Why the Primary Certificate in Vascular Surgery Will Fail
Why the Primary Certificate in Vascular Surgery Will Fail
Primary certification in vascular surgery (VS) was established last year by the American Board of Surgery (ABS) to address the concerns of vascular surgeons who, having evolved into mature specialists, were being treated as general surgeons merely skilled in one of the many components of general surgery (GS). Over the last decade, the American Board of Vascular Surgery (ABVS), supported by a solid majority of the vascular community, pressured the ABS to recognize our need to assume the education of our residents and the certification of our graduates through an independent board. A few limited compromises were gained: the Sub-Board of Vascular Surgery, later renamed the Vascular Board of the ABS, the extension of the vascular training programs to 2 years, and reductions in vascular case allocations to GS residents.
These measures were inadequate to address the root concerns of the vascular surgeons; thus, the ABVS, with the strong support of the vascular surgery community, filed an application for an independent board. This was fiercely opposed by the ABS and, as expected, rejected by the American Board of Medical Specialties. The ABS simultaneously submitted an application for a primary certificate that acknowledged that some surgeons would not require full training and certification in GS to be certified in VS. When this primary certification was approved, four training schemata were made available to us:
Programs 1 and 2 are practically the same status quo we have had for decades and are designed to achieve dual certification in GS and VS-an anachronism in today's practice patterns with insufficient exposure to VS and a heavy burden of training years. The plummeting statistics of recruitment of VS fellows in the last 5 years under these schemata reflect their shortcomings.
The 3 (GS) + 3 (VS) program is the one most talked about. Its graduates will be certified only in VS, and the training period has been shortened by 1 year. In this program, the program director in GS has responsibility for the recruitment and GS training of the future vascular surgeon. How is the program director in GS to know the pool of applicants who will decide to pursue VS? How will we, vascular surgeons, be able to interest medical students in applying to these special GS training programs? Are the GS program directors going to reconfigure their training or education schedules to accommodate the one or two candidates who want to pursue a career in VS?
The only alternative that addresses most of our concerns regarding education and certification of future vascular surgeons is the 0 (GS) + 5 (VS) program. Within this program, we would have the ability to recruit medical students directly into VS training. We would establish the optimum curriculum of training for our residents and could accomplish their education within a reasonable period of 5 years.
But the 0 (GS) + 5 (VS) program will meet most of our needs only if it were to be implemented widely. The GS program directors or chairs are likely to view it unsympathetically because it represents a loss of workforce and GME compensation. Certainly, it will require significant increases in general medical education/full-time equivalent (GME/FTE) positions and will minimize the control that GS program directors have on the vascular experience of their GS graduates.
An additional shortcoming of the 0 (GS) + 5 (VS) program is that it does not carry a parallel vascular Residency Review Committee (RRC). This independent vascular training program will continue to be vetted by a GS RRC representing the often-opposing interests of GS.
The ABS and the Vascular Board of the ABS announced these alternative programs with much fanfare in the spring of 2006. Applications were accepted by July 2006. We do not know how many program directors proposed this paradigm to their departmental chairs, but to this day, only three programs have been approved. This minuscule participation will not improve our manpower needs or strengthen our status as a mature, established specialty. It may be that we have been offered a pacifier in the form of a virtual remedy that will not be realizable to a majority of vascular educators.
*Presented at the VEITH symposium, November 2006 (reprinted with permission from Vascular 2006;14 Suppl 1:S131).
Primary certification in vascular surgery (VS) was established last year by the American Board of Surgery (ABS) to address the concerns of vascular surgeons who, having evolved into mature specialists, were being treated as general surgeons merely skilled in one of the many components of general surgery (GS). Over the last decade, the American Board of Vascular Surgery (ABVS), supported by a solid majority of the vascular community, pressured the ABS to recognize our need to assume the education of our residents and the certification of our graduates through an independent board. A few limited compromises were gained: the Sub-Board of Vascular Surgery, later renamed the Vascular Board of the ABS, the extension of the vascular training programs to 2 years, and reductions in vascular case allocations to GS residents.
These measures were inadequate to address the root concerns of the vascular surgeons; thus, the ABVS, with the strong support of the vascular surgery community, filed an application for an independent board. This was fiercely opposed by the ABS and, as expected, rejected by the American Board of Medical Specialties. The ABS simultaneously submitted an application for a primary certificate that acknowledged that some surgeons would not require full training and certification in GS to be certified in VS. When this primary certification was approved, four training schemata were made available to us:
Independent 5 (1) (GS) + 2 (VS)
Independent 4 (1) (GS) + 2 (VS)
Independent 3 (GS) + 3 (VS)
Integrated 0 (GS) + 5 (VS)
Programs 1 and 2 are practically the same status quo we have had for decades and are designed to achieve dual certification in GS and VS-an anachronism in today's practice patterns with insufficient exposure to VS and a heavy burden of training years. The plummeting statistics of recruitment of VS fellows in the last 5 years under these schemata reflect their shortcomings.
The 3 (GS) + 3 (VS) program is the one most talked about. Its graduates will be certified only in VS, and the training period has been shortened by 1 year. In this program, the program director in GS has responsibility for the recruitment and GS training of the future vascular surgeon. How is the program director in GS to know the pool of applicants who will decide to pursue VS? How will we, vascular surgeons, be able to interest medical students in applying to these special GS training programs? Are the GS program directors going to reconfigure their training or education schedules to accommodate the one or two candidates who want to pursue a career in VS?
The only alternative that addresses most of our concerns regarding education and certification of future vascular surgeons is the 0 (GS) + 5 (VS) program. Within this program, we would have the ability to recruit medical students directly into VS training. We would establish the optimum curriculum of training for our residents and could accomplish their education within a reasonable period of 5 years.
But the 0 (GS) + 5 (VS) program will meet most of our needs only if it were to be implemented widely. The GS program directors or chairs are likely to view it unsympathetically because it represents a loss of workforce and GME compensation. Certainly, it will require significant increases in general medical education/full-time equivalent (GME/FTE) positions and will minimize the control that GS program directors have on the vascular experience of their GS graduates.
An additional shortcoming of the 0 (GS) + 5 (VS) program is that it does not carry a parallel vascular Residency Review Committee (RRC). This independent vascular training program will continue to be vetted by a GS RRC representing the often-opposing interests of GS.
The ABS and the Vascular Board of the ABS announced these alternative programs with much fanfare in the spring of 2006. Applications were accepted by July 2006. We do not know how many program directors proposed this paradigm to their departmental chairs, but to this day, only three programs have been approved. This minuscule participation will not improve our manpower needs or strengthen our status as a mature, established specialty. It may be that we have been offered a pacifier in the form of a virtual remedy that will not be realizable to a majority of vascular educators.
*Presented at the VEITH symposium, November 2006 (reprinted with permission from Vascular 2006;14 Suppl 1:S131).
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