What Is a Cardiologist?

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Questions to Ask Your Cardiac Care Team
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A cardiologist is a physician who is certified to treat problems of the cardiovascular system—the heart, arteries, and veins. Cardiology is classified as an internal medicine subspecialty. Knowledge of internal medicine and other specialties is required to obtain certification.

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Education in Internal Medicine

• Graduation from an approved medical school
• Completion of an ACGME-accredited internal medicine residency program, which is a minimum of 3 years in length
• There must be a minimum of 2 years of meaningful patient contact and responsibility.
• Of the 2 years, 20 months must occur in in-patient services, ambulatory settings, and in the services of dermatology or neurology.
• Four months may be taken outside the above areas, subject to program director approval.
• The level of responsibility for patients must increase with each year of training.

Examination and Certification
After satisfactory completion of graduate education, the physician is allowed to take the Internal Medicine board certification examination. Once this examination has been passed, the physician receives board certification in internal medicine. This is a prerequisite to becoming certified in cardiology.

Education in Cardiovascular Disease Medicine
A subspecialty educational program in cardiology must provide training and supervised experience in the evaluation and management of a variety of patients with acute and chronic cardiovascular conditions. The training and experience must be 3 years in duration and at a level sufficient to acquire the competency of a specialist in the field.

• 24 months minimum of clinical training, including inpatient and special experiences
• 4 months in the cardiac catheterization laboratory
• 6 months in noninvasive cardiac evaluations, consisting of 3 months of echocardiography, 2 months of nuclear cardiology, and 1 month of other noninvasive cardiac evaluations, including at least exercise stress testing, ECG interpretation, and ambulatory ECG recording
• 2 months devoted to electrophysiology, pacemaker follow-up, and ICDs
• 8 months of nonlaboratory clinical practice activities (e.g., consultations, cardiac care units, postoperative care of cardiac surgery patients)

Knowledge and competence in performing and interpreting tests and procedures must be acquired in the following:

• history and physical examination; basic and advanced cardiac life support; elective cardioversion; bedside right heart catheterization; insertion and management of temporary pacemakers, including transvenous and transcutaneous; right and left heart catheterization, including coronary arteriography
• residents must participate in a minimum of 100 catheterizations; exercise stress testing; a minimum of 50 ECG tests; echocardiography
• residents must perform and interpret a minimum of 150 studies, including transesophageal and esophageal cardiac studies; pericardiocentesis; programming and follow-up surveillance of permanent pacemakers and ICDs; cardiovascular rehabilitation

The program must provide opportunities for residents to acquire experience with the performance and (where applicable) interpretation of:

• intracardiac electrophysiologic studies; intra-aortic balloon counterpulsation; percutaneous transluminal coronary angioplasty and other interventional procedures

The program must provide sufficient experience for residents to acquire skill in the interpretation of:

• chest x-rays; minimum of 3500 electrocardiograms; minimum of 75 ambulatory ECG recordings; radionuclide studies of myocardial function and perfusion; cardiovascular literature

The program must provide instruction in basic science, including: cardiovascular anatomy, cardiovascular physiology, cardiovascular metabolism, and molecular biology of the cardiovascular system; cardiovascular pharmacology, including drug metabolism, adverse effects, indications, the effects on aging, relative costs of therapy, and the effects of noncardiovascular drugs upon cardiovascular function. It also must provide instruction on prevention, including: cardiovascular pathology; epidemiology and biostatistics, risk factors, and lipid disorders.

The physician must become proficient in the following skills and techniques:

• evaluating and managing coronary artery disease and its manifestations and complications; arrhythmias; hypertension; cardiomyopathy; valvular heart disease; pericardial disease; pulmonary heart disease, including pulmonary embolism; peripheral vascular disease; cerebrovascular disease; heart disease in pregnancy; adult congenital heart disease; cardiovascular trauma
• managing acute and chronic congestive heart failure, acute myocardial infarction and other acute ischemic syndromes, acute and chronic arrhythmias, preoperative and postoperative patients, cardiac transplant patients, geriatric patients with cardiovascular disease
• diagnostic techniques, including magnetic resonance imaging, fast computed tomography, positron emission tomography

Examination and Certification
Once training is satisfactorily completed, the physician is eligible to take the American Board of Internal Medicine cardiology examination.

Cardiology Subspecialties
Subspecialties have developed along with new tests and therapeutic interventions. Subspecialization in these areas usually requires 1 or 2 additional years of highly specialized formal training.

• Interventional cardiology. As of 1999, an examination is administered to assess knowledge base and clinical decision making of interventional procedures, such as catheterization, balloon angioplasty, stent insertion, Rotablator, and the use of various cutting and laser devices that remove plaque from arteries. One to two years of additional training is required.

• Electrophysiology. As of 1999, an examination is administered to assess knowledge base and clinical decision making in the treatment of the electrical system of the heart. One to two years of additional training is required, specifically in the treatment of arrhythmias and the implantation and use of pacemakers and defibrillators.

• Nuclear cardiology. Many physicians receive training in these procedures during their 3 years of specialty training. Some elect to receive additional training to gain expertise in this field. They are conducted to assess the pumping function of the heart, the presence of blockages in coronary arteries, and the degree of damage to the heart.

• Echocardiography. Some physicians receive additional training in interpretation of and performance of echocardiogram and transesophageal echo procedures.

Fellow of The American College of Cardiology (FACC)
The designation of Fellow of The American College of Cardiology (FACC) represents recognition of high professional achievement in a cardiovascular subspecialty. FACC candidates must be certified both by a primary specialty board and by a subspecialty board that is a member either of the American Board of Medical Specialties or the Advisory Board for Osteopathic Specialists of the American Osteopathic Association.

Candidates must provide written evidence from their communities showing that they are recognized as specialists and consultants or as scientists. Candidates for FACC must have completed the required subspecialty training 18 months prior to review by the Credentials Committee of the American College of Cardiology.

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