Cardiology training in the USA

AAMC, Association of American Medical Colleges; ABIM, American Board of Internal Medicine; ACT, American College Testing; ASE, American Society of Echocardiography; ASNC, American Society of Nuclear Cardiology; SAT, Scholastic Assessment Test; SCCT, Society of Cardiovascular CT. In addition to core competencies in patient care, medical knowledge, interpersonal and communication skills, professionalism, and practice-based learning and improvement, the ACGME requires trainees to complete a minimum number of procedures including 10 cardioversions, 75 echocardiograms scanned, 150 interpreted echocardiograms, 50 ECG stress tests, 100 heart catheterisations, 3500 ECG interpretations and 100 nuclear perfusion studies. Having completed general cardiology fellowship, trainees may choose to enter independent practice as attending cardiologists, participate in The Match again to obtain a subspecialty training position (eg, electrophysiology or adult congenital heart disease) lasting 1–2 years, or complete postdoctoral research training. Clinical work hours in residency and fellowship are limited to 80 per week by the ACGME, averaged over a 1-month period, and trainees are limited to 30 consecutive hours of duty.8 After completing training, attending cardiologists can earn significantly more, approaching $500 000 per year.9 Shortcomings and future directions Long hours, relatively low pay and growing burden of non-clinical responsibilities have contributed to an increasing prevalence of burnout among trainees.10 The average medical student accrues more than $250 000 in debt and must begin making payments during postmedical school training or incur interest accrual.