Author + information
- Timothy F. Christian, MD⁎ ()
- ↵⁎Co-Director, Cardiovascular Magnetic Resonance Imaging, Division of Cardiovascular Diseases, University of Wisconsin, CSC H6/372, 600 Highland Avenue, Madison, WI 53792
The recommendations set forth by the Cardiovascular Imaging Committee and the Training Committees of the American College of Cardiology (ACC) (1) for level-1 training in cardiac magnetic resonance imaging (CMRI) are a welcome start to the issues facing cardiology fellowship programs. However, the problems confronting individuals seeking more in-depth applied training (levels 2 and 3) cannot be solved by didactic material and Web-based education. The hurdles mentioned by Reichek in the Journal(2) are true enough, but at the core of the matter is funding. No support sources are available for advanced training short of T-32 National Institutes of Health (NIH) training grants, which require trainers to have prior NIH funding and restrict trainees to those committed to an academic career. The pressure for the few slots available nationally is intense, and we experience that almost daily with unsolicited applications to our program—both within and outside academia. Advanced training means hands-on scanning. Consequently, sharing resources with other institutions is unlikely—particularly if both radiology and cardiology are funneling trainees through the program internally. There are simply too many pairs of hands within an institution that wish to be trained to accommodate a constant flow from an external source. Expanding the number of training centers is part of the solution, but who is to pay? Programs requiring clinical service from trainees to foot the bill are suboptimal, as the commitment to CMRI training requires time and focus, and the amount of clinical productivity to generate a post-graduate year 7 salary is formidable.
What is required are initiatives for training grants for advanced cardiac imaging that are separate from the NIH T-32 mechanism and that can accommodate those who wish to practice clinically. Part of this must be to support trainers, as CMRI mentoring is time-intensive. Moreover, CMRI has yet to be reimbursed at a rate that can support dedicated faculty who do not have significant external funds, nor can it generate the revenue to fund a fellowship. Thus, the U.S. lacks qualified trainers and it lacks funding for trainees. The ACC should consider taking the point in this battle. The NIH would be a good place to start. It will take well-trained clinicians to bring these remarkable advances in imaging to the mainstream, where patients can benefit. But as to where the funding will come from, I do not know.
- American College of Cardiology Foundation
- Taylor A.J.,
- Udelson J.E.,
- Fuster V.,
- American College of Cardiology Foundation’s Cardiovascular Imaging Committee and the Cardiovascular Training Directors Committee
- Reichek N.