Prevention Cardiology Training

To Dr Myerson: I read with interest your article "Preventive Care: Why Isn't the Horse Before the Cart?" (August 2007). Could you comment on any training available today for starting physicians in the area of preventive cardiology? Are there any specific courses for fellowships in preventive cardiology? What route would you recommend for a career in preventive cardiology? Would it be better to do a clinical cardiology fellowship first and then branch out, or are there special fellowships one can pursue immediately after residency?

—Rajat Bhatt, MD
Lubbock, Tex

Dr Myerson Replies: The field of prevention in general, and cardiovascular prevention in particular, is rapidly growing. At present there are no residency or certification programs offered in cardiovascular prevention. The only prevention medicine residency program that is available is geared toward public health, as opposed to actual clinical medicine. ?

There are many routes to becoming a cardiovascular prevention specialist. In my training as a cardiologist, I did a postdoctorate program in preventive cardiology/cardiovascular epidemiology, as well as a postdoctorate in basic lipid research. I also have a doctorate in applied and exercise physiology. Many physicians who run preventive clinics today come from internal medicine, endocrinology, or cardiology. Several medical centers and schools of public health offer preventive cardiology fellowships, some with funding from the National Institutes of Health (NIH). The NIH website can be a starting point for finding preventive cardiology programs around the country, which may have fellowships or positions for junior faculty. The National Lipid Association also offers very good training programs and certification. ?

Many cardiovascular prevention specialists combine research with clinical work. As I said in my commentary, preventive services are not well reimbursed, and research can provide additional income. Research funding can come from the NIH, industry, foundations, and/or organizations such as the American Heart Association.

Ed's Note: The results of a new study that focuses on long-term cardiovascular prevention, called the West of Scotland Coronary Prevention Study, have just been published (N Engl J Med. 2007;357:1477-1486), adding to the well-established evidence that the prevention of coronary heart disease and subsequent death or myocardial infarction can be achieved by actively pursuing prevention strategies (pages 1543-1545).

Future of Internal Medicine

To the Editor: Following the discussion of the fate of internal medicine in this journal, we need to understand that true "free enterprise" is the only real solution to our problem. As an internist practicing for 20 years, I know enough about so many clinical subjects that I could replace a whole host of specialists. If people had to pay out of their own pockets for their medical care, they would choose us (internists). However, we know that this is not going to happen. Therefore, let our congressional friends offer every doctor who has more than 50% billings to Medicare labeled as "primary care" be sent a check from Medicare, tax free. This would give us a 30% raise overnight. Congress gives tax breaks to "Big Oil." Why not give tax breaks to us?

—Bob Richey, MD
Florence, SC

UnitedHealthcare's Lab Restrictions

To the Editor: My response to Dr Lovinger's article "UnitedHealthcare to Fine 'Noncompliant' Physicians: Out-of-Network Lab Work Restricted" (August 2007) is—Sure, and in 6 months or 1 year they will switch again to someone who has lower prices.

—Gary Levin, MD
Riverside, Calif