Dr. Mat Williams is right to be concerned about adequately preparing surgery residents for emerging opportunities in cardiac surgery.  Specifically, he questions whether the present operative case requirements, even those mandated for the new integrated 6-year residency program, will prepare current trainees to undertake minimally invasive and catheter-based therapies.

Specialty Boards, such as the American Board of Thoracic Surgery (ABTS) which I served on for 10 and chaired for 2 years, are tasked with publicly certifying that a physician is adequately trained to practice his or her specialty.  Mat asks whether it still makes sense for a single Board, the ABTS, to oversee both cardiac and thoracic surgery training.  Although the original rationale for a Board of Thoracic Surgery was a focus on chest cavity organs, Mat points out that many surgeons like himself concentrate either on cardiovascular or general thoracic surgery, but not on both organ systems.  The fact is, however, that the majority of Board certified Thoracic Surgeons still operate on both the heart and lungs, despite the sub-specialization that occurs at many University hospitals. 

Operative case requirements are established by the Board to insure adequate minimum experience for residents.  The 6-year program still mandates basic surgical experience, including exposure to laparoscopic techniques, in the early years.  Although the ABTS allows some tracking along cardiac or general thoracic paths, a newly certified Thoracic Surgeon is qualified by the ABTS to safely practice basic cardiothoracic surgery.

In a dynamic and rapidly changing specialty like cardiac surgery, surgeons develop new techniques that then evolve into more common or even standard surgical operations.  That is what is now happening with transcatheter aortic valve replacement.  Mat is entirely correct that surgeons need to develop and refine catheter skills in order to safely undertake percutaneous valve procedures.  Young cardiac surgeons today will have to acquire these catheter skills through additional training, even if it prolongs their overall training time. 

Validation of our professional qualifications will continue to require formal Board certification. The current ABTS has developed a tight 6-year residency curriculum that will insure adequate training in surgical science and skills, along with concentrated training in cardiothoracic surgery. Until catheter-based therapies become more common in cardiac surgery, as has occurred in vascular surgery, residency experience with such procedures is unlikely to become part of the required operative experience.

Fortunately, smart program directors are encouraging talented young surgeon like Mat Williams to invest in the additional training required to safely perform such new procedures.  This is the way that it has always been in cardiac surgery—visionary innovators develop and refine a new technique that then becomes more widely performed and ultimately an established operation.  That’s the point when the ABTS should add the procedure to the list of operative case requirements.

You're using words such as adequate in your post, which I find very alarming. You might as well say my cardiac/thoracic surgeon is mediocre, sufficient, just barely passed whatever criteria is used to get board certified

It would be comforting to read words as excellence, beyond highest expectations, exemplary

You're performing Surgery on a human being. If it takes another year of training; I'm sure the future surgeons won't  suffer that much of a financial burden to attain the status of a superior, exceptional, and most highly regarded and respected doctor in their chosen field.