Cardiology at the crossroads.

The difficulties of obtaining promotion in the career structure jungle of cardiology have long been a matter of serious concern, and this concern is underlined in a recent detailed paper on "staffing and facilities in car-diology in England and Wales."'I This paper is a valuable addition to the report published two years before under the auspices of the Cardiology*Committee of the Royal College of Physicians of London.2 Three years have passed since the first report and nearly one year since the second, yet what has been achieved? The first paper drew attention to the unevenness in geographical distribution of cardiological consultants. Of a total of 201 cardiologists (including both those fully committed to cardiology and those working as physicians with a major interest in cardiology), 66 were working in the four London regions. Inevitably, of course, the metropolitan areas attract more car-diological attention, and the special responsibilities and problems of the London teaching hospitals demand larger numbers of posts. Some unevenness in distribution of posts throughout the country cannot be entirely avoided, but the problems are aggravated when the total number of consultants is less than desirable. Compared with one specialist cardiologist for every 220 000 population in England and Wales, there are 10 cardiologists for 200 000 people in the United States of America and many more cardiolog-ists relatively in other nations in the European Economic Community than in the United Kingdom. Even allowing for the difficulties of direct comparison between the different nations, cultures, and environments , the United Kingdom seems to be distinctly short of specialist cardiologists. 1-3 Such shortages have at least two serious consequences: firstly, the denial of essential cardiac services to populations in need, and, secondly, the denial of a realistic career structure and reasonable prospects of appropriate promotion to the rank of consultant for experienced and competent "junior" doctors and, in particular, for the senior registrars in caraiology. The report in 1981 stressed both these problems and urged the appointment of more consultant physicians with a major interest in cardiology as posts became vacant in district general hospitals.2 The report stressed the paradox of a pressing need for more consultant cardiologists existing alongside a relative excess of senior registrars available to become consultants in the ensuing 10 years. Thus expertise urgently needed by the community was not being made available. In the light of that report, the recent paper, prepared by the Centre …