Cardiology believes that these goals can be accomplished by all members and nonmember professionals participating in our continuing education programs. Leonard S. Dreifus, MD, FACC Chairman National Program Committee
Programs and faculty are subject to change. For further information write Registration Secretary, Extramural Programs Department, Continuing Education, American College of Cardiology, Heart House, 9111 Old Georgetown Road, Bethesda, Maryland 20014.
Division of
APRIL 1979 THROUGH AUGUST 1979 To be arranged indlvldually
Preceptorship6 In Cardiology. Arthur Seizer, FACC. director. Pacific Medical Center, San Francisco, Calif.
MAY 3-5
Crftlcal Care Cardology. Arlhur Seizer. FACC and Keith E. Cohn, FACC. directors. Golden Gateway Holiday Inn, San Francisco, CA
APR. 2-6
Consultant’s Course in Cardiology. Michael V. Herman. FACC, director and Richard Gorlin. FACC, Simon Dack, FACC and Louis E. Teichholz, FACC. co-directors. Mount Sinai Medical Center, New York, NY
MAY 3-5
lschemic Heart Disease. James E. Dalen, FACC, director and Thomas J. Ryan, FACC. Thomas W. Smith, FACC, Herbert J. Levine, FACC and Joseph S. Alpert, FACC. co-directors. Copley Plaza Hotel, Boston, MA
Cardiology for the Consultant: A Cliniclan’s Retreat. E. Grey Dimond. FACC and James E. Crockett, FACC, directors. Ran&o Santa Fe Inn, Ran&o Santa Fe, CA
MAY 9-11
APR. 3-4
Mana9emerd of the Patlent Who Has Survived Acute Myocardlai infarction. Sylvan L. Weinberg, FACC. director. Stouffer’s Dayton Plaza Hotel, Dayton OH
MAY 10-21
A Symposium on Cardiovascular Nursfng. Henry J. L. Marriott, FACC. and Leo Schamroth, FACC, directors. Sheraton Sand Key Hotel, Clearwater Beach, FL
APR. 19-21
New Diagnostic and Therapeutic Approaches In Cardfoiogy 1979. Edmund H. Sonnenblick, FACC and James Scheuer, FACC, directors. Plaza Hotel, New York, NY
MAY 21-24
Coronary Atherosclerotic Heart Dfsease-1979. J. Willis Hurst FACC, director and Robert C. Schiant, FACC, co-director. Colony Square Hotel, Atlanta, GA
APR. 24-27
Cardiac Arrhythmlas: Reccognltion, Efectmphyskkgy and Treabtwnt. John A. Kastor, FACC and Mark E. Josephson, FACC, codirectors. University City Holiday inn, Philadelphia. PA
APR. 2-11
APR. 26-28
Myocardiai infarctlon and Other Iechemit Heart Syndromes. C. Richard Cc&i, FACC, director and Carl J. Pepine, FACC and Leonard G. Christie, codirectors. InnisbrookResort and Golf Club, Tarpon Springs, FL
Ciinfaai Auscuftatlon of the Heart. W. Proctor Harvey, FACC, Antonio C. de Leon, Jr., FACC, and John F. Stapleton. codirectors. Georgetown University Medical Center, Washington, DC
JUNE 21-23
21-23
Medical and Surgical Masgement of Coronary Arley Diaeaae. M. Leo Hughes, Jr., FACC. director and Robert C. K. Riggins and Richard P. Anderson, co-directors. Virginia Mason Medical Center, Seattle, WA Echocanliogaphy: Fundamentals and New DeveloPmenls In Cardiac Uftrasound. Artf~u D. Hagan, FACC, director and Walter V. R. Viiweg, FACC and Joel S. Karliner, FACC, co-directors. Sheraton Harbor Island Hotel, San Diego,
CA AUG. 25-27
Tutorials in tba Tetona: Cardiac Erner9anclee (FIIHI Annual). Robert S. Eliot, FACC and Alan D. Forker, FACC and Gerald L. Wolf, co-directors. Jackson Lake Lodge, Moran, WY
Cardiac Auacultatlon Wakabo~a. Jules Cor&ant, FACC, director. Niagara Hilton Hotel. Niagara Falls, NY JUNE 13-16
Sixth Annual Sympoafum. Clinical Echocardiography: Fundamentals and New Developments in Cardiac Ultrasound. Arthur D. Hagan. FACC, director and William F. Friedman, FACC and Walter V. R. Vieweg. FACC. codirectors. Sheraton Harbor island Hotel, San Diego, CA
April 1979
The American
Journal
of CARDIOLOGY
Volume
43
875
President’s Page: Should We Reduce Graduate Cardiovascular Training Programs?
Borys Surawicz, MD, FACC In continuing the tradition of the “President’s Page,” I should like to preface it with a word of gratitude to the Editor of the Journal for a rare privilege afforded to the College President, to voice an opinion without being restricted by a subject matter, and without the restraining rigor of the Journal’s peer review mechanism. Most privileges can be readily abused unless guarded by the recipient’s sense of obligation. In this case, the obligation is to say something of interest to the membership and, if possible, to provide the reader with a stimulus for an exchange of views and ideas. I hope that my comments, which express my personal opinion because I have no time or opportunity to check my text in advance with the Board of Trustees or the appropriate committees of the College, will invite responses that I shall either answer personally or summarize within the text of ensuing “President’s Pages.
870
April 1979
The title of this “page” was provoked by the “Statement of Manpower” issued by the Federated Council for Internal Medicine on September 16, 1978.’ The Council represents the prestigious organizations consisting of the American Board of Internal Medicine, the American College of Physicians, the American Society of Internal Medicine and the Association of Professors of Medicine. The limitations of space will permit me to give only a cursory account of this statement, but I trust that I will be able to convey faithfully the opinions of the Council and explain the roots of my negative reaction to their document. I have no objection to the Council’s statement in the preamble that “continuing efforts should be made to ensure that an appropriate number and distribution of internists are available for the provision of optimum medical care for the people of the United States.” This is the reason why the Council has supported the National Study of Internal Medicine Manpower. Although the results of this study are not yet available, the Council is ready to identify the difficulty and make the appropriate recommendations for its solution. What is the actual problem? The National Study of Internal Medicine Manpower has shown that the number of trainees in subspecialty programs increased at a rate of about 11 percent per year during the past 6 or 7 years, and that the present overall 2:l ratio of general internists to subspecialty internists could reverse in the next 20 years if the present numerical trend continues. The Council’s statement does not make it clear how this calamity of substituting the subspecialty internist-who has acquired, in addition to the knowledge and experience common to the general internist, some special skills and interests-will detract from “the optimum medical care for the people of the United States.” On the contrary, the Federated Council for Internal Medicine
The American Journal of CARDIOLOGY
Volume 43
admits in its statement that most subspecialty internists now in practice deliver a substantial amount of primary care and that “delivery of primary care represents a significant proportion of the subspecialists’ professional activities.” Leaving this issue unresolved, the Council presents observations and conclusions concerning “the importance of an appropriate distribution of manpower within internal medicine, including a proper balance between general internists and subspecialty internists.” As an internist, I strongly believe that the profession of internal medicine is challenging, mind-expanding, humanitarian and beneficial to the welfare of the human race. I also expect that members of other medical specialties have similar beliefs about their own professions. But I am afraid that efforts to create “an appropriate distribution” or a “proper balance” between different specialists or subspecialists within a specialty must require some form of coercion or manipulation, which is difficult to achieve without abridging the freedom of personal choice. Unusual circumstances may force society to curtail or suspend privileges of certain groups or individuals, but the Council does not make a good case for such an action in this instance. It claims that “the overall rate of increase in numbers of subspecialty trainees has been excessive” and suggests that “reimbursement levels” for technical procedures “very significantly influence career choices among internal medicine trainees.” This prompts the Council to state that “an increased emphasis on training in general internal medicine would be in the public interest.” These are strange notions, indeed. I wonder who among the Council’s members will summon up the courage to approach a third year medical resident preparing to spend additional (usually at least
COLLEGE NEWS
two) years in a teaching hospital in order to acquire the knowledge and the skill required to practice the specialty of adult or pediatric cardiology, and tell him or her that such action is not in the best public interest because it amounts to seeking higher levels of reimbursement for technical procedures.’ And what might be the reply to the anticipated countering questions: Why is my increased knowledge, experience and competence not in the public interest? Why is it wrong to be motivated by the prospect of higher reimbursement levels? Why should the knowledge and the technical skills remain the undisputed domain of a group limited to few selected competitors? The last part of the Council’s statement entitled “Recommendations” is not surprising, in view of the previously expressed opinions. The Council recommends adjusting the number of clinical subspecialty training positions “to meet health care needs in the United States where appropriate,” and it instructs the chairpersons of departments of medicine and directors of internal medicine training programs to modify, limit or reduce the number of clinical subspecialty slots. At the same time, it states that “the number of general internists should be increased,” and their training “should place reduced dependence on technical procedures and a greater emphasis on bedside skills and clinical judgment.” While the nostalgia for the allegedly vanishing “bedside skills” cannot be dismissed lightly, the methodology of reducing the dependence on technical procedures may pose some interesting logistic problems. For instance, I can envision a scenario in which the resident is denied an electrocardiograph until he figures out from the intensity of the heart sounds whether tachycardia is supraventricular or ventricular, or perhaps is kept away from the echocardiograph before he masters the art of percussing a pericardial effusion. But the impact of technology on medical practice is a separate subject that is beyond the scope of this “page.” The statement of the Federated Council for Internal Medicine ends with a pronouncement that “further data are needed to develop a coherent national policy regarding appropriate numbers of medical
students, general internists and other primary care physicians and “subspecialists of various types.” This is probably the most significant part of the statement because it is an admission of a need for the appropriate data and an expression of hope that some appropriate information will be developed by the National Study of Internal Medicine Manpower. All of us will undoubtedly follow with interest the national manpower study and the results of other future manpower studies, but we must not forget the efforts of the American College of Cardiology to obtain the needed data. In 1973, the College, aided by a contract from the National Heart and Lung Institute and helped by the consultants representing the American Heart Association, American College of Chest Physicians and Subspecialty Board in Cardiovascular Disease, prepared an extensive evaluation of cardiology training and manpower requirements edited by Forest H. Adams and R. C. Mendenhall.* From this report, we learn that in 1973 we had 177 physicians per 100,000 population, while the number of cardiologists averaged 5.6 per 100,000 population. The cardiologists were physicians who estimated that they had spent 50 percent or more of their professional time providing care for patients with cardiac problems. About 50 percent of all cardiologists were certified in Internal Medicine and 10 percent certified in Cardiovascular Disease. Does this represent an adequate number of cardiologists needed in the country? The report wisely does not attempt to answer this question, but provides precise data relating to the number of new trainees needed to maintain the present ratio of about six cardiologists per 100,000 population. The report also lists some of the factors that could contribute to the increasing need for cardiologists. These include improving standard of care, development of new diagnostic and surgical techniques and the recently imposed restriction on numbers of foreign graduates entering the country. We must also consider the possible changes in the prevalence of heart disease. The present estimate is that 24.9 percent of the adult American population have definite or suspected heart disease.2
April 1979
It is obvious that we do not know how many general internists and how many cardiologists are needed for the optimal medical care in this country. My preference would be to see the issue determined by the process of self-regulation based on the laws of supply and demand. When the prospective cardiologists receive word that the previous graduates of cardiology training programs face problems in their practice that require no special skills, they may choose to terminate their own training at an earlier stage and embark on the practice of general internal medicine. It would be a gross oversimplification to assume that pure pragmatism is the sole power motivating human actions. The quest for new knowledge, the intellectual curiosity, the joy and pride in mastering new skills may represent a much stronger motivation than the prospects of marketability or even the prestige of Board certification. In the final analysis, it is as appropriate for the Federated Council for Internal Medicine to be concerned about the status of the general internist as it is appropriate for the American College of Cardiology to be concerned about the status of the cardiologist. However, as citizens and physicians, we all should take under advice the following statement from the Physician Manpower report of the American Medical Association adopted in June 1976: “The public can best be served under an educational system which maximizes the freedom of individuals to choose and develop their career interests and opportunities under normal competitive conditions. This applies to both the selection of medicine as a career and the choice of speciality.” 3 Borys Surawicz, MD, FACC President American College of Cardiology References Statement on Manpower. Federated Council for internal Medicine, Forum on Medicine, November 1978, p 20-21 Report of an Evaluation of Cardiology Training and Manpower Requirements (Adams FH, Mendenhall RC, ed). DHEW Publication no. (NIH) 74-623 Physician Manpower Medical Education, II. A report of the American Medical Association, June 1978
The American Journal of CARDIOLOGY Volume 43
871
COLLEGE NEWS
NEW MEMBERS The following individuals were elected to membership in the American College of Cardiology on November 30, 1978 in the category indicated. FELLOWSHIP AHMAD, Salahuddin, MBBS, Granite City, IL AKIYAMA, Toshio, MD. Rochester, NY ALEXANDER, Charles F., Ill, MD, St. Paul, MN ALOSILLA, Carlos E., MD. Jacksonville, FL ANGOFF, Gerald H., MD, Manchester, NH ARENSBERG, Daniel, MD, Atlanta, GA ATKINS, Floyd L., Jr., MD, Kansas City, KS BADKE, Frederick R., MD, San Antonio, TX BALU, Venkataraman, MBBS, Buffalo, NY BARNES, Robert N., MD, Temple, TX BAUERSFELD, Samuel R., MD, Pittsburgh, PA BEAUCHAMP, Gary D., MD, Kansas City, MO BENNETT, Fredrick A., Jr., MD, Fort Smith, AR BENOUALID, Henri, MD, Ville St. Laurent, Canada BERGER, Robert L., MD, Boston, MA BERNHARDT, Louis C.. MD, Madison, WI BITTAR, Neville, MD, CM, Madison, WI BLACKMAN, Marie S., MD, Syracuse, NY BONKE, Felix I. M., MD, PhD, Maastricht, Netherlands BORNSTEIN, Abraham B., MD, Darien, CT BREINIG, John B., MD, Nashville, TN BRENNAN, John P., MD, Nanticoke, PA BRIEF, George, MD, New York, NY BUCHNESS, Michael P., MD, Salisbury. MD BUDA, Andrew J., MD, Toronto, Canada BURWELL, Douglas T., MD, Santa Ana, CA BYAHATTI, Veerappa G.. MD, South Plainfield, NJ CHEN, Scott H. S., MD, Temple, TX CHHABLANI, Ramesh, MBBS. Chicago, IL CHIAVACCI, Wayne E., MD, Scranton, PA CHIN, Ching-Fong. MD, Huntington Beach, CA CHINOY, David A., MD, Jacksonville, FL COHEN, Willard, MD, Syracuse, NY COOPER, Terry B., MD, Birmingham, AL CRAWFORD, Fred A., Jr., MD, Jackson, MS DICK, Edward W., MD, Tucson, AZ DREW, Denis W., MD, Alameda, CA DREW, Thomas M., MD. Providence, RI DUGALL, John C., MD, Phoenix, AZ DUICK, Gregory F., MD, Wichita, KS ERWIN, Stanley W., MD, Memphis, TN EUBANKS, Donald R., MD, Clearwater, FL FABRE, Carlos E.. MD, Canton, OH FABREGAS, Ramon A., MD, Albany, NY FARUQUI, Azhar M.. MB. BS, Karachi, Pakistan FULEIHAN, Daniel S., MD. Syracuse, NY FURST, Alex J., MD, Miami, FL GAIHA, Vishnu D., MBBS, Evanston, IL GALICHIA, Joseph P., MD. Wichita, KS
872
April 1979
The American
GALLAGHER, John J., MD, Durham, NC GARDNER, Ian R., MB. ChB, South Bend, IN GARMAN. J. Kent, MD, Stanford, CA GENOVESE, Bruce, MD, Ann Arbor, Ml GILLUM, Richard F., MD. Minneapolis, MN GOLDBERG, Samuel D., MD, Rockville. MD GOWDAMARAJAN. R., MD, Kansas City, MO GRADMAN, Alan H., MD, West Haven, CT GRONDIN. Claude M., MD, Montreal, Canada HAFFAJEE, Charles I., MB, BCh, Worchester, MA HANOVICH, Gary D., MD, Minneapolis, MN HARLAN, Bradley J., MD. Portland, OR HAUSER, Andrew M., MD. Royal Oak, Ml HECHT, Harvey S.. MD, Los Angeles, CA HELLENBRAND, William E., MD, New Haven, CT HILL, James D.. Jr., MD, Berkeley, CA HILLIS, Leslie D., MD. Dallas, TX HOFSCHIRE, Philip J., MD, Omaha, NE HOWARD, Paul F.. MD, South Bend, IN HUBBARD, Francis E., MD, Philadelphia, PA HURVITZ. Richard J.. MD, Los Angles, CA HWANG, Ming Hsiung, MD, Hines, IL JACOBS, Benjamin F., Ill, MD, New Orleans, LA JOBIN, Gary C., MD, Artesia, CA KAIMAL. P. K., MD, Cleveland, OH KAWAI, Chuichi, MD, Kyoto, Japan KEELAN. Michael H., Jr., MD, Milwaukee, WI KHEMKA, Mahaveer P., MD, Anaheim, CA KLAUSNER, Steven C., MD, Salt Lake City, UT KORN, Chaihan U., MD, Peoria, IL LEVINER, John L., Jr., MD, Charleston, SC LOCKSPEISER, Lester, MD, Denver, CO LONG, Linda A., MD, St. Paul, MN LYONS, Chalmers J., MD, Albany, NY MADRY, Robert W., Jr., MD, Corpus Christi, TX MANITSAS, George T., MD, Hamilton, OH MARANDA, Claude R.. MD, St. Lambert, Canada MARTIN, Hugh M.. Jr., MD, Tampa, FL MATAR, Adel F., MB, BCh, Portland, OR MILLER, Donald W., Jr., MD, Seattle, WA MOYER, John P., MD, Sellersville, PA MURPHY, Edward S., MD, Portland, OR NANAVATI, Suketu H., MBBS. Dubois, PA NAVIA, Jose A., MD, Buenos Aires, Argentina NELSON, William H., MD, Laguna Hills, CA NICHOLS, Wilmer W., MD: PhD, Gainesville, FL NICHOLSON, Walter J., MD, York, PA NICOLOSI. Gian L., MD, Pordenone. Italy O’GRADY. William P., MD, Spokane, WA ORMAND, Jackson E., Jr., MD, Corpus Christi. TX ORNATO, Joseph P.. MD, Newport News, VA PAREKH. Virender D., MD, Port Huron, Ml PARENZAN, Lucia, MD, Bergamo, Italy PREMSINGH, Narlini G., MBBS, Kansas City, KS
Journal of CARDIOLOGY
Volume 43
PRITCHETT, Edward L. C., MD, Durham, NC PYHEL, H. Jack, MD, St. Petersburg, FL RAO, Aroor S., MBBS, Laurel, MD RICELY, James C., DO, Baltimore, MD RIGGINS, Robert C. K., MD, Seattle, WA RITVO, Arnold S., MD, Hartford, CT ROETH, Charles L., MD, San Antonio, TX ROMHILT, Donald W., MD, Richmond, VA RUBIN, Stanley A., MD, Los Angeles, CA RUBUSH, John L., MD, South Bend, IN SABAPATHY, Shanmugasundaram, MBBS, Joplin, MO SABOM, Michael B., MD, Decatur, GA SAHA, Sibu P.. MBBS, Lexington, KY SARNAT, William S., MD, South Bend IN SASTRY, Pillutla V. N.. MB, BS, Union City, NJ SAW, Eng Chuan, MD, Walla Walla, WA SCANLAN. Edward S., MD, Menasha, WI SCHNEIDER, Eurico, MD, Binghampton, NY SCHULZE, Robert A., Jr., MD, Columbia, SC SELBY, John H., Jr., MD, Gainesville, FL SERRANO-MUNOZ, Jose A., MD, Hato Rey, PR SHAH, Dilip, MBBS, Harvey, IL SHAPIRO, Jerrold E., MD, Chicago, IL SHERROD, Gene A., MD, San Angelo, TX SIMPSON, Paul C., Jr., MD, San Francisco, CA SINGH, Steven N., MD, Washington, DC SLATER. Eve E., MD, Boston, MA SMITH, David E., MD,. Little Rock, AR SMITH, Michael L., MD, Indianapolis, IN SMITH, Richard N., MD, Atlanta, GA SNODGRASS, Richard, MD, Moline, IL STARR, John W.. Ill, MD, Roanoke, VA SWAMY, S. M. Mallikarjuna, MBBS, Pittsburgh, PA SWEET, Stephen E., MD, Boston, MA TAYLOR, William R., MD, Modesto, CA TECKLENBERG, Paul L., MD, Baltimore, MD THOMPSON, Paul D., MD, Pawtucket, RI VARELA, Sergio V., MD, Mexico City, Mexico VASUDEVAN, Gopalan, MBBS, Greensburg, PA VEITH, Gary E., MD, Bay Shore, NY WAMPOLD, David B., MD, Roseville, CA WEISFOGEL, Gerald M., MD. Highland Park, NJ WHIPPLE, Robert L., Ill, MD, Atlanta, GA WILSON, Donald D., MD, Rockford, IL YAP, Vicente U., MD, Madison, WI YOU, Kwang-Duck. BM, Munster, IN ADVANCE
TO FELLOWSHIP
AMIRPARVIZ, Firouz, MD, Oak Brook, IL ASKENAZI, Joseph, MD, Chicago, IL ATALLAH, Pierre C., MD, Rochester, Ml BALIGADOO, Soorianarain. MB, BCh, Paris, France BARDACK, Richard A., MD. Marietta, GA BERGER, Marvin, MD. New York, NY BERKOWITZ, Cary E., MD, Glenview, IL BISHOP, Richard L., MD, Worcester, MA BLUMENTHAL, Jerome B.. MD, Marietta, GA CARALIS, Dennis G.. MD, Baltimore, MD
COLLEGE NEWS
CARLSEN, Andrew B., MD, Amarillo, TX CARVER, Joseph R., MD. Philadelphia, PA CHMIELEWSKI, Chester A., MD, Providence, RI CHRISTIAN. Fredric V., MD, Providence, RI CURRAN, Robert L., MD, Providence, RI DAMANI, Prabodhkumar M., MB, BS, Trenton, NJ DAVIS, David H., MD. Aurora, IL DORROS, Gerald, MD. Milwaukee, WI FIALLOS-MEDINA, Pedro, MD, Tegucigalpa. Honduras FUERTES, Antonio, MD, Madrid, Spain GELLER, Kenneth A., MD, Menasha, WI GLADSTONE, Julian L., MD, Broomall, PA GOLDENBERG, Edward M., MD, Wilmington, DE GOLDSTEIN, Marvin, MD. Scottsdale, AZ GORWIT, Jeffrey I., MD, Escondido, CA GOTZOYANNIS, Stavros E., MD, Athens, Greece HALLETT, Robert V., MD, New York, NY HALLORAN, Randolph M., MD, Richmond, VA HENNING, Robert J., MD, Los Angeles, CA HEWLETTE, Frederic C., MD, Denver, CO INGLESSIS, George, MD, Merida, Venezuela JAMAL, Nasiruddin M. K., MB, BS, Johnson City, NY JAUME-ANSELMI, Francisco, MD, Mayaguez, PR JENIKE, Frank T., MD, Cincinnati, OH KANSAL, Santosh Sood, MD, Birmingham, AL KANTER, Lawrence J.. MD, Jacksonville, FL KITZES, David L., MD, Providence, RI KLEIMAN, Jay H., MD, Chicago, IL LAMBERT, Mark E., MD, Houston, TX LONGO, Edward A., MD, Middletown, CT LUBOW, Lawrence A., MD, Morristown, NJ MACMILLAN, Robert M., MD, Philadelphia, PA MANCINI, James R., MD, Providence, RI MARKIEWICZ, Walter, MD, Haifa, Israel MARTIN, M. Herbert, Jr., MD, Dubuque, IA MITAL, Mohan S., MD, Johnstown, PA NYE, Glenn C., MD, Norfolk, VA OLAZABAL, Francisco, Jr., MD, Hato Rey, PR ORTH, Donald W., MD, Haddonfield. NJ PAES, Mauro M., MB, BS, Chicago, IL PATEL, Mehmood, MB, BS, Lafayette, LA RITTER, William S., MD, Kansas City, MO RODRIGUEZ, Gaston R., MD, Jackson, MS ROITMAN. David I., MD, Birmingham, AL SAPPINGTON, Joseph B., MD, Hartford, CT SEHAPAYAK, Georgina B. K., MD, Fort Worth, TX SPYROU, Panagiotis G., MD, Stratford, NJ STRUVER, Gerd P.. MD. San Francisco, CA TUCHINDA, Jalit, MD. Pittsburgh, PA VAL-MEJIAS, Jesus E., MD, St. Louis, MO VAWTER, Michael H., MD, Phoenix, AZ VETROVEC, George W., MD, Richmond, VA WHEELING, James R., MD, Fort Sam Houston, TX ZELDIS, Steven M., MD, New Hyde Park, NY
ASSOCIATE
LINDAU, Warren, MD, South Miami, FL MARDELLI, Talaat J., MB, BCh, Philadelphia,
FELLOWSHlP
ALBONI, Paolo, MD, Ferrara, Italy ANDERSON, Jeffrey L., MD, Ann Arbor, MI ANDREADI$, Nicholas A., MD, Auburn, WA ARKIN, Barry M., MD, Brockton, MA BARDSLEY, William T., MD, Rochester, MN BESCAK, Kenneth J.. MD, Omaha, NE BREEN, Dennis R., MD, Sacramento, CA BRISKIN, Jonathan G., MD, San Mateo, CA BURNETT, William C., MD, Tulsa, OK CASSEL, John J., MD, Allentown, PA CERETTO. William J., MD. San Diego, CA CHAUDHERY, Shaukat A., MBBS, Perth Amboy, NJ CHUN, Duck S., MD, St. Louis, MO CLARKE, Janice, MD, Cincinnati, OH COOK, John R., Ill, MD, New Orleans, LA COTE. Pierre, MD, Montreal, Canada CROUCH, John A., MD, Columbia, MO DANG, Surinder, MBBS, Fountain Valley, CA DE COCK, David G., MD, Long Beach, CA DERRIDA. Jean-Paul, MD, Paris, France DESSEN, Alan J., MD, Phoenix, AZ DHANANI, Shiraz P., MB, BS, Madison, WI DOSHI, Nitin C., MBBS. Bloomfield Hills, MI EBERZ, Dennis A., MD, Pittsburgh, PA FAULKNER, Dale A., MD, Houston, TX FERNANDES, Hilaire L., MBBS, Plantation, FL GARCIA-GREGORY, Jorge A., MD, Houston, TX GARD, Joseph Robert, MD, Lincoln, NE GENETOS. Basil C., MD, Fort Wayne, IN GOLDSCHER, David A., MD, Randallstown, MD GREEN, Richard M.. MD, Agoura, CA GRODAN, Paul J., MD, CM, Los Angeles, CA HABIB, Ahmad M., MD, Paterson, NJ HALLAM, Clifford C., MD, Indianapolis, IN HAMMAD, Abdul-Rahman H., MB, ChB, Pontiac, Ml HARPER, William K., MD, Columbus, GA HAYAT, Sultan A., MBBS. University City, MO HEGER, Joel W., MD, Pasadena, CA HERSH, Steven H.,’ MD, Wheeling, IL HESS, Michael L., MD, Richmond, VA HICKMAN, Horace 0.. Jr., MD, Beech Grove, IN HSUEH, John T. L.. BM, Flushing, NY ITELD, Bruce J., MD, New Orleans, LA JAIN, Dharam P., MBBS, Milwaukee, WI JAYAKRISHNAN, Chemmale. MBBS, Luling, LA JUDSON, Preston L., MD, Virginia Beach, VA KENNETT, Jerry D., MD, Baton Rouge, LA KLEIN, Richard C., MD, Sacramento, CA KO, Thomas Y., MD, Oxon Hill, MD KOCHAR. Mahendr S., MBBS, Milwaukee, WI KOROTKIN, Steven M., MD, Southfield, Ml KUNSMAN, William E., MD, Pittsburgh, PA LASLETT, Lawrence J., MD, Sacramento, CA LEDIS, Jeffrey E., DO, Flint, Ml
April 1979
PA McCLENDON, James E., MD, Temple, TX MCCLELLAN, Joseph R., MD, Pittsfield, MA McGREEVY, Martin J., MD, La Mesa, CA MISSRI, Jose C., MD, Madisonville, KY MORALES-BRICENO, Eduardo, MD, Caracas, Venezuela NAHORMEK, Patricia A., MD, Houston, TX NAINI, Mansoor G., MD, Livonia, Ml NAIR, C. K., MD, Omaha, NE OH. Keun C., MD, Batavia, NY OLIVER, David C., MD, New Bern, NC ORZAN, Fulvio, MD, Torino, Italy PASSO. Thomas C., MD, Danville, IL PATTERSON, F. M. Simmons, Jr,, MD, Durham, NC PIETRO, Daniel A., MD, West Roxbury, MA PINSKY, William W.. MD, Houston, TX POLLOCK, Michael L., PhD, Milwaukee, WI RAJFER, Sol I., MD, Washington, DC ROMANO, Antonio, MD, Parma, Italy SELVAN, Arthur, MD, Irvine, CA SCHICK, Edgar C., Jr., MD, Boston, MA SCHROEDER, David P.. MD, Anniston, AL SICHERMAN, Harlan Jay, MD, New Brunswick, NJ SILVERMAN, Ralph I., MD, Bronx, NY SIPOWICZ, Manuel E., MD, Anaheim, CA SLACK, John D., MD, Lexington, KY STERN, Mark A., MD, Highland Park, IL STUTTS, Baldwin S., Ill, MD, San Antonio, TX SUAREZ, Florentino, MD, Staten Island. NY SULBARAN, Tulio A., MD, Maracaibo, Venezuela TERRY, Richard F., MD, Wheeling, WV TOBEY, Martin A.. MD, Fort Worth, TX TRILLOS. Donaldo, MD, Houston, TX VOGELBACH, Karl-Heinrich. MD, Pasadena, CA WARDE. Donal A., MB, BCh, Pittsburgh, PA WARSHALL, Steven L., MD, Lake Park, FL WEINSAFT, Malcolm H., MD, Brooklyn, NY ZAKS, Jeffrey M.. MD, Southfield. Ml ADVANCE
TO ASSOCIATE
FELLOWSHIP
AHMED, Tajuddin, MBBS, Springfield, OH ALOAN, Leslie A., MD, Rio de Janeiro, Brazil MUNDALL. Stanley L., MD, Portland, OR AFFILIATE ALI. Muhammad, MBBS, Chicago, IL BHOOTRA, Radha K., MD, Bombay, India BONILLA, Victor O., MD, Chandler, AZ CHESTER, Howard A., MD, New York, NY CONRAD, Gary L., MD, Baltimore, MD CONTINO, John A., MD, Broomall, PA DEFILLO, Fernando E., MD, Ponce, PR DELMASTRO. Patrick R., MD, Tampa, FL DODD, Halbert B., II, MD, Union City, TN HARGUS, Edward P., MD, San Diego, CA
The American Journal of CARDIOLOGY
Volume 43
973
COLLEGE NEWS
INDRA. Djon, MD, Hilo, HI KANADE, Ashok, MBBS, New Orleans, LA KHAN, Majid K., MD, Edison, NJ MONDRAGON, Gustav0 A., MD, Winnipeg, Canada
SY. Albert0 0.. Jr., MD, Sidney, NY TEMPLE, Kimball B., MD, Keene, NH YAMAMOTO. Noriaki, MD. Hamamatsu, Japan YOUNAN, Kivarkis Y., MD, Parlin, NJ
PALETTA, Frank, MD, Creve Coeur, MO PULIDO, Jose Ignacio, MD, Caracas, Venezuela REYNS. Philippe Y., MD. Phoenix, AZ RIVERA-DIAZ, Don R., MD, Cayey, PR
LEARNING CENTER: PROGRAM CALENDAR ._
The American College of Cardiology’s newest department, the Learning. Center, located at the College’s Bethesda, Maryland headquarters, began operations last October with the offering of its first continuing medical education program for physicians with a specialty or an interest in cardiovascular medicine. The purpose of the Learning Center is to support the professional commitment to quality patient care by providing
a new standard of excellence in cardiovascular continuing education. For additional information concerning the programs listed below or for a complete schedule of programs through December 1978, contact Program Coordinator, Learning Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20014. Telephone (301) 8975400.
APRIL 1979 THROUGH JULY 1979 Course Director
Month/Dates
Title of Program
April 2-4
Samuel Kaplan, MD, FACC
Non-invasive Pediatric Cardiology
April 5-7
John A. Spittell, Jr., MD, FACC
Peripheral Vascular Disease
April 9-l 1
Keith E. Cohn, MD, FACC
Exercise Testing
April 18-20
J. O’Neal Humphries. MD, FACC
Coronary Care Units-15
April 23-25
Arthur E. Weyman, MD, FACC
Cross-sectional Echocardiography
April 26-26
Robert G. Tancredi, MD, FACC
Pulmonary, Renal and Electrolyte Considerations In Cardiovascular Disease
May 3-5
Daniel S. Berman, MD, FACC
Nuclear Cardiology
May 7-9
Leonard S. Dreifus, MD, FACC
Cardiac Rehabilitation:
May 14-16
Louis Lemberg. MD, FACC Agustin Castellanos, Jr., MD, FACC
CCU Update for Nursing Supervisors
May 21-23
James E. Doherty, Ill, MD, FACC
Clinical Cardiovascular Pharmacology: Rational Approach to Drug Therapy
May 24-25
Joseph K. Perloff, MD, FACC
The Fundamentals of Echocardiography: A Practical Course for Cliniclans
Ira H. Gessner, MD, FACC
The Principles of Pediatric Cardiology: A Fundamental Approach
June 4-6
G. Charles Oliver, MD, FACC
Ambulatory Monitoring and Sudden Death
June 11-13
Shahbudin H. Rahimtoola, MD, FACC
Valvular Heart Disease
June 20-22
Michael S. Gordon, MD, FACC
Cardiac Auscuttation
May 30-June
674
1
April 1979
The American Journal of CARDIOLOGY
Volume 43
Years Later
Principles and Techniques
COLLEGE NEWS
CALENDAR OF EXTRAMURAL
PROGRAMS
The aim of each program is to increase the theoretical and practical knowledge of the normal and abnormal function of the cardiovascular system in man. Most of the programs are pertinent to direct care of patients with heart disease. The need for such programs increases with the ever increasing amount of scientific and clinical data, the constant changes in technology and methodology, and the greater availability of therapeutic options. Today most cardiologists, internists and family practitioners feel the need of supplementing their professional reading by direct contact with the authors, research workers and leaders in the field. To solve these problems the Committee selects each year series of carefully super-
vised programs which are usually preceded by extensive consultations with the program directors recruited among the foremost specialists educators and scientists in the field of clinical cardiology and allied basic science disciplines. Although each program director is personally responsible for the choice of faculty, and the structure of the program, the National Committee of Continuing Education assumes the overall responsibility for the caliber of the postgraduate education and the relevance to the practice of cardiology. This is accomplished by the processes of meticulous scrutiny of the objectives, analysis of the educational methods, and studying the impact of each course on the knowledge and attitudes
of the participants. These progarns shoukl help each physician to keep up with the new knowledge, to put into practice the new advances and to retract gracefully from the obsolete and useless practices. An effective practitioner must learn and relearn, listen to new ideas, share past experiences and observe the work of his peers. The National Program Committee for Continuing Medical Educatii of the American College of Cardiology believes that these goals can be accomplished by all members and nonmember professionals participating in our continuing education programs. Leonard S. Dreifus, MD, FACC Chairman National Program Committee
Programs and faculty are subject to change. For further information write Registration Secretary, Extramural Programs Department, Continuing Education, American College of Cardiology, Heart House, 9111 Old Georgetown Road, Bethesda, Maryland 20014.
Division of
APRIL 1979 THROUGH AUGUST 1979 To be arranged indlvldually
Preceptorship6 In Cardiology. Arthur Seizer, FACC. director. Pacific Medical Center, San Francisco, Calif.
MAY 3-5
Crftlcal Care Cardology. Arlhur Seizer. FACC and Keith E. Cohn, FACC. directors. Golden Gateway Holiday Inn, San Francisco, CA
APR. 2-6
Consultant’s Course in Cardiology. Michael V. Herman. FACC, director and Richard Gorlin. FACC, Simon Dack, FACC and Louis E. Teichholz, FACC. co-directors. Mount Sinai Medical Center, New York, NY
MAY 3-5
lschemic Heart Disease. James E. Dalen, FACC, director and Thomas J. Ryan, FACC. Thomas W. Smith, FACC, Herbert J. Levine, FACC and Joseph S. Alpert, FACC. co-directors. Copley Plaza Hotel, Boston, MA
Cardiology for the Consultant: A Cliniclan’s Retreat. E. Grey Dimond. FACC and James E. Crockett, FACC, directors. Ran&o Santa Fe Inn, Ran&o Santa Fe, CA
MAY 9-11
APR. 3-4
Mana9emerd of the Patlent Who Has Survived Acute Myocardlai infarction. Sylvan L. Weinberg, FACC. director. Stouffer’s Dayton Plaza Hotel, Dayton OH
MAY 10-21
A Symposium on Cardiovascular Nursfng. Henry J. L. Marriott, FACC. and Leo Schamroth, FACC, directors. Sheraton Sand Key Hotel, Clearwater Beach, FL
APR. 19-21
New Diagnostic and Therapeutic Approaches In Cardfoiogy 1979. Edmund H. Sonnenblick, FACC and James Scheuer, FACC, directors. Plaza Hotel, New York, NY
MAY 21-24
Coronary Atherosclerotic Heart Dfsease-1979. J. Willis Hurst FACC, director and Robert C. Schiant, FACC, co-director. Colony Square Hotel, Atlanta, GA
APR. 24-27
Cardiac Arrhythmlas: Reccognltion, Efectmphyskkgy and Treabtwnt. John A. Kastor, FACC and Mark E. Josephson, FACC, codirectors. University City Holiday inn, Philadelphia. PA
APR. 2-11
APR. 26-28
Myocardiai infarctlon and Other Iechemit Heart Syndromes. C. Richard Cc&i, FACC, director and Carl J. Pepine, FACC and Leonard G. Christie, codirectors. InnisbrookResort and Golf Club, Tarpon Springs, FL
Ciinfaai Auscuftatlon of the Heart. W. Proctor Harvey, FACC, Antonio C. de Leon, Jr., FACC, and John F. Stapleton. codirectors. Georgetown University Medical Center, Washington, DC
JUNE 21-23
21-23
Medical and Surgical Masgement of Coronary Arley Diaeaae. M. Leo Hughes, Jr., FACC. director and Robert C. K. Riggins and Richard P. Anderson, co-directors. Virginia Mason Medical Center, Seattle, WA Echocanliogaphy: Fundamentals and New DeveloPmenls In Cardiac Uftrasound. Artf~u D. Hagan, FACC, director and Walter V. R. Viiweg, FACC and Joel S. Karliner, FACC, co-directors. Sheraton Harbor Island Hotel, San Diego,
CA AUG. 25-27
Tutorials in tba Tetona: Cardiac Erner9anclee (FIIHI Annual). Robert S. Eliot, FACC and Alan D. Forker, FACC and Gerald L. Wolf, co-directors. Jackson Lake Lodge, Moran, WY
Cardiac Auacultatlon Wakabo~a. Jules Cor&ant, FACC, director. Niagara Hilton Hotel. Niagara Falls, NY JUNE 13-16
Sixth Annual Sympoafum. Clinical Echocardiography: Fundamentals and New Developments in Cardiac Ultrasound. Arthur D. Hagan. FACC, director and William F. Friedman, FACC and Walter V. R. Vieweg. FACC. codirectors. Sheraton Harbor island Hotel, San Diego, CA
April 1979
The American
Journal
of CARDIOLOGY
Volume
43
875
