Considering a Cardiometabolic Subspecialty

Robert H. Eckel, MD; Ryan Syrek, MA

Disclosures

July 31, 2018

Medscape: What would you say to a critic who might dispute the need for another specialty?

Eckel: That's a good question. Most people who go into cardiology want to be more invasive in terms of skill set. One of the skepticisms could be that [potential cardiometabolic subspecialists] could just do clinical cardiology instead and be a preventive cardiologist. That would be one area of skepticism.

The argument on the other side is why a sophisticated diabetologist or an obesity/lipid-related physician needs to be further trained in ECGs and trained at all in echocardiography. Even though there would be arguments to say people could take their own training program and direct themselves to this area, there is no such desire in endocrinologists. I think the training is going to be subpar to adequately cover both benches.

Medscape: Which medical students do you think would be the ones most interested in this subspecialty, and what would your selling point be for why they should consider it?

Eckel: Most medical students don't get enamored by medical "zebras" or rare diseases. In other words, you don't hear "I just want to study congenital ventricular diverticula!" That's not something that blossoms during the second or third year of medical school, a time when decisions about the future begin to be clarified.

Obesity is common. Diabetes is common. High cholesterol is common, and cardiovascular disease causes 35%-40% of all deaths. That's the appeal, I think—appealing to common diseases where you can make a difference in a large number of people with ongoing clinical care and related research.

Medscape: What's next in terms of the movement to recognize a cardiometabolic subspecialty?

Eckel: There's work to do to create a document that would really rationalize the need for this subspecialty training. I'm sure the American Board of Internal Medicine feels like the number of subspecializations is replete and another one doesn't really need further consideration. But I think there are a number of us in the cardiometabolic space who feel differently. There is momentum here that has been created and is growing globally. I've been pretty outward about my thoughts about this for some time, and just recently have been discussing this openly with many colleagues in the field.

However, more needs to be done. There's a whole platform of people on both sides of this subspecialty view that may be willing to join the momentum and sign on to a document once created. Then, at that point, we need to adjoin with all relevant professional organizations.

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